The last Major League baseball game was played on October 30, 2019. The Nats won.
As local leaders begin to discuss a blueprint for recovery, the questions remain: How long will this outbreak last? And what will our new normal look like?
In times 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 your 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. I'm broadcasting from home. Welcome. Later in the broadcast Bill Nye, "The Science Guy" joins us for our weekly Kojo for Kids show. But first as local leaders begin to discuss a blue print for recovery, the questions remain. How long will this outbreak last? And what will our new normal look like? Joining us is Dr. Leana Wen, 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 WENGood to be with you, Kojo.
NNAMDIMaryland Governor Larry Hogan and Virginia Governor Ralph Northam have both pledged to work with local business leaders and with each other to chart a path to reopening, but what would undoing the current shutdown really look like and how would we be able to do it safely?
WENWell, I think what you said just now is the key. We all want for our businesses to get back to where they were before. We all want our economy to reopen. But we have to do so in a way that's safe and we have to have decisions that are based on data. So part of it is having the testing. I know we keep on talking about this, but this is so critical we have to have the testing in place so that we actually know that we can trust our numbers. So we know that when we are saying that there has been a reduction in the number cases that we know that these numbers are accurate that there aren't cases that are going under the radar and being undetected.
WENWe also have to have the other capabilities in place as well. It's not just testing. We also have to have contact tracing. We have to have our hospital systems be stabilized. I mean, it's important that we do reopen. But that when those decisions are made it's based on the best available data and evidence. And that we are ready to see what might happen if there is an uptick in cases again. If we do, we might have to dial it back and impose these restrictions again. And I hope that our residents are ready for several months if not longer of continued -- of continued trials for us to see what will work and what will not.
NNAMDIWhite House officials have said we can expect social distancing measures to be in place for months. How long can we expect this to go on? Is there any real way of predicting it?
WENI think that's the answer that everyone wants an answer to. And we just don't have an answer for the following reasons. One is that we don't have, again, the testing and other capabilities in place. And actually the sooner we have these in place the sooner we can reopen even more. So this is not a static picture. It really depends on what we're able to mobilize and how quickly.
WENAnd the second thing too is we are going to get some data back from the states that are reopening sooner. And we just have to have vigilance and the surveillance systems in place to see what are the lessons that we can draw from these reopenings and how much can other states then follow in their footsteps or not.
NNAMDIIn the United States Coronavirus cases are nearing one million. But here is Mark in Silver Spring with a question about those numbers. Mark, you're on the air. Go ahead, please.
MARKYes. Thank you, Dr. Wen. I have a question regarding the term flattening the curve. I want to raise a question and suggest a solution. We know that the count, for example, in New York City counts those who die within or outside the hospital. But the state only counts those who die within the hospital. We also know that they are grouped of, for example, minority groups and the elderly, who are much less likely to get access to even be counted.
MARKSo my first point is it's possible that those models that were predicting many more deaths could have been more--were likely more on mark than not. And secondly one possible solution is to look at what happen with Puerto Rico when they counted excess deaths and they were able to come up with estimates of the true number of people that died from that natural disaster.
WENWell, I think, Mark, you make a really good point about the problems with our counting.
WENWith our numbers, because we simply don't know. We don't know about the number of cases that we are actually attributing to COVID-19 deaths. We saw last week in Santa Clara that there are now cases that are back dated actually quite a few weeks before they thought that -- before any of us thought that there were cases of Coronavirus in this country. There were actually deaths as early as early February in California, which means that the first case of community transmission was much earlier than we expected too.
WENAnd likely there have been outbreaks happening around the country that we just were not aware of. And so there's again underscores why we need accurate testing and widespread testing and accurate numbers that really reflect what's happening. Or else I'm afraid that there will continue to be outbreaks that we're seeing around the country that we're just not picking up on until they overwhelm our healthcare system there.
NNAMDIThe World Health Organization is reporting that there is quoting here, "No evidence yet that recovered COVID-19 patients achieve immunity from the virus." What does that mean for any hope of a return to normalcy, Dr. Wen?
WENWell, it is concerning that we don't yet have a lot of information that can help us to guide decisions. I mean, this is as we keep on saying, this is a new disease. There's a lot that we don't know about it. And one of the unanswered questions is what immunity if any do you have if you get exposed to Coronavirus. So if you get the disease, ideally one hopes that that means your protected against getting Coronavirus again for years if not a lifetime. I mean, that would be ideal, but we don't know this for certain.
WENWe also don't know whether there is a -- whether you need to have a certain level of exposure. Do you need to get really sick in order to be protected? Or can you just be exposed and be asymptomatic and be protected in some way too? And I think that has a lot of implications including on these immunity tests on these antibody tests, because the last thing that we would want is for someone to receive one of these tests and to think, Well, everything is fine. I'm protected. I can go back to work, and go back to normal. But actually that person is not and could end up getting much sicker the second time around too.
WENSo I think there are a lot of unanswered questions, but again that's also why we have to proceed very cautiously when we discuss things like reopening and what means. And also that's why we need the vaccine, because ultimately having a vaccine and a treatment that's what's going to get us back to the actual normal that all of us would want.
NNAMDIGot a Facebook message from Lesley who wants to know, "Should all personnel in a physician's office who have close contact with patients, i.e. are within six feet of them be wearing a mask?"
WENWell, at this point the guidance around masks has changed quite dramatically. Initially at the beginning of the outbreak, the guidance was, well, only healthcare workers should be wearing masks. And by the way, healthcare workers should be wearing the N95 respirator mask. Well, then unfortunately we ran out of these respirator masks and healthcare workers had to ration these. And then even have to ration the surgical masks. Masks that were meant to be for single use now have to be used multiple times. There are now all these studies being done about how to sanitize these masks. And now there is guidance too about how everyday people, all of us, should be wearing masks when interacting with individuals when we're out in public and cannot six feet away from someone.
WENAnd the reason to do that is actually to protect others from us in case we are asymptomatic carriers. Now many hospitals -- to the listener's question many hospitals have implemented new guidance about wearing masks at all times for healthcare workers. And that is the direction that I believe we should all be going to especially as we're now advising everyone in the public -- the CDC is now advising everyone in the public to be wearing masks in order to protect others from us in case we are asymptomatic carriers ourselves.
NNAMDIAnother mask question from Frank by email. "I understand the wearing of face masks is for the wearer not to spread the germs. However, my question is if I spray my mask with an antiviral spray before I wear it, will that help me from inhaling and getting the virus?"
WENWell, I don't know what these sprays would be.
WENAnd actually I really would just -- given the comments that were made by President Trump last week, I just want to make sure that everyone understands do not ingest, inject disinfectant or bleach or soap or anything like that. I mean, Poison Control Centers in different parts of the country are already seeing an uptick from people, who are asking questions at least if not actually taking these substances themselves. And so do not do things that are unproven and actually that are really dangerous. And with regard to the mask, the best thing to do is to wear the mask.
WENYou don't need to wear a surgical mask or a hospital mask. But wear a cloth mask that way you can wash that very easily once you're done with it too. But don't spray it and definitely don't ingest anything.
NNAMDIThe CDC has added six new potential Coronavirus symptoms, chills, shaking, muscle pain, headaches, sore throat and a loss of taste or smell. What more has been uncovered about the common symptoms of Coronavirus?
WENWell, there is new research coming out, Kojo, about Coronavirus about this new Coronavirus virtually every day. There are these symptoms as was mentioned. Although the most common symptoms of COVID-19 still remain, fever, cough, shortness of breath. There are other symptoms too. And some of these symptoms that you just listed are actually quite non-specific, because if you get the flu or a bad cold you also start feeling fatigue and maybe sore throat and maybe chills and other things too.
WENThe loss of smell and taste is an interesting one because there are now growing numbers of studies that indicate that even though this is a respiratory virus and it's transmitted through the respiratory route it doesn't seem to affect just the respiratory system. That there may also be some neurological effects too as were seeing with the loss of smell and taste.
WENThere are also patients who've gotten very ill who have had damage to their kidneys into their nervous systems from potentially having blood clotting issues that have led to strokes. The states in which COVID-19 has hit really hard they have either reported that hospitals are running out of dialysis fluid, because of the kidney damage that COVID-19 has caused. And so there is a lot that we're finding out about this disease and we're finding out too that it's something that as we keep on saying is not just affecting those who are older with chronic medical problems.
WENYes, these individuals are the most susceptible, but we are seeing plenty of cases in younger people previously healthy people. And it's a reminder that we should all be watchful for this disease.
NNAMDIGot to take a short break. When we come back, we'll continue this conversation. But this is all about your questions so give us a call now. I'm Kojo Nnamdi.
NNAMDIWelcome back. Later in the broadcast, Bill Nye, "The Science Guy" will be joining us for our weekly "Kojo for Kids Show." Right now we're talking with Dr. Leana Wen, an Emergency Physician and Professor of Public Health at George Washington University about the Coronavirus pandemic and taking your calls. We got a call from Hank who could not stay on the line, Leana Wen. Hank says a friend is presenting symptoms of Coronavirus. What should he do?
WENWell, I would advise to Hank's friend and to everyone else to call their doctor. Right now we are still experiencing testing issues as in lack of testing. I would love to be able to say to Hank's friend that he can go to a particular place to get testing immediately. But unfortunately we don't know that that's the case. Depending on where you are in the country, depending on access you may or may not be able to get testing even if you have symptoms. And so the best thing to do is to call your doctor and in the meantime stay at home. Do not go out, because you could infect other people.
NNAMDIIn the Washington region we have seen more than 1500 deaths. How does that compare to the rest of the country? Is our region considered a hotspot?
WENWell, the Washington area depending on the metric that we use does come up as one of the areas with a high number of cases and deaths. And also I think there's a lot that we don't yet know about the trajectory of the illness. I know that there are many models out there that look at when different peaks are. But we have to be careful about these, because the models are only based on -- or they're only as strong as the assumptions and the data that go into them. And the models also are not static.
WENI mean, this is not a weather forecast. We're not looking at something that is going to happen and is inevitable. What we do right now has a lot to do with what happens to that model too. And it's a reminder to everyone that what we do outside of the hospital and continue to do outside of the hospital when it comes to practicing social distancing. That will influence the idea of where the curve, the trajectory of the disease is going to go. And how overwhelmed or not our hospitals are going to get.
NNAMDIWhat is contact tracing and when is it most effective?
WENSo contact tracing is the bread and butter of local public health. This is what public health officials all across the country do every day for other infectious illnesses. So, for example, if there is a case of measles or tuberculosis, what the public health officials do is to find out who that person has been in contact with during the time that they were potentially infectious. And so they ask them -- they would ask the individual to trace their steps. Every shop that they've been to, a relative that they went to visit, if they took walks somewhere, who are the people that they could have possibly exposed. And then these public health officials would then locate those individuals to see if they have symptoms and advise them about quarantining and staying away from others as well.
WENNow you mentioned about the time period. It's effective if it's done in time to capture those possible exposures before they have the chance to infect other people. Contact tracing as you can tell from my description is extremely time intensive and labor intensive. Data and technology can help. But it also depends on having those individuals who are literally able to make those phone calls and track people down. And it also depends on public trust, because those individuals have to be understood as working for the public's health and there cannot be the threat of detention or immigration fears or anything else or else people will not tell the truth and public health will not be allowed to work.
NNAMDIHere is Lee in Washington D.C. Lee, you're on the air. Go ahead, please.
LEE (CALLERHi. Thank you for taking my call. And thank you for this program. In China and Spain they had stringent restrictions on children being outside. Should the U.S. have followed their example? In my neighborhood in Chevy Chase D.C. children are outside without very much protection.
WENWell, Lee, the issue is not so much that children are outside. It's what they're doing when they're outside. I mean, in my neighborhood I see kids walking around with their parents or whom I'm assuming are their family unit. That's great. I want people to get fresh air. I mean, I have two kids myself and cabin fever is very real especially in my preschooler, who now has a lot of energy and needs to burn off the energy. And so him playing in the backyard, him running around when there aren't other people nearby in an empty field, I mean, that's good. And I would encourage kids to go outside like that.
WENThe problem and I see this in my neighborhood as well is when it looks like kids are out on playdates with their friends. That should not be happening. I mean, this is not a snow day here. You know, the reason we're keeping kids out of school and people are making all these sacrifices is so that we keep people separate from each other so that we're stopping the virus from transmitting from person to person.
WENSo I would encourage everyone listening, people in Lee's neighborhood or elsewhere, please do not get your kids together. Stay within your family unit. Get fresh air and exercise, but this is not the time to be seeing your friends in person because that is how that virus is going to be transmitted. And all those sacrifices that we're making in terms of schools being closed and businesses being shut down all those sacrifices will be in vain if we let up on our social distancing.
NNAMDIHere is Jenny in Columbia, Maryland. Jenny, your turn.
JENNY (CALLERHi. Good afternoon and thank you so much for your show. I'm a registered nurse out in Columbia, Maryland and I've been trying to find information on the numbers of healthcare workers that have been infected with this disease in the care of patients. And it seems that that information one isn't readily available and two is that there -- I have been hearing things about there being a reluctance of hospitals and healthcare systems to actually test their healthcare workers unless they have very very overt symptoms. I was just wondering if you could speak to that. And I thank you very much.
NNAMDIYou're welcome. Go ahead, Dr. Wen.
WENI mean, I completely agree with Jenny I think there have been first of all issues with testing as we've been talking about and not having enough tests available. Certainly we should be testing every healthcare worker, who wants it and needs it and certainly has had exposure, because we need to protect them. And we also need to protect those that they are interacting with as well including other staff and their patients. But Jenny is right. We don't have these numbers readily available.
WENWe see estimates from around the country. We know that thousands of healthcare workers have been infected. But as to exactly what that number is and how and what the distribution is in different parts of the country. I'm not sure that we have those data readily available. And I just wanted to once, again, just really thank Jenny and all the other healthcare workers and frontline workers who are out there every day. I mean, social distancing is a privilege for those who are able to do it. But we have to remember that the reason we're doing it is also to protect those who cannot do social distancing. And we should do our part to help those who are taking care of us, the healthcare workers and also the other essential workers every day.
NNAMDIMaryland recently acquired half a million Coronavirus tests from South Korea. Do we know any more about how these tests are being dispersed across the state?
WENYeah, I don't know that information. But I do want to say that it's really not ideal for governors to all be procuring supplies from overseas and bidding against each other. I mean, this just should not be happening. This happened with ventilators. This happened with masks. It's happening with tests and it just doesn't make sense. I mean, don't get me wrong. I'm a Marylander and I really appreciate that Governor Hogan took the initiative and did this because we do need more tests in Maryland. So I commend him for doing it. But the fact that it had to be done just doesn't make sense because we need a national coordinated effort. And at this point in the trajectory of this illness we should not be so limited in our ability to do testing.
NNAMDIWe only have about a minute left. But there are still many essential workers who don't have the option of staying home. We've spoken with many of them. Grocery store, restaurant employees, home health aides, delivery workers, those charged with sanitation, what should they be doing to protect themselves?
WENThey should be following the best public health guidance, which includes wearing masks, cleaning their hands often, washing their hands often when they get home. Potentially they could take off their clothes at the door and also just watching out for any symptoms that they may have. And once again I want to thank them for their incredible work. And the best thing that all of us can do to thank them and appreciate their work is to practice social distancing ourselves, because if we're able to do this then we can help to not only protect ourselves and our loved ones, but we're protecting everyone else in our communities as well.
NNAMDIDr. Leana Wen 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 so much for joining us.
WENThank you, Kojo.
NNAMDIWe're going to take a short break. When we come back if you're a kid and you love science, hey if you're a kid and you don't even particularly like science today could be the day that changes, because coming up Bill Nye, "The Science Guy" and adults can listen, but only kids can call. I'm Kojo Nnamdi.
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