COVID-19 Q&A with Dr. Richard Wenzel
This event has concluded. Scroll down to find a full video replay.
The news about the novel coronavirus/COVID-19 is evolving seemingly by the hour.
That makes it difficult to keep up, know what to do, and figure out the role our sector should be playing to equip the public with what the facts.
Dr. Richard Wenzel is emeritus Chairman of and Professor at the Department of Internal Medicine at Virginia Commonwealth University (VCU) Medical Center, former President of the Medical College of Virginia (MCV) Physicians, and Editor-at-Large of The New England Journal of Medicine.
Dr. Wenzel is an epidemiologist and infectious disease expert by training, as well as a fiction and non-fiction author. He will join us Wednesday, March 18 to discuss what to know about COVID-19 and how to talk about it.
- What we know and don’t know about the COVID-19 pandemic
- How folks in communications for good can be helpful in a time of great uncertainty and rapidly evolving events
- Why clear communication from trusted and knowledgeable sources is essential during a public health crisis
Notes from the webinar can be found here.
Slide deck from the webinar can be found here.
We’ve started a Coronavirus Crisis Comms Triage Kit — to share and crowdsource best practices, resources, and examples of effective crisis comms from foundations and nonprofits covering many of the tasks you’re likely attending to.
A quickly/produced & lightly edited transcript follows below (typos possible).
Sean Gibbons: We’re going to start with a little bit about communications. I’m going to blaze through this really quickly and my colleague, Tristan Mohabir is running the deck. So, I’m going to ask him to advance the slides. Let’s just start right here.
Sean Gibbons: This is a note that I got from our good friend, Anne Martens at the Bill and Melinda Gates Foundation in Seattle. She was talking with one of her colleagues who works in Global Health. And the mantra within the foundation up there in Seattle, which is obviously having an extraordinary experience, our hearts go out to the good folks in Seattle, is they were saying this: “When there is no vaccine, communications is the vaccine.”
Sean Gibbons: So, if you work in foundation or a nonprofit, or perhaps you’re working in a government entity, and you do communications work, you have a very, very important job to do just now. We’re going to talk a little bit about that with Dr. Wenzel.
But why don’t we go ahead and advance the next slide, talk about what we really mean there. Firstly, we are in an emergency situation. I don’t have to alarm you with that. I think that’s just a fact. You’re going to hear more about what the contours of that looks like from Dr. Wenzel.
“When there is no vaccine, communications is the vaccine.”
But this is a moment for us all to be helpful.
We can boost the signals of the CDC, the NIH, that’s the National Institutes of Health and particularly, local government and your local departments of health.
It is really essentially in a very crowded information space that we live in right now, where there’s lots of confusing guidance or misinformation. There are things we can do. What they probably look like is literally taking a message from CDC or NIH, or your local mayor’s office or your local department of health and just literally shared.
Could be that you’re linking to those things on your homepage now so that people have access to it. There are lots of vectors of information flowing to people. You never quite know where people are going to find the thing that could end up being tremendously helpful to them. So, if you can lend your voice and your influenced just now, that’s tremendously helpful.
Edelman just came out. You may know them. They do the trust barometer every year. They did a special just now on COVID-19. You can find that online if you google Edelman Trust COVID-19. Here are two things that jumped out at me when I saw this just a moment ago. Number one, the most trusted source of information for people right now, perhaps this will change.
But right now, the most trusted source of information is people’s employers, which means if you work at a foundation, a nonprofit, you’re helping your bosses get the word out as you’re setting policy, maybe adjusting the way that you’re working, transitioning the way we are at the network level working from home, employers have a tremendous role to play right now, particularly for those of us who are charged with communicating on behalf of our organization. This is where we can be really influential and helpful.
But we also have to be mindful of where we can’t be and that is we’re not the best messengers. Best messengers are doctors and health officials, which is why I’m about to see the stage in a quick second to Dr. Wenzel. It is really, really, really critical that we are mindful of what medical professionals, folks with MDs, trusted vetted sources. I’m not talking about, no disrespect, not Dr. Oz, but trusted doctors and health officials who are speaking in place of authority and have access to information that maybe you and I don’t have. Those are going to be the most effective messengers out there. So, anything that you can do to amplify them, to give them that signal boost, tremendously helpful.
When you’re in an emergency, I’ve said this before, for those who’ve been following the network for the last couple days, this is just a primer for anybody who just needs to get this back into their heads or maybe more importantly, get this into the heads of the bosses is right now, your job is to be brief, to deal only in facts, which means also saying what you do not know, to be incredibly clear. Sentences don’t need to be longer than seven words, and they need to be active voice.
Calm. We all need to maintain a little bit calm and perspective. This will be over, perhaps a little longer further out than we might all imagine, but it will eventually be over. And it’s important for us to constantly remind ourselves of that.
This is the other thing you want to be doing in your communications, really figuring out what’s essential. Less is more. And if you were driving down the road, ambulance comes flying up behind you, what do you do? You pull over. You just get over to the side or get out of the way. I think that has to happen with your communications right now. If you’re not sharing information, that’s the business of helping people save lives or make good decisions that are relevant for their safety right now, that’s the mode that we’re in. We are in actual emergency response mode. Get out of the way. Okay?
Also, critically important as you are communicating, particularly in the context, we try to help people get information that can be helpful for them to be safe. Information design matters a lot too. So, if you’re writing emails, this is a practice in the military, I’m going to go ahead and share with you all, which is the BLUF called, oh, boy, I’m going to forget what BLUF means. But suffice to say, you want to put the most cogent relevant information concisely up at the top of an email. It’s probably three bullet points. These are the three pieces of information. BLUF: bottom line upfront. Thank you, Ryan. Thank you.
Bottom line upfront. Give people the information they need. Don’t make them look for it. So, information design can look like three bullets at the top of an email, the headline of emails. Most of us are getting a lot of information right now. Make sure people know exactly what you want them to do. People want to take an action, you want to review something, be really clear. Headlines of your emails, bullet points at the top, the bottom line upfront what they need to know and then graphics.
Give people the information they need. Don’t make them look for it.
Really tremendous people read and we know a picture’s worth a thousand words. That’s certainly true. Graphics and visuals are incredibly powerful. You’re going to see that in a second, just what Dr. Wenzel is going to be sharing with us. Tristan, if you’ll go ahead and advance next one, please.
These are some resources we’ve made available. They are not pretty because we are not designers. So, we are working with the design team right now. Next 48 hours, 24 hours, 48 hours, whatever it’s going to be, we’re going to update them to make them infinitely easier for you all to use. We’ll practice for each. We’re going to be better in information design, with huge thanks to the J Sherman Studio up in Boston. They’re helping us do that right now but you can go ahead and avail yourselves of those resources right now.
Take a look in there. Those links, we will also share those on Twitter and hopefully, Carrie is going to toss those into the chat equipment so you can access those. And we are using the hashtag Comms4Good on social, so you can see that their C-O-M-M-S 4 G-O-O-D if you’re on the phone.
All right. I’m going to go ahead and pass it to Dr. Richard Wenzel, who’s been incredibly kind to join us. He is one of the world’s leading infectious disease docs and epidemiologists, can’t tell you how grateful we are he’s taking time away. They have two patients now in his hospital down in Richmond. As of yesterday, I think they had zero. So, things are moving rapidly. And he is a busy man, but he’s making some time for all of us.
Also, fair warning, just before we get underway, I fully expect that what he’s going to say, he’s going to scare the Jesus out of you. Just be prepared for that. Okay. Again, this is some scary stuff. All right, that said, again, he’s going to present this to you in a calm, scientific manner. So, hang in there. We’ll take some questions at the end. He’s got about 15 slides to work through. All right, Dr. Wenzel, will you take it away, sir?
Dr. Richard Wenzel: Yes, thanks, Sean. And thank everybody who’s tuned in for this. I know everybody’s busy. I have this slide on just so if anybody wants to send me a note later on, I think they wish they had asked to see my email there. And then the only other comment I’ll make is that I may mention a drug or two. I have no stock in any drug company. There’s no conflict. So, if I do that, say a bit, I don’t have a conflict. If I can have the next slide.
Dr. Richard Wenzel: So, I want to begin with epidemics. And the point I want to make is in the title. They are a natural part of life. Now, if you look underneath the bottom on the right, the recent epidemics, HIV, SARS, H1N1, Influenza, MERS, and COVID-19 all since the ’80s. This is showing you the ineluctable march of epidemics. They’re here. They’re part of our life. And if you look at this picture of Albert Camus, and the quote from The Plague, “Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky.”
Somehow, though we’ve seen many epidemics, it’s always a surprise to people that they’re there. We shouldn’t be surprised at epidemics. Now, when the epidemics occur in more than one country and the sustained transmission, we call that a pandemic, if I can go to the next slide.
Having been very much involved in H1N1 in the middle of that thinking about how we should think about pandemics, you’ll see the reference at the bottom, I’d like to suggest a new definition, the current one, sustained transmission in other hospitals, in other countries and multiple countries. It’s a little vague and it includes benign thing. You could have a pandemic of a common cold virus, that doesn’t have any meaning. So, here’s what I suggest we think about it.
Pandemic is a response to an infectious threat, requiring international surge capacity. And by that, I mean measuring incremental resources, such as medical protective equipment, incremental personnel, ICU beds, food, water, diagnostic test, drugs, even consider the incremental percent GDP needed for control. Imagine if we had all of that, from the last three or four pandemics for five or six or more countries, where we would be now looking ahead?
The communication metrics with pandemics are obviously the transmission rate. This is the capital R, naught, with a little zero at the bottom. And this says, on average, for every case of, in this case, COVID-19, how many secondary cases occur? And it’s about three right now. Disease severity, obviously, we’re talking about mortality, how many people need to be in the ICU, on respirators and other measures. And for this suggestion about pandemics, we need obviously international cooperation for the medical, legal, administrative cooperation that we need. Again, imagine if we had these numbers. Next slide, please.
So, let’s talk about SARS-CoV-2, which is the name of the virus and COVID-19, strictly the name of disease. However, we’ve used really COVID-19 for both, so I think we’ll just go ahead. For all coronaviruses, the reservoir is bats. And for secondary host for SARS it was the civet cat, for MERS it was the camel, for COVID, it looks like this strange looking creature on the left, the pangolin. And this is apparently valued for its meat in some parts of China. And obviously, the live markets where this animal was sold, had positive samples for this virus.
Now of you look at the virus in the middle, this representation, you see these knobs around it, which gives us the name corona for crown. And each of the knobs actually is a point on the virus that is seeking to dock to a special receptor in the body. And if you look at the human lung anatomy, you’ll see that the pharynx or the back of the throat, and then leading to the windpipe, the trachea, the bronchi, if that’s gets infected with bronchitis, and then sometimes the virus gets all the way down to the lung. That’s the moment.
And so, the receptor is called ACE-2, A-C-E dash two. So, the virus is looking to hook onto a receptor in any one of these spots. And then it signals that it will be incorporated into the cell where it needs to thrive and take over the cell. So, initially, if it’s just in the nasal cavity or pharynx, patients would do fairly well but gets down further and gets to the lung, then we have some more trouble.
And there, we should just note that if you look at the nasal cavity and the pharynx, it turns out that that’s where we can kind of screen patients for this. And that’s why we do it because the virus is in high numbers there. And one of the unfortunate things that we’ve just learned the last few days is, even if the patients have no symptoms versus those who have symptoms, the viral load in the nose and the throat is the same, which means that these silent people who are infected are part of the epidemic. Next slide.
So, just to again, put this back into some perspective. It’s not like we’ve never seen coronaviruses. Believe it or not, the study that I did a long time ago, just beginning my career, three years study, in military recruits looking at patients. We didn’t know what caused a respiratory infection and we ran it against coronavirus types OC43 and 229 E. And it turns out that between 1970, ’72, I can’t presume where I was assigned as a navy doctor to the Marine Corps, up to 5% of the patients with respiratory infections had one of these two relatively benign coronaviruses.
However, during the winter of ’70 to ’71, 52% of 75 recruits showed infection, including 37 of 39 hospitalized. We now have a few more that we’ve recognized. And what the punchline is that for less severe coronavirus species have circulated in the United States for years. And you see the four listed there. So, someone could have a coronavirus and it doesn’t have to be COVID-19, although that’s the one you’re going to find today. Next slide.
Now, if you just look how severe is COVID-19. The 80% of the mild, I don’t know if you can see that on your slide. Mine disappeared in the formatting, 15% are moderately severe. These patients might be treated in the hospital and 5% will be severe. And they’ll be the ones in critical care units or in respirators. So, the odds are good in terms of mild, but it depends on who you are.
Now, if you look at people vulnerable to infection on the right side, the elderly with underlying comorbidities, heart, lung disease, diabetes, others, their mortality over age 70 can be 5 or 10%, over age 80 could be 10 to 15%. Immune suppressed patients appear to be vulnerable not to infection but to a bad outcome. Similarly, with babies, just recently, those newborns and maybe up to age five or seven.
So, when people talk about who’s vulnerable, you should be asking, are they vulnerable to infection or to the adverse outcome? I think this is an equal opportunity virus. And it strikes everybody, but we’re talking about vulnerable means the outcomes.
First responders and healthcare workers, during SARS, they represented up to 20% of the total victims, and they are high risk now. One of the reasons why poor people or people living paycheck to paycheck might be vulnerable, they themselves may be forced to go to work, if they can, just to keep the money coming, and they have nobody to help them, maybe once they get ill.
Pregnant women, we’re not sure but there’s some early signs that they may be at risk for severe outcome just as they are with influenza. People in crowded space we already know and poor infection control places like cruises, nursing homes, prisons, airline travel, we know they’re going to be likely for infection, not necessarily for the outcomes. Next slide.
How is this spread? Most of the spread is from person to person by what are called large respiratory droplets. These are over 10 microns in size, a micron is a millionth of a meter. So, they’re considered large droplets that fall after about 6 or 10 feet. Now, the NIH just came out with a study showing that if you simulate the droplets after a cough or a sneeze, some in fact are tiny. That means less than 10 microns or sometimes called droplet nuclei. These don’t fall to the ground in minutes after the 6 or 10 feet, but in fact, stay in the air for up to two hours.
So, like TB or measles, which is almost always small droplets, these droplets contain the viruses like microscopic hot air balloon hanging in the air and somebody could come in an hour later after the person with TB left and still inhale this organism. They can also have because of their small size, not get stuck in the upper respiratory tract, like the trachea or the pharynx but get down to the deep part of the lungs.
The other way of spread is touching mucous membranes, our Eyes, nose, mouth after touching contaminated surfaces. For example, hand shaking and then inadvertently touching our nose. Food, sexual transmission, transfusion and IV drug use, unclear probably not at all or rare low risk.
What is our response? You’ve heard about this. Handwashing, don’t touch your face, stop handshaking, clean frequently touched surfaces. And by the way, eat well. Don’t smoke or give it up. Avoid excess alcohol. Avoid crowds or avoid all people. Next slide.
Now, I will press that we need to really be dictating our policy by science. And it should be explained by scientists in my view. And this is, as you can see, for top bracket, the German playwright and one of his books, plays was on the life of Galileo. And he has the protagonists say this, when Galileo was asked in the play, “What’s the goal of science?” And the response was, “The aim of science is not to open the doors to everlasting wisdom, but to close the doors to everlasting ignorance.” And I think that’s important as we go ahead. I will continue to say we need to do more to learn. We need more science. Next slide.
Now, just to look at the possibilities with very simple free model, next few months. So, in the left side, it says attack rate. And that ask the question, what if 10% or 20% or 30% of the community population became infected? And then next, how many cases would that be? Well, 10%, it’d be 30 million, 60 million at 20, 90 million people at 30%. Know that there are people out there say it could be much higher attack rate.
Assuming 1% mortality, then on the top, go into the middle to the bottom, you had 900,000 deaths, 600,000 or 300,000, even if only 10% of the population get infected. We admit we think about 5% of those cases. So, 5% of 90 million is four and a half million hospital admissions. And I want to point out, that’s where the 30% attack rate. These are incremental admissions above that expected. We’re already at 90% or more in most hospitals in this country, some higher. Even a 10% attack rate, that means one and a half million incremental admissions. And maybe a third of these patients will wind up in the ICU.
So, what’s the incremental ICU bed needed? Well, you can see from the top to the middle, to the bottom, 1.5 million, 1 million and a half a million, even with the most conservative attack rate of 10%. And the question, do we have the needed surge capacity? The answer clearly right now is, no, we don’t. You hear hospitals all over the country saying they’re running out of materials and they’re worried about it. In Italy, they’ve already had to make some tough decision, who gets a respirator? Who does not? Next slide.
What are we missing so far? I think discussion of the mental health impact has been understated. So, for people with mental health disease, not only we’ll worry about what’s going to happen with the infection, but worry about the situation if they get isolated.
What if their medications are unavailable? What if there’s stress on a family that pushes somebody the middle up? If no work is possible, there’s no money for medicine, food, or they’re bullying because of ethnic bias, will there be a crime increase, social disruption, I think, as a result of these stresses. Will price gouging occur? We know that’s happening. Will paid leave occur? I don’t know. Yes.
Continued widespread testing will quickly inflate the numbers. We have very little idea what our real numbers are. The last number is 6500 to 50, 65,000. Should we have designated centers for diagnosis and therapy avoiding contamination of healthcare workers and hospitals, emergency rooms, clinics? Of course, model the South Korean drive through history taking and then testing. We want to keep people out of the hospital, away from healthcare workers as possible.
So, we have national guidelines for social distancing and quarantine to have a same voice rather than each state. Next slide.
Now, there is a drug that is looking promising. Its investigational studies are going on, remdesivir. And it’s if you get down to the line for use compassionate use, and it’s made by Gilead. Again, I have no conflict of interest here. So, there’ll be people who are in the most severe case will be maybe a candidate for remdesivir. You’ll need local IRB, clinical trials are underway.
The other drug people are using, there are two drugs, chloroquine and a sister drug hydroxychloroquine. They look promising. Again, there’s a limited supply of these drugs already. And some difficult decisions will be, who should get? Should we give it to an ICU patient who’s in trouble? Should we give it to an immune suppressed person who’s got a kidney transplant who just shook hands and spent two days with somebody who turned out to be positive as a preventive drug? The bioethics of the choices are going to challenge us. Next slide.
What else to expect in the next two months? Worse numbers, more disruption, supply chains closing, possibly more political polarity if that can happen. And we still don’t have a vaccine or drugs for the next two months. We may see an increase in request for compassionate use of remdesivir and perhaps other drugs. Next.
So, how do we respond to pandemics? In my own personal view, politician should appropriate sufficient resources and coordinate the disparate talents of support teams. They may want to assess the options that also weigh economic, ethical, and social influences. But in my view, the foundation of the policy, go back please, should be based on science explained by scientists.
And the public health statements should tell us what do we know? What don’t we know? And often what we don’t think about what are the often-understated assumptions that are sometimes hidden that drive current policy? We have those people be fluid and articulate what I might call the nuance lexicon of uncertainty, we have to admit it, we don’t know much. Next slide.
So, Nassim Taleb talked about the black swan. I don’t think any epidemic is a black swan. We know they’re coming. What we don’t know is when or how severe. But in terms of risk assessment, what he does say of those things we really don’t know, don’t try to predict, instead build robustness to negate the next event. This is what we need for the next step of it. Plan to manage an unexpected event, maybe even bigger than the one we have. Next slide.
So, after COVID-19 looking to the future, I’d like to see prospective, systematic cataloging of new zoonotic viruses. We had a program called Predict that was just in the last two years, suddenly stopped. We should link the new viruses that we find with platforms for drugs, vaccines, and understanding that biology for the next steps rapidly should one of the viruses leap from animals to people.
Build robustness nationally and internationally for worst case pandemic. Build international relationships and agreements to study the surge capacity, learn from our successes and shortfalls of the response to COVID-19. Next slide.
Final personal thoughts. There are four things that I have, words in caps, social distancing. I wrote the slide up a few days ago, why wait? Institute immediately. Prevent incoming, we’ve done that by limiting how many people from foreign countries to come here. I’d like to see widespread testing, not just for the clinicians and then who’s got it, but to be able to contact the contacts of the infected case, to ask them to isolate themselves. And very importantly, try to learn. Surge capacity, we’re running out.
The key thing when we think about what to do, infected person, near a susceptible person, that’s what we have to interrupt that should guide our policy. Thank you. Let me pass on to the final slide, Q&A.
Sean Gibbons: Thank you, Dr. Wenzel. That’s a lot to take in. We have a number of questions. Go ahead, if you would, if you have a question, we’re going to take some time now to do that. Dr. Wenzel’s kind of have to stick with us for the next half an hour, maybe a little bit longer.
Why don’t we start with Christine … Krista, excuse me. Krista has two questions. So, we’ll start here. there we go. How do you recommend we structure our communications to best reach the most vulnerable populations, including those experiencing homelessness or who may have inadequate access to technology?
Dr. Richard Wenzel: Well, I first think that the scientists should be explaining what’s going on with the biology of the organism with the dynamics. And then obviously, when you’re talking about populations that are not highly valued sometimes, prison population, homeless people, I think we have to work through our social workers. And hopefully that platform is in place, to some extent needs to be really enlarged and made more user friendly.
By that, I mean, if there are barriers to delivering that message in any way, usually, for whatever reason, we have to break those barriers down. And I think it’s the politicians that have to help us break the barriers down, so the scientists can deliver the message.
Okay. Her second question is related, what recommendations do you have for conveying accurate information to vulnerable populations in a way that will be reassuring and encourage them to access available services, particularly when they may be hesitant to connect to these services because of legal status concerns or their immigration status?
Well, again, I would say we have the message coming from scientists and then we have to have those who are in charge of managing the health of people who are immigrants, if they have anybody helping them out, or to leaders in the community. In this case, maybe we’re talking about the Latino community, who are really trusted by immigrants and say, this is what we need to do to help our people. And I would say the same thing for any group. There are advocates and all the groups, we have to break down the barriers for slowing down that information flow as much as possible.
Okay, next question comes from Colby, who asks, we’ve seen several cities and states institute various forms of lockdown, closing schools, shuttering bars, et cetera. But almost always with some form of timeline in between two to four weeks.
And we’ve also heard that we won’t be out of the woods with COVID-19 until the summer, which could be as late as July or August. Do leaders truly expect that we will be able to be open some aspects of life within a few weeks. Are they just being cautious? Is this because our treatment options will improve? If not, should we really be prepared to be in significant lockdown for a matter of months? How long is this going to last I think is the short way of asking that question?
I would say we should count on disruption for another four weeks. Why people would say two weeks? I can’t answer for the recommendation. My own view is I think by mid-June, we’ll see the epidemic peak, that means the top part of the curve, it could happen a little bit earlier. But that’ll be important, as we see it on the downslide because then people realize what things are working. And we can tap hope again, if you will.
What I can’t predict at all is, what’s the slope look on the downside? How long will it be? Will it come down precipitously as it did on the way up? Or in fact, will it be a slow line or curve at the end and hang on until late summer, even on early fall.
So, I think with that, I would start and say, that’s how I would look at it. And I think we’re going to need probably closer to four weeks of major disruption. And depending on what the numbers show. Right now, it’s really hard for anyone to tell you how many cases we have, because we don’t have a test available. We don’t even have test reagents in some places.
So, Hannah asked a question, the COVID-19 task force announced this morning that the first trial of a vaccine has begun. How long do you anticipate before such a vaccine would be available to the population? And I really lock back to that question because there’s-
I’ve done a number of vaccine trials. And what happens is, you to start out with small groups, so-called phase one, and you want to see if it’s safe and healthy people, and you try different doses. So, you might have as this one, three different doses. And you give it a time zero and then 28 days later. And you’d look for side effects all along and what happens to the immune response. Do people rapidly get antibodies after one dose or two doses? So, we’re trying to get, is it safe and how many doses? And what actual milligram dose, if you will, or microgram is really the most useful?
Then you enlarge the vaccine trial and you go to phase two or three. Three is in larger groups, where you look at people who maybe missed on the small numbers might come up with a 5% risk of something bad happening, and then you look the tradeoff.
No, I can’t imagine on anything under a year will likely one and a half years, maybe even two, I’d be trying to target one and a half years before we expect the vaccine.
Okay. Next question comes from our friend Natalie and she asks, how do public officials decide when we are after COVID-19. When will we know it’s all clear is we’re out of the woods?
Yeah. There are a couple of ways that people look at that. One is to look at the case reproduction number, this capital R little zero, R naught. Again, if right now we’re seeing three secondary cases for every primary and then we begin to peak and then on the downslope, you’ll see it that’s spread out to two and a half, and then to two, and then one and a half, an epidemic still continues. If there’s anything more than one, in the case reproduction number, the epidemic will be over once we get below that.
And the second thing is to get an accurate number of the real cases. And for that, we need to test kits and some surveillance of illness besides the test kits, and we will know by then.
David asked a question that’s directly related to that which is, is there any reason that we’re not using the testing that’s been used in Asia or the WHO’s test? Is there any way that we can get it here United States?
Well, I think we’re seeing in the surge and delivery. What happened is CDC got the genetics of the virus COVID-19, very quickly developed a test to their credit, but the test got flaws when it was distributed. What they could have done right away is go to WHO, which offer the test kit, bring them in by the thousands or tens of hundreds of thousand, and we’d be much better off.
Unfortunately, we did not accept the invitation from World Health Organization to use the kits available in Europe. We should have done that. Instead, either through hubris or pride and then some FDA red tape, we were slowed down in moving ahead. Now, you have private industry, as you know LabCorp or Quest and others that are coming through with the test. I think we’re still a week, two weeks or so from being able to say to physicians, we now contest anybody. So, that was an error in the beginning. That’s why we didn’t get it going. Not our best moment.
Got you. Understood. Thank you, sir. Matt’s question. How long would social distancing measures need to be in place to prevent overwhelming the healthcare system? And maybe another way to say this is, if we could go back and just explain what flattening the curve? We’re hearing that, I think it means something different to doctors that it may be means to my nine-year-old.
Yeah. So, if you imagine drawing a curve, very steep on a piece of paper and rising and then coming down, remember on the front end, it goes up exponentially. And that’s because you have three cases for everyone primary. And you go from one to three and each one of those, then you go to nine, then you go to 27. And so, what you’re trying to do is somewhere … By the way, 15 iterations gets you 14 and a half million cases. That’s how fast, it’s hard to believe it, but do the numbers for yourself.
So, that’s where they got it from, it’s sort of a, we don’t know. But that’s an evidence that people who have access to excellent healthcare and are kind of in sequestered spaces, that’s what community spread looks like, is anybody’s vulnerable?
Yeah. And so, then what you’re trying to do is interrupt that person to person transmission any way you can, so that your peak is actually lower. And as the peak gets lower, hopefully be able to turn that on the downside more quickly, and avoid some of the big numbers that filled the area under the curve and the top peak, the worst case peak. And that’s what we’re talking about. We’re trying to flatten that peak and then flatten the whole numbers by the same token.
And the entire reason for that is we do not have a healthcare system that’s equipped to manage that surge right now?
Yeah. We do not. So, there are a couple of problems. The healthcare workers get exposed. They put themselves on isolation for 14 days, they’re out of the game. So, we’re hurting. And obviously, if they get exhausted, I have a friend in Italy. He and his team are taking care of 130 inpatients with COVID document, 15 on respirators, so they’re really hurting. We don’t want to get there if possible.
Got you. So, next question is from our friend Makiyah. There’s a lot of misinformation circulating. Does season have any impact on this virus spreading? Is warmer weather change anything for folks including I think the President say, “Just wait until spring, it’ll be okay.”
Well, the quick answer is we don’t know. Now, we know in this country influenza likes late fall and winter, occasionally early spring, but I’ve been in Taiwan and lived there for a while and see huge influenza cases when 95 degrees out and 95% humidity. So, I think one of the things that winter does is put us together inside with dryer and maybe allows the virus to be on the environment a little bit longer. But I thought proximity, there’s also another factor. I don’t think we know what will happen in the summer months, in the warmer months.
Copy that. Jennifer asked a question. Hey, buddy, how are you doing out there in Nashville? Since I’m hearing different definitions of the term social distancing, what is your definition? And what are the limits? Should people be out in nature or playgrounds? Those of us parents, we’re starting to go a little stir crazy.
Well, I showed the diagram of a person that red infected and the person to the right uninfected. What we’re trying to do is keep those two people apart as best we can, and then you go from that single person to populations of people, families trying to keep them apart from other families or for gatherings. If you want to go to a ballgame or a bar, we don’t want that to happen.
We really want to keep people pretty much at home. So, if possible, stay home. If you needed a drug, drive by the drugstore. There are now restaurants that are available for drive by meals if you need that. Unfortunately, people with more resources will be able to do things better than people without resources.
And we have to recognize that and hope our social health system will be kicked into gear and really do that and we need resources to do so that has to be part of the bailout, if you will from the government. And that’s why I say the surge capacity has to include the resources, take care of the entire population, disenfranchised as well as those who have more resources.
So, there’s some conflicting guidance that is our friend, Robert, just pointed this out that CDC says six feet for social distancing and World Health Organization says three feet. Do you have a number that you like? If you had to see both of those conflicting numbers, which one would you trust?
Oh, I would say six feet because we know from a lot of studies, people with respiratory infections, large droplets, which is what we really want to prevent mostly, with large droplets fall after about six feet. If you look at the airplane studies that’s so far out, assuming that it’s mostly large droplet, people within two rows of the infected person are really the bulk of the risk.
Now, if you have small droplets, like TB, still most of the people with the hot air balloon in case organism even two miles away are still the most likely. Over TB, I looked at the study of a large plane ride and even up to 15 aisles. So, hopefully this is most regard to droplet, stay with six feet.
Got you. Allison asks, Dr. Wenzel, you mentioned that babies and children under the age of five might be at risk. But the information so far as indicated that children are not vulnerable. This is what people are reading, indicated that children are not super vulnerable to this virus. Should we be changing that message so that parents are more informed and being more careful that their children are not getting the virus? Or do we just not have enough information yet?
Well, it requires some subtlety. If you look at all the patients in this country who’ve gotten COVID-19, only 2% have been those under age 18. But that’s maybe misleading, because may be that if you’re under 18, most of them don’t have any symptoms, very few symptom and were never tested. So, there’s a big unknown. I think they’re getting infected. I think there’s also the reservoir for infection for people older.
Now, more recently, there’s a study that just came out, pediatrics saying, if you’re a newborn and maybe up to age four or five, the severity may be greater in that group than we previously thought. This is not surprising, in some ways, because maybe a baby really doesn’t have a totally mature immune system. There may be other reasons as well. But I think you can have both a low proportion of sick people under age 18.
But be careful when you look at whether or not they’re infected. I think they’re infected but just above, but also the very newborn and up to a couple of years, maybe up to one, two to five might be more severe out from.
Next question comes from Kelly. She says, how confident are you in the estimated mortality rate that we truly do not know the numerator for this disease. It’s 1% mortality rate under or overestimated, in your opinion?
It’s a great question. We teach ourselves in epidemiology and say, epidemiologist study the long division. We need a numerator and denominator that we trust. Right now, we don’t have one. We don’t have that, the numbers we can trust. What we know is of the sick people that we’ve counted, there’s been a mortality of 2 to 3%. And that holds for several countries.
What I think is that there are larger proportions of people who have mild disease, who haven’t been tested, who maybe are carriers with maybe no symptoms, who haven’t been counted. And I think we’ll be closer to the 1%. I think the 1% is real, just to point out that still 10 times the average mortality of our seasonal influenza.
So, in your hospital right now, you said just before we came on, there were two people now who tested positive seeking treatment there at the hospital in Richmond, Virginia. Just to do the math speculation, very much mindful of that, if you had to guess if there’s two patients seeking treatment in Richmond, what’s the likely number of folks in town who have been either exposed or sick? Or is there a distinction between those two things.
That will come in to the hospital in the future?
I mean, just right now walk around the city of Richmond. How many people is that mean, walking around the city probably have COVID-19?
I’d be really guessing. I think we probably have maybe 10%, but that’s a pure guess. When I talk to the people who are really on the frontlines at Medical College of Virginia, they tell me, so far, we only have two patients, we’re like, maybe New York was two or three weeks ago.
Copy that. Marjorie has a question says, how long can this virus last on material items. Do we have to worry about purchases we make at the store? So, I think people are worried going to the store and picking up a gallon of milk, maybe bag of apples. How dangerous is that to bring into my house?
Good question. What’s been studied so far is if you have hard surfaces like plastic or stainless steel, the virus can actually live for even a day or two. This is less so on anything that’s cardboard or cloth. And if it they’ve tested also on copper, because copper has long been known to be anti-viral. And it only lasts for about four hours.
So, if you said most goods that you’re going to purchase with boxes on them probably been out for quite a while and are probably safe. Can you guarantee 100%? Not at all. Who’s touched that box before you did? I don’t know. So, I think it wouldn’t hurt to just clean those boxes off make you feel a little bit better.
Curious about the incubation period is the next question. What’s the actual time period from exposure until someone is in the clear?
Usually the answer is 14 days. So, most people can get infected usually been four or seven days, but as brief as a couple of days all the way up to 12 to 14. So, the 14 days self-isolation means that you’ve already passed the longest incubation period and that’s why that number is used.
What in your recommendation is a physician has been doing this for multiple decades. And Nicholas asks what messages can we use to communicate the current situation clearly and directly, but also ensure that we mitigate fear or concern that we don’t contribute to a panic so there’s some of those numbers we saw earlier? 900,000 people if we saw a 30% attack rate with 1% mortality rate, 900,000 people would pass away. That’s a scary number.
Yeah. I think we have to start with generalities because we don’t have good numbers. We’re in the middle of a really unusual pandemic. If we control this with our interruption between effective people and susceptibles, we’re going to be able to mitigate this significantly. But there will be an enormous amount of disruption for probably four weeks. We will develop better drugs, hopefully, within months that might be available on some drugs, at least on a capacity to use.
But still, we have to be concerned that there are a number of high-risk patients, meaning high risk for a bad outcome. Again, I think, to tell you that there’s so much uncertainty, my current hypothesis is it’s an equal opportunity virus and people will be infected no matter what stratum they’re in, but we do recognize that there are certain people at higher risk, who should take even more precautions you say. So, somebody lifted social distancing for a week, I would say, give some thought to extending that if you’re a vulnerable patient.
Got you. And that actually leads right into the next question from our friend, Amy, and she asks, if the peak might not occur until June, that’s people seeking medical attention, I believe, we’re talking about the peak in that way, why would significant disruption only occur for four weeks?
Well, that’s a good question. I think what will happen is, between now and four weeks, we’ll be able to put some real numbers and again, numerator and denominator. We’ll be able to begin to draw the curve accurately. We don’t have that right now. And we’ll be able to look at the adverse effects even better. Because maybe if we’re lucky, some of the older people are getting affected and don’t have all the severe stuff and maybe aren’t showing up for testing.
I think we put the numbers in, in some detail and get the science to tell us where we are and what the change is day-to-day, we may be able to change that. Or we may have to say, you know what, we can’t stop it. We may have to go to five or six.
And Nancy has a question very practical for those of us who are not trained scientists. How do we best protect ourselves when we’re doing things, like going to the necessary things going into the grocery store or essential items? What do you need to do to be prepared to go to the grocery store?
Well, grocery stores for a long time have been giving you these wipes that you use when you’re pushing one of their carts or something. I still think that’s a good idea. If possible, stay five or six feet away, six feet away from other people, if possible. It’s going to be a challenge. Stay as brief time as you can. Again, carry if you have available, hand antiseptic, use it liberally frequently. And certainly, when you leave the grocery store, again, put it on one more time before you drive on. So, practical things. Anybody who look sick, stay away from that aisle.
And what about when you get home? You take off your clothes, throw them in the wash or?
No. I think the issue is really your hands. And so, if you can use the cleanser, soap and water, that’s terrific. Do it and do it as soon as you get home. If you feel more comfortable wiping down the surfaces or something again, go ahead, but the handwashing is probably critical.
Okay, what about masks? I see we’re seeing lots of folks jumping on online trying to purchase these N95 masks.
Yeah. I mean, what we know is if you have a patient who’s ill, the mask particularly N95 although maybe there’s some information, maybe surgical mask, are pretty close to the same efficacy preventing that protection, that person who’s infected from spewing out droplets of any size. So, that works.
For healthcare workers who are dealing with very old patients, particularly if they’re intubated and they’re doing suctioning with the tube that goes into their trachea or windpipe, or they’re getting excavated, where the tube finally comes out and they’re coughing and choking, they need the N95 mask. They need everything. They need in fact the gowns and gloves and so forth.
What we don’t know is if you’re a citizen walking around in the city and you’re near other people, and you put a mask on the whole time, will that help? There’s soft data I saw from SARS that maybe in one study, but most of the people think that’s a limited use.
And anyone who’s tried to put an N95 on for more than 20 minutes, let me tell you, it’s tough. It’s hot. The breathing if you have any lung disease, it’s not fun. It’s hypercarbic. Because all the carbon dioxide collected right near you and you’re not breathing in oxygen the same way, it’s very difficult. Hats off to the people who need to wear those in ICUs.
A friend asks, if someone tests positive for COVID-19, does this mean you won’t be able to contract it again in the future? There’s been conflicting information about whether or not that’s true.
Yeah, for most viruses, we would say, you’re probably immune. And once you have measles or mumps or chickenpox, you’re not going to get that disease again, you get something else maybe. There are some times where people don’t get the long-lasting immunity for some viruses. And I think people are worried about the exception. But I think we should mostly expect people to be immune and how long where these viruses going to last? I don’t know whether it’ll come back in the fall or the winter again, if it dissipates in the summer. We don’t know. But I think most people are going to be safe.
Okay, next question is from our friend, Joshua. He says, what is keeping infections from increasing again in places like China and South Korea? If we reduce cases here and bend that curve down, that infection curve down, should we expect future spikes?
Oh, I see. So, if we control it, let’s say we’re in the summer and we think the last few cases on the way out, we could see a recurrence in the fall. Most recurrences have a lower smaller curve when that happens, not always. And so, that gives some comfort and there may be some reasons for that. There’s been a lot of silent infection, maybe the number of hits available during a recurrence are fewer. I hope that’s the case. I hope it doesn’t recur. But I think there’s some comfort in knowing that most of the recurrences are smaller.
Our friend, Amy asks this, I’m going to try to apply a rule called the truth sandwich to make sure I’m not doing any damage here. Amy asks, it is true that this is a medical emergency, correct?
It is a medical emergency. This is a significant serious threat to public health.
Okay. So, she then says, I know many folks suspect that this is a hoax or a political agenda tactic comparing to the impacts of H1N1 prior to an election. How do we communicate the facts in a nonpolitical way? And what do you recommend for dissolving rigidity or stubbornness to take this matter seriously. These same folks are almost trying to create public gatherings in spite of the 10-person limit. Again, there is a serious public health threat that’s facing our nation globally right now. And there are some people who are struggling to understand that and are acting in a way that’s at odds with medical best practices, what science is telling us.
Yeah. Let me frame it first, it is a medical issue. And people have a choice. And they may feel immortal or feel angry or upset with the authority, but it’s a medical issue. And if there were only their own health involved, they can make a decision to do something, but they’re part of the fabric of a public.
So, I think that not only they have an ethical issue that they’re not confronting. And the ethical issue is that they have to protect themselves from getting infected so they don’t infect their own loved ones, their own family, their own father, mother, grandfather, grandparents we’ll say and haven’t confronted that.
And so, then based on the antivaccine movement, one of the problems is that facts and data don’t seem to move people in those social circles. And the best thing you can do with people is to ask them questions about why they’re doing it the way that they’re doing it. And you try to get a dialogue going. But it’s amazing how much they’re impervious to science, even though I believe that that should be a cornerstone.
Whatever you can do to get social media and look at the sources of those comments that have been made, many of them when I’ve looked at a few, particularly antivaccine movement and the anti-climate change movement are really sources have been discredited over and over.
Again, the problem that’s difficult for me to understand if so, why do people continue to advocate that? And I don’t know the answer. It’s tribal. But it’s unfortunate and it’s a fact of life. And again, like the antivaccine group, the anti-climate change group, we’re going to have anti-COVID reality. But pretty soon, they should be able to look, now look at the incremental best, the incremental infections above and beyond through. That’s real. Hopefully, it doesn’t come home to them.
We’ll take five more minutes of your time. I know you’re busy. First from our friend Laurie out in San Francisco who is no doubt at home. She says, Dr. Wenzel, you sound so calm. Most of us are freaking out. Can you offer us some words of assurance and how are you maintaining your balance?
Well, one, I’ve been involved in a lot of epidemics. Even during my training, I lived for a while in the Philippines during a cholera epidemic where a hundred cases a day and then we had a second epidemic of dengue. And then, as a trainee who lived in Bangladesh, another epidemic of cholera. I’ve been to a lot of countries during H1N1 in Latin America and in general.
So, I know that eventually, if we do some things well and do them quickly, we’re going to be okay. It’s not surprising that people are anxious about this. It’s a normal reaction. And I think we would feel better if we had consistent messages coming from leaders. I’m talking about medical and political, same message. Here’s where we are. Here’s where we’re going. Here’s our assumptions. Here’s what we’re trying to do to preserve your health. I think those messages got a little better. We all feel a little bit better.
Thank you, sir. A couple more questions here now. Oh, by the way, before I forget, my sister, Becky says to say hello.
For folks who don’t know, my sister’s a doc, along with her husband, and Dr. Wenzel was one of their mentors, which is how we got hooked up with him. So, props to Becky. She’s out on the frontlines. We’re obviously thinking about her and let her know she is loved right now.
Madeline asks, I work for an events-based nonprofit organization for public health. How far out should we be looking to cancel events? We’re talking about four weeks of isolation, five weeks, six weeks? When should we think it’s safe to gather in large groups?
That’s a really difficult question because there are a number of people that for example have cruises they’ve signed up for, for May, June and July. I would say probably would think at least in terms of eight weeks before I’d be comfortable at all. And even at eight weeks I’m a little bit uncomfortable because as you saw from the cruise ships events, you’re closely crowded, highly communicable virus in a closed environment that just rip through some of these ships. So, depending on the type of event. Bingo is one thing. Being on a cruise ship is another. I would be cautious, a little bit slow.
And it’s a tough decision because the economy for many people depends on their keeping working. That’s really regretful.
Tracy asks, if you are healthy and your family member is healthier or you believe yourselves to be healthy, are you allowed to visit them? Or is that not advised under social distance. For instance, should I go off and see grandma and grandpa up in New York City right now?
Well, it’s a great question. And just because you’re healthy right now, a little bit after three will say in eastern time doesn’t mean two days from now, you won’t have a cough and be infected, depending on who you ran into.
So, I know a lot of people are holding off visits to their grandparents and particularly those in nursing homes. I think that’s prudent. And at that’s sad. We can try to Skype. Plus, I have an uncle in his 90s. And he says, “Look, they closed down the sports on TV. I’m terribly bored.” But he also knows that we don’t want to come visit him until this thing really close it down.
Gotcha. A question from a colleague here, as anonymous on this, says as professionals in the field of communications for good, should we limit the number of emails or social media posts that are unrelated to COVID-19? I think I’ll take a swing at that one. Just pull over to the side of the road. That’s your job right now. You’re not helping right now and you’re probably doing a little bit of harm just by getting in the way. So, please, people are getting a lot of information right now. It’s essential that we make sure that our public health officials, doctors and scientists who know about this and are knowledgeable are the people who are getting out front.
Because with all the furloughs going on in hospitals, people working from home for example, they are trying to connect with their hospital computer system and that the internet is overwhelmed. They’re unable to connect. So, you’d like to keep the internet free for communication related to the virus, as you said, and the more ramifications as I’m trying to apply.
Okay, Alexandra asks, can we trust in negative test results if a person was exposed to a coronavirus positive patient in less than 48 hours?
I think if I’m understanding this right, this is someone goes in and has been tested and comes back with a negative test, but they discover someone else was positive a day later.
Oh, when you’re negative, you’re negative for that point in time. And that doesn’t mean that four days later, that virus has now reached big enough numbers in your nose or throat or hopefully not much lower in the lung, that that won’t turn positive. So, you’re only positive for that point in time.
Gotcha. Claudia asks, you mentioned that there might not, might not be a vaccine for two months. Did she get that right? I’ve been reading 12 to 18 months?
Oh, no, it’s going to be a year and a half, but probably my best estimate for a vaccine. We may see drugs available maybe as early as six months but hopefully earlier. But vaccine, no, a year and a half.
Okay. And another question from our friend, Vicki says, have there been any cases of people getting reinfected? There’s been some reports of that, which may be confusing. So, if you can explain the science of that. Do you need two negative tests to get out of isolation or when can someone be removed from isolation?
Yeah. In terms of getting out of isolation, a lot of people would say two negatives, two different days. That’s it. I’m not aware of credible reports of people who’ve been reinfected with this in a short time interval. So, I don’t know the answers but quick response.
Gotcha. Lori’s asking for her son, our friend out in San Francisco says, my son is in Arizona, where there are a few or no cases. I live in the Bay Area. I suspect there will be cases on his campus soon enough. As a mom, I want him close. But is it better for him to stay put?
Well, no, you have to say how much do you miss … I would play the counterfactual. If he comes, what are we going to do? What if he’s infected when he arrives? What if I’m infected when he arrives or later on, versus keeping them apart? I still think social distancing is a good idea. And he has to travel somewhere to get there. Hopefully not fly, drive if you have to go anywhere. But I think you have to weigh the social situation against the current uncertainty more than reality.
Gotcha. I think we’re going to leave it there, everybody. We’ve gone 10 minutes past the hour of Dr. Wenzel. He’s busy and things are heating up a little bit down in Richmond. Sir, I just want to on behalf of everybody who joined us just thank you for the kindness and generosity of sharing what you know and being clear on what you don’t know.
I think you’ve done a tremendous amount of good and I know the folks who work here have an opportunity to be helpful. I know we want to be. If I can just ask if you’d be willing to perhaps come back and join us again in a couple of weeks when perhaps we see-
I’d be delighted. I thank the people who took the time to listen in and it’s a pleasure to participate.
Well, thank you for everything you’re doing, sir, do appreciate it. Knowledge is powerful. And you just gave us a whole big gift of it. So, thank you very, very much. And thanks to everybody.
Again, just to let you know, we’ve got a communications triage kit that’s up online. You can find that on comnetwork.org notes from today on ComNetLive on Twitter, and we recorded this so you’ll get a video and a transcript as quickly as we can turn that around.
In the meantime, if you’re not already practicing social distancing, please do so. Stay safe. And if you are in charge of hosting events, the answer right now is you need to cancel. Okay, you need to cancel them or postpone them, but probably looking out at least eight weeks, potentially longer.We’ll be back in touch with you all very soon. We’ll continue to stay connected. And again, Dr. Wenzel, thank you so much, sir, too.