Ask Us Anything About… COVID-19

Description – The video begins inside the Penn State Health Milton S. Hershey Medical Center. Two people are standing next to each other inside a clinical room. Standing from left to right are Scott Gilbert and Dr. Catharine Paules.

Scott Gilbert – From Penn State Health, this is “Ask Us Anything About COVID-19. I’m Scott Gilbert alongside Dr. Catharine Paules. She’s an infectious diseases physician here at Penn State Health Milton S. Hershey Medical Center. We want to get her back to work as soon as possible, but we pulled her away for just a few minutes to answer some very important questions. because we know everybody has questions about the situation going around right now. This strain of coronavirus has changed life here in Central Pennsylvania and across the country. We’re going to get as many questions answered, as I said, from Dr. Paules. So, we welcome your questions in the comment field below this Facebook post. And if we don’t get to them during the live interview, we’ll do our best to provide you a written response after the fact. Dr. Paules, I’d like to start with social distancing. That concept has been discussed so extensively in the public recently. But it seems to me like one person’s social distancing may be different than someone else’s. How can we come to kind of a common understanding as to what constitutes this as a best practice?

Dr. Catharine Paules – Yeah, so I think it’s going to depend a little bit about where you are in the United States and what some of your individual risk levels are. Right now, we are seeing an increase in cases in the United States. And what we want to prevent is we want to prevent this spike. So basically, has cases increased exponentially it very much stresses healthcare systems. So right here is our healthcare system capability. Everything over this would really task the system. And that just doesn’t impact COVID-19 cases, it would impact somebody that needed an appendectomy, or another kind of emergency surgery. So, the goal is to spread the cases out over time and that’s where social distancing comes in. So, I’m very much recommending that people stay home as much as possible. I know some people will have jobs that don’t allow that. But if you are able to stay home, you should. If your kids are out of school, now’s not the time to you know take them out with a bunch of other kids on a playdate, it’s time to stay home and really help protect our healthcare resources.

Scott Gilbert – So, I guess that’s one of my questions is where is that line drawn? So, kids are not in school right now. Playdates, probably still a bad idea, that defeats the purpose, right?

Dr. Catharine Paules – I agree with that.

Scott Gilbert – Okay and so, any public place? I know there’s been talks of restaurants and? Anywhere you don’t have to be essentially in the public is probably off limits, right?

Dr. Catharine Paules – Yeah, I’ve been telling people instead of going to a restaurant, maybe order takeout from that restaurant. Sort of limit those interactions as much as possible.

Scott Gilbert – Sounds good. Again, we welcome your questions for Dr. Paules here on Ask Us Anything About COVID-19. Just put them in the comment field below this Facebook post and we will certainly try to get those questions answered for you. I’m wondering what advice you have for people who may be considered to be in those high-risk groups? And first let’s stop and define those. I know the elderly, people with certain medical conditions. Can you tell us who some of the people are who are at risk of, if they were to contract COVID-19 having some more severe symptoms?

Dr. Catharine Paules – Sure, so men that are over age 60 are at risk, as well as women, but men seem to have a higher risk than women. As well as people with underlying heart disease, even high blood pressure can pose a risk. And other medical problems, like diabetes, or kidney failure, immunocompromised individuals. People with cancer, HIV are likely to be at high risk. But I want to stress that even younger and fairly healthy people have gotten very sick from this infection. So, even though most cases in those age groups will be mild, there are younger people that have had serious consequences.

Scott Gilbert – And even if the younger people may be at lower risk of getting serious ill, they still carry the disease.

Dr. Catharine Paules – That’s right and we all have people in our family, our neighbors, friends, for me, my patients that are at high risk of these complications. So, each of us practicing social distancing will help protect everyone.

Scott Gilbert – So, even these people in the higher risk groups though, they need things like groceries and essential supplies. What’s your advice for them on how they can go about procuring those?

Dr. Catharine Paules – So, I’ve been trying really hard to adopt some of my neighbors that I think are at higher risk of complications. Pick up supplies for them if I have to go out, or even order supplies. Many grocery stores will now deliver.

Scott Gilbert – Great advice. Remind us when it comes to, if someone has symptoms. Let’s just go right to the question about symptoms, because if someone has symptoms that they feel could possibly be corona virus, it could also be something else. So, as there’s no way to tell exactly, what are the first steps somebody should take? I know it’s not come directly to the doctor’s office, or the ED.

Dr. Catharine Paules – That’s right, we certainly want people to call ahead. People that are mildly ill, we may recommend that they just stay home, versus if they’re in a riskier group we may bring them in for testing. But that should be coordinated by a phone call rather than coming to your primary care doctor’s office without calling ahead.

Scott Gilbert – We have a question now from Jamie. Jamie is asking should kids be separated from adults like the English used to do? Not sure exactly what that means. But I mean in terms of, maybe a great example would be now’s not a great time for grandkids to visit with grandparents.

Dr. Catharine Paules – So, I’ve been doing that in my own life. So, as kids are out of school, I’ve been trying to facilitate younger babysitters to take care of them, rather than asking my parents who would be in a risk group to help me out. So, I don’t think that all kids need to be separated from adults, but if you are in one of those risk groups, sort of isolating yourself from everyone is a better idea.

Scott Gilbert – We have a question from Avery, and a related question from Tina. So, I’m going to take both of them at once here. Avery is asking can you test positive after having COVID-19 even if you had it several months ago. And Tina asking if someone is diagnosed with COVID-19 then recovers, basically the same thing could you contract the virus a second time? What do we know about that?

Dr. Catharine Paules – So, in terms of testing the testing that we’re doing right now looks for the actual virus. So, after a couple of weeks, no you would not test positive by that mechanisms anymore. But there are tests being developed that can actually look for your immune response to the virus. Those are not available in the United States yet. But it’s possible that we could tell that someone was infected a while ago based on those coming tests. In terms of getting this again, I have not seen any evidence to support that people get this a second time. In fact, people make a good antibody response to this virus, which suggests that at least for you know some amount of time, months to years you would be protected from a second infection

Scott Gilbert – You’re watching Ask Us Anything about COVID-19 from Penn State Health. Your questions are welcome. Add them to the comment field below this Facebook post and we’ll get them to as many of them as we possibly can in the time that we have. Carrie is asking a question that I think a lot of people have. And she’s asking do you feel it will be worse? Probably tough to answer that in a specific way, correct?

Dr. Catharine Paules – I do think we’ll see more cases and that overall, in the United States things will worsen. What that will look like, I think we’re all wondering that. And I really think that what we do today in terms of social distancing is going to make a big difference in what happens here in the United States.

Scott Gilbert – So, let’s go back to social distancing for a little bit, because what are some best practices, that if you have to interact with somebody out in public, what are somethings to keep in mind that can really help to limit the spread?

Dr. Catharine Paules – So, I really suggest going to places where you do have to interact at times with the overall number of people will be the lowest. Good handwashing or hand sanitizer is certainly helpful. If you’re sick you should not be going out at all.

Scott Gilbert – Good advice. Let’s talk a bit about Penn State Health On-Demand. I know that this is an example of a telehealth solution. We talked about calling ahead before you go to the ED, before you go to your practice, but at the same time, you know telehealth is another option, right, whether it be through Penn State Health, or whoever someone’s provider is.

Dr. Catharine Paules – That’s absolutely correct. And we are certainly working on scaling that up, both for COVID-19 questions and then maybe even to handle some of your chronic healthcare conditions without having to come into the doctor.

Scott Gilbert – All right. Because the idea is to keep people with these symptoms out of the office for obvious reasons.

Dr. Catharine Paules – That’s correct. And I think you know sort of protecting our higher risk people if we can do some of their care from home, we would certainly like to.

Scott Gilbert – A question from Melissa now asking what do you do if you get COVID-19? What kind of treatments, if any, are there?

Dr. Catharine Paules – Mostly care is supportive at this point. So, most people, about 80% can probably just stay at home and really isolate themselves from others and they won’t need any kind of medical care. But if you’re in that 20% that will, you may require oxygen, you may even require a ventilator, or higher level of care. In terms of antiviral, there’s nothing that is yet approved to treat this infection, but there are many trials ongoing to test different therapeutic options.

Scott Gilbert – A question from Kelly asking can our pets get COVID-19. I mean, it’s believed, I believe that in China, the disease did come over from, it was transmitted, was it a bat possibly?

Dr. Catharine Paules – Possibly a bat, most like a bat. It may be through some kind of intermediate host at a market. What the WHO has said is that our domestic pets like dogs are not going to transmit this to us. Although I still don’t recommend letting your dog lick your face if you’re sick.

Scott Gilbert – All right. And if multiple people are petting a dog too, it would seem that that could pose a possible issue?

Dr. Catharine Paules – As far as what the WHO has told us, we do not think that dogs are transmitting this to people.

Scott Gilbert – All right. Good to know. Do you feel that across the nation, the case count is artificially low possibly because of a lack of testing? Because in a lot of places testing is still ramping up, I mean you know health authorities are doing their best, but at this point could there be a lot of cases flying under the radar?

Dr. Catharine Paules – I absolutely think that there are cases under the radar, particularly in some of the bigger cities where people are now presenting to the hospital seriously ill. That suggests that there are many less ill people in the community.

Scott Gilbert – So, we shouldn’t be surprise if that arch kind of goes upwards. Because there could be a lot of cases right now that we don’t know about.

Dr. Catharine Paules – As testing scales up, we’ll find more and more cases that are positive for this.

Scott Gilbert – One of the questions, Stacy has a question similar to what a lot of people have asked us on social media. And that is if I have a more routine doctor’s appointment, what should I do about that? You know should I cancel it, or should I go through with it? Do you have any advice for them?

Dr. Catharine Paules – Depends on each individual’s sort of necessity to come in, but I would suggest that if you can cancel it, call your doctor see if there’s anything they need to address with you over the phone. And then, if you don’t have to go into the office, and can do it from home, that helps us all.

Scott Gilbert – Right, if they need a refill on a prescription, but you know, I’m sure there could be people with chronic illnesses that do have to have them tended to, but maybe a creative way to go about it.

Dr. Catharine Paules – That’s correct.

Scott Gilbert – All right. Why, well first let me just stop and say, you’re watching Ask Us Anything About COVID-19 from Penn State Health. I’m Scott Gilbert alongside Dr. Catharine Paules. She’s an infectious disease physician here at Penn State Health. And we welcome your questions for her. So, feel free to add those in the comment field below this post and we’ll get to as many as we can in real time and then we will try give you written responses if we’re not able to answer them here live on camera. As testing becomes more widespread in the coming weeks, who should look to eventually get tested? Is this something everyone should do? Or, should it be limited to certain groups, especially initially?

Dr. Catharine Paules – So, right now, I think the highest risk groups are people that have a very serious respiratory infection. So, they’re in the hospital and they’re very sick. And we need to know that they have this or do not have this. So, those people are getting tested. People that are in the community, that are lower risk, but may have a contact of someone that has COVID-19, or they may be at high risk of complications, they’re over 60, they have an underlying health condition, maybe they’re a healthcare worker. Those people probably should be a higher priority to test even now. But again, please call before you come in so that we can come up with the best strategy for your particular circumstances.

Scott Gilbert – Over the weekend, Penn State Health announced some changes in its visitation policy. So, patients at Penn State Health Milton S. Hershey Medical Center and Penn State Health Children’s Hospital are each allowed to have two visitors, I believe it is, in the hospital at any given time. At Penn State Health St. Joseph, it is I want to say is one visitor per patient for at least pediatrics, if not also for adults. But we’ll post a link to that policy here. I’m wondering, can you talk about the discussions happening behind the scenes about visitation. And how you mitigate the need for people to see their loved ones in the hospital with the need to keep everybody safe.

Dr. Catharine Paules – Well, I think what you just pointed out is sort of what we all have to discuss in these circumstances. Certainly, there are people that really need a visitor. Pediatric patients, for example, kids, they need a parent there. Or some of our oncology patients will be in the hospital for weeks, and weeks, and weeks. Not having visitors is very challenging for them to sort of keep their spirits up and to get through various treatments they may have. And of course, we need to weigh the risk of visitors potentially, you know brining infection in. And as we weigh those risks and as cases increase in Pennsylvania, changes might be made.

Scott Gilbert – Stacy’s asking a question about do we feel the US health system is compared for COVID-19? I think that could also be broadened down to society, in general. I guess it goes back to those steps we’re asking people to take to flatten the curve.

Dr. Catharine Paules – And that’s exactly right. I mean, there is sort of an uptick point for every, probably healthcare system in the world. Where their capacity would not meet the demand. And so, trying to keep the demand as low as feasible will help all of us take care of patients as they come in.

Scott Gilbert – You’re watching Ask Us Anything About COVID-19 from Penn State Health. We welcome your questions, your concerns. Feel free to add those as comments here in the comment field below this Facebook post and we’ll get to as many as we can in the time that we have. We did have a question, a private question sent to our Facebook page from an individual who says she works in a grocery store. Her boyfriend works for a package delivery service. They’re both in very high customer contact positions. So, it would seem that they have a special challenge there. What advice to you have for them? Perhaps about even interactions they should have with their managers?

Dr. Catharine Paules – Yeah, I do think it’s really important to raise a concern to the people that are managing them and to try to see what their plan is to minimize risk to their employees. The other thing I would strongly recommend is reaching out to your primary care doctor about what your personal risk would be if you were to get sick. If you are in one of these risk groups, it may be that you need to take a break from work for a while. And that’s something that you can discuss and sort out with your doctor.

Scott Gilbert – Right, and so those work from home decisions, those kinds of things, are the types of decisions that you can work out with your employer and make on an as-needed basis.

Dr. Catharine Paules – That’s correct.

Scott Gilbert – All right. Let’s see here, we have a question from Sheryl. She’s asking if I need to go to the doctor, should I wear a mask?

Dr. Catharine Paules – That’s a tough question. Masks have primarily been studied in ways to protect healthcare workers. And people in the community, there’s no data to show that people in the community that are not ill, so they’re healthy, that wearing a mask protects them. So, certainly if you have respiratory symptoms, it’s a good idea to put a mask on. But as for masking in the community when you’re well, we’re not generally recommending that.

Scott Gilbert – Right, and I know at least as of a couple of weeks ago there was some concerns that if everyone ran out and got masks, that would take them away from people such as healthcare providers and those in a clinical setting who need them.

Dr. Catharine Paules – And that’s correct. The things that we do in the hospital setting actually promote a lot of aerosols, putting healthcare workers at substantially more risk than the rest of the population. So, preserving the masks to help protect healthcare works is a very important concept.

Scott Gilbert – So, how are Penn State Health and other organizations taking precautions when they test people? Because you know if somebody comes; if you work it out so that somebody comes in for a test, how is that happening in a way that tries to keep everybody safe?

Dr. Catharine Paules – We’re recommending personal protective equipment. We have whole policies in place to protect employees that are going to be sort of doing the test or caring for these patients. And those are being adopted as we learn more about the virus.

Scott Gilbert – A question about what special precautions should transplant patients take? Anything for that group?

Dr. Catharine Paules – They would be potentially one of our highest risk populations. I personally see bone marrow transplant patients with infection, and I’ve been encouraging them strongly to social distance at a more extreme level than the rest of the population. Meaning, if they can avoid going out of their house, they should be staying home. And it probably depends upon when your transplant was and what kind of immunosuppression, you’re on. But as a general guidance, I would say transplant patients would be at high risk.

Scott Gilbert – Rupa is asking is the institution, meaning Penn State Health working on developing test kits here so that more samples can be readily tested? I know the answer to that is yes. The folks in our virology lab are hard at work. We hope to have a test available here at Penn State Health within the next couple weeks. But in the meantime, again that speaks to kind of I guess the evolving landscape around testing in the nation.

Dr. Catharine Paules – That’s true. So, a couple of weeks ago the only place that we could send tests was to the Center for Disease Control and Prevention. In the past two weeks, the PA Department of Health is now able to also do tests. And there are several commercial labs. So, not our in-hospital lab, but we can send tests out to commercial labs to do the test. So, how we’re deciding to test sort of depends on the patient, whether they’re admitted and how quickly we need that test result to come back. Ultimately, we hope to be able to do the test very quickly in our own lab. Maybe even turning it around within 2-4 hours.

Scott Gilbert – Carol is asking us, if I’m displaying symptoms, is there something I can take. So, any kind of treatment for those you know those common symptoms which are fever, trouble breathing, some other things like that.

Dr. Catharine Paules – Well, certainly, if you’re having trouble breathing, I would recommend that you call in to come potentially to the hospital to be managed. If you’re just having fever, or you’re having a little bit of a cough just for symptomatic things that you would do over the counter. Maybe some Tylenol or on a humidifier or something like that. And then certainly isolate yourself away from other people.

Scott Gilbert – And that speaks to a question Megan is asking, I think it’s a really important one. Because you know we’re telling people, don’t come right into the emergency department, but there are certain circumstances, possibly life-threatening circumstances when they definitely should.

Dr. Catharine Paules – Yes, absolutely. If you’re short of breath, you’re not able to breath, you’re having chest pain, then you need to come in. Call and ambulance and come in. but if your symptoms are pretty mile, just a slight cough, or a low-grade fever, then you have the time to call ahead. And if you’re not sure, call one of your primary care doctor’s nurse triage lines and they can walk you through where you should go.

Scott Gilbert – You’re watching Ask Us Anything About COVID-19 from Penn State Health. Dr. Catharine Paules from our Infectious Disease Team here at the Milton S. Hershey Medical Center welcomes your questions and concerns. Feel free to add those to the comment field below this Facebook post and we’ll get to as many of those as we can here. Stacy asking us, what exactly does social distancing mean? I feel like we did cover that a bit earlier, but is there anything else you’d like to add along those lines? Because I feel like that is possibly one of the most important things that will come out of this interview and so much other content that’s out there.

Dr. Catharine Paules – Yeah, social distancing really means trying to stay away from other people as much as you can. Now there are some of us that we can only social distance to a point. Healthcare workers for example. We have to come in and see our patients. So, the things that I’m doing are things like washing my hands, not coming to work if I’m sick, you know covering cough and sneezes. But for most of society, there may be ways to work from home. So, now going into the office. Or, if your kids are home from school, not taking them out to playdates. Now’s the time to kind of stay home. Spend time as a family. You know, maybe go for a walk, but don’t go to the mall, things like that.

Scott Gilbert – So, we have another question from someone whose son suffers from asthma asking how do I know if it is COVID-19 and he needs to be tested? That’s Cassie’s question. And that’s a good one because I know a lot of children are out there with asthma, trouble breathing obviously a symptoms of that.

Dr. Catharine Paules – So, most people will have a fever with this. Not everyone. But if you have a particular concern, say for example your son was more short of breath than usual and it wasn’t responding to the normal treatments that you would do if he were to be short of breath, then you should call your doctor immediately. To think about next steps to see if he needs a test or not.

Scott Gilbert – What do we know about co-infections? So, for example, is it a cold, or is it COVID-19? Could it possibly be both?

Dr. Catharine Paules – So, out of China, less than 2% of individuals would be positive for another virus. So, even though it’s not impossible, it does make it less likely that you have COVID-19. Particularly if it’s something like influenza or RSV that would be compatible with your clinical symptoms. So, you know, most people are not going to have two viruses.

Scott Gilbert – All right. Keep those questions coming we’ll get to as many as we can, just a few minutes left here though. You know there have been quite a surge of people running to grocery stores and other place. I mean, obviously the thing on social media is there’s just no toilet paper, there are no Lysol wipes left anywhere you look. John is asking what kind of products should we stock up on at a time like this?

Dr. Catharine Paules – I think for each person it’s going to be a little bit different. So, what I’m recommending is think about what your family would need to realistically stay mostly in the house for a couple of weeks. Realistically what would that look like, and then stock up on those supplies.

Scott Gilbert – All right. So, that might mean soap as well. I mean it doesn’t have to be antibacterial hand sanitizer, it can actually be, it can be soap, it can be a lot of different things that for people not going outside of the house could reasonably keep them clean.

Dr. Catharine Paules – That’s correct. That’s correct. And don’t forget things like your kids’ diapers or pet food, or things like that that you may need to account for.

Scott Gilbert – A good question here about he so-call incubation period behind COVID-19, do we know yet how long it takes for symptoms to start showing in somebody who’s contracted it.

Dr. Catharine Paules – Usually between 2 and 14 days. That is the incubation period that the CDC recommends that we look at. Most people will actually develop symptoms around four or five days after they’re exposed.

Scott Gilbert – And I know we mentioned a couple of those symptoms earlier but remind us. Fever, shortness of breath.

Dr. Catharine Paules – Cough.

Scott Gilbert – And cough. Those seem to be the three big ones there. And how are those different from, I mean it’s not that you can rule out COVID-19 if you have additional symptoms right?

Dr. Catharine Paules – That’s correct. It’s very challenging because there’s not a key difference that differentiates this from other respiratory viruses like influenza or RSV, things that we’re still seeing in the community. But it does seem to have less of the congestion and sore throat than some of those viruses, but again it doesn’t rule it out.

Scott Gilbert – All right. So, if you have the congestion it doesn’t mean that you don’t have COVID-19, right so just be cautious, and I guess the important thing is anybody with any kind of symptoms like that at a time like this needs to play it safe and not come in contact with people.

Dr. Catharine Paules – That’s right. Just stay home.

Scott Gilbert – And when we ask people to self-isolate. So, say for example if someone has symptoms that they think could be this, yet they live in a house with their family, how can they self-isolate in that setting. In a way that doesn’t put other people in the house at risk.

Dr. Catharine Paules – Well, the Centers for Disease Control and Prevention has an excellent guidance for this. So maybe we could direct them to that website.

Scott Gilbert – CDC.gov. Also, Pennsylvania Department of Health is a great place to look for information. We’ve got some information as well at pennstatehealth.org/coronavirus. You don’t have to remember all those links. We’ll put those in the comments section below this post here. A question from Dre, looks like, asking what can school nurses do to assist in tracking and informing public health and local hospitals? And advice you have for folks who are in that role across the region?

Dr. Catharine Paules – I would recommend talking to school administration about what’s already been put in place and maybe coordinate those responses through the Department of Health.

Scott Gilbert – Great advice. I think through this all one important thing to remember is something that a World Health Organization official said just the other day that just like a virus bad information spreads quickly. It’s important to get good information throughout this. So, the sources that we talked about, the Centers for Disease Control and Prevention, Pennsylvania Department of Health, and health systems, and media that you know and trust. You know make sure that you’re looking around for the right information. Getting it from the right places. And we’ll continue to try to provide you with the best information possible with people like Dr. Paules. Thank you for your time today and we thank you for your time in watching Ask Us Anything About COVID-19 from Penn State Health.