Dr. Eric Wargotz demonstrates the double mask method he uses to prolong the life of his N95 mask.

Dr. Eric Wargotz demonstrates the double mask method he uses to prolong the life of his N95 mask.

GRASONVILLE — Cases of the novel coronavirus COVID-19 are increasing across the United States, with increases in nearly every state reaching or exceeding summer highs. December began with Maryland registering its third highest daily increase in COVID-19 cases since the pandemic began.

The state added 2,765 new coronavirus cases Tuesday, Dec. 1, bringing the cumulative total of confirmed cases to 201,135. Hospitalizations increased by 56 Tuesday with 1,583 Marylanders hospitalized, 350 of them in ICU beds. The positivity rate in Maryland has increased from a low of less than 3% in September to 7.33% on Dec. 1.

In the face of rapidly rising numbers, Governor Larry Hogan announced a series of actions Tuesday to increase medical staff and prepare hospitals for the surge in effort to save lives and prevent overburdening the state’s health care system.

“The current surge is not only increasing the burden on our health care system and filling available hospital beds, but it is also affecting our health care workers who are already spread thin and operating under immense strain and stress,” Hogan said in a televised press conference.

How do we stem the increase in cases? What can we do to avoid more government restrictions and possible shutdown? What about family gatherings indoors during the holiday season? With college students returning home from other parts of the country for an extended holiday break how do we protect those at highest risk among our families, friends and communities? What are the current testing procedures and treatment for COVID-19? When will an effective vaccine be available and who will get it first? For answers to these questions and more, the Bay Times and Record Observer spoke to our very own local expert, Dr. Eric Wargotz of Grasonville.

Wargotz is senior staff pathologist, medical laboratory director and chief of pathology, emeritus, Doctors Community Medical Center, Luminis Health Care and clinical professor of pathology of the George Washington University School of Medicine. He is also a former Queen Anne’s County Commissioner and current judge of Orphan’s Court in the county.

“We did experience a seasonal variation into and over the summer as we spent more time outdoors, the warm sunshine with its increase in UV rays (lethal to the virus), and the increased humidity (keeping our respiratory lining cells moist and more virus resistant) did occur. Now the environmental conditions have reversed and with the cooler temperatures, many of us spend more time indoors with others,” Wargotz said.

Although there was hope the state might not see a resurgence of the virus such an increase was fully anticipated, he said, adding, “Fortunately, most if not all Maryland health facilities have prepared for the now inevitable demand on our services.”

Wargotz offered a quick review of what we know about the virus:

The COVID-19 virus is a member of the coronavirus family which infect the respiratory tracts of humans and other animals. As with other respiratory tract viruses, COVID-19 infects us by attaching to the surfaces of individual cells which form the lining, the mucus membranes, of our nasal sinuses, throat, trachea, and lungs. The response to infection of the lungs is typically an exaggerated immune response, meaning our bodies overreact to the virus and the lung tissue fills up with dead cells and fluid which then lead to difficulty breathing resulting in a need for oxygen therapy and possibly being put on a ventilator.

Wargotz is not a fan of lockdowns and said curtailment of elective procedures and surgery are not a solution.

“As time has shown us, such measures have led to increased suicide, increased drug overdoses and death, increased death due to delay of diagnosis and treatment of cancer, cardiac disease, transplants and others,” he said. “Economic consequences of lockdowns are devastating to everyone and especially to our friends associated with the hospitality industry: hotels, restaurants, etc.”

Effective vaccines are coming but not available yet. With fall here and winter coming, people are spending more time with each other indoors and the threat of virus transmission is greater.

“Since most of us do not wear masks when around others in our home, a more targeted approach to protect those individuals at higher risk of complications and death — elderly and people with chronic illnesses — is needed,” Wargotz said.

First on his list, avoid the three C’s — crowded places; close-contact settings; and confined and enclosed spaces.

Wear a face mask. While masks are not 100% preventative and experts are struggling to explain how people are getting infected despite following the mask and distance measures, masks do help impede the spread of disease, Wargotz said.

Choosing your mask wisely can also help with prevention.

“As numerous studies have demonstrated, N95 masks prevent the inhalation and exhalation of the smallest particles while double cloth masks are next best, then regular surgical masks,” Wargotz said. The more tightly woven the fabric, the better. “Neck scarves, head scarves, bandanas and neck gaiters provide the least amount of protection against inhaling and exhaling of viral particles and are not effective barriers and should not be used.”

He added that face shields also are not optimal and should only be used in conjunction with a mask.

None of the face coverings, including N95 masks, are a true barrier against individual viral particles as they are so small that the pore size of the N95 is larger than an individual viral particle, he said. The reason masks are helpful in the pandemic is that most virus particles are expelled as large and small droplets when someone coughs, sneezes or even speaks.

Masks are not perfect as they often are not properly fitted to the face and allow breathing around the edges. Also, when people touch the inside and outside of their masks they may cause contamination.

Remember to wash your cloth masks, Wargotz advised, adding there are several laundry detergents with antiviral capability as an added bonus.

“You may use spray sanitizers on the outside surface of the cloth and N95 masks but wait until the sprayed surface is completely dry. Since I have access to a N95 mask and they are not washable, I have developed my own approach to preserving it,” Wargotz said. “I wear it over a cloth mask. This way I can wash the cloth mask against my mouth and nose while markedly extending the life of the N95, which provides the greater protection. If you have access to an N95 mask and especially if you are in a high-risk group, I would encourage you to try this. You just need to make certain that the double barrier doesn’t cause you difficulty breathing normally.”

Remember that people can be infected but not show signs or have symptoms of infection, Wargotz cautioned.

“Masks do protect you and those around you: wear a mask. Combined with social distancing, masks are the best individual protection we have at this time,” he said.

Social distancing is also important. The recommended distance of 6 feet is because respiratory droplets are less likely to travel that far.

“There has been some confusion among people as to whether you should wear a mask even when 6 for more feet away from someone. I advocate that people wear their mask at all times around others, regardless of distance from them, except when eating or drinking,” Wargotz said.

Hand washing also is key in preventing and stopping the spread of COVID-19.

“We should wash hands often with soap and water for at least 20 seconds, especially after having been in a public place, or after coughing, sneezing or blowing your nose,” Wargotz said.

Avoid touching your mouth or nose and eyes with unwashed hands, he said, and you should always wash hands before eating, drinking, handling your mask, and after changing a diaper, caring for someone sick, after touching pets.

If soap and water are not available, then use a hand-sanitizer with at least 60% alcohol content.

Some nutritional supplements — Vitamin D3, zinc and melatonin — have been touted by various sources as useful in preventing COVID-19 infection. These are generally harmless when taken as indicated on the labels, but check with your health care professional first to ensure safety, Wargotz advised.

Weather is also a factor in the spread. Viruses such as COVID-19 and the flu viruses thrive in low humidity environments.

“In the fall and winter, humidity falls in our region. We know that a relative humidity of 40-60% quickly inactivates the airborne flu virus and some researchers also believe this range to be detrimental to the survival of the COVID-19 virus,” Wargotz said. “Keeping your household humidity in this range may be helpful in avoiding infection with COVID-19.”

If you don’t have a whole house humidifier, you can purchase small, single-room ones to help increase the moisture level in your house.

Also, Wargotz recommended staying hydrated.

“Drinking lots of fluids will keep your respiratory tract moist and more resistant to viral infection,” he said.

Two vaccines should be available soon. Both the Pfizer/BioNTech vaccine and the Moderna vaccines have shown more than 90% efficacy, he said. What that means is they are 90% effective in causing the development of antibodies to COVID-19 virus when injected into people.

The government has indicated health care workers, first responders and people at highest risk, such as those with chronic diseases and the elderly, will receive the vaccine first, perhaps starting as soon as mid-December. It is hoped the vaccine may be available for others by next spring.

“As the vaccines become available and protocols are defined as to who should get the vaccines, it is important, in my opinion, that anyone seeking a vaccine should have antibody testing first to see if they’ve already been exposed and have mounted their own immune response,” Wargotz said. “In such situations, where you are already antibody positive, then your health care provider may recommend that you forgo the vaccine and that it be used for someone who is antibody negative instead.”

The signs and symptoms of COVID-19 are often similar to colds, flu, allergies and other conditions.

“Fever, cough, sneezing and body-aches are common features, followed by difficulty breathing if it is COVID-19 progressing,” Wargotz said. “Loss of taste and smell are also features which if present, should raise your concern as they have been associated with COVID-19 infection.”

Anyone experiencing difficulty breathing should call 911 or get to a medical facility immediately, he said.

If you show up at your doctor’s office, urgent care center or emergency room with a history of some or all of these signs and symptoms, then typically a COVID-19 test will be performed.

There are several types of tests associated with COVID-19. The most reliable is what is known as a PCR test.

During a PCR test the health care provider will stick a long swab into your nostril to collect a sample from the part of the throat behind the nose. This test looks for COVID-19 genetic material, Wargotz said.

PCR tests have a sensitivity rate of 95% and high specificity, meaning that false positive results from a PCR test are unlikely, according to the Centers for Disease Control and Prevention.

The PCR test is covered by most insurances or may be free. If you have to pay for it, the cost may range from about $60 into the hundreds, so ask ahead of time, he advised.

Test results may be available in one to 10 days, depending on the lab and number of tests. Local health departments currently are reporting turnaround times of three to five days.

Following CDC guidelines, you should get tested if you have symptoms of COVID-19, have had close contact with someone positive for COVID-19 or your health care provider tells you to get tested.

Some people get the “rapid test” or antigen test. There are a number of antigen tests for COVID-19 currently in use, Wargotz said, and depending on the specific instrument being used one or more of the following samples may be acceptable: nasopharyngeal specimen collected by trained health care personnel; oropharyngeal specimen collected by trained health care personnel; nasal mid-turbinate swab collected by trained health care personnel or by a supervised onsite self-collection (using a flocked tapered swab); anterior nares (nasal swab) specimen collected by trained health care personnel, or self-collected and observed by health care personnel, or by home or onsite self-collection (using a flocked or spun polyester swab); or nasopharyngeal wash/aspirate or nasal wash/aspirate specimen collected by trained health care personnel; or a saliva specimen collected by the person being tested, either at home or at a testing site under supervision.

The antigen tests identify specific proteins that are present on the surface of COVID-19 when someone is infected, he said. The result of an antigen test may be available as quickly as 15 minutes after specimen is placed on the instrument.

If your insurance does not cover the antigen test, or it is not free, then your expense is generally under $100.

“Antigen testing is highly specific for COVID-19 with a specificity of about 84% to 98% but there is a higher chance of false negatives since the antigen test may not detect infections when the amount of virus is low in your body,” Wargotz said.

Antigen tests work best when someone is tested in the early stages of the virus, when they have a high viral load. A negative antigen test result doesn’t rule out a COVID-19 infection, so if you continue to exhibit features suspicious for COVID-19 then you may be asked to get a PCR test as well, he said.

A third test associated with COVID-19 is an antibody test, which looks for the presence of antibodies in a blood sample. Antibodies are proteins made in response to infections and are detected in the blood of people who are tested after infection.

“The most important point to remember about an antibody test is that it is not used for diagnosing COVID-19 infection,” Wargotz said. “It may be performed after suspicion of an infection has passed in order to determine if you had an infection.”

If you are diagnosed with COVID-19 you may experience a variety of symptoms similar to flu or cold and treating yourself as you would for those illnesses is appropriate, Wargotz said.

You should stay home and recover at home only leaving to get medical care. Get rest and stay hydrated and do not go out to stores or public areas. Wear your mask over the nose and mouth at home if other people are with you.

Tell your close contacts that they may have been exposed to COVID-19.

You may resume being around others after 10 days since symptoms first occurred and 24 hours with no fever without the use of fever-lowering medicine if other symptoms also are improving, Wargotz said.

If your symptoms worsen, including difficulty breathing and hearing sounds in your chest, then seek immediate medical attention, he said.

If you are hospitalized for COVID-19 infection, you may be treated with any combination or all of the following: IV fluids, oxygen, steroids, Remdesivir, or antibodies (plasma from other people and/or the recently approved Eli-Lily monoclonal antibody) and other treatments, Wargotz said. The Regeneron product, which the the president received, is now an approved antibody treatment.

In the hospital, a team of health care professionals will manage your care and decide if you need breathing assistance with a ventilator, he said.

Your comment has been submitted.

There was a problem reporting this.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language. PLEASE TURN OFF YOUR CAPS LOCK. Don't Threaten. Threats of harming another person will not be tolerated. Be Truthful. Don't knowingly lie about anyone or anything. Be Nice. No racism, sexism or any sort of -ism that is degrading to another person. Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts. Share with Us. We'd love to hear eyewitness accounts, the history behind an article.

Top stories in Dorchester County delivered to your inbox at 6 a.m. every Friday.

Top stories in Kent County delivered to your inbox at 6 p.m. each Monday and 6 a.m each Thursday

Subscribe to this newsletter to have the latest obituaries delivered to your inbox twice weekly.

Top stories in Queen Anne's County delivered to your inbox at 7:00 a.m. each Wednesday and Friday.

Your account has been registered, and you are now logged in.

Check your email for details.

Invalid password or account does not exist

Submitting this form below will send a message to your email with a link to change your password.

An email message containing instructions on how to reset your password has been sent to the e-mail address listed on your account.

Your purchase was successful, and you are now logged in.

A receipt was sent to your email.