It hasn’t been a good couple of weeks in COVID-19 news in Los Angeles. Just yesterday, L.A. County tallied upward of 4,500 new coronavirus cases, shattering the previous record for the biggest increase in new infections day over day. And this is after Governor Newsom ordered that several categories of business shutter again and Mayor Garcetti warned that alarming statistics could trigger a second safer-at-home order.
Dr. Tom Yadegar, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center, has been on the front lines of the battle against COVID-19 since the virus first hit California, creating life-saving guidelines to treat the sickest patients suffering from virus.
As the city teeters on the brink of another shutdown, we spoke with Dr. Yadegar about what he’s seeing every day—and what people can do to keep the crisis from getting worse.
I was in a store in Santa Monica the other day and the man working behind the counter wasn’t wearing a mask. He said it was “too uncomfortable to wear all day.” Explain the importance of wearing a mask.
Wearing masks is important on two levels. For the person wearing the mask appropriately, it decreases the chance of inhalation and consumption of viral particles that could cause an infection. But more importantly, it helps prevent that person from unknowingly spreading any viral particles towards others around them.
You see people with a mask on, but there nose isn’t covered. Doesn’t that defeat the purpose?
That’s not effective because a lot of particles come out of the nose. We all have to do our part. This is an inexpensive, cost-effective way to slow down the spread of the virus. Some patients have complained to me that it’s itchy or claustrophobic, but the alternative is that we all just stay home.
We are close to a complete shutdown again. Can we avoid that and how long until we know if these latest closures will work?
We should know in two to four weeks. Social isolation and stay at home orders are effective, however, I don’t believe this a sustainable, long-term solution. People can’t spend the rest of their lives stuck in their homes. Until a vaccine is available, stay-at-home orders and social isolation continue to be the best way to slow community transmission. Understanding that COVID-19 spikes occur in local clusters rather than countywide can help guide the extent of a shut down. Ideally, shut downs are initiated based on how overwhelmed hospitals in a local cluster are, not just by the amount of positive cases. It’s tricky to find balance, as everything is intertwined.
What is safe to do? Is it safe to go to a restaurant and eat outside?
That’s the million-dollar question. Although we are in the midst of a global pandemic, the outbreaks occur in localized clusters. The information that is necessary to answer this question is not easily attainable. In order for someone to make the decision to go to a restaurant, the best way to make that decision is to have information regarding COVID-19 cases in your particular area. If there was an app where you could see in real time the case prevalence, then you can make an educated decision and weigh the risk. But It is definitely safer to be outside. That said, I’ve seen patients who have required hospitalization after being in a large group outside and contracting COVID-19. It’s still safer to be outside but you need to social distance.
What are you seeing in the ICU these days?
Over the past ten to 14 days, we have definitely noticed an increase in patients presenting from the community. The vast majority of the patients that are hospitalized have not been admitted to ICU. We are getting a lot of young patients in ER testing positive but stable and being discharged home for self-quarantine. We are far from reaching our ICU capacity. But other hospitals in other counties are at capacity.
There is conflicting information about how long after exposure to the virus that someone would have symptoms.
The vast majority of people—about 90 percent—get symptoms within five days but it can take up to two weeks. Obviously every county is different and it’s about the source of the outbreaks.
Explain the difference on the numbers when we are looking at a localized coronavirus cluster in the community versus an outbreak at a place like a nursing home or even a prison.
It’s difficult to make an appropriate judgement of the scale of positive cases without differentiating between local community transmission cases versus local nursing-home resident cases. Even local nursing home cases are difficult to differentiate, as these numbers currently include staff, which should be counted separately. These are two very different patient populations with two separate risks associated with spread. The people in nursing homes aren’t going to restaurants or movies. When numbers get reported all together it’s hard to decipher the true risk in a particular community. That’s why nursing-home data can also be erroneously reported.
A new report says up to 40 percent of COVID-19 infections may be asymptomatic?
The virus needs to get into your body’s cells to replicate and cause an infection. Younger people don’t have the receptors for it to get into those cells so that’s why most young people show no severe symptoms. But there are those rare cases where you see a 90-year-old having few symptoms and then a 30-year-old going into ICU.
People also talk about recovering from COVID but still having no taste or sense of smell for months. Others talk about having no energy or reduced lung capacity.
This is definitely a real disease and has real consequences. Even people who recover may be dealing with consequences for weeks or months.
So you can’t really compare the coronavirus to the flu?
That’s right. With influenza it can take a month but most people recover from the flu. When we see a serious case with COVID, even if they survive, they can be dealing with consequences for a long time.
Because symptoms present differently in different people, many wonder if they had the virus but assumed it was the flu. That’s why antibody tests became so popular. But is a test to see if you’ve had a previous COVID infection just a waste of time? New reports say even if a person gets COVID, they may only have immunity for months, not years.
I’m not sure if it makes a difference. I wouldn’t get one. You still have to wear a mask because we just don’t know about how long immunity lasts amid these new reports.
You’ve been on the front line for about four months now. What’s changed since back in March?
Early in March, we were just learning about COVID-19. We are still learning about it but we certainly know a lot more. Over the past few months, we have gained a significant amount of insight into the treatment of patients with COVID-19. We do have several options to treat patients. These include medications such as Remdesivir, which inhibits viral replication, as well as convalescent serum. We use these medications if patients present within the first ten to 14 days of their symptom onset. We also have immunosuppressive medications, which we initiate on a case-by-case basis, when patients exhibit signs and symptoms of cytokine storm, [which is where the immune system goes into overdrive].
Of course, there is the race to find a vaccine. Medical researchers around the world are developing more than 150 coronavirus vaccines. This week there was positive news from two different companies about progress they are making in human trials. But we are also heading into flu season and coronavirus cases are skyrocketing. What’s the good and bad news?
The bad news is that while we were hopeful the number of cases would substantially decrease as we move into the summer months, the fact that we are having a surge is an ominous predictor of what may happen in the fall and winter. The good news is that in the few months we have been dealing with COVID-19, we have learned a tremendous amount about how to treat the patients and we are more successful at keeping them from progressing into needing ICU care. There are also so many different scientists and countries looking for a vaccine. We have the most intelligent people in the world looking to find a vaccine.
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