On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
Public health experts have long warned that fall and winter could bring a resurgence in coronavirus cases as more and more gatherings move indoors.
“Half of all covid-19 spread is by people who have no symptoms, and someone you know could just as easily be an asymptomatic carrier as a stranger. If you wouldn’t sit in a room, maskless, with random people, you shouldn’t have an indoor dinner party with close friends, either,” Dr. Leana Wen wrote for The Washington Post. “We should be just as careful in relatives’ homes as we are in grocery stores and doctors’ offices.”
So, what might cooler weather mean for the pandemic and a possible second wave? And how can we continue to see friends and family safely in these colder months?
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; @DrLeanaWen
KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5, welcome. Later in the broadcast it's Kojo for Kids with Prince George's County Fire Chief Tiffany Green. But first, as we know, the president himself is now being treated for the coronavirus. We will discuss what we know about his diagnosis and treatment. And White House Press Secretary Kayleigh McEnany said in a statement today that she has tested positive for the coronavirus. We look at what public health experts are saying about how we can all prepare for cooler weather and what could be a spike or a new spike in cases.
KOJO NNAMDIJoining us to discuss the latest coronavirus news and as always to answer your essential questions is Dr. Leana Wen, Emergency Physician, Contributing Columnist to The Washington Post and a Visiting Professor at George Washington University, formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you for joining us.
DR. LEANA WENNice to talk to you as always.
NNAMDIDr. Wen, let's lead off by the biggest national news of the past few days. President Trump was hospitalized Friday at Walter Reed Medical Center after testing positive for the coronavirus. What do we know about how he's doing and the care he's receiving at the Bethesda Military Hospital?
WENWell, I have no doubt that President Trump is receiving exceptional medical care. He has access to the best specialists in the world and I have no doubt that he is being treated well and I know that I join all of us who are among your listeners to wish him a speedy recovery. And I know that we're all sending our thoughts and our prayers to the president and in fact, all those who tested positive and are receiving treatment including many people within our government at this point. I think there are many unanswered questions, though, about the president's condition.
WENIn fact, there is such contradictory information that it's caused a lot of confusion, because on the one hand we're being told that the president is doing very well that he has a mild illness, but on the other hand the treatments that he is receiving suggest that actually he has a much more severe illness than what is being let on. So, for example, dexamethasone, he is receiving a steroid medication that's given to patients with severe or critical COVID-19.
WENIt, in fact, is not indicated and maybe harmful to patients with a non-severe disease, and so if he is receiving this then it just makes us wonder about how severe his condition is. And I hope that the White House will decide to be much more forthcoming about the state of the president's health.
NNAMDILeana Wen, the president took a ride in his motorcade yesterday to greet well-wishers outside the medical center, a move which public health experts like yourself have strongly criticized. You, in fact, tweeted, "If Donald Trump were my patient in unstable condition and contagious illness and he suddenly left the hospital to go for a car ride that endangers himself and others I'd call security to restrain him. Then perform a psychiatric evaluation to examine his decision making capacity." That tweet has since gone viral. What has the response been like for you?
WENYou know, it's an interesting question about going viral. Not really something that I had intended in sending this. I was actually, frankly, just really horrified, Kojo, when I saw the images. I couldn't believe it for two reasons. Number one, I was thinking about -- because I'm a clinician, I always have to think about first, well, what would I do if this were my patient? And he's not my patient just to clarify, but I do think about what if I had a patient who was from everything that I know in unstable condition, who has had at least two drops in oxygen saturation, one that was so low that he went to the hospital in the first place, who is on at least three medications including one to treat severe to critical illness.
WENIf that patient were in my care and decided to go for a car ride, I would not allow that to happen. If this patient decided to go anywhere really felt strongly about going, I would assess his mental capacity to decide whether he really understands the risks and benefits. And given how complex the situation is, might request for a psychiatrist evaluation to see if this patient really understands and really has the mental capacity to make that decision given the risk to his own health.
WENThen there's the other level as well, because I looked at these images and thinking from a public health lens we know that the -- where people have the highest chance of acquiring, transmitting COVID-19 is in close settings where there is no circulating air, where there is an actively contagious individual who is in very close contact for prolonged periods of time. I mean, this was a hermetically sealed vehicle where certainly there were no windows open with a person who is actively having symptoms with people in close contact. And I just could not believe that anyone would choose to endanger other people's lives like that much less the President of the United States.
WENAnd then I thought what kind of message is this sending, because we say to patients that they must isolate for 10 days following the onset of their symptoms because they cannot -- otherwise they're at risk for spreading it to others. I've thought about all the patients, the people that I know who could not see their family members, who were dying in the hospital, because of the risk of spreading this illness. So what kind of message does it send that the president could violate these public health protocols?
NNAMDIWell, we know that a number of people in the president's circle have tested positive. But there are still hundreds, who may have been exposed at various gatherings including the largely maskless unveiling of Supreme Court nominee Amy Coney Barrett that took place in the White House Rose Garden. What do we know so far about how many have been infected and how they were exposed? We just heard the president's press secretary say that she has tested positive.
WENWe are still finding out a lot more about this. It does appear that that White House Rose Garden ceremony was some type of -- it might have been a super spreader event. Although, I would also hope that people would see that maybe it's not necessarily even that event. But it's all the other events around it too. So that event was outdoors and we saw images of people in close contact not wearing masks, shaking hands, hugging, etcetera. There is certainly a likelihood of spread there.
WENBut in addition to that public event outdoors there were also multiple other private events indoors that are with the same individuals where the potential for spread is even greater, because it's indoors versus outdoors. To my knowledge, there are some contact tracing, I believe, that started, but there are many reports of how contact tracing has not, for example, been led by the CDC, by the experts at the CDC. I've spoken to my counterparts at various health departments in the country where individuals, who attended that ceremony would have gone back to their home states and they have not had direct outreach, and I am actually very concerned about this.
WENOf course, we as a nation need to be thinking about and worrying about the president's health, but what about the health of all those other individuals who might have been exposed by the president or by the aides themselves. Some of these individuals may have great access to healthcare themselves. And we've seen, for example, that people like Governor Chris Christie, the former Governor of New Jersey and others testing positive. And then Governor Christie, for example, checked himself into a hospital to get treatment. I'm glad that people are getting tested and getting the treatment that they need, but what about the wait staff? What about the Secret Service agents? What about people who attended the rallies? What about their families?
WENWe know that access to healthcare, access to testing is a major problem around the country and we also know that contact tracing is a major barrier that public health departments are already understaffed.
WENAnd so I really hope that the same types of precautions given to the senior White House aides are also going to be -- or the same resources given to the senior White House aides are also made available to other people around the country too.
NNAMDIDr. Wen, why is clarifying the timeline of the president's positive coronavirus test and subsequent hospitalization so important?
WENIt's important for two reasons. First it is important for the purposes of understanding the president's course of illness and then second for understanding for purposes of contact tracing. So first, let's talk about the president's illness. Right now, what we know what has been publically disclosed is that the president tested positive for coronavirus at some point on Thursday and that he had symptoms starting on Thursday. Somehow, though, by Friday he developed these extreme, I mean, quite severe symptoms to the point that he had a drop in oxygen level. Had to be transferred to the hospital, put on various treatments.
WENI mean, that's an extraordinary progression in terms of time course. And if that time course is correct, that suggests that the president got hit by a very large amount of virus and then got acutely ill very quickly. That's very concerning considering that the average time between symptom onset to when somebody ends up requiring ICU care is 10 to 12 days, and the time between symptom onset to developing shortness of breath is five to eight days. So if the president progressed within one day, that's very concerning. On the other hand if he did not actually get tested regularly as they say that he did or maybe even develop symptoms earlier, that puts his time course in a very different light. And so it's important for us to know that.
WENThe second reason it's important to know as I mentioned is for contact tracing purposes. People are the most infectious 48 hours or so -- in the 48 hours period before they develop symptoms. So if the president developed symptoms earlier than Thursday, it's important for us to know so we can trace his contacts back to that period as well. Again, this is not only about his health, which is, of course, of paramount importance, but also the health of other people around him as well.
NNAMDIWhat doctors learned 100 years ago from the 1918 pandemic is the spread of these viruses can get much worse in the colder months. What should we expect, Dr. Wen, as fall and winter arrive here in the Washington region?
WENWell, I am concerned about this. I mean, I know that so much of our attention and rightfully so over the last several days has been on the president's health, but we are still facing surges occurring across the country. Basically, as you and I have talked about before, Kojo, we are playing whack a mole. We have a situation where first we have upticks and huge surges in the Northeast that's controlled, then in the South and the Sunbelt relatively under control, but we actually are still seeing surges in these areas along with surges occurring now in the upper Midwest as an example.
WENAnd so we are entering this fall to winter season with a much higher level of infection than we should. We still have about 43,000 new infections every day. It's going to be harder for people to be outdoors versus indoors, which is a risk factor. Also people are experiencing quarantine fatigue. And then we have other respiratory viruses, the cold, the flu, etcetera, that may be occurring at the same time, and maybe insufficient testing as a result.
WENAnd so I really worry about the confluence of all of these factors and hope that everyone will continue to take all the precautions including mask wearing when we cannot stay six feet apart outdoors. If we're indoors, we should keep our masks on at all times if we're with people who are not in our immediate family and try to keep at least a six foot ideally a 10 distance given what we now know about aerosol spread.
NNAMDIGot to take a short break. When we come back, we'll be continuing this conversation with Dr. Leana Wen. I'm Kojo Nnamdi.
NNAMDIWelcome back. Our guest is Dr. Leana Wen. She is an Emergency Physician, a Contributing Columnist for The Washington Post and a Visiting Professor at George Washington University. Here is Ira in Arlington, Virginia. Ira, you're on the air. Go ahead, please.
IRAI'd like to know what ended the 1918 pandemic and what we can learn from that.
WENReally good point, about the 1918 pandemic I think there are a lot of lessons for us to learn from that. It was influenza and not coronavirus so it's a different virus, but similar lessons. And actually one of the other lessons that I just want to convey about 1918 and this ties into, Kojo, what you and I were talking about earlier about timing was that actually the second wave of that pandemic was much worse than the first wave. And that's, I think, another reason what makes a lot of us worried coming into the fall that what is yet to come could be even worse.
WENYou know, at some point in that pandemic a lot of people ended up getting influenza. And then that influenza virus just became something that's part of the repertoire of viruses that we're all exposed to. And the thought is that with coronavirus that something similar may well happen. That it may be a virus that we as humans end up living with for quite some time. Of course, a vaccine would be hugely helpful. Just as we have for the flu vaccine, although, it is important to remind everyone that the vaccine is by no means a panacea.
WENThat it is likely that for some time to come -- first of all, it's going to take us many months to get this vaccine distributed and available. But also that there is -- we will still almost certainly have to keep up our mask, social distancing, other public health measures even after the vaccine is released as well.
NNAMDIIn a recent column for The Washington Post you wrote, Dr. Wen, that we should be just as cautious socializing with friends and relatives as we are taking a trip to the grocery store. Well, Will in Adelphi, Maryland, emailed to ask, "Is there sufficient data to conclude how much transmission might be happening in public places like supermarkets? I spend 30 to 45 minutes once a week in my supermarket. Everyone is wearing a mask, but some not covering their noise." In my particular case, my zip code seems to have the most number of confirmed cases of all zip codes in Maryland. Should I start shopping at supermarkets far away from my house?
WENInteresting. So let me answer these questions separately. So first, let me get to the listener question specifically. And then I'll address you question as well, Kojo.
WENSo the question about the supermarket. So first of all a reminder that everyone should be wearing masks correctly. That correct consistent use is important. So, of course, covering our mouth in addition to our nose is important. There is fairly low risk with going to the supermarket especially if people are abiding by guidelines in general. Yes, some people may not be wearing their masks correctly. But I think if everybody is wearing mask, generally it also means that those individuals are trying to follow other guidelines. For example, they're trying to keep a six foot distance. I would say that especially if you are a more vulnerable individual with chronic medical illnesses or are older in age, you should try to go during off times when it's not as crowded.
WENAlso limit the number of shopping trips that you have. If you can limit your shopping to once a week instead of going several times a week that also reduces your risk every time. I don't think it's necessary to drive much further and go into another area instead, but rather I would limit the number of times that you go and try to go during off times. It is a good question about how much occurs -- how much transmission occurs in these settings.
WENWhat we are finding out and we don't have empirical data about this, but this is to your question, Kojo. What we are finding out from public health officials around the country is that where the spread is occurring has changed since the beginning of the outbreak. In the beginning it was in congregate setting, in nursing homes, in jails, in homeless shelters where many outbreaks were clustered. There are still outbreaks in these settings to be sure.
WENHowever, the new infections that we're seeing, the high numbers are actually in informal gatherings with extended family and friends. They're not grocery stores. They're not buses. They're not workplaces or schools where actually many protocols have been put into place to protect us. And I wrote this op-ed to point out that if we are going to be so careful at school, at work, in grocery stores, we should be just as careful with our loved ones, because there is no face of someone who has coronavirus.
WENAnd it just doesn't make sense. If we're going to be so careful in school and keep desks separated six feet apart and kids are wearing masks to school, but then kids are leaving school and going to have playdates with friends where they're touching one another and not wearing masks that kind of eliminates all the good that was done with all these protocols at school. And so it's a reminder to all of us. Just use our commonsense, but really keep in mind that what's driving the outbreaks now are these informal gatherings.
NNAMDIWell, Dave asks in a Facebook message, "How do you recommend managing gatherings like Thanksgiving?"
WENIt's going to be tricky. And I think it will depend on people's preferences. So there are a number of ways to do this. Obviously the safest thing to do is to not see extended family or friends except outdoors. You could get a heater. You could get a fire pit. I mean, you could wrap up really warmly and see people outdoors. That certainly is going to be the safest thing. The idea of the pandemic pod, one could try as well. If it's really important for people to be seeing one another over Thanksgiving, everyone could keep themselves quarantined essentially not see other people or really limit their risks for the two weeks prior to everybody getting together.
WENIf you are in an area with sufficient testing, you could also do a combination approach. Everybody could get tested, for example, just before seeing one another and also keep each -- and keep as isolated as possible prior to that test. So I think there are a number of ways to do this. But using an abundance of caution and recognizing that, look, if we're not going -- if you're not going to go out, and pick 10 people from the grocery store to come with you and sit in a room together for four hours, you should also not be seeing your relatives for four hours at a dinner table either.
NNAMDIHere now is Carol in West Virginia. Carol, you're on the air. Go ahead, please.
CAROLYes. I'm 86 and my grandson and wife -- his wife and their child live with me. She's in the first grade. And she takes a bus. She's in a pod at school where I think there are 20 children. And they wear masks on the bus. But they do not wear them at school. And I'm concerned about my possible exposure, and I wondered what I should be doing.
WENI'm not quite sure that I heard the entire scenario, Kojo.
NNAMDIShe was saying that her grandchildren and their child live with her, and their child goes to school in a pod. But she wears a mask on the bus, but she does not wear a mask when in school. And she's concerned about herself being affected.
WENI see. And she's 86 years.
NNAMDIShe's 86 years old, yes.
WENI had heard. Yeah, I mean, I think that many families are in this situation. I would say that you should talk to the grandchild or the family and see how many precautions are being followed. Is everything being followed? And if everything is being followed in school, I would actually be less concerned than about what happens outside of school. Make sure that these kids who are in school don't also then go have extracurriculars that are unprotected. Don't also go to birthday parties. Just the school alone, I'm actually less concerned about.
WENIf you are very concerned, Carol, about exposure, because you're older and have medical issues as well, you could also consider being in separate spaces as the grandchildren, so perhaps wearing a mask when you're indoors with one another. But I think that ultimately it's about reducing the risk of the grandchildren or the great grandchildren while they're in school.
NNAMDIDr. Wen, when is the best time to get a flu shot and why is that particular inoculation so important this year?
WENThe best time to get a flu shot is right now. Definitely get the flu shot before the end of October before flu season fully kicks in, more important now than ever, because we want to avoid the confluence of the flu and coronavirus. And so the sooner this could be done the better.
NNAMDIAnd if there's any kind of silver lining, doctors are predicting a milder than usual flu season this year. Why is that?
WENBecause the same precautions that are used to prevent the flu are also used to prevent coronavirus and vice versa. So we've seen in other countries that have implemented these measures like mask wearing, hand hygiene, etcetera, that they had a milder flu season. We might expect that in this country. However, we should not -- that alone does not mean that we should let down our guard. We should absolutely all get the flu shot and remember to keep on our guard in particular now with our loved ones. Don't treat our loved ones any differently than we would strangers.
NNAMDIDr. Leana Wen is an Emergency Physician, Contributing Columnist for The Washington Post and a Visiting Professor at George Washington University. She formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you once again for joining us.
WENThank you, Kojo.
NNAMDIUp next Tiffany Green, the Fire Chief in Prince George's County, but only kids can call. I'm Kojo Nnamdi.
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