Transcription:
Coronavirus: Fact vs Fiction and the Role of Masks

Scott Webb (Host):  We are all hopeful that a COVID-19 vaccine will be available in the near future. But there are many myths about the virus and there still seems to be some uncertainty about the effectiveness of wearing facemasks. And joining me today to help clear up some of the myths and explain why masks are so effective in limiting the spread of the virus, is Dr. Kaite Khandelwal Gilman. She’s a surgeon at the Mark Twain Center and a COVID-19 survivor. So, Doctor thanks so much for joining me. We’re discussing COVID-19 sort of fact versus fiction today. We’re also going to discuss the importance of masks. Information about COVID-19 and the recommendations keep changing. So, let’s go through some of these things. Is COVID-19 similar or at all like the flu?

Kaite Khandelwal Gilman, MD (Guest):  This is common misconception that COVID-19 is just a mutated form of the cold or the flu and is similar to the flu and this is false. And while you can have similar symptoms as the flu, like fever, body aches, and pains, cough, stomach upset; there are very striking differences. And the first is that the mortality of the seasonal flu is 0.1%. That means that one out of a 1000 people who have the flu die. The mortality of COVID-19 was initially thought to be really high between 4 and 5 percent. But with more testing and finding more asymptomatic infections; we’re seeing that the mortality seems to be between 0.5 and 1%. And that means that it is still five to ten times more deadly than the flu.

Furthermore, the transmission of COVID-19 is between 2 and 2.5 meaning that if you get it, you’re going to spread it to between 2 and 2.5 people if you’re not using precautions. And that is higher than the flu. The only reason that we’re seeing the death rate may be comparable to the flu is that we’ve taken such drastic measures to curb its spread. The problem is that we’ve never seen this disease before. This is a novel Coronavirus. We have no vaccine for the Coronavirus where we have a vaccine for the flu. So, we can protect our older individuals of higher risk or the very young, we can prevent the spread by vaccination where even if the vaccine doesn’t prevent you from getting it, it will definitely make a more mild disease.

The good news we have with Coronavirus, is that while it’s more deadly than the flu; 80% of people will be asymptomatic or mild and up to 15% will have severe infections requiring oxygen, though 5% will require hospitalization with ventilation. The other difference we’re seeing in the flu is not just the type of disease but it’s the range of problems you are getting with COVID-19. We’re seeing blood clots throughout the entire body including legs. It is causing amputations in healthy individuals. We’re seeing blood clots in the lungs that can cause a pulmonary embolism and can lead to death. We’re seeing people with stroke because of blood clots in the brain. Definitely, we’re seeing heart failure and furthermore, it’s harder to treat because you can have a build up of hydrogel like substance in the lungs and this inhibits the ability of the lungs to absorb oxygen. So, even if we put you on a ventilator, your lungs aren’t able to get that oxygen your body needs to continue with its normal function. We’re seeing other things too. We’re seeing some late term miscarriage and while rare, it occurs. We’re seeing overactive inflammatory response and we’re seeing a higher incidence of multisystem inflammatory response syndrome in children after they’ve recovered from the Coronavirus.

Host:  Yeah and let’s talk about recovery. Because there seems to be this feeling that if you have a mild case of COVID-19, that you’re going to be just fine and that’s not necessarily the case is it?

Dr. Khandelwal Gilman:  You know there’s a big misconception that as long as you fall into the mild or moderate group of COVID-19 infection; you’ll recover completely. And this is a unfortunate falsehood. And what we are continuing to find is that there are severe lasting effects of COVID-19 infection even with those who are asymptomatic. So, you can have a healthy individual that has a very mild infection and shows up months later with fatigue or headache, brain fog, insomnia, joint pain, chest pain, shortness of breath, heart arrhythmias, high blood pressure among other symptoms. There’s been several COVID recovery clinics and those are being flooded, they are not being able to get anyone in for a long time because so many people are coming with these symptoms. Recently, a JAMA article which is one of the highest quality medical journals we have, released a study that showed that 78 out of 100 people had cardiac or abnormalities two to three months after infection. And 60 out of 100 had ongoing heart inflammation, independent of their preexisting conditions, severity and overall course of acute illness or from the time from original diagnosis.

So, that’s scary. That 78 out of 100 people had cardiac abnormalities. We’re seeing lots of lung fibrosis even in asymptomatic people. And in fact, these are so severe, that COVID-19 infection will preclude possible military recruits from joining. And those include any recruits who were hospitalized or had any disqualifying post infective complications. This is a very severe disease and we don’t know what the long term sequelae will be.

Host:  Well we definitely know a lot more now than we did when this started let’s say back in March and when we talk about medications, we’ve heard about remdesivir, or even convalescent plasma. So, when we talk about medications that might prevent or treat COVID-19, what’s the fact versus fiction there?

Dr. Khandelwal Gilman:  So, at this time, unfortunately, we do not have any medication that can prevent or treat it. Hydroxychloroquine, which you’ve seen a lot in the news has was initially promising, but the studies have now shown that there’s no difference in people receiving it in their rate of catching the Coronavirus. What we are getting better at is treating those who have infections. So, like you were mentioning, convalescent plasma and remdesivir as well as some steroids, we’re seeing a much better outcome in patients. Additionally, we’re putting patients on anticoagulation when they meet certain indications. All of these increase the survival rate of patients but unfortunately, we have a long way to go and there are other factors that we’re facing like shortages of these medications. We’re facing some regions that are hit really hard run out of ventilators and ICU beds and treat everybody with the same attention that we would like to do that’s going to increase those rates when we have each doctor covering 20 to 30 ICU patients, they’re not going to be able to catch everything. So, our systems are overwhelmed when this disease comes out of control which is why we’re working so hard on not spreading the infection and keeping the numbers down.

Host:  And one of the ways that we can keep the numbers down of course, is to test and to test as many people as possible which of course wasn’t possible early on and our ability to test and to turn those results around quickly has definitely changed. And I think one of the misconceptions and maybe you can confirm or deny this, one of the misconceptions is that the COVID-19 test has a high false positive rate. Is that true?

Dr. Khandelwal Gilman:  That is a myth. That is in fact false. False positives are rare. What we see more is higher rates of false negatives. And there are several types of tests. There’s a PCR and an antigen test. Those tests are used to determine if you have an active infection. The antigen test may pick up only 7 out of 10 positive cases. So, that means that 3 out of 10 people who have the active COVID-19 have a false negative. This false negative can also be higher if you get a test too soon or too late. If you are just exposed, you may not have as many viral particles as is required to actually show up on a test or if it’s too late. PCR tests are much more accurate. There’s been some discussion that they are so accurate they can pick up viral particles that are no longer active. And what that means is that say you had an infection and you recovered. So, you are no longer contagious. If the PCR can pick up fragments of your virus, then you will get a positive test saying yes, you have that when you are actually not in fact, infectious anymore. So, that’s not a false positive, that’s just a positive when you no longer need to quarantine.

And those are much rarer. For the most part, if you have a positive test; that means that you have the infection. The antibody test on the other hand, is a test that determines if you have in the past had the COVID-19 infection. This occurs after your body has time to make the antibodies. And we are not quite sure what that means when you have antibodies, but we are studying right now how long they last and if that confers any immunity or not. And at this time, we cannot safely say that if you’ve had it before, you are immune or how long you’re immune. So, that is a big area of study that is happening right now.

Host:  Yeah, and again, it feels like we know so much more now than we did before and yet, the longer I hear you talk today, the more I realize there’s just still so much we don’t know, and we may not know for some time. Maybe we don’t even find out the answers to some of these questions until after there’s a vaccine. One of the things I know, during COVID-19, and during lockdown, is that people have been drinking alcohol more. In fact, a lot of stores and companies have made it really easy to have it shipped to your house and I don’t know whether that’s because people think it has any effect on the virus or not but I’m going to assume that drinking alcohol does not reduce the risk or rate of infection. Does it?

Dr. Khandelwal Gilman:  You are correct. Unfortunately, alcohol while using a hand sanitizer of 70% alcohol is effective in killing the virus on surfaces or your hands; it is ineffective if consuming alcohol and this is one of the many hard side effects of this really hard time for our country and the world. People have been increasing their alcohol consumption at alarming rates. And in addition, to having the effects of alcoholism, you are decreasing your immune system. You’re actually preventing your body’s natural abilities to fight off the Coronavirus, so you are putting yourself at higher risk of infection.

Host:  I want to shift to talking about face masks. You and I were talking off the air a little bit and let’s just start here right up front. Do face masks help to prevent the spread of COVID-19?

Dr. Khandelwal Gilman:  Yes. They do. This is a hot topic. And a lot of this comes from the fact that when COVID-19 first hit, there was a lot of disagreement for many reasons about the use of face masks. But as time has gone, the majority of scientists, politicians, and physicians have come to a consensus that wearing masks in public prevents the spread or helps curb the spread. The role of the mask and the degree of protection will change with the type of mask used. And this makes sense. So, if you think about the way that the disease is spread; it’s spread by droplets and aerosolized particles that releases when someone sneezes, talks, laughs, sings, coughs, breathes. Wearing a mask will decrease the amount of droplets and virus particles an infected person will release. The better the mask, the more droplets and virus particles will be caught. The real issue that we have is you wear a mask to protect those around you. You wear a mask if you keep your businesses open. You wear a mask to protect everybody, not just the people who are sick or have multiple comorbidities. You wear a mask to protect everyone around you from catching and spreading it.

The thing to remember too is that you don’t need to wear a mask just when you have symptoms, but you wear it all the time. And the reason is, you are most infectious before you have any symptoms. So, the time leading up into your infection until when you start to get aching, yo start to get fevers, of cough. That is when you are having the highest viral count in your body. So, if you wear it all the time, you will be able to prevent the spread or at least slow the spread when you are infective. The other thing is that masks also do confer some protection to the wearer. But this again, depends on the type of mask. And additionally, it depends on how you wear the masks. So, if you are wearing a mask but it’s below your nose or if you are wearing a mask that is thin and you can see through, or even if you wear a mask and it’s protecting, the coronavirus is on the outside of your mask and then you touch your mask and touch your mouth or your nose or your eyes; you’re still going to be able to transmit those viral particles into your body.

Host:  And Doctor, we know that not all masks are the same. So, let’s go through that. What’s the best type of mask to wear and how should we be wearing them?

Dr. Khandelwal Gilman:  The best masks are two to three layers. The first layer is a hydrophilic that can absorb water like a cotton. The second layer can be like a coffee filter or another layer of cotton or some sort of filter. And then the third layer is something that kind of repels water so a polypropylene on the outside or a polyester cotton blend. And that kind of is going to maximize both your protection and the spread. The next thing is you want to wear the mask securely over your nose and mouth, secure it under your chin. You want it to not have big gaps and people who are wearing the mask under your nose think of it like wearing your underwear below your genitals, it doesn’t work. You pull it up over your nose. The next is when you take them off, if you just consider the outside of your mask to be dirty. That is what has been collecting and protecting you and have all of the possibly dangerous viral particles. So, when you take it off, you take it off behind your ears. You fold it with the inside out so that all of that dirty layer is folded inside and then you wash it after you wear it.

Additionally, the CDC does not recommend the use of gaiters or face shields at this time. They are actively evaluating face covers but right now, they are not sure about the effectiveness of them so it’s best to not wear them.

Host:  And Doctor, I’m sure many of us have seen these videos from stores, these confrontations over wearing masks. And I’m wondering if you have any thoughts about why mask wearing has been so polarizing?

Dr. Khandelwal Gilman:  Part of the problem of when this mask debate hit is that there was a lot of factors at hand. One was that there was a mask shortage for healthcare providers. So, by having the public wear masks they were taking the needed supplies from healthcare providers. The second was that masks became politicized and I think subsequent to that, we’ve kind of all come to a conclusion that it’s actually – there is no political statement you make by wearing a mask. You can put your beliefs on the mask. Coronavirus does not care if you are a certain color, if you are a certain religion, if you’re a certain political party. Coronavirus will hit everybody equally. And so I think that just like you do certain things to protect the society like you observe traffic laws, you wear seatbelts. These are things that are just safety measures you do if you are part of the society to protect those around you and protect yourself.

And so I think that what started off message was having if you wear a mask you are believing this and if you don’t wear a mask, you’re showing your belief of this. But I think right now, we’ve kind of come to a conclusion that wait if we want to keep our country open and we do, we do, these are devastating effects. And if we want to keep each other healthy, you wear a mask. And in regards to the dangers of the mask, I’m a surgeon, and I have asthma. I have worn a mask for up to 14 hours in a specific case, a case where I am having to focus so intensely that one millimeter slip of my hand can be catastrophic for the patient. And I don’t like them. I don’t like the smell. They can erode my skin. I’ve gotten wounds from them. But I wear them. And I have worn them before this. I will continue to wear them. And I’ve never had CO2 poisoning. I do not use a special mask. There have been studies that showed prolonged use of masks when worn properly, do not cause CO2 intoxication or oxygen deficiency.

There are some groups, very few, for example someone with severe COPD who may need to discuss this with their physician and on a case by case basis, they can discuss whether it is safe for them. But the majority of people over two years old should be wearing a mask to prevent them but more importantly to prevent the spread of the disease and keep our country open.

Host:  Absolutely. And we kind of started things today by just addressing the elephant in the room if you will. This is just unlike anything else, any of us have ever seen or experienced before. And I just wanted to ask before we wrap things up here; what’s your optimism level for a vaccine sometime in the near future and do you believe it will be safe and effective for everybody? I know it’s a loaded question but what are your thoughts on the vaccine?

Dr. Khandelwal Gilman:  I think that there’s always a silver lining to every situation. And we as a worldwide community have responded like never before seen. We have the best minds from all over the world, different countries, different languages working on the very same problem at the very same time. We are the fastest in history developing this vaccine. Luckily, we have been doing vaccines for a long time, so we have a head start in that we know kind of how they work. We have a system for them before we even had like narrowed the candidates, we were building facilities to make and distribute possible vaccine candidates.

So, I’m very, very optimistic about this. We’re doing widespread studies now and they are very promising results. I think that as far as the safety of that vaccine, I think that we have a lot of data on decades and decades of very in depth data on the safety of vaccines. So, one, I will recommend my family and high risk individuals to have a vaccine. And I also will take the vaccine when it comes. It is a loaded question. I can’t guarantee that the outcomes of it, but what I’ve seen is very, very promising. But in the meantime, we don’t have it and I don’t think we’re going to have it for several months at least and then when we do have it, we’re going to have to distribute so much of it. So, what we need to do as a public to keep each other safe and keep our families safe and keep our communities open and our businesses going is we need to stay home if we are sick. Stay at least six feet apart. Wear a mask. Wash your hands with soap and water for 20 to 30 seconds and avoid touching your eyes, nose, mouth with unwashed hands.

Host:  Things have changed so much. There are things that we didn’t know before that we know now and when it comes to science and medicine and all of this; how do we explain to listeners how things have changed, how much they’ve changed, why they’ve heard different things along the way? How do we explain that to them?

Dr. Khandelwal Gilman:  Well when COVID-19 first hit, it was a novel virus the world had never seen. People were collapsing in the streets of China, the virus was spreading rapidly without thought to boundaries, politics or race. Scientists and physicians around the world were so desperate to try to figure out the mechanism of the disease, how to prevent infection and how to treat patients that were acting different from anything they had ever seen before. And there are standard pathways of science that include rigorous experiments where and I’m a scientist, so I’ve been through this. it is frustrating and slow. You do an experiment, it fails. You do another one and it fails. You have an idea, you test it, it’s not correct. You work really hard until you find something that works and then you repeat it, then you submit it for peer review, then they have questions, they go back, you write it up, it’s edited, it’s sent back. You do extra experiments. You do extra studies. You finally submit it and you publish it and all of this process has happened in the public eye. Because the time has been measured in human lives. So, instead of doing the rigorous studies and peer reviews people were so desperate to get their information out so prepublication papers were released, theories were flooding out and people were clamoring for effective treatment based on a similar virus in the past.

We additionally faced worldwide shortages that kind of came as the results if we don’t have enough masks to protect our healthcare providers who have know exposure, why would we be telling people to go out and buy them and take them away from the healthcare providers? But luckily, as more information emerged about COVID-19, and our supply chains have been able to accommodate for the increased strain, we’re now very certain that there are certain measures that can be used to help curb the spread of COVID-19. Those include, mask wearing, hand washing and social distancing.

Host:  And Doctor, as we wrap up here today, I know that you and a number of your family members are COVID-19 survivors. And that’s amazing. So, what was that experience like? Contracting the virus, surviving it and what have been the after effects of having COVID-19?

Dr. Khandelwal Gilman:  I got it in early March before the lockdown, before we knew a lot about the virus. And it was – I was the first person who was tested, and I actually had a false negative test which is why I can speak to the high rate of false negative tests with COVID-19. At the same time, my dad got it, my brother got it, my sister got it and probably several other family members who were unable to be tested. And each one of us had a different severity of disease. Each one of us has different long standing complications. My sister who is an absolute athlete, lost her taste and smell and was tired and had a very minimal disease. She recovered without any incidents. My brother who is also very athletic, healthy and young, he had a more severe disease where he had extended fevers and his long term sequalae include palpitations, fatigue and shortness of breath. I have asthma and my asthma has really been affecting my breathing. I wake up at night unable to breathe. And causes a lot of anxiety. I don’t have the same exercise tolerance and I’m an athlete and I’m healthy as well. My dad who is older, was very scary. But he survived. He lost 20 pounds and was really fatigued but when I was infective it was the fear of me who am I going to infect. I was really careful to stay at home. But it’s that fear that I’m carrying something that could cause death of somebody else and then just waiting and seeing how it’s affecting my body and waiting and seeing how it’s affecting my family’s body, and will these symptoms go away or will they continue.

I’m very passionate about spreading this information about prevention because I’ve gone through that and when people say this is nothing and this is not a real disease, or this doesn’t have real consequences; I didn’t find that to be true for myself. I haven’t seen that to be true for my patients. And while fortunately, many people do recover without any complications; I feel so passionate that we can really help mitigate the spread and protect people from going through what we did with simple tools of face masks, hand washing, social distancing.

Host:  Definitely. And just listening to you, hearing you speak today and your knowledge and your advice and your own personal story and the story of your family; thank you so much for sharing that. I know you’re not trying to be. You’re just trying to save lives, but I really found it to be inspirational and I really do appreciate your time today. Thank you. That’s’ Dr. Kaite Khandelwal Gilman. And for more information go to www.dignityhealth.org/central-california/locations/marktwainmedical. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Hello Healthy a Dignity Health podcast. I’m Scott Webb. Stay well.