Selected Podcast
COVID-19 Facts
Dr. Mark Whitman shares the important facts you need to know about COVID-19.
Featured Speaker:
Marc S. Whitman, MD
Dr. Marc S. Whitman is an infectious disease specialist in Trenton, New Jersey and is affiliated with multiple hospitals in the area, including Capital Health Medical Center-Hopewell. He received his medical degree from Rutgers Robert Wood Johnson Medical School. Transcription:
COVID-19 Facts
Michael Carrese: This episode of Capital Health Headlines about COVID-19 was recorded on March 31st, 2020. With non stop media coverage and social media on fire about Coronavirus and the disease that causes COVID-19. It can be easy to lose track of what's factual and what's just speculation or rumors. So we're going to spend the next few minutes going over what is actually known to be true about COVID-19 so you could make the best decisions for you, your family, and your community. This is Capital Health Headlines, the podcast from Capital Health. I'm Michael Carrese, and our expert guide today is Dr. Marc Whitman, a Board Certified Infectious Disease Specialist with Capital Health System. So Dr. Whitman, you specialize in dealing with infections actually that are difficult to diagnose. Would you put COVID-19 in that category?
Dr. Whitman: Well, I would say in the beginning it posed some challenges, but as we have more and more cases and more community spread of COVID-19 it's becoming more common and less to diagnose when patients present to the emergency department at Capitol Health with symptoms. It has been having a relatively typical picture in most presentations. So it's less difficult to diagnose. We just have had challenges with our testing, getting results back in a timely fashion.
Host: What is the latest on testing availability? And are you at this point, you know, public health officials seem to be saying two things. One is we want to do a lot of testing so we know what's out there so we can track it and know what to expect. But on the other hand, if you have symptoms that are mild, we don't necessarily want you to be tested because we don't want you to create risk by doing so, to yourself or the healthcare providers and there's not enough tests. So how do you sort all that out?
Dr. Whitman: Well, ideally from an epidemiologic standpoint, it'd be helpful to know everyone's COVID-19 status, but we don't have the ability. And to date we haven't had those testing kits available. I work inpatient at Capital Health and we prioritize the people that we test. We prioritize that to be anyone who's admitted to the hospital. We need to get their tests as soon as possible because we have to be able to identify who's positive and who isn't. So we can have them appropriately managed in place within the hospital setting. We need to get those results back so we can make sure we're treating everyone appropriately. We also prioritize healthcare workers who come in with symptoms cause we need to know their status as soon as possible, so we can manage how we're going to deal with them being out and staffing issues. We tend to prioritize also those with, what we call co-morbidities or other illnesses.
But essentially what I've been doing because I work inpatient is we prioritize those that get admitted. We haven't had the test to test everyone who comes. So, you know, we've encouraged people, if you have mild symptoms like fever and cough and you're not having anything associated with that to be concerned with the shortness of breath that you stay at home and isolate yourself at home, and socially distance yourself as best as possible, but don't go out. We encourage that. And then if you have symptoms that worsen, then you come to the hospital for evaluation, so we haven't been promoting testing those individuals who are going to have to come to the hospital since we have to get the results back as fast as possible. And those are the sickest, those are hospitalized and our healthcare workers.
Host: Right. Totally understandable. So fever and cough seem to be the, the main things there, but as you say, the, when the breathing gets labored, that's probably when you should get more worried about it.
Dr. Whitman: So some of that depends on your risk category. If you're over 65, we'd be a little more concerned. But essentially the symptom that we become most concerned about is the shortness of breath, that may be shortness of breath at rest or if you're finding yourself getting more short of breath when you're doing activities, walking up the stairs at home, walking around the house, all those kinds of things. If you find that you're doing minimal exertion and having shortness of breath. Especially if it's something that you're not normally used to dealing with or symptom they don't typically have. That's something that you may want to reach out and talk to your physician. Physicians aren't seeing as many patients in the office, but most primary care physicians are providing telemedicine through video or by phone. And that's something that you reach out to them and discuss and, they can help you decide whether or not you might need care. And they would typically refer you to the emergency department.
Host: And what does this virus actually do physiologically? It causes shortness of breath because it's creating fluid in the lungs or what's happening?
Dr. Whitman: So the virus is a virus that causes respiratory tract infection. It could be, minor causing something similar to, you know, if you've ever had a upper respiratory tract infection that causes cough or maybe low grade fever. But what happens with this virus is that it causes an inflammatory reaction in the lung itself. So what we call lower respiratory tract infection. So an infection involving the lung itself, the lung tissue, it gets into the lung tissue and causes infection associated with this inflammatory reaction, which looks like a pneumonia. It's not specifically fluid. But you were looking at chest X ray of someone who has heart failure versus someone with fluid in the lungs, it looks very similar to someone who has COVID-19 infection of the lungs.
Host: So in terms of treating it, what options do you have?
Dr. Whitman: Well, if you want to watch the news and you'll see Dr. [Inaudible] who speaks, there's no specific approved treatment for Coronavirus. There are several pathways of research that are being looked at to find a specific treatment. Nothing is approved. The most readily available treatment is what you probably read about something called the Azithromycin, which is an antibiotic that's often used to treat certain types of respiratory tract infections. And there's another medication which everyone's been talking about, which is hydroxychloroquine. That's similar to Chlorequinn. The hychloroquine has not really been very available in the United States for quite some time, but hydroxychloroquine has because it's used to treat certain rheumatologic conditions. So it's been readily available. That medication has an antiviral properties, and in anecdotal studies, it's been shown to be effective in decreasing the amount of virus that people share, the amount of virus that can be detected when you do a swab of their nasal pharynx or a swab of the oral firing.
So, or a test for DNA particles from respiratory secretions. So it's been shown to do that in some, there's some traditions that have looked at that, especially for instance in France and also in China. And have used it and, they're stating that there is efficacy for using either hydroxychloroquine alone or hydroxychloroquine in combination with the Azithromycin, but these aren't controlled studies. That means, we still don't know for sure whether that's effective. And just more scientific research has to be looked at to do that. But since it's readily available, that's something many of us have been using since there really is no other specific treatment. There's other medications in the pipeline. There's an antiviral, [inaudible] that is available at one point through what we call compassant use and now it's entering what they call an expanded access phase. And that's going to be looked at by the company that makes it to see whether that's effective against the COVID-19 or Coronavirus.
Host: I want to make sure we're going over some of the basics here for folks to understand how to protect themselves and you know, what they should be doing in the middle of all this. So remind us how Coronavirus spreads?
Dr. Whitman: Well, Coronavirus spreads like many other virus, like influenza, we know that for sure. There's still scientists and and research physicians trying to look at the ways that it spreads, but we know for sure it spreads through respiratory droplets. So a cough can travel and you know, the droplet can travel, we think up to six feet. Someone can certainly catch it if someone coughed and it's in the air in that way. It also will land on the surface and if you touch that surface and then bring your hand to your face, you can catch it that way as well. So that's why we recommend that you keep your hands clean, especially after touch surfaces. And if you touch a surface, certainly you want to have your hands clean before you would touch your face area. There might be a decrease in transmission if you're wearing a mask so that you're within six feet of someone and those droplets are carrying and you have a mask, there's less transmission that way. So those are the main ways. I mean, you get, so essentially you can breathe it in if you're close enough to someone who has it, and you can also bring it onto your face. If you touch something that's, that has viruses on it and then you can catch it that way as well. That's why I recommend hand-washing as one of the major ways to prevent transmission.
Host: And is it clear that you can get sick from people who don't have symptoms?
Dr. Whitman: That's not entirely clear. We do know that people who get COVID-19 get it in different ways so that someone can have very minimal symptoms and they're at that time likely infectious and able to spread it. So if you're going to a large gathering, someone may have very minimal symptoms, a low grade fever that they don't even know, a very mild cough, and they may be able to and are probably able to transmit the virus at that time. Less is known about the ability to transmit it. If you're completely asymptomatic, but it's certainly possible and probably more likely that there are people that are able to spread it asymptomatically. That's why it's really important to practice social distancing, to keep yourself at least six feet away from another person because you don't know what stage they may be in. They have very mild symptoms and they may think it's fine, go out and shop or do things, you know, go to a party. Those kind of possibilities. So it's something that we're concerned about and that's why recommendations are that you socially distance yourself, stay six feet away from someone and only go out if absolutely necessary.
Host: Yeah. And I wanted to, as we wrap up here, stick on that for just a second because I do think as the stay at home situation for people stretches into weeks and maybe even months, there'll be some temptation to cheat. I mean, people might be thinking, Oh, what's going to get a cup of coffee with a friend at their house going to hurt things in the overall picture or going to the store to get something I really want, but not something I really need? What would you say as a physician to folks to help them understand how important it is to stay with that plan of social distancing?
Dr. Whitman: Well, you have to understand that you may pick up the virus, you may not have symptoms and, there's so much we don't understand about why one person gets very sick. So you could take that virus that you pick up, if you're not practicing social distance, your friend, your family member, and they catch it and have a completely different response to you than you did, and get very sick from it. Sick to the point that they have to be on a breathing machine for support, sick enough, in fact for the possibility that they could die. So you have a role and a responsibility to stay away from other people and listen to the recommendations that are coming out from the medical experts regarding social distancing. It's one of the major ways we can keep people safe if we're not spraying the virus.
If the virus has no one else to go to, the virus will die. When you spread it to another person, then that person's present to another person. And that's when we have the number of cases that we're seeing throughout the country. So it's an important thing to do. Again, you know, you may yourself be perfectly fine, have minimal symptoms, but you may spread that same virus to someone you know and then they may be the same age and maybe your parents and they're going to get very sick from it. So that's why we're encouraging people to heed the warnings of the experts and listen, and practice social distancing, no unnecessary travel. It's been probably the main tool that we have to prevent spread of a COVID-19
Host: Well that's well said and I'm glad you had an opportunity to emphasize that message. And Dr. Whitman, I want to thank you for taking the time and wish you the best of luck as you are out there treating patients in this really difficult situation.
Dr. Whitman: Thank you.
Host: You've been listening to Dr. Mark Whitman, a board certified infectious disease specialist with Capital Health System. To stay up to date and fully informed on COVID-19 please visit Capitolhealth.org/coronavirus where you'll find information from the CDC and other expert sources. If you found this podcast helpful, please share it on your social channels or check out the full podcast library for additional topics that may interest you. Thanks for listening.
COVID-19 Facts
Michael Carrese: This episode of Capital Health Headlines about COVID-19 was recorded on March 31st, 2020. With non stop media coverage and social media on fire about Coronavirus and the disease that causes COVID-19. It can be easy to lose track of what's factual and what's just speculation or rumors. So we're going to spend the next few minutes going over what is actually known to be true about COVID-19 so you could make the best decisions for you, your family, and your community. This is Capital Health Headlines, the podcast from Capital Health. I'm Michael Carrese, and our expert guide today is Dr. Marc Whitman, a Board Certified Infectious Disease Specialist with Capital Health System. So Dr. Whitman, you specialize in dealing with infections actually that are difficult to diagnose. Would you put COVID-19 in that category?
Dr. Whitman: Well, I would say in the beginning it posed some challenges, but as we have more and more cases and more community spread of COVID-19 it's becoming more common and less to diagnose when patients present to the emergency department at Capitol Health with symptoms. It has been having a relatively typical picture in most presentations. So it's less difficult to diagnose. We just have had challenges with our testing, getting results back in a timely fashion.
Host: What is the latest on testing availability? And are you at this point, you know, public health officials seem to be saying two things. One is we want to do a lot of testing so we know what's out there so we can track it and know what to expect. But on the other hand, if you have symptoms that are mild, we don't necessarily want you to be tested because we don't want you to create risk by doing so, to yourself or the healthcare providers and there's not enough tests. So how do you sort all that out?
Dr. Whitman: Well, ideally from an epidemiologic standpoint, it'd be helpful to know everyone's COVID-19 status, but we don't have the ability. And to date we haven't had those testing kits available. I work inpatient at Capital Health and we prioritize the people that we test. We prioritize that to be anyone who's admitted to the hospital. We need to get their tests as soon as possible because we have to be able to identify who's positive and who isn't. So we can have them appropriately managed in place within the hospital setting. We need to get those results back so we can make sure we're treating everyone appropriately. We also prioritize healthcare workers who come in with symptoms cause we need to know their status as soon as possible, so we can manage how we're going to deal with them being out and staffing issues. We tend to prioritize also those with, what we call co-morbidities or other illnesses.
But essentially what I've been doing because I work inpatient is we prioritize those that get admitted. We haven't had the test to test everyone who comes. So, you know, we've encouraged people, if you have mild symptoms like fever and cough and you're not having anything associated with that to be concerned with the shortness of breath that you stay at home and isolate yourself at home, and socially distance yourself as best as possible, but don't go out. We encourage that. And then if you have symptoms that worsen, then you come to the hospital for evaluation, so we haven't been promoting testing those individuals who are going to have to come to the hospital since we have to get the results back as fast as possible. And those are the sickest, those are hospitalized and our healthcare workers.
Host: Right. Totally understandable. So fever and cough seem to be the, the main things there, but as you say, the, when the breathing gets labored, that's probably when you should get more worried about it.
Dr. Whitman: So some of that depends on your risk category. If you're over 65, we'd be a little more concerned. But essentially the symptom that we become most concerned about is the shortness of breath, that may be shortness of breath at rest or if you're finding yourself getting more short of breath when you're doing activities, walking up the stairs at home, walking around the house, all those kinds of things. If you find that you're doing minimal exertion and having shortness of breath. Especially if it's something that you're not normally used to dealing with or symptom they don't typically have. That's something that you may want to reach out and talk to your physician. Physicians aren't seeing as many patients in the office, but most primary care physicians are providing telemedicine through video or by phone. And that's something that you reach out to them and discuss and, they can help you decide whether or not you might need care. And they would typically refer you to the emergency department.
Host: And what does this virus actually do physiologically? It causes shortness of breath because it's creating fluid in the lungs or what's happening?
Dr. Whitman: So the virus is a virus that causes respiratory tract infection. It could be, minor causing something similar to, you know, if you've ever had a upper respiratory tract infection that causes cough or maybe low grade fever. But what happens with this virus is that it causes an inflammatory reaction in the lung itself. So what we call lower respiratory tract infection. So an infection involving the lung itself, the lung tissue, it gets into the lung tissue and causes infection associated with this inflammatory reaction, which looks like a pneumonia. It's not specifically fluid. But you were looking at chest X ray of someone who has heart failure versus someone with fluid in the lungs, it looks very similar to someone who has COVID-19 infection of the lungs.
Host: So in terms of treating it, what options do you have?
Dr. Whitman: Well, if you want to watch the news and you'll see Dr. [Inaudible] who speaks, there's no specific approved treatment for Coronavirus. There are several pathways of research that are being looked at to find a specific treatment. Nothing is approved. The most readily available treatment is what you probably read about something called the Azithromycin, which is an antibiotic that's often used to treat certain types of respiratory tract infections. And there's another medication which everyone's been talking about, which is hydroxychloroquine. That's similar to Chlorequinn. The hychloroquine has not really been very available in the United States for quite some time, but hydroxychloroquine has because it's used to treat certain rheumatologic conditions. So it's been readily available. That medication has an antiviral properties, and in anecdotal studies, it's been shown to be effective in decreasing the amount of virus that people share, the amount of virus that can be detected when you do a swab of their nasal pharynx or a swab of the oral firing.
So, or a test for DNA particles from respiratory secretions. So it's been shown to do that in some, there's some traditions that have looked at that, especially for instance in France and also in China. And have used it and, they're stating that there is efficacy for using either hydroxychloroquine alone or hydroxychloroquine in combination with the Azithromycin, but these aren't controlled studies. That means, we still don't know for sure whether that's effective. And just more scientific research has to be looked at to do that. But since it's readily available, that's something many of us have been using since there really is no other specific treatment. There's other medications in the pipeline. There's an antiviral, [inaudible] that is available at one point through what we call compassant use and now it's entering what they call an expanded access phase. And that's going to be looked at by the company that makes it to see whether that's effective against the COVID-19 or Coronavirus.
Host: I want to make sure we're going over some of the basics here for folks to understand how to protect themselves and you know, what they should be doing in the middle of all this. So remind us how Coronavirus spreads?
Dr. Whitman: Well, Coronavirus spreads like many other virus, like influenza, we know that for sure. There's still scientists and and research physicians trying to look at the ways that it spreads, but we know for sure it spreads through respiratory droplets. So a cough can travel and you know, the droplet can travel, we think up to six feet. Someone can certainly catch it if someone coughed and it's in the air in that way. It also will land on the surface and if you touch that surface and then bring your hand to your face, you can catch it that way as well. So that's why we recommend that you keep your hands clean, especially after touch surfaces. And if you touch a surface, certainly you want to have your hands clean before you would touch your face area. There might be a decrease in transmission if you're wearing a mask so that you're within six feet of someone and those droplets are carrying and you have a mask, there's less transmission that way. So those are the main ways. I mean, you get, so essentially you can breathe it in if you're close enough to someone who has it, and you can also bring it onto your face. If you touch something that's, that has viruses on it and then you can catch it that way as well. That's why I recommend hand-washing as one of the major ways to prevent transmission.
Host: And is it clear that you can get sick from people who don't have symptoms?
Dr. Whitman: That's not entirely clear. We do know that people who get COVID-19 get it in different ways so that someone can have very minimal symptoms and they're at that time likely infectious and able to spread it. So if you're going to a large gathering, someone may have very minimal symptoms, a low grade fever that they don't even know, a very mild cough, and they may be able to and are probably able to transmit the virus at that time. Less is known about the ability to transmit it. If you're completely asymptomatic, but it's certainly possible and probably more likely that there are people that are able to spread it asymptomatically. That's why it's really important to practice social distancing, to keep yourself at least six feet away from another person because you don't know what stage they may be in. They have very mild symptoms and they may think it's fine, go out and shop or do things, you know, go to a party. Those kind of possibilities. So it's something that we're concerned about and that's why recommendations are that you socially distance yourself, stay six feet away from someone and only go out if absolutely necessary.
Host: Yeah. And I wanted to, as we wrap up here, stick on that for just a second because I do think as the stay at home situation for people stretches into weeks and maybe even months, there'll be some temptation to cheat. I mean, people might be thinking, Oh, what's going to get a cup of coffee with a friend at their house going to hurt things in the overall picture or going to the store to get something I really want, but not something I really need? What would you say as a physician to folks to help them understand how important it is to stay with that plan of social distancing?
Dr. Whitman: Well, you have to understand that you may pick up the virus, you may not have symptoms and, there's so much we don't understand about why one person gets very sick. So you could take that virus that you pick up, if you're not practicing social distance, your friend, your family member, and they catch it and have a completely different response to you than you did, and get very sick from it. Sick to the point that they have to be on a breathing machine for support, sick enough, in fact for the possibility that they could die. So you have a role and a responsibility to stay away from other people and listen to the recommendations that are coming out from the medical experts regarding social distancing. It's one of the major ways we can keep people safe if we're not spraying the virus.
If the virus has no one else to go to, the virus will die. When you spread it to another person, then that person's present to another person. And that's when we have the number of cases that we're seeing throughout the country. So it's an important thing to do. Again, you know, you may yourself be perfectly fine, have minimal symptoms, but you may spread that same virus to someone you know and then they may be the same age and maybe your parents and they're going to get very sick from it. So that's why we're encouraging people to heed the warnings of the experts and listen, and practice social distancing, no unnecessary travel. It's been probably the main tool that we have to prevent spread of a COVID-19
Host: Well that's well said and I'm glad you had an opportunity to emphasize that message. And Dr. Whitman, I want to thank you for taking the time and wish you the best of luck as you are out there treating patients in this really difficult situation.
Dr. Whitman: Thank you.
Host: You've been listening to Dr. Mark Whitman, a board certified infectious disease specialist with Capital Health System. To stay up to date and fully informed on COVID-19 please visit Capitolhealth.org/coronavirus where you'll find information from the CDC and other expert sources. If you found this podcast helpful, please share it on your social channels or check out the full podcast library for additional topics that may interest you. Thanks for listening.