– First I’ll introduce myself. I’m Amy Gray Beck. I’m the Executive Director For Outreach and Engagement with VCU Alumni. I’ve been with VCU for eight years, and this is my first webinar on Facebook, so hopefully the– – Mine, too.
– (laughs) Yeah. Hopefully the first of many. Because we’re excited about offering virtual programs to alumni; we’ll be doing this for the weeks to come so this is just the first one. I told Dr. Gravatt she’s the guinea pig for us, but I think it’ll be really great.
So, if you wouldn’t mind, Dr. Gravatt, I know they’re probably wondering, “What, she’s doing taste tests with her students?” Dr. Gravatt is the Vice Chair of Education Associate Professor in the VCU School of Pharmacy. She’s also a VCU alumna. So if you could, tell us what you do, what that, that long position really means day-to-day, that’d be great. – Yeah, so I have a mixed position, so I actually spend most of my time over at the School of Pharmacy where I teach; my main teaching responsibilities are infectious disease, and so I teach and lead our infectious disease module. I also teach an infectious disease elective for our students, and then I still have a clinical component to my job and I spend five, three five-week blocks over at the hospital where I’m an internal medicine clinical pharmacist, where I round with the physicians, make recommendations, do a lot of education there, and then I take fourth year pharmacy students on those rotations with me.
And then in addition to that, with my Vice Chair responsibilities, so I oversee kind of all the educational pieces within my department. As far as doing course coordination, evaluations, I’m Chair of Curriculum Committee, so I do a lot with curricular design and implementation and that type of thing. So, my day-to-day, it differs everyday, which is kind of what I love. I never get bored, so I love the, I get to teach and it’s something I really, really enjoy but I also still am into clinical practice as well.
– That’s great. Well, thank you for taking time out of your busy day, ’cause obviously you’re incredibly busy, to be here with VCU Alumni and the world of VCU Ram fans. And I do want to say, I have no medical background and so, for those of you that, maybe also don’t have that, I’ll be able to ask questions of Dr. Gravatt that maybe, “Can you explain that a little bit more?” Because I’m not gonna understand that. – That’s okay.
– So, great, are you ready to dive in to some questions? – Yeah, yeah, let’s go ahead and get started. – Okay, awesome. So, this, we’re gonna start really simple, kinda from the beginning, and then work our way into some details. And thank you to those of you that submitted questions in advance; we’ll be getting to those as well as questions that you submit live.
So you can put them in the comments below, and I’ll be getting them and sending more questions. So our first question is, “How is this coronavirus strain different “from past strains,” ’cause that’s why we’ve kind of changed from corona to COVID-19. Can you kind of explain how it’s different? – Yeah, absolutely, okay, so coronavirus, in general, it’s an RNA virus. And so, there’s actually different forms of coronaviruses.
And coronaviruses have been around for a long amount of time. Actually, there is a subset of coronaviruses called human coronaviruses, they’re alpha and beta, and they cause usually common upper respiratory tract infections, things like the common cold, those kind of things, and usually, for the most part, we have the symptoms, we get over them, and then we don’t have any other issues. However, just like with a lot of other viruses, if your immune system is compromised, or extremes of age, any of those risk factors, that could still put you at risk for developing complications even with these other coronaviruses, okay? Now coronaviruses are interesting, I think, because they can mutate and adapt very quickly. And we have seen evidence of that with the novel coronoviruses.
And so there have been other novel coronaviruses that have preceded this one. So the first one was the first strain that was called SARS or severe acute respiratory syndrome. And this was found mostly over in Asia, back around 2003; interesting, that’s when I graduated. But this was kind of a big thing.
It was a coronavirus, and then several years ago in 2012, there was a Middle Eastern respiratory syndrome, or MERS-CoV, which was also a coronavirus, as well. Now, all of these, like specifically SARS and MERS, these were primarily found in animals originally. They think it was to be bats that then infected other animals that then mutated and were able to be transferred to humans. Now we don’t have direct confirmation at this point because everything is so new with the COVID 19, whether or not this originated from an animal source but that is the thought is that, that it should be a pack to a pangolin is actually the animal they think it’s coming from that came from China and then mutated and was able to infect others; now how are these novel coronaviruses different than the ones that cause the common cold, okay? And it has to do with a couple of factors.
The one factor has to do with how virulent these are. These other more human coronaviruses, the alpha and beta ones that I talked about, those that cause the common cold, you have symptoms for several days, but the mortality’s not very high. However, with SARS and with MERS, it’s a completely different story. So, with those, we had much higher mortality rate, which is the reason why it was kinda put on alert for both of these.
So SARS and the mortality rate was 10 percent of individuals that got infected versus MERS was anywhere up to 30 percent or higher. So, kind of comparing this to the other novel coronaviruses more like it, SARS and MERS, this is the reason why we’re taking COVID-19 very serious, and the reason why our actions with it are very different than what you would do for the common cold. – Okay. Helpful.
So, what does COVID-19 stand for? – Okay, so, great question, so, it stands CO for corona, V for, VI, for virus, and D is for disease, so coronavirus disease. 19 is because it was discovered in 2019. So it was discovered at the end of last year so COVID-19 is just directly from that. If you look in the literature, too, sometimes you can also see it being done as SARS COVID two, so they’re calling it kind of like the SARS because it is severe acute respiratory syndrome that it’s causing.
So sometimes you’ll also see it being referred to as that. But it’s also COVID-19. – That’s great, so now I know what I’m talking about everyday when I say it, thank you. – Yeah, coronavirus, yeah. – So, this is a great question that I hadn’t thought of. But when and if there is a vaccine, would it become an annual shot like the flu shot? Is this something that’s gonna be something that we need to take advantage of every year? Or would it be something like a small pox polio vaccine given to children once? – So that’s a great question.
And the answer is, “We don’t know.” And part of this is because all of this is brand new. I mean, a lot of this just got started at the end of last year. One of the things that we’re still trying to work out is how does the body build immunity to COVID-19? And we don’t have a good sense of that. Now if you compare it to the other novel coronaviruses, and the immunity built with those, even those, they vary.
So for SARS, the individuals who had SARS, they were able to actually have immunity for eight to 10 years after having SARS. So actually, pretty long time. Versus those that had MERS, it was anywhere from one to three years. So we really don’t know at this point what that’s gonna look like.
So as far as annual versus more frequently than that, we don’t really have any idea. – Okay. Another question that we have, “Do you believe that the measures the local, state, “and federal governments are taking “will have a large impact, “the social distancing that we’re practicing right now?” – So I believe strongly in the social distancing. And here is the reason why, okay? This is one of those times when I kind of almost wish I had my whiteboard to be able to draw it for you.
But if you Google this, you can see it, okay. So the big thing with viruses is about is how many people can one person infect, okay? So, and with this particular virus, it’s not necessarily that one person only will infect one other person and then that person will infect another person. It is not that way. So with this particular virus, the ratio that we’re looking at is anywhere from two to three people.
So if you are infected, or if you have the virus, there’s a potential for you to infect three other people. So let’s just talk exponential here. Then those three people infect three other people, three other people, three other people, three other people, and so we know that with this particular, the way it’s spread, is through mainly through aerosols but also there is a fecal oral route that’s also been examined as well for individuals that have had COVID-19, they have actually examined stool studies and they’ve looked at that it can be positive in the stool for quite some time after having the virus. So that is another way of transmission so that again goes to the most important ways to not expose yourself to the virus.
So we know that these particular droplets can stay in the air anywhere for up to three hours after a sneeze or a cough, so it’s just gonna be hanging out there. You don’t know that it’s, you’re getting ready to walk through it like a spiderweb. But it’s just there, and they also can live on certain surfaces such as stainless steel, cardboard, other things, for a longer period of time. Mainly the ones that are, that we’re worried about are stainless steel and then also plastic, seems to be for a prolonged period of time.
So, so really, not being exposed is the biggest thing. So, keeping six feet of distance between you and other individuals because that’s actually about how far those aerosolized particles can go so that’s where that comes from. So the less people you’re exposed to, the less chance you are to be exposed to the virus. And then again, because this is a novel one, our bodies haven’t seen this before.
They don’t know what to do with this, so this is brand new immunity that we’re building here. And so, again, you don’t know if you’re gonna be that one individual that reacts badly to it, and so I really do feel like social distancing is gonna be extremely important and it’s because of how many people you can infect. And so I definitely believe that it is the measure that we have to take and we can’t stand down from it now. I mean, you gotta keep on going with it, so– – Yeah, well we’ve adapted well. (laughs) – (mumbles) the good news is, I think a lotta people are realizing maybe it’s not so bad.
I kind of have joked with my family, so I actually grew up on a beef cattle farm out in a tiny little place called Spencer, Virginia, which was not near anything. I mean, we’re talking 30 minutes from the nearest grocery store, an hour to get to a city. – My goodness. – And so I told my parents, I said, “Good news; I’ve been “practicing for this my whole life. “I grew up with social isolation, so here we are.” – That’s perfect. Well, one thing that gets me through social isolation is having my dog.
She’s ready to go on a run. She’s ready to cuddle up when I’m ready to cuddle up. So I have a great question from Rodney Harry on Facebook. So he asks, “Are there any special precautions “I need to take with my dog?” – That is a great question.
So far, we have not seen any issues with transmission from humans to their pets. So, yes, I know I just told you that an animal may have given us this. And everybody’s like, “What the heck is going on?” But, no, there has not be shown to have any issues as far as transmitting the virus to your cat, your any kind of other animal that you happen to have in your home, at least that has not been widely out there at this point. So, and I know that, actually I just saw recently, so our dog is a rescue dog that we got from Southside SPCA, and they were sending out things like, “It’s okay to still get rescue animals. “They’re not infected.” So, I think that’s a good message to put out there, that you need your animals.
Don’t get rid of your animals. They’re important. – No. Definitely. So, when I am able to go to the grocery store to get my essentials, what things should I be picking up? Are there general things that I should be doing to keep myself healthy, that we should be doing to keep ourselves healthy, during this pandemic that can help? – So I think there’s a couple of things, and I know it’s gonna sound like a broken record for some of these, but it’s really, you just gotta stay healthy, okay? And so, what does that entail? Getting enough sleep.
Good news, if you’re being able to work from home and that kind of thing, you’re cuttin’ down on your commute quite a bit so take advantage of that and being able to make sure that you’re getting enough sleep is really, really important. Adequate nutrition. So, making sure that you’re still eating healthy meals that maybe we’re not overindulging and all of the pandemic snacks. I think just kind of being mindful of that is important, mindful eating.
Exercise; I’m a huge proponent of exercise. I’m a runner myself, and so I run almost on a daily basis and then as well work out in my home. And I, keeping those routines up, I think are very, very important both for you mentally but also for your immunity. I think that it’s a great thing for you to be doing.
So I think just keeping yourself healthy and doing those things along the way are gonna go a long way. I know some people are worried about should I be taking extra vitamins? Should I be, what else should I be doing with this? And the answer is, “If you’re eating a well-balanced diet “with vegetables, fruits, those kind of things, “you should be fine,” okay? And there hasn’t been any studies that have shown that specific vitamins are doing anything to be able to prevent this disease or to help you; now we do know there are some vitamins that are associated with increasing your immunity. Items like zinc, vitamin C, vitamin D, even. So, if you happen to be taking those supplementations, I think that’s fine, but again, there’s nothing to say that any of those are really gonna do anything as far as preventing or kind of keeping you, but the big thing is just keeping yourself healthy in the meantime.
– Okay, and thinking about being healthy, you were talking about doing exercise and getting out and running. It’s gonna get warmer. And so, Josh Zang just asked on Facebook, “How do you think the warmer months “will affect the transmission rate of the virus?” – Thank you, Josh. Josh is one of my students.
– Oh, (laughs) hi, Josh. – Hey, Josh. Okay, so how do I think that it’s gonna change the transmission? The answer is, “We don’t know.” It started in the winter, and it hasn’t been tested with warmer climates yet so the answer is “Do we think this is gonna die off, “kind of like what we see with the flu?” We don’t know. Now if you compare it again to the other coronaviruses, which is the only template that we have, SARS, that was also a winter virus. It started to die down by about July in that particular case.
If you look at MERS, MERS originated in a very hot place, in a Middle Eastern peninsula, was very sustainable in very warm temperatures so how is this virus gonna do, we really don’t know at this point, so we can hope and again, I’m a huge advocate for getting outside, getting fresh air, just not being around a lot of people. One thing I realize I did not talk about, which I think is important, important, important, is again washing your hands repeatedly, both if you’re going out and about, you need to be prepared for sanitizing whatever things that you’re touching, as well as constant washing your hands and washing your hands for at least 20 to 30 seconds and making sure that you’re really preventing those viruses from hanging out on your hands before you then touch everything else. I know everybody’s like, “Oh, gosh, I’m not supposed “to touch my face,” which is very hard to do. – I know; I have an itch right now, I’m trying not to scratch. It’s so hard. (laughs) – Oh my gosh, it’s a conscious thing and I’m telling you the struggle is real; I have the same problems.
So I feel a little bit better if, at least, I’m washing my hands, but if you are out and about at all, you need to be prepared to be washing your hands or have a way to be able to do that. – And how serious should I get about this? If I go to the grocery store, I’ve just thought about this, if I go to the grocery store, I go to Aldi and I’ve got all my bags and all my stuff and I’m carrying everything, when I get home, should I put my clothes in the laundry and take a shower? – That is a good question. Now there’s no direct recommendations on this, but if you look at what they’re actually recommending even for healthcare professionals or others that may have been exposed, that is kind of the recommendation is leaving your clothes off at the door. Taking your shoes, making sure that you’re not tracking your shoes into your house.
It could be spreading things. I saw a recent thing today, which there’s no data to support this, about what if the coronavirus is hanging out on the packaging of, my groceries? One person said, “Well, just leave ’em outside “for three days,” and I’m like, “Well, the milk, ” the milk, are you leaving the milk outside?” I mean, I think the things that could be the most likely, again, things in plastic or those items, you could think about if you do have any of the Clorox wipes or anything like that to kinda wipe down those surfaces if possible. The nice thing about Aldi’s, Lidl, a lot of these places, you can bring your own bags, okay? – Right, right. That’s helpful. – So, I will say when I went to Aldi’s, when was this, a week and a half ago, what I did was I just let them put everything in my cart, and I actually waited till I got to my car and then I put everything in bags in my car.
So all of that was, stayed in my car, my bags, everything else, so that way it was one less place to kind of pick that up and then put it in there. Now, is that the best way? I don’t know. – Right. – And obviously I had hand sanitized before, after, during.
Had my wipes with me ready to go on the cart. – We’re getting lots of questions. So this is so great. – Oh, good, that’s good. – So Jessa Nelson has just asked, “How do health experts determine “how much of the curve flattening has to happen “before they make the call to ease up “social distancing restrictions?” – That is a good question.
And unfortunately, I’m not one of those people that has to make that decision. But I can tell you what I do know; I do know that we have to see that we’re on a downward trend on that slope and none on the upward. Bad news, Virginia, we’re not on the downward trend right now, so we’re on the upward. And I’m not saying that it’s getting to a place of panic, and I don’t want anyone to be panicking, ’cause I do think that because some of the things that we were done as far as halting schools, moving offices to online, doing a lot of these things has helped curb some of this, okay, but what we’re seeing right now in infections are people that probably got infected two weeks ago.
That was before we even started all of this. So now we’re gonna start seeing what is social distancing really gonna do? But it does take, I think, everybody doing their part because even once we started that, we were noticing people were still going out and about. A lot of places were still packed with people as far as what did that, were people adhering to that 10 person rule or not I think was a whole ‘nother ball of wax. So I think that we’re gonna have to start seeing a decrease in the trend and then I think you add two weeks to that.
Because you’re gonna have to see a decrease below a certain threshold and then you gotta wait two weeks for whoever was exposed to those individuals, did they have symptoms and then we’re gonna see. So I think we’re gonna be waiting here for a little while in this holding pattern. – And not that I think that you can predict the future, but you are our infectious diseases expert, so and multiple people asked this, but if we started to do social isolation around two weeks ago and take our kids outta schools and those kinds of things, do you have a sense of when the curve will go back down? – No, I don’t. That’s the hard part.
We’ve never seen this before so we don’t know. Now what I can tell you is, based on the experience we have, which is in China and Italy and Iran and other places, that by doing social distancing in China, it decreased the rates by 90 percent, okay? So we do know the social distancing works, okay, but we have to do it, and we have to be prepared to see that sustained time. I think part of the problem is we have never had to do anything like this. At least in my lifetime, I never remember having to stay in place, stay at home, because there is worry about infections minus, as we were talking about, when I had a newborn infant and then I just didn’t wanna take the newborn infant out because of this reason.
But in the same way, we’re gonna have that same time period that we’re looking at. This is not just gonna go away in a matter of a week or two and I know that’s frustrating to people. But by doing that, I think we’re really protecting the public and others in general, so, and it’s also protecting our healthcare system from being overwhelmed. And that’s, I think, the biggest thing.
Because 80 percent of the people that get this virus, they do fine. They’re able to be at home. They don’t need any treatment; they’re fine. But then there’s 20 percent that don’t do fine, that need to be hospitalized.
And there’s an even smaller percentage of those that need intensive care. I mean, quite a bit of intensive care. And that’s what we’re worried about is making sure that we have those resources available. So our healthcare practitioners are not having to make difficult decisions when it comes down to who gets what respirator and why.
– Well, let’s switch gears a little bit to talk about VCU because I’ve seen that, a lot of really exciting articles coming out about VCU’s involvement in what’s going on. And so, one of them I saw that VCU held was one of the healthcare system’s chosen for clinical trials on investigational drug therapy for the virus. So what does that mean for VCU Health, what does that mean for cases that are local, what does that mean for students, because it is a teaching hospital, are they involved at all? – So, our students being involved, not that I’m aware of unless they’re getting admitted with the COVID-19 and I hope that that’s not the case. At this point we did just a couple of days ago one of the researchers actually got approval for looking at one of the newer drugs, Remdesivir, and they are already enrolling patients.
Now here’s the key thing with the Remdesivir. There’s two different trials that they’re looking at with this; one is for those that are critically ill, that are on respirators, who are being ventilated, that kind of thing. So there’s one arm with that and then there’s another one, those with moderate disease but are still hospitalized. So again, we’re still mainly looking at those sicker of the sickest, so that 20 percent.
We’re not looking at treating the 80 percent. So that’s really where a lot of the emphasis is being pushed is the sickest of the individuals, so– – And students are not helping to test those? – Not to my knowledge is that they’re not being involved in those studies at this point, so, now as far as, are there other trials that are out there looking at other agents, yes, there is, and I do know, I talked with someone today who is on IRB about we’re looking at enrolling other patients in other trials and we’re trying to get other trials up and running. There’s another one with a drug called Atezolizumab, which is a biologic agent that’s an IL-six antagonist. So one of the things with this disease, especially in severe disease, the patients, once they develop the pneumonia, they get this surge of kind of like their body, their immune system is trying to attack it, which it should.
But at the same time, that it’s causing a lot of damage, especially to the lungs. And it’s called a cytokine storm, so you may have heard things about that and that’s kind of what is associated with it. But, what this drug does, it kind of helps with that cytokine storm because one of the cytokines is the IL-six and so they’re actually looking at enrolling patients and using, and I do think, I already know that they have used this already in some patients. So that’s another drug that they’re looking at.
The other one, and I know this has been in the news this week is using patient’s blood that have already had the COVID-19 to be able to treat other individuals, essentially taking the antibodies that have been formed from people who have been exposed to the disease and giving that to sick patients. Now that has been shown to be beneficial in other viral illnesses. Ebola is a great example of this, where they did this. But the problem with this is, and they have a process at VCU for being able to do this, we’re not far enough into this to be able to really get that blood from infected individuals that are far enough out, where they’ve developed enough antibodies that would be useful for individuals.
But once we get there, I do think that we may see some of those trials being going on as well. – Yeah, that’s really exciting. The other thing that I read about was the new in-house test that we see you developed. Are there, to be testing for COVID-19, are other hospitals creating their own tests? I’m not on other health university Facebook pages, but, so how does the test work, how will it impact Richmond, will the test be shared locally, regional, national? Yeah, what’s what’s – So some of those, I don’t know of. – the life of that? – I can tell you that it is a PCR test.
It is a test that essentially, we’ve gone from being sending out our test samples and having to wait days to a week to finding out if someone’s positive to, if sending it in-house, we can find out in hours. So it is actually – Incredible. – Streamlining the process quite a bit. It’s streamlining those individuals who need to get hospitalized versus not getting hospitalized so I think that they’ve seen some major wins with being able to do it in a much faster pace.
At this point, they’re only really using this test locally for those who are being treated as an in-patient or at VCU. So we have not necessarily released this test to other individuals. Now are other institutions doing the same thing? Absolutely, UVA has developed their own test, and I think there was something that came out just the other day about them actually making it available for other institutions to be able to use their own in-house tests, and I’m not sure about the specifics; I’m assuming they developed their own PCR to be able to do, and I don’t know the turnaround time for them with that. And then, other states, if we look at what other states have done, University of Washington did that, as well, and a number of other states have developed their own test which is actually getting faster results than having to wait from a centralized lab where you’re waiting days to find out.
So, and that is part of the thing, when we’re looking at these numbers; so we’re looking at these numbers, but I wanna be honest in that we’re not really looking at the true numbers. Because there’s still a large number of, group of people that are not being tested that probably have it. So if we’re living under the false hope of this is the only group of people that have it, I don’t think that that is actually true, these are all the people that have been tested. So, and right now, the testing is being especially dedicated to anyone with severe symptoms, anybody with known contact with individuals that have been proven to have COVID-19, and then obviously any kind of healthcare professionals that have been exposed.
And kind of putting the priority there. – Yeah, well, I’d be remiss if I didn’t say we’re so proud of the faculty and the researchers and VCU Health for all the work that they’ve been doing and all of the healthcare workers in VCU treating all of the patients. It’s just been remarkable and we’re with you in spirit. So thank you, if you are watching this and you’ve been one of those people.
– Absolutely, I mean, Dr. Dorn and the micro-lab, they’re amazing, and they do amazing things baseline and a lotta people don’t know a lotta what they do behind the scenes, and, I mean, and a lotta my colleagues in internal medicine, the nurses I work with, the physicians I work with, the other pharmacists I work with, RTs, OTs, PTs, all of you, I mean, environmental services, we need each and every one of you and we’re just so grateful, I think, for all of you out there. – Incredibly grateful. And so back to what you were mentioning that we don’t really know the real numbers, Steffy Kaye had a great question, and she said, “Regarding being a carrier, “is that the same thing as being contagious?” Where, does it have a period that ends, I think it’s two weeks; I know some carriers for some diseases, are carriers for long periods, even for life. – Okay, so the answer is we don’t know all of the answers on this. Now are there some people that are considered asymptomatic carriers which means they’ve been exposed to the virus, the virus is replicating in their body, but they just haven’t shown signs and symptoms? Yes, we do know that that is occurring for people. The data that we do have is data out of China that has looked at this, and they looked at up to 10 percent of transmission from person to person could be from asymptomatic carriers.
So we do know that those individuals exist, but we don’t know to what extent. Because, again, we’re not testing those individuals. And especially if they’re not having any symptoms, they’re not even going to a healthcare provider to even be able to get the testing and I think, at this point, quite honestly, they probably wouldn’t be prioritized in order to get testing. So the answer is we don’t know, so you have to treat yourself as if you are, if you, especially if you’ve been exposed or if you start developing symptoms unless you know otherwise.
So that’s where it goes back to limiting the interactions that you’re having with other people, washing your hands, and just being mindful about where you’re going. I think that’s the biggest thing, because it could be that you have been exposed and you are still shedding virus, and could be exposing others and not realizing it. To what extent, we don’t know what all is happening here in the United States yet because we haven’t had enough time to be able to really look at that, but I do feel like that is part of what’s going on, so, ’cause there’s probably is asymptomatic coverage and the other thing is, if you look at median time from the time you’ve gotten exposed to when you start exhibiting symptoms. It’s five to seven days.
That’s a good bit of time that you can be walkin’ around and that virus is in there, attacking your cells, havin’ a little party, replicating, and you’re sneezing it out or coughing it out not thinking anything about it, not meaning any harm, but I think that that is the other part of it is that you could go quite a long time before you’re having symptoms to really know. So that’s where that few weeks comes from is that is the prime time during the viral shedding processing, kind of getting rid of it. – Yeah, so, along those line where you’re kind of asymptomatic or you might just randomly cough, Kevin Taylor asks, “Is taking my temperature “a good way to self test?” – You can take your temperature. But again, that’s not gonna absolutely say you have it or you don’t; now, are most individuals having a fever, especially when they’re symptomatic, especially when they have the highest of that viral shedding that’s happening, which is usually happening about day five to seven then, yes, you can see that, and that’s actually one of the things that they recommended even in China for individuals to do as they were isolating themselves, is to be taking their temperature on a daily or twice daily basis.
I don’t think that’s gonna hurt but I also just wanna put out there that one thing we don’t want to put ourselves in the pigeonhole of, is every infectious thing that happens during this time is only COVID-19, right? We still have a lot of things that are still out there. Flu, flu is still out and abound, okay? People are still being diagnosed with flu, and it still could be flu. So that’s one thing to consider. Strep throat, especially with your kids and that kind of thing.
Ear infections, we can’t ignore common things being common that are causing some of these, but I do think with, just knowing what we know, you have to treat it as is until proven otherwise. But we just can’t say though that everything that’s happening, that has a febrile illness, is definitely gonna be COVID-19 ’cause I think we could be, if we go down that road, we could be missing some important things, though, that could be treated. – A little bit along those lines, but how do I identify a mild case. What does a mild case look like? I feel like we’re seeing the extremes and if I have a mild case, how do I, do I go to the grocery store? What are your, what have you heard for recommendations for living with a mild case? – So if you have a mild case, the recommendation is to quarantine yourself.
So that means that you need to be around the least number of people possible for at least 14 days. And that’s where, that number comes in is to kind of allow the virus to do its thing and kind of get out of your system. During that time, it is not recommended that you’re going out in public, that you’re doing those things, so that is a time when you’re gonna have to rely on friends, family, to kind of help you out. Being willing to ask for that help.
And then also, too, there’s a lot of services now that we have now that we didn’t have before. Uber, a lot of other things as far as shipped and a lot of other apps, I don’t wanna, Instacart, things that can deliver your groceries to your house, where you don’t have to be exposing others. So there is a better way than saying, “If I can’t get to the store, I have no other way.” Now I do know that those options are not available to our friends in rural areas, so I think about like back where I grew up. Nobody is doing Instacart out to my parents’ house.
So I mean, you lose cell phone service out there so, much less, like getting Instacart out there. So that goes back to really make sure if you are unhealthy and you have the ability, check on your neighbors, check on those other individuals that might not be able to get out and about. And be willing to lend that helping hand or share what you have so that way they don’t have to go without or put themselves or others in harm’s way because they feel like they have no other choice. – Yeah, and so what does a mild case look like? – So, a mild case was gonna look like essentially the flu, okay? So, we’re talking about runny nose, coughing, shortness of breath, and the one symptom with this particular virus that seems to be getting a lot of people is the shortness of breath.
It seems to persist for a little bit of time, which is longer than probably what you would even see with the flu or that kind of thing. Fever, definitely you can see that. Not as much with the myalgias and kind of muscle aches and pains that you see with the flu. It’s not to as long extent and a lot of just feeling really tired and run down so if you’re starting to feel that way, then I think that’s a time when you need to take care of yourself, rest, rest, rest.
I know nobody likes to hear that and even for myself, it’s very hard to do. But really just taking care of yourself and isolating yourself during that time so you lower the risk of being able to share that with others. And again, 80 percent of people are in that boat, okay? Where they’re getting these symptoms, they’re getting over it, but the problem is they’re potentially passing it off, again, to those three extra people maybe in the 20 percent boat and that’s the problem. – Okay.
We have a question from Facebook of Shuvani Romden. Shuvani says, “Hello. “I have an uncle blood pressure “beta blocker and statin medication,” I don’t know if I’m saying that right. “We’ve both seen articles talking about “certain medications increasing the chance of “having bad outcomes if they become infected “with coronavirus. “Is there any truth to this? “Are there certain drugs we should stay away from? “Thanks.” – Okay, so that’s a great question; there’s been a lot in the media circulating around, and part of it all has to do with this enzyme called angiotensin.
Okay, so we have a group of drugs that actually block different types of angiotensins so we have the ace inhibitors, and then we also have then angiotensin receptor blockers as well, and they’re commonly used for things like hypertension, for cardiovascular disease, or patients with chronic renal disease, and heart failure; all of them are recommended to be on these ACE NRs. Now why is this important in a virus and where does that even make any sense? The reason why is the way this virus kind of gets into the host cell is through an angiotensin receptor, okay; and so angiotensin two is the receptor, is the co-receptor, that it uses to be able to get into the host cell. And the thought, there is some postulation, that if you are on one of these drugs that block it, there’s two sides to this. Is that, by blocking angiotensin one, you can actually up-regulate angiotensin two, which is actually creating more angiotensin two, which is more little receptors for that virus to hang onto and get inside, okay.
That is not proven to be true yet. But that is one postulation. The other thought is if they’re on these blocking medications, then they actually may have a protective effect. So do we know which way we’re at at this point, no.
We do not; at this moment, the American College of Cardiology and the American Heart Association have all said, “Continue your blood pressure medications “and the rest of your medications “as prescribed for now.” There is no recommendation to go off of these medications so for now it’s safer to stay on them than to go off of them. We do not have any concrete data saying that these patients fairs better or worse with COVID-19. What we do know is those very patients are the ones that are at the highest risk for developing the complications. Patients with heart disease, diabetics, patients with chronic kidney disease, these are the patients that we’re seeing that have the highest mortality.
And partially because a lot of those patients also can have immune dysfunction as part of it, too. So, taking control of their other disease states right now and continuing on those medications are gonna be really important. And I think even more important now, because a lot of primary care providers have had to go to telemedicine and it’s sometimes not quite as easy to get in to see your physician and some things may have gotten changed with those, so really gonna be important for patients to take care of themselves and really stay on top of their health during this time period. – Okay, thank you, that’s super helpful I’m sure, for a lot of people that are watching.
– (mumbles) Continue those meds. Don’t stop, don’t stop. – Here’s a little bit of a different question. And this is something that I think my husband is still holding over my head because I said no.
The question is from Kevin Taylor, “Can we play golf? “More specifically, can we ride in a cart “with someone that has been as careful as we have been? “Obviously you’re less than six feet away.” What are your thoughts on golf? Do you have any thoughts on golf? (laughs) – Okay, I don’t have a personal thought, but interesting thing to note, I live on a golf course. There’s a tee box right outside of my house. So I see a lot of golfers out and they’re out there today. I think this person answered their own question, okay? I’m not gonna take a stance on this, but I do think that you need to be making sure that you’re six feet away from that person.
Are you living with that person? Now if this is a person that’s in your household, then there’s no difference from you being out in that golf cart, than you being inside the house. But let’s say that person doesn’t live with you and I’m gonna bet my money that that’s probably the case. (Amy laughs) Then I’ve got a feeling that it’s gonna be hard to both have individuals in the cart and maintain six feet of distance away, not touch those same plastic and metal surfaces at the same time. I was talking about this with my husband about like, I said, “I think this could be a big boom for golf,” actually, ’cause outside, fresh air.
I was like, “But I think maybe we gotta change “with the way we’re doin’ things.” Like making sure that golf carts are being decontaminated. Do you know how they’re wiping them down? And again, because things are living on plastic surfaces for up to three days, so that could be a concern. But maybe it’s one of those times where we send out more golf carts. One golfer per cart.
That seems a lot safer to me and I still think that you probably could maintain that social distance when you’re actually playing. So I think it depends on how you’re playing, but I think having people side by side in any confined space, that’s really going to be hard to do with six feet, so I don’t know, maybe somebody has got a very creative solution to that, and I’m sorry if I’ve upset anybody. I think it’s just gonna be hard to do and still be in the cart. – Yeah, okay.
So, Mary Elizabeth is asking, “What are your thoughts “about the people in Wuhan, who are testing “positive again after recovery?” – So that is a good question. The answer is we don’t have a lot of information on those individuals yet, and are they actually testing positive and they have symptoms? Or are they just testing positive? What we do know is that viral shedding period, so the time in which your body is still getting rid of the virus, it can vary per person. And we do know, even for other viruses, even the flu, for example, that viral shedding period can be different for someone that has a normal immune system and someone who doesn’t have a normal immune system. Actually, if your immune system is not working as well, that viral shedding period can last even longer.
And so, is it possible that you could still be shedding virus and maybe if there, really what we’re doing is we’re finding out those people that are still asymptomatic carriers versus they actually have true disease. The answer is we don’t know at this point. So, and that goes back to, I think one of the questions that someone had posed earlier that we hadn’t talked about yet, but there are two different strains of this virus, okay? It’s all the same virus, but there’s two different ones. There’s the L-type and the S-type.
Right now, we’re not testing for a specific type, I’ll go ahead and tell you. The thought is that the L-type is the one that is the most virulent, and probably what we’re actually seeing but just genetically, they’re slightly different. And so, could it be that they’re getting the S-type instead of the L-type? Very similar, like if you think about with the flu, right? Flu A, flu B, right? Just because you had flu A does not protect you against flu B, so in the same way, when you get the vaccine, they vaccinate you against the most common types that they predict are gonna be out that season, but it could be that there’s a rogue one and a lotta times there is. And I think that could be the same thing with this coronavirus as well, so I think to be seen of what we can do with that information; I think we’re gonna get more of that as the kind of months go on.
– Yeah, there’s another question that I’ve thought about myself ’cause I’ve been in the grocery store and I’ve seen someone cough and then I’m like (gasps), “What do I do?” So the question is, from Tara Powell, “If the virus can be aerosolized, “how can people protect themselves in environments “with recirculated central air systems?” What do we do? – Well that is a good question. I mean, I think that goes back to a couple of things. Limiting your exposure to being able to be in those environments, I think is gonna be key. So, if you’re in a more public place, whether it be having to go to the pharmacy, having to go to the grocery store, those areas, you need to be as quick as possible.
But now is not the time to dilly-dally. I mean, I know for myself, going to the grocery store alone without children is like a luxury beyond all things and just being able to just revel and look and not have things being thrown in your cart or people flying out of your cart or some form of the above. But I think that you need to get in, get out. Less exposure, I think, is the biggest thing.
It’s just not being in those environments where you’re going to, it’s gonna be hard to be able to maintain that. Even I know a lotta grocery stores in other places say, “Please make sure that you’re at least “six feet away from the next person.” So is everybody good at estimating what that looks like? Maybe, maybe not. But I think that, it’s gonna be hard to know, and I do know that in the interim, every time someone coughs, someone’s gonna automatically think, “Oh, COVID-19.” But we gotta problem; we’re in the middle of allergy season, and that is out and about in Virginia for sure. So a lotta times, people are probably coughing or maybe they have something else going, maybe they just swallowed something the wrong way, for heaven’s sakes.
So we can’t automatically assume or I think, judge people with if you see someone that’s coughing, don’t automatically assume that, but I think at the same time, I would not be like, “Oh, let me walk right over there “where they’re coughing, and get a closer look “and see what’s going on.” (Amy laughs) I think common sense needs to prevail on some of these things. – Right, but if I go out for a, I don’t have to worry about going outside for a run and inhaling. – Yeah, I think that, and I’m still running everyday and my thing is just making sure that you’re still, again, not being right up on top of another individual. I’d pass people on the sidewalk. But, again, that passage is very quick. The likelihood that we’re going in the same space, actually there’s a girl who I run with, and we’re still meeting, but we’re also running further apart, so for this very reason to making sure that we’re still maintaining– – That’s a good idea.
– But we’re still able to talk. We’re still able to run and it keeps us accountable and I think that, again, exercise is important. But I do say that if you are an individual that is a high-risk individual, so if you are over the age of 70, if you are diabetic, or if you have hypertension, cardiovascular disease, chronic kidney disease or some kind of other immune compromising disease, which is a lot of individuals, then really limiting your exposure to those crowded areas is gonna be important. Especially depending on where you live.
I live in a more rural area but if you’re living in the city, that might be difficult to do, so maybe it’s choosing those times when it’s not as many people out and about. Maybe that’s before the sun comes up, I realize. But that might be the safest time for you to be able to do that versus when it’s a little bit busier. – Right, okay, that’s helpful.
Phillip Jan has a question about a specific drug, and I’m probably gonna butcher the name, but he says, “I’ve seen a lot of public interest “in drugs such as hydroxychloroquine, “chloroquine, that to me, “appear to be based on the flimsiest “of evidence and pose potential risks “due to their side effects profile. “Is there something I’m missing that is driving “this excitement?” – Okay, so I think I know this person. I think Phil is a former student of mine. So Phil Jan, so hi, Phil. So what do I think about the hydroxychloroquine? I think that we have, what data we have, which is basically what has come out of China and some of the other areas and that’s the best we have at this point.
Hydroxychloroquine is the drug that we use for rheumatological disorders, but also for treatment of things like malaria and that kind of thing as well as chloroquine. So, it works in kind of a unique way for viruses. Kind of in the enveloping and of the uncoating part of the virus once it gets into a host cell. What we do know based on, and I will agree, it’s a lower number of patients.
But we have to go with what we have right now. We do know that taking this particular drug, it can lead to decreased viral shedding. So that means that you may actually shed the virus for less period of time than other individuals. On the limited data that we have, and when I’m talking limited data, I’m talking about we’ve got 200 or less patients that we’re looking at here, there does seem like there could be improvement and surrogate markers, so quicker turnarounds, those kind of things, but we just don’t have the numbers of individuals that we’ve treated yet to be able to say this is improving mortality.
And these drugs aren’t benign. I mean, that is the honest to goodness truth. They do have side effects and risk factors, so it can do things like ’cause prolonged QTC and so if you already have somebody that has a prolonged QTC, this isn’t a great drug for you. It also can be myelo-suppressive and so a lot of these patients are coming in with low white counts and this particular drug could lower that even more which could them at higher risk for developing other infections and so there’s a concern with that particular piece of the medication as well as liver toxicity.
So, but I think, of all the options that we have right now, I can tell you just sharing what’s being done at VCU, I do know that it is being used in patients. I do know that for now, we have access to it, but I think that not every place has that luxury. So, I think that it needs to be used in the right patients, and I do think that we have developed treatment algorithms to making sure that those patients get it. Again, the biggest thing is to do no harm.
It may be beneficial but we also don’t wanna do harm as well, so I think we’re gonna see more of this come out as the days go on, but I think it could be promising but do I think that it’s gonna be the cure for everyone? No; there are actually trials going on right now in evaluating this for a prophylaxis, and then also for post-exposure prophylaxis but it’s mainly being used in healthcare professionals. Actually, there’s a couple of research trials, not going on at VCU, but at other places and looking at this. So I think we’re gonna learn more.
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Source: VCU Alumni
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