smoking and covid-19

Smoking and COVID-19: What You Need to Know

The annual Great American Smokeout is set for this week, November 19. So our concierge doctors thought this would be a good time to look into what we know about the combined effects of smoking and COVID-19.

This is especially important because there has been some confusing information on the effects of cigarette smoking on the disease, with some early reports even suggesting that cigarette smokers who contract COVID-19 actually fare better than non-smokers. Subsequent studies have found the opposite: that smoking increases the risk that the virus causes more damage in smokers.

Tobacco’s extensive effects

One study, reported in The Guardian, analyzed more than 11,000 COVID-19 patients. It found that about 30 percent of those with a history of smoking saw their conditions progress to a more severe or critical state, versus 17.6 percent of non-smokers. Researchers concluded that “smoking is a risk factor for progression of COVID-19,” with smokers nearly twice as likely to develop severe symptoms.

In addition to the well-known damage to the lungs and cardiovascular system—both of which are compromised by COVID-19—smoking has also been shown to suppress the immune system’s ability to fight infection in the body.

“Tobacco products cause inflammation in the airways and affect lung immunity, which makes people more susceptible to infection in general,” Dr. David Christiani, a professor at the Harvard TH Chan School of Public Health, told the paper.

In a scientific brief released this summer, the World Health Organization (W.H.O.) concluded that “the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients.”

The brief also reiterated that, in addition to the findings on the coronavirus, “Tobacco causes eight million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.”

We believe it’s safe to add COVID-19 complications to that list.

Benefits of quitting

If you smoke, you’re not alone. More than 32.4 million people in the U.S. still smoke cigarettes, according the American Cancer Society (ACS). Unfortunately, as a result more than 16 million Americans live with a smoking-related disease.

But it’s never to late to quit.

Here’s a timeline from the ACS showing what happens when you stop smoking:

  • Twenty minutes after quitting your heart rate and blood pressure drop.
  • Twelve hours after quitting the carbon monoxide level in your blood drops to normal.
  • Two weeks to three months after quitting your circulation improves and your lung function increases.
  • One to nine months after quitting, coughing and shortness of breath decrease. Tiny hair-like structures (called cilia) that move mucus out of the lungs start to regain normal function in your lungs. This increases their ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • One year after quitting the excess risk of coronary heart disease is half that of someone who still smokes. Your heart attack risk drops dramatically.
  • Five years after quitting your risk of cancers of the mouth, throat, esophagus, and bladder is cut in half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker in two to five years.
  • Ten years after quitting your risk of dying from lung cancer is about half that of a person who is still smoking. Your risk of cancer of the larynx and pancreas decreases.
  • Fifteen years after quitting your risk of coronary heart disease becomes that of a non-smoker’s.

Ready to quit?

There are myriad ways to successfully stop smoking. What works for one person might not work for another. And studies show that the average smoker tries several times before giving up the addiction entirely.

“No matter your age or how long you’ve been smoking, quitting improves health, both immediately and over the long term,” the ACS says. “Giving up smoking is a journey, and it can be hard, but you can increase your chances of success with a good plan and support. Getting help through counseling and medications doubles or even triples your chances of quitting successfully.”

You can also download numerous quit-smoking apps to help, or find tools and tips at Smokefree.gov. The site also offers live chat help for those trying to quit. In addition, each state has a quit line, which you can access by dialing 1-800-QUIT-NOW (1-800-784-8669).

Of course there are various medications also available, so if you’re trying to stop smoking, please talk with us. We can help find the best path for you.

The coronavirus pandemic has had everyone on edge for months, and smoking may be one way you’ve used to cope. But, as with increasing alcohol or drug consumption, it’s unhealthy and ultimately unhelpful.

safely celebrate holidays

How to Celebrate the Holidays Safely

As we head into the holidays, our concierge doctors are concerned that pandemic fatigue might tempt people to throw caution to the winds and just celebrate, starting with Thanksgiving.

The fact is, we’re all fed up with the “new normal.” People want more than anything to return to the way our lives were before this scourge attacked the world early this year. Pandemic fatigue is not only real, it’s totally understandable.

“In the spring, it was fear and a sense of, ‘We’re all in it together,’” Vaile Wright, a psychologist at the American Psychological Association (APA) told The New York Times. “Things are different now,” she said. “Fear has really been replaced with fatigue.”

This led to a sense of complacency and carelessness. While understandable, this caused a wave of increased cases and deaths in the U.S. and around the world.

“Citizens have made huge sacrifices,” Dr. Hans Kluge, the World Health Organization’s (W.H.O.’s) regional director for Europe, told the Times. “It has come at an extraordinary cost, which has exhausted all of us, regardless of where we live, or what we do.”

The high cost of carelessness

A recent report in The Washington Post serves as a cautionary tale for our country. Canada celebrates their own Thanksgiving on the second Monday of October. Despite warnings from public health officials there to limit celebrations to members of the immediate household, apparently that advice went unheeded by many Canadians.

In the weeks after, Canada saw rising case numbers as a result. Ontario, for example, reported a record-high number of daily cases within two weeks of the holiday. A single gathering of 12 extended family members in Toronto resulted in a cluster of coronavirus cases.

“People did not mean to spread COVID-19,” Deena Hinshaw, Alberta’s chief medical officer of health, told The Post. “But it is a reminder that social gatherings where social distancing and masking are not used consistently are a significant risk for spread.”

We can understand the longing to get together for the traditional holidays, beginning with with Thanksgiving. But that is, unfortunately, a recipe for disaster.

“We are set up for just a perfect storm—a conflagration,” Megan Ranney, an emergency medicine professor at Brown University, told The Post recently. “Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country.”

This country’s leading infectious disease expert, Dr. Anthony Fauci, likewise warned that Thanksgiving celebrations could lead to even more cases.

“That is, unfortunately, a risk, when you have people coming from out of town, gathering together in an indoor setting,” he told CBS News recently. “It is unfortunate, because that’s such a sacred part of American tradition.”

Yes it is. But we’d like to suggest some ways to minimize that risk and safely celebrate the holidays.

A few COVID-19 reminders

First, let’s review a few facts.

The SARS-CoV-2 coronavirus is one of the most contagious viruses known to man. It spreads readily through the air and by surface contact, from those who have symptoms as well as those who don’t.

Because of this, areas with high air circulation, such as the outdoors on a windy day, tend to be safer than crowded indoor spaces with poor ventilation.

Far deadlier than the flu, the coronavirus travels through the bloodstream to every part of the body. This is why it’s so difficult to treat, and why many of its victims appear to suffer months-long aftereffects.

How to safely celebrate the holidays

With that in mind, if you’re preparing to celebrate the holidays, here are a few tips.

The Centers for Disease Control and Prevention (CDC) recommends limiting gatherings to those in your immediate household. If you’re going to host a Thanksgiving dinner, the CDC suggests holding it outdoors. It also says to only invite family and friends from your immediate neighborhood.

“Gatherings with more preventive measures, such as mask wearing, social distancing, and hand washing . . . pose less risk than gatherings where fewer or no preventive measures are being implemented,” the CDC says.

Other ways to judge risk, according to the CDC:

  • Indoors is riskier than outdoors.
  • Poor ventilation is riskier than good ventilation (e.g., places with open windows and doors).
  • Longer gatherings are riskier than shorter gatherings.
  • More attendees pose a greater risk than fewer attendees.
  • Local attendees pose less of a risk than those traveling from other areas who may have been exposed at home or during their travels but aren’t yet showing symptoms.

If you can’t control the environment, the attendees, or their behavior, you need to ask yourself whether one holiday is worth the risk.

“Staying home is the best way to protect yourself and others,” the CDC says.

As we noted above, we’re all tired of the precautions necessary to reduce the spread of the novel coronavirus. But parents, for instance, remain on high alert to ensure the safety of their children for eighteen-plus years. If you think of it in these terms, a year or two of vigilance might seem more acceptable.

Remember, the fastest way for this thing to be “over” is to deny it new hosts. This includes the bodies of you and your loved ones. Please follow these tips in order to safely celebrate the holidays.

flu shot twindemic

Flu Shots Can Help Avert a ‘Twindemic’

The U.S. Centers for Disease Control and Prevention (CDC) recommends all adults and children older than six months receive a flu shot by the end of this month. The CDC says it takes at least two weeks for the vaccine to become effective. Then it won’t reach its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected.

Therefore, our concierge doctors suggest you get your flu shot for the 2020-21 influenza season as soon as possible. While there have been scattered reports of shortages around the country, The Washington Post recently reported a record number of flu vaccine doses—between 194 million and 198 million—have been ordered. Because the vaccine is shipped in stages, more is on the way.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual. If you’re not able to get your vaccination now, don’t get frustrated. Just keep trying.”

The CDC’s Dr. Daniel Jernigan, to the Associated Press (AP).

COVID-19 and flu overlap: a ‘twindemic’

We were fortunate the 2019-20 flu season was winding down this spring as the coronavirus crisis began to hit the country. This year, however, we’ll be looking at the possibility of a “twindemic”—both waves hitting at once.

So it’s especially important that as many people as possible get vaccinated for the flu this year. The flu shot won’t prevent COVID-19, but it can help reduce the strain on our already overburdened health care system.

“Since hospitals and doctors’ offices are going to be very busy caring for COVID-19 patients, a flu vaccine can help decrease burdens on the health care system and make sure that those who need medical care are able to get it.”

Dr. Susan Bailey, president of the American Medical Association (AMA) and an immunologist in Fort Worth, Texas, told CNN.

Last year, the CDC estimated that the flu killed 22,000 Americans, and resulted in hospitalization of an additional 400,000. By contrast, at least 215,000 Americans have died of COVID-19 since March.

Hopeful signs

Health experts are hopeful the precautions we’ve been taking to avert COVID-19—hand washing, social distancing, and wearing masks—will mean this season’s flu won’t take as severe a toll as in previous years. But they all insist that widespread vaccinations are necessary.

Even if the flu vaccine isn’t 100 percent effective in preventing influenza, it has been shown to reduce the length and severity of the illness in those who contract it. In addition, if you’re unlucky enough to contract COVID-19, you won’t want your body’s defenses to be weakened by a prior bout with the flu.

This is already present in the Southern Hemisphere, where each season’s flu strikes over the summer. From South Africa to Australia, public health experts reported remarkably low levels of influenza among their populations. They attributed this partly to coronavirus lockdowns and to extremely high participation in influenza vaccinations.

One pharmacy in Cape Town, South Africa, for example, reported that the demand for flu shots was four times higher than in previous years. People were trying to avoid the co-morbidity (simultaneous presence of two or more diseases) of contracting the flu in addition to COVID-19.

“People were lined up outside the pharmacy down to the corner of the street waiting to get their injections. We had to prevent people from coming into the store.”

Ellis Henen, owner of Sunset Pharmacy, told The Post.

Additional benefits of the flu shot

We hope Americans will have the same attitude to this year’s flu shot.

Some people think they’re still protected from the one they received last year. But having received a flu shot last year won’t protect you from this season’s strains of the virus. This is because your immunity from a year ago has deteriorated by now. In addition, manufacturers create a new vaccine each year based on which strains the World Health Organization (WHO) expects to be predominate. This is based on which strains were seen over the summer in the Southern Hemisphere. So this year’s shot will include strains different from those in last year’s inoculation.

It’s important to remember, even if you contract influenza after receiving the shot, it’s likely to be less serious than if you’d skipped being inoculated. And the flu vaccine offers additional benefits, especially among the elderly. For older people and those with chronic health conditions, recent studies show the extra benefits of a flu shot. It’s as effective in preventing a heart attack as quitting smoking, using cholesterol-lowering drugs, or taking blood pressure medications.

So be sure to let us know if you’re interested in getting a flu shot. If you encounter a shortage, we may be able to help you locate a supply nearby.

overcome chronic conditions

Healthy Habits Can Conquer Chronic Medical Conditions

We’ve heard a great deal lately about how those with chronic conditions—diabetes, high blood pressure, and obesity—are more likely to become sicker when exposed to the SARS-CoV-2 virus that causes COVID-19. Even leaving aside the coronavirus, many individuals have thought that having multiple chronic medical conditions such as those or others (cancer, asthma, coronary artery disease, and so forth) doomed them to a premature death.

But our concierge doctors have recently come across some good news for those people. It turns out that healthy lifestyle habits can overcome multiple types of chronic conditions and help extend your life.

Lifestyle impacts on chronic conditions

A new study reported last month in the journal PLOS One followed nearly 481,000 middle-aged adults in the U.K. for up to nine years. Of those, 93,746 had two or more chronic medical illnesses (known as multimorbidity) such as those mentioned above.

The researchers focused on four lifestyle factors: smoking, diet, physical activity, and alcohol consumption. They then weighted each of these factors (some healthy foods vs. a great deal, moderate physical activity vs. a great deal vs. none, and so forth) and broke them into four categories:

  • healthy
  • very healthy
  • unhealthy
  • very unhealthy

Then they assigned each study participant to a category.

Their results show that those who practiced the healthiest habits lived longer than those who did not, regardless of their current medical challenges.

In particular, men with a very healthy lifestyle were found on average to live 6.3 years longer than those with a very unhealthy lifestyle, while women in these same categories were found to live an average 7.6 years longer.

Even those in the third category, unhealthy, saw some benefit over those with a “very unhealthy” lifestyle.

Healthiest habits

Not smoking had the largest impact on life expectancy, according to the researchers. Smokers at age 45 were found to live five to six years less than non-smokers, regardless of other disease complications. Because the screening question asked only if participants were current smokers, it is fair to assume that the large study cohort included many former smokers. This proves quitting smoking at any age does confer health advantages.

Regular physical exercise also showed a significant benefit. Those who engaged in some type of regular physical activity lived longer than those who did not. Even if the exercisers had serious medical conditions. Researchers defined regular physical activity as that which met the global health recommendations: 150 minutes a week of moderate physical activity or 75 minutes of weekly vigorous activity.

Men who engaged in regular physical exercise gained an additional 2.5 years of life on average. The benefit for women was slightly lower; they gained 1.9 additional years of life.

Surprisingly, a healthy diet– defined as consuming at least five different fruits and vegetables daily– and moderate or no alcohol intake demonstrated little benefit in increasing life expectancy.

Never too late

We hope our patients find these results encouraging. They show that—even with multiple chronic illnesses—you can not only influence your life expectancy with healthier habits. And they show you can improve your quality of life by following standard guidance for a healthy lifestyle.

These include:

1. Diet

Avoid processed foods, and consume a diet high in seafood and fresh produce. Include fruits and vegetables, nuts, olive oil, and beans. and low in red meat, dairy, sugar, salt, and saturated fat.

2. Exercise

A daily minimum of a half-hour of any kind of mild-to-moderate exercise is crucial to overall health. If necessary, it can be broken into 10-minute increments throughout the day. Even a daily brisk walk will help.

But for optimal health, we recommend any kind of regular, vigorous movement. Try to add up to 150 minutes (2 ½ hours) per week.

3. Stress relief

When your body thinks it is constantly under attack, studies have shown such chronic stress puts you at greater risk for serious health problems, including cardiovascular disease, cancer, digestive disorders, impaired memory and concentration, anxiety, and depression.Reducing stress is crucial to maintaining good health, so:

  • take time for hobbies
  • practice relaxation techniques
  • exercise regularly
  • eat a healthy diet
  • stay in touch with friends

At the same time, avoid unhealthy stress relievers like smoking, excess alcohol consumption, and illicit drug intake. These practices merely mask stress triggers temporarily. They can cause damage to the body, as well as to your mental health, in the long run.

coronavirus symptoms

One More Reason to Avoid COVID-19 Infection

“I feel like an old person; I’m only 46,” a bank examiner from Brooklyn, told the New York Post recently. “I don’t wish this on my worst enemy.” She contracted the virus March 23, and still experiences body aches, hot flashes, arthritis and her hair has been falling out in clumps.

As some people toss around phrases like “herd immunity” (the notion that the virus should spread through the population to eventually produce a general immunity) and blithely attend “covid parties” hoping to achieve the same effect, our concierge doctors thought we’d explore one of the lesser-known risks involved in that type of thinking.

‘Long haulers’

Many of those who survived the disease are beginning to speak out about the long-term effects they’re still experiencing months later.

Shelby Hedgecock first tested positive for COVID-19 in April, negative in May. Nevertheless, she tells CNN she is still having neurological issues, cognitive issues, shortness of breath, chest pain, loss of smell, and body aches and pains that send her to bed for days if she participates in even the gentlest forms of yoga.

“[My symptoms are] just all over the place, and I’m insanely tired,” she told CNN’s Chris Cuomo recently. Cuomo, who also contracted COVID-19 early in the pandemic, reports similar lingering coronavirus symptoms.

Amy Watson, 47, of Portland, Oregon, appears to have been responsible for introducing the phrase “long hauler” which is now attached to the syndrome. Now in her sixth month of dealing with such coronavirus symptoms as painful burning sensations on her arms, torso, head and neck, she created a COVID-19 patient support group called Long Haul COVID Fighters.

Strange debilitating symptoms

Survivors on numerous online COVID-19 support groups describe a constellation of nearly 100 lingering symptoms.

Natalie Lambert, an associate professor of medicine at the Indiana University School of Medicine, surveyed more than 1,500 members of a group called Survivor Corps.

“They’re not quite sick enough to be hospitalized, but they are suffering from very severe symptoms, sometimes for a very long time at home,” she told NBC News.

Respondents to her survey reported 98 different coronavirus symptoms they’d experienced since their diagnosis, including:

  • dizziness
  • anxiety
  • headache
  • rashes
  • joint pain
  • shortness of breath
  • heartburn
  • diarrhea
  • fevers
  • memory impairment
  • cognitive difficulties
  • sleep disturbances
  • vision problems

Alexandra Plazas-Herrera, 41, told the Post she suffered bleeding from her nail beds and the skin was peeling off her face a few months after catching COVID-19.

“It was super weird, like horror movie stuff,” she said, adding that she has also experienced a lingering fever, fatigue, persistent brain fog, poor coordination and inability to concentrate.

Many of those who report chronic symptoms had only mild or moderate cases of COVID-19; most were not serious enough to be hospitalized. A large number of them report they were healthy and “in the prime of their lives” before becoming infected. The syndrome also appears to affect all ages.

How common is this?

The Centers for Disease Control and Prevention (CDC) released a survey in July of 292 people who had tested positive for the virus. It found 35 percent of respondents had not returned to their previous state of health. Other surveys, mainly in Europe, put the incidence as high as 80 percent.

Twenty percent of those in the CDC survey were between the ages of 18 and 34 with no prior chronic medical conditions.

“Data categorically show it’s a real thing,” David Putrino, a doctor of neuroscience and the Director of Rehabilitation Innovation at Mount Sinai Hospital in Manhattan, told ABC News. “These individuals are experiencing fatigue, dizziness, nausea, GI symptoms, pain . . . in the spine and chest.”

No one knows yet how long these troubling coronavirus symptoms will last; some survivors report early symptoms receding and being replaced with new ones.

Unanswered questions

Because the virus is still so new, medical science as yet has no answers for these people.

Jake Goldenstein, 20, still can’t walk down the street without becoming completely winded. He also suffers from debilitating headaches, digestive issues, congested sinuses and a racing heart.

“They gave me all types of medications. I was on a nebulizer, I was on multiple inhalers, they gave me multiple [antibacterial] medications, literally all types of medications,” the former hiker and baseball player told the Post. “None of them really seem to help.”

Lea Lane, a travel writer for Forbes caught COVID-19 in March. She’s seen pulmonologists, cardiologists, gastroenterologists, vascular specialists and neurologists. She reports her new primary care doctor told her she has “post-viral syndrome,” and “hopefully it will someday go away.”

If you experience lingering symptoms of COVID-19 infection, of course we will do our best to help manage them. But for now, our best advice is to avoid becoming infected in the first place:

  • avoid places with large crowds, especially indoors
  • always wear a face covering in public
  • wash hands frequently for at least 20 seconds

Remember the primary means of transmission appears to be aerosolized virus particles emitted—including by those showing no symptoms—when talking, laughing, coughing, singing or just breathing. These aerosols can linger in the air for many minutes or even hours. So never go any place where you don’t feel safe.

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome Is a Real Disease

The condition known as chronic fatigue syndrome (CFS) has been getting more attention recently due to its possible association with the novel coronavirus. This is because a number of COVID-19 survivors have been experiencing long-lasting effects that appear similar to those of CFS.

Read more
cardiac care

The Changing Picture of Cardiac Care

For decades, cardiologists have treated suspected heart disease the same way: regular stress tests, angiograms, angioplasty, and cardiac bypass surgery to repair defects. But several recent studies have upended this standard treatment protocol, so our concierge doctors at MD 2.0 wanted to share these new findings with you.

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wear face masks

How Masks Stem the Spread of COVID-19

As cases of COVID-19 continue to soar here in Florida, our concierge doctors are disturbed by the number of people who still refuse to wear face masks in public. We believe it’s because they don’t understand the usefulness of face masks in stemming the spread of the coronavirus.

So we’d like to explain the rationale behind the need for everyone to wear face coverings when they are around other people.

 

New knowledge

One study published last month in the journal Lancet found that, without a mask or social distancing, the risk of transmitting the virus to others is 17.4 percent. With a mask, that number drops to 3.1 percent.

Another British study released last month showed that if everyone wore face masks when they weren’t showing symptoms of the illness, it would be twice as effective at reducing transmission of the virus than if they wait until symptoms appear.

“Our analyses support the immediate and universal adoption of face masks by the public,” said Richard Stutt, a co-leader of the study at Cambridge University, adding that this measure combined with social distancing could be “an acceptable way of managing the pandemic and reopening economic activity.”

And according to a study by the University of Washington’s Institute for Health Metrics and Evaluation IMHE), if 95 percent of Americans wore face masks in public, it could prevent 33,000 deaths in the next three months, with 7,870 deaths prevented here in Florida alone.

“People need to know that wearing masks can reduce transmission of the virus by as much as 50 percent,” said IMHE Director Dr. Christopher Murray,” and those who refuse are putting their lives, their families, their friends, and their communities at risk.”

 

Easy spread

The problem with the SARS-Cov-2 virus is that it is remarkably easy to spread, and that at least a third of those who have it show no symptoms for several days, so they don’t know they’re infecting others.

Researchers from the National Institutes of Health (NIH) recently used laser light-scattering technology to reveal how even normal speech emits thousands of oral fluid droplets per second that can linger in the air in confined spaces for up to 14 minutes afterward. Coughing, talking, laughing, and singing produce even more potentially infected droplets.

Wearing protective face coverings significantly cuts down on the spread of these droplets.

 

All ages at risk

This is important because so far we do not have reliable treatments for COVID-19, although the drug remdesivir has been shown to shorten hospital stays by about four days. We do not have a vaccine, and may not have one for many months, or longer.

The only real—and effective—weapon we have against the SARS-CoV-2 virus is denying it new human hosts. And that means keeping our respiratory droplets to ourselves, whether through social distancing or wearing face coverings, or both.

Some people—especially younger people—resist wearing a mask because they think they’re invulnerable to the virus, or that it won’t affect them seriously if they do contract it.

There are two problems with that thinking.

First, according the the Centers for Disease Control and Prevention (CDC), those in the 18-49 year old cohort have gone from accounting for about 27 percent of hospitalizations during the week ending March 7th to 35 percent last week. Note that these are hospitalizations, not infections, meaning that younger people were sick enough to require emergency care.

Here in Florida, the median age of those infected has dropped from 65 to 35, which Gov. Ron DeSantis attributes to increased social interaction in younger age groups.

 

Perpetuating the pandemic

Second, as more young people become infected, they pass it to others their own age and older, including people who are immune-compromised.

Last week, Vice President Pence urged young people to take the virus seriously, to practice social distancing, and to wear face masks.

“Younger Americans have a particular responsibility to make sure that they’re not carrying the coronavirus into settings where they would expose the most vulnerable,” he said.

As Dr. Anthony Fauci told CBS News last week, “A risk for you is not just isolated to you, because if you get infected, you are part—innocently or inadvertently—of propagating the dynamic process of a pandemic.”

The paradox is that not wearing a mask is actually hurting the economy, along with other people, and prolonging the misery.

Miami, Palm Beach, and Broward county beaches will now be closed for the Fourth of July weekend. Many bars and restaurants that had been open here were forced to close, throwing more people out of work, and further frustrating those who have spent so many months confined to their homes and who had wanted to resume their normal lives.

“For pretty much every state that we’ve looked at, if we can get people to wear masks, we can not only save lives but . . . we can also save the economy, because we can keep businesses going,” IMHE’s Murray said.

In other words, those who aren’t part of solution are a part of the problem.

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