Ep 04 - Your COVID Questions Answered with Epidemiologist Tessa Crume, PhD

Tessa Crume, PhD, associate professor in the Epidemiology Department at the Colorado School of Health at the University of Colorado Anschutz Medical Campus, answers your industry-specific questions about COVID-19 and its effect in your treatment room. Dr. Crume discusses why the virus is so contagious and dispels myths about the virus. Plus, Dr. Crume shares a wealth of resources for protecting the safety of you, your loved ones, and your clients.

<p>0:00:00 S?: You are listening to  ASCP Esty Talk, where we share insider tips, industry resources and education  for aestheticians at every stage of the journey. Let's talk, because ASCP knows  it's all about you.</p>
<p>0:00:18 Speaker 1: Hi guys, and  welcome to ASCP Esty Talk, Back to Business, let your setback be your comeback.  And today I'm really excited because I am here with Dr. Tessa Crume, who is an  Associate Professor in epidemiology department at the Colorado School of how at  the University of Colorado, Anschutz Medical Campus. Her research focuses on  the development and utilization of public health surveillance systems to  understand the burden of disease and identify disproportionally impacted  populations. Now she has been an academic researcher since 2011, before what  she worked for a decade as an applied epidemiologist at the state and federal  level analyzing surveillance data and evaluating public health impact. Dr.  Crume has to the core epidemiology class at the Colorado School of Public  Health for nine years. She strives to help public health professionals, clearly  communicate core epidemiology concepts to the public. Whoa... Well welcome, Dr.  Crume, how are you? </p>
<p>0:01:23 Speaker 2: I'm doing great,  it's a pleasure to do this interview. I bet you never thought you'd be  interviewing an epidemiologist.</p>
<p>0:01:31 S1: I really didn't, but I  am so thrilled that I tracked you down and found you, because I know our  listeners and members are just really excited to just get as much information  as they can of really understand what the circumstances are, and what we have  to look forward to possibly in the future. So I think this is great. Let's just  start with, how are you feeling today about everything? Are you feeling  hopeful? Are you feeling kind of pessimistic. What's been on your mind? </p>
<p>0:02:01 S2: I have like a lot of  people have been rather stressed out. [chuckle] I have a young child and he is  of course out of school now, and so we're doing home-school which is rather  challenging.</p>
<p>0:02:20 S1: Oh yeah, I hear you,  girl.</p>
<p>0:02:23 S2: It's amazing how long it  can take to get through all of his schooling and how little he'll actually do  if I'm not sitting right there with him. And then, of course, this is an  exciting scary demanding time, for epidemiologists, so there's a lot of work to  do, so trying to balance it all. And I'm not gonna lie, I've probably not been  doing, self-care like I should.</p>
<p>0:02:53 S1: Yeah, it's hard, right?  To keep up with all of that and it's kind of feeling like you're kind of just  trying to keep the wheels on the bus right now.</p>
<p>0:03:02 S2: Absolutely, I get this  little headache that starts in the back of my head at about 10 AM and it lasts  all day.</p>
<p>0:03:10 S1: Wow, that's no fun at  all.</p>
<p>0:03:14 S2: Well, no.</p>
<p>0:03:16 S1: So what do you feel like  you're missing right now? That you're missing I guess pre-COVID society, and it  could be professionally or personally. What are you missing the most? </p>
<p>0:03:30 S2: So what I'm missing the  most is I love to travel. I have always been a big international traveler, and  since having a child my very favorite thing, is being able to take little  adventure trips with my son. And we were planning to go to Vietnam this summer.</p>
<p>0:03:49 S1: Oh no, darn it! </p>
<p>0:03:52 S2: That is not gonna happen  and I'm trying to roll with it, but I had planned a summer of adventure and  that is not gonna happen.</p>
<p>0:04:03 S1: Well, I think it's  everybody, right? The best laid plans, and it's kind of even just dealing with  some of the sadness or disappointment that goes along with it.</p>
<p>0:04:13 S2: Yeah absolutely. It's a  changing world, and you just have to roll with it but, I was gonna be eating   ____ on the street.</p>
<p>0:04:24 S1: That's sounds so  amazing. Well, at least you can do some escapism and watch some really great  videos. And maybe some National Geographic and I'm hoping.</p>
<p>0:04:36 S2: Catch up on my Netflix? </p>
<p>0:04:38 S1: Yeah, well let's start  getting into maybe some more of the meat of this interview. So given your  background in academic studies, what's really been keeping you up at night? </p>
<p>0:04:53 S2: So I'd say there's two  major things. The first thing, of course, is just the impact that the situation  is having on our society and on individuals. It's really stressful to just see  the news updates on my phone come through about the economic impact and of  course all of the health impacts and thinking about how to balance the need to  socially isolate and protect vulnerable people from the just outrageous impact  this is having on individuals. So one kind of balance that we really struggle  with considering the public health implications of this situation is, a  significant portion of our population is experiencing some pretty severe  emotional and personal impacts due to social isolation, particularly those that  deal with anxiety and depression.</p>
<p>0:05:58 S2: And of course our  teenagers and our pre-teens this is having an impact on them that will probably  stay with us for quite some time. And suicide rates are climbing and it really  pushes people that are in less than ideal situations like living in homes that  aren't safe... It really puts an incredible... Put us all in an incredible  pressure cooker and some people are experiencing horrible consequences from  that. So of course, as we recommend and identify the need for social isolation,  we have to also acknowledge that there's a huge cost that's beared by a portion  of our population.</p>
<p>0:06:48 S1: Wow, that brings up some  really good points. I think it's kind of the things that you don't realize are  going on behind closed doors.</p>
<p>0:06:56 S2: Absolutely even a close  friend of mine her daughter committed suicide, a couple of weeks ago. So I've  really had I think a personal impact of the cost that we're paying.</p>
<p>0:07:11 S1: Yeah, and how old, out  of curiosity, was your friend's daughter? </p>
<p>0:07:15 S2: She was a senior in high  school.</p>
<p>0:07:17 S1: Oh, my goodness. So she  was really young, still. So challenging. So, let's bring it now to the next...  Bring it down to maybe talking about our members in the profession that we  serve. What do you think are the biggest issues facing aestheticians, massage  therapists, hair stylists and manicurists during this peri-pandemic time? </p>
<p>0:07:46 S2: So the biggest issue, of  course, is the nature of the work, and I certainly am no expert on the nature  of those professions work, but many of them involved very close, intimate  contact and so re-engaging in that work will mean significant exposure and we  are... We can't remain closed forever. I've already highlighted some of the  downsides to maintaining social isolation and it's just a given that we will  re-open our society at a time when there is still significant personal risk  from exposure to this virus. So, of course, the biggest challenge is making the  personal decision to return to work. And in this interview, I'd really like to  discuss a variety of considerations that should go into that decision. And also  just talk through the protection measures that each individual should plan on  it, and each business should plan on when making that decision.</p>
<p>0:09:02 S1: I love that I'm so excited,  I can't wait to flush out this out with you. So, on that same note then, when  do you think professionals should reopen? And now this is your opinion, based  on the knowledge that you have and the background, that you have, what do those  conditions need to look like to be present or what are the factors that should  go into considering reopening? </p>
<p>0:09:29 S2: So I think the first  factor is to understand your local mandates. Everybody lives in a jurisdiction  where those mandates are slightly different. And the first consideration is  what is the structure of those? And so, in the city where I live in, we've  transitioned from a stay-at-home-order to a &quot;safer at-home&quot; phase.  Which means that face coverings are mandatory while we are out and about at  outside of our homes. And then starting this next Monday our businesses will be  allowed to reopen in a phased approach. And so my current jurisdiction that  approach is that businesses can open with 50% of their employees as long as  they can maintain a six-foot distancing and abide by the face covering order.</p>
<p>0:10:36 S2: So of course, every  business is going to have to consider if they can meet that mandate, so that's  the first consideration. I think the second thing to state is that I would not  put myself in a position to tell someone when... How to balance that  decision-making about the need to return to work and make a livelihood. I'm  sure that there are people that have some flexibility about that decision, but  other people are in an extremely vulnerable position financially and do not  have that flexibility, and I would not place any judgment or pressure on  someone who made the decision to return to work earlier rather than later  because of the need to maintain their livelihood. But I think if you do decide  to return to work that you need to have a solid plan in place for protecting  yourself and protecting your clients.</p>
<p>0:11:37 S2: And I can kind of walk  through what I think that should look like but I will say that I have examined  both of your websites and I was just blown away by the quality of the advice  and information. So I would say that your two publications have provided just a  very thorough road map to the decisions that should go into re-opening a  business.</p>
<p>0:12:04 S1: I thank you so much.  It's really great just to get an experts point of view and to look at that. Our  team has worked so tirelessly to put that together and continues to work on it  and just it's evolving every day, right? All the different things that are  happening in society, in business, there's just, it's changing on regular  basis, so thank you. I think I would really love to hear what you feel like if  we could start with the principal changes that need to occur in the physical  area, if we could kind of talk about that a little bit, any ideas that you have  on that? </p>
<p>0:12:49 S2: So I think that a great  place to start is identifying a resource for structuring those considerations  and I actually think your website has provided a really nice framework for the  different levels of consideration. So I would probably direct your members to  go to that website. I can tell that it drew almost directly from  recommendations by the WHO and the Centers for Disease Control. So, it is  structured around the very best recommendations given what we know about this  ever-evolving situation. I think one of the first things to consider is kind of  the structural layout of the business place. So thinking about how you will...  How many employees will be allowed to enter into a particular business place to  be able to maintain six foot distances? </p>
<p>0:13:50 S2: And I think it's really  important that you have a clear plan for cleaning and sterilization throughout  the day, between clients, and then of course there needs to be a pretty  thorough cleaning and sterilization process at the end of the day. All  professionals that work at the business need to wear a cloth mask. And I can  talk about the procedures for wearing cloth mask...</p>
<p>0:14:24 S1: Also that, I think that  would be really great. That's something we haven't touched on at all. If  there's any tips or... Yeah, procedures, anything on cloth masks would be  excellent.</p>
<p>0:14:35 S2: Yeah, there's a whole  protocol.</p>
<p>0:14:38 S1: Okay.</p>
<p>0:14:38 S2: And then that I think  would be really helpful for people to prepare themselves for is, you'll be  working in a business place. Some people may be more adherent to  recommendations than others, some of your co-workers maybe... Some will be very  vigilant, some will be less vigilant and as well as your clients. So having  structures in place to try to make the expectations extremely clear, you don't  want people to have to get into a position of getting into difficult,  uncomfortable conversations with their co-workers. We're all operating in a  very high stress environment. So if you see your co-worker walking around  without a mask is that gonna put additional pressure on you? Are you gonna have  to engage in some sort of confrontation? And we just wanna try to take as many  stressors off the table as possible when we re-enter into our work life. And  so...</p>
<p>0:15:44 S1: I think that's... If I  could even just jump in. I think that that's a really good point that maybe we  haven't thought about so much and as far as what is the repercussions if  someone isn't following the expectations set out? And I think in my personal  opinion, is that you should be conveying what the repercussions are to staff  prior to something like this happening, right? So that they understand  thoroughly that you are a team and these are what you what needs to be done in  order to keep your business open and keep everybody safe. So that's a great  point.</p>
<p>0:16:25 S2: Yeah, and I think trying  to put that pressure on management as opposed to the individual co-workers in  the business would just take some pressure off the table because... And I would  actually think of it as a leadership responsibility as opposed to enforcement.  This is an opportunity, of course, people in positions of management, need to  model the behavior but they also need to be able to frequently, communicate the  expectations and be prepared to gently correct, we don't wanna humiliate anyone  or add pressure. And then just have... Probably in writing, I'm a big fan of  signage at times like this. I think it's very easy, just me personally.  Sometimes I put on a mask when I go out for a walk. Sometimes if I'm playing  around in my front yard, I don't necessarily do it but I tell you if I see a  sign, that ensures that I will adhere to the behaviour. And so, I'm a huge fan  of signage to remind people what the expected behavior is.</p>
<p>0:17:43 S1: I'm so excited that you  mentioned that as well. Here at our associations, ASCP, at AHP and APMP and  ANP, we here have created ready-made signs for all of our members that they can  post in their waiting rooms, they can post on their doors for temperature  stations to show that treatment room has been cleaned, and sanitized for  shampoo bottles to show that those ones are clean and sanitize. Just a really  great way to have, like you mentioned all these different signs around  communicating to the clients, but also to communicating to staff to let them  know what has happened and what has occurred. So yes, all the way signs, signs,  signs. Brilliant.</p>
<p>0:18:35 S2: Yes. And with any  protective health behavior, people are gonna have slips. And so, I think just  maintaining the expectation with continuous communication and reminders is the  way to make sure that we're all adherent to the level that we need to be. So  that's one level of what I would recommend making sure that you have in place,  when deciding to return to work. I think another really important consideration  is evaluating your own risk level. So are you engaged in a particular type of  service that... I think about people that wax my eyebrows, that really, their  face is right up in my face. So obviously that person could be at an elevated  risk compared to someone even giving a pedicure or potentially hair services  would be slightly lower risk. Maybe not.</p>
<p>0:19:40 S1: Actually that brings up  a quick question, can I jump in there just so I don't forget it. Is there any  concern with hair stylists for instance, when they're blow-drying your hair and  let's say there's everyone's social distancing. But let's say there's three  different hair stylists in the salon. Is there any concern with blowing all that  air ground? </p>
<p>0:20:04 S2: So actually another  recommendation that is pointed out on your website and I would just emphasize  is the importance of trying to increase ventilation in the indoor space. And  I'm not really concerned that a blow dryer would increase risk necessarily,  because this is a virus that is so infectious, if you are treating someone that  is transmitting the virus you are going to be exposed to the virus that is  pretty much the bottom line.</p>
<p>0:20:39 S1: It's a guarantee, right?  It's that contagious.</p>
<p>0:20:42 S2: It's extremely  contagious. So, small little measures like the blow dryer or even potentially a  wet towel. I really don't see a rational for why that would increase risk any  more than just being in the close proximity of someone who is shedding the  virus.</p>
<p>0:21:04 S1: Very good, okay, good,  you heard it here. People right here from an epidemiologist.</p>
<p>0:21:09 S2: I'll just make the  disclaimer, that there are so many complex aspects of science that make it  really hard to have one particular person have a level of expertise that would  be able to...</p>
<p>0:21:27 S1: No, that makes sense to  be able to give absolutes.</p>
<p>0:21:31 S2: Yes, but I do feel  pretty comfortable about that statement that this is an incredibly infectious  virus. And really, the best thing you can do is not be in proximity of someone  who's shedding it. That's really the main protective behavior that you can  employ to not be infected with the virus. But when we do return to work, we are  increasing our exposure. That really is the bottom line. And so, it is  important to take into consideration when you're deciding to return what is  your risk status? And I feel like we've had some pretty clear communication  about the high-risk groups. So it's individuals over the age of 65 and individuals,  of course, who are immune-compromised, or have chronic underlying health  conditions like diabetes, hypertension, chronic kidney disease. So if you have  any of these conditions or if you're in that high-risk age group, I would  really encourage you to factor that into your decision making process.</p>
<p>0:22:45 S1: Great advice, that's  great, thank you, Dr. Crume. So, we've chatted a little bit and then you kind  of teased us on cloth mask protocols. Can we go back to that? And can you share  some of your thoughts of how we should be treating our cloth masks or things  that we should consider? </p>
<p>0:23:04 S2: Sure. So, cloth masks  are a way to protect other people from ourselves. So, it's quite important that  if you have a client who's coming in that you not only are wearing your mask,  but of course that the client is as well. And cloth masks are not going to  protect us if that person is shedding the virus, the virus is extremely small.  It's so small that it verges on that borderline between being a particle and  being a gas. That's why the only true way to keep yourself from it is and N95  mask that is properly fitted. So we need to treat our cloth masks as if they  are potentially contaminated. So when you go into your office, you should wash  your hands. The great thing about this situation is this virus is extremely  vulnerable to soap. Washing your hands with soap is one of the best things you  can do. Of course, we've been told this over and over again, but before you put  on your cloth mask wash your hands, and then put it on try to only touch the  ear loops or that ties that you have to tie it onto your face.</p>
<p>0:24:22 S2: It's important that once  you have your mask on, you not fool with it during the day or during the period  of time, you have it on. And if you do, you take it off, you wash your hands.  We always wanna wash our hands after we take off our masks, and then you put on  another mask. Because we don't all have the luxury of having a sewing machine  and sewing all these beautiful, fancy masks, many of us are gonna have to turn  to less density cloth masks, that will work just as well. There's a great video  about how to cut a pair of socks, to make a little mask.</p>
<p>0:25:03 S1: Oh wow, haven't heard  that one.</p>
<p>0:25:06 S2: Yeah, Google it.</p>
<p>0:25:08 S1: Okay.</p>
<p>0:25:10 S2: An expert on  environmental infection that works it at my school. Actually he wears a shop  rag. There are these rags you can get at Home Depot that are basically slightly  beefier paper towels. I'll send a link to a video of how you make a mask. You  basically just fold it like accordion style. You staple it over on the ends and  then you put a little rubber band. So if you are in a situation where you're  gonna need to be... And you probably will need to have a couple of different  masks for yourself during the day and you don't have an excess of cloth masks,  then you need to think about these other less fancy, but just as effective ways  of having a mask.</p>
<p>0:25:58 S1: So if you are wearing a  cloth mask during the day, then you remove it, you're recommending that you put  on a fresh new cloth mask, the next time that you put it on and put that one  into the laundry.</p>
<p>0:26:13 S2: Yeah, unless you have a  mask that is so comfortable that you can put it on when you start your day, and  you don't take it off until you're done, you need to have a supply of mask  throughout the day. If you take your mask and you pull it down below your nose,  then you really need to take that mask off and get a new mask. Now that makes  you wanna itch your face more than not being able to itch your face.</p>
<p>0:26:43 S1: Right, it's so true. All  you wanna do is just itch that face.</p>
<p>0:26:47 S2: And I've more of these  masks on my sewing machine and they really bother my ears and so if I don't  keep them on. I keep them on when I go to the store the entire time but I think  about if I had to wear one all day long, I would need a couple of different  ones. I would need to be able to change them during the day, and I'd probably  would move towards more having a mask that tied with ties, so that it's not  putting pressure on my ears all day to one that just was around the ears.</p>
<p>0:27:21 S1: Gosh those are great  tips, I think, yeah, maybe even to just having a variety so that... Ones that  tie, ones that go around your ear, just switching it up maybe all day long, is  going to just provide some relief to... I can't imagine wearing one all day  long. That would be challenging. I think that's gonna be one of the topics that  we have on our next podcast, just talking about how to treat the skin from...  Personally, treat your own skin from wearing a mask on an ongoing basis and  what that can do to your face. So that'll be interesting. Any other comments on  face masks? </p>
<p>0:28:03 S2: I would say that before  you return to work, you just also do some experimentation at home. You try with  a couple of different types of masks if you can make masks try wearing them  around your home for a couple hours to get a sense of what design is gonna be  the most comfortable for you. Try to go through your old sock drawer, make a couple  of those. It's really gonna be a matter of experimenting to find a design  that's most comfortable for you. I think one more thing to point out about  masks is that we also wanna mask that allows us to breathe comfortably. So  there's been some great videos and great web calls that I've attended about  different materials that we can make masks out of, and the different level of  filtration that we could expect from them. But unfortunately, as we move into  materials that may filter out more virus for example, the very best material if  we were going to try to make really great masks would be a vacuum bag that had  a hepa filter in it.</p>
<p>0:29:13 S1: Wow, yeah that would be  great.</p>
<p>0:29:15 S2: That is extremely hard  to breathe through. And the more difficult that the materials that you make  your mask out of is to breathe through, the more likely you are to just, as you  try to suck in air, to just suck it in from the little gaps on the side of your  mask which, of course, at that point, is defeating the purpose of the mask in  the first place. So that's why, CDC and the WHO are really just recommending  simple cloth masks. Again, these aren't to protect us from contracting the  virus, they're to catch the... Though the virus is very small, a lot when we're  coughing or breathing, a lot of the virus it's coming out of someone is coming  out associated with these larger droplets. And so the mask is really catching  those larger droplets and a cloth mask is just the most feasible for the  average person.</p>
<p>0:30:15 S1: So, can we say that one  more time, 'cause I just want to... And I'll actually have you say it one more  time because I think that that's the key. I think we get very confused as our  society gets confused as to why we're wearing the mask and it's... We think  it's to protect ourselves. But just explain that just one more time. So, we are  crystal clear to everybody.</p>
<p>0:30:41 S2: So while the virus is so  small that it really is almost acting as a gas, when someone has the virus, the  majority of the virus particles, that they are releasing are associated with  larger droplets of sputum or water droplets as the exhale and so the mask is  protecting other people by capturing those water droplets. And if we have a  mask that is made out of such thick material, that it's impeding our breathing,  then we're just sucking in air from the sides of the mask where it's not  properly fitted to our face. That's why The N95s are only efficient when they  are properly fitted to the face. So for the average person, it's just  recommended that you wear a cloth mask that allows you to easily breath 'cause  that will capture all those large virus particles that are just associated with  water droplets.</p>
<p>0:31:46 S1: Hey guys stop. Let's  take a quick break.</p>
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<p>0:32:40 S1: Let's get back to the  conversation. What will be some of the factors that play into its continued  transmission? </p>
<p>0:32:50 S2: Yeah, so I think this is  a good topic for people to be able to prepare themselves for what the next two,  potentially two years of our life is going to look like. There is a hope of  course, that with the summer months, we'll see less transmission. And the  relationship between viral transmission and seasonality is actually quite  complex. There are researchers out there who specialize on seasonality. And of  course we hope that we'll see less transmission, but there are reasons to think  that we might not, that there will still be significant transmission over the  summer and a lot of that is just due to how infectious this virus is. However,  in the summer, people do tend to congregate less in small spaces, small indoor  spaces. I know in the winter, I'm going to the museum, with my child and we're going  to jumpy places and in the summer we're playing outside. So there is less  crowding generally in the summer months, I think.</p>
<p>0:33:58 S2: None of us expect to be  going to our concerts and our big parades, this summer. So there will be  measures in place which will lead to a summer that doesn't involve huge crowds.  So there probably will be a little less transmission this summer but what we  learned from the flu epidemic of 1918, is that the summer time, kind of, lulled  people into a false hope that the epidemic was over and then when fall came,  there was really a resurgence and that's when the majority of mortality  happened. And so, well it's nice to think that the isolation that we've all  been enduring for the last couple of months will mean that we're moving into a  period where this will become something of the past may be a false hope. I  think most epidemiologists are prepared for a potential resurgence of  transmission over the winter.</p>
<p>0:34:58 S1: When you say resurgence,  do you mean... Will it be more intense, a bigger ressurgence or will it be  similar to what we saw in March, February-March, April? </p>
<p>0:35:13 S2: If the flu epidemic of  1918, is any lessons to us, it could be worse. I think most of us are braced  for it to be worse. And what we've been hoping to achieve during the last  couple of months of suppressing viral submission is preparation of our  healthcare system. So being able for our healthcare system to be prepared with  more ventilators, more intensive care beds, and the personal protective equipment  that they need to safely treat patients. We're hoping to be prepared if there  is more transmission during the winter. I think another important factor is  that it's estimated that 95% of our population has not been exposed to this  virus.</p>
<p>0:36:02 S1: Really? That high? That  seems very high.</p>
<p>0:36:06 S2: Very high. So in really  heavily impacted geographic areas like New York City, it's possible that maybe  80% have not been exposed to the virus. But in a population like where I live  in Denver the estimate is that 95% of the population is naive to this virus,  therefore susceptible to contracting it.</p>
<p>0:36:30 S1: Okay, another question  for you there, then. Do you have any idea on what the percentage is of people  who do contract it, that are asymptomatic? </p>
<p>0:36:42 S2: We unfortunately don't  know that yet. We're still in such an early phase of understanding this virus  and as you know, in the United States, we've failed to set up an adequate  testing infrastructure to be able to identify, not even among people who are  sick, who are actively presenting with symptoms that we think is COVID, we  can't even test all of them. So, unfortunately we've not been able to do  adequate testing to understand how many people have the virus that are  asymptomatic. But it certainly is thought that asymptomatic individuals are  contributing to a decent proportion of its spread.</p>
<p>0:37:27 S1: Okay, well we need more  testing it sounds like. What are some of the other things that will help us in  being done with this virus and getting it in control? What does that look like? </p>
<p>0:37:45 S2: Well, in Public Health,  of course, we're all hoping that the testing infrastructure, will be put in  place relatively soon. It's been, I think one of the most depressing aspects of  watching this unfold as an epidemiologist...</p>
<p>0:38:02 S1: Yeah, sure.</p>
<p>0:38:02 S2: That it felt like we  should have been prepared. I worked the original SARS outbreak when I was an  epidemiologist back in 2003, and I also worked as an epidemiologist after 9/11,  and huge pots of money came into Public Health for emergency preparedness and  it has really been heartbreaking to see how unprepared we are given decades of  preparation to handle the current situation. The hope is that we're making  progress every day and by the time we move into the winter months that we will  have a testing infrastructure that will allow us to adequately understand who  has the disease and also a contact tracing infrastructure so that the context  of those people can be notified and can submit to isolation measures to prevent  further spread.</p>
<p>0:39:04 S1: So, talking about other  measures to help us contain the spread, I have some family members who had a...  They just could not get tested. They were showing symptoms but it was really  difficult for them to get a test. We believe that the symptoms are... There's  just a lagging off now basically, but not the other major symptoms and it's  been months. And so they are going into... They've had their blood taken to see  if antibodies for the virus are currently present. Talk to me a little bit  about antibodies and finding out, getting that type of information. And how  that benefits us.</p>
<p>0:39:53 S2: Yeah, so we're in a  somewhat challenging period of time for getting the... We call them serological  tests that test for the presence of antibodies which would indicate that you  have had infection because we are just developing those one body tests now. And  when you develop a new test, it really needs to go through an evaluation  segment where you are able to compare it to a gold standard and understand the  sensitivity and the specificity of the test. Right now, a lot of the tests that  are being offered have not been rigorously evaluated so if you get a positive  test result, it's possibly a false positive.</p>
<p>0:40:36 S2: And the test has  interacted with a different Corona virus. Corona viruses are a common cause of  colds, so the serological tests, some of them are flawed and they will pick up  prior infection, to a different Corona virus. And there's also a possibility of  a false negative so it just didn't detect antibodies even though they were  present. Another factor is we don't know if prior infection results in  protection against re-infection. So at this point, I think we are too early in  the process of both developing a valid test for antibodies and also  understanding do antibodies protect you from re-infection? So I would encourage  anybody that has had a serological test to ask a lot of questions about what is  the performance of this test? What is the sensitivity and the specificity? And  if you have questions about that reach out to your health department.</p>
<p>0:41:42 S2: I know in my city, there  is a number I can call and I will be put in touch with an epidemiologist. And  I've actually called that number and ask that person questions, and they will  really help you think through or point you to resources to try to understand  some of the complexity, but I would recommend that people do not change their  behaviors, their behaviors that would protect themselves or protect other  people on the basis of an antibody test.</p>
<p>0:42:14 S1: Great information. Okay,  so what other resources should our professionals that we serve, what should  they refer to for the most current and up-to-date information, what would you  recommend? You mentioned the health department I think that's a great resource  for sure.</p>
<p>0:42:33 S2: So one thing that I've  found in my city, and may apply to other individuals living in the United  States is that we have a very fragmented public health system. So in some  states it may be better than in other states. In my state, it's a very local  control state, and because of the current crisis, it's kind of resulted in a  &quot;every man for himself&quot; mentality. Where different local health  departments are making different decisions in a somewhat isolated manner. This  is because of, again, this crisis and this lack of leadership that has really  unmasked the dysfunction of our public health system. So the way that's played  out for finding good resources, at least for me, is that I find that I get the  answers to my questions when I go on the Centers for Disease Control website.  And I've also found, when I look for resources at my state level or my city  level, I find that they are not necessarily very thorough and they almost  always just link to the CDC Resources.</p>
<p>0:43:43 S2: So, it's been my  experience that the Centers for Disease Control website, is where I find the  answers to my questions I find that their answers are... They have just an  incredible wealth of resources. And I'd like to point out a couple of their  resources to your listeners. But they also have a lot of different detailed  recommendations like I've been advising a homeless shelter on some of their  practices and I find they have an entire set of resources devoted to homeless  shelters. I actually think that your website has developed what I would say is  the most comprehensive set of recommendations to individuals that provide  beauty services. And excuse me if that's not the right term.</p>
<p>0:44:32 S1: No, that's correct.  Beauty and wellness services, yeah, absolutely.</p>
<p>0:44:35 S2: I thought your website,  your resources were extremely thorough and I could tell that they pulled from  the recommendations from the CDC and the WHO. So, I would recommend for your  listeners to view that as the front line for resources about their practice.</p>
<p>0:44:56 S1: Yeah, just so everyone  knows who's listening, the resource that she's referring to, you can go to if  you're an aesthetician you can go to ascpskincare.com/back-to-practice. It's  the same thing for any of the other sites. Just make sure it's a  /back-to-practice and that will get you there, and that's constantly being  updated and we'll make sure that all these details and everything that Dr.  Crume is sharing will all be in the show notes, so you guys will have an all  out your figure tips. But keep on keeping on here.</p>
<p>0:45:34 S2: So, another resource  that I wanna point out and it's kind of part of another recommendation to have  a plan in place for if you become sick. It's a high anxiety situation. If you start  to realize you're getting sick and having a plan in place can I think, help you  to walk through that experience with a little bit more, a little bit less  panic. The reality is we get sick all the time, come fall we're all gonna get  cold, and we're all gonna wonder, if we have COVID. And so for me, having a  plan in place before it happens, we'll help me walk through that situation with  a little bit more grace and intention than if I didn't have a plan in place.  There's a recommendation to develop a document that lists your... It's called a  care plan, that lists your emergency contacts, a document that would list any  of the medications that you're taking, any chronic health conditions and I'm  going to send you a link to a template for a care plan so that your listeners  can have it, and it's a document that you would want to send to your emergency  contact.</p>
<p>0:46:56 S2: So I, for instance, I'm  a single mom and if I got sick, I'd be nervous to reach out to my elderly  mother to help me. And in reality, I'd be reaching out to friends who certainly  don't know all of the medications I take, who don't know my conditions. And so  having a document that I can have already prepared that I could hand to them  if, God forbid, I needed to go to the hospital, I need someone to have that  information to be able to advocate on my behalf. And so it's good to have that  document prepared. And I think also being aware of what you would do if you got  sick. And the CDC actually has a wonderful little tool called a self-checker  and it's an online tool to help guide you make decisions about what kind of  medical care, most appropriate to seek given your underlying medical conditions  and the nature of the symptoms that you're experiencing. And so I just played  around with it last night, and I put in my underlying conditions and I just  imagined that I had a fever and a cough and it gave me the recommendation to  contact my medical provider within 24 hours. So had I put in more severe  symptoms like shortness of breath, or inability to breathe, it would have  recommended that I call 911. But I recommend that if you start to have symptoms  that you have in plan, a place for how you're going... What kind of decisions  that you would make based on the type of symptoms you have. And so, this CDC  self-checker is a great tool to help you make those decisions.</p>
<p>0:48:43 S1: I know that a lot of the  medical offices and such doctor's offices are now opening up a little bit more  to seeing clients. Is there any guidance out there to help us with us being an  advocate for ourselves and saying, I want to physically see a doctor or, okay,  a teleconference, tele-appointment is okay? Or should I go to Urgent Care  because I want to see someone? Any ideas or any thoughts you can share on that  with us? </p>
<p>0:49:18 S2: Yeah, so I think that's  a very important point. Earlier on in this situation, we heard on the media and  we were, I think kind of, put into this state a panic that if we needed to go  to the doctor, we wouldn't be able to go. And that really is not the case. Our  healthcare system has risen to the challenge. They started out with only  tele-health. I have a lot of physician friends. Every one of them is seeing  clients in the office. So if you get symptoms, I recommend that you reach out  to your healthcare provider. You wanna notify them ahead of time, of course,  when you're making your appointment. But every physician I know is seeing  patients, so you always wanna start by, of course, reaching out to the office,  and letting them know your symptoms so they can advise you on the levels of  protection that they need to be prepared, but you are not going to be denied  care. At least in my jurisdiction, I've been really checking in with my  doctor's office, to understand what their situation is. But they've been very  clear that if you have symptoms, you reach out and you will see a provider.</p>
<p>0:50:38 S1: Okay. We had mentioned a  little bit at the beginning of the program about blow dryers. We've also been  hearing a lot of chatter on the social media channels out there and calls  coming in about, for aestheticians, should or should you not be using steamers  in the treatment room? Can this spread the virus more or make it more  contagious? What are your thoughts on that? </p>
<p>0:51:04 S2: So my thoughts are this  is an incredibly contagious virus and adding in a blow dryer or steam is not  gonna significantly change how infectious it is. If you are in a small room and  you are face-to-face with someone that has the virus, you are most likely going  to be exposed to the virus. I don't think that steam or blow dryers is going to  have a significant impact on the likelihood of transmission. I think one of the  most important things is identifying ways to increase ventilation. If it's  possible to have a window open and have a fan that is sucking air out of the  room I think that would be ideal, but I understand a lot of treatment rooms  probably aren't situated like that. Having an air purifier in the room could  help. We haven't been able to scientifically evaluate that, but there's every  scientific rational to think that it would help but I don't think that steam  and blow dryers are going to alter the infectiousness.</p>
<p>0:52:11 S1: So next question, are  there any dermalogical symptoms we should be aware of that is associated with  this disease? </p>
<p>0:52:20 S2: So the most severe would  be a bluish tint to the skin, but that would really be a symptom of it being  saying COVID. And so I would hope that that would be an unlikely scenario to  encounter in practice. But people with a fever, sometimes have flushed skin, so  it's possible that slightly flushed skin could be a symptom of infection. One  of the symptoms that people have really been talking about is a loss of smell  or a loss of taste which a lot of people report in early disease. So that's one  of the symptoms that they screen you for if you present for care for possible  infection.</p>
<p>0:53:08 S1: When is it safe for a  practitioner to remove their mask? </p>
<p>0:53:12 S2: Well, let's remember  that mask aren't protecting us, they're protecting other people. And so, I  think every time you touch your mask, you introduce potential contamination to  your mask. So I would recommend that you have a procedure in place where you  just take off the mask at the point where you can wash your hands and you...  And then at that point you put out a fresh mask.</p>
<p>0:53:44 S1: Are there any other  repercussions? We talked a little bit about just protocols or procedures that  we should put in place for wearing a mask. Are there any other long-term issues  or complications that could arise from wearing a mask all day, like CO2  exposure or reduced oxygen intake? </p>
<p>0:54:09 S2: So I've attended a lot  of talks about masks over the past couple of months.</p>
<p>0:54:14 S1: I bet you have.  [chuckle]</p>
<p>0:54:16 S2: The science of masks and  the only things that I've heard is, of course, we don't wanna put masks on to  children less than two. We don't wanna put masks on to people that can't remove  them themselves 'cause we don't want this to be a suffocation risk, and though  we wanna think about these exciting materials that we can use to decrease the  risk of us being exposed to the virus, the likelihood that we could design a  mask that would truly achieve that is very low. So that's why we just wanna  think about comfortable cloth masks that allow us to breathe comfortably that  we're not going to have to fool with once we put it on. So yes, if you design a  mask that is really preventing your air flow and it's not allowing the air to  exchange, you are going to have a hard time breathing, you're gonna wanna pull that  mask off which defeats the purpose of wearing it. So that's why the  recommendation is really a simple comfortable cloth mask.</p>
<p>0:55:28 S1: Okay, very good, you  heard it right here you guys when is it safe? If you know that your client has  had COVID 19, when is it safe to treat them? </p>
<p>0:55:41 S2: So they are not supposed  to leave isolation until they have had no fever for 72 hours or three days and  they've had an improvement in their symptoms. So I would recommend that it be  part of the screening process that you would administer to people before they  would enter your service that you ask if they've been diagnosed or if they have  had COVID, has it been at least three days and maybe to air on the side of  caution, you might aim for five days since they have had no fever, and they've  had an improvement in symptoms. I don't think anybody who is still coughing  should be going out in public.</p>
<p>0:56:29 S1: How do you suggest  handling all of these changes that we've talked about today, with your clients?  So when do you think that beauty and wellness practitioners should start  communicating these changes with their clients? </p>
<p>0:56:45 S2: I think they should  start communicating them as soon as possible. The salons that I attend I've  actually already received communications from them. I kind of assume that  they're trying to remain in contact with their clients so that they don't lose  their clients, but they are starting to just send communications just to let me  know the timeline for when they're considering open up and the processes that  they're putting in place to have an intentional safe environment. A lot of us  are very anxious to return to our beauty services and I think getting  communications from our providers will allow us to make decisions about how  safe we feel it is to return and also give us assurances that they are taking  the risk, seriously.</p>
<p>0:57:39 S1: So with that being said,  what do you think about the current wave of states reopening their businesses? </p>
<p>0:57:47 S2: So as I've mentioned, of  course I'm concerned about transmission. I recognize the unprecedented risk of  the time in which we are living, but I also understand intimately the hardships  that this has presented. Personally, I'm not opposed to an intentional and I  hesitate to use the word &quot;safe,&quot; because it is not safe, [chuckle]  reopening of businesses. And I think that this is a situation that we will  likely be living in, for... I think most people estimate 18 months, and in  reality, we are not all going to stay isolated in our homes for 18 months. So,  I think this is something that we just need to start walking through. It's  going to change the fabric of our lives, potentially forever. But I'm a big fan  of biting off one chunk at a time, and I think that next chunk is what is the  new normal going to look like, and that's going to include businesses open with  different processes in place.</p>
<p>0:59:05 S1: Well, you have shared so  much amazing insight with us today, I can't even thank you enough. Are there  any other bits that you want to make sure to share with our listeners? </p>
<p>0:59:18 S2: Well, I just... I know  this has been very difficult for me, and I just have so much, I guess, concern  and empathy for the impact that this has had on everyone's life, and I just  wish you the best luck, and safety, and health, moving forward. And I will say,  nobody knew who epidemiologists were before this, but we are there for you, we  care about you, and we are here to help. So, don't hesitate to call your local  and state health departments, and get the resources and information that you  need.</p>
<p>1:00:00 S1: That is great. Well,  before we go, I always usually like to kind of wrap up, asking our guests, what  resource would you recommend to our listeners? Now, this could be personal, it  could be professional, it can be a blog, a podcast, a book, anything at all.  What would you like to recommend? </p>
<p>1:00:21 S2: Yoga and gardening have  been the only self-care I have engaged in, to tell you the truth. [chuckle]  It's something that my son and I have done together, and at the end of our  stressful days, when I'm totally spent, and we've had a couple of fights about  getting through his school, we do a little bit of yoga together, and that makes  us both feel better.</p>
<p>1:00:43 S1: Where can our listeners  reach you, or follow you? Do you... Anything, do you have social media channels  that you'd like to share, or a website? </p>
<p>1:00:54 S2: Well, I do have a  website at my university, I'll send you a link to it. I'm not a terribly  prolific on social media, I'm kind of a shy, introverted person.</p>
<p>1:01:07 S1: Well, you do it really  great, then.</p>
<p>1:01:09 S2: Well, I'll tell you who  I follow is... I follow the governor, in Colorado. I feel like he has been an  incredible leader, and I know that he has really engaged epidemiologists and public  health researchers in his decision making, and I have found that he  disseminates some of the best resources that I've heard about, to have access  to community and also the most accurate information. I also follow, on social  media, my state health department, because I find resources that I didn't know  about through them. And, of course, because I'm in a school of public health at  the university, of course, I follow them. And I've been so grateful to be part  of a university during this whole time, because they really are so progressive  about supporting their employees, and they've provided links to... Out of our  psychiatry department, about different self-care topics. And boy, I was  watching on one night, on the challenges of parenting, and handling anxiety,  and it brought me to tears, it was just so relevant. So, you know, our  universities have a lot of resources, that are just absolutely top notch. So,  those are mine...</p>
<p>1:02:38 S1: That sounds amazing. And  the topics for... That you were mentioning, is that for consumers? Can anybody  attend some of those webinars? </p>
<p>1:02:52 S2: Yes. And webinars are  being developed as public health resources, right now, under the recognition  that people are under unbelievable amounts of stress, and they need additional support  to... You know, it feels like we're going through this alone, but we're all out  there. Loneliness, isolation, family stress, relationship stress, and there are  a lot of amazing resources that I have accessed, and I'll certainly share some  with your listeners.</p>
<p>1:03:29 S1: Well, that sounds  amazing. I think just sometimes to know that you're not the only one feeling  this way, or having these emotions, makes it a little less difficult, so that  would be wonderful. Well, thank you so much, Dr. Crume. We really appreciate  you taking the time and sharing everything. Thank you so much.</p>
<p>1:03:49 S2: Yes, it's been a  pleasure.</p>
<p>1:03:52 S?: Thanks for joining us  today. If you like what you hear and you want more, subscribe. If you wanna  belong to the only all-inclusive association for aestheticians that includes  professional liability insurance, education, industry insights, and an  opportunity to spotlight your sick skills, join at ascpskincare.com. Only $259  per year, for all this goodness. ASCP knows, it's all about you.</p>

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