What:
Media were invited to attend and ask questions at this Virtual Press Conference with a Newswise Live Expert Panel to discuss the COVID-19 crisis.
Topic: Testing, Drug Discovery, Infectiousness, and more. Italy is flattening the curve while the U.S. has become the epicenter. What have we learned about the virus and how will we know when the tide turns on the rates of infection? Is social distancing working? Are enough tests available to identify and isolate the infected? What have we learned about the virus surviving on surfaces and in the air? What mathematical models can help to predict the peak and hopefully the decline in new cases as time goes on? Is the end in sight?
Who:
- Juan Dumois - Pediatric Infectious Diseases physician, Johns Hopkins All Children's Hospital
- Sumit Chanda - Director and Professor, Immunity and Pathogenesis Program, Sanford Burnham Prebys Medical Discovery Institute
- Brian Hedlund - Professor, University of Nevada Las Vegas
- Eric Forgoston - Professor, Mathematical Sciences, Montclair State University
- Jessica Peck - Clinical Professor, Baylor University School of Nursing
When: Thursday, April 2, from 2-3 PM EDT
The transcript of this expert panel is available below.
THOM: Welcome to this NewsWise Live Virtual Press Conference. We have today an expert panel of researchers, doctors and other professors who are prepared to talk about the COVID-19 crisis and various topics related to that. We have with us Dr. Juan Dumois from Johns Hopkins All Children’s Hospital. We have Dr. Sumit Chanda from the Sanford Burnham Prebys Medical Discovery Institute. We also have Professor Brian Hedland from University out of Los Vegas. Eric Forgoston from Montclair State University and Jessica Peck from Baylor University School of Nursing. Thank you to all the experts for joining us today. Thank you also to the media who have logged in and are attending, we want your questions, please do chat those questions to us. We will offer to let you ask your questions live in the meeting or if you’d like us to just relay them to the expert ourselves, we can do so. Please rename yourself so that we make sure we know who are identifying from the media. Click on the little three dot menu in the upper corner of your picture and rename yourself with first name, last name and your media outlet.
I want to go ahead and get started with Dr. Chanda and some questions for you. Dr. Chanda, you’re a specialist in virology, immunology and drug discovery so I wanted to talk with you about while the hopes remain that there could be a vaccine that might take more than a year for that to happen, so what’s happening right now to test existing drugs that might have some effect on COVID and help flatten the curve?
CHANDA: The vaccine, I think if everything goes well, we’re probably looking at about year to a year and a half. In the meantime, what we’re looking to do is develop existing therapeutics and see if they have any ethicacy against the virus. Right now, there are several exciting compounds that are in clinical trials, I think some of the more advanced trials are coming out of Gilead in the Bay area in San Francisco using a molecule called Remdesivir. Another molecule from Japan, favipiravir, which acts in a similar manner as Remdesivir, and both of those are showing some signs of promise in clinical trials. These are antivirals that were developed for other viruses and now they’re being repurposed. Typically, a drug discovery effort takes five to 10 years, I think our best shot right now to get something to market and into patients quickly is to take old drugs and see if they work against the current Coronavirus that’s circulating.
THOM: And what concerns do you have that the virus could develop drug resistance? Is that something that we’re looking at?
CHANDA: Yeah, so Coronaviruses are RNA viruses, RNA viruses are notorious in being able to develop resistance and Remdesivir, which is the compound from Gilead, there’s already been some resistance reported, not against Coronaviruses but other viruses that it’s been [AUDIO ERROR -- 0:06:01.1]. The strategy really is going to be I think developing a drug cocktail that boxes the virus into a corner, we did this for HIV. HIV therapy consists of about three different anti-retrovirals and that allows the therapeutics to not allow the virus to develop the resistance against any one set of molecules but then allow effectiveness for all three drugs to suppress the virus.
THOM: One more question for Dr. Chanda before we move on to one of the other experts and I want to remind the media in attendance to please chat your questions to us, we’d love to have you ask them live or we can relay them from the chat to the expert. Dr. Chanda, can you tell us about some of the work that you’re doing on this bio archive that’s been funded by the Gates Foundation and involved looking at those other already preapproved drug compounds and whatnot?
CHANDA: Yeah, I’d be happy to. So, right now what people have been doing is taking educated guesses as to what existing drugs might work against the virus. What we’re doing is using a collection as you mentioned that was funded by the Gates Foundation and developed by the Scripps Research Institute here in La Jolla .We partnered with a lab out of Hong Kong, Dr. Young’s lab who’s actually was the discoverer of the first SARS virus that came out in 2003 and what we’re doing is we’re testing about 13,000 known drugs, so they are drugs that are either FDA approved or have been in phase one, phase two, phase three clinical trials and we’re looking to see one by one if they can knock down the virus. If they can knock down the virus, we know that there is a safety record associated with these compounds and these can be very quickly developed into clinical candidates that can go into clinical trials for testing to see if they work in humans.
THOM: Great, thank you so much Dr. Chanda. I want to turn now to Dr. Dumois from Johns Hopkins All Children’s Hospital. Dr. Dumois we have a question in the chat from one of our reporters, Deb Wood with Nurse Zone. She’s interested in hearing your suggestions for nurses and other health care workers who are working on the frontline and then going home, what can they do to reduce the risk of transmission to their families and what are some best practices? Dr. Dumois? It looks like Dr. Dumois’s video feed is not working at the moment, we’ll give him a second to return. Let me ask this question then of Professor Peck. Professor Jessica Peck at Baylor School of Nursing. I know you’ve got experience with this area as well; would you like to take this question?
PECK: Sure, I’d be happy to, thank you Thom. You know, the great news is that nurses and other health care workers are well versed in infection control and so we do know some basic things that we can do. There is widespread discussion about stripping down in the garage and taking off of your clothes that provided care in and then going to shower before you have any contact with your family. I’ve seen a lot of really creative things. Some health care workers and nurses are making sacrifices to stay away from their families at this time. There is a group in Texas who is arranging for health care workers to RV’s or vacation homes so that they can have a safe place to self isolate, as well as other health care universities and other systems making other arrangements with hotel chains to be able to do that. The other thing that you can do is make sure that you’re monitoring symptoms really closely at home, taking your temperature regularly. If you have any symptoms to self isolate as soon as possible.
THOM: Great and I see Dr. Dumois has joined back in the meeting and I hope your audio and everything is working. Dr. Dumois, did you hear the question about how nurses and health care workers can protect themselves and their families when they come home?
DUMOIS: Yes, and I thought that answer I just heard was great.
THOM: Excellent, anything that you’d add to it?
DUMOIS: No, I think that monitoring for symptoms when you’ve had a possible exposure is really important. One thing that we have tendency to do is that when we start to get that scratchy throat, to discount it as, “Oh, I just have a dry throat or my allergies are flaring up.” It’s better not to assume allergies but to maybe really be vigilant about that new symptom and whether it might be the onset of a COVID-19 illness.
THOM: What other advice do you have for families about how to properly do social distancing? Things like whether objects need to be cleaned and wiped down when they come inside from a delivery or from going to the store? And then what to do if someone does become ill in your household?
DUMOIS: You know, it is possible for objects to get contaminated by the virus from the hands of someone who just handed you an object. We think that the virus can survive on the surfaces of packages and other objects for at least several hours, so that if you get an object delivered to the home or bring an object from outside the home into the home, you can try to disinfect it. Some people are preparing sprays of common household disinfectants or even diluted bleach will also work to just spray on and sterilize any object that you bring in. If you want to make the diluted bleach, the formula is four teaspoons in a quart of water.
THOM: Great, Dr. Dumois we have a question from the chat. This is from Elaine Howley at US News. She’d like to know about the current thinking on reinfection, if a patient recovers from COVID, can you get it again or do you in fact gain some immunity, is this even known at this point? If it’s believed that immunity is imparted, is there any understanding yet about how long that might last with regard to the vaccine, also is it thought that it would be like the flu, which needs to be updated annually or might it be able to last longer?
DUMOIS: Those are great questions. We don’t have all the answers yet but we do know that the body’s immune system does respond to the virus and creates immunity for the person who’s recovered from the virus. In fact, the blood from people who’ve recovered from COVID-19 is being used as treatment for new patients because of the immunity that has developed and the antibodies that have been formed in the blood. What we don’t know is how long and how protective that immunity is after you’ve recovered. We’ll probably learn more about that over the course of the next one to two years and get really definitive numbers and information on that.
THOM: Great, thank you Dr. Dumois. I have one more question from the chat, this is from Ashley Pap. Do you know about any promising aspect of serological testing and antibody treatments and what are any current challenges to them?
DUMOIS: Serological testing refers to testing somebody’s blood for the presence of antibodies produced by their immune system against the COVID-19 virus and if those antibodies are present when you run the test, that means they’ve had the infection in the past and those antibodies can be present in someone who may have been infected by never even had any symptoms. Of course, people who had the COVID-19 disease, they will also manifest antibodies, unless they have a significant weakness of the immune system where they just can’t make those antibodies properly. As I mentioned before, those same antibodies that we’re going to be looking for in the new blood antibody test, are what are being used and extracting plasma, the liquid component of blood from survivors of COVID-19 to help treat new victims of COVID-19.
THOM: I want to go to Dr. Chanda as well on this question. I’m sure a lot of people remember that this was crucial to treating Ebola several years, to take the blood plasma from those who had survived and recovered from that illness. What do you know about looking into the serological options here for Coronavirus?
CHANDA: Yeah, I have to concur with Dr. Dumois. It’s still early days but it appears that the body is mounting a pretty vigorous immune response that is likely to be protected. The key is going to be two things. One, how long that protection lasts for and two, does the virus mutate to avid that protection? Like flu does every year, which is why we need a vaccine every year. One thing that we’re trying to do, we’re trying to look at -- get patients from the original SARS outbreak, the two viruses are very, very similar antigenically and we want to test their blood to see if they still have any residual antibodies, it’s been a while but if they still neutralizing antibodies, these are antibodies that can block virus from replicating, that will give us clue as to whether the immune response to the current virus may be long lasting or maybe in the order of years or so.
THOM: We have another question from the chat, this is from Jessie Hicks at Vice. Jessie asks, can you tell us about at home testing? There is some talk about this potentially becoming a possibility, where are we with this right now in terms of the technology and regulatory hurdles and is this something that we can expect to see anytime soon and would it be reliable? Dr. Chanda, do you have any thoughts about that?
CHANDA: You know, diagnostics is not my area of expertise, so I’ll pass that along.
THOM: Dr. Dumois, do you have any thoughts about that?
DUMOIS: Yeah, I think the best prospect we have for an at home test is a type of test that was recently approved by the Food and Drug Administration. This test is different then the test everybody is doing now which detects the RNA of the virus. That test that everyone is doing now is called a PCR which stands for Polymerase Chain Reaction. This other test that you alluded to, one that could potentially be done at home would have technology similar to a pregnancy test or when you go to the doctor to be checked for strep throat, they swab the throat and they do a rapid strep test. Those tests detect molecules on the surface of the virus in a relatively rapid and easy way to where one could get results back in 10 or 15 minutes, they’re not too complicated and they don’t usually require expensive machinery. Those tests, we’re hoping, are tests that doctors can perform in the office to get rapid results, right now, that’s not available. The doctor in his office or clinic can collect a specimen but then it has to be sent to a reference lab for a PCR. The same technology that’s used for that rapid test in a clinic office could later be developed into something that is done at home but usually it’s first developed for use in offices, so it may be quite a while before we see in home testing.
THOM: Thank you, Dr. Dumois. I have a question from Susan Berger. Susan, would you like to go ahead and ask this live?
BERGER: Basically, I wanted to know if someone who recently had cold and flu symptoms with a cough that lingered, they got completely over it, it was maybe four, five, six weeks ago, is there a way to test to see if maybe that was Coronavirus? I’m thinking in particular I have one daughter who has rheumatoid arthritis who is particularly freaked out because she’s immune compromised. She thinks because a month or so ago she did have a cough and a cold that she recovered from and if she knew that she had the Coronavirus it would really change how she feels about everything at the moment?
THOM: Dr. Dumois, do you have an answer for that?
DUMOIS: Yes, I think that if somebody had to know for some reason, they could request the standard test that is done now, the PCR to be done on a nasal swab, especially if it’s somebody with a weakened immune system. For example, your daughter with lupus is on medications that we -- what we sometimes see is after you recover from a viral illness there can be prolonged shedding of the virus in one’s respiratory secretions and we see that with a lot of different respiratory viruses. She could possibly get a positive test even with an illness that resolved a month ago, however a negative test now would not rule out that she had it a month ago, only a positive would be useful information. If it was positive, she wouldn’t need treatment or anything, she has no symptoms but it could tell her that that was the likely cause back then. In the future, when we have a blood antibody test, that is a much more reliable way to look for evidence of previous infection when you no longer have symptoms but that is not yet available.
THOM: We have a question from David Gotfredson from New 8 San Diego, David go ahead with your question.
GOTFREDSON: My basic question is, when will that antibody test be available? We have a lot of people who think they may have had it, they can’t get a test now because they’re not widely available, I want to know, when I can I mail order a test saying I’m already recovered, so I know that maybe at least for a year I might be immune, I might be okay going out in the community as a journalist because my antibodies have been found? Thanks.
THOM: Who of our experts feel they can answer that question? Dr. Dumois, any thoughts on that or Dr. Chanda?
CHANDA: The tests are available for people in the lab but they’re not -- they haven’t been regulatory; they haven’t undergone regulatory approvals. Right now, these tests need to be thoroughly vetted by the FDA and made available to the public. The technology is there, the agents are there, the manufacturing capability is there but these tests need to make sure that the false positive and false negative rates fall within an acceptable range to make them available widely for either in home use or point of care use at medical facilities.
THOM: And another question for Dr. Chanda from Anita Barthomew at Forbes. Her question, I understand that PCR tests are coming back with about 30 percent false negatives, is that number correct first of all? How does this affect the ability to control the spread of the virus?
CHANDA: Again, I think I’m going to defer to Dr. Dumois or some of the other guests, diagnostics are not my specialty.
THOM: Yeah, I understand. Dr. Dumois, any thoughts about that?
DUMOIS: Yes, that is true. A recent study came out looking at the likelihood of detecting the COVID-1 virus by PCR from sampling different parts of a patient’s body. The nasal swab that we usually do was positive maybe about 60 to 70 percent of the time. When you have a false negative test and somebody who really has the virus, that weakens our ability to detect and control the spread of the disease. When a test that we think is pretty good, like this type of PCR has false negatives, there can be different reasons. One of the more common reasons for a false negative is poor quality of the specimen that was collected. For example, if a swab is done just at the opening of somebody’s nose, that may not be as good of a quality specimen as when the swab is inserted a couple of inches back into somebody’s nose. That difference in quality affects the possibility of truly detecting a virus that’s there.
THOM: Thank you, Dr. Dumois. We have a question in the chat that I think segues nicely to introduce another one of experts, Dr. Forgoston. Dr. Forgoston the question in the chat is something that you and I talked about beforehand, is there any chance of another peak to this epidemic, say later this year in the fall? Would a double peak epidemic be something that your statistical modeling might be able to forecast and what are your thoughts about that?
FORGOSTON: Right, so a lot of places around that world in the United States have implemented mitigation strategies, including social distancing. We have to be very careful when we go to release the social distancing and the other mitigation policies that have been put into place. If the disease is still in the community and there is still plenty of susceptible individuals, then if you just release all of these social --
THOM: Sorry for that interruption Dr., please continue.
FORGOSTON: If the disease remains in the community and a large pool of susceptible individuals, which there will be, if you just openly release all of these mitigation policies, then the disease will take off again. We have to be very, very judicious and careful about how we do this. This is where mathematical modeling can play a significant role in trying to better understand the timing of releasing and exactly what to release and potentially in what order. Is it maybe okay to allow school children to return to school but we maintain other polices, those sorts of questions? For certain, we have to be very careful or we could have another epidemic peak later on.
THOM: Professor Forgoston, could you explain a little bit about terms like contact rate, recovery rate and the reproductive number and how those parameters go into the modelling about the spread of the disease?
FORGOSTON: Sure, the contact rate is a measure of how many contacts per time between susceptible and infectious individuals, multiplied by the probability that an infectious individual will actually transmit the disease to a susceptible individual. The contact rate contains information about both the number of social interactions, as well as the infectiousness of the disease. The recovery rate provides a measure of how long it takes and individual who has been infected to recovery from the disease and become healthy again. Those two parameters are very important to understanding the spread of a disease, both just in the real world but also, we need those parameters in our mathematical models to make good quantitative predictions. The reproductive number that you asked about, that’s just another quantity that tells you how many secondary infections will be produced by a single infectious individual if that single infectious individual is placed into a population on only susceptible. For example, if the reproductive number was three, then we would expect on average that a single infectious individual would then create three new infections.
THOM: Professor Forgoston, you have kind of an example of a model that I think really helps to illuminate the jump in that reproductive number and what the outcome could be. Could you explain that a little bit, going from something as low as 1.5 to only moving up to a 3 has a really huge impact on the number of cases in a longer term?
FORGOSTON: The reproductive number again is the number of secondary infections created by a single infectious individual. If the reproductive number was 1.5, then we would expect one single individual who’s infected with a disease to transmit the disease to one and a half people and then each of those one and a half individuals would transmit the disease to another one and a half individuals and so on down the line. If we looked at 10 iterations of that process, then at the end of it we could see that the original infectious individual would be responsible for infecting a total of about 58 people. Now, if we change the reproductive number to three, that doesn’t seem like we’ve increased it that much but let’s go through the same process and we’ll see exactly what’s happened. Now, one infectious individual will create three new infections, each of those three infections will then infect three more people and so on down the line. At the end of 10 iterations again, that original single infectious individual will be responsible in total for infecting about 59,000 individuals. There you see dramatically the exponential growth of the disease that we hear about all the time in the articles and the media as we follow what’s going on. It’s also easy to see from the analogy, for this example, how social distancing can really bring down the reproductive number and try to control and contain the disease. As you implement social distancing, you are breaking these chains of transmission and stopping an individual from infecting three, maybe they are infecting one or less than one and that’s how you bring the disease down.
THOM: One more question for you Professor Forgoston before we move on to another expert, from the chat, freelancer Robert Adler asks, what is the current best estimate of the mortality rate and do you have any insights into why this seems to vary widely from country to country? I’d love for you to get into some of interventions and the variation in those interventions that different regions and countries are taking to maybe explain that.
FORGOSTON: I think that’s a good question that is not entirely known and some of this I’m not going to be able to speak about because it certainly depends on epidemiology and medical demography of different countries. There are a wide variety of possible reasons, again different countries their demography is different, they have different amounts of older individuals versus younger individuals and we certainly seem to see a difference in how this disease affects younger individuals to older individuals. Certainly, control policies can be affective and can play a role but there are certainly probably I just can’t speak to but perhaps Dr. Dumois could say something about?
THOM: Absolutely, Dr. Dumois?
DUMOIS: I think that the different demographics of the populations in the different countries is an important factor. Another factor though maybe to what extent those countries have been able to implement more wide spread testing because we know that the more you test, the more you’re going to find. In South Korea for example, where they were able to rapidly ramp up the production of the tests and to test broad swabs of the population and to quickly implement quarantining of the infected people and their contacts, they were able to relatively quickly have a significant effect on controlling things or trying to control things. If you don’t test as much, countries that have limited testing to only the sicker patients, are not detecting the infections in the more mildly ill patients, so their overall numbers are going to be reflected very differently. They may report higher death rates in those countries that are doing only testing in the people sick enough to be hospitalized because it’s the hospitalized patients that are more likely to die of it. Whereas if you were testing a lot of people with colds who end up having COVID-19, then you’ll have a much larger number in the denominator and your death rate falls.
THOM: Thank you, Dr. Dumois. I want to go to Professor Peck and first ask a question about your tweeter feed. Professor Peck had a tweeter post go viral a couple days ago, I’m going to share my screen to demonstrate this, is everybody seeing that? I wasn’t seeing it highlight the right window, so it wasn’t doing it. Here’s Professor’s Peck’s tweeter feed, she shared this diagram, which I’ll admit gives you chills a little bit. Professor, what was your motivation for sharing this? What did you hope for people to understand from this in terms of the danger of COVID and what they need to do? What kind of response have you had?
PECK: You know for me as a nurse and a mom of four, I was just seeing significant non-adherence to the recommendation and orders to stay home and that one looked like the biggest threat in my community and I was getting phone calls and emails and texts right and left asking, what should we do? As nurses we always want to provide sound, straight forward advice but when we deliver it in a clinical, sterile, generic sounding way with a lot of technical talk, it can be hard to get the message across. When I started testing and swabbing people in my clinical practice and saw the picture with the test instructions and people’s reaction, I was inspired to share it honestly with a little bit of humor intended but I was really shocked to see how widely it resonated with people.
THOM: We have a question from Dana Williams at NBC 7 San Diego, her question, as we are learning more about the virus, is six feet still an appropriate amount of distance? Also, there is conflicting guidance from officials about the use of masks for healthy individuals who are trying to prevent getting the virus themselves, are there best practices for this? Dr. Peck, if you can talk about those couple questions, the right ways to do social distancing and misuse of things like masks and gloves that maybe give people a false sense of security, what concerns are there?
PECK: Sure, absolutely. Six feet is a good general rule to follow. One of the things that’s unfortunate is honestly the term social distancing and we really should be emphasizing that this physical distancing. In this time, we have so many people that are afraid and that are anxious and nervous and don’t know what it is and we need to lean in socially and use all of these forms of technology that we have to really foster those social connections. As far as physical distancing and wearing masks and gloves, I think probably everybody on this call has been in the grocery store and seen people wear gloves all throughout the grocery store and they feel -- when they’re choosing their grapes. I recently travelled before this started and I saw people wearing masks on the plane and they would wear a mask and then the flight attendant would come and say, “What would you like to drink?” And they would take their mask down and say, “I’d like this and this.” And they’d take their mask off to eat and drink and I think -- there actually is a science to wearing personal protective equipment and if you ask any nurse, I guarantee you, any nurse about their glove exam and doing sterile gloves and having to prove that you can do that well in school, they will remember it with great fear and trembling and so I think hand washing is the absolute best way to protect yourself from the virus. To not have a false sense of security right now, there are now universal recommendations for mask wearing for the public and until we have enough protective equipment for health care providers and more instructions and evidence on how that helps protect us, then your best bet is going to be to stay that six feet apart and to wash your hands and stay at home.
THOM: Thank you Dr. Peck. I want to go now to Dr. Hedlund from University of Nevada Las Vegas. Dr. Hedlund, you’ve studied a lot of different kinds of viruses, other pathogens, those occurring naturally and especially ones that are extremophiles from places like hot springs like that. What can you tell us generally about testing for microbe’s ability to remain viable on surfaces and in the air and then potentially infect people?
HEDLUND: There are two very general approaches that we can use to look for microorganisms in different environments, one of those is relying on cultivations, cultivation dependent approaches. We rely on our ability to figure out some way to grow the microbes in the lab. We sample them however we -- Dr. Peck showed one way of sampling some microbes but there are lots of different ways to sample microbes, depending on where they are and what microbes there are. Again, cultivation approaches, people have to know how to study them in the lab and grow them. The other general approaches are cultivation independent approaches, for those we’re generally looking for a biomarker, often that’s DNA or RNA, genetic material and in that case, we need to know how to look for that specific genetic material.
THOM: Another question about lab testing and cultivation of viruses from Heather Kramer in the chat from HJK Digital Health Tech News. She wants to know if someone can address the exponential growth of viruses and how these are calculated and estimated? She’s curious to hear about the surge that’s coming and how that number gets estimated? Professor Hedlund, about viruses in general, that could be helpful.
HEDLUND: In general sense each virus, if it’s a lytic virus it has a burst size and so a cell lycées and releases viruses that burst size is an important parameter to think about for a viral infection. For other viruses necessarily lycée host cells that way and so you have rates of viral shedding and so on. Those would be important parameters to think about when thinking about how a virus proliferates.
THOM: Thank you professor. One question, not quite about the medicine but about the academic environment. You’re teaching labs and working with students online now, how does that change things? How are you adapting your classroom environment to being virtual when students can’t come to the lab and use microscopes and petri dishes and things like that? What’s happening there?
HEDLUND: For me personally it’s been a shock. Some of my colleagues I think were better prepared and had more online experience. I personally didn’t have much online experience at all and so I’m teaching a microbial ecology class and I had about a day and a half to switch it from the normal in person class to an online class. I would say that was not that difficult, there are technologies to do it, just like there are technologies for interviews that we’re doing right now. But as you mentioned, lab is quite a bit more challenging, at University of Nevada Las Vegas we have over 800 students going through general microbiology labs a year and again, we had very little time to suddenly switch from in person labs using microscopes and petri dishes to a virtual system. I’m not really the person on the frontline, I oversee people who are teaching assistants and lab coordinators for that but there are some health care that are a lot of heroic efforts but in education there is a lot of heroic efforts to suddenly change that. It’s not as good, so we all know that being able to drive a car is not the same as watching a person talking about driving a car or watching a person driving a car. That same thing with using microscopes and doing steak plates or serial dilutions for counting viruses and so on. But that’s where we are right now and we’re just doing our best.
THOM: Thank you, Professor. I want to go back to Dr. Dumois with a question here in the chat. This is from Marie Rosenthal from Infectious Disease Special Edition. Can you talk about the GI symptoms and is this something that is being treated in cases and is it possibly a source of the transmission of the infection, like a fecal oral transmission?
DUMOIS: Yes, we do have some information on the fact that many of the COVID-19 patients do have some intestinal symptoms. They can have some diarrhea or belly pain, sometimes even vomiting. Overall, it’s about 15 to 20 percent who come in, will have fever with some GI symptoms and maybe with their respiratory symptoms. There is a smaller number of about two or three percent that may come in with primarily their stomach symptoms and perhaps with fever and not yet manifest the respiratory symptoms that might appear a day or two later. We do know that the virus can be shed in the feces, in the stools. We can detect in some patients when someone bothers to run a PCR test on a stool specimen and therefore it’s possible that the virus could be transmitted from one person’s feces to another person’s hands who has direct or indirect contact with that stool specimen. A very likely scenario where that might occur is someone who goes to the bathroom, defecates, wipes themselves and then proceeds to through the bathroom and maybe not even wash their hands on their way out. They may be contaminating objects in that bathroom as they’re leaving the restroom, contaminating objects with virus.
THOM: One more question from the chat about the symptoms. Someone asked if it’s true that there is I believe a loss of sense of taste during infection?
DUMOIS: Yeah, it’s been described that some patients will describe that they have a decreased sense of taste and or a decreased sense of smell and in some cases, the decreased smell or taste precedes the other symptoms of fever or cough or congestion.
THOM: Very interesting. Thank you, Dr. Dumois. Again, to Professor Forgoston, another question about the epidemiology and modelling of the disease progression from Anita Bartholomew at Forbes. To what extent does the containment of the virus depend on collaboration between governments of different countries and do you see this happening to the degree that it needs too?
FORGOSTON: I think the more that there is collaboration, the better results we can achieve as a worldwide community. I think clearly the collaboration is not there yet, it’s probably for a variety of reasons, including at the moment, lots of countries are so overwhelmed, they’re just trying to deal with what’s happening within their own country. We also see within the United States that there isn’t even necessarily great collaboration between states. This disease is very infectious and no place will be spared, so again, the more collaboration that gets put into place, the better off we all will be.
THOM: Thank you professor. To Dr. Peck, regarding PPE and protection for health care workers. From the chat we have Sherry Trig from Medical Design asking, can you address whether the increased production of this protective equipment is having an impact on prevention and treatment? Are we seeing those supplies shored up or is this still a major issue and what concerns do you have there?
PECK: I think a lot of that just remains to be seen, part of it going to depend on the demand by patients. We did, here I’m in Texas and we got a stockpile that was distributed accordingly, being rationed. I still know many nurses, myself included, I have N95 that I got from my neighbor who found a box in his garage, he owns a masonry business and that is my mask that I have in a paper bag to take care of it and so I can tell you from my personal perspective, no we still don’t have enough but I think that as the production continues and as we’re trying to consolidate health care services to more urgent care centers and to more hospitals and to be judicial and use evidence based guidelines that that will get better.
THOM: Thank you Professor Peck. Another question following up about some of your concerns. There has been a lot covered in the media about millennials and Gen Z and some generational strife about how this crisis is being handled. I wonder what your thoughts are on that and what else you think the public needs to understand about how to protect themselves and what they might be misunderstanding?
PECK: I’m so glad you asked about this Thom because I think we’ve all seen a lot of quite vitriolic and heated discussion and accusations of people, especially accusing to a large extent unfairly millennials of not caring about grandma or being selfish and those kinds of things. I think that and there’s been some funny memes back and forth too about the differences between millennials who are not in college anymore, that’s Gen Z, there is some education that probably needs to happen there but I think that they don’t care, it’s not that people are callus and they want to get other people sick, it’s that they don’t perceive this as a real and personal threat. Part of what lead me to tweet and why I think it’s resonated so much with the public is that the health belief model is helpful at looking at other people’s behaviors when it comes to issues like this. It all has to do with your perception of a health risk. You have to believe that you are susceptible to something or that it’s going to be severe in order for you to be motivated to change your health behaviors. You have to believe that there is going to be some benefit to you from adopting that health behavior and you have to believe that the barriers are not insurmountable. Right now, a lot people in this early phase, they don’t know someone who has been directly impacted by COVID-19 or someone that’s acutely ill. All they see is that their job is threatened or their economic wellbeing is threatened. It can seem like, I’m not going to get the Coronavirus, that’s not going to happen to me but I think for some of those people that saw and responded to my tweet [INAUDIBLE -- 0:47:45.3] that seemed realistic. That seemed like that might be something…
THOM: Sorry, just one second, we have an audio interruption. Please continue, we’ve muted it.
PECK: No problem. I think that’s why it resonated so much because they thought, I don’t really believe I’m susceptible to the Coronavirus but I might have to have that swab and so I’m going to stay home. If that’s what we can do and if that’s what the discussion, is to encourage staying home, thoughtful hygiene and flattening the curve, then I’m grateful for that.
THOM: One of the responses to your viral tweet was a little bit of concern trolling, saying, aren’t you risking discouraging people from getting tested who should get tested because this looks like an uncomfortable and painful procedure. What’s your response to that? Is it worse to give people honest information about how serious of a test it is in the hopes that they’ll do the other measures that they should do? Where does that come out in your opinion?
PECK: Well, nurses are the most trusted profession as ranked every year by Gallop so you can always trust us to be honest and tell you if something is going to be uncomfortable. As far as the reception and the concern trolling as you put it, I’d like to say it was never my intent to discourage anyone from getting tested. Nurses are pros and other health care professionals are pros at making uncomfortable procedures tolerable. It’s not a particularly painful test for most, although decidedly uncomfortable but the greater risk currently is not staying home and exposing more vulnerable sections of the population to potential of a more severe illness. The concern is not testing people who are asymptomatic, the honest truth is we just don’t have enough testing to test every single person that either wants to be tested or has mild symptoms and we need to reserve those tests for our patients who are higher risk, for patients that present more acutely ill. If you do have mild symptoms or don’t have symptoms, the best thing that you can do for health care works, for across the country is to stay home and to wash your hands. I think my tweet was intended with a bit of humor which I think resonated well if you read through the responses. I got a good laugh at some of the creativity and the funny responses. I obviously have not read them all, I haven’t read 100,000 responses but laughter is an important element for resilience in this time and if it starts conversations with a bit of humor then I think that’s good for the soul and the body.
THOM: Thank you. Dr. Chanda, another question from David at News 8 San Diego, are you testing hydroxychloroquine and azithromycin or do you know about any studies that are testing those compounds?
CHANDA: These have -- they do work in the lab; we can see in the lab that hydroxychloroquine can inhibit virus replication. There have been a number of clinical studies I think that were probably I think charitably could be categorized as not the most rigorous scientific studies, clinical study that showed some positive results. A recent study coming out of China actually is probably the most hopeful study, it’s a case control study showing some level of ethicacy. The thing I want to caution people for is that hydroxychloroquine has been proposed to be a panacea for a number of different viral infections in the past and every time we’ve seen it work in the lab and then gone into the clinics, we never saw a signal. Particularly for influenza, people did both a prophylactic trial and therapeutic trial and absolutely showed no effect on influenza although it worked great in the lab. This really underscores the importance of rigorous clinical testing and case control studies to vet these molecules before people start relying on them as therapeutics against treating COVID-19.
THOM: Another question for Dr. Chanda that I’d also like to get the other experts to weigh in on. This is from freelancer Robert Adler. So far it seems that US has not flattened the curve or gotten the virus under control. What more do you think needs to be done or what does the US need to be doing differently? Dr. Chanda, Dr. Dumois, Professor Forgoston, I’d like all of you to weigh in on that.
CHANDA: I’ll quickly start. I think we and this was alluded to before, I think we need to look at the countries where they have gotten things under control, so namely South Korea and Singapore, have enacted very rigorous testing, covering a much larger percentage of the population and also contact tracing. This is the strategy that they have used and many businesses in South Korea and in Singapore are actually not shut down because they are able to implement these kinds of strategies to prevent wide spread outbreaks of the virus.
THOM: Dr. Dumois, any thoughts about how the US is doing at flattening the curve and what more needs to be done or what needs to be done differently? Do we have Dr. Dumois’s audio? There you go Dr. Dumois.
DUMOIS: Is that better? Okay. I think our current attempts to flatten the curve have had some beneficial effects because in certain areas that have not had huge surges of cases flooding the hospitals, it was anticipated that by now they would have and this degree of separation and closing of businesses where people crowd together may have helped in those areas. New York City I think it was too late to help New York City with regard to the amount of social distancing that was implemented because the virus has already spread very quickly among that very large population and that’s why those hospitals are so busy and having trouble keeping up. I think there have been some beneficial effects, some in more areas than others. I agree totally with Dr. Chanda’s recommendation that contact tracing is going to be a vital way of controlling this epidemic in the United States over the next year, until we get a vaccine. What the corollary of good contact tracing is more testing. It goes back to the question of, are we doing enough testing? Do we have enough test kit available? We need more and more will be coming.
THOM: Thank you, Dr. Dumois. Professor Forgoston, your thoughts about what the US is doing to flatten the curve, what more needs to be done and I have a follow up question from the chat on this line as well.
FORGOSTON: I agree with both Dr. Chanda and Dr. Dumois. The policies that have been implemented in the US are effective in flattening the curve, there is no doubt. But speed matters and the quicker that you can implement these policies, then the stronger effect that you will see. As far as testing and contact tracing, these are critical and going back to my response earlier about when can you release these mitigation policies, unless you have testing and contact tracing and ideally serological testing to know who has antibodies, you just can not release these policies.
THOM: A further question on the disease pandemic modeling from Yazmin Racedie. How long do you predict the pandemic will last and how can your models predict that? While cases in China are declining, what is making the death tolls in Europe, Italy, Spain and other places like the US so high? Based on maybe the absence of maybe some of those more aggressive interventions that China did.
FOREGSTON: The mathematical models that we have do allow us to make predictions on when epidemics will end but a lot depends on the control measures that are in place. We can put these effects into the models and determine things like if you implement this type of policy then this the resulting effect and this is the decline and the severity of the epidemic. However, there is a difference between a government putting a control measure into place and people actually abiding by that control measure. There could possibly be a bit of disconnect between what a model is predicting and what actually happens in real time. With regards to differences between China and other places in the world, there is no doubt the data we’ve seen from China and the associated epidemic trajectory, they look very different from the data and then epidemic trajectories that we’re seeing pretty much everywhere else in the world. I would say we have limited knowledge on what exactly the polices were that China implemented. We don’t really know what sort of testing and contact tracing they had available and we don’t have full transparency on the exact sort of mitigation control measures that they put into place. Without that full knowledge, it’s difficult to explain the data that we see coming out of China. On the other hand, in places that we do have full transparency like Singapore verses Italy, that can explain the difference measures that they’re implementing can in fact explain the data that we are seeing.
THOM: Thank you, Professor Forgoston. Going back to China and some of the origins of the disease, I want to ask Dr. Hedlund, as you study viruses in the environment and the diversity of the ecology and microbiology, this obviously a disease that originated as a Coronavirus in bat species and somehow made the jump to humans. What are you and other scientists studying to understand these microbes as they exist in wildlife and other naturally occurring cases like this, to try to predict and prevent these kinds of mutations that allow diseases to jump to humans?
HEDLUND: This isn’t research that I’m doing but the CDC for example does active monitoring of fruit bats and rodents and other mammals that have high densities and large population numbers and some of these animals seem to commonly be sources of transmission from virus to humans. This is something that we do need to keep monitoring and I think we do need to watch the wildlife trade as well. It really needs to be clamped down a bit and managed better.
THOM: And with your knowledge of all these viruses that exist in wildlife and naturally in the environment, what’s your general advice to people not to freak out and become germaphobes about this kind of thing?
HEDLUND: Good question. Before this pandemic I think microbiology had been gaining a lot of ground and people I think had been more optimistic about microorganisms then they had been for a while. I think it’s really important when we pull out of this and we will pull out of it, to just keep in mind that there are microbes all over the place and not all of them are looking at humans and licking the chops. There is something like 10 to the 31st viruses on earth, that’s the 31 zeros. I did a back of the envelope calculation, if you stack head to tail so to speak, they would reach from the earth to the moon and back 10 to 14th times, back and forth, back and forth with 14 zeros, viruses are everywhere, bacteria are everywhere. The real concern and on a daily perspective once we pull out of this is microbes from other humans, that is the best place to find a microbe that is dangerous for humans is another human. There are a lot of positive health benefits for people to interact with microbes, especially neonates, it’s important for treating the immune system to recognize self verses non-self and different microbes help us to digest our food properly, make vitamins, hormones and things like that. We shouldn’t be generally germophobic but I think pulling out of this we should learn some lessons about interactions with people and maintaining good hand-face hygiene and things like that.
THOM: Thank you, Professor Hedlund. One more question for Dr. Chanda from the chat, Carry Rosette, you mentioned a cocktail treatment may be an effective process to prevent COVID-19 and so, would that mean that you target the lung and the GI where it seems like the majority of the virus receptors exist?
CHANDA: The actual pharmacology of these drugs are still a matter of debate. Right now our strategy is to target the lungs because that’s where the disease technology is and so if we can keep the viral burden down in the lungs, most people are dying from these respiratory type pneumonias and it doesn’t seem other than the shedding there is a big clinical impact of the virus replicating in the GI. Right now, we’re just monitoring the effects, we’re going to be monitoring the effects of these drugs, particularly in the lungs and probably secondarily in GI and other tracks.
THOM: Professor Hedlund, you and I talked beforehand about the diagnostic test that have been made possible by using other viruses discovered in the environment, what do you know about the possibility of developing some sort of antibody test for this Coronavirus and if that was something maybe a microbe might help to facilitate or anything like, if you could explain how that sort of process works with the PCR tests for example?
HEDLUND: Antibody tests definitely aren’t my expertise but tests we’re looking for nucleic acids, so DNA and RNA, there are certainly advances pushing on those. Those are more generalizable then antibody-based tests and so for future pandemics and for a wider variety of diagnostics or different things, those are always going to be valuable. Some of the companies, some companies that I interact with and some that I don’t interact with out there are looking for novel polymerases; so these are enzymes that can recognize and amplify DNA or RNA for diagnostics or for general research, and it turns out that the highest density of polymerases per DNA or per mega base of DNA is in viruses themselves. Viruses are experts in propagating themselves, that’s what they do. There is quite a bit of research looking into thermophilic or heat loving polymerases from microbes in hot springs, from viruses in hot springs to improve diagnostics. PCR was mentioned, that uses DNA polymerase from either bacteria or [INAUDIBLE -- 1:01:55.5] depending on the details of the kit. But I think viruses have some really promising polymerases too, and I think we’ll see that becoming more common going in the future.
THOM: Thank you professor. We’re just about at the hour mark and I apologize to anyone who asked a question that we didn’t get to. If we can go just a few more minutes, there are a few that I think are pretty good questions. I think Dr. Chanda, I’d like to ask you two of these. Is there any reason why colder weather may lend itself to virus transmission and could we be looking at the Coronavirus reacting to changes in weather as we move into spring and summer?
CHANDA: The field of seasonality of viruses is still fairly controversial, so I don’t think we definitively know why flu for example is seasonal. Viruses are more stable in colder, dryer environments. It could be that kids are in school during the winter but not in the summer. There are a number of different reasons but it could be that yes, this virus could go seasonal. Early data seems to suggest that there is some sort of hemispheric trend on this but again, I’d like to have my colleagues maybe who have better insight into that data give their input. There is a good chance that this could die down in the summer and a resurgent back in October. Just wanted to remind everybody, if they go back and look at the history books in the 1918 pandemic, not to be too alarmist but the second wave of the 1918 influenza pandemic is really when the majority of deaths happened. Fortunately we have a lot of different drugs and treatments in the pipeline that are better than what we had 100 years ago but I think we still need to stay vigilant and stay on our toes here.
THOM: And one other question from the chat before we wrap things up. Why are we not using the same test that was being used in South Korea? Their testing for IGG and IGM and it reportedly is available as a finger prick test in South Korea. Why are we not doing that in US? Do you have any knowledge about that doctor?
CHANDA: You know, I don’t know, this is really a regulatory question, not necessarily -- the science is the science. I think maybe somebody with some background on the regulatory status of these might be better at providing an answer to that question.
THOM: Do any of other experts have any knowledge about that? Paul Yang submitted that question in the chat, it looks like you have a stumper so you win the prize Paul, please leave your name and email and we’ll contact you to collect your prize. Any of the experts, I’d like to ask you all to let us know real quick here, any kind of misinformation you’re seeing that you want to make sure gets addressed. Dr. Chanda?
CHANDA: I would say the press is really starting to read too much into these clinical trials and maybe come up with headlines that are not necessarily supported by the data. I would let the FDA do their jobs and let them vet the data, let them tell us when things are effective or not effective instead of reading too much into the headlines of you know, one trial that came out that says, anecdotally 10 people got better on hydroxychloroquine, then you get people with lupus who can’t get access to the drug, people are hoarding, people are taking I think drugs that are unsafe that are related to hydroxychloroquine but not that. I think that the public should be measured and I know people are looking for rays of hope but, let the process play out and let the medical and regulatory and scientific community do their jobs and they’ll make that available, that information available when it’s ready for public use.
THOM: Thank you. Dr. Dumois, any misinformation or other kind of general concepts that you think the public needs to understand better?
DUMOIS: Some of the most prevalent misinformation I’ve come across and had to try to explain is the claims of different types of dietary supplements to help prevent you from getting COVID-19 or to treat it once you get it. We don’t have any good evidence about ethicacy of any dietary supplement against this particular virus but we do have a lot of information about other viral infections. The best data that we have says that certain vitamins for supplements may help certain people who are deficient in certain vitamins, like vitamin A, vitamin D deficiency or zinc deficiency but any child or adult who has a well rounded diet, with a lot of the good things that they should eat are not going to be deficient and will not benefit from such supplements. If a child is a rather picky eater and will not eat any greens and doesn’t like fruits, well then that may be someone who benefits from a daily multi vitamin with minerals but otherwise, don’t go spending a lot of money on supplements.
THOM: Thank you, Dr. Dumois. Dr. Forgoston, any misinformation or misunderstandings that you’re seeing out there that you’d like to clear up today?
FORGOSTON: I think the public needs to be cautious when they hear predictive values being thrown around, such as one million individuals are going to die or two hundred thousand people are going to die. You have to realize that these numbers are coming from different models. Every model will give you a different answer and there is a lot of uncertainty in the parameter values that go into these models. There is a lot of value in them but we shouldn’t just pick on just one number and run with it. They give us a range of possibilities that allow us to say something meaningful.
THOM: Thank you professor. Professor Hedlund, any thoughts about any misinformation you’re seeing out that you want to clear up today?
HEDLUND: I don’t have anything to add. I just want to say that people should stay home and stay safe and limit interactions. Also, I just want to say this is a great panel. I really enjoyed learning from everybody here.
THOM: Thank you so much. Dr. Peck, any thoughts about any misinformation or anything that hasn’t already mentioned like that, that you want to clear up today?
PECK: I do. I agree with everything that’s been said. Absolutely, those things are really important. I think in all of the press coverage, as a nurse, speaking as a nurse, we cannot forget the human element of this. We have hundreds of well qualified leaders, we have thousands of brilliant scientists who are working on all of this and as we’re trying to filter information through the media it can be overwhelming to the average person, just to try to understand. I see a lot of misinformation on social media. Right now we have a significant loss of primary care access, people cannot go -- we were encouraged, the CDC is encouraging people not to go for preventative care, not to go for minor illness, so where they were usually ask a trusted health care professional for advice, they’re not able and so I’m seeing questions asked me like, hold your breath [INAUDIBLE -- 1:09:54.1] you feel short of breath, that’s a test for Coronavirus or you see the virus lives in your throat for two days before it gets in your body so if you gargle then this will help and people are desperate for information from people that they trust. I think it’s going to be really important just to package information that’s easy to understand and that’s practical and that’s evidenced based and right now what that is, is staying home. We have nurses and other health care providers all over the country literally putting their lives on the line in the front line of this crisis. It’s so important what the general public, they want to do something and they need to understand that staying at home really, really does help. That we are going to be there for them, that we are working on all of these things but what they can do is to stay at home and to go to a trusted source. Telehealth, we’ve seen a huge increase in the proliferation of telehealth, patients can access providers by telehealth or by phone call by calling, I would encourage them to do that and not to rely on ironically viral Facebook posts for information but to go to a trusted heath care source for that.
THOM: Thank you, Dr. Peck. We have one final question in the chat here, the last minute, I’m going to give this to Dr. Dumois and give him the last word. Dayna from NBC 7 in San Diego, the study that said one third of patients have been tested to find out that they are actually positive after a second test, this false negative number that we talked about a little bit earlier, do you have any further thoughts on this and is that valid?
DUMOIS: That’s an interesting point, I as physician will use that sort of information that we even know about other viruses, that because of the limitations of a test we know that most tests are not going to be 100 percent accurate in detecting an infection. If I as clinician, have not found a cause of a patient’s infection but I have a high index of suspicion that a certain infection may actually be the problem, I will repeat that test a day later and that test that was initially negative may then become positive because for whatever reason there may be more virus present in the sample or we collect a better sample, it becomes positive. It is a valid practice to consider repeating a test after an initial negative result.
THOM: Great, thank you Dr. Dumois. With that, we will move toward conclusion. Thank you to all the panelists, Professor Hedlund, Professor Peck, Dr. Chanda and Professor Forgoston, thank you all so much for joining us. For the media, we’ll make sure to provide you with the PIO contact info of all of these experts so that you can follow up with any further questions for any articles that you may be writing. Jessica, did you have any other final thoughts you wanted to share?
JESSICA: No, thank you everyone for participating. It’s very helpful information and I think a lot of people got a lot of value out of it, so I appreciate it.
THOM: Thank you very much everyone. Have a great rest of your day and stay healthy and safe out there.
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