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Dr. Selwyn Vickers: Hello, and welcome to the Checkup. I'm Dr. Selwyn Vickers, Senior Vice President of Medicine and Dean of the School of Medicine. And today my guest is Dr. Mike Saag, he's a well known Infectious Disease Expert with a focus of long-term on HIV, and in most recently, an understanding at a deep level of COVID 19. I brought Dr. Sag on the show today to discuss this personal experience with COVID-19 as well as his perspective on the virus as an infectious disease expert. Welcome to the checkup Mike.

Dr. Saag: Thank you. Thanks for having me.

Host: So I have a few questions. I want to get your thoughts on, and obviously you have one from personal experience, both from the test and itself, and actually getting through the virus. I understand that you contracted coronavirus back in March. Can you describe that experience to us?

Dr. Saag: It's pretty horrible. It's something nobody wants. In my particular case the first five or six days were not too bad. I was a little bit symptomatic, but thought I was going to get through it with a mild case. On day seven is when the horror started when the morning was fine, the afternoon and evening, I started to get what we would call a cytokine storm and I'd have fever, chills, body aches. Every part of my skin hurt. And I developed what I would call fuzzy thinking. The worst part of it was those wee hours of the morning between midnight and 2:00 AM. When my pulse ox would drop a little bit and I would sit there and wonder is the next 15 minutes going to be the time when I'm going to have to call 911 and get into the hospital. And if I get to the hospital, am I going to go on a ventilator? And I just waited out every night, next morning, I'd feel better. I thought I'd beaten it. And then the next day, the exact same thing for eight days in a row, it was like Groundhog Day. And every night was exactly the same, that deep concern that I was going to have to go to the hospital. So it said fear of the unknown of not knowing what's coming next. That was for sure the worst part of this for me.

Host: Mike, when you say symptoms, a lot of times people don't completely correlate that to something that significant you, a symptom can be that I, you know, I have a sore thumb or I have an ache in my calf, but as it relates to the scale of symptoms can you describe what the symptom of feeling like you can't breathe? Or feeling like you're getting your breath is what's being limited? How does that line up on the scale of what people can experience when it comes to symptoms?

Dr. Saag: Yeah, it varies person to person. And that's also part of the difficulty of this disease is that it's not uniform. Everybody has a differently, but for me it was chest constriction feeling like I couldn't take a deep breath and it wasn't like an asthmatic where you feel like you're breathing through a straw. It was more like I got a cough when I take a deep breath in the, the paroxysms of cough would lead to almost syncope and some degree of nausea. And those spells I'd watch my pulse ox and it would go from 95 to 90 and I would kind of go, Uh-oh, and so those are symptoms, but I really think as a total body experience of just not getting comfortable, the fever was there, but for me it never got much above a hundred and a half, 101, but it was really this horrible feeling of just being, for lack of a better word Viremic and having these cytokines flying around in an uncontrolled way.

Host: Yeah. And I can understand how frightening that is. And I do think that for many individuals, one of the more frightening things that correlates of am I going to live, is can I breathe? Right. If I mean, there are a lot of things that I may not correlate with losing my life, even though it's a severe symptom, but can I breathe is one, whether it's, you know, leads to something severe or not is really frightening.

Dr. Saag: Yeah. The feeling of suffocation. And we can all relate to it. If you go to a pool or something and somebody holds your head down and that desperation of wanting to get the next breath, I didn't get that bad, but there are people who are that bad.

Host: Oh, absolutely. Mike you've obviously dealt with epidemics in particularly the HIV epidemic. Your career has been dedicated to that. How in any way, is this moment similar to anything you've experienced through the AIDS epidemic?

Dr. Saag: There are actually are a lot of similarities. Going back to my personal experience, the notion that I was going through something for which there was no treatment. And we're sort of spoiled that if we get something, they can throw a treatment at it. Well, this is so new. There's nothing to treat. Well, that's the way the AIDS patients were in the eighties. And as a provider taking care of them, it was so difficult for them to come in and say, what are you got for me? And I had nothing much, but handholding. And that was the experience for me in that quarantine bedroom for 22 days of not knowing what to do and not have anything to do.

Host: Mike, how do you think COVID-19 has reframed the public's thinking of the risk around infectious disease or viral particles or even bacteria as it relates to a public health issue?

Dr. Saag: Certainly the public is now almost expert in commentary, at least about what infectious diseases are, for us in the field. This was more of a hypothetical that people talked about in schools of public health, and schools of medicine. When they said, well, there could be a widespread epidemic. They'd refer back to the 1918 Spanish flu. And everyone kind of said, yeah, yeah, but we'll deal with it. We don't think it's going to come. And it's actually here. This is a horrible pandemic. And it's one that we as a country and we as a global community have got to pull together on. And so far, we're not doing a great job of getting on the same page, in my opinion, partly because politics are playing into it. Economics are playing into it, and people are just kind of struggling to get at what is the truth. So the public is trying to get their head around how viruses are transmitted.

I think it's clear for this one, it's in the air. We initially thought it was on surfaces. And now that we know it's from somebody who's infected creating, I would describe it as a cloud, around them, as they're breathing, that cloud gets further as they talk or scream or sing. And that's why it becomes so important for us to wear a mask. And we've all been talking about that. But if people can kind of imagine that that cloud is there a lot of times, the people are transmitting the virus without symptoms. And that's really the pernicious part of this, the occult part of this, the horrible part of this, that the 24 hour period before symptoms develop is the peak time of transmissibility. So you or I could be out doing whatever we're normally doing, feeling fine, but yet we could be a super spreader and not realize it. The mask cuts that down by 85 to 90%, if we're able to comply with.

Host: So I would say that if you were to say, what is the one thing that the public could do, is really be committed to wearing masks. It's just a part of our culture going forward.

Dr. Saag: Yeah. I'd take it a step further. I'd say everyone right now should think about themselves as an 80 year old person with some chronic conditions, every one of us, and then ask yourself, what am I going to do to protect myself from getting this? And that means I'm going to stay at home as much as I can for now, when I go out, I'm going to wear a mask. I'm going to avoid any group gathering of people where people are not wearing masks. And if we did those simple things, I think we could mitigate the infection.

Host: Mike, how is the impact of this virus challenged by the fact by number one, in the context of medical science, we don't have a cure for it. And also in the current standards of development, we don't have a capacity or a technique to make a vaccine short of eight to 12 to 16 to 18 months. Where do you see that impacting? And then where do you see research? If we ever face this again, getting to a point where we don't take a year to truly get the ability to immunize our population?

Dr. Saag: Well, let me go back to the AIDS epidemic and then directly answer the question, we think about AIDS syndrome was defined in 1981. The causative agent wasn't known until '83, the test wasn't even available until '85, and treatments weren't available until '87. This infection, we first heard about it in inklings about in December, the virus was identified and its genetic structure was identified and sequenced by January 10th, a vaccine was developed in two days at the national vaccine research center at NIH. That vaccine is now moved forward into trials. There are 10 to 12 vaccines currently in development. And this is all in the matter of five months we have a test and we already have a treatment. This is remarkable. So in a word or phrase, I would say science gives us hope, but there's still a lot we don't know. And what we were anticipating was that maybe by the summer, this would kind of go away.

It was a little bit of magical thinking, but there are other viruses that tend to decrease in the summer. We're not seeing that. In fact, we're seeing the opposite, at least in the United States. So what can we expect? We can expect until proven otherwise this virus is going to remain with us for at least a year more. And that's tough to grasp that's tough to understand or comprehend, but that's the fact. And so we have to learn how to live with it. Meanwhile, treatments are moving forward in clinical trials. We've got more trials here than we can even hardly manage. We're managing them, but that we have a lot of options. That's good news. And the vaccine trials are moving forward into phase three, phase three within five months of first identifying the virus. That is amazing. We might have an answer by the end of this year in 2020. And if we're lucky enough to see that the antibody and immune response is protective against transmission, it actually reduces transmission by at least 70%.

Then we have an MRNA vaccine that can be scaled up and maybe made available to folks by this time next year in large number, that's a lot of ifs. And I don't think we can count on ifs. Vaccines are tough in AIDS. We've tried for 35 years and we're not even close really. So for this to come through, I would go back to Greek tragedy and say, it's like a Day set Mokena where the protagonist is saved from a horrifying event by the Greek gods. That's what a vaccine will do for us short of a vaccine. I'm feeling pretty good that maybe by the next five to six months, we'll have better treatments than Remdesivir. And then we can manage just like would do influenza and say Tamiflu. So that's maybe a bit of a hopeful note.

Host: Mike, final question one, any closing thoughts, but what have you seen from our healthcare and research community as they've come together to support the individuals who succumb to the virus?

Dr. Saag: It's very tough for healthcare providers and we saw that in New York but we're seeing it here now. The notion of taking care of an ill patient is always difficult. This has made triply difficult because not only do you have to take care of a dying patient or somebody desperately ill, you've got to dawn protective equipment and doff it every time you walk into the room, you've got to down deep, there's a concern. Am I going to pick this up? And yes, young people do get sick and end up in the ICU and some of them die. That nagging fear is always there. And the worst of it, my opinion is the fact that because of the infection, we can't let others in the room. Family is not there. The patient's dying alone. I can't having gone through and just being worried about going to the hospital. I can't even begin to imagine how difficult it is for the patient dying alone, just with the healthcare worker there. So they've got to be the comforter and chief for each person, and then communicate with the family who are just going crazy with grief at home and not being able to say a final farewell to their loved one. I can't imagine a worst case scenario for all the above, for the healthcare workers, the family. And of course the patient.

Host: Well, Mike, I too, I think that is one of the greatest challenges and tragedies of having the healthcare workers who bear not only the burden of the medical illness, but bear the emotional difficulty of being that only person of the last person that they're with someone who is who's dying. Fortunately it looks like our ICUs are really doing a good job of getting people off the death's door and getting them back into the regular floors and home. So, Mike, I thank you for sharing your experience. Hopefully it will inform our community. I think this is one of the most important topics we can have on Checkup. And we thank you for your leadership in the School of Medicine.

Dr. Saag: Thank you.