Dr. Rahaf Al Masri

An infectious disease specialist talks about the science of COVID-19 and best practices to protect against infection

Texas Gov. Greg Abbott — who had already lifted COVID-19-related statewide restrictions on some businesses effective Friday, May 1 — announced on Tuesday, May 5, that hair, nail and tanning salons can begin reopening today (May 8) and that gyms can begin re-opening on May 18.

While some celebrated the announcement, seeing it as a necessary step in beginning to revive the state’s sagging economy, others are concerned that it is too soon and that reopening now will result in a sharp spike in the rate of infections and deaths. And in fact, both the Trump administration and Abbott himself have acknowledged there will likely be a huge jump in the death rate by the end of this month.

According to a Trump administration internal document obtained and published by The New York Times, federal officials expect about 3,000 deaths and 200,000 new cases daily by June 1. The predictions are based on modeling compiled by the Federal Emergency Management Agency.
Currently, there are about 1,750 deaths and 25,000 new cases daily nationwide.

Abbott, in a May 1 call with state legislators, said, “Listen, the fact of the matter is pretty much every scientific and medical report shows that whenever you have a reopening — whether you want to call it a reopening of businesses or just a reopening of society — in the aftermath of something like this, it actually will lead to an increase and spread. It’s almost ipso facto.” A recording of that call was leaked to the press.

As of 7:30 a.m. Thursday, according to the New York Times’ constantly updated “Coronavirus Map,” there were 35,438 reported cases of COVID-19 in Texas, the ninth-highest number of all the states.

The map also notes that 985 people have died of COVID-19-related causes in Texas.
So, as the state begins to return to some semblance of business as usual amid the steadily rising numbers of infections and deaths, Dallas Voice asked Dr. Rahaf Al Masri of North Texas Infectious Disease Consultants to talk about the science of COVID-19 and how to stay safe going forward.

— Tammye Nash

Dallas Voice: It seems most people think a “second wave” of COVID-19 infections is inevitable. They point to the Spanish Flu epidemic in 1918 and the fact that the second wave in that epidemic, which hit in the fall, was worse than the first. What do the folks at NTIDC think? Will there be a second wave? And if so, what do we need to do to mitigate the effects? Dr. Rahaf Al Masri: It is very likely that we will have a second wave of infection. Dallas County is still reporting a high daily number of infections, and loosening restrictions is likely to lead to an increase in the number of new cases.

We encourage everyone to continue to be vigilant, minimize unnecessary outings, maintain six feet distance and wear a mask (cloth based) in public.

Some have suggested that the second wave, if there is one, would only happen because the SARS CoV-2 virus had mutated from what we are seeing right now. Other sources, though, say that SARS CoV-2 seems to be mutating more slowly than usual. If there is a second/third wave, what will cause it? There is no evidence to suggest that SARS CoV-2 is mutating in a way that would be significant. Most experts agree that it’s likely we will see a fluctuation in the number of cases for months to come, with an expected increase in the fall when conditions are favorable to the virus. This is more likely to be due to continued transmission rather than viral mutation.

Some have said that once you have had COVID-19, you will be immune, unless the virus mutates, and that our best bet to quell the epidemic is “herd immunity.” But info I have read indicates that may not be true, that some people who have had COVID are becoming re-infected, and that the human body does not necessarily react to this and certain other coronaviruses by developing an immunity. Who’s right here? Should we be trying to establish herd immunity? Is that a viable defense? “Herd immunity” is an appealing concept; however, we have to be careful before applying it in this situation. Early studies show some benefit from giving convalescent plasma to patients with COVID-19, but it is early to conclude that antibodies provide long lasting immunity. More studies are needed, and in the meantime, we still need to be cautious and protect the most vulnerable in our communities.

We have seen a very public and angry backlash against requirements and even suggestions requiring wearing masks in public. Some suggest that people wearing masks are making the infection spread more quickly because of cross contamination (people not wearing masks properly, people touching their mask, etc.) What is the best advice on wearing masks? This [claim that not wearing masks is better] is incorrect. Wearing a cloth mask is recommended by the CDC and highly encouraged by most local governments. [But] surgical masks and N95 masks should be preserved for heathcare providers and first responders.

We always advise our patients to be careful where they get their information from and to choose a reliable scientific source of information. The CDC website — cdc.org — is a great option.

Are we re-opening everything too soon? What would be the effects of lifting quarantine too soon? This is a difficult question. We certainly understand the devastating economic effects of the quarantine on our communities; however, many infectious disease specialists are worried that we are reopening before seeing a significant decrease in the number of cases.

It is possible that we will see an upward trend in the number of cases as more businesses open.

What is your advice for folks right now in terms of getting “back to normal”? This is an unprecedented and challenging time for all of us. We need to rethink what “normal” means. We will need to stay vigilant for a long time to come.

For now, it means following the CDC recommendations and the guidelines that local governments are establishing to start opening the economy while still respecting social distancing recommendations. We are all in this together, and we all need to do our part to protect each other and protect the most vulnerable among us.