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Scott Webb: Staying healthy during COVID-19 is a critical challenge that requires following guidelines and the advice of medical professionals. And joining me today to help us all stay healthy is Dr. Edwin Hayes, he's an Infectious Disease Specialist at Prisma Health. This is Inside Health, a podcast brought to you by Prisma Health. I'm Scott Webb. So Dr. Hayes, thanks so much for being on today. I know that South Carolina has seen a substantial rise in cases of COVID-19, what are the main things that every family should know about COVID-19?

Dr. Hayes: Well, I think it's very important that people are aware that we're in the thick of it right now. The cases have been going up every day. This is a contagious disease that can pass from people who are symptomatic, as well as people who are not showing symptoms presently. And there's a huge range of how well people will do with getting this disease. But really the best thing to do is to prevent yourself from getting the disease in the first place.

Host: That sounds good doctor. So let's talk about the symptoms for COVID-19.

Dr. Hayes: So, the symptoms of COVID-19 are all over the place. Probably the most classic things are fever, cough, maybe sore throat. Some people can have diarrhea, but there's a lot of unusual symptoms that we're seeing more and more like conjunctivitis, with pink, irritated changes in the eyes, or a loss of smell is actually kind of a famous, unusual symptom we've been seeing, which can also be associated with changes in taste. Where food either doesn't have taste or starts tasting like garbage. So it's been a wide range, but again, probably the most classic are issues with breathing, cough, and fever.

Host: Well, you know, and I think that that's probably, what's so challenging about this, you know, not only maybe for the healthcare workers, but for the rest of us, is that a lot of what you were saying? It could be other things, could be a cold, could be allergies could be flu. When should we believe that it's not a classic thing, like a cold and it could be something else. In other words, when should we be tested, who should be tested?

Dr. Hayes: So, some of the things we do to try and suss out whether someone has, is truly infected or not is looking for particularly severe symptoms. Like if they're having difficulty breathing, that's probably not just allergies. And that's something that should be investigated by a doctor sooner than later. Another thing that can be a little bit of a clue is whether or not they're aware of an exposure to someone who's already been sick with COVID-19. So getting tested not only helps the individual to figure out if they're sick, but if someone can confirm that they've had the illness, that might help someone else they've been exposed to, to have a better sense of whether or not what they're feeling is from COVID-19.

Host: So, what should we do if we've come into contact with someone who has tested positive or who might have been exposed?

Dr. Hayes: So, a little bit of that depends on what you define as contact. Was this a casual passing in the hallway with both individuals wearing masks? Is this someone that you're living with at home and that you're spending long periods of time and close company with? That will depend a little bit on how aggressively you want to do things like be investigated for an actual infection with testing versus potentially just self monitoring yourself. I'd say in instances where you are concerned at the very least, you should keep very close eyes on your own symptoms, potentially get your temperature checked daily, to see if you have signs of a fever and consistently be wearing a mask, which is really recommendation that you should be doing, whether or not you think you've recently been exposed to someone. If you think that you have a more concerning exposure where you're potentially living with someone who's recently tested positive or has a high suspicion for COVID-19, it's probably reasonable to monitor yourself very closely, try to avoid contact with other individuals, and get tested yourself. Probably the most important thing is to discuss with your healthcare providers because the details of these situations can be so varied from person to person.

Host: So, if I test positive, how exactly do I self-isolate?

Dr. Hayes: Yeah. So that's a great point. And there's a little bit of language here that's important to understand, is isolation is referring to an individual who's actively ill taking themselves out of exposure opportunities with individuals who are not sick, but who could become sick. As opposed to quarantine, which classically is defined as someone who was exposed to someone who is actively ill, who is separating themselves from other individuals and being monitored to see if they do become sick. So isolation really is the appropriate term. I appreciate you using that term in particular. Now, when you are actively sick and you're isolating, the best thing to do is to stay at home as much as possible. If you're living with other individuals who are potentially going to get sick from you, you can try and avoid having physical contact with them, staying in a separate room, eating meals separately. When there are times where you're going to be interacting with other people in your household, or if you need to go out, for some reason, you should be wearing a mask, washing your hands frequently. And again, just trying to stay as far away from other individuals as possible.

Host: What's the best way to protect high risk individuals, including the elderly and those with medical conditions that might make them at higher risk or put them at higher risk?

Dr. Hayes: So, all of these same protective measures that we've been doing are the protective measures that are going to protect more elderly and high-risk individuals washing your hands consistently, avoiding being around other individuals as much as possible. And if you have someone who's sick at home and you also have someone who's high risk of getting very ill, if they become sick, you could consider having them stay in a separate household. Or if you can't do that, at least have them stay in a separate portion of the household where they're not going to be coming into contact with each other as much. Washing the hands, washing surfaces around the household, washing surfaces that you interact with regularly, or that those people at risk or those people who are sick interact with regularly, can help to fight the spread of transmission. And really that's the most fundamental thing you want to do is to stop this problem before it starts, especially in those who are most susceptible to severe disease.

Host: So, I wanted to talk about Remdesivir and convalescent plasma, and have they helped patients with COVID-19? What are you finding? What are the results? How are those things going?

Dr. Hayes: So, according to the studies that we have out of NIH, as well as the Gilliad Phase Three Simple Studies, which were also engaged in at Prisma Health, along with sites around the world, there does appear to be some benefit to Remdesivir. Remdesivir is an IV medication that essentially mimics one of the building blocks that the virus uses to create new copies of the virus. When the virus takes up Remdesivir, thinking it's one of the building blocks for production, it ends up gumming up the works. It stops the factory, the preliminaries of the virus from making more copies of the virus. That's the theory. That was the theory when Remdesivir was originally created to fight other viruses like Ebola and MERZ. But when they actually put it into clinical practice, there is some thought based on what the NIH data shows, what the simple studies data shows that it will help people maybe get better a little bit sooner, maybe five days worth of treatment is just as good as 10 days.

And maybe people will have less issues with their breathing or how long they're in the hospital. If they received the drug. Now, this is some of the picture. There's still a lot of studies that need to be done, like how people are going to do when they're on multiple medications or treatments on top of Remdesivir, and how those treatments work together, which brings me to convalescent plasma. Which you mentioned, convalescent plasma is where you take antibodies essentially, you take the liquid part of the blood that has the immune system and the antibodies in it from a person who had COVID-19 and then got better. So their immune system has learned how to fight the virus. That's the theory. And if you take out a portion of their blood, you take the plasma portion of their blood with the antibodies and the immune system in it. And you put it in someone who's actively sick. That sick person is going to have the other individual's antibodies, helping to fight the virus.

And potentially some of that person's immune system helping to explain to the sick person's immune system what's going on and help it to calm down, to prevent the inflammatory process that we see. Now, we have seen some results with convalescent plasma in the hospital setting that are anecdotal, but do seem promising. Some people have shown some good response, but really that's for folks who were treated usually earlier in the course of disease, there are some folks who've gotten convalescent plasma and who really haven't shown much of a response. And those tend to be folks who are further along in course of their illness, which might be a testament to the fact that the damage is already done. And really a lot of these treatments probably do their best work when they can be given early, before you're seeing scarring in the lungs, before you're seeing irrevocable damage in the rest of the body. For the actual outcomes on a statistical level for plasma, I feel like there's a lot that still needs to be gathered.

As I said, what we've seen is anecdotal and what we really need, what the responsible medical approach is, is to gather all this information from what we've done so far and look at it, give it a good, hard objective, look and see whether or not there's a statistically significant difference. And I think that that literature should be coming soon, but we don't have all of it now to make very confident decisions about kind of how to announce the efficacy of the drug. So I think it has a place. I think its best place is within the confines of a clinical trial, where we gather this data and use it to help affirm our decisions. But there are at least some anecdotal situations where I've seen good outcomes. So I'm interested in the therapy. I think it's a therapy worth pursuing, but I think it needs a lot more research. All of this does, this is all just very new, the whole, you know, the whole issue with the virus is new.

Host: Are there long-term health implications for people who've had COVID-19 do we have any sense of what life could be like for them 10, 20, 30 years from now?

Dr. Hayes: Yeah. Well that's a really interesting question. And I, you know, in some ways that's kind of the million-dollar question with this, is what are the long-term implications? And it can be hard to kind of rub the crystal ball and see this because the disease has really only been around since what the end of December, the beginning of January. So we don't have that much time we can extrapolate from other diseases like SARS, like the name even SARS Kovi two, that we use for the active disease process from COVID-19 is because of its close genetic relationship to SARS. Which was big outbreak back in the day that we saw in Asia, as well as Canada and some other places. They did do studies on SARS, looking at long-term outcomes and they would see issues up to two years later with people still working to get back the functionality to breathe appropriately. They're still working on getting their breathing back. It could take two years before they're back at a functional level with their ability to breathe. Some people were having big issues with hip fractures.

So, steroids were used a lot with SARS back then and steroids themselves can have side effects. One of those side effects can be the effect on the bones leading to things like hip fractures. And that was a big issue that they would see after a two-year follow-up of folks who had SARS. And then the psychological component is huge. A lot of people would have issues with depression, anxiety, the trauma of being in the hospital being vented. And I suspect that you're going to see that one of the largest reverberating issues from all of this, not just the people who are sick, but their family members and really all of us who are going through a kind of steady constant trauma, are mental health issues. And those will definitely be long-term. Now specific to the physiology of COVID-19, in terms of just like a disease process affecting an individual, it does seem that probably some people are having long-term side effects from things like clots. So they will get something like a stroke.

And even after the virus has gone, that stroke damage will remain. And that could be something that they live with for the rest of their lives. Other issues that we might see long-term that are a little less grim, but important to consider is the immunity itself is how long term is the immunity that we're going to get to this virus? Is it going to be three months? Is it going to be two years? It's hard to say. Some folks think that if you extrapolate from other Coronavirus infections, you may see something where you have a kind of brief immunity. That's going to wane down over time and potentially allow you to be reinfected. I don't know that I've seen a lot of data yet to really strongly convince me that people can be reinfected. But again, it's just so early in the course of disease, the hope would be that if people develop immunity after an initial exposure, that's going to be enough to kind of get them through this pandemic. And that hopefully we'll be able to elicit some kind of immunity that can be used for other individuals on top of vaccines, on top of convalescent plasma, just the immunity, the herd immunity. It's going to be useful here, but those are also just long-term implications that everyone is not entirely confident about right now. We're still figuring it out.

Host: One of the things that's been alarming is an increase in younger COVID-19 patients, especially under the age of 30. Does the disease impact them any differently? And why is it important for them especially, to help to stop the spread?

Dr. Hayes: So, it does seem like the worst brunt of the disease is for the elderly populations. As people get older, we've had a whole range of individuals coming into the hospital. Not too long ago, had someone who was just 18 years old coming in, who was getting coordinated for convalescent plasma. And I think that even though older folks are those who have comorbidities like diabetes or being overweight, tend to be more likely to get severe infection, the best way to protect them isn't by these treatments like Remdesivir and convalescent plasma. The best way to protect them is to prevent them from getting sick in the first place and younger individuals who don't have a severe disease, who aren't going to be on their back at home, stuck in a bed, trying to get better. Those individuals are going to be out and about in the community with the disease, potentially spreading it around. So those individuals need to protect not only themselves, but the people around them by doing things like washing hands, wearing a mask, social distancing, they're going a long way to helping people. That treatments like Remdesivir and convalescent plasma could only dream.

Host: What would you say to people who maybe just aren't taking this disease seriously enough?

Dr. Hayes: We can get past this. We can beat this. I really think we can beat this, but it's going to take a unified response from everyday people. It's going to be the people in the community who really dictate out what happens with this disease process. People can speak from a podium about anything. You know, the CDC can say whatever they want, but it's got to be the buy in from everyday citizens that really make public health work. And those same individuals are the ones who are going to beat this disease and kind of get this whole world running again by wearing masks, washing your hands, and social distancing or physically distancing or whatever you want to call it. By stopping the spread of disease, you can really end this, but it's going to take a unified effort from everyone involved. If you happen to not be taking this seriously and you become sick and you start to understand how significant this is, you know, you've got a real opportunity to turn this around by contacting the American Red Cross.

Or more locally within the State of South Carolina Blood Connection based out of Greenville, contacting them, letting them know that you were sick and that you want to donate plasma. You can donate convalescent plasma, and you may be able to save the life of someone else who becomes sick. So even if you feel like I wasn't taking this seriously before I got sick, now I understand, but it's too late. It's not too late to do something. And I think that's a very empowering principle here for the communities. Anyone can do something to make this turn out better for everyone.

Host: That is a great place to end and great advice. And I know that you're right. I think we all do that. We will get through this eventually, but we aren't there yet. And it really does require that everybody do their part. And as you say, if you did get the disease, help someone else, pay it forward, give the convalescent plasma because it might save somebody else's life. So really educational, inspirational to talk to you today, doctor, thank you so much for your time. And of course stay well. Stay up to date on the latest developments with COVID-19 by visiting Prismahealth.org/Coronavirus. And if you found this podcast helpful and informative, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Inside Health, a podcast brought to you by Prisma Health. I'm Scott Webb, stay well. And we'll talk again next time.