Q+A With a Physician
With Dr. Phong Nguyen, an internal medicine doctor with Kaiser Permanente Hospital at San Rafael, leader of screening and caring for patients infected with COVID-19.
J: I think that this is an important question specifically for people my age, but why should people, including teenagers, be sheltering in place and social distancing during this time?
P: The uniqueness of this virus and why it’s so problematic is that this infection doesn’t get most people very ill. So [for] most people, especially when they are younger, it’s just like a mild cold. … With this virus, it can stay dormant in a person for up to two weeks. So, if you get infected, you don’t even know you're infected. You’ll go about in the community and see other people [for] up to two weeks. And it’s mild, so when something is mild you still go on with your day, especially teenagers and young adults, right? You just think, “Oh I have a little cold, no big deal.” But for patients 65 and older, like our grandparents, eight out of 10 deaths, people that die from this, are over the age of 65. It goes up significantly when they’re over ... 80 years old... [COVID] passes through young adults, which is why it’s important to shelter in place because that is how it spreads. We really need the young: college students, high school students [and] young adults to help with the older population by staying away from each other. It’s really the younger population that goes out to restaurants, schools, concerts and sporting events. Older adults don’t really go to outdoor activities so that’s why it is important for your peers to really lend a hand to this shelter in place.
J: What will the consequences be if people continue to disregard shelter in place?
P: What happens is that, during a pandemic, there’s a spike, meaning everyone gets sick. And if everyone gets sick at the same [time] they all go to the hospital at the same time. It’s kind of like a door ––When everybody rushes to the door it becomes a bottleneck and they all get trapped, trampled and people get hurt. And you can see a lot of examples around the nation of places that haven’t. I think California was one of the first states to shelter in place, so if you look at New York, you look at Louisiana, you look at the other states, they didn’t do shelter in place early enough. What happens is you have a spike and everybody goes to the hospital which means there’s not enough medicine, not enough beds, not enough [of] anything. Plus, you can’t forget the normal people who go to the hospital because of a heart attack or stroke too. So you also have a normal group of people who have to go to the hospital for normal things plus this other group who have COVID. Now, the idea of shelter in place is to stop this. Let’s just say 100 people get sick; do you want all 100 to get sick at the same time or do you want to spread it across three months so that there’s more care? It’s called flattening the curve. When you flatten the curve, yes it lasts longer but it’s not everyone getting sick at one time, then we can provide care for those people.
J: And then hospitals run out of equipment etc?
P: Exactly. If we don’t shelter in place what happens is that the pandemic, (I want to preface that I am not an infectious disease physician this is just based on my knowledge as a family physician), if people don’t shelter in place you will see more spikes later on. If it passes through and people are still not sheltered there can be other spikes of [a] coronavirus outbreak. Because it just doesn’t go away 100%, it can come back if it mutates.
Stop here, ^^ ones to put in the page
J: How did the spread of this infectious disease begin?
P: That’s a very good question, and this is the theory we have. Coronavirus is a large family of viruses that can be seen in animals. It’s in pretty common animals like dogs, cats, horses, cattle, bats; and usually it’s pretty benign. Usually they just live within them, but the problem is that viruses mutate. I’ll use an example like the flu, [which] mutates every year. So, the flu vaccine changes every year. So what happened is that coronavirus mutates. It mutated and transmitted from an animal to humans. We believe that it was bats that were the original animal of source. And so then, for a little more background, it mutated enough where it transmits from human to human now. That’s just really unlucky. We saw the same thing with SARS and MERS.
J: Should people be worried about COVID-19’s rapid advancement across the US?
P: I think worry, anxiety and fear are all natural emotions when we’re dealing with uncertain times. I think there should be a healthy amount of caution, meaning we should practice social distancing, that’s really key, and practice shelter in place, and really prevent the spread. But, we still need to be healthy. So we recommend that people get exercise throughout the day. 15 or 20 minutes of either [a workout] in a home gym or outside. I think that also the key is socializing. We can do that through social media, Zoom or phone calls because we feel alone now; a lot of people who are isolated are feeling alone, but we don’t need to. It’s called COVID socialization; it's part of life. Like the flu season, it’s just a part of life. And I think that instead of becoming panicked, instead of hoarding, instead of being fearful, we should educate ourselves, socialize and be cautious.
J: What is the procedure to test for COVID-19?
P: So for COVID-19, the way we test at [Kaiser Permanente Hospital], I can’t speak for others, but we use ... what we call a nasopharyngeal swab. What we do is that we take what is like a Q-tip almost, but medical, and we swab your throat, kind of like a strep test. Then we take it and we go into your nose, which can be a bit uncomfortable. But we get the back of your nasal passages and we’re looking for the virus. Then we test for it, and it takes about 24 hours for us to get it back, but we’re looking at New York tests to get it back within 45 minutes to 50 minutes. We want to make sure that it’s accurate, right, because something brand new isn’t the most accurate and if it isn’t accurate then why test? So we’re working on receiving tests but I think the scientists and pharmaceutical companies are working hard to find the medium between something accurate, speedy and that we can use right away.
J: And nurses that test these, do they test in full gear? What is the risk of them getting infected?
P: The person that is getting tested or the “testees”? J: The testees, like nurses or doctors that go out and test people for COVID?
P: We have criteria on who we test and who we don’t test. And the reason why is that there is a limit on supplies for tests. This is not something that we could have planned for in advance to produce 300 million tests. Right now, we have this procedure at Kaiser where you get written up and then you would test. You would swab yourself behind the mirror then they would test you. So, there isn’t really any risk that the doctor or the nurse doing the test would face; you have a face shield, eye protection, a mask, etc so it is very low risk. I think you’re at more risk just being in society, catching COVID-19 from families or friends and just being around the public, not necessarily doing the tests.
J: This is just a question that I personally am curious about and that I think many others may be curious about: do you personally have an idea of why so many people have stocked up on toilet tissue?
P: It’s funny because I had to look that up when I saw it, but I also had an inkling to maybe why. Physiologically, when there is ever a pandemic or a natural disaster, something that we can’t control as humans, because we can’t control this, it’s a natural disaster in a way, people become fearful. We lose that feeling of control; [the] majority of people like to feel in control. So what people want to do is feel like they can do something that keeps them in control. Like to say, “I’m in control of my life.” And part of that is hoarding. When they go to the store, people will hoard food. They may buy pasta and be like, “What do I need to buy if an apocalypse happened?” Then part of it, something personal, is the bathroom and hygiene. People want to know, “If I go to the bathroom, what do I need bare minimum?” And one of these things is toilet paper. Since toilet paper is big and bulky, it feels good to have that in the house and feel stocked. It’s not really a shortage of toilet paper, it's more a concept of people thinking that they can’t control what’s going on in their life; they can’t go out, they can’t control the stock market, but the least they can do is hoard a bunch of stuff. It is more of a physiological component than a rationalization. People have bought a few months' supply of toilet paper and toilet paper is still being made today, but that is really what we see and my best educated guess of why we see a shortage of toilet paper and other cleaning supplies. It’s not like people think they need to buy coffee for three months, or soda. You know, if you go to a supermarket there’s tons of fresh food and vegetables left. It’s the anxiety that we have to be empathetic for and understand, and the toilet paper is an element of that right now. It is what it is and we just try to help people understand.
J: More generally, why is COVID-19 different from other diseases such as influenza?
P: It’s because of what I was saying before, COVID can stay asymptomatic for so long. Because it is mild in younger adults, but is so deadly for older adults. That’s the problem. It is almost like the virus has adapted very well to transmission. It has adapted so that people can still function but it is becoming very problematic for patients who are older and patients who have pre existing medical problems such as asthma, cancer survivors [and] those on chemo. These are people who are in need. That is why this particular disease is causing problems for us.
J: Are there any cures or vaccines being trialed to your knowledge?
P: There are. A typical vaccine can take 5 to 6 years to develop. Fast tracking it would take a year to a year and a half, and that is super fast tracking it. The problem is that we invent a vaccine and give it to somebody completely healthy, but we don’t know what the side effects are. If the side effects cause something bad like cancer, you would want to know. You have to do clinical trials to see what it does down the line or if it could cause something else like a nerve problem or get you sick. We have to find a way to see whether it’s safe and effective. So that’s the problem: the safety and effectiveness. Because what you’ll be doing is giving it to hundreds of millions of people, and if 1/100 people get sick from it is it really worth it?
J: And making a vaccine in one to two years, that’s super fast isn’t it?
P: That’s super fast. And you still have to test it out on people, like a volunteer. Not many people want to test the new vaccine. So usually, we test it on animals to watch and see what it does. You want to see what it does; you can’t speed [the process] up. Hearing from experts, it will probably take a year to a year and a half tops.
J: Are there any current medicines that help ease pain from the virus? There have been rumours spreading around and on the news about how certain meds may help, so from a doctor’s perspective do you have any information on this?
P: So, if you take 100 people, about 80 of them will have a mild, mild cold. For that we recommend over the counter measures such as Tylenol, Advil, Mucinex. Of the 100, about 15% of them will become hospitalized. There’s not a lot of treatment in hospitalization other than IV fluid and hospital care. About 5% will become critical care. Like I said, these are going to be older people with weaker immune systems. So there is going to be no magical medicine right now. We have ideas and are experimenting, but there is no 100% cure. It’s not going to be kombucha and açaí berries. But we’re working on it and I feel confident that scientists are grinding 24 hours to come up with a solution for society.
J: What should people do if a family member contracts the disease?
P: So if someone you love has COVID, you want to provide a safe, isolated place for them like their bedroom. And you want to enforce it, practice social distancing and stay six feet away. Now if it is an adult, that’s easy. They can just live in the room, watch TV and go on the Internet... right? I think it becomes harder with children, kids and adults that can’t take care of themselves. And so, at that point, you need to clean areas that the patient comes in contact with a lot like door knobs, tables, chairs. You want to wipe those down pretty regularly if somebody is sick in the house. So put masks on the patient who is sick, then a lot of wiping down, cleaning and social distancing.
J: I just have two more questions for you, they’re pretty straight forward. On what surface does COVID-19 last the longest on?
P: Well, we don’t know what it lasts longest on. COVID is passed through respiratory droplets and when it lands on a hard surface like a table or a door handle, it can stay there for hours, not days. But the problem is that with highly trafficked areas like door handles, people touch them all the time. We infect it over and over. So what we want is to wipe down keyboards, laptops, phones, especially phones. If you think about it, somebody coughs into their hand, they touch their phone, then they wash their hands but then they touch their phone again. Guess what? It just got reinfected. That is what I would recommend cleaning: those things that are utilized often.
J: There was a short rumor going around that summer heat would help kill the virus. How do you feel about that?
P: Well, we hope so. We don’t know. It could be the summer heat or it could be the natural progression of the disease. We don’t know because we’ve never been there. Typically, viruses don’t do well during summer but we got to hope. The best thing is hope that by summertime this will pass and I think that is what we have at this point. It is a good idea, and we just have to cross our fingers.
J: Yep, that’s the goal. Those are all of my questions, thank you for your time.
P: Of course, thank you for talking to me and reaching out.