Transcription:

Scott Webb: Welcome to part two of a two-part series on COVID-19 one year later, what we've learned so far and how the vaccines can help us defeat the virus and get back to living our lives without social distancing and restrictions. And joining me again today is Dr. Mario Cole. He's a pulmonary disease and critical care specialist at SVMH.

This is Ask The Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Dr. Cole. Thanks so much for your time again today. I want to talk to you about your experiences personally. Suiting up in PAPR every day, every time you would go into a patient's room, then having to go home to your family. How did that change life for you? What's it like to be a doctor, to be a healthcare provider dealing with this deadly pandemic and everything you had to do at work to protect yourself, and then you have to go home? And was there this fear of bringing it home to your family? What was life like for you doctor?

Dr. Mario Cole: Certainly, that was a concern. We gathered insight from observing what was happening in New York and on the East coast, since it hit there first. And we saw what the common practices were, and there were always things that you saw in the literature or in the news about there was one doctor I remember in particular who bought an RV and parked it in front of his house because she didn't want to go into the home after having taken care of patients in the ER.

And there were many similar stories that people are afraid to go home. And then other doctors, who would completely shower somewhere else before they would come home and change clothes. But the majority of physicians that took care of them, who were using PPE, protective equipment, didn't do that.

And so my personal routine was that when I came to work, I was already dressed in scrubs. If I had to go into a COVID patient's room because I was in the unit that day, I would put on the gown and isolation, gown and gloves and double gloves and the whole PAPR. And I would basically prepare and go in and take care of the patient and then come out and ungown and sterilize myself per the routine protocol. And that's what I did.

Some of my colleagues actually changed clothes. They would change before they would go home, some were showering. And everyone did what they felt comfortable with. I was trained, years ago, how to put on the PPE and how to take it off. So I was comfortable with the standard routine. I didn't really alter what I did.

Scott Webb: As you say, everybody had to do what they either had experience with or what they were comfortable with. And good to know that you felt comfortable in your routine and being able to go home and protect your family.

And talking about families and patients and families, you all were really the bridge for them, right? So when patients were in the hospital, in the ICU and being treated, they weren't able to communicate directly with their families. So you all doctors, nurses were the bridge to their families. What was that like?

Dr. Mario Cole: That was sometimes difficult because there was so much misinformation on the news. And then, you know, word of mouth about things that were thought to improve outcomes or cure COVID. And we spent a fair amount of time reeducating family members. And yes, you know, while I was giving someone an update about their mother or grandfather, I was also having to reeducate them or at least correct some of their ideas, misinformation that they had gathered from whatever source, the internet, news or family member.

And so that was different. This was something new. You know, I've been a critical care physician, and in medicine now almost 20 years. And prior to COVID, you know, I would say, "Your grandmother has pneumonia. We're going to give antibiotics. And this is what I expect, and this is what we can foresee to happen." And that's kind of how the conversations went and I would give them an update. "Well, she's progressing. He's getting better or he's not getting better."

But with this situation, we were combating a lot of misinformation and folks were looking things up on the internet or talking to somebody at the grocery store. And then they say, "Well, doctor, have you considered trying this medication? Or how about trying this?" That was a challenge. It certainly was a challenge.

Scott Webb: I'm sure that it was. A lot backseat doctors, if you will. As you say, so much misinformation out there. There still is. And it's really challenging, you know, because all we want is for this to go away and to get back to our lives and to take these masks off, right? And so everybody's, for the most part, trying to do the right thing. They just seem to be maybe coming at it in different ways, different angles.

Dr. Mario Cole: That's correct.

Scott Webb: And I'm sure that you've learned so much. As much as you already knew a year ago about medicine and everything else, I'm sure that you've learned so much about COVID-19. So let's talk about it. How does it attack the body, treatments, proning, medications? What have you learned in the last year?

Dr. Mario Cole: Certainly, you soon recognize phenotypes, body types, you know, which patients are more likely to deteriorate at a faster rate than some others based on their phenotype, their body size, also do they have underlying disorders, kidney disease, diabetes, that kind of thing. We also know about timing, you know, when we should apply medications and when we should not apply various treatments.

We have also learned how to discuss things with families and having to deal with someone who's convinced that they know how to treat their grandmother based on something they read on the internet. So again, there's been so much that we've learned and growth as physicians and hospital staff as a company over time.

Now, certainly, for a standard ARDS, acute respiratory distress syndrome from bacterial pneumonia, we have on occasion prone patients, meaning that typically a patient is on their back when they're on a ventilator, that's the supine position. But with ARDS, some patients are so severe that we have to prone them, meaning that we put them on their belly. Well, with COVID patients, it was quite often that we had to do that much more so than a standard bacterial pneumonia-induced ARDS. And so that was something that we've all kind of learned.

And there were some other ventilator modes other than the standard modes that we used in terms of managing patients, where we let them do more of the work of the breathing and controlling how deep and how quickly they were breathing. And that seemed to work better for some patients, but alternatively, it worked worse for other patients.

And so what we learned is that COVID wasn't just one uniform patient. Each patient was very individualized in terms of how we had to care for them and how we manage the ventilator, how often we had to prone them and when can we supinate them. That's something that we actually had to learn.

Scott Webb: And I'm sure that was incredibly difficult, knowing that every single patient who came through or the patients that ended up in the ICU, that each one of them would have to be taken on a case by case basis and perhaps treated completely differently for the same deadly virus. That's got to be really difficult.

Dr. Mario Cole: Right. And the other thing that may not have been discussed much that we felt during the height of the pandemic is medication shortage. We were sometimes out of morphine or sometimes out of the particular paralytic that we were using to kind of help them be comfortable on the ventilator. We would get a notification from the pharmacy that he couldn't be ordered. There was a national back order.

And so we were having to use agents that were maybe second or third tier because the first tier agents were no longer available nationwide. And so as a hospital staff and as a physician, you were having to basically learn how to use different tools. I mean, you had tools, but they were different. And so there's always some nuance that you had to learn and certainly that was challenging.

Scott Webb: Yeah. And like a great jazz musician. I'm sure that you all learn to improvise. I keep thinking to myself that on the other side of this, maybe there will be some silver linings. And maybe in this case, you know, the fact that the entire healthcare system, all roughly 20,000 of you, have had to improvise and adapt and pivot and work together more so than ever before. Do you believe in silver linings, doctor?

Dr. Mario Cole: I do. And certainly I think this has made us all more aware that we're all related to each other and that we are all kind of responsible for each other's health. Certainly, people are a lot more aware of their surroundings, you know.

Certainly, I'll just give you a quick story. My wife and I were shopping at Costco and she started choking on some chewing gum. And it was amazing how quickly there was a wide circle clearance around us as people backed away. And she recovered, but everyone in this age of COVID made the assumption that she had COVID and no one wanted to get infected, so everyone backed away. And it was just amazing how everyone is very aware now of everyone else. And even now going up and down the aisle at the grocery store, people are a lot more aware of their space between each other.

We took a trip to Japan a few years ago. And when we were riding the trains, I was amazed that I didn't really hear anybody coughing or sneezing. And occasionally, you would see someone in a surgical mask and I would ask my wife, "I mean, why are they in a surgical mass?" And she would say, "Well, that was somebody, you know, who's wearing a mask to protect everyone else."

And people don't do that here. And maybe that's something that could be adopted and that if you understand that you're sick and potentially are infectious that maybe you wear a mask or maybe you stay home. I think we've all kind of become more aware of our responsibility to each other to protect ourselves.

Scott Webb: I think you're so right. And about your wife, I'm glad she's okay. Glad there was a doctor in the house, if you know what I mean? And I hope you're right. I really hope that if this has taught us anything, it is that we are all really responsible, not only to ourselves, but each other. And I hope that is one of the many silver linings that comes out of this.

I want to talk about those patients who were lucky enough to recover and go home. Have you been tracking them? How are they doing health-wise? What do we know about the long-term health effects right now?

Dr. Mario Cole: So we're still discovering some and certainly we're only a year out. And I'm sure five years from now, we'll still see some sequella. But typically, most people recover within about three months. It has been in my experience. I still have some people on supplemental oxygen seven or eight months post-discharge from the hospital.

The other thing that doesn't get discussed often is the neurological sequela. I've had patients who have been discharged, who are still confused four to six weeks later. When their respiratory status, their lungs have recovered, they don't have any shortness of breath, they're not coughing, but they're still "foggy" and they're having difficulty managing their normal, the checkbook, their finances, because we understand now that it can cause neurological issues.

Scott Webb: So let's talk about the vaccine. You got that first shipment of Pfizer in December. Then there was a shipment of Moderna that followed and all the frontline workers got vaccinated. So what was that like for you to get the vaccine? What did it mean to you? It's major, it's a big deal. And I'm sure it was a big deal for all of you, right?

Dr. Mario Cole: And certainly it was. As a pulmonary critical care physician, just like ER physicians and others, you know, we were the ones when the patient was going down and needed to be intubated and placed on life support, we were the ones performing that. And so we were very close to their mouth. You're at the highest risk of actually contracting the illness yourself as a provider when you're getting ready to intubate someone.

So to be given the opportunity to get the vaccine was phenomenal. Knowing that now I have an additional level of protection in addition to the PPE I was wearing, the mask and the CAPR and everything.

So certainly, it was great. There was, you know, some fear between the first injection and the second injection about contracting the illness because we weren't fully vaccinated, but certainly once we got beyond that and we knew we were vaccinated and had, you know, roughly an approximately 95% chance of not getting this infection, that certainly lifted a load.

We have families and I go home and my wife is still not vaccinated. I have children at home who are not vaccinated and you worry, because they have to go out and get groceries and put gas in the car and that kind of thing. You worry about your family members. So certainly until everyone's vaccinated including our families, we're always going to be somewhat concerned. But again, having been vaccinated, it's a great feeling.

I'm sure it is. And it was so gratifying to know that those of you on the front line and the real frontline workers were getting vaccinated and being able to do your jobs with a whole lot less fear. But as you say, you still have families, right, that you have to go home to and they haven't been vaccinated yet.

And as excited as you all were about getting that vaccine, we know that a lot of people are not excited about it. There's a lot of fear, confusion, misinformation. Let's talk about the skepticism about the vaccine and how do we convince people that regardless of which one, Johnson and Johnson, Pfizer, Moderna, that in order to get back to our lives, we need just about everybody to get the vaccine, right?

Well, I think it's going to be ground roots. And certainly, Bob is also a physician, so he's been vaccinated. And it's just Bob speaking to family members, your friends, your neighbors. And believe me when I walk outside and I'm walking through the neighborhood and people know who I am, I get stopped as I'm walking my dog to talk about the vaccination and whether, you know, should they take ivermectin or should they get the vaccine. I have these conversations almost daily, you know, when I go out in my normal rounds.

I think it's going to be grassroots that you'll have to know somebody who was vaccinated and see how they're doing and then recognize that they did well and that maybe you should take it as well. Certainly, the more times we see celebrities and other people out in the public eye and getting vaccinated and doing well, I think the better it will be, but there's always going to be someone who's going to refuse and that may put other people at risk. But certainly, that is you're right.

Scott Webb: Yeah, it is. And, you know, the conversations nationally, perhaps globally just about vaccines in general has been an ongoing one and there are strong opinions on both sides. And it's just that you, as an expert, as a frontline worker, you know, I love hearing from you and this conversation today has been so good and so great to hear what you've been through, what you've learned, and really I can hear the optimism in your voice, which is amazing.

So as we wrap up here, doctor, anything else you want to tell people about COVID-19? What you've been through, the past, the present, the future, and really your optimism level that we will get back to the lives that we were living before COVID-19?

Dr. Mario Cole: I want people to kind of educate themselves and try to do what they can to make sure that whatever information they're acting on is accurate information. And so I would go to the CDC website or NIH or WHO. I'd definitely go to the primary websites and get information for yourself firsthand if you don't have access to a physician or a nurse or someone who's dealing with COVID on a regular basis.

It's very difficult when people are just relying on what the read on Twitter or Facebook or other social media without going to the primary source. And they can actually harm themselves by acting on information that isn't entirely accurate or correct.

Certainly, I advocate that when it's offered to you that you strongly consider getting vaccinated, whichever vaccine is available to you to protect yourself and not just yourself, but also your family members and people that you encounter in your day-to-day life.

Scott Webb: Yeah, that's very well said. I couldn't say it any better myself. So Dr. Cole, my best to you and your family and everybody else there at SVMH. Thank you so much. And you stay well.

Dr. Mario Cole: Thank you. I appreciate you having me on.

Scott Webb: For more information on COVID-19 go to svmh.com/coronavirus. And we hope you find 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.