COVID-19 - One Year In

Transcription:

Melanie Cole (Host):  Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And today we're talking about COVID-19, one year in. Can you believe it's been a year of this? Joining me today is Dr. Bud Lawrence. He's the Medical Director of the Henry Mayo Newhall Hospital Emergency Department. Dr. Lawrence, as I said in my intro, can you believe that we've gone through a year so far? I'd love for you to update us, tell us what's going on. What do we know now? Help us to understand some of the latest information that we're hearing.

Bud Lawrence, MD, (Guest): Well, thank you so much for having me today. I think it's an important conversation. I Agree. I can't believe that we are already one year into this. Time seems to be going by both extremely slowly and very quickly. I would say the most important things to know about this is that it's still here. COVID is still here. It is still affecting patients. We still have new patients coming into the hospital. We have new positive results and we still have to respect COVID in terms of its effect on our communities. So, that's really the most important thing. I should say that over the past year, we have certainly learned quite a bit about COVID, yet in the same breath, there are still many things that we don't know. One of the challenges that we've had this whole time with COVID is getting a robust amount of information on how to treat this illness, how to keep it from spreading. We know the simple things to do, but the real in-depth things I think will bear themselves out over time as we get more research that's been compiling data throughout the past year to slightly longer than a year in other countries.

So, once we start getting that information, that data, I think it would be very helpful for us to understand the real finer points about this illness. But I should say that, we have learned quite a bit. We've become much better at helping patients when they get sick enough to come into the hospital. We have really refined our treatment modalities, a lot of trial and error to get to where we are here today. But I should say that we are definitely in a much better position than we were with year ago.

Host: Well, like the flu, when they come up with the flu vaccine, Dr. Lawrence, we look at other parts of the globe to see what happened and make the vaccine based on that. Have you, has this also been the case with COVID? Have we been able to look at what they've done? How have you learned the things that you've learned?

Dr. Lawrence: Let's break down the vaccine piece a little bit. The initial vaccines that we have out now, which currently we have the Moderna and the Pfizer vaccine, those are mRNA vaccinations, and they were made very early on in the COVID process within the pandemic. Essentially, once they were able to get the genetic code of the Coronavirus that causes COVID, they were able to really rapidly within days, create these vaccines.

And then they had to go through the testing processes and the approval. And then, you know, the making sure we have enough to give to people and the rollout process. So, these are based on what we knew about this Coronavirus back in the very beginning. So, it's not like that flu vaccine in the sense that it hasn't been fine-tuned or honed but it is still extremely effective. So, one of the things that we know about these vaccines is they're remarkably effective in keeping people from having severe or moderate COVID infections in terms of having symptoms. So, we know they work really well, but they are based on the initial genetic makeup of the coronavirus when it initially came out and there have been some variants. I'm sure as everyone listening to this podcast knows. There have been very intuitive cropped up from various countries. And even a variant in Southern California. So, at this point there is a little bit of trepidation on in terms of how these vaccines will work. But the initial information that we have is that they both still work very well against these variants, but I could foresee an issue where just like that influenza vaccine that we have to have yearly, that there will likely need to be boosters for COVID and those boosters may contain additional material to combat these variants. Again, a lot of this is still unknown. We, like everything in COVID we really don't have a lot of data.

Host: Well, and it's interesting the mRNA technology is not new, right? This has been around a while.

Dr. Lawrence: It has, it's been used in other medications, for example, medications that treat cancer. But it is in particular, extremely effective as a vaccine for the Coronavirus that causes COVID. With most vaccinations, it would be very rare to get efficacies that it works so well as these vaccines do where it's working up to 95% of the time in the test populations. And I think we're sort of seeing that as well in the real world when this vaccine has rolled out. So, extremely effective vaccines with what is felt to be very safe technology that we have had in the past. I think that rolling out the vaccine currently, where we are now, today, we are seeing a significant decline in our COVID-19 cases.

After all the holidays caused a big bump in cases, we're seeing a significant decline. And I think a lot of that actually has to do with the vaccine. Granted we have not nearly vaccinated the number of people that we would like to. However, I think that those vaccinated people are sort of disrupting this chain of transmission from person to person. So, that the COVID-19 does not go rampant through the community. It's sort of stifled if you can think of it that way. And I think that has made a big difference in the amount of cases that we've been seeing over the past week or two.

Host: Fascinating what you guys have been able to accomplish, Dr. Lawrence. I mean, you really blow me away. You ER docs and all of you frontline healthcare providers have just been nothing short of heroic. Amazing. And any other words that I can think of, but it is really amazing what you guys have done. So, tell us, as far as you guys are concerned, how have protocols and recommendations changed now we're even hearing from Dr. Fauci about double masking. What have you been hearing and what are you telling your patients?

Dr. Lawrence: I think I said this before, but one of the most amazing things about COVID is just understanding what we don't know and things change so frequently. Medication recommendations change. Masking recommendations, quarantine recommendations. Everything is very fluid and I would anticipate to maintain that fluidity. And I think you will see more changes as we move forward, because again, all the data and information that we usually have about disease processes, we don't really have that for COVID-19, but it is trickling in. We're amassing more and more data over the months. And I think over the next, probably five, six, seven, eight months, we'll probably get some very good research done that really gives us clear guidance because clear guidance is something that we've really struggled with through COVID.

The most notable thing that you probably have seen the news is medications, certain medications come into favor. We think that they might work and in a couple of some anecdotal cases that patients did very well. And then they realize, well, wait a second, maybe this medication causes more harm than good. We've seen a great deal of that throughout COVID. And I think that the masking requirements or the recommendations have been changing, all those things have been changing. At some point, we're going to settle on what we know works, but I don't think we are there yet. So, what I tell patients is that this is today's current recommendation. What I'm telling you today, might, same thing with this podcast, might not be what we're talking about a week, two weeks or a month or two months from now. And I think that people in the community need to understand that there are very few truths in COVID that we know to be accurately truthful.

And we are trying our best. We have very smart people trying to go through and figure out what the optimal way is to manage this. And I think we're making excellent headway. And I think the proof is in the pudding with that, we see a lot of patients are doing when they get so sick, they have to come to the hospital, many of those patients are doing much better than they did in the beginning of the COVID illness process, you know, a year ago when we really were just overwhelmed with cases, weren't able to provide personalized care. We're able to do all that now, and we're seeing much better outcomes. That said, I do think there are more changes to come in the future.

I think the most important recommendation to patients or community members is to keep yourselves educated. I think most people in the community these days are fairly educated. And try to maintain that and still continue to learn on your own about what the current recommendations are. Because again, I would expect them to continue to change as it is a continually moving target that we're all kind of on the same rollercoaster, everybody's riding together. And at some point, the rollercoaster is going to stop and we'll have a really good understanding, but I don't think we're there yet.

Host: Well, that's an important message Dr. Lawrence, and we have to be patient. I know some people are really getting this COVID fatigue and they're not patient, and they want to go out and resume life the way that it was. But we have to stay the course, as you said, we're all on this rollercoaster together. So, speaking of the future, do you think, and this is in your opinion, that things will go back to normal? Like, I mean, when you think about it, we used to forcefully exhale onto a birthday cake and blow out candles, and then everybody would eat said cake. Are we going to not be doing things like that anymore? I mean, I'm fine with never doing that again, but really certain things people are wondering. And even my husband is wondering, he says, I think we're going to be wearing masks for the next 10 years. In Asia, they've been doing those kinds of things for years. What do you see happening here?

Dr. Lawrence: So, my personal opinion and I'm not a fortune teller, but I think that there will be a return to normalcy, but I think we have to maybe redefine what normal is. I think that's going to be the trick. I think that probably everybody listening to this has watched a movie at home or a TV show where you see a bunch of people at a concert or a baseball game, or even something silly, like people shaking hands and your birthday cake analogy. Like you look at that now and you're like, what is this craziness that we were doing before? How could we have ever put ourselves in that high risk situation? So I think that there, I do think that there will be a return to a more normal. I think that there, that we will be able to have baseball games in person and sporting events and concerts and school.

Obviously, school is huge. There will be a return to normal, but that normal is almost certainly going to look fairly different. And whether it's for 10 years, like your husband thinks or indefinitely I do think we will be able to get our small businesses back on their feet, that we will be able to get kids back in school and we will be able to get back closer to life as we knew it before, but I think that we all have a better respect for what we would now consider to be high risk behaviors. And I think that whether it's COVID-19 or some other virus or any other contagion, we I think are going to have a better respect for that.

And I think that we have a better understanding of how to manage that. And I think that will carry with us for a very long time, if not indefinitely. So, I'm hopeful that things will come back to normal. I agree, people are fatigued from this. This has been a huge challenge, not only economically, but also socially. And from a mental health standpoint, there is essentially a mental health crisis going on right now, as we try to deal with this. I think you brought it up before our healthcare workers are our frontline heroes in health care that have been working on this. Just imagine that they have been doing this for over a year now. And it is remarkable the effort that our healthcare heroes have given to their respective communities nationally, and in fact, throughout the world. I mean the difference of leaving work today versus two years ago, you are two times, three times, four times more fatigued from wearing a PPE, N95s all day.

It's not that you can't do these things. It's just that it is it's exhausting. And my heart goes out to all of our healthcare heroes, our first responders, police, fire, all these people that are out on the front lines, helping patients through this and helping our communities stay afloat. They deserve a special, thank you. And I'd like to deliver that to them today because not only has it been hard for our community members throughout the world, it's been a challenge significantly to our healthcare providers and frontline personnel.

Host: You're choking me up, Dr. Lawrence. Everything you're saying is 100% and it's still such a mystery. And I'd love for you to give us some final thoughts. You've given us a lot of encouragement here today, and a lot of great up-to-date information. But if you would summarize what we know now that maybe we didn't know one year ago, whether it's the variant or variants or protocols or whatever it is, what you would like the public to know about how you all are doing and what we can expect, if we can even say what we can expect, but what you'd like them to know.

Dr. Lawrence: Well, I would say, I don't know that we can know what to expect, but I think that we can be cautiously optimistic that all the smart people out there that are coming up with new protocols, new medications, and new ways to manage this disease that we have had a significant improvement in how we manage COVID-19. I think that the vaccines that are out now and the vaccines that are coming again, you know, there are supply chain issues in getting these vaccines to the amount of people we want to get them to. I think that once we get these vaccines in play, the landscape of COVID-19 is going to change significantly.

I think we are already seeing that. I think that that is something that our community and the public as a whole needs to understand. You may have concerns about being vaccinated. You may be anti-vaccine, whatever your thought process is, now is the time to come together as a community, as a state, as a nation, and as a world to get vaccinated for this disease process so that we can stop the havoc that it's causing not only in lives, but in mental health and in economic distress, not only to individuals, but obviously to businesses. This is our chance to sort of right the ship. And so I am cautiously optimistic. I'm even more than cautiously optimistic that things are heading in the right direction.

I think we need to pay attention to the things we've said the whole time, which are wear a mask or maybe two masks or three masks. And also you know, wash your hands. Don't touch your eyes and face, the little silly things that I think we all know now. I think we still have to keep those on the top of our head and I think we still need to practice those good behaviors. There are variants out there now and I think it's important for people to know that those variants are a result of mutations from this virus. And these mutations are essentially mathematical. The more viruses that are being produced in the world, the more likely there are to have mutations that are significant, that can either cause worsening disease in patients with COVID or maybe they're more contagious and more people get COVID.

Those mutations are mathematical. If we can cut down the number of viruses floating around on earth, the number of mutations will decrease. So, it is yet another reason to get your vaccine. Because any person who's vaccinated and is going to have a much less number of viral particles floating around this planet. And that means there's going to be a less likelihood of a significant perhaps even disastrous mutation from this virus. And we need to be aware of that and we need to be proactive and the best thing that we can all do is to limit the number of viruses on the planet and the best way to do that is to get vaccinated.

So, in conclusion, I think that we're heading in the right direction. There are many reasons to be optimistic. I can't really say, like the end is near, like, the light is at the end of the tunnel but I do feel that way. But I do again, think we have to probably redefine what is a new normal for our society. And I think that will define itself. And I'm hoping that we can get back to a state where we're past this fatigue and that it's no longer a huge, massive burden on our minds and our communities and on our world. So, I am hopeful that in the short future, that things will head back into some element of normal so that we can all move on with our lives and be the productive humans that we are.

Host: Well said, Dr. Lawrence. Wow. You are such a great guest. What an informative episode this was. Thank you so much for updating us and listeners please share this show with your friends and family, on your social channels, because I can tell you right now, and I do a lot of these shows; this one was definitely one of the most informative. He gave us the, where we are and what has changed and what we still need to do. And it was so, so important. I hope that you will share this show and spread the information around so that we're all getting really quality information that we can trust from the experts at Henry Mayo Newhall Hospital.

And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. For up-to-date information on the Coronavirus, please visit Henrymayo.com and click on the Coronavirus link at the top of the page and you can get that up-to-date information that we all really crave. And please, again, share the show so much. We're learning this great information and it's stuff we all need to hear. I'm Melanie Cole. Thanks for listening.