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16 - Dr. Suzanne Donovan: The Novel Coronavirus

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From cargo media. Don't bring don't touch that doorknob and certainly don't touch that friend. If you're a Germophobic me this is your show. We've hijacked this week's edition of meet me in the middle to bring you parts of our corona virus edition of one of our other shows medicine. Where still practicing? I'm Bill Curtis. It's important politically and psychologically to separate fact from fiction and media hype from authoritative. Real advice will be guided through this discussion by our host of medicine. We're still practicing doctor Steven Tailback and the infectious disease specialist and infection control expert Dr Suzanne Donovan. The last time. Dr Donovan was in our Malibu Studios. She shared her experiences fighting allowed breaks in the West African nation of Sierra Leone as well as her multi decade efforts to control the AIDS crisis. If you WANNA be inspired by a true story of heroism you owe it to yourself to check out our fourth and fifth episodes of medicine. We're still practicing so sit back. Join me in learning a thing or two about real corona virus and its political and personal realities. Hey Mike where's my pierrot? Welcome to medicine. We're still practicing the corona virus edition. I'm Bill Curtis if you've joined us here before you've heard me introducing my co host as the triple board certified doctor of Internal Medicine Pulmonary Disease and critical care. My good friend Dr Steven Tailback but wait as of today. He's the quadruple board-certified earning certification for stroke and neuro critical care. That's amazing congratulations. Steve Certifiable thank you very much okay. We've all heard about this newfangled disease at Wuhan. China called the corona virus. It's the one that the World Health Organization called a grave threat to the world. Well Dr Tailback and I have invited back in amazing doctor to set a straight on the subject Dr Suzanne Donovan. She's one of the most inspirational professionals. That Stephen I have ever had the honor of having on our show. She's a renown infectious disease. Specialist and infection control expert with olive you. Ucla Medical Center in Sylmar California. So who better to help us understand the realities and the rumors around Corona virus? Dr Suzanne Donovan. Welcome back thank you for the invite to come back and talk about this new epidemic with with all of you Dr. Steve. Tell us what we're really dealing with here. Corona virus has been around for probably millions of years. I mean it's nothing new. I mean the small little are in a particle but it hasn't been as virulent as we're we're seeing. I don't think in in the history of certainly man but best to talk about. You know what this is I think is our esteemed guest. You know why now why this little virus that has sort of caused colds and flu like symptoms. Why now is it becoming so deadly? What's going on? I think we all need to remember that. This is the third epidemic. We've had related to a corona virus. We had SARS and two thousand and two two thousand and three the next decade we had Moore's Middle Eastern Respiratory Syndrome in around two thousand twelve and now we have this novel Corona Virus In Two thousand twenty two thousand nineteen rarely initially At least identified in China so this is nothing new and also. It's really important to remember that our ability to detect epidemics and detector. The the origin of the epidemic has changed dramatically in the last fifty years with molecular technology. So we've just gotten better at testing for it. I think we've gotten better at early. Diagnosis of outbreaks. It's a you know you would know if there was a pandemic correct and you know so that would not be any mystery but is this not more virulent than SARS. And Moore's well I think when we use the term variant. We have to be very clear what we're talking about variance refers to a disease and its ability to cause organ destruction or death to the host. The data that we have to date is that this is much less virulent than SARS immerse. The other thing I I think it's really important to say is. There's a lot of talking heads out there in corona virus. Some that are super smart. Much smarter than than I am Maybe some that are a little less informed and we know very little about this virus at this point we don't know the attack rate in other words if we one of US had the virus in this room right now how many individuals would be infected in the next two weeks. We don't really know that the other thing we don't know we don't know the case fatality rate in other words out of ten people that have corona virus. How many will go on to die? Or how many will end up have having significant morbidity or disease from this ending up in the ICU ending up on a ventilator. We have none of this data coming out of China. All we're seeing the tip of the iceberg. The tip of the iceberg are the dust and the people being hospitalized. We have no idea of the scope of the number of individuals that are infected. That are awesome. Dramatic or mildly symptomatic because that data is not there. I think are most important job if you look at murders and SARS or even a bola and the US is first to manage the anxiety and to manage the communication and the message about this virus. It's important that the the public know about this virus so that everyone can be alerted to the dangers. I just unfortunately on a soapbox about Iran sponsor reporting and and sensationalism. But I think it does a disservice to the population. The chair of Public Health at Hong Kong University said that he believes sixty percent of the world's population is at risk. Had he come to a statement like that he's doing what's called and I believe that article that he wrote is not not yet peer reviewed. He's doing what is called mathematical modeling of outbreaks. So there's something called are not Which is would be similar to the attack rate which is the number of individuals that are going to be infected during the time the individuals infectious so influenza would be around one and a half individuals may be to to put it in perspective. Measles would be around fifteen to seventeen well much more concerned about a measles case which we had recently in Los Angeles coming in on a case of corona virus. So if you look at the handful of cases that we've had in the US were not seeing exponential growth here in the US. What's the difference between having the flu and having Corona via? That's a great question. I would say for most individuals with Krona virus which we diagnosed all the time in the US. It's like having a cold. You're more likely probably feel a lot sicker with the flu than you would. For the run of the mill corona virus this particular corona virus. We don't quite understand the dynamics of what it does and individuals yet. What we do know is that there appears to be a lower rate of complication in the pediatric population. For reasons. We don't understand what we don't know is whether this corona virus is going to be like SARS during the SARS outbreak the virus responsible for SARS was able to change its genetic code become more virulent to actually become more dangerous to the human hosts that did not happen. Jer. The murs outbreak. And we don't know what's going to happen with this virus and so. I think we have more unanswered questions about both the clinical presentation of what happens when someone gets sick but also the dynamics of the infection why do younger individuals not get as sick as older individuals? Is there anything any symptom at all that you can tell? Us IS UNIQUE TO CORONA virus. That is different than the flu. I would say there is nothing that would distinguish a bad cold from someone with a hospital. Not Test for corona virus so the current CDC criteria because it's different in every country the current criteria is that you have a combination of clinical symptoms. And what we call epidemiologic risk factors so epidemiologic risk factors is. Where have you been and mortar? Have you been doing stuff? We ask our kids all the time. So where have you been? Have you been the China? And what part of China is number one and number two? What symptoms are you having and the symptoms are looking for is a fever and respiratory symptoms? Portent Tori meaning. I'm coughing cough and shorter breath or fever. If you have a strong epidemiologic risk factor. You're from Wuhan or you're in a household with someone from Wuhan who is symptomatic and you have symptoms of a fever or a cough that hospital. Er should call public health. And they will confirm that and then they will authorize screening. No doctor in the studio can order this test. It's not audible through a private lab this incubation period that they've been talking about which is to to fourteen days basically anytime during that time you can essentially be a carrier right. You can give it to people. Let's talk about those terms. A carrier is different than someone who has mild symptoms versus someone who's symptomatic. There was one case reported out of Germany that was published as a letter in New England Journal of Medicine stating that an a symptomatic case transmitted the virus however it appeared the authors did not talk to the patient per day. Yes so they wrote up the communication and it turned out the case was symptomatic but what is very important remember is for most the vast majority of infections there is a very clear relationship between the amount of virus in your body and your symptoms. What that means is your most likely to be infectious when you have symptoms and the way you transmit corona virus. The main way to transmit corona virus is by coffeen and depositing droplets anew your three feet away from me so I could infect you. If you're a symptomatic the only way you can transmit that virus is by touching your mucus membranes and then touching a surface than than you would touch it. This is a very low risk issue. We need to focus in on the symptomatic population. Does this live on surfaces. Yes it does for how long well? I'm I would love to find that outright. So we're still getting environmental surface data but we know in general corona viruses are what are called enveloped viruses. So they have a little protection around themselves so they can persist on surfaces for even over a week. Which is why it's very very you karen me Suzanne in this country. We do not have ongoing corona virus transmission. I see here where we live. Many students many individuals wearing masks. And I'm wondering the only reason to wear a mask is if you're having symptoms or if you're robbing a bank well. I think the wearing a mass for self protection. There is no reason to where mask in the absence of you having symptoms or you're going into a hospital and you're going to be seeing a patient but only when you're working with the patient we're not advocating and you're not advocating. I'm sure using a mask of any kind to be in the general population whether you're on an airplane whether you're having dinner in Chinatown there's little reason to be doing that in this country. There's two reasons that to do it number one for what you just said a number two. We now have an international shortage a both categories of math. So what can the general population do without becoming hysterical to protect themselves in a general sort of way day to day? We've already said that they shouldn't be walking around with masks. Does it help them to use hand? Sanitizers alcohol based sanitizers or should we be washing our hands more frequently or does none of that really have an impact hand. Sanitizers can be used for corona virus. Anything that has a high enough alcohol. Content will kill corona virus. I think the problem when we talk about hand sanitizers is there. That's a big market and you can have varying degrees of alcohols and Santa Senator. That works here. Yes and the reason I like. Hand sanitizers is. It's very convenient. You can carry a hand sanitizer with you. You frequently do not have access to soap and water In many places so I. If you're traveling bring a hand sanitizer with us at effective against the flu as well yes. It is back in the category of allaying concerns. Would it be safe to say for our listeners? That those people who Thus far that are dying of the corona virus. The novel Corona Virus are people who are more elderly more infirm or immuno-compromised the typical death that you see from the influenza virus recent H One n one notwithstanding from a decade ago or less than two thousand and nine. Yeah but is it not safe to say that really those people who are most risk those people who are elderly infirm immuno-compromised Isn't it the same with the flu? It is indeed and that's the point M it's a national security issue is not if if the media is propagating the panic mentality if you can certainly say that there's no reason for panic at this juncture and yet the media is fanning the flames of panic. Because that was is what's going to get people to tune in to their show but with should be saying is just the opposite. Yes is dangerous. It's serious but at this juncture there should be saying. There's no reason for alarm. I think it underscores something we talked about in our last show is the grave importance of supporting our public health agencies. Both here in this country and internationally and I believe I mentioned in the last show that our current government cut back funding for both the CDC which trickled down to cutbacks in the public health departments. Who are the first responders to every epidemic? They also cut back funding for international laboratories that were scattered throughout the world where the focus was on emerging infections. And I think instead of talking about you know concerns about getting on a bus or going into chinatown or am I safe on my school campus. We really need to focus attention on supporting our public health agencies. Where I'm going to want to talk about that a little boy in a minute. But we're GONNA take a quick break while. I see what it takes to go live on the moon. We'll be right back on medicine. Were still practicing join Dr Steven Payback and Bill Kurtis for real conversations with the medical professionals who have their finger on the pulse of healthcare in the modern world available on all your favorite pod casting platforms produced by Kirk. Oh media what you GONNA do about. So it turns out that the moon has decided to quarantine earth. And I can't go but we're back so taste at Hunnam World Health Organization director-general. He addressed four hundred researchers as he entered the Geneva. Who Meeting. I think there was today or yesterday. Can you tell us a little about that meeting? Who for those of you? That are not familiar with it would be kind of like the CDC for the world. And I think People's Health Organization stands for World Health Organization rooms. It it's based in Geneva and it's funded by any country that ends up donating The US I believe has cut back on their donations. But it's funded. We need to talk about that later. Yes what most people don't realize it's severely under resourced. And in fact I think during the Ebola outbreak. Cdc was more well resource than the WHOL and so they're very dependent on each country providing resources to support both the epidemiology and the response to these outbreaks. They don't have a clinical arm So really what? They're focused in is on public health the public health response and so they were finally allowed to go into the into China to do their investigation. And actually the individual who's leading that effort led the effort during the Abullah outbreak and he's very well regarded. I was very discouraged that the CDC team as of yet has not been clearly invited to join the WHO team. So let's go back to our director general as he addressed these these researchers in Geneva and he made three points that I want to go with you. He said this outbreak is testing or political solidarity. Whether the world can come together to fight a common enemy that does not respect borders or ideologies. It's a test of financial solidarity whether the world will invest in fighting this outbreak. Now or pay more later and deal with its consequences and a test of its scientific solidarity. Will the world come together to find shared answers to shared problems? Let's talk about those individually for minute. Okay the political solidarity the borders and the ideology is. How do you expect it? That's going to be affected by this process. Well it's very interesting. I I don't think that we are all going to come together in a combined moments and yet I think if there if the tides change politically in this country we will certainly do better than what we have done in the past. But I think there has been a movement that is gaining momentum when you're talking about climate change that this is not too far off from the same issue and certainly affects US epidemiologically. The World Health Organization is doing the best. They can with limited resources. But I think that it's wide open for somebody to come and organize countries in a way that is really beneficial epidemiologically and also on the climate scale issue. Everyone talks about the problem. But have you? Had anybody really suggest a reasonable solution? I think that's a timeframe issue. I think that people in other countries as well as some people in our own believed that the climate change issue doesn't affect us as our generation and so they're not worried about it where this might ruin your February but my point is what we need to do and I don't have this misapprehension that this podcast is going to do it. But I think people talking and communicating. Hopefully we'll help stimulate and inspire people to organize to come up with solutions globally. The second item was. It's a test of financial solidarity whether the world will invest fighting this outbreak. Now or pay more later and deal with its consequences but you position on that. He's speaking to the fact that the WHO is critically under-resourced and I don't think most people understand when they made the distinction of calling the corona virus an epidemic of international importance. I think people were thinking. Oh that's just like a label. It actually means something that means that they are asking specifically for money from participating countries when they make that call. It's asking for resources. Vis-a-vis is a national emergency Therefore you can get federal funds to your local states is mobilising funds. Were exactly up until recently the. Us has been the leader and outbreak response. Even if the outbreak has not been in this country or this continent. We've been the leader. We been the expertise. There's a reason why the Chinese public health department is called the Chinese. Cdc because we train them so the fact that we are not on the ground. China during this epidemic is is really disconcerting because we have the expertise we have the experience we have the knowledge the ability to work with a lot of different systems. And it's really a political crime to not have the involvement at this level that we have to offer. It's a test of scientific solidarity. The world comes together with a goal of finding shared answers to shared problems. You expect. That's going to happen in this case. Why an optimistic attornal optimists. That's the purpose of who? I just love what he said. And I would hope that we combine financial solidarity with scientific solidarity and that is the function of. Who and it's the function of every country really in the world that has the resources to cooperate share data and support the. Who's efforts so? Is that what we should be doing then? Globally is just supporting. Who or do we need. Some other Governing Body worldwide a group of physicians from every country coming together to be more political than the. Who is capable of being? I think there's other groups of physicians that come you know to come together for responses but the purpose of the WHO is really to be the international response to pandemics and if we don't support them than were were each doing our own thing and really looking after our own interests in the WHO H. O. Technically should be serving the world's interests and not countries and trust even though it's based in Geneva it's not just Swiss physicians it frequently will use the resources from the. Cdc IT works very closely with NGOs non governmental organizations like MSF doctorswithoutborders international. Red Cross Many other organizations so I I really do support What he is said whether he's going to get the support and whol will get the support. I am concerned Because I think the. Us has traditionally been a leader in this area. And I don't see us being leader play why I think it's our current administration. I mean is it. Is it a political thing whether we get involved in something that is so a political? I think it's an approach that we focus on. Us entrusts to the exclusion of other countries. Whether it's an economic Whether it's an immigration whether it's global warming or whether it's outbreaks political platform. I think of our current station if it was you know the the former administration I think there would be much more far-reaching In terms of you know a global support and supporting other countries but we have some of the best scientists in the world here in this country and we have some of the best doctors. And you know we have Suzanne Donovan Right. And she's in a fall globally. But you know there's seven billion people and there's only so many people she can take care of but if Suzanne is willing to get involved globally. That happens outside of the purview of our government. Right true but I mean Suzanne is not going to be able to fund the she's not going to be able to fund the World Health Organization in any appreciable degree. That money is going to have to come from governments. Is it money thing Suzanne? I think it's a combination of financial resources whether it's for protective equipment for education Who one of their huge charges are large chargers that they do is is education and developing resources within each country so that that country can become its own leaders and public health and epidemic response. Many those resources have been cut back over the last five to ten years in two thousand and fourteen We had expanded support for public health in this country and for international labs to evaluate emerging infections and the support for those labs have been caught recently and it is it that financial support that leads to a vaccine. It's not just financial support that leads to the vaccine. I mean if you look at what happened with the goal of vaccine. A lot of that is is other agencies like the Gates Foundation coming together To lead the charge. I don't know that. Who is going to lead the for vaccine? I suspect it's going to be other entities that too and I think people are looking at vaccines are looking at medications or looking at quick fixes. The foundation to respond to any epidemic is basic epidemiology putting people on the ground doing contact tracing to every case. So that you stop the chain of transmission and. I don't believe that happened at the beginning of this outbreak and China and unfortunately I don't even know that we have any data of where. This outbreak originated. We know that some individuals had exposure to a live animal market. I don't see any data from that. Live animal market that any of those animals had this novel corona virus so Suzanne. You've probably had to experience this before the Dealing with a virus that is considered an enemy. That doesn't respect borders or ideologies. Can you tell us a little about when it's worked when you think that we've been cooperative as a world and will it come together? This time. I think the outbreak that we had in in Liberia and Sierra Leone In two thousand fourteen were. Who WORKED WITH NON-GOVERNMENTAL ORGANIZATIONS AND THE CDC? I think it worked very well. It was late. It was a very late response but it did come together. It did not happen in the most recent Ebola outbreak where I think people had what we call outbreak fatigue. You know it followed a two year outbreak and really add the hell with the Halloween with it and it was in the DRC were most people. Don't even know where that wasn't global. I wasn't global it. Didn't it didn't really impact us in the same way where the entire western Africa was impacted. My sense politically as being someone older is that we've we've shifted to are much more isolationist point of view and I've always made an argument that were one plane trip away from an outbreak I know that's not GonNa make you feel good but that's true. We can pull in our guns. Build WALLS SHUDDER BORDERS. But whatever is happening across the world is going to make its way here. Suzanne can you give our listeners? A couple of go forward thoughts that you can leave them with so that they can have a good sense of what's happening with this virus. What are the three points that we should know about it? I think when when we reflect on the corona virus outbreak. I think we need to remember. We've been here before we've experienced to prior krona virus outbreaks and we've learned a lot from those outbreaks. The hospital system in the. Us has tremendously improved. It's infection control response. And there's some simple things people can do to protect themselves against Corona virus and flu viruses. You've already heard those. Wash your hands. Stay home if you're sick but the other more important thing is is more of a global approaches is really supporting our public health system. The foundation of responding to any epidemic or even better yet preventing epidemics is supporting the CDC the WHO and our local public health departments. So Dr Donovan Worship. People go to get reliable information other than the show of course going forward the CDC has a fantastic site for novel corona virus. And and in fact just go to the site because you can pretty much learn about any recent outbreaks that are going on in the US or internationally but they have a really good site for the public. That gives you up to date information. You can also go to the. Who Site which also gives you more of an international slant but the CDC site for people in the US is is really fantastic resource. Dr Steve With all the Doctor Susan Donovan said about. We really don't know everything about this virus yet. We really pick the right name for the show. This is medicine. We're still practicing. Indeed we every day doctors Zan Donovan. Thank you so much for coming and I'm sure either. Next time I sneeze or next time. We get a chance to have you back here. We would be honored. Thank you very much. Thanks for joining us. We'll see you again. Expect if you like what you hear. Please tell your friend and let us know how we're doing by leaving a comment. It really helps. If you give us a five star rating and we really appreciate it you can also subscribe to the show on Apple podcasts. Stitcher or wherever you. Listen to your favorite podcast. This episode was produced and edited by Mike. Thomas Audio Engineering. By Michael Kennedy and the theme music was composed and performed by. Celeste and Eric Dick. Thanks for listening. Room Kirk Oh media media for your mind.

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