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Melanie Cole (Host):  Welcome to Expert Insights with the Carle Foundation Hospital. I’m Melanie Cole and today, we’re discussing an important COVID-19 update. Joining me is Dr. Robert Healy. He’s the Chief Medical Quality Officer at the Carle Foundation Hospital. Dr. Healy, it’s a pleasure to have you back on with us. So, what’s the latest information on COVID-19 and the community? What’s happening globally? What are you seeing in the trends?

Robert Healy, MD (Guest):  You know it’s seems like we’ve been living with it for years, but it’s only been a number of months. And things do change rapidly. We predicted this at the beginning that we saw examples of for instance PPE recommendations would change from week to week and it would be pretty frustrating for frontline workers to try and figure out what do we need to do to keep ourselves protected et cetera. So, where are we at now? We’re in a steady state is how I would put it right now, at least at Carle in east central Illinois. We’ve seen like the rest of the state and a lot of the parts of the country have seen a decrease in numbers of cases. We have a decrease in the number of the percentage of our tests that are positive. We’ve seen not as much of a decrease in our hospitalizations but a decrease in our hospitalizations, but we still have really sick people being in the hospital. Probably about ten days ago, we had the highest number of people in the hospital at the Carle Foundation in Urbana, we had 14 people including five in our ICU and we’ve had a couple of deaths this last few days in persons in their 40s and a person in their 30s. so, on the one hand, we’re seeing numbers drop, we’re seeing less people in our community that are coming back positive but we’re still seeing that the people who do get it, can be very sick and it can be very deadly.

Host:  Wow. It’s such a mystery this virus. So, do people fell that it’s going away? Do you attribute the decrease to people doing masks and social distancing? To what do you attribute the decline?

Dr. Healy:  I think the story about masks is really interesting. Because before COVID, before the recommendations to wear masks when we weren’t able to be six feet away from anybody or from somebody, and to wear masks all the time in the healthcare setting. We did that because we thought it made some sense because the heavy droplets would be blocked from if I had COVID before I had symptoms, or even if I had symptoms, if I’m coughing or sneezing that wouldn’t go kind of those dramatic videos that we’ve all seen on the internet where it shows how far coughing and sneezing can go. We thought it made sense that that would help protect people and indeed it has shown to. There has been – there are studies now that showed that it does protect people. If I’m wearing a mask you are protected from getting any infection. So, that’s something that we’ve learned. We hoped it would be true. We did a lot of things to try and prevent the spread and it looks like wearing masks has really helped.

I think the other thing that’s happened is we’ve been outside more and when we mix with people like everyone would do, have to interact to – we try to keep separate but interact when we are out in the community, when we’re shopping, when we’re picking up food for dinner et cetera. I think being outside has shown to be less of a risk than being inside. So, what do I mean by that? If I’m in a room or a car and someone has the infection, then it’s a pretty good chance that I might get the infection. I think that when we’re out at family gatherings or like some worship services have done being out in the parking lot or being outside in like a picnic area. I think the sun helps; well it helps us feel better but it also there is some evidence that the UV rays from the sun help to kill the virus faster. And also, the breeze, the air around us is mixing around so much and blowing away that it doesn’t seem like it’s that infectious in those environments.

Host:  It is so interesting. So, do you have any CDC or World Health Organization updates for us as of now Dr. Healy?

Dr. Healy:  The updates still state that we should be trying to stay six feet away from people if possible and that we should wear a mask unless there’s some medical reason for us not to be wearing a mask. So, those updates are similar. The other – it’s not an update, but just it’s more of availability of testing. So, getting tested I think is an important thing especially if you are a healthcare worker working on the frontline. I don’t think it’s a bad idea to get tested every couple of weeks just to make sure that you don’t have the disease. We know more now that about the fact that people can get this virus and be infectious and not even know about it. Especially younger people in their 20s and 30s, that seems to be happening more and more. But otherwise, the CDC and WHO haven’t made a lot of dramatic changes. We’re waiting to hear more of studies on antibodies and serology, but we haven’t heard those things yet.

Host:  Well then let’s talk about antibodies and antibody testing because it’s going around. We’re hearing those terms. Tell us a little bit about antibody testing. Who can get tested? And how do they make an appointment? How does someone go about wanting to get tested for antibodies?

Dr. Healy:  It’s available at Carle’s lab for instance we have availability to do many – hundreds of antibody tests a day if we need to. We’ve limited it in a way and that is that we’ve – we started by looking at our employees and our staff and when we got the availability to do the antibody tests, and a little bit about the antibody test. It tests for one type of antibody called IGG. There’s another one called IGM that this isn’t testing for yet. There’s still some issues trying to figure out the best way to test for that antibody to this virus. But the IGG antibody means that you’ve been exposed to the virus that causes COVID-19 and your body’s made antibodies against it. That’s really all we know right now. That’s all we can say for certainty is that if you have an antibody test and it’s positive, it means that you’ve been exposed to this virus sometime in the past. Usually at least two weeks ago or further back in time. So, we wanted to do first was look at our employees especially the frontline staff in the emergency department and the respiratory therapists and the anesthesiologists, the ICU doctors and nurses and staff who saw most of the COVID patients in the beginning. And luckily saw that there wasn’t a lot of positive antibodies in that group.

And indeed, as we’ve gone along and tested more people in our system, so we’ve opened it up to all employees now so everyone in the hospital, everyone in the clinic et cetera, can get this test done. It wasn’t mandatory of course. People chose to do it or not. But the ones that chose to do it, there’s been a few thousand people that have got it done and our positive rate is only 1.7%. So, that was something surprising to us. We thought that we’d have a higher positive rate especially in the people who were at the highest risk and people in the emergency department and those high risk areas did have a higher rate, but it never got above 10% of the people that were tested that showed that they had been exposed to this virus.

I think of that in two ways. One, is it’s really good that there wasn’t a lot of exposure to our frontline staff and I think that means that they did a really good job of paying attention to what the CDC was saying, what public health was saying about wearing the proper PPE and keeping safe when they were dealing with patients that had the disease. Because we’ve had a number of patients like 70 or 80 that have been admitted to Carle Hospital here in Urbana that have had the infection proven.

Back to the antibodies. We were happy to see that not many people were exposed. We’ve seen a similar rate in our community of all people that were tested with antibodies or for antibodies only about less than 2% have been exposed to the virus in the past. Like I said, it’s good news but in a way, like most things, there’s a double edge to it because that also means that’s only less than 2% of our community that’s been exposed and we’ve already had such a dramatic change in our society and our work lives and ultimately, it needs to spread through more of us either through the infection itself or hopefully through a vaccine when it comes out and then we’ll be protected. But going back to serology. So, we tested the employees. We haven’t recommended that Primary Care Doctors test their patients. They can do that. Any Carle doctor can order this test. But really, it’s more of a just a curiosity right now because we can’t say that if you have antibodies you’re protected. And we don’t want to give the impression that if you have antibodies you could take more risk, wearing less PPE, hanging out with more of your friends or family et cetera. That wouldn’t be right, right now, because we don’t know what this means.

Hopefully we’ll hear from the studies that are being done now that a positive antibody means you’re protected in some way for some length of time. We just don’t have that answer yet. So, people that are curious, can talk to their primary care doctor or their provider and ask about it but probably what they are going to be told is it really doesn’t help because we don’t know yet what it means and once we do, we can start doing the test on a broader range of patients.

Host:  What is contact tracing Dr. Healy and is this something important?

Dr. Healy:  Contact tracing is critical. It’s a tool that Public Health has used forever. I recently read a book about the cholera epidemic in London in the 1800s and it was important back then. It’s important now. What contact tracing is, is once you find someone that has the disease, you talk to them and you find out who they’ve been around and who is at risk of getting the disease from that person. So, say I came back as a positive, I would be asked where have I been, especially in the last 48 hours. Who have I been around. Was I wearing a mask or not. Where was I when I was with people. Hopefully the answers are going to be I wasn’t really around a lot of people and I didn’t do a lot because we’re not doing much right now. But I would be asked about that and with the important question being, who could I have exposed to the virus. And what we think now is that you have to be within six feet of somebody for at least 15 minutes to get the infection from them. That’s not a hard and fast rule but that’s what Public Health is going by. So, for instance, with me, I’ve been with my wife for the weekend and I’ve been within six feet of her and we don’t wear masks when we’re at home because we’ve been at home together throughout the quarantine. So, Julie would be considered a contact because she was exposed to the fact that I had the infection, she’s exposed. And Public Health would talk to her about her keeping others safe by staying home and also her possibly getting tested now or at least getting tested when she develops symptoms if she were to.

Host:  So, before we wrap up, should we be preparing for a possible second wave Dr. Healy? You are so intelligent, and you’re so informed on this. Do you think there will be one and if there is, will we be ready?

Dr. Healy:  Oh boy, that’s a great question. So, I’ll look in my crystal ball here and see. One fact is when you look at the graphs: we’re still on the first wave. We’re still seeing 20-22,000 cases a day in our country, and we haven’t seen a dip like other countries have. So, you could argue that we’re still in the first phase or a plateau. I think that in the fall if history is any guide, we will see more cases. We will get a second bump in the number of cases we get. I think we’re definitely more ready for that now than we were for the first one because we had such little information about it. However, what I hope doesn’t happen, I don’t know if we as a society could really handle this is that if we get a very large spike in cases, if we have to go back to being on – staying home and not doing much outside of our houses. That would be really bad for our psyches and could we do that enough to prevent rapid spread of the disease? It’s really hard to know.

So, I expect more cases in the fall like all respiratory viruses, they will get worse in the fall because we are together more, the humidity level is lower, and the virus can live longer on surfaces. So, I think we’ll get more cases in the fall and I hope we just can handle them, deal with them, that they don’t overwhelm our healthcare system especially ICU beds and ventilators. But I feel good that we’re at a good place to handle that surge if we do get that in the fall.

Host:  So, one last question Dr. Healy. This virus is such a mystery. And you’ve given us so much great information. Wrap it up for us with what you feel we know now that we did not know a few months ago when I interviewed you about COVID-19.

Dr. Healy:  We understand the basics of the disease course. Meaning that people that get exposed if they are going to become symptomatic, usually at about five or six days, they start getting symptoms, the symptoms are the things we’ve talked about which could be headache, shortness of breath, cough, sore throat, fever. We also realize that some people just get a little bit of one of those symptoms or no symptoms at all. We also realize some people especially young people, get GI symptoms. So, instead of a cough or fever, it could be a diarrheal illness. So, we understand better what the disease looks like. We know that it could last probably seven to ten days. At about five days into the infection, is a critical point because if people are going to get sicker, then that’s usually when it happens. So, about ten days after exposure, five days after they get symptoms, and so we really need to have people watch out for especially for shortness of breath and let us know if they have any so that we can evaluate them right away.

We know that people get over this and they seem to do fine. We know that some people the effects last for longer. We don’t know how long that is yet because it’s still way too early in the course of this illness. I think another important thing we know is that this disease does not seem to be airborne. We worried about that a lot in the beginning. But it doesn’t seem to be airborne and also, it seems like it’s a little harder to catch than we thought.

Meaning, I remember one study from one of the early cruise ships when they went in after seventeen days, they still found the virus on the surfaces of that room. Or people can be positive for their test even after ten days and they are feeling fine. We know now that those things aren’t infectious. The people after their symptoms are ten days and they don’t have a fever for three days; they are not infectious even though they could have a positive test. And we know that it doesn’t seem to live on surfaces and become infectious as easily as we thought it might. So, I think that wearing masks, staying away from large groups of people. If you are going to be with groups of people, being outside versus inside. Those are all things that we know now that we didn’t know before.

Host:  Thank you so much Dr. Healy for that incredibly important update on COVID-19. Thank you again. That concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at www.carleconnect.com for more information. We hope the information gained will be applicable to your work and life. And if you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.