Speaker 1: From Kurt Coe media.
Speaker 2: It's still here. Numbers are still climbing. Who would have
Speaker 2: predicted that the health and medical community would be at
Speaker 2: odds with the politicians on how we handle the climate
Speaker 2: of this pandemic. I know you think you've heard enough
Speaker 2: about this code requires. But new developments are worth understanding
Speaker 2: in each of our actions and personal decisions will affect
Speaker 2: our families our friends and our communities. In this episode
Speaker 2: you'll hear some new coping 19 facts that are worth
Speaker 2: your time. It's stuff you need to know. This is medicine.
Speaker 2: We're still practicing.
Speaker 3: I'm Bill Kurtis of course first to my friend and
Speaker 3: co-host Dr. Steven Tabak. He's a quadruple board certified doctor
Speaker 3: of Internal Medicine pulmonary disease critical care and neuro critical care.
Speaker 3: And he is on the front lines of the covered
Speaker 3: battle out in California for which we are eternally grateful.
Speaker 3: Steve how you doing. Thanks for remotely tuning in. Hey Bill.
Speaker 3: Good to see you. And a very special guest Dr.
Speaker 3: Kristin Muffet. She's an associate physician in the pediatric infectious
Speaker 3: disease division at Boston Children's Hospital and she's a multiple
Speaker 3: award winning physician and professor of pediatrics at Harvard Medical School.
Speaker 3: Christy is also affiliated with Brigham and Women's Hospital. She's
Speaker 3: certified in general pediatrics and infectious diseases by the American
Speaker 3: Board of Pediatrics. And Dr. Moffitt we'd like to thank
Speaker 3: you for breaking away and joining us today. Thanks for
Speaker 3: having me. Tell me how is Boston Children's focus changed
Speaker 3: during this virus.
Speaker 4: Boston Children's like every hospital in Boston March and early
Speaker 4: April were all frenzied months as we were preparing like
Speaker 4: hospitals I'm sure all around the world for what we
Speaker 4: were anticipating to be a surge in Kogut infected patients.
Speaker 4: It became fairly clear relatively early in the pandemic with
Speaker 4: data coming out of China that children did not seem
Speaker 4: to be suffering the same severity from this infection as
Speaker 4: older individuals and adults did. We were not completely sure
Speaker 4: whether or not that data would hold true as the
Speaker 4: virus swept across the world. Luckily that has actually held
Speaker 4: true but that should not be taken at all to
Speaker 4: mean that children don't get sick from this. Some children
Speaker 4: do get sick from this. Some do require hospitalization. In
Speaker 4: some studies up to a third of children who require
Speaker 4: hospitalization require ICU level care. So Boston Children's also was
Speaker 4: in a unique position in Boston as you know Boston
Speaker 4: has an abundance of hospitals for people to choose from
Speaker 4: excellent hospitals all of them. But Boston Children's is the
Speaker 4: only freestanding Children's Hospital. There are several other children's hospitals
Speaker 4: in Boston but they all have their physical spaces their
Speaker 4: units their hospital beds contained within larger hospital systems that
Speaker 4: treat adults. So a decision was made within the city
Speaker 4: for Boston Children's to be able to take care of
Speaker 4: all pediatric patients in Boston who required hospitalization so that
Speaker 4: the pediatric beds in those other hospitals that were within
Speaker 4: adult hospitals could be committed to caring for adults with cold.
Speaker 5: It seems like a good plan.
Speaker 6: Well even you just mentioned that children are substantially less
Speaker 6: susceptible to this virus than older people or at risk
Speaker 6: of the children who do get seriously affected by this virus.
Speaker 6: Apparently more than 75 percent of the fatalities in children
Speaker 6: related to this virus are those of minorities. Can you
Speaker 6: explain why that's happening.
Speaker 4: Yeah that is very true. The disproportionate effect that this
Speaker 4: infection has had on black and Latino individuals that has
Speaker 4: been seen in adults is playing out very much in
Speaker 4: children as well. And that's true both of acute covered infections.
Speaker 4: And then as you may know we were all surprised
Speaker 4: in the pediatric realm to start to understand this other
Speaker 4: entity called Emmett SC or multi system inflammatory syndrome in children.
Speaker 4: It seems to be overwhelming inflammation that occurs in children
Speaker 4: largely two to four weeks after a covert infection. So
Speaker 4: both acute Kogut and MSE are impacting minority populations in
Speaker 4: pediatrics substantially. So why is that the most likely explanation
Speaker 4: is that children are most likely exposed in their households
Speaker 4: and in their communities. And those are exactly the households
Speaker 4: in the communities in which the adults are suffering the
Speaker 4: most serious consequences and highest incidence of colon 19 infection.
Speaker 4: So I think that children really very much are reflective
Speaker 4: of that.
Speaker 7: It's an interesting statistic when you look at it. I
Speaker 7: know from the adult side we certainly see in that
Speaker 7: population there's a lot of multi-family housing multiple families living
Speaker 7: under one roof and that sort of social crowding seems
Speaker 7: to have an impact but also of those people who
Speaker 7: are not financially immune so to speak from the virus
Speaker 7: and that they must go to work every day to
Speaker 7: feed their family. You can't be a day laborer and
Speaker 7: do it. The resume you actually need to show up
Speaker 7: and anytime there is that expectation there is not going
Speaker 7: to be a lot of social distancing at the workplace.
Speaker 8: And so we think that lower socioeconomic in general would
Speaker 8: be forced to continue their work in their jobs in
Speaker 8: spite of the fact that the risks remain the same.
Speaker 3: And the statistic is not percentages of people who get
Speaker 3: the virus. It is a death toll of people who
Speaker 3: have the virus. So is it biological that affects them
Speaker 3: differently or lifestyle or food or.
Speaker 4: Yeah. Those are all definitely hypotheses that still frankly require investigation.
Speaker 4: And I think that there may even be a multifactorial
Speaker 4: explanation for it. One that is along the lines of
Speaker 4: what Stephen was mentioning is a difference in access to
Speaker 4: health care for these affected populations as well. It certainly
Speaker 4: is possible that there may be a biological explanation. Our
Speaker 4: hospital in coalition with over 70 other hospitals are studying
Speaker 4: the genetics of children who are impacted by either severe
Speaker 4: cold infection or by MSE but there isn't anything clearly
Speaker 4: being borne out yet in terms of solid genetic reasons
Speaker 4: that make the immune response to these affected populations different necessarily.
Speaker 4: There's still some work to be done there but as
Speaker 4: you suggested to build the underlying potential complicating factors that
Speaker 4: might be called comorbidities and some are also higher in
Speaker 4: these populations and make them at higher risk and more
Speaker 4: susceptible to more severe sequelae of this infection.
Speaker 6: So this isn't new that we need to find thousands
Speaker 6: of healthy people who are willing to take part in
Speaker 6: a trial for a vaccine. You're not vaccinating the people
Speaker 6: who are already sick. Great. So there must be a
Speaker 6: history of being able to find people who are willing
Speaker 6: to participate in such a thing. How do they go
Speaker 6: about finding these people.
Speaker 9: It's varied historically in terms of what the vaccine was
Speaker 9: being designed to prevent in terms of how dire the
Speaker 9: infection was and how much a population was affected by
Speaker 9: a given infection.
Speaker 10: But historically some infections that especially the ones that were
Speaker 10: devastating to families and to children most families were very
Speaker 10: eager to participate in vaccine trials. And in bringing those
Speaker 10: vaccines into children whether there was a monetary compensation that
Speaker 10: was offered or not.
Speaker 1: So I think that there will be families that are
Speaker 1: eager to be part of these trials. I was surprised
Speaker 1: in our own front. We're running a large trial at
Speaker 1: Boston Children's trying to enroll children who've had covered 19.
Speaker 1: And we're asking these families to bring their children back
Speaker 1: into our hospital for blood drives that they don't otherwise need.
Speaker 1: And I really having done a number of clinical trials
Speaker 1: that involve research only blood drives was not sure that
Speaker 1: this was going to be an easy sell for families.
Speaker 10: But I've been very surprised by how eager families are
Speaker 10: to contribute to the advancement of our knowledge of this
Speaker 10: infection and the response of families to enroll in the
Speaker 10: study has been really amazing.
Speaker 11: What do you think the penetration of this anti vaccine
Speaker 11: sentiment is out there. What percentage of the families that
Speaker 11: you are in contact with do you feel are anti vaccine.
Speaker 7: Once we have a vaccine what percentage of the population
Speaker 7: will accept it or looking at the other way will
Speaker 7: not accept it.
Speaker 1: Yeah. So I think it may vary a little bit
Speaker 1: in terms of how that's unique to a covert vaccine
Speaker 1: and how that applies to a sort of anti vaccine
Speaker 1: population in general.
Speaker 10: I've been reading that polls most recently about covert vaccine
Speaker 10: uptake are suggesting that it's only about 60 percent of
Speaker 10: the population that sound like they are willing to go
Speaker 10: forward with vaccination. And that's even if one frankly is
Speaker 10: determined to be safe and effective in some of these
Speaker 10: larger trials which is concerning.
Speaker 12: So I think it's really going to depend on how
Speaker 12: the data from these trials look for the public to
Speaker 12: be able to make informed decisions about that.
Speaker 8: You think about the theory that New York and Massachusetts
Speaker 8: because of housing being a little bit more crowded that
Speaker 8: there is a higher viral load that lends itself to
Speaker 8: a higher mortality as opposed to maybe a lighter viral
Speaker 8: load more of an outdoor lighter load causing less severe disease.
Speaker 9: Yeah that may be part of it. I think the
Speaker 9: other factor that sort of supports that Stephen is that
Speaker 9: the communities in Massachusetts that were hit the hardest when
Speaker 9: we were surging tended to be communities that were exactly
Speaker 9: those that you described dense housing multigenerational homes. So I
Speaker 9: think that is certainly likely buyer in the fatality rate
Speaker 9: and in the severity rate that you just have this
Speaker 9: higher concentration of individuals a higher concentration potentially of virus.
Speaker 9: And when a person is getting infected with a higher
Speaker 9: viral burden they will have a severe infection.
Speaker 11: That being said are you going to restaurants. And if
Speaker 11: so only outdoor restaurants I'm assuming that there are none
Speaker 11: that are open or that maybe minimal that are open
Speaker 11: for indoor seating. What has been your personal policy.
Speaker 9: Yeah Massachusetts has opened indoor seating at limited capacity with
Speaker 9: lots of risk mitigation practices in place.
Speaker 12: That being said I am still only doing outdoor seating
Speaker 12: Yeah me too. I think the study that came out
Speaker 12: that showed it was like a two and a half
Speaker 12: higher likelihood for individuals to have died in the 14
Speaker 12: days before their covered infection. Exactly.
Speaker 13: So we're going to take a very quick break and
Speaker 13: we'll be back with Dr. Kristen Moffitt.
Speaker 14: And when we come back we're going to talk to
Speaker 14: her a little bit about the concept of surfaces and
Speaker 14: whether they're a danger. We'll be right back.
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Speaker 2: So we're back with Dr. Kristin Moffitt and Dr. Steven
Speaker 2: Tabak and Christie.
Speaker 6: Wonder if you would tell us whether I should still
Speaker 6: be alcohol wiping down all my groceries and the mail
Speaker 6: that's dropped off and when this first happened I was
Speaker 6: pretty relentless and if someone approached our front door I
Speaker 6: pretty much sprayed them down with alcohol which has been
Speaker 6: your lifelong policy anyway as I well it has it
Speaker 6: has this thing has worked its way into a general
Speaker 6: Forbes heart. But I have to ask you is the
Speaker 6: concept of surface transmission no longer a concern. Is it
Speaker 6: just breathing in a droplet. Where do we stand on that.
Speaker 9: Yeah I wouldn't say a zero concern but I think
Speaker 9: it has become abundantly clear that the overwhelming majority of
Speaker 9: transmission events are occurring through the air.
Speaker 19: It is still conceivable that if somebody who was had
Speaker 19: a high viral burden. So the day of symptom onset
Speaker 19: for example and they had just sneezed on a doorknob
Speaker 19: and you went and touched that doorknob within minutes afterwards
Speaker 19: and then went and touched your nose your mouth your
Speaker 19: eyes you could infect yourself that way. But I think
Speaker 19: short of those kinds of extreme circumstances transmission through contaminated
Speaker 19: surfaces does seem less likely. I think you know decontaminating
Speaker 19: the mail not sure necessarily needed.
Speaker 11: Although I will recant the story of my my cousin
Speaker 11: who is an economics professor at New York when covered
Speaker 11: first broke out there he was at the grocery store
Speaker 11: and witnessed somebody sneezing into their hands and then picked
Speaker 11: up an apple looked at the apple and put it
Speaker 11: back in the pile of apples and he was calling
Speaker 11: me and saying should I eat fruit again or not.
Speaker 19: I think washing our fruit anything that's not already in
Speaker 19: a package. You know any any fruit where you're where
Speaker 19: you're eating the skin. I think washing it makes sense
Speaker 19: that I would have said that. So.
Speaker 6: So let's go back to our kids. I'm sure we
Speaker 6: have lots of listeners who have kids that are going
Speaker 6: to school now because it seems like a lot of
Speaker 6: our country has invited the very young kids like preschool
Speaker 6: kids to come in and experience school in these small
Speaker 6: pods like seven other students or what have you. Where
Speaker 6: some of the older kids are now dealing with the
Speaker 6: online thing but you can't do that with the very
Speaker 6: youngest kids. So with the very young kids what is
Speaker 6: your advice to parents for how they explain what's going
Speaker 6: on to their kids and tell them yes you have
Speaker 6: to wear pants and you also have to wear a mask.
Speaker 19: Yeah yeah I think it's a real challenge I think
Speaker 19: for parents to keep the conversations age appropriate and what
Speaker 19: that means really is to have conversations with them that
Speaker 19: they can understand that aren't scary to them and it's
Speaker 19: possible to do that.
Speaker 20: And at the same time make them feel empowered like
Speaker 20: they're contributing to being a part of the solution for this.
Speaker 20: So framing things in terms of these are the things
Speaker 20: we have to do to keep our friends safe to
Speaker 20: keep our teachers safe and so that your family stays
Speaker 20: safe and so that you stay safe framing it in
Speaker 20: terms of these are the things that doctors are doing
Speaker 20: to keep themselves safe when they're taking care of patients.
Speaker 20: And so you can do this too and be just
Speaker 20: like a doctor and helping someone to keep other people
Speaker 20: from getting sick.
Speaker 7: And he techniques for the post adolescence and beyond even
Speaker 7: the 18 to twenty five set that seemed to be
Speaker 7: take the perspective that it really is not going to
Speaker 7: affect me and this is my time to enjoy my
Speaker 7: life and I'm going to take my chances without really
Speaker 7: taking into account the impact that maybe they're having on
Speaker 7: other people.
Speaker 19: I think then the message needs to change and the
Speaker 19: message then needs to hit the motivation that age group
Speaker 19: is motivated. They are just inherently wired to want to
Speaker 19: be with their peers to want to congregate to want
Speaker 19: to socialize. They want to be able to go to
Speaker 19: their sports. They want to be able to go to
Speaker 19: whatever it is they do for extracurricular activities their theater group.
Speaker 19: They want to be in classrooms and on campuses with
Speaker 19: their peers.
Speaker 20: So the message there is if you can't do these
Speaker 20: things collectively to keep transmission under control none of those
Speaker 20: things are going to be available to you.
Speaker 19: Campuses are going to close classrooms are going to close
Speaker 19: basketball teams aren't going to be able to play. So
Speaker 19: getting out the motivation and really trying to target the
Speaker 19: messaging there is going to be more impactful with that
Speaker 19: age group.
Speaker 3: So speaking of that age group I understand that there's
Speaker 3: a terrible vaping problem. And I understand that while vaping
Speaker 3: is never recommended under any circumstances apparently it's causing teens
Speaker 3: and young adults additional risks of contracting covered. Why would
Speaker 3: that be.
Speaker 12: Yeah I think that there are probably changes that happen
Speaker 12: in the cells that line the respiratory track from chronic
Speaker 12: exposure to some of the substances that people are vaping
Speaker 12: it may not even be necessarily what they're intending to
Speaker 12: vape it may be an additive that they don't even
Speaker 12: know is there that can be having a serious impact
Speaker 12: on the cells that line their airway in terms of
Speaker 12: the effectiveness of their response to this virus.
Speaker 21: We certainly see that in our adult pulmonary population. But
Speaker 21: I've I've seen it in you know in adolescence and
Speaker 21: I've heard of it.
Speaker 8: This is not just a high school college problem. But
Speaker 8: this is middle school and even grammar school.
Speaker 3: Dr. Steve does vaping in general reduce your immunity.
Speaker 11: It increases your risk of pulmonary infections because your main
Speaker 11: protective source is going to be the respiratory epithelium. This
Speaker 11: would call silly aided epithelium which actually has these little
Speaker 11: finger like projections that beat out and beat upward any
Speaker 11: particulate matter that come into your respiratory tree. And if
Speaker 11: you are going to do damage to that primary mechanism
Speaker 11: Yeah it will lend itself to having ongoing and worsening
Speaker 11: lung injury. It lends itself to increased respiratory infections you
Speaker 11: want to avoid vaping at all costs.
Speaker 6: Dr. Muffet Can I just ask you when you picture
Speaker 6: someone smoking and they exhale the smoke. Is that kind
Speaker 6: of a good representation of what these droplets could be
Speaker 6: doing when someone is simply well blowing out in that
Speaker 6: kind of a form in your space.
Speaker 22: Yeah I think that the active exhalation from vaping or
Speaker 22: smoking is probably a bit more forceful than are just
Speaker 22: sort of sitting here inhaling and exhaling and if you
Speaker 22: want to see really amazing pictures of droplets respiratory tract.
Speaker 22: There are some researchers and fluid dynamics that have taken
Speaker 22: these like unbelievably slow down time lapse photographs of sneezes.
Speaker 22: For example if you haven't seen them that are enough
Speaker 22: to make you absolutely want to just live in a bubble.
Speaker 6: So Dr. Moffat I wonder if you could tell me
Speaker 6: do you expect there to be a different type of
Speaker 6: coverage season this fall in Massachusetts compared to California and
Speaker 6: Florida from a weather standpoint.
Speaker 23: I think that the impact of the weather on this
Speaker 23: virus does not seem to be very impressive.
Speaker 24: I mean if you look at the parts of our
Speaker 24: country that were surging when it was warm and we
Speaker 24: were in better control in places where it was cooler
Speaker 24: I think it's really hard to say there may be
Speaker 24: a modest impact in terms of the virus actually having
Speaker 24: specific viral characteristics that make it maybe more likely to
Speaker 24: cause infections in the cold weather. But I think it's
Speaker 24: going to be more social determinants of cold weather that
Speaker 24: are going to put those parts of the country where
Speaker 24: we get cold weather at higher risk.
Speaker 6: We're certainly we hear more and more about the viral
Speaker 6: load and how if somebody sneezes in your face and
Speaker 6: you get a large viral load you might get a
Speaker 6: bad case of the disease. On the other hand this
Speaker 6: virus is very small and I know there's no such
Speaker 6: thing as just one or two. But let's say you
Speaker 6: got one or two viral cells are you still going
Speaker 6: to build up an antibody to the disease if you
Speaker 6: get a very small load.
Speaker 23: That's a great question.
Speaker 22: It's actively being studied because it's such an important question
Speaker 22: and I think it's still maybe a little too early
Speaker 22: to say for sure but there are data already that
Speaker 22: suggests that if you had a relatively mild infection you
Speaker 22: don't mount at least the same antibody response that those
Speaker 22: with more severe infection do. So those who get very
Speaker 22: sick from this infection Seem to have what's called neutralizing
Speaker 22: antibody which is really the most important type of antibody
Speaker 22: to measure you want to know how capable antibody detectable
Speaker 22: in a person's blood after they've had this infection how
Speaker 22: capable it is of actually neutralizing this virus in a
Speaker 22: petri dish. And it does seem that those who had
Speaker 22: mild or asymptomatic infection have much lower levels of that
Speaker 22: neutralizing antibody in their blood and levels that don't seem
Speaker 22: to last as long.
Speaker 13: OK well we're going to take another quick break and
Speaker 13: we'll be right back with Dr. Moffitt and we're going
Speaker 13: to talk about long haulers the folks that get this
Speaker 13: virus and it appears that they have it for a
Speaker 13: very very long term.
Speaker 2: We'll be right back.
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Speaker 2: Listen and subscribe from Kurt Coe media media for your
Speaker 2: mind but we're back with Dr. Moffit and Dr. Steven
Speaker 2: Tabak and there's this kind of new term being thrown
Speaker 2: around long haulers people who have suffered from Kovic 19
Speaker 2: and do so chronically for long periods of time.
Speaker 6: Was there a reason why some have said long standing
Speaker 6: symptoms and even when they're healthier than others who should
Speaker 6: by all rights be more at risk. You have these
Speaker 6: long hollows who can't seem to get rid of the virus.
Speaker 6: Why is that.
Speaker 11: I think from the adult side what we see in
Speaker 11: it's variable because there are some people who seem to
Speaker 11: smolder along and get better and then we do see
Speaker 11: that period of time people smoldering along and then they
Speaker 11: hit a critical time in day seven to day nine
Speaker 11: where it seems like to completely compensate and they wind
Speaker 11: up going to our ICU and on many times on ventilators.
Speaker 11: It's rare that we find somebody who actually gets better
Speaker 11: almost completely resolved and then dies compensates. That's not been
Speaker 11: my experience. If you're smoldering you're wrong low level oxygen
Speaker 11: and you seem to be holding your own they can
Speaker 11: deteriorate in that magic window of seven to nine days.
Speaker 11: One can surmise that your body is doing its best
Speaker 11: to keep the virus at bay because you do mount
Speaker 11: a response and maybe initially you can keep the virus
Speaker 11: at bay. And then with any war from the virus
Speaker 11: that starts mounting a stronger and stronger response.
Speaker 7: And then just overwhelms your ability to completely defend against it.
Speaker 7: And now you're feeling the brunt of it getting the
Speaker 7: better of you at least at that time. Christy what
Speaker 7: are your thoughts about that.
Speaker 12: Yeah I think that there's been a lot of debate
Speaker 12: in the pediatric world because we were so surprised by
Speaker 12: this am I see entity. It's not a system inflammatory
Speaker 12: syndrome in children that seems pretty clearly to occur about
Speaker 12: two to four weeks after an acute combat infection. And
Speaker 12: frankly in the majority of children who's experienced NYSE their
Speaker 12: acute infection was very mild and sometimes even asymptomatic. So
Speaker 12: we are often relying to figure out whether or not
Speaker 12: a patient actually is experiencing MSE they present with symptoms
Speaker 12: of fever and overwhelming inflammation. So they're hyper inflamed and
Speaker 12: that inflammation is affecting their body in different ways. But
Speaker 12: there are a number of other entities unrelated to covered
Speaker 12: that can look like that as well. So we're relying
Speaker 12: on whether or not they still have a positive PCR
Speaker 12: for covered in their upper airway or whether or not
Speaker 12: they've mounted an antibody response yet to call it.
Speaker 3: What is the age range where that tends to hit.
Speaker 27: Yeah. So then the median age is about 10 to
Speaker 27: 11 but it is being seen in some older teenagers
Speaker 27: and young adults and it is being seen in some
Speaker 27: even down into infancy.
Speaker 3: Christy one of the things that were apparently supposed to
Speaker 3: avoid if our kids get covered is giving them aspirin.
Speaker 27: Why is that so aspirin in the setting of specific
Speaker 27: infections in general.
Speaker 10: Handful of viral infections in general in children has been
Speaker 10: associated with a very very serious condition called Rice syndrome
Speaker 10: that can severely impacts a lot of your vital organs.
Speaker 10: So aspirin in general is not recommended in children. If
Speaker 10: children are experiencing fever from a possible infection or discomfort
Speaker 10: otherwise then either ibuprofen or acetaminophen products would be recommended.
Speaker 6: And I also understand for adults ibuprofen is not a
Speaker 6: good idea as compared to other types of anti inflammatory.
Speaker 11: So initially it was off the list. Now I don't
Speaker 11: believe that there is any warning against non steroid holes
Speaker 11: in the adult population. We tend to use Tylenol for
Speaker 11: fever abatement and for pain control just because it's easier
Speaker 11: on the kidneys and it's easier on the stomach provided
Speaker 11: you're not getting to the point where you're getting to
Speaker 11: liver toxicity but it's much easier to damage your kidneys
Speaker 11: with a non steroid a longtime inflammatory like ibuprofen than
Speaker 11: it is to hurt the liver with Tylenol acetaminophen.
Speaker 10: Thoughts about that on the pediatric side in general in
Speaker 10: pediatrics for fever for pain ibuprofen if you're over the
Speaker 10: age of six months ibuprofen is typically recommended it just
Speaker 10: tends to be very effective particularly for fever reduction. And
Speaker 10: as long as it's dosed correctly and not giving in
Speaker 10: to higher dose are given to frequently children in particular
Speaker 10: tend to tolerate it very well but acetaminophen products would
Speaker 10: certainly be an option too.
Speaker 6: So I wonder if we could take a little detour
Speaker 6: here and talk to you about re infection and what
Speaker 6: we know because one would think this has now been
Speaker 6: going on since March. We're now in October. I wonder
Speaker 6: if you could tell us if we know anything more
Speaker 6: about whether people are getting this virus for a second time.
Speaker 27: There was a lot of alarm I think with the
Speaker 27: first clearly documented case of re infection. So the trick
Speaker 27: to documenting re infection is that you really can't rely
Speaker 27: on just continued positive PCR testing because some people stay
Speaker 27: positive for a very long time from their primary infection.
Speaker 27: So the first documented case of reinvention occurred in an
Speaker 27: individual in Asia who was infected if I recall initially
Speaker 27: in April March or April return of I'm travelling sometime
Speaker 27: in the last month or so and only had a
Speaker 27: repeat code the test as a travel screen or return
Speaker 27: from having been elsewhere and tested positive but was asymptomatic
Speaker 27: but they actually were able to sequence the virus from
Speaker 27: the first test compared to the second test to confirm
Speaker 27: that it was a different viral sequence and therefore this
Speaker 27: was indeed me infection.
Speaker 3: Is the virus mutating that much at this point.
Speaker 27: It's not that the virus is mutating that much but
Speaker 27: there were detectable enough differences to ascertain that it was
Speaker 27: two different viral infections basically.
Speaker 21: And then the big question is was the primary infection
Speaker 21: did that confer immunity on the second. Because you can
Speaker 21: re in fact me all day long if I don't
Speaker 21: have symptoms I'm probably not going to be upset about that.
Speaker 27: So I think with with that first case report I
Speaker 27: think that scientists were relieved actually and said Well of
Speaker 27: course he was asymptomatic with the second infection and that
Speaker 27: just proves what we would suspect which is that the
Speaker 27: first infection confers immunity against getting very sick from this.
Speaker 27: If you see it again. But of course not too
Speaker 27: long after that there was the second case report of
Speaker 27: re infection in which again because of two different viral
Speaker 27: sequences they were able to confirm it was indeed re
Speaker 27: infection in the individual actually was sick with the second infection.
Speaker 27: So everyone who maybe took a little bit of reassurance
Speaker 27: from the first case report that was quickly done away
Speaker 27: with the second case report. But I think in general
Speaker 27: re infections it's not surprising now that we have millions
Speaker 27: and millions and millions of cases that we will see
Speaker 27: re infections from seasonal corona virus experience. We know that
Speaker 27: even if you get some immunity from seasonal coronavirus it's
Speaker 27: longevity is not such that you know we infection is
Speaker 27: an impossibility.
Speaker 11: But encouraging that it seems to be very low rates
Speaker 11: because I know I have not seen any patients that
Speaker 11: came in at least to the hospital that had to
Speaker 11: be readmitted with it would seem to be a new infection.
Speaker 6: So Christy if your best friend comes down with covered
Speaker 6: and isn't bad enough yet to check themselves into the
Speaker 6: hospital but this is your best friend and now we
Speaker 6: have all these treatments like grim death severe and otherwise
Speaker 6: to region and what have you do you recommend to
Speaker 6: your best friend that they begin a regimen to try
Speaker 6: to minimize the virus or do you wait for it
Speaker 6: to get so bad that they have to go to
Speaker 6: the hospital.
Speaker 28: Yeah at this point there's really nothing that has solid
Speaker 28: evidence to suggest that taking it when you're only mildly
Speaker 28: ill is going to really have an impact on your outcome.
Speaker 29: So at this point my recommendation would still be if
Speaker 29: you're feeling crummy but you're still stable enough to be
Speaker 29: at home that continue what's referred to as supportive care
Speaker 29: which is hydration fever control making yourself comfortable would be
Speaker 29: my recommended advice for that individual but if they're starting
Speaker 29: to feel shortness of breath chest pain any of the
Speaker 29: myriad of symptoms should prompt a very very urgent evaluation
Speaker 29: given any patient that would come to the adult floor
Speaker 29: who is not requiring oxygen or had low mediator levels
Speaker 29: low fare and low CERP things that we for better
Speaker 29: or worse.
Speaker 8: We we're monitoring we will be sending those patients home.
Speaker 6: Dr. Moffitt I sat around with family the other day
Speaker 6: and we were drinking some wine and I said you
Speaker 6: know I can't taste this wine. And of course everybody
Speaker 6: laughed and said Aha. Why is it that supposedly one
Speaker 6: of the symptoms of having covered is loss of taste.
Speaker 29: And I have been reading headlines about some clear impacts
Speaker 29: of the virus directly on your olfactory cells in particular
Speaker 29: which are basically our sense of smell cells and our
Speaker 29: sense of smell is so innately linked to our sense
Speaker 29: of taste that whatever it is that the virus is
Speaker 29: seeming to target in our now cells seems to be
Speaker 29: having this rather unique symptom. I'm asked often how are
Speaker 29: we gonna tell the difference between flu and Kobe at 19.
Speaker 29: How are we going to tell the difference between other
Speaker 29: winter respiratory viruses and coping 19. My short answer is
Speaker 29: we're not. There is so much overlap in the symptoms
Speaker 29: of influenza and Kobe 19 that it will be nearly
Speaker 29: impossible to distinguish the two based on symptoms alone with
Speaker 29: the exception of someone maybe having lost their sense of
Speaker 29: taste her smell which seems pretty unique to cope with 19.
Speaker 6: Do you expect that we're gonna get some good news
Speaker 6: about treatments or vaccines over the course of the next
Speaker 6: six months or should we be digging in and assume
Speaker 6: that we just have to get used to this for
Speaker 6: a while.
Speaker 30: I think we will be getting good news. I don't
Speaker 30: know that I would assume that in that timeframe it's
Speaker 30: going to be associated with a confidence that we can
Speaker 30: lighten up on what we're already doing.
Speaker 31: But I think we will get good news. I think
Speaker 31: the best part of the vaccine landscape is that there
Speaker 31: are over 200 vaccine candidates in development over half a
Speaker 31: dozen of which have already advanced into Phase 3 trials.
Speaker 31: And so the best vaccine outcome. And I think even
Speaker 31: the vaccine makers would say this the best vaccine outcome
Speaker 31: is that there are multiple Kogut 19 vaccine are shown
Speaker 31: to be safe and effective and therefore you could move
Speaker 31: several into populations. And yet our world vaccinated more quickly
Speaker 31: than if there was just a single contender that came
Speaker 31: out on top for example that showed to be safe
Speaker 31: and effective.
Speaker 21: That's the silver lining in many ways right that the
Speaker 21: global nature of this means that we are so many
Speaker 21: resources are being mobilized and being brought to bear on
Speaker 21: this disease as it's not an orphan illness.
Speaker 11: It's something that affects every country every person that I
Speaker 11: think is very encouraging.
Speaker 6: And do you expect countries to export their vaccines to
Speaker 6: other countries in that event or just pass on the
Speaker 6: technology and the biochemical solutions that led to that vaccine.
Speaker 30: I think a lot of those discussions have already even
Speaker 30: happened in terms of how the vaccine development got funded.
Speaker 31: So a lot of the funding that was offered to
Speaker 31: support development of the vaccine was contingent upon access in
Speaker 31: different populations in different nations. So I think a lot
Speaker 31: of the ways in which the vaccines will be distributed
Speaker 31: by the different vaccine makers is already baked into the
Speaker 31: cake and economic forces for free economies I think pushed
Speaker 31: in that direction as well.
Speaker 8: Right. I mean it's better for the economy it's better
Speaker 8: for that corporation to sell it to multiple countries why
Speaker 8: would they limit it.
Speaker 6: So I think in that regard economics actually works and
Speaker 6: everybody's favorite so as we wrap up I just want
Speaker 6: to ask you one question about Harvard and how you
Speaker 6: teach there. What will be permanently changed in the way
Speaker 6: you communicate and what you communicate to your students from
Speaker 6: this experience was covered 19.
Speaker 32: I think personally for me as an infectious diseases physician
Speaker 32: but I think most physicians in general in all fields
Speaker 32: would say this right now is that there has never
Speaker 32: been in my lifetime as humbling a public health event
Speaker 32: a public health crisis as cover 19 I think of
Speaker 32: the Times in March when we were watching this sort
Speaker 32: of march its way from China. I think I personally
Speaker 32: still had some sense that we were going to fare
Speaker 32: OK that we would certainly see this virus come our
Speaker 32: way we would see it start to circulate in the
Speaker 32: United States but that we would be able to keep
Speaker 32: it from becoming as unbelievably rampant as it has become.
Speaker 32: And I think that I never could have expected and
Speaker 32: so many people I think in infectious diseases and in
Speaker 32: medicine in general never could have expected just how unbelievably
Speaker 32: destructive this pandemic could have been.
Speaker 6: So you may inject humility into your teachings at Harvard
Speaker 6: going forward.
Speaker 32: I think that this pandemic really struck a tone of
Speaker 32: just how much we don't have control over things that
Speaker 32: happen naturally. And even when they're infectious it's really been astonishing.
Speaker 3: Dr. Kristen Moffitt thank you for joining us today.
Speaker 33: We want to thank Dr. Stephen Tabak Dr. Kristin Moffitt.
Speaker 33: We want to thank J.P. Morgan Private Bank for introducing
Speaker 33: us to today's guest as well as last week's Dr.
Speaker 33: George Rutherford. So thanks J.P.. This is medicine we're still
Speaker 33: practicing and it produced by A.J. Mosley music for we're
Speaker 33: still practicing is composed and performed by Celeste and Eric Dick.
Speaker 33: Please send this episode to your friends and have a
Speaker 33: socially distant zoom cocktail with them and chat about it.
Speaker 33: And of course don't forget to leave us a review.
Speaker 2: Catch you next time on medicine. We're still practicing. Bye
Speaker 2: bye everybody.
Speaker 5: From Kurkov media media for your mind.