Transcription:
COVID-19: Why And How We Should Flatten the Curve

Bill Klaproth (Host):  This VCU Podcast in COVID-19 was recorded on March 25, 2020.

The spread of COVID-19, also referred to as the novel coronavirus, is a rapidly evolving situation having impacts on our daily lives, loved ones and our hospitals. It’s been over a decade since the world experienced its last health pandemic, but VCU Health has the expertise and experience in handling new disease threats. They’re closely monitoring the outbreak and proactively taking action to keep their patients, team members and community safe.

Now the World Health Organization, or WHO, has repeatedly underlined the importance of “flattening the curve” in order to tackle the coronavirus pandemic, calling on countries around the world to impose sweeping public health measures. Now you are hearing that term a lot. But what does it mean? Dr. Gonzalo Bearman, epidemiologist and director of VCU Health’s Infection Prevention Program, is here to talk with us about exactly that. Why flattening the curve is so critical and what each one of us can do right now to help.

This is Healthy with VCU Health. I’m Bill Klaproth. Dr. Bearman, let me ask you this first. What do you do in your role as an epidemiologist?

Gonzalo Bearman, M.D. (Guest):  So, my role as an epidemiologist at VCU Health is to oversee the hospital infection prevention program. And the underlying principle is that this program strives to assure that all patients, visitors and health care workers at VCU Health are safe during the course of their visit, stay or work and to limit the introduction and transmission of infection to the health care system.

Host:  So, bring us up to speed. At this point, what do we know about COVID-19?

Dr. Bearman:  So, COVID-19 is a new virus that we have yet to experience. So what’s important about that is that we have no immunity across the world with this virus. We also do not have any effective vaccine, so that limits our ability to really fight the virus. And we also don’t have any proven or FDA-approved medications to treat the virus at this time. So that makes it all very challenging. On top of that, we are learning that the virus can cause severe disease in a minority of people, but in that minority of people, specifically patients or individuals who are greater than 60 to 65 years of age and have underlying chronic conditions; that disease can be potentially life threatening to them.

Host:  So we’ve all been asked to help flatten the curve. Can you explain what that means?

Dr. Bearman:  Flattening the curve really refers to a concept known as the epidemic curve, and what it is, is a graphic representation of the number of cases over time. Now you could imagine if there are a lot of cases occurring in a short period of time, the curve is very high and steep. Flattening the curve is a measure in which the number of cases is less, so it’s not as steep and it’s spread out over time and not all at once. The reason that’s important is that would allow for decreased stress on health care systems and response mechanisms to deal with the threat of that infectious disease. So, it’s really a way to both decrease the number of infections and to space them out in time so that they not appear all at once.

Host:  So, from your standpoint, as an epidemiologist, why is this important?

Dr. Bearman:  This is really important for the following reasons. And I think to answer this properly, I probably should go over the four major things that we can do to prevent or to minimize infection or pandemics or outbreaks.

First is rapid diagnosis. And that, as you know, is a huge challenge right now since there’s a shortage nationwide of diagnostic kits for COVID-19.

No. 2 would be vaccination, which would certainly limit the transmission of an infection such as COVID-19. However, the reality is that a vaccine will not be available for likely 12 months, at least produced to scale.

No. 3 would be treatment, and this is something that we don’t have right now that’s effective and produced on mass. We are not able to use treatment either to prevent disease, such as prophylaxis, or to minimize the impact of disease, such as with treatment of any infectious disease.

 And then the last thing for us to, in our armamentarium, which would be No. 4, are something known as nonpharmacologic interventions, and these interventions are what you hear about day in and day out such as social distancing, isolation, quarantine, hand hygiene, closing schools, respiratory and cough etiquette. This is our primary pillar that we have right now to minimize the impact of COVID-19 and to flatten the curve.

The reason we want to flatten the curve, once again, is that it allows health care systems, health departments and the public to better prepare and respond to the cases that do arise. There would be fewer cases coming in less frequently at a slower rate so that there’s not a massive surge of patients going into the health care system requiring care.

And lastly, hospitals like VCU Health are prepared to help patients and to deal with all patient concerns, but we do need the public to do its part. And the part of the public is really to stay aware of the situation. Stay up to date on information by visiting the health department websites in Virginia -- for example, the CDC website -- and really abiding by the recommendations by health authorities with social distancing, isolation, hand hygiene, cancellation of mass gatherings. Those kinds of things are critically important. Staying home when you are sick, provided that you are not sick enough to require hospitalizations. Stay home so as not to infect others.

Host:  So, if I have this right, there are four steps to preventing a pandemic. One is rapid diagnosis, two is vaccination, three is treatment and four is nonpharmacologic interventions, which really falls on the public. You are talking about social distancing, shutting down businesses, shutting down bars, shutting down schools. So what can one person do right now to help flatten the curve?

Dr. Bearman:  The most important thing I think for an individual, a citizen, to do is to really stay aware of the situation. Get your updates from credible sources -- health department websites. Certainly the CDC is a good place to look for information also. Really abide by the recommendations for the nonpharmacologic interventions, which are the things such as washing your hands frequently, staying away from work, from others if you are sick, socially isolating, practicing respiratory and cough etiquette, washing your hands after coughing, coughing or sneezing into a tissue and promptly throwing that tissue away. Wiping down surfaces in the household, particularly in the kitchen or common areas. Those will all help minimize the risk within your home for the spread of COVID-19.

Host:  And for people that are unhappy with this or just don’t understand it; there is evidence that this really works, is that right?

Dr. Bearman:  Oh absolutely. In health care systems where they have been very, very aggressive with diagnosis, contact isolation or tracing and isolating people and using non-pharmacologic interventions, the curve has significantly flattened. The best examples would be South Korea, Hong Kong and also Singapore. They have been very aggressive with that.

Host:  And it’s good to see their measures working. We are all feeling anxious about this. We are all a bit scared about this. So, for someone listening to this podcast right now, who needs a little bit of hope, and we all need some hope, is there anything that you are seeing that makes you hopeful?

Dr. Bearman:  Well I think that the reports that I’m seeing from other countries such as South Korea, Singapore and also Hong Kong are encouraging that nonpharmacologic interventions are effective. I also am optimistic that we will eventually have better treatments, or treatments are approved, and also a vaccine available within 12 months. But I also think it’s important to stress that situations such as pandemics really require a collaborative effort. It’s really a collaborative sacrifice. And if we all are in this together, to try to do the right things not only for ourselves but for our loved ones, with the nonpharmacologic interventions, we can significantly impact the rate of propagation of this virus in our country.

Host:  And I’m confident we’re going to do that. So, thank you for that ray of hope if you will. And then the ray of hope leads to okay, this is going to be over sometime, hopefully sooner than later, no matter what that is, nobody really knows, months from now potentially. So, let me ask you this, we’re just not going to say okay, everybody go outside, everything’s great now, businesses are open, have fun. There’s going to have to be some kind of measures in place. How do we do this? Otherwise we are just going to reignite this thing again, and we are going to have these big pop up waves of coronavirus. How do we re-assimilate back into our regular lives and communities?

Dr. Bearman:  Right. I think it will be a step-wise approach to kind of reassimilating ourselves to our prior norm. But to do that, we also have to have other provisions in place, and I think we would have to have a system of surveillance and an assurance that we have the appropriate testing available so that if there is concerns about resurgence of this disease, COVID-19, that we are able to quickly and promptly identify it and do the appropriate isolations. In addition, if we have a vaccine available sooner than later, that would certainly be hugely encouraging for allowing us to go back to kind of business per usual.

Host:  So, when you say surveillance, are you talking about on an individual basis? Because right now, we’re shutting down whole communities, whole states even. What does surveillance mean to us? Help us understand that.

Dr. Bearman:  So, what I’m saying is at present, in the United States, we have more people sick than we are reporting because we are unable to test them. The testing availability is just not there. So, if we go back or when we go back to business as usual, then as a proviso, we should have the ability to test people should they manifest symptoms so that we know that those symptoms are COVID-19 and not something else. And if they are COVID-19, we’ll have a much better understanding of the amount of disease out there, which will be the prevalence, and we would have a better mechanism to say okay, you’re infected, you need to stay home, social isolate it, et cetera, et cetera. Those measure must be in place before we go back to business as usual.

Host:  So, that type of testing and surveillance, that sounds like it could take a long time before we are ready to implement that on a wide scale in this country.

Dr. Bearman:  It could. Unfortunately the U.S. is far behind other developed countries in testing capability at this time.

Host:  Okay. So we’ve got our work cut out for us. So, I’m going to put you on the spot right now and ask you to pull out your trusty crystal ball. And I know there are no answers to this. Nobody really knows for sure. But what is your best educated guess on when we might get back to some form of normalcy?

Dr. Bearman:  So, I would say to begin with, the crystal ball is fuzzy. However, my prediction is that within three months, we might start to normalize things. That’s my prediction.

Host:  Well, all right, I think a lot of us know that we’re going to be dealing with this for a long time. But if we can get a sense of normalcy within three months, that’s a lot better than a year. I got to tell you.

Dr. Bearman:  A year would be tough. Now in three months we won’t have a vaccine but hopefully the most critical component, which will be the availability of testing -- and we will have a ramp up in the appropriate personal protective equipment so health care workers, and people working in health care, feel that they can provide care in a very safe fashion.

Host:  And in three months, might we have a better protocol on how to treat this? We won’t have all the answers, but maybe we’ll learn when we see a COVID-19 patient, this is what we have to do first. This is what we have to do second. Might we have those types of answers within three months?

Dr. Bearman:  Yes. Almost certainly within three months, we’ll have a better understanding of which of the medications, either new medications or repurposed medications, can be used preferentially for severe cases of COVID-19.

Host:  And that, too, would give us a ray of hope as we look to the future. This has really been informative and interesting, Dr. Bearman. Thank you so much for your time today.

Dr. Bearman:  Absolutely sir. Pleasure.

Host:  That’s Dr. Gonzalo Bearman. VCU Health is prepared and up to date with the latest information and care for COVID-19. And for more information on COVID-19, please visit www.vcuhealth.org/covid-19. That’s www.vcuhealth.org/covid-19. And if you found this podcast helpful, please share it on your social channels. And explore the full podcast library at www.vcuhealth.org/podcast for more health topics of interest to you. This is Healthy with VCU Health. I’m Bill Klaproth. Thanks for listening.