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Scott Webb: This COVID-19 Podcast was recorded on November 10th, 2020. With COVID cases on the rise in Salinas Valley and Monterey County, the flu season upon us and the holiday season nearing, it's a great time to have on Dr. Mahenda Poudel again, he practices at the SPMC multi-specialty clinic in Salinas, and he's an infectious disease specialist at SVMH. This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. So doctor, thanks so much for joining me. How are things looking in Monterey County in regards to the Coronavirus, the death toll, infections, testing, and so forth?

Dr. Poudel: Well, like the rest of the country, you know, cases here in our County are also going up at a really alarming rate. As of yesterday, we've had over 12,000 confirmed cases and hundreds of hospitalization, I want to say probably close to 1000 hospitalization, if not more. And we passed a green threshold of hundred and one deaths in our County. And you know, this is really concerning situations for a County of our size and population.

Host: Those numbers are alarming. Can you tell us which communities have been affected the most by COVID-19? Latinos, African-Americans older people, people with pre-existing conditions?

Dr. Poudel: Like everywhere else, this virus is affecting people of color and lower socioeconomic status. And in our County, mainly it's Hispanics given our demographics. And most of the infections here are clustered around Selena's zip code and South County. And you know, most of the patients that have been hospitalized or have tested positive, predominantly work in the agriculture population or they're related to the worker in a related to field work in population. Most of our patients is young population given they're working, they're more taking risk and they're just outgoing. And what we've seen is most severe cases we see in elderly population, mainly 65 years and older, and with pre-existing conditions like diabetes, heart disease, lung disease, kidney disease, and people who die are usually old with these pre-existing conditions and are morbidly obese.

Host: And do you think it's just that people are delaying care? They're not going to the hospital. They're not being tested in a timely fashion. Now, how bad is the situation when we think about people who are not feeling well, but they're also not seeking treatment?

Dr. Poudel: Well early when the pandemic started, patients were really scared to come to the hospital because, you know, nobody knew what to expect. Even we, as healthcare providers, we didn't know how this is going to look like. And for the last six to nine months, you know, we have learned a lot from research journal articles and also taking care of the patients, like thousands of patients that have been hospitalized in our County. And right now we have access to testing. We test everybody that gets admitted through the emergency or through the direct admit. You know, we have access to therapeutics, anti-virals, convalescent plasma, steroids. We have enough oxygen in bed and you know, everybody who is positive gets cohorted to a specific unit. We call it our COVID floor.

So, all our patients with COVID go there at rest of the hospital. We only have negative patients for the most part. So what that means is hospitals are really safe place to come in to seek medical care, because we know you will be tested. We know, you know, you will be cohorted away from those COVID patients, if your COVID negative. And even if you have COVID, it is really important that you come in early to seek medical attention, because some of the therapeutics that we have, they work if we can get to you early on. So I think that the point I'm trying to make is there's no reason to be scared to seek medical care, the appropriate medical care that you need.

Host: It is alarming that people aren't feeling well, but they're also not going to the hospital, not getting tested. And I think one of the reasons for that might be that there's some confusion, you know, when we talk about the cold and flu in COVID and it's hard for people to know, well, is this just a common cold? Is it my allergies? Let's talk about this. How is COVID-19 and influenza similar, different? We know they can both be deadly because they can both lead to pneumonia, but let's go through this. How are they similar? How are they different?

Dr. Poudel: No, I think that's a great question. I get that asked a lot. Before I answer that question, I just want to visit our last question and see why patients are delaying to seek medical care. You know, a point I want to make is if you delay care, you may lose your opportunity to have a good outcome. And again, I really want to emphasize that please, you know, if you need medical care, don't hesitate to come to our emergency to reach out to your doctors because we have tele-health. So, you know, getting back to the difference and similarities between COVID and influenza, you know, both are respiratory illness caused by two different types of viruses. COVID is caused by SARS Covi-Two, influenza is caused by seasonal influence of virus. And like you said earlier, both could we really deadly and can cause severe respiratory illness and put you to death.

Every year, we've heard that hundreds and thousands of people dying from influenza. However, COVID just has been around for six to nine months and has already killed more than 200,000 and counting patients in the United States. So both of them do have pretty significant and severe outcomes and, you know, risk of dying. So there are some key differences between those two infections COVID seems to spread a lot easily then seasonal influenza. And it takes a little bit longer for patients with COVID to symptoms. So there they have a longer what we call a pre-symptomatic period from the time of exposure. And it's pretty alarming that you can have pre-symptomatic transmission, meaning you don't have symptoms, but you could transmit to others.

And, you know, for flu, there is certain level of protection given flu shots and, you know, previous infections, but with COVID, we don't have that luxury. Although, you know, there's talk about some vaccines coming out pretty soon. So, you know, so these are the key differences. And without testing, it's really hard to know because both of them could look alike and could have pretty bad outcomes. One symptom that is pretty unique to COVID-19 is a new loss of taste and smell, which we, you know, we don't see it with seasonal influenza.

Host: Yeah. Interesting that you mentioned that because I spoke with another doctor who mentioned that as well. And he said that if you start your morning brushing your teeth and you can't taste your toothpaste, and then you go to have a cup of coffee and you also can't taste the coffee, can't smell the coffee, and you haven't been feeling well, then it may not be the flu as you might've chalked it up to, it might actually be COVID-19. And that would be a, certainly a good time to be tested. As you say, it's the one really unique thing about COVID that we do know is that sudden loss of taste and smell if we have minor symptoms and we think it might be the flu, should we take that leap? Should we come in for the COVID test?

Dr. Poudel: Well, I think both COVID and influenza have kind of, you know, spectrum of symptoms and it really depends on what symptoms, you know, you're having and what your underlying health condition is, how young you are, how sick you are. I think the bottom line is if you don't feel good, mean you can't breathe, you have chest pain, you're gasping for air or your family member, you know, is confused or is not their self. Then that means, you know, they need to seek immediate medical attention and get tested. Because not only it has implication in terms of their care outcome, you know, even having minor symptoms, it may be prudent that you find out what infection you have, because you know, it's different in terms of isolation, going to work you know, going to see your family. So you know, it really depends on all these factors.

Host: Definitely. And is there an actual test for the flu? Is there a way to confirm that somebody has the flu?

Dr. Poudel: Yes. There are several tests that we can do for influenza sort of testing is similar to COVID-19 you collect a nasal or nasal pharyngeal swab, and it's a pretty rapid test and we've been doing it for several years and it's really it's readily available in almost all urgent care emergencies and most of the doctor's offices too.

Host: You know, when it comes to flu vaccinations, there's a myth. A lot of people believe that when you get vaccinated for the flu, that it gives you the flu. And I know that that's not true, but I want to hear it in your words. And also people believe that if they get the flu shot, there's no chance that they'll get the flu. That's also not true. So you can get the flu shot and still get the flu, right? But when you get the flu shot, the vaccination, you're not being given the flu helped me sort all this out will you please doctor?

Dr. Poudel: When you get a flu shot, the way it works is your body mimics as if it is fighting the flu virus because its vaccines are made out of some firewall particles. So you're not getting a real infection, but your body is being tricked as if it's being exposed to a real virus. And what that means is your body's immune system comes into play and produces antibody so that they remain in your blood for the rest of the season. In case you come in contact with the virus later on that it gets neutralized. And it can cause severe illness. So your body is essentially fighting an infection like condition. So that means, you know, you feel a flu like after a flu shot. So that really means that your immune system is coming into play. That's how these vaccines work. So it is not that you're getting, you know, you're getting flu after a flu shot.

It is, you're generating this immune response so that you can be protected. You know, I think this is probably the most important time in the history to get a flu shot. Because we're in the midst of a global pandemic, cases are rising. And if you get a flu, then you know, it suppresses your immunity for next several days, to weeks, and you may be more susceptible to COVID-19 down the road. And keep in mind, flu shots may not be a hundred percent effective. We know that for a fact, but if you get flu shot, then it may not protect you completely, but it decreases significantly your risk of dying and getting severely ill. So that's the reason that we're recommending flu shots to all our patients.

Host: You know, doctor the holidays are upon us, usually a time when people travel, they want to see their families. And there are people locally and throughout the country who are not adhering to distancing guidelines, masking, and so on. They're throwing parties, weddings, quisiera, seeing an increase in cases as a result. But would you like to say to those people?

Dr. Poudel: You know, holidays are a great time to see families reconnect, share, and spread love. And it's just a pleasant time of the year. We're already in a stressful situation with the pandemic and not being able to see your family. It just adds stress. Unfortunately, you know, as of now throughout the country, with increasing number of cases, most of those we're seeing in small household gatherings. So what that means is as the holiday seasons come in, as people start celebrating with gatherings, it's getting colder outside. So it'll be indoors where there's not good ventilation. There is a increased risk of COVID-19 infections. Experts are predicting that next 10 to 12 weeks are going to be the darkest in the history of pandemic with, you know, significant increased amount of new cases, hospitalizations, and death. And I think it is really important that everybody does their part in terms of protecting themselves, their family, and their loved ones. So what I would recommend is if you're healthy, if you can survive this pandemic, you can always celebrate next year because these holidays do come every year.

And if you can, you know, virtual celebrations are great, kids are doing virtual school. So, you know, for one year, I think we can celebrate Thanksgiving or Christmas with FaceTime. And you know, if you want to celebrate, it is important that you do small gatherings with your own household, and you have to really assess the risk in terms of what's the level of community transmission in an area. It says, what's your immunity, what health conditions you have. And if you're traveling, then you got to assess the risk of travel at the airport at, you know, bus stations, gas stations, restrooms what's the, you know, amount of exposure in terms of duration. Is it going to be outdoors, indoors? How many people so, you know, you have to take into consideration all these factors. One thing I think I really want to get out there is if you're exposed or have symptoms consistent with COVID, you should really isolate yourself and do not host gatherings or parties. And, you know, hopefully, you know, you're doing a favor to yourself and your community.

Host: How much longer do you suspect it will be before we have a COVID-19 vaccine, before it's approved, and who's going to be the first to receive it. Healthcare providers, elderly, the ill? I think a lot of people feel like that even when there is a COVID-19 vaccine, that so many of us are so far down the line in terms of having access to it that it's not going to make much difference in our lives in the short term. What are your thoughts on that?

Dr. Poudel: Well, I think we all heard yesterday that there was an announcement made by Pfizer and by BionTech saying that COVID vaccines are more than 90% effective. That's a remarkable number. You know, if that holds, that's huge to have that data in a short period of time. Hopefully, you know, within the next six to eight weeks, we're going to have what we call a safety data. So we have this efficacy data, we know it works, but we just want to make sure these vaccines are safe. So as soon as we have the safety data, hopefully within the next several weeks, then we're going to have access to those vaccines. And unfortunately, early on, we're not going to have enough vaccine for everybody. So these are going to be prioritized based on their risk of exposure. So I think the first people to receive a vaccine would be healthcare workers, frontline workers, EMS, then your vulnerable population, like the elderly, and then as the supply and access of the vaccine grows and it will be distributed to the general public. So realistically I think we're looking at probably sometime early to mid 2021.

Host: It's great to be excited about the vaccine. That's great news. But it's going to be a while before some of us can actually get the vaccine. So we need to keep up with all of the guidelines, masking, distancing, washing our hands, all of that, right?

Dr. Poudel: Exactly. That is very true. So we're expecting, you know, the first path hopefully will be towards the end of 2020 you know, healthcare workers and EMS and vulnerable population. And for general public, hopefully, you know, early next year to meet next year. And like you said, even if we have a vaccine, there is not going to be a fairy tale ending to this pandemic for a while. So just, you know, giving out vaccine doesn't mean there is this cloud that just disappears all of a sudden and we're, you know, back to 2019, we still will need to you know, continue to wear masks, social distance, wash our hands and not do large gatherings and just be vigilant about everything in terms of quarantine and contact tracing, and continue to test.

Host: As we wrap up here today, doctor and so great to have you on and your expertise as an infectious disease specialist, if you could speak directly to the community, Salinas Valley, Monterey regarding flu season, the Coronavirus pandemic, what would you like to say to them? And let's be sure to mention again, as you stressed earlier about going to the hospital, if you don't feel well.

Dr. Poudel: As I mentioned earlier, we think the next 10 to 12 weeks are going to be really critical and crucial in terms of protecting ourselves and our community. There will be increasing number of cases, hospitalizations, and death. And you know, we get deeper into the pandemic. The pandemic fatigue setting in people are not following social distancing and masking. So I would urge you to not let your guards down, continue to mask, continue to practice social distancing and hand hygiene, avoid large gatherings, especially during the holiday season. And please do get your flu shot to protect yourself and your family. And lastly, before we wrap up, hospitals are relatively a safe place to seek medical attention. We have enough access to PPE testing. All patients that are diagnosed with COVID go to a specific unit at SVMH. And if you delay seeking medical care, you may have bad outcomes. And I would urge community to not hesitate, to seek medical attention, in our emergency, in our doctor's office. We have tele-health. So there are all kinds of ways that you can access healthcare. And, you know, we want to make sure we keep our community safe during this hard time.

Host: A great way to wrap up their Doctor, the bottom line is get your flu shots, get the COVID-19 vaccine if and when you can. And in the meantime mask up, keep your distance, wash your hands, remain vigilant, stay positive, and great to talk to you again and you stay well, doctor, thank you so much.

Dr. Poudel: Thank you.

Host: For up-to-date information on COVID-19, please visit svmh.com/coronavirus. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb, stay well, and we'll talk again next time.