PORTSMOUTH – As more details emerge about how the coronavirus spreads, medical professionals are concerned the mixed messages over the past couple months have had a compounding effect on the impending "surge" of COVID-19 cases projected to occur in every state in the weeks ahead.

New Hampshire and Maine are projected to hit their surge of medical resource usage due to acute COVID-19 cases requiring hospitalization April 17, according to the Institute for Health Metrics and Evaluation (IHME). The independent health research center is part of the University of Washington medical school.

According to IHME, New Hampshire faces an average statewide shortage of 74 regular hospital beds, 82 intensive care unit (ICU) beds and 132 invasive ventilators. IHME estimates Maine faces an average statewide shortage of 118 regular hospital beds, 115 ICU beds and 143 ventilators.

Across the country, hospitals face average shortage of 87,674 regular hospital beds, 19,863 ICU beds and 31,782 ventilators ahead of the predicted nationwide surge date of April 15, according to IHME.

For most people, COVID-19 results in only mild or moderate symptoms, such as fever and cough. People with mild illness recover in about two weeks, while those with more severe illness may take three to six weeks to recover, according to the World Health Organization (WHO). For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, or death.

Dr. Ben Locwin of Portsmouth is an expert on infectious disease epidemiology. He conducts clinical trials internationally for breakthrough medical treatments. He has worked closely with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

Locwin has worked on vaccine candidates for SARS-CoV-2, the coronavirus. He also has been involved with epidemiological modeling and case tracing for the current pandemic, assessing patient cases, public health and community outreach and teaching clinicians.

Locwin said among the confirmed cases COVID-19 worldwide, none are being attributed to the patient making contact with a surface where the virus is persisting from and then self-inoculating themselves by touching their mouth, nose or eyes before washing or sanitizing their hands, despite early warnings from the WHO about how the virus spreads via physical contact. For this reason, he said, stores that are wiping down shelves and wall panels are mostly engaging in a symbolic ritual, without much actual preventive value.

Instead, Locwin said coronavirus infects people through the sharing of aerosolized droplet particles from people in close quarters inhaling and exhaling the same air, talking, coughing and sneezing, within which he said sneezed particles can be detected upwards of 27 feet away, traveling at 200 mph. He said with these biological realities, the recommended social distancing threshold of six feet of space between people in public would be more effective if it was 10 or more feet and that the ban on gatherings of 10 or more is critical to reduce transmission.

"It's possible for particles to persist in the air for minutes," Locwin said. "This is what makes respiratory transmission so pernicious."

Locwin said from the onset of the pandemic, leading global health organizations offered misleading or counterproductive information by overstating the risk posed by touching surfaces where larger droplets are persisting. He believes the misinformation negatively impacted countries like the United States in mounting a more effective public response to the outbreak.

"Unfortunately, especially for an international organization, the WHO has published some misleading information, which has the potential to lead people astray, both regarding the particulate nature of bioaerosol transmission, as well as faulty recommendations to avoid ibuprofen if ill with COVID-19," Locwin said.

"Much about the epidemiology of the situation and the virology of SARS-CoV-2 is not particularly accessible to people, including clinicians, who often don't have the training to interpret it," he added. "So (clinicians are) being asked by a panicked public and answering the best that they can. The volume and velocity of inquiries have outpaced the flow of accurate information."

The mixed information from top global health officials has complicated efforts by local infectious disease specialists to combat the spread of the coronavirus.

Dr. Apara Dave, an infectious disease specialist with Core Physicians in Exeter, said the changing nature of the transmission data from when the novel coronavirus emerged as public health threat, is further stressing personal protective equipment (PPE) resources.

"It raises a lot of questions," Dave said. "(The changing information) forces us to constantly re-evaluate our PPE policy. So we have to stay abreast with the transmission data while balancing the demand on our PPE amid the nationwide shortages all hospitals are dealing with."

Dr. David Itkin, an infectious disease specialist associated with Portsmouth Regional Hospital and Wentworth-Douglass Hospital, said he believes the existing data on the spread of COVID-19 is inconclusive. He said for COVID-19, the R0, (pronounced R-Not) is between 2 and 2.5, which is closer to influenza’s R0. A virus’s R0 represents the average number of people who catch a disease from one infected person.

Itkin said he believes if aerosolized particles were a larger factor contributing to the spread, COVID-19’s R0, would be much higher like measles’ R0, which ranges between 12 and 18 because it is an airborne disease.

"We’re not at the truth yet," Itkin said. "It’s one thing for aerosolization to play some role in infections, but it’s another thing if the aerosolized virus presents a high risk for causing infection."

On the heels of CDC Director Dr. Robert Redfield announcing Wednesday upwards of 25% of patients with COVID-19 are asymptomatic, Locwin said he advises individuals to wear masks in public so possible carriers of the virus reduce their ability to shed it into the ambient air in a grocery store, for example.

"(Asymptomatic cases) are likely a big source of infection, which makes the transmission more insidious," Locwin said. "As of (Monday) we had 314 cases in New Hampshire, that was 56 more than the day before. We know because of epidemiological data that number is anywhere from 10 to 100 times higher, and it’s clear there are thousands of cases not being diagnosed."

New Hampshire had 540 confirmed cases as of Friday morning.

Locwin said as the nation braces for the anticipated surge of COVID-19 cases, grocery stores will become some of the biggest hotspots for transmission. He advised shoppers to let the parking lot be their guide to decide when to shop if a store hasn’t yet limited the number of customers permitted inside at any one time, like Trader Joe’s and Market Basket have done. If the supermarket has not limited the number of shoppers, he said don’t go inside if the parking lot is more than half full. Paradoxically, Locwin said, if stores increased their available hours rather than decreasing them, it would spread out the demand and reduce social contact.

"You have to act as though everyone, including yourself, is infected; from there, that will lead to better behavior," Locwin said. "The grocery store can’t do anything to keep itself clean that the customer can’t undo by showing up when ill and being a human vector for the virus. The onus is on the customer to keep isolated or at a safe distance."

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