Influenza, United States, Cova discussed on Mayo Clinic Q&A
Welcome to the Mayo Clinic. Dr Holy Magazine Guy. We're recording this episode on April the Twenty Second Twenty twenty and half with me again today Dr Greg Poland. Who's an infectious disease by polity expert from the Mayo Clinic? Thanks for being here Dr Poland. Whose ENJOY IT? I wonder if you'd start out today by just sharing as the latest numbers that you're hearing what's going on with the pander well worldwide word about point six million cases on Monday when we spoke just a couple of days ago it was about two point four so this is still a rapidly moving a pandemic in the US were it at just about eight hundred twenty thousand cases we were at seven hundred sixty five thousand on Monday. We have about a little over forty five thousand deaths on Monday. Were we were at about forty thousand deaths so while those numbers are still high one is beginning to sense that they're plateauing and as we talked about this lag period between when you get exposed than when you get sick enough to be counted can be fourteen to twenty eight days or so so we're just starting to see that plateau in the hard part will be the patience to continue this for perhaps another month or so. You talked a little bit about the numbers and it's the still were still seen infections. Does living in households convey any risk for transmission. What do we know about that since? We've all been social distancing concentrating infocomm that somebody there was a study just released from from China. That was a household transmission. Study they And I'll just look at the numbers here they had One hundred five people that were infected three hundred ninety two household members. All who were tested with. Are you look at the secondary attack? It's it was seventeen percent adult so in other words. If I'm sick what's the risks that my wife or another adult in the household would get infected? It was about seventeen percent about four percent for kids. If that index case quarantine themselves with all the measures we talked about household. Transmission was zero so it really works the court. The other side of that coin was well. What about the spouse where there'd be you the most intimate contact that attack rate was about twenty eight percent it? These measures are important. I know sometimes I get questions from people saying well. If somebody in my household has it is. Isn't it inevitable? As a matter of fact you can drive that two zero and that's a remarkable things speaking to the power of hand washing respiratory etiquette an appropriate isolation warranty. Well that is really amazing. Because if you think about all the surfaces that are shared in a household etc maybe it gives us hope for going back to work in doing other activities proper precautions. At some point there is such a dizzying array of Tessa for Cobra. Nineteen being discussed in the media and otherwise both tests for. I haven't now and serology tests for did I ever have it. There's talk about household kind of tests that can be done at home. Is this likely to become a reality and would help with the testing numbers that were seen? Were whether it's just not enough capability to test. Will you know you've you've put your finger on a an absolutely key issue in terms of how do we intelligently reopen and how would we intelligently reclosed this fall which many of us think is is like and a key to that is going to be testing? Otherwise we have no real idea of the amount of community transmission. That's occurring. The problem is in the rush to get these tests. Out The FDA has issued emergency use authorizations and what that means is that they haven't gone through the usual very careful clinical testing that we would normally put a test. That's going to be used in humans through so Some studies have suggested that the sensitivity and what that means is if I actually am in fact a new. Do this test army. What's the chance that it will be positive? Might only be about fifty percent five. Oh a flip of a coin and so I think before. We really have widespread testing. We're going to need assays that have been validated. And where we know Are they going to be appropriate and give us a good intelligence? The other tests that that was just released which is an interesting. One is the idea of allowing people to have it home. A Swab test so this is not have been infected. It's M. I. Infected now. I'm in what they're proposing lease. This company that's released it is to put. What looks like a q tip gist into the first half inch or inch of the of bananas and doing that on both sides. We have no idea how good dad ask say. Is We know that. In general you have to do a nasal torrential swab which goes up quite a bit into the nose in nasal passages It's uncomfortable. Somebody's unlikely to do that to themselves. On on their own and they're gonNA start with using it in healthcare workers first responders. So it's it's something that holds promise but I think we need to see the data a little while ago. We were hearing an awful lot about hydroxy Clark wine. And his sister Maya San in even president trump was talking about it on some of his Daily updates So much so that here mail. We had to put limits on how people prescribe those medications when a to preserve the supply. What do we know at this point about whether those are effective for treating who've nineteen but let me make a comment because I think it it pertains to so much surrounding this pandemic there is of course immense pressure and desire to get things out quickly whether it's a drug cast of vaccine and one understands that in has great empathy for People? Healthcare workers etc. Who who need to know. Want to know but there is no substitute for careful patients of scientific work. Let's just take this example of hydroxy chloroquine and reminds me a lot of pressure public and otherwise as you said to do something in us this. We now have to create good studies. That are showing one study done in in the Va that there was no benefit to this. Another study from France showing there was no benefit to either one or combination of those in fact evidence of harm in it as you and I know some of those drugs can do things to the heart rhythm like prolonged some of the electrical activity and actually cause harm. If they're not monitor Again I think this is really important because it says now when we actually done. The clinical trials is all this enthusiasm warranted and more and more data is accumulating to say no and in fact there might be Har- now other anti-viral drugs like rim. This aveer which we talked about it is a is a different story. We have some encouraging news. There look forward to hearing Morris Develops WE'VE HEARD ABOUT RISKS FOR PATIENTS? And what makes covert worse for? Some patients perhaps male different age groups that Cetera. Are there other risk factors that are becoming known that affect Either the development of Cova nineteen or how the the vitalize progresses illness for those patients that scenario where inside fourteen fifteen weeks. We've developed a lot of knowledge so I think everybody's familiar with the fact that older age heart disease lung disease diabetes things like that are risk. Factors We have not seen pregnancy. Be A risk factor for complicated disease. I have to say that's a surprise. Given how pregnancy is very much a risk factor for influenza. Smoking is turning out. Of course no surprise there to be a risk factor but a couple of things that are a little bit interesting here and that we don't have an answer for one is that males of any age seemed to have more severe disease than female so I mentioned of any age because it's not simply hormonally driven. There's something else happening there. In our our host genes. The other thing is that obesity. Now we did know that from from flu. So it's not that much of a surprise but obesity is turning out to be a risk factor that may increase your risk of severe disease by as much as two fold so we're beginning to get a more and more complete picture the other thing that has just recently has been reported is about five cases of Gaon Beret. This isn't a sending paralysis. This can happen with a variety of viral and parasitic infections. It can happen from influenza. And now we're starting to see some cases as a result of Kobe. Nineteen not very many but nonetheless case reports here and there there's a report that came out of South Korea about one hundred and forty patients. I believe who had been tested positive with Cova. Nineteen men seem to recover and now again tested positive. What did you make of that? You can imagine the the concern that this is raced in. It's a very complicated issue. I think probably one of two things is happening. One is maybe just very ability in testing. I do not believe that these people have recovered. And then that quickly been reinfected that would not be consistent with everything we know about the human immune system so it's either variability in testing or one part of that can be remembered that the RTP CRI say the diagnostic essay is just detecting pieces of the virus. It doesn't mean that there is virus in there that's so to speak live and capable of infecting somebody else it could be residual pieces of the virus that are there as part of your recovery on so what they're doing and it's an appropriate step though as you might imagine has some risk associated with a is there actually culturing that virus in human cells in a test tube to see are we actually seeing live virus or just these pieces. The same thing has happened in regard to checking stool specimens. Some people are shedding virus for as long as thirty days. Does that mean they're infectious? We don't know and in fact. Some countries some locales in the US. The country of France and others are actually going to waste water and sewage treatment plants and looking for evidence of the virus. And what I've noticed. Is that this is the other side of the disease is before people have actual symptoms. They can detect at the population level virus in the wastewater in the sewage. And they know that in five days they're gonNA start seeing cases so we're learning a tremendous amount here the the trick will be putting it into the proper context and understanding. You talked a little bit earlier about how it may be necessary to be reactive. So in other words that as we begin to open we may see changes in in the incidents Or even the second wave of infections that I've been hearing about what does that mean and when might have happened as somebody who studies these viruses in his EVAC sinologist. I have. I'll say grave concern when you think about this. Kobe outbreak in the US. It started in mid to late February so we were in fact past are influenza epidemic. It's unlikely that will happen. This fall rather we will have in a perfect overlapping fashion influenza epidemics and CO VID recurrence occurring. The problem is that the symptoms overlap nearly exactly particularly initially the second is the tremendous surge demand on the medical system and the third will be the anxiety around that and do we really close everything down again and do what we've just been through for the last Several months at this remains to be seen. I think what's going to be really key. We have difficulties with getting people to take flu vaccine. What's really going to be key to encourage everybody six months of age in older. Which is the recommendation to get a flu van scene and in this case to get it as early as it's available now wait until December January. Oh you have done..