Transcription:

Introduction: This Columbus Community Hospital Podcast on COVID-19 recorded on April 29th. It's another edition of our podcast series, Columbus Community Hospital Health Cast.

Bill Klaproth: As COVID-19 continues to impact the nation. There are a lot of questions about testing and treatment here to answer some of those questions is Dr. Mark Howerter, Physician Director of the Columbus Community Hospital Emergency Department. Dr. Howard, thank you so much for your time. So first off, can you start by talking about some of the testing methods that are available?

Dr. Howerter: Yeah. The test that we have available right now are a couple of different varieties. One's called a PCR nucleic acid test. That's the kind that gets sent to a reference lab that we do not get instantaneous results from. Usually it's a two to four day process typically to get results back. Very sensitive test, meaning that if you have the illnesses apt to pick it up. So it's about 95% sensitive. And then the other test that's available, at least to us is the test put out by Abbott and that's got a lot of fanfares. That's a test we can get a result back in about 45 minutes, so we could do that in house, and that's called an antigen test. A little different in that it's not quite as sensitive, maybe only about 70% sensitive, which means that you could have early virus and it may miss it. Frequently we will turn around and do a PCR test to confirm the negatives. If it is, say if it says you're positive, then you definitely have it, but those are the two tests that we are generally doing at this time.

Host: And those are the two tests that you're using at Columbus Community Hospital?

Dr. Howerter: Yeah, those were the, those would be the two types of tests that we have available.

Host: And can you explain the process? What does this testing entail?

Dr. Howerter: When a person has suggested symptoms and or known exposures, then what we'll do is the test. Now that the PCR test is called a nasal pharyngeal test, that means the swab goes a little deeper into the nose, has to stay there for a few seconds, collect enough RNA and determine whether the virus is there. The antigen test is one that just goes just kind of rim, the tip of the nostril, a little easier test to do. But again, that one isn't quite as sensitive. That's how we do the test when they're necessary.

Host: So one big question people have is the quantity of tests and why medical facilities aren't testing more people. Of course we hear a lot in the news about testing. Can you speak to that?

Dr. Howerter: That's a little bit of a disconnect between the policy makers and you know, what can happen in reality, and we've been seeing that a lot on a lot of fronts, but basically the entire country, in fact, the entire world has been trying to test for COVID. So you know, in an illness that wasn't even known to most of us until the first of the year, and the fact that A, tests have become available, which means they had to be manufactured from scratch and then get them distributed to the entire country and actually the entire world. And that's a pretty massive project when you think about it. So the rollout has been, you know, not as fast as everybody would have liked, but in reality probably still pretty remarkably fast. But the fact of the matter is that we just don't always have enough test. When we first started testing, we literally had about 30 tests available period. And so we had to be pretty judicious about who got to test. We could run a test in one day. As this has gone on, the number of tests has improved. And you know, right now we probably have in the order of about 400 tests available. So that's, you know, significant improvement. You know, we still have to be judicious about who gets a test. We don't want to squander tests because if you really need the test, we don't want to have run out because we just didn't use them intelligently.

Host: And as we continue to talk about testing, aside from testing for the actual virus, there are some antibody tests out there that are said to determine if someone has recovered from the virus. Can you explain those tests and your current thoughts about those tests?

Dr. Howerter: Yeah. So briefly antibody testing. And you know, we can do antibody testing for most viruses, you know, measles, mumps, rubella, chickenpox, etcetera. And there's a, what we call an acute and convalescent serum antibody. And so and those antibodies are, are the same classifications of antibodies for all viruses. So if you have one class of antibody, we know you're currently sick and if you have another class of antibody, we know you're not currently sick but you have been sick and that's kind of recognition of previous disease. So the same types of antibody tests are being developed for COVID. Now unfortunately it has to be developed for each specific virus. Even though they are the same class of antibodies. It's like classifications of cars. Not all cars are forwards, you know. So not all antibody tests would necessarily test for Corona. So these have been developed, they haven't been FDA approved. They are FDA sanctioned for emergency use, but they're not FDA approved. They are not widely available.

Host: All right, well thank you for that information on testing Dr. Howerter, so let's shift to when someone tests positive for COVID-19 first, let's clarify. There is currently no vaccine or cure for COVID-19. Correct?

Dr. Howerter: That is correct.

Host: And at the same time we have heard doctors are using different drugs to help lessen the severity of symptoms. One of those is hydroxychloroquine and that has been in the news recently. What can you tell us about the use of hydroxychloroquine?

Dr. Howerter: Yeah, so hydroxychlororoquine, has coming in with a lot of fanfare. And the thing about hydroxychloroquine is there's been a lot of observational studies, if you want to call them that, but observational anecdotes that there were cases where it seemed like hydroxychloroquine made a difference. But you know, the gold standard for how we practice medicine is we love randomized clinical trials where we can actually try it over a bigger population. Does it truly in fact make a difference or is it, you know, did we just happen to notice that somebody got better and happened to be on hydroxy chloroquine, and it was truly cause and effect. So some of the early studies that have come out and they aren't great studies. I will preface this by saying that none of these studies that have come out yet are very good studies. They aren't really well-designed, but they were done very hurriedly, but they haven't shown quite the promise that we had hoped. But as a side note to that, some of the studies that have been done, they've used hydroxy chloroquine on the sickest of the patients and they had the highest death rates and that probably isn't real surprising. So what we do know is that there's observational evidence that it might work, but what we don't know is there any true evidence? So right now the FDA is not recommending it. We will still use it in elected cases and, you know, the jury is still out.

Host: Yeah. With the FDA said there's insufficient clinical evidence at this time to be able to recommend it for use. However, that doesn't mean for specific individuals at a different timeline within someone who tests positive for COVID-19, it may in fact work. We just don't have those answers yet. So as time goes on and more tests happen, we will have those answers. It may be useful. Very early on for a certain specific portion of the population. Those answers still need to come.

Dr. Howerter: That's absolutely right. You know, my, my bias is that I think what we're going to find is that if it's used very early, it probably makes an impact in some cases and if it's used late, you know, the cows out of the barn. It isn't very effective in that scenario.

Host: Right. So more testing at this point is needed. And there are many, many, many different tests and trials for many different types of drugs going on right now is researcher certainly race for a treatment and for a vaccine as well. And speaking of that, do you know of any other drugs that are showing promise to help symptoms of COVID-19?

Dr. Howerter: Well, yeah, there are several that are being studied. So far. Nothing has been earth shattering, remdesivir, which is an antiviral drug has been studied, doesn't look like it's the silver bullet that we hoped it would be. But it may be helpful. Some of the anti HIV drugs are being studied and again, you know, we just don't have enough information to know whether they truly help or not. It appears that in the people that are really sick, those drugs may not be as helpful. And again, probably like hydroxichloroquine, they may have better useful than they're used early. The other thing that's really exciting I think is plasma from recovered patients. So these are antibodies taken from recovered patients, that also is being studied, not available to just anybody. The only way you can get that is in the domain of a study. But it does look like the early returns are looking like that's probably going to be really helpful.

Host: Well we know there's many researchers and doctors and scientists working on this, so it's good to hear they are making progress. So when someone tests positive and is experiencing minor symptoms and can manage those symptoms at home, is that the best recommendation? Just stay at home at that point?

Dr. Howerter: Yeah, it absolutely is. I mean just from a numbers standpoint, you know, you couldn't even conceive of hospitalizing everybody that's got COVID-19. There's, there's not enough hospitals in the world to do that. People that have minor symptoms is going to be much like a common cold and, we clearly wouldn't hospitalize everybody with influenza or the common cold. And this is the same scenario, and really the people with minor symptoms, especially those that don't have the risk factors that they're not diabetic, not obese, non-smokers, don't have chronic lung disease, don't have hypertension, don't have heart disease, and aren't immunosuppressed for one reason or another. That group that don't have the risk factors and have minor symptoms will clearly get better without requiring any kind of intensive medical treatment.

Host: And Dr. Howerter, last question, is there anything else you would like to discuss regarding COVID-19 testing or treatment?

Dr. Howerter: Yeah. Again, I think the testing that we have available to us now is pretty good as far as determining whether you have it or not. The treatments so far, there is no panacea. It's mostly common sense is getting plenty of rest to staying hydrated. It's avoiding other people so that you don't spread the disease and tincture of time and you tend to get better. For those that have it, that feel like their symptoms are worsening, they get more short of breath, they are having mental status problems, things like that. Then they definitely need medical attention and those are people that we would hospitalize generally.

Host: You know, this is an ongoing story and kind of a moving target from time to time, so it's a great to have. You want to get the latest regarding COVID-19 and I'm sure we're going to be learning and understanding a lot more about this virus as time goes on. Dr. Howerter, thank you so much for your time. We really appreciate it.

Dr. Howerter: Great. Thank you.

Host: That's Dr. Mark Howerter, and for the latest information on COVID-19 in Columbus and how the Columbus Community Hospital is responding, please visit Columbushosp.org, that's Columbus H O S P.org and if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Health Casts from Columbus Community Hospital. I'm Bill Klaproth. Thanks for listening.