On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
Life as we know it has been dramatically upended by the coronavirus in the course of a few weeks. In an effort to slow the spread of COVID-19 — the disease caused by the novel coronavirus — the entire country is now in a national emergency.
In the Washington region, with more than a hundred cases of COVID-19 now confirmed, schools, churches, movie theaters, restaurants and bars have been shuttered. Millions of Americans are working remotely, or are in danger of losing work altogether.
In this time of uncertainty, we look to medical professionals for guidance. Emergency physician and public health expert Dr. Leana Wen joins us to share her expertise and answer the essential questions.
Produced by Julie Depenbrock
- Dr. Leana Wen Emergency Physician, Visiting Professor, George Washington School of Public Health
KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Later in the broadcast the impact of school closures on students, parents and educators in the Washington region. But first, life as we know it has been dramatically upended in the course of a few weeks in an effort to slow the spread of COVID-19, the disease caused by the novel coronavirus. The entire country is now in a the state of emergency.
KOJO NNAMDIIn the Washington region, schools, churches, movie theaters, restaurants and bars have been shuttered and millions of Americans are working remotely or in danger of losing work all together. So today it's your turn. Joining us to discuss the latest coronavirus news and to answer your essential questions is Dr. Leana Wen. She is an Emergency Physician and Professor of Public Health at George Washington University. She formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you for joining us.
DR. LEANA WENHappy to be with you again, Kojo.
NNAMDIThe number of positive cases of COVID-19 has increased exponentially since we spoke with you last week. And I can't believe that was only a week ago. What's the latest news on the spread of coronavirus?
WENWell, it's a good point that it seems like there's news coming out every hour and that the number of cases of COVID-19 have been doubling every three days, which is extremely alarming, because this is what happened in Italy. This is what happened in Wuhan, China. This is what happened in other places where there was a severe outbreak that overwhelmed the healthcare system.
WENAnd I think if it's any message that I want to convey today is that we are in this upward trajectory of cases. And at the rate that we're going we will likely overwhelm our healthcare system, but all is not hopeless. In fact, there is a lot that we can do in order to change the trajectory of where we are and that includes social distancing that includes many of the measures that we've been hearing about in the media.
NNAMDIGlad you mentioned social distancing as one of the terms I'm going to ask you to help define. But I'll start with community spread. What is community spread?
WENInitially when COVID-19 was first found in the U.S. the cases were of individuals, who traveled from other countries and so acquired COVID-19 somewhere else. And then the goal at that point when there were limited cases and all were travelers, the goal was to contain, was to figure out who these individuals are, contacts and try to contain the spread of COVID-19 only to those individuals. The problem is when not all these cases are found and there is person to person transmission within communities here in the U.S. Then it becomes much harder to trace.
WENOne of the issues that we've been talking a lot about is lack of testing. But I want to emphasize that lack of testing has been a major barrier, because if people aren't tested especially because we know that many people with COVID-19 may be asymptotic. They may not have any symptoms or they may have mild symptoms that look like a cold or the flu.
WENAnd they may not be diagnosed with COVID-19. So they are transmitting it to other people without realizing it. So as we get more tests up and running we are seeing many more cases of coronavirus in our communities and these are -- all these new cases are not of people traveling from other countries and brining it in. But they are of cases of someone transmitting it to someone else, who lives in the community. And at that point, that's what we have to switch from the containment phase of trying to identify individuals to mitigation, which is how can we reduce the spread of the disease to larger populations?
NNAMDISocial distancing, what is it and why does it matter?
WENSo social distancing is a broad term that refers to physically separating from others in order to reduce the spread of a disease, in this case, COVID-19. So COVID-19 is transmitted as a -- it's a respiratory virus that's transmitted from person to person. So if you do not have person to person contact meaning this is something that's transmitted if you are within six feet of someone and you sneeze and cough on someone or you touch the same surface as someone.
WENBut if you do not have contact with someone, who has coronavirus, you're not going to get it. And so the idea of social distancing is that if we can reduce gatherings of people, if we can reduce the instances where people are in contact with one another then we could potentially stop the disease or even if we cannot stop it, the goal is to reduce the rate of the spread so that we don't overwhelm the healthcare system all at the same time, because that is the cause of mortality.
WENThat's the cause of death that we're seeing around the country -- or not around this country yet, but around the world. In Italy, the healthcare system became so overwhelmed, because so many patients needed intensive care units, so many people needed hospital beds all at the same time that there just wasn't room for them. And the way to avoid that happening here in our country is to try to reduce the rate of spread, so that even if the same number of people get coronavirus at least they get it over many months instead of all in the same few week period that would then burden the healthcare system.
NNAMDIOn the issue of social distancing, here is Kyle in Washington D.C. Kyle, you're on the air. Go ahead, please.
KYLEYeah. Good morning. A question in line with that is, I mean, we're hearing lots of different things about social distancing. A lot of us are working remotely at home. You know, single parents, parents with kids, they want to get outside. But last night I was watching Jake Tapper and Sanjay Gupta talk on CNN and they were talking about how frustrating it was to see people rollerblading and biking and having picnics in the park. And I think we're just getting inconsistent guidelines on what we should be doing and how we can leave the house safely and how much space, you know, we need to keep between ourselves and interacting with other people. So it would be great to get some advice from you on that. Thanks.
NNAMDIIndeed. Dr. Wen, as recently as Monday I went bike riding in the park and there were several people on the trail pushing strollers with kids walking along. As a matter of fact, there were more people than usual. Can you tell us about that? Hello, Dr. Wen? We seem to have lost contact with Dr. Wen temporarily. But we'll keep our questions lined up. We're going to move on to Kenneth in Northeast Washington. Kenneth, can you hear me? You're on the air. Go ahead, please.
KENNETHHello. Yeah. I can hear you. Can you hear me?
KENNETHYeah. I just had a suggestion for, you know, the governments and municipalities, and the wards to put more porta potties around. Businesses are restricting uses of restrooms, and we don't want public, you know, people relieving themselves in public. So I'm suggesting more porta potties. Got to go on the streets or wherever in the park, the National Park Service could do it as well.
NNAMDIOkay. That sounds like an excellent suggestion. We'll hear when we get Dr. Wen back what she thinks about that. And here now with sharing an experience with us is George in Silver Spring. George, you're on the air. Go ahead, please.
GEORGEHi, good afternoon. I work for the federal government and I came in yesterday and I was told to leave immediately, leave in the morning, you know, right away, and no laptop, no remote work, no telecommuting, nothing, just, you're on administrative leave until further notice. Get out of here. And I thought that that was a very very unfair way of treating an employee.
NNAMDIYou work for the federal government?
GEORGEThe Library of Congress.
NNAMDIAnd how long have you been with the Library of Congress?
NNAMDIAnd you were simply told when you arrived at work yesterday morning to simply go home.
GEORGEWell, it was about an hour after I got there. It was in the middle of the morning.
NNAMDIWas there any explanation for why you were not being asked to work from home?
NNAMDIThe kind of job that you do, would it be possible for you to work from home?
NNAMDIWere you informed at all as to whether you will be communicated with further to -- with anymore instructions about what you might be required to do?
GEORGENo. No. They told us -- no. Apparently I'm persona non grata and no, there was no additional information about when that might change, indefinite.
NNAMDII guess you'll have to stay tuned or simply try to stay in contact with your place of employment to see if there are any changes. Regrets, thank you very much for your call, George. Dr. Leana Wen is back with us. Dr. Wen, before you left we were talking about an individual, who called in and wondered what about people talking in the park, taking kids in the park, etcetera in terms of social distancing. Can you respond to that?
WENYes. Absolutely. Apologies. This is one of the challenges of now social distancing. In fact, we are now in charge of handling technology and other things that we might not be used to before. But for social distancing -- think of social distancing as the physical distance between you and other people. So we are all -- by the way in these times being asked to make tremendous sacrifices. And I do want to recognize that we are being asked to do things in a pretty unnatural and rather extraordinary way. We're used to going out. We're social creatures, but we're asked to do things very differently.
WENBut think of it as if schools are being closed, the reason schools are being closed is that we don't want kids to be congregating together. So while schools are closed, do not get your kids together on playdates. Don't go to birthday parties. I mean, these should be common sense, but if we get our kids together that negates the whole purpose of schools closing.
WENAll said that doesn't mean that you should isolate yourself. You could distance yourself physically, but not isolate yourself. So with exercise you should definitely feel free to go outside and walk. But ideally choose a place to walk where you're not likely to be within six feet of someone else. And if you are -- think of ourselves also as a family unit. People who live in your particular household, and so if you and those in your household can go out together, but do not get together with other households. And if you do see people who are walking next to each other or who are walking in a crowd, try to go around them and walk six feet away. But don't just stay indoors, because you also need your exercise for your own emotional well-being as well.
NNAMDIIs there a difference between self-isolation and self-quarantine?
WENThere is. The technical difference is that isolation is for someone, who is ill. Quarantine is for someone who is not, but has had exposure. And so you might be told that you have to self-isolate if you have coronavirus or if you have symptoms, but cannot get tested, and you're told to self-isolate at home. Meaning that you are actively infectious, you could transmit the disease to others, and that's the reason why you're self-isolating.
WENQuarantine is something else. Quarantine is that you haven't had symptoms yet. But you've had exposure and you are keeping yourself away from other people also because you don't want to infect them, but you're not showing symptoms yet. So the actual what you do may be very similar. But there's a technical definition in why you're doing it.
NNAMDIOnto the phones again. Here is Shelly in Chantilly, Virginia. Shelly, you're on the air. Go ahead, please.
SHELLYYes. Thank you very much, Kojo. I love your show. My question is this. We're hunkered down. But, of course, we still have to go shopping. What can we do to make sure that we're not inadvertently maybe picking up coronavirus that someone else might have touched?
NNAMDIDr. Wen, people are going shopping. There are several supermarkets that have put aside special times for a population more at risk. People of a certain age to go shopping in those supermarkets, but what should people do when they do go shopping?
WENIt's a great question. First of all, I would say reduce your frequency of shopping as much as possible. A lot of us are used to going down to the shops once every few days to pick up necessary supplies, but this is a time to reduce that frequency. Write out a list of everything you need and try to go once every two weeks instead of once every two days or whatever we may be used to. If you are a person in the category of the most medically vulnerable, if you are elderly, you have chronic medical conditions, you're right. Some stores have set aside special hours for these individuals, but this may be a time that you can also ask relatives or friends to help to shop for you also.
WENIf you do have to go yourself definitely -- in your family there's no need for everyone to go. Have one person go and do the shopping, because by limiting to one person you're also limiting your risk. Try to stay six feet away from others at all times. You can also reduce the risk by wiping down the rail of the carts and wash your hands frequently, because that ultimately at the end of the day is what will reduce your risk of getting any virus including COVID-19.
NNAMDIDays ago President Donald Trump declared a national emergency. Can you tell us what that means exactly?
WENWell, the declaration itself sends a signal by virtue of the fact that it was the president calling an emergency and not just a public health emergency, but a national emergency meaning that this is not something that just affects health, but all other aspects too. I think it does send a level of gravity that we really need at this time. It also frees up resources for state and local governments and allows a degree of flexibility in spending and funding for local and states that are much needed as well.
WENBut I think that what I've heard the president say that's the most important and not just the president, but also so many of our elected leaders and public health leaders say in the last couple of weeks that's so critical is the importance of all of us taking matters into our own hands. It is a terrifying time to be in when we have this outbreak, and we're seeing numbers that are escalating by the day. But we are not powerless against the virus.
WENIn fact, this is a time for us to come together and show our solidarity and to say, look, our biggest -- our best chance of safeguarding our health of this nation is to flatten the curve, is to reduce the rate of transmission of the virus right now. The most important single thing that each of us can do right now is to stay at home. Do not go out. Do not spread the virus to other people and keep ourselves healthy and safe. And also importantly don't go to the ER.
WENThe ER is not the place you go unless you have an acute illness that you have to go to the ER for. But don't go to the ER if you're worried about coronavirus, because by going you're actually potentially exposing yourself, exposing other people and you're taking up space, because medicine and healthcare is still happening now. And you don't want to take up the space of somebody who needs those acute care services. So we all have the power to make a difference right now. We just have to come together as a community and as a society.
NNAMDIHere is Steve in Alexandria, Virginia. Steve, your turn.
STEVEHi. This is for Dr. Wen. I'm an international airline pilot. And I spent the first month of the year flying back and forth to Milan. And my question is, excuse me, shouldn't the CDC or at least the companies of the airlines employees be tracking or surveying their aircrew. It seems like a really extraordinary demographic of people, who all wear the same uniform, who are all tech savvy who can be tracked and really shed some important light on how this disease is spread internationally.
WENIt's a wonderful question. And I am not sure what the CDC is already doing or the WHO, what they're already doing in this respect. I think right now in this country, because there is so much community spread that's happening it does make sense also to focus on these mitigation efforts, right. The initial efforts were focused on containment on trying to figure out how we can prevent the virus from entering our country and then spreading. But now that it has spread all over its spread in all 50 states. The numbers are climbing every day. These efforts are focused on what to do in our communities to reduce that rate of spread. But I also do agree that there could be valuable information learned even if it's not for this outbreak, but for future outbreaks by tracking our -- the airline employees as well.
NNAMDIDr. Wen, what are the symptoms we need to be looking out for?
WENThe main symptoms of coronavirus, this new coronavirus COVID-19 are fever, cough and shortness of breath. Differently than a cold patients with coronavirus tend to not have sneezing, dripping nose, although that's possible. They are also atypical symptoms of COVID-19 also that include abdominal symptoms, abdominal pain, nausea, vomiting. And generally patients who have high fevers that are not feeling well also have body aches and other symptoms too.
WENNow as I talked about these symptoms you will see that they're not dissimilar to influenza and to some other respiratory viruses, which is again why diagnosing COVID-19 is challenging. It's also why we need far more tests because one may not be able to know based on the symptoms alone what they have. And having these tests will allow us to see what is the true spread of COVID-19 in our communities, because right now it is -- the numbers are likely far higher than what's reflected in the official estimates.
NNAMDIIf someone begins showing symptoms, what steps should that person take?
WENIt's a great question. And this is something that is changing by the day, because as of right now as we're speaking there just are not enough tests in our area and around the country. So here's what you should not do. You should not go to the ER. Again, I emphasize this because there aren't enough tests in the ERs and very likely you're not going to get tested. But you will be exposed to other illnesses and clog up the healthcare system for those who need acute care services.
WENIf you have symptoms, first of all, don't go out. Don't go outside and potentially infect other people. That would be the same if you have coronavirus or if you have something else. If you're coughing and sneezing, you have a fever and you have a cold or influenza you shouldn't be going out either. So don't go out. Definitely do not go to the ER unless you really need the ER, because you're ill. Call your doctor. This is the key. Call your doctor and see what the procedures with your particular doctor's office might be.
WENYour doctor's office -- many doctors have switched to telemedicine and may be able to do it telemedicine consultation with you where you could use your phone for Skype or Facetime or just your phone and talk to your doctor. Your doctor may well tell you that your symptoms are mild. That you should be recovering at home using what we call symptomatic management meaning that you treat your symptoms. You drink plenty of fluids. You stay hydrated. You stay well-rested. You take over the counter medications like Tylenol for your fever.
WENI hope that we will soon get to the point that anyone who needs a test will be able to get one, but we're not at that point yet. And very likely if you had mild symptoms your doctor is going to tell you to self-isolate at home, to take over the counter medications and other symptomatic treatment. And if you truly need the ER, because you cannot breath or you have some other acute issue, your doctor can help to make arrangements for you to be -- to go there in a safe way so that you don't infect other people.
NNAMDIIn Maryland, Governor Larry Hogan has pledged to turn vehicle emission sites into drive thru test centers. Why hasn't there been more testing sooner? What's the hold up here?
WENThis is a great question and it seems in analyzing what happened that there were multiple points of failure. I mean, there were multiple missteps that were made that has led us to the situation that we're in, which is we simply don't have enough tests, and that's tampering clinical treatment of patients. It's also preventing us from doing the right public health interventions because we just don't know what's happening. All that said, I think it's important for us to move forward and do what we can now.
WENThe federal government is distributing tests now to states by the -- I believe that they said about two millions tests are going to be distributed. But it's not just a matter of getting tests out. People also have to be tested. And ideally the testing can be done away from other hospital ER settings so as to separate the patients, who need COVID-19 testing from all those who need healthcare for other reasons.
WENSo that's why these drive-in centers, separate makeshift facilities are so important. The test also then has to be processed. And I understand that there are also some holdups on that end as well, because it is not reasonable to ask people to wait days for test results when ideally they should come back within hours to again, best guide clinical management. So all of these issues need to be worked out.
WENAnd I think in the meantime it's important for everyone to do their part too, and have patience and I think grace because while we could look back and say there are all these things that should have been done differently they were not. And at this point we are really in this together. We will get through this together, but we have to take the matters that we can into our own hands and try to again, not go out. Stay at home and help each other to reduce the transmission of disease in our own communities.
NNAMDIDr. Leana Wen is an Emergency Physician and Professor of Public Health at George Washington University. She formerly served as Baltimore's Health Commissioner. Thank you so much for joining us.
WENThank you very much.
NNAMDIGoing to take a short break. When we come back we'll look at the impact of school closures on students, parents and educators in the Washington region. I'm Kojo Nnamdi.
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