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

05/18/2020

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.

Author URLs:

About Dr. Tessa Crume

Podcast Transcript

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.
[music]
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? 
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.
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? 
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.
0:02:20 S1: Oh yeah, I hear you, girl.
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.
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.
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.
0:03:10 S1: Wow, that's no fun at all.
0:03:14 S2: Well, no.
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? 
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.
0:03:49 S1: Oh no, darn it! 
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.
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.
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.
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.
0:04:36 S2: Catch up on my Netflix? 
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? 
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.
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.
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.
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.
0:07:11 S1: Yeah, and how old, out of curiosity, was your friend's daughter? 
0:07:15 S2: She was a senior in high school.
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? 
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.
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? 
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 "safer at-home" 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.
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.
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.
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? 
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? 
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...
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.
0:14:35 S2: Yeah, there's a whole protocol.
0:14:38 S1: Okay.
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...
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.
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.
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.
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.
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? 
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.
0:20:39 S1: It's a guarantee, right? It's that contagious.
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.
0:21:04 S1: Very good, okay, good, you heard it here. People right here from an epidemiologist.
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...
0:21:27 S1: No, that makes sense to be able to give absolutes.
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.
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? 
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.
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.
0:25:03 S1: Oh wow, haven't heard that one.
0:25:06 S2: Yeah, Google it.
0:25:08 S1: Okay.
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.
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.
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.
0:26:43 S1: Right, it's so true. All you wanna do is just itch that face.
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.
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? 
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.
0:29:13 S1: Wow, yeah that would be great.
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.
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.
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.
0:31:46 S1: Hey guys stop. Let's take a quick break.
0:31:52 S?: Is your skin care practice, totally covered? If you're an ASCP member, you know that you have great professional liability insurance that covers you, but what about your stuff? Well, ASCP offers business personal property insurance, which is coverage for your stuff. It's a professional contents coverage to policy that protects your smashers, your cabinets, your steamers, your zappers, all those good things protected by an insurance policy that starts to just $95 per year. To learn more about BPP coverages as we like to call it, please come visit www.ascpskincare.com/bpp, and there you can get your BPP from ASCP, ASAP.
0:32:40 S1: Let's get back to the conversation. What will be some of the factors that play into its continued transmission? 
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.
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.
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? 
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.
0:36:02 S1: Really? That high? That seems very high.
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.
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? 
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.
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? 
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...
0:38:02 S1: Yeah, sure.
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.
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.
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.
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.
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.
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.
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 "every man for himself" 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.
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.
0:44:32 S1: No, that's correct. Beauty and wellness services, yeah, absolutely.
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.
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.
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.
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.
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? 
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.
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? 
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.
0:52:11 S1: So next question, are there any dermalogical symptoms we should be aware of that is associated with this disease? 
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.
0:53:08 S1: When is it safe for a practitioner to remove their mask? 
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.
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? 
0:54:09 S2: So I've attended a lot of talks about masks over the past couple of months.
0:54:14 S1: I bet you have. [chuckle]
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.
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? 
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.
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? 
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.
0:57:39 S1: So with that being said, what do you think about the current wave of states reopening their businesses? 
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 "safe," 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.
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? 
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.
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? 
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.
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? 
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.
[laughter]
1:01:07 S1: Well, you do it really great, then.
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...
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? 
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.
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.
1:03:49 S2: Yes, it's been a pleasure.
[music]
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.