Selected Podcast
UNPUBLISHED BY REQUEST-Social Distancing - The Science and Impact on COVID-19
Dr. Patricia Cummings explains how COVID-19 is transmitted, who is at risk, what it means to be asymptomatic, why wearing masks and employing social distancing techniques has been so important and how Eisenhower Medical Center is preparing to deal with COVID-19 patients while keeping non-COVID-19 patients safe.
Featuring:
Patricia Cummings, PhD, MPH
Dr. Patricia Cummings is the Director of the Department of Epidemiology Research and Evaluation. She received her doctorate in Epidemiology from the University of California Los Angeles (UCLA) Jonathan & Karin Fielding School of Public Health, and a Master’s Degree in Public Health with a specialization in Epidemiology and Biostatistics from the Keck School of Medicine at the University of Southern California. Dr. Cummings joined Eisenhower in 2016 to conduct epidemiologic research and perform a wide range of investigative and analytical activities related to hospital-based disease surveillance, antibiotic stewardship, infection prevention and control, and population health. She has been the principal or co-principal investigator of multiple federal and local-funded research and evaluation studies focusing on antibiotic resistance prevention, the built environment, foodborne diseases, obesity, diabetes, and cardiovascular health, including school-based nutrition and food policy implementation. She has also conducted research on age-related diseases and received an award from the City of Los Angeles in 2009 for her research. In 2015, Dr. Cummings developed and led the Built Environment & Health Impact Assessment Unit at Harris County Public Health in Houston, Texas. She was selected by the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials to be a mentor for their Health Impact Assessment Demonstration Sites. From 2008 to 2014, Dr. Cummings worked for the Los Angeles County Department of Public Health and was involved in a number of high-profile, public health policy evaluation efforts, such as menu-labeling, the County of Los Angeles’ Healthy Food Procurement Board Motion and 100% Healthy Vending Machine Policy. As reflected in her 2014 invited speech at the prestigious CDC Public Health Grand Rounds, “Preventing A Million Heart Attacks and Strokes,” and her publications on chronic and infectious diseases, she has substantive experience working on public health issues both nationally and locally. Transcription:
Bill Klaproth (Host): This Eisenhower Health podcast on COVID-19 recorded on May 12, 2020.
We’re all being asked to wear masks and social distance, so what is the science behind this? How important are these measures and how long will we need to do this? Let’s find out with Patricia Cummings, Director of Epidemiology, Research and Evaluation at Eisenhower Health. Dr. Cummings, thank you so much for your time. So, you’re an epidemiologist. Can you explain to us what is epidemiology?
Patricia Cummings, PhD, MPH (Guest): Epidemiology as I’m sure a lot of people are hearing in the news these days is the study of disease in human populations. And there are actually different subspecialties of epidemiology like infectious disease epidemiology, cancer, chronic disease. But right now, a lot of epidemiologists are obviously focused on studying the spread of the SARS-COV-2 virus which is the virus that causes COVID-19 in our population.
Host: Well as an epidemiologist, I’m sure you’re very busy with the COVID-19 pandemic. So, let me ask you this. Can you explain the types of information you are trying to gather and share with the community?
Dr. Cummings: Yes. So, we are gathering information on COVID-19 testing, confirmed cases, hospitalizations, and deaths and we track trends of these surveillance measures across our population as well as resource utilization. Things like ICU occupancy, ventilator use so that we are able to prepare for any potential surge or future peaks of COVID-19. And something we did early on in the epidemic back in late January or early February was model the projected spread of COVID-19 in our communities. So, together with my colleague Dr. Roch Nianogo from the UCLA Fielding School of Public Health and our Epidemiology team here at Eisenhower Health, we developed a model to project the spread of this virus across our Coachella Valley Population. And the model looks at a susceptible population and how people in that population once they are exposed to this virus go from infected to either hospitalized, recovered or death. And the reason we did this is because our population is very different from other parts of Riverside County, the region, the state. We have a large elderly population and also other vulnerable or at risk population such as those with chronic disease or those who are immune suppressed and the results from this model helped our hospital and our community plan for COVID-19 emergency response.
Host: So, help us understand this then. What is the epidemiology of COVID-19 and how does it impact transmission between people?
Dr. Cummings: Oh yes. So, globally, to date, we know there have been about 4 million total cumulative confirmed cases with about 300,000 deaths and about one million of those cases and 80,000 deaths have actually occurred in the United States. In California, what we’re seeing is about 70,000 have been infected with close to 3000 deaths which gives us what we call in epidemiology, a case fatality ratio of about 4%. So, how does this impact transmission? That’s a great question and what we use in epidemiology is called the R nought. Have you heard of it?
Host: I have heard of it, yes.
Dr. Cummings: So, it is an important concept in epidemiology and is a crucial part of public health planning during an outbreak. It describes the intensity of an infectious disease outbreak by looking at the average number of cases an infected person will cause during their infectious period. So, initial estimates out of Wuhan, China suggested an R nought of around 2.2 to 2.7. But I’ve seen this range from 1 all the way up to 5. And this is really important because we use this number to project the spread. So, since the current COVID-19 pandemic has an R naught of around 2, that means one person infects two people, those two infect another two and so on and so forth. So, to put this into perspective, measles has an R nought that ranges from 9 to 18. So, it’s highly infectious. So, these are the types of measures that as an epidemiologist, we continue to track in order to track the spread of this virus.
Host: This is really, really interesting stuff. So, I’ve read that an R nought below one is when we stop this thing in its tracks basically.
Dr. Cummings: Yes, exactly. Exactly. You got it.
Host: Well see I’m a quick learner Dr. Cummings. So, let me ask you this. You talked about the case fatality rate being at 4% in California. How is that calculated and how does that figure into the pandemic?
Dr. Cummings: That’s a great question. And I’m glad you asked this question because it’s a really important point for people to understand. The case fatality rate is the number of deaths that occur divided by the total number of confirmed cases. So, this is very different from what is the mortality rate which divides the number of deaths by the total number of susceptible people in a population. So, because these are two very different measures; there has been a lot of confusion in the media. And one notable recent example were two doctors in Bakersfield, California who were listing off death rates, but they failed to understand the critical difference between these two and the importance of what we call selection bias.
So, there are a lot of intricate things in epidemiology that we are very familiar with that others may not be aware of. And so, case fatality rates change over time with the epidemic and they change based on area and can vary even by community. So, it’s important to understand that there is a difference between those two.
Host: All right, we thanks for explaining that to us. So, a case fatality rate of 4%, that is a lot more deadly than the flu?
Dr. Cummings: Yes. Compared to flu, yes, exactly. And we know that certain people, so the case fatality rate may vary across populations. So, for example, with people with comorbidities, there is limited information right now about risk factors for disease severity. But based on what we know so far, is that older adults and people with serious underlying medical conditions may be a higher risk for severe infection and even death.
Host: So, for people with an underlying health condition or other comorbidities such as heart disease, diabetes, cancer; these people are at higher risk to get sicker if they contract COVID-19. Is that right and do we know why?
Dr. Cummings: Yes. So, people who are 65 years and older, people who live in a nursing home and people of all ages actually who have underlying medical conditions like chronic lung disease, heart disease and conditions that can cause someone to be immune compromised. What’s interesting is since we don’t know a lot about this new disease, scientists are using what we do know from SARS-COV which was the virus that caused the 2002 to 2003 outbreak. And it’s similar to SARS-COV2 in that both of these viruses bind to a protein called ACE-2 and I don’t want to get too into the weeds here, but angiotensin converting enzyme ACE-2; this protein is expressed in high concentrations in our lungs and because this is the protein SARS binds to; it’s able to invade our lungs and since our lung tissue has a lot of ACE on it’s surface, when it gets into your lungs; it can cause pneumonia.
So, for people with underlying conditions, it actually makes it very difficult for your immune system to launch a good immune response. So, this allows the virus to colonize, infect and make you very, very sick.
Host: Well that makes it very easy to understand why people with underlying health conditions are at a higher risk to get sicker if they contract COVID-19. So, thank you for explaining that to us. That makes a lot of sense. And then can you explain why wearing masks and employing social distancing has been so important and why it will continue to be, and then can you talk about people that are asymptomatic? What does that mean?
Dr. Cummings: Two great questions. So, first, to get a COVID-19 you need to get respiratory droplets from an infected person who coughs or sneezes into your nose, eyes, or mouth. So, it’s really important that we are all washing our hands regularly or using hand sanitizer with wearing masks. The hope is that the virus spread will slow down by covering your nose and mouth, especially for those who are symptomatic. If they cough while wearing a mask, those droplets will be contained by the mask. And that’s another reason physical distancing is so important because the farther that you are from individuals who are symptomatic; the less likely you are to contract the disease from the droplets of an infected person.
Another concern is that droplets live on surfaces and someone who touches those surfaces can then touch their face and get the virus. The likelihood of this happening is pretty rare and as long as you are washing your hands and practicing good hand hygiene and don’t touch your face; then that becomes even less likely.
In terms of asymptomatic people, so asymptomatic means that the person may be infected without producing or showing symptoms. And what we know from this current virus is that the incubation period which is when you are exposed until when you get the symptoms is about five to six days. So, what that means is a person can be infected for five to six days with the virus before showing any symptoms, and in that time, could be spreading the virus to others. So, we know there could potentially be a large number of infected people who don’t show any symptoms, for example one study showed about 80% of cases were mild or with little to no symptoms. So, given this information, epidemiologists have known that the real number of infections was and is likely to be much higher than the confirmed and reported cases that we’re seeing.
Host: So, that just illustrates how easily COVID-19 is spread and why wearing masks, washing our hands, not touching our face, physical distancing as you call it, is so important. And these measures are going to be around with us for a while, isn’t that right?
Dr. Cummings: Yeah, well when we begin to enter into the different phases of reopening, especially in California, it’s important that people continue to practice the recommended public health measures. So, we – what I like to tell people is we are really entering a new normal. But hopefully, it’s a safe normal that protects all people regardless of age, race or socioeconomic status and we really need to be protecting our most vulnerable population. So, as I mentioned, those with chronic conditions that can’t launch that good immune response. So, that’s why it’s so important that we continue to practice physical distancing and mask wearing to protect those vulnerable populations.
Host: So, we all need to do our part. We all have a role to play. And you’ve done a great job of clearing up some confusion for us. Here’s another one I think there’s some confusion about flattening the curve in the minds of the average person. It benefitted our healthcare systems because we didn’t overwhelm them with more patients than they can handle. But that doesn’t mean we are done with the virus. It means we will see the virus in the community for a longer period of time, correct?
Dr. Cummings: That is correct. The virus isn’t going away. So, initially, we wanted to slow the spread so that our healthcare systems were not overwhelmed. So, this is what we meant by flattening the curve. And to do that, we implemented all these protective measures like home quarantine, physical distancing, school and business closures. So, the larger the population, and or the more dense a city is, like New York, the more people are susceptible and the harder it is to control. So, for example, the Coachella Valley has about 440,000 people on average. We know that fluctuates with our seasonal residents while LA County has 10 million people and it’s a lot more dense than here. Therefore, we expect to see more cases and spread in LA County versus Coachella Valley.
Now with that said, just because we may see a lower number of cumulative cases in our valley, it doesn’t mean we won’t potentially see greater disease severity or death due to the fact that our population is high risk, largely elderly with many comorbid conditions. But the bottom line is COVID-19 isn’t going anywhere and we may continue to see periodic spikes as things start to reopen or we may see another large surge potentially in the fall. We just don’t know yet how for example, climate or seasons will affect this virus. So, it’s important we remain vigilant.
Host: Yes, that’s something we all need to do. So, many people have been delaying care because of concerns about going to the hospital. So, is it safe for people to go to the doctor or hospital if they need to? Many people have these pent up healthcare needs. Can you talk about how Eisenhower has addressed these safety concerns?
Dr. Cummings: Well I think the hospital is actually one of the safest places to be right now. So, do not hold off your healthcare needs. If you need to see a doctor or have an emergency, please seek care immediately. Eisenhower Health has implemented many protective measures for our patients and staff including masking everybody who enters our hospital at every entrance. We also set up a COVID hotline. So, people can call ahead prior to coming into the hospital where they are asked a number of screening questions. And it’s really important that people continue to call that hotline if they think they’re sick with COVID-19 so we can triage them appropriately.
In addition, for suspected COVID-19 patients, there are separate entrances and designated screening areas and we also have a large testing drive through that’s away and separate from all of our hospital buildings for people who have an appointment to get tested with COVID. For people with regular appointments, patients are actually being screened when they arrive so that the risk for all patients and staff is minimized. And we also, are using innovative things like Telehealth options for those nonurgent healthcare needs. So, Eisenhower Health has really done a lot and has taken a lot of precautions to reduce the risk here and so, the safety of our patients is really of our utmost priority.
Host: And then last question Dr. Cummings. How is Eisenhower Health preparing for and dealing with COVID-19 patients while continuing to serve other patients and ensure safety for the community?
Dr. Cummings: Yes so, we are continuing to inform the community about the epidemiologic trends of COVID-19 in the Coachella Valley so that they understand the ongoing presence of the virus including any signs of another spike or a large surge. And this information is critical to get out so that hospitals in the community can adequate prepare and respond. So, we are continuing to track the trends for our community and distribute this information publicly.
Host: Really good information and a great message. Dr. Cummings, thank you so much for your time. This has really been informative and insightful. Thank you again. We really appreciate it.
Dr. Cummings: Thank you.
Host: That’s Dr. Patricia Cummings and to learn more about how Eisenhower Health is managing the Coronavirus, please visit www.eisenhowerhealth.org/coronavirus. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): This Eisenhower Health podcast on COVID-19 recorded on May 12, 2020.
We’re all being asked to wear masks and social distance, so what is the science behind this? How important are these measures and how long will we need to do this? Let’s find out with Patricia Cummings, Director of Epidemiology, Research and Evaluation at Eisenhower Health. Dr. Cummings, thank you so much for your time. So, you’re an epidemiologist. Can you explain to us what is epidemiology?
Patricia Cummings, PhD, MPH (Guest): Epidemiology as I’m sure a lot of people are hearing in the news these days is the study of disease in human populations. And there are actually different subspecialties of epidemiology like infectious disease epidemiology, cancer, chronic disease. But right now, a lot of epidemiologists are obviously focused on studying the spread of the SARS-COV-2 virus which is the virus that causes COVID-19 in our population.
Host: Well as an epidemiologist, I’m sure you’re very busy with the COVID-19 pandemic. So, let me ask you this. Can you explain the types of information you are trying to gather and share with the community?
Dr. Cummings: Yes. So, we are gathering information on COVID-19 testing, confirmed cases, hospitalizations, and deaths and we track trends of these surveillance measures across our population as well as resource utilization. Things like ICU occupancy, ventilator use so that we are able to prepare for any potential surge or future peaks of COVID-19. And something we did early on in the epidemic back in late January or early February was model the projected spread of COVID-19 in our communities. So, together with my colleague Dr. Roch Nianogo from the UCLA Fielding School of Public Health and our Epidemiology team here at Eisenhower Health, we developed a model to project the spread of this virus across our Coachella Valley Population. And the model looks at a susceptible population and how people in that population once they are exposed to this virus go from infected to either hospitalized, recovered or death. And the reason we did this is because our population is very different from other parts of Riverside County, the region, the state. We have a large elderly population and also other vulnerable or at risk population such as those with chronic disease or those who are immune suppressed and the results from this model helped our hospital and our community plan for COVID-19 emergency response.
Host: So, help us understand this then. What is the epidemiology of COVID-19 and how does it impact transmission between people?
Dr. Cummings: Oh yes. So, globally, to date, we know there have been about 4 million total cumulative confirmed cases with about 300,000 deaths and about one million of those cases and 80,000 deaths have actually occurred in the United States. In California, what we’re seeing is about 70,000 have been infected with close to 3000 deaths which gives us what we call in epidemiology, a case fatality ratio of about 4%. So, how does this impact transmission? That’s a great question and what we use in epidemiology is called the R nought. Have you heard of it?
Host: I have heard of it, yes.
Dr. Cummings: So, it is an important concept in epidemiology and is a crucial part of public health planning during an outbreak. It describes the intensity of an infectious disease outbreak by looking at the average number of cases an infected person will cause during their infectious period. So, initial estimates out of Wuhan, China suggested an R nought of around 2.2 to 2.7. But I’ve seen this range from 1 all the way up to 5. And this is really important because we use this number to project the spread. So, since the current COVID-19 pandemic has an R naught of around 2, that means one person infects two people, those two infect another two and so on and so forth. So, to put this into perspective, measles has an R nought that ranges from 9 to 18. So, it’s highly infectious. So, these are the types of measures that as an epidemiologist, we continue to track in order to track the spread of this virus.
Host: This is really, really interesting stuff. So, I’ve read that an R nought below one is when we stop this thing in its tracks basically.
Dr. Cummings: Yes, exactly. Exactly. You got it.
Host: Well see I’m a quick learner Dr. Cummings. So, let me ask you this. You talked about the case fatality rate being at 4% in California. How is that calculated and how does that figure into the pandemic?
Dr. Cummings: That’s a great question. And I’m glad you asked this question because it’s a really important point for people to understand. The case fatality rate is the number of deaths that occur divided by the total number of confirmed cases. So, this is very different from what is the mortality rate which divides the number of deaths by the total number of susceptible people in a population. So, because these are two very different measures; there has been a lot of confusion in the media. And one notable recent example were two doctors in Bakersfield, California who were listing off death rates, but they failed to understand the critical difference between these two and the importance of what we call selection bias.
So, there are a lot of intricate things in epidemiology that we are very familiar with that others may not be aware of. And so, case fatality rates change over time with the epidemic and they change based on area and can vary even by community. So, it’s important to understand that there is a difference between those two.
Host: All right, we thanks for explaining that to us. So, a case fatality rate of 4%, that is a lot more deadly than the flu?
Dr. Cummings: Yes. Compared to flu, yes, exactly. And we know that certain people, so the case fatality rate may vary across populations. So, for example, with people with comorbidities, there is limited information right now about risk factors for disease severity. But based on what we know so far, is that older adults and people with serious underlying medical conditions may be a higher risk for severe infection and even death.
Host: So, for people with an underlying health condition or other comorbidities such as heart disease, diabetes, cancer; these people are at higher risk to get sicker if they contract COVID-19. Is that right and do we know why?
Dr. Cummings: Yes. So, people who are 65 years and older, people who live in a nursing home and people of all ages actually who have underlying medical conditions like chronic lung disease, heart disease and conditions that can cause someone to be immune compromised. What’s interesting is since we don’t know a lot about this new disease, scientists are using what we do know from SARS-COV which was the virus that caused the 2002 to 2003 outbreak. And it’s similar to SARS-COV2 in that both of these viruses bind to a protein called ACE-2 and I don’t want to get too into the weeds here, but angiotensin converting enzyme ACE-2; this protein is expressed in high concentrations in our lungs and because this is the protein SARS binds to; it’s able to invade our lungs and since our lung tissue has a lot of ACE on it’s surface, when it gets into your lungs; it can cause pneumonia.
So, for people with underlying conditions, it actually makes it very difficult for your immune system to launch a good immune response. So, this allows the virus to colonize, infect and make you very, very sick.
Host: Well that makes it very easy to understand why people with underlying health conditions are at a higher risk to get sicker if they contract COVID-19. So, thank you for explaining that to us. That makes a lot of sense. And then can you explain why wearing masks and employing social distancing has been so important and why it will continue to be, and then can you talk about people that are asymptomatic? What does that mean?
Dr. Cummings: Two great questions. So, first, to get a COVID-19 you need to get respiratory droplets from an infected person who coughs or sneezes into your nose, eyes, or mouth. So, it’s really important that we are all washing our hands regularly or using hand sanitizer with wearing masks. The hope is that the virus spread will slow down by covering your nose and mouth, especially for those who are symptomatic. If they cough while wearing a mask, those droplets will be contained by the mask. And that’s another reason physical distancing is so important because the farther that you are from individuals who are symptomatic; the less likely you are to contract the disease from the droplets of an infected person.
Another concern is that droplets live on surfaces and someone who touches those surfaces can then touch their face and get the virus. The likelihood of this happening is pretty rare and as long as you are washing your hands and practicing good hand hygiene and don’t touch your face; then that becomes even less likely.
In terms of asymptomatic people, so asymptomatic means that the person may be infected without producing or showing symptoms. And what we know from this current virus is that the incubation period which is when you are exposed until when you get the symptoms is about five to six days. So, what that means is a person can be infected for five to six days with the virus before showing any symptoms, and in that time, could be spreading the virus to others. So, we know there could potentially be a large number of infected people who don’t show any symptoms, for example one study showed about 80% of cases were mild or with little to no symptoms. So, given this information, epidemiologists have known that the real number of infections was and is likely to be much higher than the confirmed and reported cases that we’re seeing.
Host: So, that just illustrates how easily COVID-19 is spread and why wearing masks, washing our hands, not touching our face, physical distancing as you call it, is so important. And these measures are going to be around with us for a while, isn’t that right?
Dr. Cummings: Yeah, well when we begin to enter into the different phases of reopening, especially in California, it’s important that people continue to practice the recommended public health measures. So, we – what I like to tell people is we are really entering a new normal. But hopefully, it’s a safe normal that protects all people regardless of age, race or socioeconomic status and we really need to be protecting our most vulnerable population. So, as I mentioned, those with chronic conditions that can’t launch that good immune response. So, that’s why it’s so important that we continue to practice physical distancing and mask wearing to protect those vulnerable populations.
Host: So, we all need to do our part. We all have a role to play. And you’ve done a great job of clearing up some confusion for us. Here’s another one I think there’s some confusion about flattening the curve in the minds of the average person. It benefitted our healthcare systems because we didn’t overwhelm them with more patients than they can handle. But that doesn’t mean we are done with the virus. It means we will see the virus in the community for a longer period of time, correct?
Dr. Cummings: That is correct. The virus isn’t going away. So, initially, we wanted to slow the spread so that our healthcare systems were not overwhelmed. So, this is what we meant by flattening the curve. And to do that, we implemented all these protective measures like home quarantine, physical distancing, school and business closures. So, the larger the population, and or the more dense a city is, like New York, the more people are susceptible and the harder it is to control. So, for example, the Coachella Valley has about 440,000 people on average. We know that fluctuates with our seasonal residents while LA County has 10 million people and it’s a lot more dense than here. Therefore, we expect to see more cases and spread in LA County versus Coachella Valley.
Now with that said, just because we may see a lower number of cumulative cases in our valley, it doesn’t mean we won’t potentially see greater disease severity or death due to the fact that our population is high risk, largely elderly with many comorbid conditions. But the bottom line is COVID-19 isn’t going anywhere and we may continue to see periodic spikes as things start to reopen or we may see another large surge potentially in the fall. We just don’t know yet how for example, climate or seasons will affect this virus. So, it’s important we remain vigilant.
Host: Yes, that’s something we all need to do. So, many people have been delaying care because of concerns about going to the hospital. So, is it safe for people to go to the doctor or hospital if they need to? Many people have these pent up healthcare needs. Can you talk about how Eisenhower has addressed these safety concerns?
Dr. Cummings: Well I think the hospital is actually one of the safest places to be right now. So, do not hold off your healthcare needs. If you need to see a doctor or have an emergency, please seek care immediately. Eisenhower Health has implemented many protective measures for our patients and staff including masking everybody who enters our hospital at every entrance. We also set up a COVID hotline. So, people can call ahead prior to coming into the hospital where they are asked a number of screening questions. And it’s really important that people continue to call that hotline if they think they’re sick with COVID-19 so we can triage them appropriately.
In addition, for suspected COVID-19 patients, there are separate entrances and designated screening areas and we also have a large testing drive through that’s away and separate from all of our hospital buildings for people who have an appointment to get tested with COVID. For people with regular appointments, patients are actually being screened when they arrive so that the risk for all patients and staff is minimized. And we also, are using innovative things like Telehealth options for those nonurgent healthcare needs. So, Eisenhower Health has really done a lot and has taken a lot of precautions to reduce the risk here and so, the safety of our patients is really of our utmost priority.
Host: And then last question Dr. Cummings. How is Eisenhower Health preparing for and dealing with COVID-19 patients while continuing to serve other patients and ensure safety for the community?
Dr. Cummings: Yes so, we are continuing to inform the community about the epidemiologic trends of COVID-19 in the Coachella Valley so that they understand the ongoing presence of the virus including any signs of another spike or a large surge. And this information is critical to get out so that hospitals in the community can adequate prepare and respond. So, we are continuing to track the trends for our community and distribute this information publicly.
Host: Really good information and a great message. Dr. Cummings, thank you so much for your time. This has really been informative and insightful. Thank you again. We really appreciate it.
Dr. Cummings: Thank you.
Host: That’s Dr. Patricia Cummings and to learn more about how Eisenhower Health is managing the Coronavirus, please visit www.eisenhowerhealth.org/coronavirus. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I’m Bill Klaproth. Thanks for listening.