The first lecture this year of the Navigating the Medical System Lecture Series took place on Tuesday evening, October 13, remotely, with over 80 participants, and featured Dr. Calvin Hwang, MD, MPH, FCCP, Assistant Professor in Clinical Medicine at Weill-Cornell Medical College and Patient Safety Officer for the Department of Medicine NewYork-Presbyterian Hospital Queens. Dr. Hwang spoke about what to expect and how to manage COVID-19. The lecture as always was co-sponsored by Congregation Etz Chaim. Ms. Christina Yoon, Director of Community Outreach Representative and Community Health Initiatives at NewYork-Presbyterian Hospital Queens, greeted the audience, and then Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, welcomed everyone to the ninth season of the lecture series and then he introduced the speaker.
Dr. Hwang offered a comprehensive lecture on COVID-19. He began by sharing good sources for information, which include the website for the CDC and the website for the New York City Department of Health. He then shared some staggering statistics. In the United States, 7.85 million people have been infected with the coronavirus, COVID-19. There is no natural human immunity, which means we are all susceptible to this virus. In New York State, 480,000 have been infected and 32,896 died from it.
Because the virus was discovered less than one year ago, the scientific understanding continues to evolve; every month there is new information. Until a few weeks ago, the number of cases was leveling off in New York City. In the last two weeks, there are hot spots in Brooklyn, Queens, and Far Rockaway. These high-risk areas have restrictions on gatherings right now, as well as small business closures.
Dr. Hwang then went on to explain how immunity works. There are two types of immune responses. The first type is innate immunity, which is fixed like skin, or acid in the stomach, or a cellular defense. The second type is adaptive immunity, where our body learns how to defend itself from new pathogens by generating organism-specific antibodies. Vaccination helps the body develop adaptive immunity. Most anti-infectives, such as antibiotics or antivirals, “buy time” for our bodies to develop good adaptive immunity.
Until a person exhibits symptoms, it is a subclinical infection. For COVID-19, this period is four to 14 days. Remember, during this time you can infect others and not know it!
The main way that the COVID-19 virus infects others is through the respiratory tract via airborne droplets or aerosols. Droplets are microscopic but generally fall onto surfaces within six feet. Aerosols are much smaller and linger in the air for hours at a time. It is possible to get infected if you first touch a contaminated surface, and then touch your face with unwashed hands, but this is less common. There are rare reports of vertical transmission, such as a pregnant mom transmitting it to her fetus.
The main problem with respiratory droplets and aerosols occurs with prolonged indoor exposure with poor ventilation. Sneezing, coughing, singing, and exercising indoors present a risk. This is why the recent White House gatherings and choir with singing can be super-spreader events.
Lower risk exposures include hand-to-face contact from packages, groceries, personal pets, and outdoor activities. Proper hand washing will prevent infection from these lower risk exposures. Proper hand washing with soap and water takes around 20 seconds of washing. Try singing the Alphabet Song the next time you wash your hands! If you can’t use soap and water, an alcohol-based hand sanitizer is the next best thing.
To reduce your risk of infection, practice social distancing, mask wearing, hand hygiene, and avoiding close contact with an infected person. The CDC defines “close contact” as within six feet for more than 15 minutes.
Surgical and cloth masks are recommended for non-healthcare providers. The neck gaiter is good if it has enough layers. N95 should be left to health providers as it requires specific training for proper fit. The N95 with a valve is also not recommended, as it does not protect others. Respirators are also not recommended, as it is only for health providers performing high-risk procedures. It also requires more training than the N95 to use properly. Lastly, a face shield without a facemask is not recommended, as it does not protect the wearer from breathing in aerosols.
For a mask to work properly, it should cover all holes on your face (mouth and nose) and your chin. You should not adjust it after it is on. Do not grab the front. Use the ear loops to remove it.
Dr. Hwang then explained the difference between quarantine and isolation. A healthy person who is exposed to someone with illness must quarantine for 14 days from the last exposure. Isolation is for the person who has the disease. The healthy person must monitor his or her symptoms and not leave the house when in quarantine. If you have a negative test after exposure, it does not mean that there is no infection. This was shown in the recent outbreak at the White House.
Symptoms of COVID-19 include cough, fever, shortness of breath, chills, muscle pain, sore throat, and loss of taste and smell. Less common symptoms include the following: chest tightness or pain, diarrhea, nausea, vomiting, headache, and sore throat. Worrisome signs include the following: trouble breathing, pain in the chest, inability to stay awake, and blue color of lips or face. You can use a pulse oximeter to measure oxygen in your system, and if it is less than 94%, you should seek medical attention.
Risk factors for developing severe disease include the following: age 65 and older, male, chronic medical problems, obesity, diabetes, heart failure, COPD, sickle cell anemia, immune-compromised, chronic kidney disease, and cirrhosis. Of these, only obesity is potentially modifiable with time.
The treatment for COVID-19 is to rest, drink fluids, have a proper nutrition, and sleep on your side or belly. If a family member is sick, he or she should isolate in a separate room and bathroom, if possible. Disinfect frequently-used surfaces like doorknobs, light switches, and phones, and maintain good air flow in your home.
There are a few approved drugs for the treatment of COVID-19, but these are restricted for hospitalized patients who require oxygen or mechanical ventilation. Many of the other drugs that have been tried have not proven to be effective. There is not enough data on other antivirals or monoclonal antibodies. “Keep in mind that scientific studies take time, and we need to study more patients.”
In terms of a possible vaccine, the best-case scenario is spring or summer 2021. A vaccine must prove that it is safe and that it works before it can be approved by the FDA. After that, there will be many production, distribution, and administration challenges to overcome.
Dr. Hwang used the analogy of defensive driving when trying to protect yourself from COVID-19. Anticipate potential problems; stay away from high-risk situations. Keep the big picture in mind and maintain safe distance. Check on others and maintain a strong sense of community. Adopt a healthier lifestyle and enjoy the outdoors. If someone is not following the proper protocol, rather than shame him or her (which does not work), try saying, “I want both of us to be safe. What can we do?”
Both Dr. Hwang and Dr. Breite urged everyone to keep regular appointments with their doctors and to get a flu shot. No one wants to have to deal with COVID-19 and the flu at the same time.
The program concluded with a lively question-and-answer session. The next lecture will be “Advances in Medicine,” given by Dr. Mel Breite.
Everyone who participated left more knowledgeable and appreciated this informative, detailed lecture. The community appreciates Dr. Hwang’s work and efforts on our behalf, as well as this wonderful lecture series that is so helpful.
By Susie Garber