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Scott Webb (Host): We've learned a lot about COVID-19 over the past six months or so, but there's still a long road ahead joining me today to help give us an update on the viruses Dr. Thomas File. He's an Infectious Disease Specialist at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So Dr. File, you're an infectious disease specialist and great to have you on, what's the latest on COVID-19. You know, what do we know about the virus today? Let's say that we didn't know a few months ago?

What is the latest on COVID-19?

Dr. File: I mean, there are several things. I think we're learning more about the transmission. I mean, we know that this Coronavirus, the SARS Kovi two is much more highly transmissible than other seasonal respiratory viruses or other Coronaviruses. For that matter. In other words, it's much more contagious. And I think we're learning more about this aspect about this virus, that many percentage of the patients are asymptomatic, but yet they still can spread the virus. And this is, I think, very unique about this particular virus. In fact, some studies suggest that up to 40% of the patients infected have no significant symptoms, but yet can be spreading. This makes it very difficult to contain the virus. I mean, if you look at other viral infections and I'm just going to take an example of the prior SARS, which was in 2003, 2004, which is mainly in China, although it did go to other parts of the world as well, fortunately, not too much here in the United States.

But if you look at SARS, transmission occurred after people were sick and he didn't tend to see this asymptomatic group of patients who then would transmit it. So in that case, it was fairly easy to stop the pandemic or at least the epidemic, in that case. Because if you quarantine people that had symptoms, then you would be able to stop transmission. And that's what happened with that. But with this, it's very difficult because now you almost have to assume that anybody is positive because they may not have symptoms. And so that's a significant, you know, issue that we've learned about this virus that makes it somewhat more difficult. Also, we're learning more about the symptoms. I mean, if you recall earlier in the pandemic, we focused on the respiratory symptoms, and specifically those that might have pneumonia. So we talked about, you know, patients who had cough fever and shortness of breath, but now we know that there's a variety of other symptoms that are associated with this infection.

I mean, and these can be nonspecific. I mean, headache, chills, sore throat, muscle legs, body aches, loss of smell, taste, even gastrointestinal symptoms like diarrhea and a variety of different skin Rashes can all be associated with this virus because now we find that it just does not affect the lungs. It can affect other organs as well. I mean the heart, the brain, the skin, the kidney. So these are very concerning. And I think what I'm very concerned about, and we're just beginning to learn about this is the potential long-term effects of the virus. Because as we know Scott, I mean the great majority of patients who are infected with this well survived, certainly 98%. And particularly when you're take to the case that a lot of these patients are asymptomatic, but that doesn't mean that everybody who survives it completely recovers. I mean, we're becoming aware of, we've only followed this for about eight or nine months that, you know, patients who have had pneumonia can have persistent lung effects or even heart effects.

I mean, there was a recent study out of Germany looking at patients and most of these patients were outpatient. So they weren't even sick enough to come to the hospital that the majority of the patients, when they did some studies to look for the potential for heart damage, the majority had some heart damage and some of these patients were totally asymptomatic. So this is a great concern because, you know, we know that, you know, some of these athletes now, this is a concern. I mean, I know that there was a pitcher for the Boston Red Sox who had, COVID-19 subsequently had one of these heart conditions called myocarditis and now is out for the whole year. As we now know, the college football season is in jeopardy because of the concern for some of these issues. And so a lot of this we're just beginning to learn about right now, and we'll learn more as we have time to go on and see about the potential for these long-term effects.

Host: Yeah. And unfortunately it does appear that we're going to have time, that vaccine is coming right, but perhaps not for six months or more, and we're going to have more time to learn more about COVID-19 aren't we?

Will we have more information about COVID-19 by the time the vaccine comes out?

Dr. File: Well, that is true. As I said, we're learning daily and there's still lots of unknowns about what's going to happen with this virus. I mean, now that we're going to be going into the fall shortly, the concern is, as we see with other seasonal respiratory viruses, will there be increased surge? Will there be a uptick which we always see with influenza that could affect the manifestation of COVID-19 as well? So as we go through, we're going to learn more. We're going to see how, as we try daily, some schools try to reopen, you know, how that's going to affect transmission and the potential for surges in the fall.

Host: Yeah. And I think that that's, what's most concerning for a lot of people is because the symptoms of COVID-19 or the effects of COVID-19 mirror so many other things like the flu, cold, seasonal allergies, things like that, now that we're heading into season, people are wondering, should they, you know, at least vaccinate themselves against the flu and anything else they can. And I'm guessing the answer is yes?

Should you vaccinate yourself against the flu and anything else you can?

Dr. File: Definitely. I mean, this is going to be extremely important as we go into the Fall of this year is to have a high percentage of the population be immunized for influenza, because there's a great concern that co-infection of influenza and the SARS Kovi two virus that causes COVID-19 can be associated with a more severe disease than just an infection was one of these. But we just don't know that. I mean, and that's something that we're going to have to see as we go on, but to prevent that obviously, if, if we can have the great majority of the population immune to influenza, then of course, the best way to do that is to receive the vaccine then hopefully that will reduce that possibility.

Host: Yeah, absolutely. So let's zoom in here a little bit and talk about how things are going at Summa health specifically. And do you have any COVID-19 patients currently?

Does Summa Health have any COVID-19 patients currently?

Dr. File: Yes. We've had COVID-19 patients ever since about the second week of March. I mean, we experienced like many others in the country end of March and April, relatively high numbers of cases. And then as the number of cases started to drop, at least in our area, we saw through the end of April and the early part of may a significant drop. But unfortunately as these communities opened up and we started to see increasing cases now we're seeing sort of an uptake a little bit not nearly where we were in March, but we're seeing what I'll call a low level of persistent activity, but it's not causing a burden right now. It's not overwhelming our hospital system. And we certainly hope that with appropriate community mitigation procedures or policies or good health measures that we won't see that, but we're concerned what's going to happen in the Fall.

Host: Yeah. And I'm assuming you have a separate COVID-19 ICU, right?

Does Summa Health have a separate COVID-19 ICU?

Dr. File: That is true. We have a separate ICU for our COVID patients and we have a separate general floor for COVID patients as well.

Host: How are you doing screening? Testing? Is drive through testing available? What's the turnaround time on test results?

How is Summa Health testing for COVID-19?

Dr. File: Well, Scott, that's a very important question because we know from the standpoint of how we're going to try to control this this pandemic, that testing is really important. So we can identify patients early and potentially contact trace, and reduce the spread. So we've been testing in house for several months. We certainly test all the patients who are symptomatic who are coming in into our hospital. With our in house testing right now, the present turnaround time for our accurate tests is about six to eight hours. We're looking to add other tests for which we would be able to shorten that turn around time. We have made arrangements for drive through testing, particularly for our patients who are going to be undergoing surgical procedures or at risk aerosolization type of procedures. We want to know that those patients, even if they're asymptomatic, could potentially be harboring the virus, because we know if they're going to have surgery and they're at the presently asymptomatic or presymptomatic, which means they haven't developed their symptoms yet. It's important for us to know, because we may want to delay their surgery because studies have suggested that these patients may not do as well post surgical procedures. So we are doing testing and we will continue to do testing because it's extremely important to try to counteract the effect of this virus and to reduce the spread.

Host: You know, I wanted to ask you about the incubation time and we're talking about so many people with COVID-19 being asymptomatic. Do you have any sense of, do we know, you know, if you've been exposed and you've gotten COVID-19 how long before, you know, the test results would be positive?

How long does it take for a COVID-19 test to come back positive after you receive it?

Dr. File: Yeah. Well, that's a good point. I mean after exposure, I mean, we know that the meantime or median time, I should say for a patient to develop symptoms is about five days, but it can go anywhere from about two to 14 days. But as you mentioned that a lot of these patients are asymptomatic, so should we test them or should we not test them? If we are going to test them, it appears that the best time to test a patient who does not have symptoms, and they have an established time when they were exposed to somebody, and they were at risk exposure, which means that they were in close contact, maybe, you know, within six feet, weren't wearing masks. And they were with them for about 15 to 30 minutes, we would consider that an at risk exposure. And so we would probably wait about five to seven days after that, if you are going to do testing to see if they could potentially have asymptomatic infection from that exposure

Host: In terms of treating COVID-19 patients, are you using Remdesivir, convalescent plasma for the more severe cases?

How is Remdesivir, convalescent plasma used for treating COVID-19 patients?

Dr. File: Well, we are. And again, this is an area where we're learning a lot. I mean, mainly because we have randomized clinical trials that are beginning to tell us which interventions are going to be beneficial to patients. I mean, we now know, Remdesivir is given to patients who are at least sick enough to come into the hospital and have certain criteria, mostly requiring supplemental oxygen, it doesn't necessarily mean they have to be intubated or on the ventilator, but if they have lower levels of oxygen and require supplemental oxygen, like on the nasal cannula, we know that giving Remdesivir benefits those patients. And so we are using Remdesivir quite frequently in our patients who require admission to the hospital. We have not used a lot of convalescent plasma, but we also know that patients who have developed more severe complications and require intubation in other words, are getting worse from their standpoint of the respiratory status or other considerations, and are in the ICU and on the ventilator that giving those patients steroids is beneficial. In the randomized clinical trial showed that indeed it actually reduced mortality. So as we get the results of this information, and the clinical results of these studies, it tells us how best to use these interventions to reduce the impact, and indeed reduce the mortality in our patients. And that's good.

Host: So, our masks, distancing, hand-washing the keys to protecting ourselves? And is there anything else as an infectious disease specialist that you recommend?

Is there anything else as an infectious disease specialist you recommend?

Dr. File: Well, Scott, those health measures that you just mentioned are critical, and until we have the vaccine, this is the best defense we have against this pandemic against this virus. And most specifically masks, I mean, I can't emphasize strong enough to our listeners, the need to wear mask. I mean, we're getting more and more compelling information. There was just another study out of Duke that was published yesterday suggesting the importance of masks, and how they reduce transmission. As you know even cloth masks can reduce the amount of air droplets that go from a patient who may be asymptomatic to perhaps a spread it to another person. So masks are extremely important. I think it really helps reduce the transmission. Obviously distancing is really important. Hand hygiene is really important, but I think really important as well, because I think what we've seen that has been the probably the source of much of the cases over the Summer has been congregating, or in gatherings or in bars. And so if you're in close proximity to others, particularly if you're not wearing a mask then there's going to be an ease of transmission. So we really have to reduce that these health measures are extremely important. It's the best that we have right now until we have a vaccine. And it's extremely important. We all have our responsibility to try to reduce the spread of this virus, to our loved ones, to our colleagues. And so the data is clear that they work. And so it's important for us to do this.

Host: As we wrap up here today, doctor and so great to talk to you, what else can we tell listeners about the virus and especially a timetable for a vaccine.

More information about the COVID-19 vaccine

Dr. File: We hope that the vaccine is going to be effective. We have to wait for these a phase three clinical results. And as I said, I think we're significantly concerned about the potential for long-term effects. Is it going to have effect potentially on even those who have asymptomatic on the lungs, on the heart? And what's going to happen in the fall as we go through here? So again, the message is that we need to practice these health measures that have been shown to be effective in reducing the spread such as masks, distancing, and not congregating in gatherings for which there may be transmission.

Host: Well, and, you know one of the advantages of this job that I have is that I get to talk to experts like yourself. And when I hear it from you, it just, it really hits home for me. You know, these are the things that we can do that we should do, and it's our best defense against something that none of us, including an infectious disease specialist have ever lived through in the United States. So Dr. File, thank you so much for your expertise and your time today. And of course stay well. For more information or to book an appointment visit Summahealth.org. And if you found this podcast helpful and informative, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Healthy Vitals, a podcast from Summa Health I'm Scott Webb, stay well. And we'll talk again next time.