Transcription:

Melanie Cole (Host):  Welcome to TVH Health Chat with Temecula Valley Hospital. I’m Melanie Cole and I invite you to listen in as we give you a little COVID-19 education, the history, transmission and testing. This should be a fascinating episode. Joining us is Dr. Robert Veve. He’s the Medical Director of Temecula Valley Hospital Clinical Laboratory. Dr. Veve, it’s a pleasure to have you with us today. Give us a little lesson on the history of COVID and the hallmarks and history of human pathogens. Tell us a little bit more about this virus and how did this happen?

Robert Veve, MD (Guest):  Sure. Okay. Well it’s actually good I think it’s pretty fascinating history. The first documented cases of coronaviruses actually were not in humans. They were actually discovered in chickens back in 1931 up in North Dakota and they realized that these chickens had a very highly, highly contagious respiratory disease that they called Avian infection bronchitis. And very lethal. Between 40 to 90% of the chicken population actually when they got infected with this virus, they would end up dying from the virus. And they realized it was something new that they hadn’t been dealing with before. They didn’t quite know that it was a coronavirus at that time, but they did know that it was something that they hadn’t actually seen before.

But the symptoms actually are strikingly similar to what you see in humans. They had shortness of breath, and bad coughing and they were very tired and listless. And like I said, quite a few of them ended up dying from it. They called it infectious bronchitis virus at the time and then back in 1937, they were actually able to culture this particular virus. They didn’t know yet again, that it was a coronavirus because they just didn’t have the technology to actually look at the virus with wan electron microscope, yet to see what the structure was.

And then in the 1960s, they were actually performing studies on patients with the common cold and they were trying to determine how these colds were transmitted and whether to not you could actually take cold virus from one person and put it into another and get them infected. So, they put together these studies back in England and actually at the University of Chicago they did some of this work also where they would inoculate the nasal cavity of a healthy donor with fluid that they washed out of the nasal cavity of somebody that actually had a common cold. And they were able to induce colds in the healthy volunteers. And what was interesting about that is they discovered that there was one patient who was patient B814 for boy number 814, he was the 814^th person in that particular study who got a cold and when they looked at the virus itself that they were trying to grow, they realized that this is something new that they hadn’t actually seen before. So, it was something very novel and then back early 1965 to 1966 they were able to actually culture this virus again, it didn’t have any properties of anything that they were used to seeing at that point.

And then there was a second isolette that they discovered in 1966 out of the University of Chicago which is one of the viral types that we’re familiar with today that causes the common cold. But again, they didn’t know they were coronaviruses until 1967 when they were actually able to do electron microscopy using very powerful microscope that can actually look at submicroscopic particles and they were actually able to see that these viruses had this round shape with these spikes that came off of the surface that to the researchers at that time reminded them of the corona of sun looked like. And that’s when they actually named them coronaviruses based on the structure that they could see on electron microscopy.

So, that was when they got their name. So, yeah pretty fascinating right? So, there are actually four subtypes of coronaviruses that cause colds that we’re all infected with on a fairly regular basis. About 15 to 20% of common colds are caused by coronaviruses and we’ve been living with these things for centuries. You get a little sniffle, maybe you have a little bit of a sore throat, but they generally don’t really cause any severe pathology in the patient. And we got along fine with them until 2002 really was when something happened actually. And back in 2002, between 2002 to 2004, there was a jump of a new coronavirus from the animal population into humans that occurred in China. And that was SARS, so you are probably familiar with the SARS outbreak from back then. And that’s also a coronavirus and it’s very similar to what we see now with the current coronavirus, in fact they are so closely related that they have the same name. SARS virus is SARS-COV and the coronavirus that we have now that we’re all dealing with is SARS-COV2. So, they are very closely related.

And that was actually a pretty significant infection. There was about 8000 cases worldwide, a little bit more than 8000 cases worldwide which lead to about 775 deaths. So it had a fairly high mortality rate. It was about 9.6% and there were 27 cases reported in the United States at that time but there were no deaths. And they got that under control because that was so explosive, and it was easier – actually a lot easier to contain because it was mostly symptomatic people who were spreading the disease in healthcare facilities. So, once they realized what was going on, they were sot of able to shut it down. And since 2004, there haven’t really been any more cases of SARS, the original SARS. And then again, everything was quiet for a while and then another coronavirus jumped from animals into humans and this was in 2012 in the Middle East. There was this coronavirus called MERS called Middle Eastern Respiratory Syndrome. And that actually jumped from camels in Saudi Arabia into the human population and that actually has the highest mortality rate of all of the coronaviruses. So, there were about 2500 cases worldwide and about 875 deaths so that mortality rate was close to about 34%, very high. There were two cases in the United States. Nobody died from it and those are actually imported from Saudi Arabia for healthcare workers who were coming in to work in the United States.

And then of course, in 2019, COV-19 or the current coronavirus actually jumped again from an animal into humans somewhere in China and that Hubei Province in China and it’s just been spreading literally like wildfire since then. So, right now, in the United States, there’s about 7.6 million infections and we’re at 213,000 deaths and yeah so that’s kind of where we are with it. But they are all beta coronaviruses, SARS, MERS, and COVID-19 and they are all derived ultimately from bats. That’s kind of the natural reservoir for these particular viruses.

Host:  So, now on to the recent coronavirus. Please tell us how this is transmitted because there’s been some confusion about whether it’s airborne, aerosolized or not, can you walk into one that might be floating in the air at the grocery store, how long do they live on surfaces. Tell us a little bit about the incubation period because I think that this is the question on so many people’s minds.

Dr. Veve:  Sure. So well let’s start with the incubation period. The incubation period for COVID is about 14 days from the time you become exposed to the time you should develop symptoms. So, if you don’t develop symptoms after 14 days from exposure you are likely not going to. So, as far as transmission. The virus is transmitted predominantly through respiratory droplets. So, close contact with people, being within six feet of them if they don’t have their facemask on when you breath and you exhale, and you speak, you are emitting little particles from your lungs that have water vapor in them and the virus actually gets trapped in that water vapor.

So, that’s the primary mode of transmission. And those particles are actually large, and they will fall to the ground. What was debatable or what was debated for a while was whether or not it could be transmitted airborne and airborne transmission means that it’s the particles are so small that they become aerosolized and they can just kind of float in the air. And as I said, there was some debate early on whether or not that could happen under normal circumstances. We know that that can actually happen in the hospital. So, if you go into the hospital and you have certain procedures, they are going to create aerosols which can actually put that virus up into the air. There is also some evidence now that the virus actually can be aerosolized sort of out in the environment when people are in close quarters and they’re doing things like singing or screaming or yelling. So, being inside in close contact with one another actually is a high risk for transmitting the disease because of aerosolization. But again, predominantly it’s going to be from those respiratory droplets.

It can actually stick to surfaces as well. Early on, they weren’t sure how long it could survive on surfaces. The thinking now is that it can survive probably for a couple of hours on surfaces before it actually dries out and is not infectious anymore. On your skin, it you don’t do anything to clean your skin; actually a recent study that I just read the other day actually said that these things can survive on skin for up to about nine hours. But if you use soap and water or an alcohol based cleanser, it will clean it off.

Host:  So, I want to talk more about the handwashing aspect of this versus sanitizer, but asymptomatic carriers seem to be a big mystery with this virus Dr. Veve. If they stay home with no contact, how many days would they be con – how do we even know if they are asymptomatic? How would somebody know unless we’re testing them and if we’re not, are they just waling around spreading this virus. Tell us about asymptomatic carriers because that seems to be one of the very biggest mysteries.

Dr. Veve:  Yeah, so actually the - probably the majority of disease is spread from asymptomatic carriers. About 70 to 80% of people who become exposed to the virus and can actually carry the virus are asymptomatic. About 20% of the people who are exposed will actually develop symptoms. And of the patients who develop symptoms, about 16% or so will have mild symptoms and the other 5% or so, maybe a little bit more will have severe symptoms or become critical. And it’s really that severe symptom and critical patient population that impacts the hospital because those patients get hospitalized. But as far as the asymptomatics, the vast majority of people actually who are infected with it are going to be asymptomatic. And you’re right, you would never know if you have the virus if you ‘re asymptomatic unless you get tested. Which is why we really are trying to encourage people to get testing frequently. This way if they are found to be positive, they will actually quarantine at home. And the current CDC guidelines are that if you’ve come in contact with somebody, this gets a little bit confusing, but all the information is there on the CDC website if anybody is interested in reading it. it does get a little bit confusing but if you are asymptomatic and you think you might have been exposed to somebody who has COVID, but you haven’t been tested; the recommendation it to stay home for at least 14 days because of that incubation period that we spoke about earlier.

If you are asymptomatic and yo have tested positive for COVID, but you are still asymptomatic, the recommendations are to quarantine at home for at least 10 days from the time of your first positive test and then after ten days as long as you are fever free for 24 hours and you’re not taking any fever reducing medicines then you wouldn’t be taking fever reducing medicines if you were asymptomatic because you are asymptomatic. But the recommendation is ten days and then fever free and then you can stop your self-isolation.

Host:  So then, tell us a little bit about the handwashing and testing as well because there’s so much for us to cover Dr. Veve but tell us why handwashing briefly why this works versus sanitizer which kills this but for some reason the soap, what, it breaks it down, that fat, it breaks it down. Tell us a little bit about why that happens.

Dr. Veve:  Yeah, so I think what happens with the sanitizers is the sanitizers, the hand sanitizers are alcohol based sanitizers are actually put into a solution that actually makes them a little bit viscous, so they stick to your skin and after a while, if you keep rubbing that on your skin, they actually become less effective. Soap and water on the other hand will just clean everything off of your hands and it’s really just sort of the best way to go in terms of cleaning the virus and those viral particles off of your hands.

The other thing with sanitizers is that some of that hand sanitizers are contaminated with alcohols that actually can cause harm. So, denatured alcohols and methanol’s can actually cause harm to you, so you have to be pretty careful about looking at what the ingredients are in those particular sanitizers. So the best thing to do really is to just wash your hands with soap and water.

Host:  Now let’s talk about testing briefly because I know that this is one of the keys, right, so speak about testing and the antibody test. If you were to tell somebody right now Dr. Veve, I think if you have questions you should get tested or you should get tested for the antibodies. Tell us what you would do, what you would tell people and really what the difference in these two tests are.

Dr. Veve:  Sure so, the testing is really centered around a couple of things. One is do you want to know whether or not you currently have the virus or do you want to know if you’ve been exposed to the virus. So, the main way that we’re testing now for the presence of the virus is either doing what’s called PCR which is a test that actually looks for the genetic code or part of the genetic code of the virus. It’s very specific. It’s very sensitive. And the other thing we can do is what’s called antigen testing where we are looking for certain proteins that are on the surface of the virus. Either one of those either the antigen test or the PCR based tests are designed to look for virus in the sample itself. The antibody tests are actually designed to look for your response to the virus. So, the problem with the antibody test is that it doesn’t tell you if you are actively infected. And the PCR test and the antigen test doesn’t tell you whether or not you actually have any response to the virus. So, really, they are sort of complimentary to one another.

So, if you were curious if you were currently infected, you would do either the antigen or the PCR test. If you were curious that you might have been infected sometime in the past, three four weeks ago; maybe two months ago, then you would want to do the antibody test. Now the thing that the antibody test doesn’t tell you at least the current antibody tests that are on the market, they don’t tell you whether or not you actually have immunity to the disease. Because they are not specifically looking for antibodies that will actually neutralize the virus. That’s a different type of a test that’s called a neutralization antibody test and currently there’s nothing on the market available commercially at least, for people to know whether or not they have neutralizing antibodies and the way to do those tests is very cumbersome and it’s very expensive and it’s just not feasible to test everybody for neutralization at this point.

So, I think part of your question also was if somebody asked me what I would do about the antibody test, again, I would say it really depends on what you are curious about. If you want to know if you are infected right now, antibody testing isn’t going to tell you that. And the other thing about the antibody test is it takes about 10 to 14 days from the time you were exposed to the virus until those antibodies will actually rise to a detectable level with the current technology. So, it’s just not going to tell you whether or not you have an active infection.

Host:  And what about contact tracing? Is that important to do?

Dr. Veve:  Yeah oh absolutely. So, the point of contact tracing is if somebody tests positive for coronavirus, since it’s so infectious, right, it’s basically spread from person to person, through the air, yo want to make sure that, that particular person and anybody else that they’ve come in contact with is found and isolated so that they can stop the transmission among that particular group. You could imagine if I’m infected and I came in contact with five other people around the time when I became infected; those other five people might be infected from me and then they would go on to infect other people. So, the idea behind contact tracing is I find out I’m positive, I tell the contact tracers everybody that I’ve been in contact with and then they reach out to them to see who they’ve been in contact with and convince everybody in a perfect world, to just isolate for 14 days at home and if everybody did that, you really would shut down the spread and the transmission of the disease.

Host:  Do you think there will be a second wave and if so, are we ready Dr. Veve? As we wrap up, how should we prepare for a possible second wave if you think that there is going to be one. You have so much knowledge. Share it with the listeners right now about COVID, what you would like us to know about what’s happening right now, what could happen in two weeks or four weeks or six months. Tell us your best advice and what you think we should do to prepare if there’s going to be a second wave.

Dr. Veve:  Sure. So, as far as first wave, second wave, I like to think of this as this is just one big wave. It hasn’t disappeared. It’s slowing down in some parts of the country; it’s rising in other parts of the country. So, I personally don’t like to think of it in terms of waves. I think we’re in the middle of it, we, in some places it’s in a little bit of a lull, in other places it’s expanding. What I’m concerned with though is that as we move into fall as the temperatures drop around the country and people start moving back inside; and come in close contact with one another, we’re going to see increased rates of transmission again especially if people don’t wear masks and if they can’t figure out a way to keep their distance from one another. So, my concern is that over the next few months, we’re actually going to see a rise in cases again. So, it becomes very important as people are moving indoors for work and school and all the other activities that everybody want to engage in, that they just keep wearing a mask to try to cut down on that transmission as much as possible.

As far as six months from now, I wish I had a crystal ball. Most of this is really going to be determined by whether or not we have safe and effective vaccine and also how long it may take for that vaccine to be deployed to everybody in the country. Remember, there’s three hundred thirty, three hundred and forty million people in the country and as of now, we only have 7.6 million documented cases. So the vast majority of people still, at least either haven’t been tested or haven’t been exposed. It’s probably a little combination of both. So, I would anticipate that we’ll see a rise in infections through the fall and the winter months and then as that vaccine comes out and gets deployed, we should see it come under control. But I still think it’s going to take a while. And just let me reiterate, please wash your hands, wear your masks, be cognizant of social distancing and keep each other safe.

Host:  Thank you so much Dr. Veve, really such an interesting episode and you gave us so much education about this virus that has been such a mystery to so many of us and really some really great advice. So, thank you so much for that. And that concludes this episode of TVH Health Chat with Temecula Valley Hospital. Please visit our website at www.temeculavalleyhospital.com for more information and to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Temecula Valley Hospital podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. I’m Melanie Cole.