COVID-19 Update From Infectious Disease Expert, Dr. Chris Ohl - 4/16/2020

That's about April 16th now. So I think we've all been dealing this for about six weeks. It seems like six years, but uh, but it's only been six weeks. So, um, I just wanted to start out a little bit with, uh, what's going on with a coven 19, um, across, uh, the United States. Um, so, um, it would appear that, um, a lot of places that were initially, uh, hit the earliest and that would be the West coast are, uh, have definitely hit their peak and their numbers are coming down. Um, and some of those communities are starting to relax. Um, some of their, uh, social distancing, uh, California notably at is not, uh, relaxing any social distance in at all. They have a little bit further to come down on their mountain, um, uh, before they're ready to do that. Um, they, uh, some of the hospitals in those areas that were hit hardest are actually starting to share some of their ventilators and other medical supplies with other areas now in the country.

So that's a very good sign. So, um, the big urban centers, uh, in the U S particularly New York, um, looks like is hit peak, but, uh, after their peak they're seeming to have a longer shoulder, if that makes sense. And their cases per day numbers are coming down more slowly, but it does seem like their hospitals are in quite so overwhelmed now. And the number of new admissions in those hospitals are starting to decline. I'm sure they would like them to decline quicker, um, as we all would for them. But, uh, but they are, um, coming down all it slowly. Um, some of the other areas in the United States including new Orleans seems to be doing better as well. Uh, Detroit still struggling some, um, and uh, both with new cases and uh, and with hospitalizations. Um, so what the, I think all of this in summary for the U S says is that different places are in different timelines.

Um, and um, some places, uh, you know, have already gotten, kinda slammed and they're coming down. Some places have not been slammed at all, uh, and are just sort of perking along. And then other places still have the potential, um, to become a problem and, uh, and have their case numbers go up and have their own little epidemic in their own place. Um, social distancing and sheltering in place is clearly working in these areas. Uh, no ifs, ands or buts. So here in North Carolina, um, um, our numbers are also coming down as a state and, uh, and in most of our communities, so, um, in Charlotte, uh, the, the net new cases per day are coming down, hospitalizations are coming down some, again, everyone would want them to come down quicker, but at least they're coming down at a rate here in our area and the triad as I've described the past, rather than having a mountain of cases and going past the peak, we're more on a Mesa, you know, that sort of flat, high plateau and a, and we're kind of perking along with that, um, with a low number of cases per day.

Um, and Forsyth and Guilford County. Um, and uh, and in the triad area at large, um, and our hospitalizations, new hospitalizations seem to be just perking along. If anything, maybe there's been a little bit of a decline in cases from last week. I won't say we're past peak because you have to have a mountain to have a peak. Maybe, maybe there was a mound that we went over last week and a little bit more time and we'll know, um, um, whether that, how meaningful that's going to be. But we're doing well here. Um, and our social distancing is really working in our sheltering in place is working. And uh, again, I, I gave a big shout out to all of us as citizens in our communities here. Uh, this is, uh, uh, we have avoided a huge problem here because of us, because of us as citizens and because, uh, we're doing what we need to do, uh, to keep transmission of the virus at Bay.

Uh, and from giving it to person, to person. Let's bring it home to you guys. Um, you know, every epidemic is nothing but a series of a million little mini epidemics that come together and you're doing your part to keep transmission down in your community, in your neighborhood and potentially even in your own household. So, uh, keep it up. We're doing, we're doing a great job. Another shout out to our kids. Their kids again, have taken a big brunt of this. Um, they're the ones who don't get graduation. They're the ones who are missing their friends and, and the social Maloo is really important and for kids. And so, uh, tell your kid today, thanks. Um, because they're their shelter in some burden to the, um, so where, where do we go here from now? How do we get off our Mesa and the triad?

How do we get off of our, uh, off of and out of our, our epidemics that are past peak in our cities and, and, you know, in the state? Well, um, we're, we're, we're working on that or, or closer to solutions, I think, than we were a week ago and definitely closer than we were two weeks ago. Uh, I know here in Winston Salem we've extended our shelter in place for, for what, three weeks I think. Uh, basically so it'd be like the second week of may, somewhere in there. Other cities and counties have done the same in our area. We're waiting to hear from the governor on this, uh, and what we're going to do as a state. Um, and I've, as I said last week, it's, it's, uh, you have to weigh two things. You know, you have to weigh safety and viral transmission and the epidemic on this hand and then you have to weigh our economic viability on this hand.

Cause certainly we will want to get back to work and, and be able to be doing the things that seem more normal. Um, when, when we do relax our social distancing and sheltering in place, I think it's going to be a graduated process. So a won't be all at once. All in one. We won't, we won't wake up one morning and hear, okay, life's normal again because it still won't be because the virus is still around. Um, and we have to be careful. Didn't let it recrudesce or resurge again cause once we uh, once we relax or shelter in place, uh, then the, the virus is going to try to push its way back again. And so if you do it in a more gradual way and in a controlled way, um, it, you know, make that likelihood last. Um, so what might that look like?

Well it might be that some businesses might be able to open before others. We'll see what that list looks like. It might be that some activities will be able to come back before others. I think the ones that are going to be later on the list are going to be things that involve large congregate activities. What does Congress get mean is where a lot of people come together. Um, and uh, things like sporting events. Um, and uh, and unfortunately maybe um, are places of worship depending on how many people would be there, you might see limitations still put in place and how big a gathering can be and what social distancing during that gathering might look like. Well restaurants come back, probably there may be somewhere in the middle as far as how we, we come back again. I'm, I'm kinda guessing cause I'm, there's a lot of people putting input into, into how this might look, but you may be going back to a restaurant where the tables are six feet apart, which is good news because you'll get better service, more waiters, less people, always a good ratio.

Um, but we'll have to wait and see how that happens. I don't really see much relaxation occurring at all until, until the end of April personally and I, and I wouldn't advocate that, um, we do that until the end of April. I think the communities that have gone out to the, to the middle of may are, are the ones who are on the safest line and that that's where it would, my recommendations would be, I think we'll know a lot more by then. So what do we do between now and the middle of may when we relax our social distancing and shelter in place? Well, there's a lot of work to be done. I think I mentioned last week. It's kind of like going down a safety checklist before taking off on an airplane. Um, and you need to make sure that everything is in place for us in healthcare. We didn't have to make sure we have enough PPE.

Um, and uh, what's PPE, personal protective equipment that we use to examine and take care of patients who might have an infection. Um, and then the second thing is, is that we have to have more availability of testing, uh, testing availability and the triad is increasing every day. Um, and I'm going to come back to that in a minute, uh, for us specifically in our area. Um, but, um, um, we will need this testing to be able to identify people who have infections and then put that person in isolation at home if that's the best place for them. And then, um, and then quarantine their contacts, which means people who have been in contact with that person. We'll be spending 14 days more watching Netflix. So this is part of our strategy I think to get out of this is because rather than quarantine, the whole community of Forsyth County for instance, while we will be doing is identifying the sick people and isolating and quarantining their contacts.

And so there'll be a smaller segment of people, but our communities and our citizens are going to have to be ready for that because it, you know, it's again, 14 days staying at home, um, more if you're a contact of somebody who has coven 18, but those tests have to be available and we have to have the, uh, the people trained at the health department and such in order to track down those contacts. Um, some people have been seeing that there's apps on phones to be able to help with contact tracing, a little bit of privacy issues maybe with some of that. But public health, public health takes privacy into account for everything. And, um, and so I'm not sure that that's a big problem for those apps on the phones. Um, the other thing on the checklist that we need to have is a, is a community ready to do the relaxation of, of shelter in place, um, at the right time and be adherent to it still.

So, um, again, it's probably going to be at least a few weeks, few more weeks yet to endure this. The good news is is that it's working and then we'll start to relax. But we want everyone to relax in a controlled way to gather and be good citizens about how that's done, which means paying attention to it. Um, you know, I tell people that it's, we've done a great job with it now it's worked. It's kinda like we've got three quarters of the way through a good basketball game, but the score is still real close. If you're Duke, do you think coachK is going to let up and just let it go and say, Hey, we played a good three quarters. All right, we'll just kind of relax now and let it go now. Now coach K is not going to say that he's going to finish, he's going to finish that game.

And otherwise, the first three quarters are for not apologies tall, the UNC fans by the way, or the Lake fans. So, um, I've been getting a lot of questions, things about details still on, on where we're at and where we're going. Let's talk a little bit about testing and testing in our area. So I wake forest Baptist health, we now have in house testing, which means we're not having to send it out. We have the capacity to do all of our inpatients and our, um, and our ed patients right now and, uh, and healthcare workers, uh, starting next week, um, we're going to be able to increase that capacity to doing more people. Um, and this will, um, include, um, patients, um, who, um, might be older, you know, over the age of 65 and or, uh, have other, um, underlying health conditions that, um, that I have a respiratory illness, the flu, like illness with fever and or cough that they would be able to be assessed and then tested if thought to be needed.

Not everyone needs to be tested. We're not going to be opening up testing yet for everybody. Um, we just don't have the capacity. And as we've talked about before, if, if you're otherwise pretty healthy and you think you have the flu, um, it could be coven but it doesn't really matter cause you could just stay at home and, and, and put yourself in seven days of isolation. And then, uh, and then as you're at seven days, if you've had three days of improving health, then you can leave isolation. And that, that's gonna work for, um, for almost everybody. Vulnerable patients are, are the ones who may be in nursing homes, ones with a lot of other I, any health conditions or older or infirm. And for those people, it helps the doctor take care of those people if they have a diagnosis and what's going on.

So those, those are going to be the next priority group. Um, we also want to make sure that people who live in group homes and, or people who, um, are in like dorm, like situations and living, if they have respiratory symptoms that they get tested because we have to do special things in those group settings to make sure other people don't get it. So that's a, well, how we're going to be testing next week and, and I think all of the healthcare facilities there are ramping up per testing. Is testing going to be available at a point of care yet in your doctor's office? Doesn't look like it. Not yet. Anyway. Um, and those tests are a little bit, have to be done in a such a way that people without a lot of training or background in laboratory medicine can do them. And most doctor's offices aren't quite set up for that yet.

Um, but w but as time goes on, I think we'll have more office based testing, um, and in the future and that would be a good thing. Lot of them. The news about testing, using blood tests, serology, what does a blood test measure? It measures your immunity. Um, and an antibody, an antibody is a molecule in our body that attacks the foreign agent such as a virus taches to it, and then gets it out of the circulation or gets it out of the airway or out in the lung. And we can measure those antibodies. Uh, presumably if you have antibodies, it might mean you're exposed, um, to have been exposed to coven 19. Some things about antibody testing though is it takes a while for the antibody to come up. Affirming the time here, in fact into the time we can measure good levels of antibodies is probably at least three weeks.

So it's not really that helpful when you're sick because you haven't mounted that antibody response yet. It's more helpful and knowing whether you have been infected in the past. The other thing we don't know about those antibodies is, uh, how well do they work? How well do they protect you? Um, and, uh, we need to find that out. And so we do studies and we need to do some studies in that. And then the third thing about that antibody is how long will it last? So, uh, if you get Cove 19 today, will you be protected in a year? So first we have to find out how protected you are and then if you are protected, how long that'll last. So we have some science to do and that science will be going on through the summer. Uh, we had, uh, we at wake forest Baptist health will be participating in such, and I think you may have been hearing on the news about a large survey.

We call it a serologic survey that we'll be doing measuring antibodies and people to see how many people have been infected in our neighborhood and maybe how well that protection works. So be looking for that. Um, uh, as a, as we go on, uh, other things I'm asked about, um, besides testing is, um, masks. So we're been asked to wear cloth masks and pelvic. Some grocery stores are requiring masks, other places aren't requiring masks. What are these cloth masks do for us? Well, they're, they're basically, if, if you have coven 19 and you're in that stage before you've sick and have symptoms and know it, which could be 24 hours beforehand, um, there is this, there's about 17% of people might shad virus before they actually have their symptoms. And so if you wear a mask that keeps your respiratory goblets from getting out there in the environment, um, wearing masks, the smell is, is more important when social distancing isn't possible.

So for those more crowded markets and stores where it's harder to stay away from people, places that see a lot of people where it's really, you know, more crowded and there's more people traffic, um, they're not really necessary outside. Um, and uh, and in your own home you've already kind of exposed that area. So you probably don't need them in your own home unless there's someone in your homeless sick. And then that person who is sick should be wearing the mask cause it keeps their goblets to themselves. Um, um, some hospitals in the region might be asking you to wear a mask when you come in, uh, in the future. So if you're, um, a patient or visitor, um, to the hospital or have some business in the hospital, you should bring a cloth mask with you in case you're required to use that when you've come in.

Um, the, um, aspects about visitors and patients coming in hospitals. So we won't be relaxing or visitor restrictions until we're coming down the slope of our Mesa. Um, more, um, there's still some virus being transmitted in the community and so we still need to keep our patients safe. We still need to keep you safe as a visitor and we need to keep our staff safe. So, um, we are still going to be eliminating visitors until the shelter in place. Orders are starting to be relaxed. And then like everyone else, we're going to be relaxing visitor restrictions in a graduated and safe way. We don't have a timeline for that right now. Um, but uh, we, we will still be doing visitor restrictions for awhile as I think all of our health care facilities in the region. We coordinate this and do it together. So, um, and I know it's tough if you have somebody in the hospital or a loved one.

Um, and it's tough to not be able to be there for them and it's tough for them not to be there for you to be there for them. And we, we really understand that, but we have to keep everybody safe. Uh, the emergency department, if you have an emergency as the phone call says, call nine one one, right. Um, if your emergency isn't, isn't quite as much of an emergency, but you have to visit, uh, the emergency room. It's, let's say while social distancing, you're doing batting practice and your break your wrist, uh, you can be safe going to the emergency department at any hospital in the area. Cause all our hospitals, we take measures to keep patients who might have coven separate from patients who don't. So the D is still a safe place for you. So if you need to go to the ed, go to the ed.

If it's not an emergency and you have your sick, maybe it's with fever or cough. Call your doctor first and see if you really need to go. No one wants to go to an emergency room if you don't need to be there. So, um, and then, um, lastly, um, when you are using a mask and cloth masks, um, there's a few things about it. Um, it's if you're going to be taking it on and taking it off all the time, it's best just to leave it on. Um, because if you get the goblets from your respiratory track on your mask and there happens to be a virus, any virus there and then you're messing with it and taking it on and off, then you'll get it on your hands. So, and then after you've taken your mask off, wash your hands, cause then you get it off your hands and it goes down the sink or it goes into the sanitizer.

And so that's the right way to do it. And you probably don't want to be mucking with your mask or, or touching in the ladder, messing with it. Although I, I see, I know it's hard to do cause they're not always comfortable, but we don't mess with it if he can. Um, and then, uh, lastly, um, so if you remember last week, I, uh, asked everyone to help me out with a personal thing that my wife Vera, who's also an infectious disease doctor, wanted to, uh, give me a haircut. I wasn't so sure about that. And, uh, so I asked everyone to vote. And so here's the votes. Um, out of almost 800 people who voted, 431 55% said, let it grow, be a hippie. And 45%, three, 355 said to get, get the haircut. So I talked to Vierra as she conceded, um, conceded the election and said, you know, I really didn't want to cut your hair anyway.

Um, and, uh, um, and she said, you know, I'm pretty busy, so I got other things to do with my time. So, uh, until, um, social distancing is really let up, you'll all be seeing my hair grow. So bear with me on it so that if there's any questions, uh, I'd be happy to take questions. Um, otherwise, I think we covered most of our issues. You mentioned. Yeah. Expect that to continue or do you expect any sort of deacon? So will our Mesa continue? Um, yeah, I think it will. I think it'll start to come down gradually. It may already be coming down, starting to gradually, but you know, when, when it's a Mesa, it's a little bit hard to know your changes in elevation. Um, so it'll come down gradually. I what? I don't think we're going to see, unless social distancing is released all of a sudden, I don't think we're going to see a big peak in our area. And man, isn't that good news? I mean, yeah. Who wants to be overwhelmed with an epidemic? No one wanted to be like New York. We felt form, but we didn't want to be like them. And, and I really don't see that in our area at all. Um, so, uh, hopefully we won't have a peak. We'll have maybe have a little mound, mole Hill, I don't know. But, uh, um, but I don't, I don't see a big peak in our area.

Yeah. I think a lot of people are, uh, I don't know if frustrate is the right word, but there are other, for example, protests in Michigan yesterday and that, that kind of thing. Do you, is it still important to people in these next few weeks until there's an order just to remain?

Yeah. So, yeah, I mean, the protests that we saw in Michigan, uh, I'm not sure how patriotic those protests were. You know, I'm not really a political person, but, um, yeah, I mean, like I was saying, we're three quarters of the way through the basketball game. Let's be like coachK , let's not let up on this Ferris. And so, yeah, a few more weeks to three more weeks. Um, I know it's not fun. Um, but Oh well I do something three quarters of the way through and then let go and, and blow the game. We don't want to do that. So yeah, a few more weeks. Um, I think we're through a good majority of it, but a few more weeks. Let's be steady

doctor, with the cloth cloth masks. Is there a way to clean them? Do you throw them in the washing machine, would you say?

Yup. Your class mask. I would throw it in the washing machine. Yeah. The detergent. How water detergent. That's what's needed in a dryer afterwards is fine. Here's your chance to give a fashion statement to write different masks. We'll see how that goes.

And I know the, uh, the big concern has been the places where older people stay, the retirement homes. What, which, what have you guys been doing to help them deal with this stuff? I don't, we have a bunch of those in our area.

Yeah. So retirement homes and nursing homes. So, um, yeah, so we're working together with the County health departments, um, with our nursing home populations. For those of you who have loved ones in the nursing homes, you know, it's, um, it's really been tough because, uh, we, one of the things we do there is limit visitors too, cause we don't want people bringing it in. We screen our staff going into those areas to make sure they're not sick. Uh, and then people with respiratory infections, we test them, um, people who are becoming new to the nursing homes. So if you're a new nursing home resident, you might be spending, uh, depending on the vigil home, 14 days in a certain wing and then, and then moved into the general population. So on and so forth. Retirement homes, um, you know, so like a, we call them assisted living, they're a little bit different because most people have their own rooms and there's not as much congregate activity. They're being encouraged to social distance as well. Um, and in a lot of their activities where they would all come together, um, you know, have been more limited and, um, so that we don't get groups of people together. And again, these are people we would like to test if they get symptomatic.

Is, is that kind of a place that even if they're not symptomatic, maybe like test everybody in one of those places. So no, who's got it

right. So that's a good question. Would we take a facility and just test everyone to see who's got it and who doesn't have it. So, um, we don't, so asymptomatic people, people without symptoms, there's only really certain things that would prompt us to test them because the, if I sat in the past a positive test, it's hard to know what it means cause we don't know what you're going to get it. Negative test doesn't miss a scarily mean you won't. So, so we would not be doing that unless there was an outbreak in that facility. So let's say we found out, Oh my gosh, there's 12 people who've gotten coven in, in, in facility X. um, then we, we might do that. And that was done with the nursing home outbreaks in Seattle. We've done a few of those here in the, in North Carolina, in the nursing home outbreaks.

So we haven't had a nursing home outbreak in our area here. Um, I should probably knock on wood, cross my fingers, throw salt on my, my shoulder cause we don't want that. But, uh, yup. There. Um, and then the, uh, sometimes there might be certain instances where we might test somebody before a surgery where there, where the surgeon has to go up into the airways and we want to make sure they don't have it because there was a big aerosol generated with that. But other than that, we should probably not be testing it. Oh, women in labor will get tested, I think, um, starting next week, um, at least in our facility, I think other facilities might be doing it already or will be. And the reason why is that, um, labor, um, is, uh, is, is if you've been with somebody in labor or you've gone through labor yourself, you know, it's an aerosol generating thing. Um, because, uh, it's a, you're encouraged to, to make the noises and stuff that you need to, to, to release your energy. And so the, so people will be tested, I think before that. Any other questions? Every news, every week though, the news gets a little better, doesn't it? Um, I think, um, but just to remind people, we're in this for the long haul and, um, and, uh, and we, we will need to make sure that, uh, uh, we get out of our, our epidemic portion of this or get out of our first wave and then start planning and, uh, and, and making sure that if a second wave comes along that we're ready for it so we can stop it down before it gets to be a big one.
 

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