Mayo Clinic Q&A: Inflection Point
If you're looking for special. Cme credits to fulfill controlled substance prescribing requirements we will be re releasing popular mayoclinic talks opioid edition on Thursdays these meet Arezzo Wisconsin and updated Minnesota state guidelines to claim. Cme credit for listening to these episodes visit C. E. Dot Mayo Dot edu slash opioid pc. Coming up on Mayo Clinic. Qna The last day in the United States the number of cases increased by forty percent or a new corona virus questions answered by an infectious disease specialist that we are indeed seeing more and more cases and evidence of widespread community transmission in various parts of the nation. How can you safely isolate when you're entitled quarters? They get their own bedroom. They don't come out of that room without a mask. They're not having dinner face to face with the others in the family. What's the best plan for recovering? If you're diagnosed with the virus get enough. Sleep adequate nutrition copper exercise in this case outdoors. It's really a question about what? What about the people who have symptoms? Most of them can be managed at home. And what's the latest on medicines for people who contracted cove in nineteen? This is really been you know the race if you will because it's GonNa take a long time to develop. There are a number of them in clinical trials but nothing has been published that would tell us definitively yet answers to these and other covert one thousand nine questions next on Mayoclinic. Qna hello everyone. I'm Dr Tom Shy. And I'm Tracy McRae for another corona virus. Update were joined on the phone by Mayo Clinic. Infectious Disease and vaccine. Dr Greg Poland Dr Polin good to talk to you good to be back in talking with you Netra Poland. You suggested in a recent editorial I think a week or so ago that the United States really needed to go into what you call suspend mode that. We needed drastic and clear action. Are we there yet? I think we are very much at that. Inflection point. We are right now at a point. Where if we do this we could do. What happened in Korea? Where we flatten the curve out. If we don't do it it's likely will be more like Italy and see an explosion of cases. We're recording this on Thursday march nineteenth. What has changed since the last time we spoke about a week ago. I think what's happening is that we are indeed seeing more and more cases and evidence of wider spread community transmission in various parts of the nation. Now so far I think the CDC said today we've got about ten thousand confirmed cases in the United States. Over one hundred fifty deaths Does that seem like too many or about what you would have expected for now. I think about what we would expect but one thing that's really critical and I think hard for people to understand what we are seeing. Today is a reflection of reality two weeks ago. So what we expect today will not be what we will see two weeks from now so in the last day in the United States the number of cases increased by forty percent four. Oh that's why I call this an inflection point so you would expect that number to keep going up and then hopefully. The curve would flatten and tell us exactly what that means. So if we were to institute to true social distancing and go into a suspend mode meaning nothing. Non-essential happens unless it can be done for example by teleworking so where. We don't have people together if we were to do that. We will see cases increase quite a bit for about ten to fourteen days after we institute that Suspend Mode if we don't do that we'll see cases continue to increase and intend to fourteen days. We will see that curve. Go UP THE WAY. A rocket goes up straight. Can you please tell us what does it mean to safely self isolate? And what does it incorrect safe? Isolation look like well what self-isolation really gets at is this and it sounds kind of self obvious but if you don't breathe in the virus or touch a contaminated surface and touch your eyes nose or mouth. It is impossible to get infected with this. So the idea behind social distancing but behind self-isolation is that you take away the opportunity to inadvertently breathe in this virus or to touch a contaminated surface that somebody else has touched or coughed or sneezed on so that you don't become infected in essence. What's that what that is doing is what we call. Suppressing the are not that's the reproductive number of the virus right now just to use a round number. It's about two or less if we can suppress to under one meaning that for every one infected person they spread it to one or less people then we will see this pandemic abate now. Do we know how long this virus can stay active in the air and also on a surface we do. There are some nice that have been done Showing that it can last anywhere from two hours to nine days heavily dependent on the unoccupied. Ulum size that is how much virus on the ambient temperature on the ambient humidity and the amount of exposure to UV light. That's why it's really important that we are trying to get across to people. The idea of washing your hands before you touch your face or eat and disinfecting sanitizing publicly touched surfaces whether that means as Tracy was asking in your home in your workplace or wherever you're studying may be if someone in my house has the virus. What should because isn't it about fifty percent of us are going to catch this virus. Is that what the last odds were as I am? I making that upper that right. So you're referring Tracy to mathematical modeling studies so so with that proviso okay. The estimates have been as low as forty percent as high as seventy percent a B bull in the UK and in the US. So what does that mean in a household same thing? It means right now. You want to have social distancing `isolation of those that are sick from those that are not. What would that look like? Let's say you had an adult in the home? That was sick. They get their own bedroom. Ideally with an open window. They don't come out of that room without a mask they. They're not having dinner face to face with the others in the family. The surfaces that they touch outside of the room and inside of the room are wiped down regularly with a for example Bleach or Lysol type solution. That's what that's what that looks like at the home level. If someone has the virus is a good idea to wear a mask what if you don't have it even if you're in the same household it does it help to wear a mask? The way that a mask helps. You is really kind of two. Fold One. It prevents you from inhaling large respiratory droplets and it is a memory aid to keep your hands off your eyes nose and mouth what it does not prevent is the aerosolize virus which is an important way in which this virus is transmitted but it tends to be more with cough or as physicians when we do procedures that cause the virus to be. Aerosolize ask you have to wear a different kind of mass like an end ninety five but if you do get the virus you should wear a mask. Yes all right now. Are they any medications? That are available that will that will help alleviate the symptoms or speed the recovery. If you do get the virus. Tom This has really been you know the race if you will because it's going to take a long time to develop a vaccine and so what's the next step it's polyclinic or monoclonal antibody therapy or it's vising or more importantly repurposing existing antiviral medications to try to help and there have been a lot of them? Propose there are a number of them in clinical trials right now but nothing has been published in terms of a randomized clinical trial that would tell us definitively yet. But I'm thinking for symptom treatment and particularly non steroidal anti inflammatory drugs. We have heard that you shouldn't be taking Ibuprofen if you have a virus. So that was the recommendation made by the French government. And the W. H. O. I don't happen to share that recommendation because I don't see an evidence base to support that none. The less the preferred medication would be something like acetaminophen. Non steroidal particularly in the older adult population. Who are more likely to have symptoms? Have other adverse effects for example water and sodium retention or bleeding risk? The president said he would like to fast track. The antiviral treatments is that possible. Yes the president has what's called Emergency use authorization privileges so he could determine whether it's an antiviral or a a therapeutic or a vaccine that we and his advisors say the the risk of the disease is greater than the risk of an fully not fully tested therapy and they could they could release it for that purpose so we know that older. Americans those with chronic diseases are more at risk of getting the corona virus and then recently we saw a headline that said the World Health Organization warns that some children developed severe or critical disease from Corona virus. Virus is there any age goop? That's safe on. I would say there's there's no age group that's perfectly safe and it's not an issue of more likely to catch the virus. It's an issue of more likely to have symptoms or severe disease. So we know that the older you are the more co morbidity you have a win in the course of the epidemic pandemic you get. The infection makes the difference in in case fatality rate. So it's y you know. These numbers are based on populations. But when it comes down to the individual you have to look at that in a very individualized way do you. Think the millennials as they've been accused of are the ones who are actually spreading this disease and they're not really taking the proper precautions as older. Americans are doing. I don't think that they're responsible for spreading anymore disease than anybody else but I do share the concern that they have gotten the message that well. This isn't going to affect me so we'll go out for example and I'm writing my bike. I see the bars and the restaurants still crowded. I see people crowded on on the beaches down here and I'm quite surprised by this and I think it's because you know at that age and didn't we all we kind of thought we were invincible. And they may not recognize the risk to not only themselves but others particularly people at higher risk last week. We were all being advised on how to talk to our children about Corona virus and about cove in nineteen. Would you please tell me how to speak to my aging parent about Cova Nineteen? Yeah I think it's the same way we wanNA talk to everybody. It's it's facts not fears. It's showing them. What wisdom is which is being informed being appropriately prepared but one still has to go on living life at least in some context. What's the best plan for recovering if you are diagnosed with Colvin Nineteen? Well I think what we need to remember. Is that eighty percent of the population. Who gets this is going to have mild or no symptoms so other than isolation until they are. Well there's really nothing else they need to do a then what all of us need to do. All the time get enough. Sleep adequate nutrition Proper exercise in this case outdoors or in your garage It's really a question about what? What about the people who have symptoms? Most of them can be managed at home because the only treatment is symptomatic. The ones that are of concern are people who have more severe disease who need medical support or maybe even ventilate Ori. Or blood pressure support. They have to be hospitalized. So let's talk about testing. I think there are a number of test available around the country. What are the criteria that you need to meet to to get test yeah? Those criteria have are very fluid and in some cases have been suspended Now what does that mean for the medical system? Obviously you can't handle five thousand tests a day at this point Capacity is of Necessity Limited. So what we're trying to do is physicians is to say well. We're going to test. The people who have had exposure to somebody that has a confirmed case that his traveled to a high risk area. Those would be or or symptoms that are deteriorating. And where we think well. Maybe this isn't influenza. This could be something else. Those are the appropriate people to be treating right now in till such point where we have point of care essays or we grow the capacity enormously in order to really detect. What is that base of the pyramid? Look like how many people are out there who have had infection and have recovered or having are infected. But don't know it that's a tough one to get your head around I'm a wannabe infectious disease. Walk Dr Paul. And so here's a question I have for you. What percentage of the population needs to have had the virus built up? You know had the virus recovered from it and built up natural immunity before you'll start to see a decline in this virus. That's a great question Tracy and I. I really wish I could give you a quantitative answer. What you're getting at is a concept called herd immunity and we don't know what that number is what we can say is look at the amount of infection that occurred in China and today was the first day so far that they have not reported any cases so the qualitative answer is it has to be very widespread or a very long time before we get to that point. My other question has to do with SARS. How is this different than the SARS epidemic? Well it's similar in many ways and different in some ways one of the ways in which an SARS was different is that there were super spreaders. We have not yet identified super spreaders with SARS Kobe to another important way. Is that for the most part people with SARS did not transmit it to other people until they had symptoms berry different from this disease where it's becoming apparent. The transmission can occur when people are ase symptomatic pre-symptoms so a big difference. The other thing is that we're we're certainly seeing a lot of severe disease across the nation. This particular virus has a piece on. It called the asks protein. The spike protein that is very efficiently adapted to bind with the cellular receptor and cause infection. Probably more so than SARS was which is going to be an issue. What's viral shedding? What does that phrase mean when I hear that in the news? What that means is that somebody is actually if you will shutting the virus meaning that we can detect it in their mucus in their sputum when they cough in their nose in their mouth. That is a saying that the viruses present and able to be shed and transmitted to others. Well let's talk about a vaccine briefly. Do you think we'll have a medication to treat it? Before we have a vaccine to prevent it. I would think probably so Tom. I just think that the regulatory pathway for a vaccine we have to be very slow deliberate. Peer reviewed data evidence before we start injecting vaccine into people before. It's been fully safety tested. Well of course we have to ask you about toilet paper. It seems to have become the icon of mass panic. Is there any reason for people to be Hoarding Toilet Paper? This one. Mystifies me to tell you the truth. I do not understand that. It is not as if this disease regularly causes diarrhea. I mean there are about three to five percent of adults that have diarrhea or GI symptoms. But it is not what I would horrid and you send me a question asking what would I stock up on? Yeah well this is a little personal but cheap yellow mustard and dark chocolate because I love those too about domestic travel. Yeah do you think that's appropriate? Would you be afraid to travel domestically? It's not so much afraid as aware that I would be violating the very principle that I'm espousing. Which is when you get onto an airplane with whatever two hundred five hundred other people you are increasing the chance of transmitting the virus to other people who then disembark that plane and let's say there were five hundred of them. Go to five hundred other g graphic locations and you can see how a virus like this could exponentially spread my personal opinion. I know it's disruptive. Is that the way to beat. This is to suspend those activities on on a temporary basis It seems like you're fairly optimistic that we're actually doing that. I think we have started down that road I think. An here's how I talk to the government and to organizations about it imagine that we actually do head toward the the More ADVERSE CASE SCENARIOS. That are happening. What would we have wanted to do now to unwind that from happening and I know you can go overboard with that? And I know that Particularly economically this is disruptive but I think in view of what we're seeing what we need to do is suspend those activities now. The problem is it doesn't work unless everybody does it. All right. I guess they're clearing the beaches down in Florida. So yeah so you think. The warm weather will help That's really speculation. Based on what we saw with SARS that started in November of two thousand and two and by July of two thousand and three disappeared. Now there are other factors involved but that is one reason. People are speculating. Along with the fact that the normal for seasonal human corona viruses that circulate every year disappeared during the summer spring time frame only to reappear. In the fall we'll hope it warms up soon so much great information actor. Poland one last question. What is your best advice for people and their families at this point in the pandemic I really think and again I understand. This is disruptive. I really think that let's let's work with each other to to learn good hand washing technique. Let's cover our cough that respiratory at etiquette and let's learn how to clean our hands or sanitize our hands after touching any look surface and before touching. I are Is knows her mouth. And then suspending those activities that are non essential going to a movie house or a restaurant is non essential at a time like this so the fate of the virus is in our hands is why I feel optimistic Tom. I don't feel like a victim here. I think we know what to do. Even with the limited amount of knowledge that we've gathered in inside of three months. We know those things work if we will do them as a nation Dr Greg Poland Infectious Disease and vaccine expert from the Mayo Clinic. Thanks so much for being with us. Pleasure mayoclinic. Qna is a production of Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic. 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