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Bill Klaproth: This St. Joseph's Health podcast and COVID-19 recorded on June 25th, 2020.  

St. Joseph's Health presents another edition of its podcast St. Joseph's Health Med Cast. So what have we learned at this point in the COVID-19 pandemic, such as what are the common and less common symptoms? What is the impact of asymptomatic carriers?

What about testing? Who should get tested and will we have a second wave come this fall? Well, let's find out what Dr. Helen Jacoby, Medical Director of infectious disease at St. Joseph's Health. Dr. Jacoby thank you so much for your time. Great to talk with you. So from what we have seen since the COVID-19 pandemic began, it seems as if the disease presents itself in a number of ways, what are the most common and least common symptoms at this point?

Dr. Helen Jacoby: Okay. It's an excellent question. And I'll preface this by saying we are still learning a lot about this virus. We know a lot more now than we did, you know, back in February and March when it first came to this country. But I think we still are going to learn a lot more over the next few years, but the most common symptoms seem to be, a loss of the sense of taste and smell, a fever. Sometimes a fever that the person isn't entirely aware of, cough, some shortness of breath, sort of flu like symptoms. There are a number of patients who feel just really exhausted, and you know, sort of just generally unwell. So I would say that's the most standard presentation that we look for, but there is a lot of variation. There are people who have diarrhea, especially, at the beginning of the illness. And then there are some people who have unusual presentations. There are occasional neurologic symptoms. We had one person at our institution his first sign of this was Guillain-Barre syndrome, which is a neurologic problem related to the immune response to an infection. And that's been seen with other viral infections and has been reported very occasionally with a COVID-19. There are people who develop a blood clot because the viral infection tends to make your blood, a little more susceptible to clotting. So we had one patient where that was her first symptom. And then there were occasional children who have a very exaggerated immune response to this and could be, can become very ill, not from the virus, but from, their immune response. And then there are, of course, people who are, completely asymptomatic, but still have the infection.

Host: So speaking of asymptomatic carriers, it's true, then that a number of people have had COVID-19 but have been a symptomatic. Is that right?

Dr. Jacoby: Yeah. There certainly are people who have the infection are. You know, documented with appropriate testing to have it and never have had any symptoms. And there have been some really good studies looking at this one that was done early in the outbreak was actually in the nursing home in Seattle, where they decided to test all 76 residents. And when they did that, they found that 23 of them were positive, but only 10 of those people had symptoms at the time. So. People that they tested more than half were actually asymptomatic, but a few days later, some of them came down with symptoms, but when all was said and done three of those elderly nursing home residents never developed symptoms from COVID-19. So yeah. It's absolutely true that some people don't have symptoms. The rate of that is much higher in young, healthy people. We believe that in the nursing home residents, I was talking about some people who test positive are what we call presymptomatic meaning that they develop symptoms a few days later, but what you happen to catch. 
Positive tests before the symptoms developed, but many of them go on to never have any symptoms at all.

Host: So these asymptomatic carriers are walking around spreading it, and they don't even know they're spreading it because they don't know they have it. So if that's the case, how do they keep from spreading it to others?

Dr. Jacoby: Yeah, it's another good question. This is where the, universal mask use and social distancing becomes so important because if you yourself cannot be entirely sure that you're not infected. And if you can't be entirely sure that people that you're around aren't infected, the best thing to do is behave as if they might have the infection. So wearing a mask will do an enormous amount at preventing any viral infection from you being transmitted to other people, because if you pull off or when you're speaking, the virus gets caught on the mask and volts spread to others. The mask also helps protect you from, droplets that are coming out of other people's mouths. So that by both people wearing a mask, that's really pretty good protection. If there's nothing. Perfect in terms of COVID-19 prevention, but mask use is enormously helpful. The other thing that's helpful is distance. You know, people talk about a distance of six feet and that's because droplets from somebody's mouth when they're talking or coughing, typically don't travel further than that.
So by staying six feet away from others, by keeping a mask on. you help guard against those asymptomatic shedders then the last thing I will say is that hand hygiene is very important, so that if you're out and about and touching a lot of surfaces and you don't know who else has touched that, and whether they could have accidentally, coughed on their hand and touch the elevator button, if you clean your hands regularly, and especially before you touch your nose or your mouth or your eyes that will help protect you against virus in those scenarios.

Host: And those are really good guidelines. We all. Should be following. So as far as testing goes, in your opinion, who should get tested, should everyone get tested or only those who have symptoms?

Dr. Jacoby: You know, if we could test every single person all at once, that would go a long way. We could, you know, take, you know, we could take everybody who's test positive and put them all in quarantine. And, but, you know, we are testing capability is nowhere close to that. And lots of people wouldn't agree to do it anyway. So., I think a random asymptomatic person. There's no reason to go in and get yourself tested, but there are. Scenarios where it's helpful. For instance, in nursing homes, I have an elderly relative in a nursing home in another state and they go around and test them every two weeks, all the staff and all of the residents. And then, put in quarantine, anybody who test positive and that's been really very, very successful in terms of reassuring everyone that there's not a lot of coronavirus there and in catching any potential outbreaks before they happen. And they've had a very low rate of infection there.

Host: Yeah. Well that seems like a smart, targeted use of testing.

Dr. Jacoby: Exactly. And I think a lot of places, you know, nursing homes, especially are doing that kind of thing. And you could apply that to other scenarios where spread is likely, or if somebody gets infected, for instance, I've got a daughter going back to college in the fall and her college has announced that they're going to test all the students when they arrive. And then try to keep them reasonably separate from everybody else for a week and then touch them again. And again, I think the idea is they're bringing in students from all over the country. They don't want to start an outbreak with an asymptomatic person, so let's test everybody and then let's keep them all in a community together. You know, it's kind of like the nursing home thing. You test everybody when they're coming in and then you try to avoid. People bringing in the infection from outside.

Host: Well, you kind of get a baseline then. Yeah. And you can go from there.

Dr. Jacoby: Exactly. And what you're really worried about is one person spreading the infection to a whole bunch of other people who then spread it to a whole bunch of others. You want to nip that in the bud.

Host: And we nip this in the bud by following the guidelines you mentioned before, where the face covering, wash your hands, practice, social distancing, but. As human nature goes, those things seem to fall by the wayside. People aren't wearing masks as religiously as they should. Are you concerned about that?

Dr. Jacoby: Absolutely. You know, that is the best way of dealing with the fact that you don't know who's infected and who isn't infected all the time and you get success when everybody together follows these guidelines. If you have a lot of people who aren't following the guidelines and some of them become ill and start spreading it to the other people, not following the guidelines, that's when you get resurgence of the infection. You know, and I think we're seeing some of that in the country. I think the stage that have been the most, you know, I don't want to use the word rigid, but where mask use and distancing have really been emphasized, those States I think, are doing better right now than the States that have opened earlier. And haven't been putting as much of an emphasis on distancing and mass cues.

Host: Well, I think there definitely is a correlation between those States that enacted a mask policy early in those that didn't and the States that were. We're seeing a resurgence in now they are now going to a mask policy. So as we see this resurgence in the summer, this is kind of worrisome, looking ahead to the fall. Are you concerned? We're going to see a resurgence of COVID-19 in the fall.

Dr. Jacoby: It is worrisome and you know, I'm worried somewhat right now for the summer, given what's happening in some States where the rates are continuing to rise. In terms of the fall. I don't think we've shown that this virus is more or less common in different seasons or in different temperatures. You know, that's absolutely true of the flu, but I don't know that that's true of coronavirus. So. Fall is concerning because of things like school, starting colleges starting, a lot of people wanted to get back to their normal routines. It's also concerning because the flu will start to come out again and that's going to complicate the situation because the symptoms of flu and coronavirus are very similar. And for medical providers, it's going to be hard to sort out who has, which, and that's also going to stress our testing supplies because it's the same companies that make the flu testing kits that make the coronavirus testing kits. And right now they're putting all their efforts into the coronavirus tests. So I hope we'll have enough testing for flu.

Host: Well, I just hope that we are prepared to come this fall. And can I ask you about. A vaccine, we hear so many different stories about one, one or two or three might be available. Can I ask your thoughts about a vaccine since we hear so many different things?

Dr. Jacoby: Well, you know, I think you hear different things because we really don't entirely know. I know that massive efforts being put into vaccines and a number of places, and I think there's a very good chance that, you know, one or more of them will, will prove to be at least, moderately effective. So I am hopeful that we'll have something that will help, but it could be that it's effective. You know, kind of like the flu vaccine is effective. It prevents a lot of cases, but it's not perfect. Like, vaccines for, you know, smallpox were back in the day of smallpox. And then the challenge of course, will be to get the vaccines to all the right people, because you know, you think about it. Most people in the world really should get vaccinated and the supply will be limited for quite some time, but I do have some hope that that will help. Down the road. I think that is our best, hope. And you don't. We gave it to the most vulnerable people, we might be able to get the rate of coronavirus down to such a low number that we could behave, you know, more or less normally, even if there. Are cases here and there.

Host: And last question, dr. Jacoby, as we move through COVID-19 is it safe to say that our medical professionals are understanding this virus more and really learning how to treat it when they see it?

Dr. Jacoby: Absolutely. That's true. And I should emphasize that the vast majority of people who become ill with COVID-19 have a complete recovery, you know, people hear the stories of the people who don't have a good outcome. And there have been an enormous number of people who've died from this, but the mortality rate is still very, very low compared to the number of people who have it. It's not as low as, you know, the flu, but the mortality rates probably somewhere around no more than, you know, one to 3%. and that it's hard to know, because we don't really know how many people are asymptomatic. But most people who get this, especially otherwise healthy people are likely to do fine. The biggest risks are for people who have underlying illnesses, you know, diabetes, heart disease, hypertension, GOPD, you know, Obesity may be a risk factor. We're still, again, we're still learning a lot of this. 

Host: And we will learn more as we continue on through the COVID-19 pandemic. Well, we thank you for your service and people like you that are helping to educate and take care of us. All Dr. Jacoby. Thank you so much for your time. This has been great. We appreciate it.

Dr. Jacoby: You're welcome. I enjoyed it. Thank you.

Host: That's Dr. Helen Jacoby and for more information, please visit SJHSYR.org/coronavirus. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is St. Joseph's Health Med Cast from St. Joseph's Health. I'm Bill Klaproth. Thanks for listening.