WEBVTT - COVID-19 Chapter 2: Disease 0:00:02.680 --> 0:00:04.600 Reading about it in the news, I knew it was 0:00:04.640 --> 0:00:06.480 going to be bad, but we deal with the flu 0:00:06.559 --> 0:00:09.000 every year, so I was thinking, well, it's probably not 0:00:09.080 --> 0:00:11.800 that much worse than the flu. But seeing patients with 0:00:11.840 --> 0:00:15.120 COVID nineteen completely change my perspective and it's a lot 0:00:15.160 --> 0:00:18.639 more frightening. I have patients in their early forties, and yeah, 0:00:18.680 --> 0:00:21.400 I was kind of shocked. I'm seeing people who look 0:00:21.480 --> 0:00:24.919 relatively healthy with a minimal health history, and they're completely 0:00:24.960 --> 0:00:27.600 wiped out, like they've been hit by a truck. This 0:00:27.640 --> 0:00:30.680 is knocking out what should be perfectly fit, healthy people. 0:00:31.360 --> 0:00:33.760 Patients will be on minimal support, on a little bit 0:00:33.760 --> 0:00:36.440 of oxygen, and then all of a sudden, they go 0:00:36.520 --> 0:00:40.239 into complete respiratory arrest, shut down and can't breathe at all. 0:00:41.280 --> 0:00:45.680 It's called acute respiratory distress syndrome ARDS. That means that 0:00:45.720 --> 0:00:49.159 the lungs are filled with fluid. Patients with ARDS are 0:00:49.200 --> 0:00:52.120 extremely difficult to oxygen eight. It has a really high 0:00:52.159 --> 0:00:55.440 mortality rate, about forty percent. The way to manage it 0:00:55.480 --> 0:00:58.120 is to put a patient on a ventilator. The additional 0:00:58.160 --> 0:01:03.520 pressure helps the oxygen go into the bloodstream Normally. ARDS 0:01:03.560 --> 0:01:06.240 is something that happens over time as the lungs get 0:01:06.319 --> 0:01:09.400 more and more inflamed. But with this virus, it seems 0:01:09.480 --> 0:01:14.640 like it happens overnight. Typically with ards, the lungs become inflamed. 0:01:14.680 --> 0:01:17.360 It's like inflammation anywhere. If you have a burn on 0:01:17.400 --> 0:01:20.039 your arm, the skin around it turns red from additional 0:01:20.040 --> 0:01:23.520 blood flow. The body is sending it additional nutrients to heal. 0:01:24.160 --> 0:01:27.399 The problem is when that happens in your lungs, fluid 0:01:27.400 --> 0:01:31.120 and extra blood starts going to the lungs. It first 0:01:31.120 --> 0:01:33.120 struck me how different it was when I saw my 0:01:33.200 --> 0:01:37.160 first coronavirus patient go bad. I was like, holy crap, 0:01:37.640 --> 0:01:40.840 this is not the flu. Watching this relatively young guy 0:01:41.200 --> 0:01:44.760 gasping for air, pink, frothy secretions coming out of his 0:01:44.840 --> 0:01:47.720 tube and out of his mouth. The ventilator should have 0:01:47.720 --> 0:01:49.880 been doing the work of breathing, but he was still 0:01:49.960 --> 0:01:54.160 gasping for air, moving his mouth, moving his body, struggling. 0:01:54.680 --> 0:01:57.160 When you're in that mindset of struggling to breathe and 0:01:57.240 --> 0:02:00.240 delirious with fever, you don't know when someone is trying 0:02:00.280 --> 0:02:02.320 to help you, so you'll try to rip the breathing 0:02:02.360 --> 0:02:04.520 tube out because you feel like it's choking you, but 0:02:04.560 --> 0:02:08.919 you're drowning when someone has an infection, I'm used to 0:02:08.960 --> 0:02:12.399 seeing the normal colors you associate with it, greens and yellows. 0:02:12.520 --> 0:02:15.360 The coronavirus. Patients with aards have been having a lot 0:02:15.440 --> 0:02:18.320 of secretions that are actually pink because they're filled with 0:02:18.400 --> 0:02:21.600 blood cells that are leaking into their airways. They're essentially 0:02:21.680 --> 0:02:24.560 drowning in their own blood and fluids because their lungs 0:02:24.560 --> 0:02:27.400 are so full, so we're constantly having to suction out 0:02:27.400 --> 0:02:30.840 the secretions every time we go into their rooms. I 0:02:30.880 --> 0:02:32.720 worked a long stretch of days last week, and I 0:02:32.760 --> 0:02:35.600 watched it go from this novelty to a serious issue. 0:02:35.919 --> 0:02:38.080 We had one or two patients at our hospital, and 0:02:38.120 --> 0:02:41.839 then five to ten patients, and then twenty patients every day. 0:02:41.880 --> 0:02:45.320 The intensity kept ratcheting up, more patients, and the patients 0:02:45.320 --> 0:02:48.840 themselves are starting to get sicker and sicker. When it 0:02:48.880 --> 0:02:52.240 first started, we all had tons of equipment, tons of supplies, 0:02:52.600 --> 0:02:55.080 and as we started getting more patients, we started to 0:02:55.160 --> 0:02:58.360 run out. They had to ration supplies. At first, we 0:02:58.360 --> 0:03:01.160 were trying to use one mask per patient. Then it 0:03:01.240 --> 0:03:04.200 was just you get one mask for positive patients, another 0:03:04.240 --> 0:03:07.200 mask for everyone else, and now it's just you get 0:03:07.200 --> 0:03:12.720 one mask. Even if you survive AARDS. Although some damage 0:03:12.720 --> 0:03:15.200 can heal, it can also do long lasting damage to 0:03:15.240 --> 0:03:17.880 the lungs. They can get filled up with scar tissue. 0:03:18.080 --> 0:03:21.959 AARDS can lead to cognitive decline. Some people's muscles waste 0:03:22.000 --> 0:03:24.080 away and it takes them a long time to recover 0:03:24.160 --> 0:03:27.000 once they come off the ventilator. There is a very 0:03:27.000 --> 0:03:29.880 real possibility that we might run out of ICU beds, 0:03:29.960 --> 0:03:32.240 and at that point, I don't know what happens if 0:03:32.280 --> 0:03:34.639 patients get sick and need to be intubated and put 0:03:34.639 --> 0:03:37.400 on a ventilator. Is that person going to die because 0:03:37.400 --> 0:03:39.200 we don't have the equipment to keep them alive? 0:04:23.320 --> 0:04:25.560 Oh my gosh. 0:04:25.760 --> 0:04:30.680 Yeah. That was an account from a respiratory therapist at 0:04:30.680 --> 0:04:34.800 a hospital in Louisiana who remained anonymous. For that account, 0:04:35.080 --> 0:04:38.080 I found it on Pro Publica. It was published on 0:04:38.160 --> 0:04:40.040 March twenty first, And we'll put a link to the 0:04:40.160 --> 0:04:44.600 full description in our show notes and on our website, 0:04:44.600 --> 0:04:48.000 because that was just a small excerpt from the description. 0:04:48.520 --> 0:04:53.440 It's you know, it's very eerie to read and to hear, 0:04:53.640 --> 0:04:56.560 because what it does is it reminds me of a 0:04:56.600 --> 0:04:59.760 lot of the first hand accounts from the nineteen eighteen 0:05:00.080 --> 0:05:03.720 Luenzo which I know has been brought up. The comparisons 0:05:03.760 --> 0:05:07.560 have been brought up constantly, and some are inappropriate comparisons. 0:05:08.160 --> 0:05:12.320 But just that description of healthy individuals being struck down, 0:05:12.440 --> 0:05:16.479 all people of all ages being struck down, and the 0:05:17.200 --> 0:05:22.160 horrible thought of not being able to breathe, Yeah, and 0:05:22.240 --> 0:05:23.520 drowning in your own fluids. 0:05:23.680 --> 0:05:25.720 Yeah, it's really scary. 0:05:26.360 --> 0:05:31.120 I mean, it is scary. And we should introduce ourselves 0:05:31.120 --> 0:05:33.040 before getting too much into this. 0:05:33.440 --> 0:05:34.120 Yeah, we should. 0:05:34.560 --> 0:05:37.760 Hi, I'm erin Welsh and I'm erin Oman Updyke and 0:05:37.839 --> 0:05:39.600 this is this podcast will kill you. 0:05:40.240 --> 0:05:43.720 Welcome back everyone, or maybe welcome for the first time 0:05:43.800 --> 0:05:46.520 if you jump part way into series. If you're one 0:05:46.520 --> 0:05:51.040 of those people. This is our not so many minisod series, 0:05:51.120 --> 0:05:53.640 Anatomy of a Pandemic, where we're answering all of your 0:05:53.680 --> 0:05:58.320 listeners submitted questions about COVID nineteen, the disease caused by 0:05:58.760 --> 0:06:02.640 SARS COVID two. In our first chapter, we covered the 0:06:02.720 --> 0:06:06.880 virus itself, so all of the biology of SARS CoV two. 0:06:07.960 --> 0:06:10.880 In this episode, chapter two, we're going to talk about 0:06:10.920 --> 0:06:13.599 the disease that this virus causes, what it looks like, 0:06:13.960 --> 0:06:16.800 how it's spread, and how physicians and healthcare workers are 0:06:16.839 --> 0:06:17.919 dealing with this outbreak. 0:06:19.040 --> 0:06:22.720 But first, as always, it's quarantiny time. 0:06:23.000 --> 0:06:24.280 It's quarantine ay time. 0:06:24.600 --> 0:06:30.320 In this episode, we are drinking the creatively named quarantine 0:06:30.360 --> 0:06:35.480 y two, Quarantining number two. Aaron, what is in Quarantining 0:06:35.560 --> 0:06:36.040 number two? 0:06:36.360 --> 0:06:38.560 You know, Aaron, It's kind of a whiskey ginge. 0:06:39.120 --> 0:06:41.640 Yeah, I mean I would, I would call it a 0:06:42.040 --> 0:06:45.440 Kentucky mule perhaps if you happen to have a copper mug. 0:06:46.240 --> 0:06:51.160 I did not, so the picture is disappointingly non copper. 0:06:51.560 --> 0:06:54.080 It's all right, you did your best, thank you. 0:06:55.040 --> 0:06:55.320 Yeah. 0:06:55.320 --> 0:06:58.400 So it's basically ginger ale whisky of whatever kind of 0:06:58.400 --> 0:06:59.920 whiskey you want, and some lime. 0:07:00.920 --> 0:07:03.520 And we'll post the full recipe for that quarantine as 0:07:03.520 --> 0:07:06.640 well as our non alcoholic plusy Breta on our website 0:07:06.680 --> 0:07:10.520 and all of our social media channels as always as always. 0:07:11.240 --> 0:07:16.360 Okay, So, as we mentioned, we've talked about the virus itself, 0:07:16.400 --> 0:07:18.840 so now let's talk about the disease that this virus 0:07:18.880 --> 0:07:22.440 is causing, COVID nineteen. And I do think that's a 0:07:22.520 --> 0:07:26.160 particularly important distinction because, as we'll hear more about this 0:07:26.280 --> 0:07:30.920 virus can infect you without necessarily causing severe disease, and 0:07:30.960 --> 0:07:33.760 that's super important in understanding the spread of the virus, 0:07:33.800 --> 0:07:38.080 because people who appear asymptomatic and otherwise healthy or just 0:07:38.120 --> 0:07:41.600 have very mild cases could still be infected with and 0:07:41.640 --> 0:07:45.120 therefore sneezing or coughing out the virus and spreading it 0:07:45.160 --> 0:07:49.080 to other people. So we talked to doctor Colleenkraft, who 0:07:49.200 --> 0:07:52.360 many of you may recognize from our first coronavirus episode, 0:07:52.520 --> 0:07:54.240 and she's going to walk us through a lot of 0:07:54.240 --> 0:07:57.280 your questions about the clinical disease that this virus causes. 0:07:58.240 --> 0:08:00.760 Let's go over some of the basics first, so shall we? 0:08:01.520 --> 0:08:06.560 Let's we shall? So one big question is what is 0:08:06.600 --> 0:08:10.520 the timeline of this illness? And what you're going to 0:08:10.600 --> 0:08:12.960 see is that we still don't have the answers to 0:08:13.040 --> 0:08:16.080 every question when it comes to this disease, and the 0:08:16.200 --> 0:08:19.160 timeline is kind of one of those that we don't 0:08:19.320 --> 0:08:23.160 fully know, but we do have a better handle on 0:08:23.200 --> 0:08:25.320 it than we did in our episode that we released 0:08:25.360 --> 0:08:30.000 back in February. So, first of all, it seems like 0:08:30.240 --> 0:08:34.560 the incubation period is on average about five days an 0:08:34.640 --> 0:08:39.080 incubation period is the time from when you're first exposed 0:08:39.679 --> 0:08:42.800 to that disease to when you first start showing symptoms 0:08:42.880 --> 0:08:47.040 of that disease. Okay, so on average this is about 0:08:47.080 --> 0:08:51.240 five days. It can range most studies, it seems like 0:08:51.320 --> 0:08:54.680 the max range is about eleven. So when you hear 0:08:54.760 --> 0:08:59.120 about being quarantined for fourteen days, that's because we think 0:08:59.280 --> 0:09:03.200 and we're pretty sure that after fourteen days, if you 0:09:03.240 --> 0:09:05.960 haven't started to show symptoms, you're probably not going to 0:09:06.000 --> 0:09:08.439 show symptoms. So that's kind of the max range to 0:09:08.520 --> 0:09:12.080 make sure that you don't spread this disease unknowingly to 0:09:12.160 --> 0:09:16.160 someone else if you're exposed. And this number like around 0:09:16.200 --> 0:09:19.560 fourteen days, that's consistent with what we saw with SARS one, 0:09:19.679 --> 0:09:20.520 SARS classic. 0:09:20.800 --> 0:09:21.120 Okay. 0:09:22.200 --> 0:09:26.200 Now, the other thing is that from a retrospective study 0:09:26.240 --> 0:09:31.280 of people that had COVID, the severe disease. This study 0:09:31.320 --> 0:09:34.200 looked at people who were hospitalized for COVID, so pretty 0:09:34.240 --> 0:09:39.200 severely ill. The median time from when symptoms first started 0:09:39.679 --> 0:09:43.920 to discharge from the hospital was twenty two days. So 0:09:44.000 --> 0:09:47.079 that's a long time for somebody to be in the hospital. 0:09:47.480 --> 0:09:50.040 And I think that that's an important indication that for 0:09:50.080 --> 0:09:53.320 people who get seriously sick, they can be sick for 0:09:53.440 --> 0:09:57.440 quite a long time. The other thing that this study 0:09:57.480 --> 0:10:00.320 looked at was viral shedding, so at least some measure 0:10:00.360 --> 0:10:03.840 of how long somebody might potentially be infectious, and they 0:10:03.880 --> 0:10:06.920 found that the median number of days that people were 0:10:06.960 --> 0:10:10.719 shedding virus was twenty days from the onset of symptoms, 0:10:10.920 --> 0:10:14.319 which is again a pretty long time if somebody is symptomatic, 0:10:15.559 --> 0:10:21.160 that is a long time yep, and longer than fourteen days. 0:10:21.320 --> 0:10:24.040 Yeah, that's I think. But I think the other thing 0:10:24.240 --> 0:10:26.880 that you mentioned that it's sort of this is just 0:10:26.920 --> 0:10:30.800 looking at people who had severe disease curR exactly, Yes, okay, 0:10:31.000 --> 0:10:33.680 So I wonder I think. I mean, of course, as 0:10:33.760 --> 0:10:36.400 this pandemic progresses, we're going to get more information about 0:10:36.400 --> 0:10:39.720 those people who have milder cases or are asymptomatic and 0:10:39.760 --> 0:10:43.400 how much virus they're shedding at various points throughout their 0:10:43.520 --> 0:10:44.319 course of infection. 0:10:44.640 --> 0:10:48.680 Exactly, Yeah, exactly. Okay, So then the question is what 0:10:48.760 --> 0:10:50.160 are some of these symptoms? 0:10:51.320 --> 0:10:54.800 Okay, So the biggest symptoms are the ones that most 0:10:54.800 --> 0:10:57.520 people have probably heard about in the news quite a lot, 0:10:57.880 --> 0:11:00.600 so fever, which, by the way, the death definition of 0:11:00.600 --> 0:11:03.120 a fever is a temperature of over one hundred point 0:11:03.240 --> 0:11:07.280 four degrees fahrenheit or thirty eight degrees celsius. Then there's 0:11:07.320 --> 0:11:11.200 also cough, generally a dry cough, not a super wet 0:11:11.360 --> 0:11:14.600 or a super productive cough, and then shortness of breath. 0:11:15.440 --> 0:11:17.600 So these are the general symptoms of the disease that 0:11:17.640 --> 0:11:19.080 we call COVID nineteen. 0:11:19.559 --> 0:11:20.439 But we know. 0:11:20.520 --> 0:11:24.480 Now that SARS covy two, the virus like SARS one 0:11:24.640 --> 0:11:27.840 and MERS, can infect your lung tissue and cause a 0:11:27.840 --> 0:11:32.280 lower respiratory disease, not only an upper respiratory infection the 0:11:32.320 --> 0:11:35.480 way most of the common coronaviruses do. Okay, So what 0:11:35.559 --> 0:11:38.800 does that mean, Well, it means the possibility of very 0:11:38.840 --> 0:11:41.560 severe disease like we heard about in the first hand account, 0:11:42.360 --> 0:11:44.760 and in the case of this virus, it seems that 0:11:44.840 --> 0:11:49.160 about twenty percent of cases are severe. And that doesn't 0:11:49.240 --> 0:11:51.760 mean that twenty percent of cases need ICEE you and 0:11:51.840 --> 0:11:54.720 ventilator care, but it does mean that potentially up to 0:11:54.800 --> 0:11:58.480 twenty percent of cases may need at least hospitalization and 0:11:58.520 --> 0:12:03.520 some oxygen support or some IV fluid support. An analysis 0:12:03.559 --> 0:12:07.240 from China suggest that there at least about fourteen percent 0:12:07.280 --> 0:12:12.679 of cases were severe and five percent were critical, And 0:12:12.720 --> 0:12:15.360 that means the same kind of picture that we talked 0:12:15.400 --> 0:12:18.319 about in our coronavirus episode when we talked about SARS, 0:12:18.679 --> 0:12:20.600 and the same description you heard in the first hand 0:12:20.640 --> 0:12:25.640 account so ards, ground glass opacities on X rays, potentially 0:12:25.640 --> 0:12:30.600 needing intubation. It's serious. It's a serious, serious disease, and 0:12:30.640 --> 0:12:33.160 people can also go into shock, which we've talked about 0:12:33.200 --> 0:12:35.880 a lot on the podcast. But essentially what that means 0:12:35.920 --> 0:12:38.720 is that your organs aren't getting enough blood flow in 0:12:38.800 --> 0:12:42.000 this case because of overwhelming infection, which leads to leakage 0:12:42.000 --> 0:12:46.040 of fluids and then hypoperfusion, and then of course there 0:12:46.120 --> 0:12:49.080 is also always the risk of a secondary infection on 0:12:49.200 --> 0:12:50.720 top of this viral infection. 0:12:51.640 --> 0:12:55.840 It can be pretty gnarly. But also in this case, 0:12:55.920 --> 0:12:59.040 what we see that is different from SARS and mers 0:12:59.360 --> 0:13:03.200 and what in our first episode about coronaviruses was still 0:13:03.280 --> 0:13:05.960 kind of a gray zone. That's a lot more clear 0:13:06.040 --> 0:13:11.200 now is that asymptomatic or very mildly symptomatic infection is 0:13:11.240 --> 0:13:15.320 not only possible, but it's likely actually responsible for quite 0:13:15.360 --> 0:13:19.040 a lot of the spread of this disease. It's estimated 0:13:19.400 --> 0:13:23.480 that about eighty percent of cases are mild, which, while 0:13:23.520 --> 0:13:26.480 that's great news for the majority of people who get infected, 0:13:26.559 --> 0:13:29.120 it means you're not necessarily going to be looking at 0:13:29.160 --> 0:13:32.640 such a severe disease. It also means that this disease 0:13:32.720 --> 0:13:35.640 is easier to spread since not everyone who's sick maybe 0:13:35.640 --> 0:13:40.200 even realizes that they're sick. And how does this disease spread. 0:13:39.960 --> 0:13:46.480 Erin well, respiratory droplets as we well know, but we're 0:13:46.520 --> 0:13:49.480 not going to go into that. We're going to allow 0:13:49.559 --> 0:13:54.760 our expert, doctor Collingcraft from Emory University to explain how 0:13:54.880 --> 0:13:59.760 respiratory droplets work, as well as other characteristics of this disease, 0:14:00.000 --> 0:14:02.360 how wo'ds spread, how we're testing for it, who we're 0:14:02.400 --> 0:14:05.040 testing for it, and finally, how we treat it. 0:14:05.800 --> 0:14:35.800 Right after this break, my. 0:14:35.800 --> 0:14:39.000 Name is Colleen Kraft and I'm the Associate chief Medical 0:14:39.000 --> 0:14:42.880 Officer at Emory University Hospital. My training is in infectious 0:14:42.880 --> 0:14:44.760 diseases and clinical microbiology. 0:14:45.800 --> 0:14:48.680 Thank you again, so so much for joining us. We 0:14:48.760 --> 0:14:51.080 know that you have just been swamped with work and 0:14:51.120 --> 0:14:53.760 so we really appreciate you taking the time to kind 0:14:53.760 --> 0:14:58.040 of talk about COVID nineteen. I mean since our first 0:14:58.080 --> 0:15:00.360 interview with you, which has been you know, about a 0:15:00.400 --> 0:15:03.280 month and a half ago. A lot has happened. 0:15:03.560 --> 0:15:06.120 Yes, like a lifetime has happened. That's how I feel. 0:15:06.480 --> 0:15:10.320 Yeah, yeah, so we'll jump right in. We are talking today, 0:15:10.360 --> 0:15:14.200 of course, about SARS COVID two, the virus that causes 0:15:14.480 --> 0:15:19.080 COVID nineteen. So we know that it's transmitted through respiratory 0:15:19.240 --> 0:15:24.600 droplets or direct contact with somebody's respiratory droplets, like other coronaviruses. 0:15:25.160 --> 0:15:26.680 Can you tell us a little bit about what that 0:15:26.800 --> 0:15:30.800 means in contrast to viruses that are airborne and when 0:15:30.840 --> 0:15:35.800 people talk about respiratory droplets, like what exactly does that include? 0:15:36.000 --> 0:15:40.000 Sure? So I think it's it was really funny to hear. 0:15:41.480 --> 0:15:44.200 I've been to a number of town halls around Emory 0:15:44.280 --> 0:15:47.480 and I had one of my audience members best described 0:15:47.520 --> 0:15:51.240 it as, you know, it's your saliva, So it's sort 0:15:51.280 --> 0:15:55.080 of I view respiratory droplets as being sort of the 0:15:55.080 --> 0:15:58.480 wet aspects of our coughs and sneeze, and that's that. 0:15:58.520 --> 0:16:02.200 I thought that was very well described that way by 0:16:02.200 --> 0:16:06.040 this employee. And I didn't answer your your airborne question. 0:16:06.160 --> 0:16:09.400 So what happens is when we cough or sneeze, it's those, 0:16:09.480 --> 0:16:12.360 it's like a wet, heavy droplet, and that kind of 0:16:12.440 --> 0:16:15.640 goes to the ground right sooner because it's heavy. But 0:16:15.800 --> 0:16:19.600 when they are really small, then they can aerosolize and 0:16:19.640 --> 0:16:22.400 they can actually sort of hang around in the air 0:16:22.440 --> 0:16:24.520 for longer. And so that's why every time there's a 0:16:24.520 --> 0:16:27.880 new respiratory virus we sort of pretend like it's airborne, 0:16:27.920 --> 0:16:29.960 just to make sure it's not airborne, because that is 0:16:30.000 --> 0:16:33.760 sort of a different transmission route that that can hang 0:16:33.800 --> 0:16:38.200 in the air longer and it can go farther. But 0:16:38.640 --> 0:16:41.480 you know, from what everything we know, this coronavirus still 0:16:41.520 --> 0:16:46.880 behaves like our droplet spread coronaviruses, gotcha. 0:16:48.280 --> 0:16:51.840 So at this point we have a better idea of 0:16:51.880 --> 0:16:55.040 what a typical course of COVID nineteen looks like. Can 0:16:55.080 --> 0:16:57.880 you walk us through what that is like? You know, 0:16:58.000 --> 0:17:00.600 day one, day two, what do you typically see? 0:17:01.160 --> 0:17:04.040 Yeah, so we're seeing the same things as being seen 0:17:04.080 --> 0:17:06.679 and observed in other parts of the world. And so 0:17:07.520 --> 0:17:10.600 we have the vast majority of these individuals have a cold. 0:17:11.640 --> 0:17:15.159 It may be an unpleasant cold more than for others, 0:17:15.200 --> 0:17:18.520 but most people have a very mild illness, probably most 0:17:19.119 --> 0:17:22.879 similar to our common cold. In general. We are seeing 0:17:22.920 --> 0:17:26.280 people though, that come in with basically a viral pneumonia 0:17:26.359 --> 0:17:29.240 type picture. Viral pneumonia should really make the hairs on 0:17:29.280 --> 0:17:32.560 the back of your neck stand up, because that's probably 0:17:32.600 --> 0:17:35.920 what happened in the nineteen eighteen Spanish flu. And this 0:17:36.000 --> 0:17:38.919 is again along with the airborne aspect, this is what 0:17:38.960 --> 0:17:42.040 we're always looking for in these new viruses. Does it 0:17:42.160 --> 0:17:46.080 have a propensity to cause lower respiratory tract infection? If 0:17:46.080 --> 0:17:50.000 it does, that makes us scared because we can't. While 0:17:50.000 --> 0:17:52.919 we can do a lot with bacterial pneumonia, a viral 0:17:52.920 --> 0:17:56.760 pneumonia is very scary because usually don't we can't treat 0:17:56.840 --> 0:17:59.359 most of the viruses that we get, and so we 0:17:59.400 --> 0:18:01.360 definitely don't it down and the lung where it can 0:18:01.400 --> 0:18:05.400 cause scarring and difficulty breathing. And so for a subset 0:18:05.440 --> 0:18:07.840 of people that for the most part tend to be 0:18:07.960 --> 0:18:11.919 ill ill at baseline, we have a group of people 0:18:11.920 --> 0:18:17.200 that also are getting symptomatic lower respiratory tracts syndrome who 0:18:17.359 --> 0:18:20.040 are not quite as ill as the typical person we're 0:18:20.080 --> 0:18:23.480 hearing about that is succumbing to this disease. So we've 0:18:23.480 --> 0:18:26.240 had a number of individuals that yes, they have other 0:18:26.280 --> 0:18:29.480 medical problems, but they don't necessarily have respiratory medical problems, 0:18:29.520 --> 0:18:32.320 and they are having you know, sort of a viral 0:18:32.359 --> 0:18:35.399 pneumonia picture, and we have had a few that have 0:18:35.560 --> 0:18:39.840 been needed to have mechanical ventilation or a breathing tube. 0:18:40.760 --> 0:18:44.440 Gotcha about how long does is the course of disease? 0:18:44.520 --> 0:18:47.080 You know, I know that for some people who have 0:18:47.200 --> 0:18:51.400 milder cases it may be shorter than for others. But 0:18:51.480 --> 0:18:53.320 what do we see on average or what does it 0:18:53.359 --> 0:18:56.600 look like for the people with more mild symptoms compared 0:18:56.640 --> 0:18:58.560 to the people with more severe outcomes. 0:18:59.240 --> 0:19:02.640 I would say it's it's that typical three day kind 0:19:02.640 --> 0:19:06.200 of feeling bad, achy, and then the next day is 0:19:06.200 --> 0:19:08.240 maybe a little bit better, not great, and then the 0:19:08.280 --> 0:19:11.160 next day you're sort of back to feeling like you're 0:19:11.359 --> 0:19:15.440 among the living. And then you know, then we also 0:19:15.640 --> 0:19:17.919 recommend for at least for our employees to sort of, 0:19:18.400 --> 0:19:20.880 you know, kind of self isolate for a few more days, 0:19:20.920 --> 0:19:22.680 just to make sure you're not sort of still having 0:19:22.760 --> 0:19:26.840 those secretions coffin sneeze because we don't want to keep 0:19:26.840 --> 0:19:29.520 spreading it. And so that's sort of a mild course. 0:19:30.040 --> 0:19:33.879 The more severe courses tend to be you know, I 0:19:33.880 --> 0:19:36.159 think the damage is done within the first week, and 0:19:36.200 --> 0:19:38.480 then what we're doing is trying to support the body 0:19:38.560 --> 0:19:40.640 so the body can mend after that. 0:19:41.480 --> 0:19:46.080 What does that supportive care look like, both in terms 0:19:46.080 --> 0:19:49.199 of that during that first week of intense symptoms and 0:19:49.240 --> 0:19:52.240 then the sort of you know, the healing stage. 0:19:52.920 --> 0:19:55.879 Right, So it sounds like it's your grandmother patting your hand, 0:19:56.200 --> 0:19:58.959 is what supportive care sounds like, I think to most people. 0:19:59.480 --> 0:20:02.359 But in the case of some individuals that have severe disease, 0:20:02.400 --> 0:20:05.359 it may mean that they have a breathing tube, they're 0:20:05.359 --> 0:20:07.919 in an ICU, they have many other things that are 0:20:07.960 --> 0:20:10.919 helping support their body until the body can kind of 0:20:10.920 --> 0:20:13.480 get rid of the virus itself. So this is sort 0:20:13.520 --> 0:20:15.600 of how we describe things back in the bola days, 0:20:15.640 --> 0:20:17.840 where you know, most of the time what we're doing 0:20:17.920 --> 0:20:22.040 is just supporting, like with life support, basically to try 0:20:22.080 --> 0:20:25.879 to keep things going until the body can create and 0:20:25.920 --> 0:20:29.399 clear that virus. That's what happened during a bola with coronavirus. 0:20:29.240 --> 0:20:32.560 It's sort of similar. So supportive care when you're at 0:20:32.600 --> 0:20:37.040 home maybe niquil and television, which sounds really great to 0:20:37.080 --> 0:20:40.560 me right now, and when you're in the hospital. Though. 0:20:40.600 --> 0:20:43.280 What that is is if we need to help one 0:20:43.320 --> 0:20:45.399 of your body systems function, we will do that. 0:20:47.040 --> 0:20:50.919 Okay, do we know at this point how much things 0:20:50.960 --> 0:20:54.280 like viral load might correlate with the severity of symptoms? 0:20:54.320 --> 0:20:58.159 Are the people that have milder cases, are they as 0:20:58.280 --> 0:21:01.000 infectious to others? Are they shedding as much viral particles 0:21:01.040 --> 0:21:02.480 as these more severe cases? 0:21:03.520 --> 0:21:07.200 Right? So, I think this is a great question. And 0:21:07.480 --> 0:21:09.280 I think as this is where you're going to see, 0:21:09.280 --> 0:21:12.280 my laboratory in side come out quite a bit. So 0:21:12.320 --> 0:21:15.359 it's really easy when we talk about viral load in 0:21:15.400 --> 0:21:19.200 the blood or plasma or serum to sort of understand 0:21:19.200 --> 0:21:22.679 how to standardize that by copies per mili liter or 0:21:22.680 --> 0:21:26.439 something like that. When we're doing a respiratory swab. I 0:21:26.440 --> 0:21:29.920 think it's really hard to standardize. And because this test 0:21:30.000 --> 0:21:32.679 is so new, we don't have the test standardize in 0:21:32.720 --> 0:21:35.720 and of itself, So the testing results at our institution 0:21:35.960 --> 0:21:38.480 may be a little bit variable compared to another institution, 0:21:38.560 --> 0:21:40.600 and that's because we don't have a gold standard yet 0:21:40.680 --> 0:21:43.879 to compare on all of the machines. So I agree 0:21:43.920 --> 0:21:48.240 with you. However, we have seen very anecdotally that we've 0:21:48.240 --> 0:21:52.159 had people with very high viral loads that basically didn't 0:21:52.160 --> 0:21:55.080 even look like they were sick, and we question whether 0:21:55.119 --> 0:21:57.560 or not we should even swab them. And I had 0:21:57.600 --> 0:22:01.920 extremely high amounts in their nose, whereas we've also had 0:22:01.920 --> 0:22:04.320 people that have had moderate amounts that are sick and 0:22:04.359 --> 0:22:08.199 on a ventilator. And so, while I think there's an 0:22:08.280 --> 0:22:11.280 aspect that correlates, I think the way that we obtained 0:22:11.560 --> 0:22:15.920 the swab is going to make this difficult unless there's 0:22:15.960 --> 0:22:19.639 some sort of serum or plasma or surrogate tests we 0:22:19.680 --> 0:22:22.600 can use that can be very standardized with its input. 0:22:23.880 --> 0:22:29.040 And so going revisiting this aspect of perhaps asymptomatic individuals 0:22:29.119 --> 0:22:33.120 or people with very very mild cases of this, can 0:22:33.160 --> 0:22:36.639 you talk about sort of the incubation period when people 0:22:36.720 --> 0:22:40.880 might start becoming infectious, how long they remain infectious, and 0:22:40.920 --> 0:22:44.720 then sort of how much do you think asymptomatic individuals 0:22:44.840 --> 0:22:46.800 might be contributing to the spread of disease. 0:22:48.280 --> 0:22:51.879 So I think they probably are contributing to the spread 0:22:51.920 --> 0:22:53.800 of disease. I think that's why some of these more 0:22:53.840 --> 0:22:58.040 dramatic things that we're seeing are the social distancing and 0:22:58.080 --> 0:23:00.760 being really aware of your even more so just your 0:23:00.800 --> 0:23:03.800 own hand hygiene, just your own persona as it relates 0:23:03.840 --> 0:23:07.040 to anybody else. And so I think that we are 0:23:07.119 --> 0:23:10.800 taking measures to have that not happen. Right school's closing. 0:23:11.240 --> 0:23:12.840 Let's talk about where there could be a lot of 0:23:12.880 --> 0:23:17.159 asymptomatic spread of disease. That would be a school. So 0:23:17.200 --> 0:23:20.199 you got a bunch of kids shedding virus everywhere in 0:23:20.240 --> 0:23:24.480 close proximity, with limited hand and face and everything hygiene, 0:23:24.960 --> 0:23:30.520 And you can tell I have children, and that's just like, 0:23:30.760 --> 0:23:33.400 that's just a setup for transmission. So I do think 0:23:33.440 --> 0:23:38.120 that while asymptomatic people are shedding, we're really taking dramatic 0:23:38.119 --> 0:23:40.720 efforts on like I've ever seen in my short lifetime. 0:23:40.760 --> 0:23:44.560 I suppose really to even work on stopping that. I mean, 0:23:44.640 --> 0:23:48.560 hospitals aren't allowing very many visitors, you know, public places 0:23:48.560 --> 0:23:52.240 of all but canceled everything. So we're actually really trying 0:23:52.280 --> 0:23:55.879 to break that cycle, which I think has to me 0:23:56.040 --> 0:23:59.959