Corona Virus Epidemic: A Clinical Update and Interim Guide
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Corona Virus Epidemic: A Clinical Update and Interim Guide


(Intro music) Hello and welcome everybody to another
exciting episode of SCI talks 2.0 as always my name is Dr. Jack Seksenyan and
in today’s episode I have one very wonderful and exciting guest to talk
about the recent outbreak of the corona virus.
She’s an infectious disease physician and an assistant professor at
Cedars-sinai Medical Center who deals with a lot of topics related with
infectious diseases and recently she has given multiple talks regarding
specifically the corona virus. So she is here today to talk to us about this
epidemic and give us the facts and the details regarding this and kind of bust
the myths that has been going around on the media regarding some of the details
related with the corona virus. So with that I want to introduce Dr. Priya Soni
and she will introduce herself as well, give us a quick background about herself
and tell us all about the corona virus so Dr. Soni please can you introduce
yourself and tell us about what you do and give us a little bit of information
about the corona virus. (Dr. Soni) okay hi everyone my name is Dr. Priya Soni, like you said,
I’m a pediatric infectious disease specialist so I specialized in taking
care of children with all types of infections. I’m a clinician but also I do
some clinical translational research with Kawasaki disease specifically in
children and looking at a microbiome with Kawasaki disease but with
everything that’s been going on I’ve taken it upon myself obviously to really
stay abreast of all the information and research that’s come out with SARS CoV 2
which causes the entity called Covid-19 which you guys I’m sure have heard so
much about. ( Dr Seksenyan ) Awesome so can you tell people that are hearing a lot of
information on TV, the news and other sources, of what is the Corona virus and
why there’s so much let’s just say panic going around. Yeah so um coronaviruses have been around for hundreds of years right so
there are many different types of coronaviruses that are known to infect
humans there are four major coronaviruses that are known to infect
humans that cause just basically a mild cold and literally don’t have any cause
of mortality they don’t you know they don’t kill you and you just got a little
bit of a cold now there have been three particular coronaviruses that have been
popping up in the last few decades that have been of particular interest as they
made the jump from an animal species to human the first of which was with SARS
which we know was an outbreak that started in 2002 2003 which started in
China as well but eventually we found out that that was kind of related to
civet cats in China as an intermediate hosts that ended up becoming a pandemic
I think there are about 8000 cases around 800 some deaths but now of course
we’ve contained that particular virus the second corona virus that’s made the
jump from I guess animals to humans is MERS so the Middle Eastern respiratory
syndrome is another type of corona virus that was implicated in 2012 or so
specifically confined to the Arabian Peninsula but it has a higher mortality
rate we just didn’t see as many cases there were a couple hundred cases of
which many people died but that we still see circulating here and there but it’s
not as big of an issue as as now moving forward to – now with SARS CoV – also
known as Covid 19 so that’s kind of the background and history on these
particular corona viruses but know that they’ve been around since pretty much
that they’ve been discovered and noted by humans since the 1960’s but have
probably been amongst us for her you know hundreds of years
(Dr Seksenyan ) if I may interject and ask a quick couple of questions regarding
definitions. Can you maybe quickly briefly tell us what it is for something
to be a pandemic versus an epidemic and what are these terms that we see in the
media all the time and what did they actually mean in terms of
epidemiological definitions. (Dr. Soni) yes so first you know there’s all these terms
that are being thrown out and I think it’s important to note that an epidemic
is something that’s sort of sustained transmission ongoing in in multiple
different areas that’s just amongst us a pandemic is
sort of on a global scale of an epidemic widespread throughout pretty much all
countries and so whether or not this Covid-19 has already moved towards a
pandemic is probably a mute point you know I think we’re already getting
there with the numbers now just I just checked a few minutes ago on the Hopkins
tracker up to a hundred and thirteen thousand people so that are infected and
I mean I think we have to keep in mind that pandemic doesn’t play to the
world’s population being wiped out you know we had a pandemic of h1n1 influenza
right and and then we we were able to get that strain of the virus within our
flu shots that we take every year and it’s still circulating among us but it’s
not you know wiped out half of the population so we can’t be afraid of the
P word and I think that’s one of the messages that I want to bring across to
you today that’s that’s wonderful because I know people are telling you
well it’s a pandemic you know and they hear historical terms being used with
them again wiping half of the world population and the word that’s what I
want you to clarify because it doesn’t mean it’s gonna kill people it just
means the amount of spread across the globe
and and just to kind of expand on that you know I’ve had a lot of people tell
me oh it’s like the Spanish flu of 1918 where 50
million people were infected things like that you know we’re talking about a very
different time period in life right so that was a pre vaccine pre-antibiotic
era in terms of technology infrastructure and we just didn’t have
the means to handle the sort of outbreak which we do now and so let’s keep that
in perspective – awesome so going along would can you tell us a little bit about
some of the symptoms people have been experiencing and specifically with this
in fact I know in general there’s a you know the potential the cough and a fever
but are there any specific symptoms that are related with this or is it just the
general you know feeling sort of stuff yeah so the symptoms actually vary so it
can be pretty mild course where you just have a little bit of a runny nose cough
congestion but the main symptoms that the CDC really wants you to be aware of
is fever up to 83 percent of patients that have been studied with this do have
a fever shortness of breath as well as respiratory distress moving to
respiratory failure now you’re at that point you’re probably going to be one of
the ones that has more of a severe course those are your earlier symptoms
within the course of this infection but some people just have a mild sort of
cold and they recover from it and what we’re seeing is that the majority of
people over 50% you know have recovered from this without any complication so
this is like just getting the cold but the question I get from a lot of people
is that then why is there so much media coverage on this and why I mean I’ve
seen images of Costco being cleaned from all of their water and toilet papers
that people are worried that they may be quarantined or something is that
something people should actually be concerned about them yeah I mean I think
what we know so far of course this is a very rapidly evolving topic but well we
do know is that the people that have died have been particularly in a
specific age group so 50 year old and above particularly patients that have
other comorbid conditions what that means is if you’re an adult above 50
with heart disease that you have something called COPD which is chronic
obstructive pulmonary disease, diabetes some of those other comorbid conditions
that already cause your immune system to be a little bit stressed and in a state
of inflammation some of those patients are not having as great outcomes as
other people so those are particularly the ones that are being most affected by
this virus and there are up to about 29 percent that I read progressed to what
we call ARDS which stands for acute respiratory distress syndrome and it’s
it’s basically your lungs kind of gone into overdrive and it sets off an
inflammatory cascade that you can’t recover from and a lot of patients that
develop a RDS with this infection that are older they do end up passing away
unfortunately and a lot of patients that also develop this infection that are
older with other comorbid conditions can also get co-infection with other things
so the co infection with a bacterial process like a pneumonia that eventually
leads to their demise so the take-home point is older adults particularly
affected by this and they are the ones that are unfortunately dying from this
now is this any more unusual than and although older adult with comorbid with
morbidities getting the flu for example because to me it seems that it’s no
different than getting the flu if you’re an older adult who hasn’t got the
vaccine and has all these comorbidities yeah great question I think the short
answer that is we’re still trying to figure it out
as you know each flu season is different right so this particular flu season for
2019 2020 is kind of on par with our previous year
but in 2017 the flu strain that was circulating was a little more virulent
and at that point we were seeing way more deaths but just to keep things in
perspective I do want your audience to know that the flu has killed upwards to
20,000 plus patients this year and the final numbers
we’ll find for sure in in the next coming months but the flu is definitely
causing more mortality than this right now the problem with the for loop the
thing with the flu is that we know that the flu will eventually the flu season
will kind of die down right so we will sort of certainly stop
circulating by April May June definitely we’re not gonna see as much activity
we’re already this is week three of decreased activity of flu I just checked
the CDC today and we don’t know what’s going to happen with the corona virus we
don’t know if it’ll continue to circulate he’d been given changes in
seasonal patterns so but if you were to follow some of its other predecessors or
its family members we expect sometimes the warmer season to decrease maybe yeah
yeah maybe and I hope so and I think we all hope so
but if we look at the SARS data we see that SARS sort of continued to circulate
even in the warmer months and and even so now we see that there are certain
countries like Thailand Philippines warmer climates where we’re seeing cases
of koban 19 so I think the your the answer to your question is a little
complicated but to be determined what happens with this and the main thing is
this is probably like another version of the flu maybe the flu on steroids
a little bit of more robust virus but we will get through this and there will be
a time usually these coronaviruses cycle out in about a two year cycle so
hopefully sooner than that if we can get a vaccine and kind of work with that and
get some sort of treatment options but typically they tend to die out in a
two-year cycle so what should people watch out for in that instance in the
meantime should they avoid travel altogether and what are some of the
precautionary thing that they could do to avoid either passing it on to their
elderly family members or even contracting them themselves great
question so right now for travel its we have governments and you know political
systems working all sorts of way it’s like to contain the virus and to stop
its spread but it is going to spread you know viruses don’t respect orders and if
you think about the amount of travel we had when the SARS pandemic occurred in
2002 about a billion travelers and now we have five billion travelers going all
over the world so keeping that in mind it’s really stopping travel is just sort
of like a temporizing measure right so if you have a cut on your leg you apply
pressure just stop the wound from bleeding it
will slow things down but it’s not going to necessarily stop
the spread of this virus well you should know is that the CDC has made
recommendations to limit travel to certain high-risk countries so what that
means is they’re recommending no travel or leisure or other purposes to to China
to South Korea Italy and Japan as well so those are the four main countries
that are sort of having the most travel restrictions right now within the US you
know I think it’s important to exist precaution and to make sure you’re doing
the normal things you know washing your hands at least 20 seconds with warm soap
and/or with warm water and soap or using it not to cut you out but just to tell
the viewers you should always be washing your hands yeah regardless there’s always a good idea
absolutely you know and you know if you don’t have access to a sink and soap and
water then at least get a 60% alcohol-based hand sanitizer – to clean
off your hands with specific regards to travel you know I think it would be wise
to to kind of get those maybe get those travel size Clorox wipes or wet ones and
just kind of wipe down your tray table and the immediate surfaces because we
actually don’t know how long this virus lives on full mites or basically
inanimate objects and so specifically does that have any kind of comorbid
conditions like lung issues should they avoid traveling in general until things
are a little bit calmer or I guess based on what you’re saying as long as they’re
not traveling outside of the United States yeah I mean you don’t see
sustained and this could change you know in a week or so once we have more
testing available but we’re not seeing sustained sort of infection amongst
different parts of our country yet so at the moment I think just exhibit
precaution with traveling domestically and to really be careful about any any
anybody who can we come in contact with that might be sick with a respiratory
tract infection you know covering your mouth when you sneeze and cough and
really I’m just making sure if you shake hands with someone to to wash your hands
before you touch your face or your nose or your eyes
okay and I know a lot of people are asking where can I get masks where can I
get ten sanitizers we’re running out of them does everybody really need to have
a mask on even if they’re traveling I mean is that a necessary precaution
everything that they should do or only if they’re sick to prevent them from
passing it on yeah I mean if you are otherwise healthy with no respiratory
symptoms there’s no reason for anybody to be wearing a mask the mask sort of
gives us the perception of control right we think that we’re we’re stopping
something or we’re doing something about this so I think a lot of it is sort of
these behavioral and cultural patterns but you don’t need to be wearing a mask
do you have respiratory symptoms you really should be at home and resting and
not being in places like the airport that sort of thing so a lot of times
people think that the mask is protecting them but you think about it all of your
secretions are sort of cooling right there and so the most common time that
you’re going to be infecting someone else or even self inoculating is when
you take that mask off right so as to take it off properly if you do use it
and you do have symptoms speaking of infection is there any data
because I’ve seen some places where they said that at least in China there’s some
evidence that somebody who had it and cleared the virus was somehow able to be
reinfected is that necessarily true yeah I’ve read about that case too and I
think we still need more data about whether reinfection is truly a thing or
maybe that person just didn’t clear the virus completely and had some prolonged
shedding it’s it’s it’s not clear in that particular case so the short answer
is not sure but probably not something that you can get reinfected with in my
eyes if we’re looking at how other types of viruses in this family
react and then they were saying that at least in China they found that there’s
two strains of this virus going on so yeah well that getting reinfected with
one versus the other although speaking if they’re in the same
family you shouldn’t be reinfected again because of the way the immune system
works at least the way I understand know that that paper that came out last week
is all preliminary data and I know there’s a lot of mixed feelings amongst
the scientific community about the al strain and the a strain of this this
particular the two different types of this virus I think we need more
information in that study they basically looked at the genomes of 103 patients
and they were able to find this distinction we’re not sure what that
means in terms of like how dangerous one particular strain is to another I think
that there’s some thought that the S strain which is the more ancient strain
is circulating more amongst outside of Wuhan and mainland China and that one is
the one that’s a little less dangerous and causing less issues so less
mortality so I think the jury is out on what exactly this means and and what
this new information about the L and the S type of this virus mean and so for
people who have let’s say schools that they’re running for like daycare centers
should they be concerned about shutting him down in the United States especially
given the fact that the younger population isn’t as affected what
precautionary thing should they be doing or it’s nothing to be done until the CDC
announces something at this point yeah I mean keep your so look at the CDC but
also check out the websites for your local
local state public health departments and what their recommendations are
because there are some differences with what the CDC is recommending and versus
what’s going on at a local and community level so I always say just you know do a
quick google search and and just see what the recommendations are in your
particular area but closing down schools and things like that I don’t know if
it’s necessarily warranted just yet I think a lot of conferences and you know
things like that where you’re congregating large groups of people
those sort of exposures can be limited to help contain the outbreak but then
again we we have a bottleneck here because the testing methods have been so
limited that we don’t know if there has been sustained community acquisition of
this and we just don’t know it because of the testing I don’t think everybody
needs to be tested but I think we have to kind of keep that in mind that there
might be some people that have it and just have mild infection and are just
walking around normally you’re on yeah and do you know how long the incubation
period is and how long it takes for it to be a transmissible between
individuals yeah so the data that’s come out from the Chinese studies show that
the incubation period is probably around five days or so before onset of symptoms
so the quarantines that you’ve probably read for the 14 days is it’s like an
over estimate most likely I think in the coming weeks we’ll have more information
and those recommendations or or soft quarantine and you know impose
quarantine might change to be a little bit less but we just don’t know we’re
doing 14 days as like sort of the catch-all but really and truly it’s
about five days between you and an exposure to an individual with kovin 19
and onset of symptoms five to seven days and
when is the virus the most infectious period yeah so so that we don’t know but
what we think is considered true contact with someone is basically you and that
person there’s about you know six feet or less in between you and you’ve been
in the same area for more than ten minutes that’s probably a higher risk of
transmission so if people are feeling the symptoms that you said earlier the
best thing that they could do for themselves and for the communities just
stay home until they feel better yeah stay home you know if you’ve got a high
fever with cough runny nose there’s no reason for you to be out and about and
trying to tough it out you know we just really recommend that people stay at
home and rest and and take it easy to get over these things I mean typically
with respiratory viruses I will say that you have to be without fever for at
least 24 hours before you can kind of go back into real life and all of your
other activities and in terms of developing a vaccine for this I know
there are a couple of vaccines that are being shipped out to be tested how far
do you think we are potentially from having I know that’s a lot of questions
isolated question I think vaccine is definitely our best bet and if we can
get something within the next 12 months that would be fantastic and absolutely
amazing the there are clinical trials for other
options including treatments specifically something called run
desapear those are ongoing right now with in China and then also within the
United States amongst people who have been infected but our best bet is to get
a vaccine especially to our most vulnerable population our elderly and
and those with other conditions and hopefully in the next 12 months or so so
do you do you think that on a world scale just a philosophical
question we were prepared for a pandemic like this I think overall personally
we’ve done a fabulous job of containing it and slowing it down as much as
possible because if this was in the 1900s it would probably blow up a lot
yeah I think one of the things that you have to keep in mind is like when you
look at the SARS era in early 2000s the Chinese government and you know other
governments we they weren’t sharing this information as readily you know they’re
kind of sometimes hiding some of the cases and things like that but they’ve
been extremely transparent in this situation about sharing data and and and
sharing how many cases they’re seeing and really sharing the genome of the
virus so researchers can start developing types of treatments and cures
and vaccines so they’ve been a lot more transparent than in the past and because
of our technological revolution we’re able to really pinpoint any sort of like
cases they’re new infection that’s rising we’re able to kind of alert the
emergency preparedness teams and kind of get things in motion but I do think from
a health care and insurance standpoint there are a lot of barriers that we
still face and that you know limit the containment of such outbreaks but
overall I’m very optimistic with the way this has been handled so far so we’ve
learned a lot I guess from this as well but moving forward I think will be even
more prepared and in transparency especially in the scientific world is a
must I think in order to contain these kinds of things and I remember reading
it was like within a month or so that you know they had already sequenced the
genome of this thing and I was very very shocked like how rapidly things were
we’re moving in the scientific front yeah it’s incredible actually and you
know there’s a lot of talk initially about how this is a bat virus and we
quickly realize that there’s probably and there
definitely is an intermediate animal host that the virus is more similar to
and so the question is now let’s try to figure out what that host is and efforts
to also help contain it so so that part of it is still not nailed down yeah so
they found this bat virus it’s really interesting
so in southern China there’s a believe it’s a horseshoe bag that they found
about 96 percent homology with the new corona virus and but it still wasn’t
perfect right because the corona virus has these spike proteins on the outside
and there was a different receptor a domain binding site and that led us to
believe that there is another animal reservoir in between the bats and the
humans and so that is sort of yet to be determined one of the animals that we
think might need intermediate hosts is an animal all the Pangolin and that is a
basically like a scaly mammal that is the most traded legal animal in the
world and basically it’s used the scales are thought to have some medicinal
properties but the meat is is sold all over the world and that might be
something that comes up in the future as a potential intermediate host for this
virus I see I guess they could be used as a model model to studying how the
virus is evolved right I mean yeah absolutely absolutely and then you know
in the past some of the containment strategies also involved kind of
addressing those you know animals the animal from preventing the spread from
animal to human so what kind of Public Health and hygiene measures and things
can be taken to prevent additional spread interesting from a a epidemia
logical point of view how we could narrow it down to the exact animal and
and it’s quite interesting with all the advances in technology and science like
you’re saying to be able to even determine different strains the origin
and the pace at which it was happening you know it’s quite remarkable and the
sharing of ideas and information is I think the key in slowing down something
like this and preventing it from yeah absolutely and I think you know enough
to kind of take what the media is doing with this and take it with a grain of
salt and read information from good resources from CDC from your local
public health departments you speak to your physicians you know and and also
keep in mind that this might be something that you know is just
circulating amongst us so it might be something that we have to kind of deal
with on an ongoing basis so might be next winter it’s it’s cold flu and Koba
19 season and we have to kind of be prepared for that too and I know I’ve
been stressing people a lot about getting their vaccines and being
up-to-date about their vaccine do you think of course having all of these done
can prevent you from getting sick even from something like this you know if
your immune system is well educated and is out the end is able to fight all
these other infections then it might not have a harder time fighting something
like this in the future yeah absolutely you know I think if your immune system
has been primed with you know the flu vaccine for example it’s it’s kind of
prepared to fight against other types of respiratory viruses it can only help in
this sort of situation so definitely encourage everyone to get their flu shot
especially those with respiratory conditions and asthma and other
immunocompromised needs less than 50% of the population of the u.s. gets their
flu vaccine every year which is staggering to me
you know and we have more than 20,000 deaths in the season alone so I really
do want to encourage everyone to get their flu vaccine because it’s it’s it’s
way bigger than the koban 19 yeah and we know it’s definitely cyclical so it’s
not like the flu ever will go away this this has a potential to go away a couple
of years but the flu will always be there so I mean I can try to stress it
to people to make sure they get the flu vaccine and when I compare the numbers
between like you’re doing with the flu and this people sometimes only then see
the importance of the flu you know I think we need to start calling the flu
maybe like you know Excel 58 or give it a new name scream scary name huh yeah
give it a new scary name maybe we can call it Cove it 3 or something I don’t
know but it’s just something that’s been a problem every single year just sort of
sometimes breeds indifference when something new and novel sort of catches
our attention as a society so we should also keep that in mind okay well this
has been very informative I know for me as well even as a physician so I think
the viewers are gonna definitely enjoy hearing all of this do you have any last
sort of additional comments to make before I would just say you know stay
informed and of course everything that I’ve said today it’s a very rapidly
evolving topic so please you know keep that in mind and wash your hands and
your seat and always consult your personal physician with yeah and you
know these symptoms to get a better idea of what’s going on sure you take this as
a sort of an educational thing rather than a medical advice and always consult
your personal physician absolutely thank you so much Akop. thank you so much for
coming onto this and educating all of us about
details and some of the important questions that people have been asking
all right thank you have a wonderful day thank you! You too.

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