On Friday, April 17, the Ebell of Los Angeles hosted an online presentation, open to the public, by Angelique Campen, MD, an emergency room physician at Providence St. Joseph Medical Center in Burbank. Campen, an Ebell member who also teaches medicine at UCLA, shared her ER-based experience treating a wide range of COVID-19 patients and cases, and acknowledged that there is a lot of “misinformation” going around about the disease.
The Current Situation
Campen prefaced her remarks by saying the City and County of Los Angeles have “been cooperating greatly” with doctors and emergency rooms throughout the area, which has been a big help to health care professionals dealing with the pandemic. Thanks to the city and county efforts to help slow the spread of the disease, she said, hospitals are far from overwhelmed so far.
In fact, she said, the traffic in most emergency rooms is down about 50% from normal levels, so “we are prepared” to handle the current influx of COVID-19 cases, including the kind of isolation and provider protections that COVID-19 patients require when they arrive. (The reduction in ER use, Campen said, comes partly from medical professionals making greater use of other tools, such as online consultations, and also the fact that many people who use emergency rooms for non-emergency conditions seem to be staying away right now. That’s true to such a degree, Campen said, that she worries a bit about “where all the strokes and heart attacks have gone,” since she isn’t seeing as many of those these days.)
Campen explained, however, that even though the overall number of COVID-19 patients in ERs is still fairly low at the moment, ER staff members are definitely working harder than ever. And much of that workload involves the extra effort required in treating COVID-19 patients. For example, each time workers see a new patient, they must don a full set of personal protective equipment – including a Tyvek suit, shoe and hair covers, face shield, gloves, and yet another gown over all of that. And when that patient has been dealt with, they have to strip off all the equipment, and suit up again with all new equipment, before seeing the next patient. She said it’s a routine that each employee can go through as many as 30-40 times per day…which also explains why health care workers are currently in such desperate need of more and more protective garments.
Masks, Gloves and Virus Transmission
On the topic of face masks, Campen echoed what other medical professionals have been saying, which is that lay people do not need to wear professional-grade N95 masks, which should be reserved for doctors and nurses who are actually in contact with very sick patients who are likely to cough on them. COVID-19 is spread by droplets of respiratory secretions (it’s not airborne like measles), so while it can be “aerosolized” and float in the air briefly, Campen said, the droplets quickly fall to the ground, where they are unlikely to infect anyone.
The more widespread kind of masking, with homemade face coverings used for everyday activities, Campen said, is not for the mask-wearer’s own protection, and won’t keep the wearer from being infected. (Cloth masks “don’t work as filters” and aren’t fine enough to keep virus particles out.) But they can help prevent the spread of COVID-19 by the mask wearer, who may not yet have symptoms or know they are contagious (people can actually spread the virus for several days before they become noticeably sick). Also, Campen said, cloth masks provide a good reminder for people not to touch their faces, which is very important. Campen said the biggest mode of transmission for COVID-19 is someone coughing, those droplets landing on a surface, and then someone else touching the surface and then their own eyes or nose.
That said, however, Campen said it’s not worth worrying too much about how long virus particles remain viable on specific kinds of surfaces such as carcboard or metal. “The way this virus is going to spread,” she said, ” is from another person, or by touching a public surface and then touching yourself.”
And, even more specifically, “I would not worry about cleaning the outside of every item from Instacart.” That’s because, she said, the odds of someone coughing on a specific spot on a specific package, and then you touching the package in exactly the same spot, is pretty small. Instead, she said, it’s much more dangerous to touch “public surfaces,” such as shopping cart handles and door handles, which everyone touches in exactly the same spots, over and over.
Campen also said that wearing gloves to the grocery store is unnecessary. In fact, she said, “I am not a supporter of wearing gloves in public,” because she thinks it can make people over-confident. Gloves can still transmit the virus from surface to surface, she said, and if you touch an infected cart handle, and then pick up a package, even while wearing gloves, the virus will still be transferred to the package. So it’s better, she said, to sanitize public surfaces before touching them, if you can, and always wash your hands with soap and water as soon as you get home. (And don’t touch your face along the way!)
Campen explained that testing for COVID-19 involves identifying the coronavirus’ RNA in respiratory secretions. In hospitals, the test is done with a swab inserted deep into the nasal passages, where it must remain for 2-3 full seconds. (And if the swab doesn’t reach far enough back, and isn’t left in place long enough, the test results may not be accurate – which may be why many early tests, done before medical personnel really had the hang of the technique, returned false negative results.)
Campen was careful to emphasize that the test won’t tell if you were previously exposed to the virus if you’re not currently sick, so testing people who have no symptoms is not helpful, and would waste a lot of valuable test kits that should be reserved for more vulnerable groups (those who are currently sick, health care workers, senior citizens, and those with pre-exsiting conditions).
Also, Campen said, it’s worth noting that every test puts a health care worker in close contact with a sick person, which risks that worker’s health and uses yet another full set of personal protective equipment – more good reasons not to perform any more tests than are medically necessary.
Still another reason hospitals don’t test people who aren’t critically sick, Campen said, is that the treatment for people who have mild cases of COVID-19 and those who have some other kind of bug is exactly the same – go home, rest, and try not to pass it on to anyone else. So valuable testing resources should only be used when the test results will make a difference – which is when a person is sick enough to be admitted to the hospital. At that point, Campen said, hospital staff need to know if the patient has COVID-19, so they know if the patient needs to be isolated, so the staff can take extra precautions when treating them, and because there are specific treatment protocols for specific diseases, and you need to know which disease someone has, or doesn’t have, before you can treat them.
On the bright side, Campen noted that in more than 4,000 hospital-based COVID-19 tests so far, less than 10% have been positive, which shows just how many other viruses are also making people sick right now.
And finally, another kind of COVID-19-related test is a blood test for antibodies. Antibody tests don’t tell whether you have an active case of the virus, but whether or not you were exposed at some point and your body has built up enough antibodies to fight future infections.
Campen said antibody tests will become more widely available soon, and will be “a lot more useful to the world” than tests to see who is currently infected and who isn’t. Campen said she recently took an antibody test and was quite surprised to learn that she does not have any COVID-19 antibodies, despite her direct exposure to many COVID-19 patients…which shows just how effective good hygiene is.
How the Virus Works
Campen said the way COVID-19 kills people is by damaging lung tissue, which then paves the way for pneumonia, which can cause the lungs, and then other organs, to fail.
In young people, the mechanism for serious consequences is a bit different. Campen said that while our bodies normally boost production of white blood cells to fight infections, COVID-19 actually reduces the number of white blood cells, which makes some people – especially those who are younger, with less well-developed immune systems – much more vulnerable to serious secondary infections. So they may get sick with COVID-19, then feel better briefly…and then get even sicker as another virus or bacteria moves in, and they don’t have enough white blood cells left to adequately fight the new infection.
And the virus’ behavior is different still in people over 65, said Campen. In some older patients, she said, the immune systems revs up so much to fight the COVID-19 infection that it can sometimes begin to attack the patient, resulting in things like pneumonitis (inflamed lung tissue), which there just isn’t enough lung function left to fight after battling the initial COVID-19 infection.
After her main remarks, Campen also took many questions from audience members. Here are several that provided even more good information.
Does the virus penetrate skin?
No. Campen said that direct introduction to the eyes and nasal passages are the most frequent means of infection, so if you touch an infected surface, you may transfer virus particles to other sufaces, but you’re unlikely to catch anything as long as you wash your hands before touching your face. And to make sure your hands don’t pick things up again from the surfaces you previously touched, you should also frequently clean the items you touch most often, including cell phones, credit cards and wallets…and don’t take more things than you’ll absolutely need when going out to stores, etc.
Do we have to clean our clothes, shoes, groceries and mail?
Campen said she does think it’s good not to wear your outdoor shoes indoors, because other kinds of diseases – such as Hepatitis A, which is found in feces and urine, and on surfaces like sidewalks where those other substances can be found – can be tracked into the house. But it’s not necessary to strip and shower when you get home from the grocery store. The most likely place for the COVID-19 virus to have been picked up, she said, is your hands…so just be sure and wash your hands thoroughly with soap and water as soon as you get home.
How soon will herd immunity and vaccines allow us to resume normal life?
For those who are wondering whether the effectiveness of the current “Safer at Home” restrictions means we’ll soon be able to move about more normally, Campen cautioned that “we can’t just stay in our homes for two months and say, “OK, we beat it.”” For herd immunity to protect everyone and allow our most vulnerable groups to resume normal life, she said, at least 60% of the population needs effective levels of COVID-19 antibodies, which means they either have to catch and recover from COVID-19, or they have to be vaccinated. And at this point, only a very small portion of the population has had the disease, and vaccines aren’t ready yet…and both of those things are going to take a lot of time.
Surprisingly, Campen said, coming up with a vaccine is actually the easy part. The hard part is verifying the effectiveness of the vaccine over time, which is just as important. For example, she said, an early Ebola vaccine, which seemed promising at first, actually “poured fuel” on later infections – those who received the vaccine and were later infected got much worse cases of Ebola than those who were not vaccinated. And that’s the kind of thing that takes time to learn through careful studies.
Campen said she doesn’t expect there to be a coronavirus vaccine approved by the FDA until at least next year, so in the meantime we’re left with allowing our least vulnerable populations to get sick, and managing that process so it doesn’t overwhelm the health care system. In short, she said, “We’ve sacrificed our economy to save our health care system.”
But while that may sound pretty dire, Campen also reminded everyone that the vast majority of COVID-19 cases are relatively mild, and most people who catch it recover just fine. In fact, she said that when she calls many people to report their COVID-19 tests were positive, they’re actually surprised: “You’re kidding…that was coronavirus?”
Why don’t you hospitalize everyone who has COVID-19?
Campen noted that there are a lot of sick people in hospitals, so you don’t want other sick people to be there if they don’t have to, because they’d be vulnerable to all the other infections. So she said that unless someone with COVID-19 is critically ill, they will be sent home – perhaps even with oxygen and a nurse – to recover in a less risky setting.
Is it safe to eat takeout food?
Yes. Campen reiterated that people don’t usually catch the virus by eating it, and also that the liklihood that someone coughed on or touched a contaminated hand to the exact spot on a takeout bag that you touched when you picked it up, is very small. And you can always wash your hands after touching the bag and removing the food containers, providing even more protection. So far, Campen said, there have been no reports at all that anyone has caught COVID-19 from a package brought by a delivery driver.
How long can you use or re-use the same N95 face mask?
Campen noted that a professional N95 mask will protect the wearer from somone else coughing nearby as long as there is no visible debris on the outside of the mask. Also, she said, wearing another, lighter mask on top of the N95 mask can help keep it clean longer. But you should only handle an N95 mask by the ear loops, to further minimize contamination. Finally, though, she noted again that you don’t need an N95 mask as long as you remain at least 6 feet away from other people, so you aren’t exposed to their respiratory droplets.
Can you boost people’s immune systems by treating them with antibodies from those who have been sick and recovered?
Campen said this might help protect someone who was already sick and fighting COVID-19 as a secondary infection…but right now, only the very sickest people are receiving antibody and/or experimental drug treatments.
Is it safe for senior citizens to go shoppping during the special hours stores have set aside for them?
Campen said grocery stores are currently among the most high-risk locations, because there are lot of people in and out, and everyone touches everything in the store. And since her preference is that people in high risk groups avoid high risk locations, she said she would recommend that seniors do not go to grocery stores right now, if they can avoid it, even during separate shopping hours.
What are the current hospitalization and mortality rates for COVID-19?
Campen said that about 10% of COVID-19 patients right now are being hospitalized, and about 1% die, which is similar to the flu. But the prognosis is much worse for those who need to be put on a ventilator – about 75% of those patients die. And among COVID-19 patients who also suffer cardiac arrest, the survival rate has been zero (which has prompted some difficult ethical discussions about whether time and resources should be spent on resuscitation efforts in those cases).
How can we safetly transition back to more normal activity?
Campen said most people can be safe at work, as long as everyone practices good hand hygiene and social distancing – with no hugs or handhsakes. Instead, she recommended adopting Asian traditions, such as nods and bows. Also, Campen noted that scientists and health care professionals have battled pandemics before, and do have some good experience. “H1N1 mortality was much higher,” she said, “But it didn’t spread like this.” So, yes, she said, “things will change” in our world, “but we’re going to get past it.”
For more infomation, you can follow Campen at @acampen on Twitter, or @glamerdoc on Instagram
About Elizabeth Fuller
Elizabeth Fuller was born and raised in Minneapolis, MN but has lived in LA since 1991 - with deep roots in both the Sycamore Square and West Adams Heights-Sugar Hill neighborhoods. She spent 10 years with the Greater Wilshire Neighborhood Council, volunteers at Wilshire Crest Elementary School, and is the co-owner/publisher of the Buzz.
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