Edited Transcript of Dr. David Price video, “Empowering and protecting your family during the Covid-19 pandemic”

I wanted to put up my edited transcript of a video that has gone viral over the last few days. It’s a video call with  Dr. David Price of the Weill Cornell Medical Center in New York City. Dr. Price is a Fellow in Pulmonary Medicine and Critical Care, who works primarily with Covid-19 patients, so has had a good deal of experience treating this new illness.

The opinions expressed are his opinions, and some medical professionals disagree with some of his points particularly about the potential for transmission from speaking. In general, though, I found this interesting and useful.

Video Link: (57 minutes video)

https://vimeo.com/399733860 

Title: Empowering and protecting your family during the Covid-19 pandemic

Edited transcript. (Edited for clarity. Headings, underlines and boldface are mine.)

Right now in New York City with Covid, we are accepting about 20% of the volume of Covid patients in the city and so technically as an ICU doctor patients will come to the hospital, see someone like my dad, who will decide if they’re sick or not, If they’re good enough to go home they never see me. If they are sick then they’ll come up to the floor and then if they’re very sick, then that’s when someone like myself will get involved. My job is to decide which patients need ventilators and once patients are put on ventilators how long they have to stay on them. The treatment of these patients and so my whole long-winded point is that I’m kind of in a unique position to comment on what’s going on.

The first point I want to make is why did I think it was important to have this phone call;  I think in the medical community, especially for people on the front lines, there’s kind of two thoughts right now about interacting with your family and talking to your family about what’s going on. The first is to get angry. I think that that a lot of doctors are looking around the country right now especially doctors in New York and thinking that people are not taking this seriously so there’s kind of a desire to scare people into getting serious. There’s a second kind of feeling out there right now and I think that this is what I’m feeling right now is that doctors like myself are in a very unique position to actually empower people right now.

And what I mean by empowering is to learn about this disease. I know you guys have a lot of questions. We will get to as many of these questions as we can. But the main reason I want to have this call is that I don’t want you guys to be scared. We’re three months into this in the medical world and we understand this disease. So I’m going to go through ways to protect your family and then what to do if and when someone gets Covid-19 and how we can protect our circle.

Just a quick introduction as to what’s going on in New York.

I work at probably the premier hospital in New York City. It is a 1,200-bed hospital. We do everything from surgery to transplant transplants heart transplants. At this point, we do none of that.

Almost none of that. Our hospital is almost exclusively a Covid-19 hospital. And so people enter through a secure gate in the front. Almost exclusively what I do all day long is to see people with Covid-19.

But we’re learning and we know a lot and what I want you guys to know is that every single day we’re getting better. We know more and I am confident that the stuff I can tell you today. I’m should make you guys feel like when this comes to your community that you don’t have to be scared and that you can protect your family.

Before I start I just want to say thank you for everyone who responded to all of the mask requests. It was overwhelming. I’m receiving masks pretty much every day now. We still have a severe shortage but it’s something that is improving every single day and I think it’s just really great to know that I have all you guys behind me.

What is Covid-19?

Okay, so let’s get into stuff that’s actually helpful. So the first thing is just what is Covid-19, I mean, it’s now every single news story it’s political and economic. What is this disease? So this is a virus. It’s from what we would call really think of the common cold family the coronavirus family. But what’s unique is that the human body has never seen this virus before. And so this obviously started in Wuhan the thought is that it came probably from an animal and then made this way into the human body for the first time.

And so when the common questions I get is what is this disease look like? Commonly people have fever and cough and they have a sore throat. And then the virus goes to their entire body and what we have found is that the most likely place that this will affect is your lungs.

And so people will commonly have a cough but for about 80% of people, you just don’t feel good. You have a mild cough maybe have a little headache. The disease lasts from what we’re seeing between five to seven to fourteen days. Some people who have a mild disease by about day five are starting to feel better. People who aren’t feeling better usually start to get short of breath around day three to five and then start to feel better around that seven-day mark.

The first kind of big topic we’re gonna talk about and I think the reason I wanted to have this call is how to protect your family.  I think we’ve learned a lot and I want to kind of share all the stuff that I’ve learned so far with you guys. So I think the first thing is how do you get Covid-19. I  think that this is really important and we really learned a lot over the last couple weeks to months about how you get this disease.

The overarching theme is sustained contact with someone who has this disease, of which the vast majority is people with fever and aches. Or with someone who is about to get the disease. So someone in the next two days who’s going to develop symptoms of this disease. The way that you get this is the transmission of the virus almost exclusively from your hands to your face. From your hands to your face and into your eyes, into your nose or into your mouth.

So there’s a lot of talk about contact or getting it through contact hands to face there’s also a small thought that it can be aerosolized that it can kind of exist a little bit in the air before at this point is that you actually have to have very long sustained contact with someone and I’m talking about over 15 to 30 minutes in an unprotected environment meaning you’re in a very close room without any type of mask in order for you to get it that way.

But to very simply state the overwhelming majority of people are getting this by physically touching someone who has this disease or someone who will develop it in the next one to the two days and then touching their face. And so that actually I think it is incredibly empowering.

As I’ve been in the hospital the last two days it’s the thing that makes me smile a little bit is that I actually know now that I won’t get this disease because I know to protect myself and so I just want to give you guys a few very practical tips to how to protect yourself.

Okay, the simple statement of fact. Covid is in your community. I’m gonna say that again, whether you live in Texas, whether you live in Tennessee, whether you live in Florida, Covid is in your community right now. That is not to scare you. That is to just tell you so that you can then take the steps that I’m talking about and not be scared.

How to Stay Safe by Keeping Your Hands Clean and Germ-Free

So the first step which I think is incredibly clear is to become a hand cleaning fanatic. Know where your hands are and know that they’re clean and sterile at all times.

So very simply for what this means for me in the city is that I walk around with hand sanitizer like Purell. So I walk around with Purell and so every when I leave my apartment everything that I see that I’m going to touch I make sure that I Purell first.

So when I leave my apartment door and I go to the elevator, it’s okay that I touch it with my hand, but then I Purell. When I go downstairs and I open the door it’s okay to touch the door. You can open it with your elbow, but if you touch the door then I make sure to Purell.

So we know that if you keep your hands clean that you’re not going to get this. The second point is that this is not a disease that we’re getting because someone is sick and touched something and then an entire community of ten people gets it because they touched that.

It’s mostly from sustained contact with people who have Covid-19. Out of an abundance of caution, we also make sure that everything we touch,  we’re cleaning our hands. So that’s the first thing is to become a hand cleaning fanatic. Just keep your hands sterile, and you will not get this disease.

The second thing is you have to start psychologically working on the connection between your hands and your face.

So I’m terrible at this. I touch my face all the time. Literally all the time. You don’t realize that you move your hand, you know, you scratch your nose and so the virus has taken advantage of this and the reason why people get this disease is that you have sustained contact with someone. So someone at a party has this and you shake their hand.

And then you touch your face. It’s that simple. That is how you get this disease. So what does that mean? I think there are two practical things that you can do. One is just to start to be aware of when you touch your face. Atul Gawande is a Harvard trained surgeon who is very famous, has a recommendation for people to just start wearing masks. The idea here is not that the mask is going to prevent you from getting Covid because as I said, it’s not a disease that you are getting from the air. The reason to put on a mask is that you just stop touching your face.

And so what I would recommend is now when you’re leaving your house is to wear a mask. And I think those two things combined are incredibly powerful and will prevent the transmission of the disease in your family in ninety-nine percent of cases. Know that your hands are clean and sterile, and don’t touch your face.

There are going to be an obscure 0.01% of patients who get it and we will just never know but I think for you that is an incredibly important way to protect yourself.

Three, you don’t need a medical mask. These masks that people are wearing are not protecting them from getting the disease and front care health line workers need these masks right now. (A medical mask is an N95 mask, which blocks 95 percent of particles, as opposed to a surgical mask, or a dust mask.)

That’s not to say don’t wear a medical mask. If you have one, that’s great,  put it on but it doesn’t mean you have to have a wild supply of masks or N95’s or anything like that. The general community has zero need for an N95 mask. In the hospital where all I do is take care of patients with Covid-19, I only wear an  N95 mask if I’m in the room with that patient doing something that’s going to make them have aerosolization of the virus. That is no one in the community. So to summarize. Always know where your hands are and what I mean by that is when you leave just become aware of when you’re touching stuff, that’s not from your protected home environment.

So if you’re going to go to the grocery store. If you’re going to touch the cart just clean the handle. If you go into the store, and you see people around don’t touch them. It’s incredibly simple. The fourth that I’ll say which is the thing that the government is talking about and kind of is the same principle is distance yourself and so this is incredibly fascinating in New York City it actually has not changed our life that much. So I think when you go to the pharmacy, you don’t have to wait directly on a line with someone, you can stand a couple of feet back from them. Practice physical distancing whenever you are outside your house.

Four important points (the Rules):

 

  1. Always know where your hands are and have hand sanitizer. When you touch stuff that’s outside your home, just make sure that you’re washing your hands.
  2. Start to learn how to not touch your face. A really good way to do that is to start wearing a mask when you’re out and if you want to practice,  wear a mask in your home.
  3.  You don’t need an N95 mask or a medical mask. Any mask will do because this is not preventing the disease. This is training you not to touch your face.
  4. And the fourth thing is just to stay away from people. Stay 6 feet away from people.

So I think this when you understand those four rules the next thing I think is so important becomes true.

You don’t have to be scared of the outside world. No, you don’t have to be scared of your neighbor. And I’ve actually found that to be incredibly liberating right now. So I’m here in New York City, and we’re receiving food from delivery men. We have to go outside to the grocery store. It’s a time when we are all really scared.

And I think it’s what makes it worse outside is when you look at the person next to you and think that the person next to you is going to somehow harm you or harm your family. But when you know that the only way you’re going to get this disease is if your hands are dirty and that if you touch your face or that you are way too close to that person, it becomes incredibly liberating and then all of a sudden the person at the store is not your enemy, they are someone who’s going through this with you.

The delivery person is not your enemy, they are a hero. They’re going out and delivering food at a time when there’s a communicable disease that they don’t. The mailman is a hero. You know, these are people that we have to acknowledge the same way we’re acknowledging and celebrating health care providers.

When you understand this disease and know exactly what to do to prevent getting it then it allows us for the next couple weeks to months to be able to sustain the system that we have we have to be able to have mail, we have to be able to get delivery.

Social Distancing and shrinking your social circle

But if you can protect yourself and you know your family safe then I think that’s empowering. Socially, it’s incredibly important and we do this at my mom’s house as you have to shrink your social circle. And so what does that mean? So in our family, I think you guys know that my parents live on a farm.

We have a lot of traffic to the farm. We had families who could come and see the horses. You have to understand that every person every one of those people has potentially two or three other contacts and two or three other contacts. And so what I would highly encourage you guys to do as the country is shutting down is find you’re isolation group,  find your group of three people or four people your family and set boundaries, and that is it.

The people who are going to get this are people who are maintaining large social circles at this point.

So what does that mean for my family is Gene and our kids and my mom are on the farm. And that is exclusively the social circle that they’re with. They talk to their family every day, they see people through Facetime but there’s no one coming in and out of the house. They can still go to the store and you can go to the store without any fear because you know, if you wash your hands and you don’t touch your face, you’re not going to get this disease. It’s very important at this point to keep your social circles small. Don’t have don’t be going to the Elks club or don’t be putting yourself in a situation where you have a lot of contact with a lot of people because it’s just a vulnerability, you don’t know that the person at the club who you slopped hands with two days later will not have this disease.

So the third thing that I want to talk about is something that is inevitable in a group chat that’s this large is what you do if you get this disease? If you listen to nothing else through this entire thing, just please listen to this part. In Wuhan China,  throughout the world, the vast majority of the spread of Covid-19 is through home and family transmission. Throughout the world, the way this is transmitted is from husband to wife, father to son, daughter to brother and so again, that’s incredibly scary but it’s also something that if you understand the rules is incredibly empowering.

So what do you do if you get sick? Quarantining Tips

If you develop a fever and you are otherwise fine, then isolate yourself from your family. So what does that mean? it’s just simply about the same rules about hands and touching your faces, you don’t want sustained contact with the person who’s sick to the point where you’re going to be able to pick this up off of surfaces or off their person and then touch your face. So what people are recommending is that if you’re able,  have the person in a separate room.

If you’re able, have the person who’s sick have their own bathroom. If the person has to come out and interact with people in the family, this is a perfect indication for one medical mask and the reason is you want to put the mask on the person who is sick. And so if in our apartment if I was sick and I had to come out and interact with my family before I would leave the bedroom, I would wash my hands, I would put on a mask, and then I would sit down and eat food at the table and then after that when I was done I would eat the food, I put it in the sink and make sure that anything I touched which is a very simple area on the table, is just washed and then I’ll go back to my room. The point is to not have sustained contact with someone in your home who has this disease. You’re gonna want to take care of them, you’re gonna want to be in and out of there, checking their temperature. Don’t’ do it!

If you’re touching the thermometer constantly to their mouth that is where the disease exists and then you’re gonna get it on your hands, then you’re gonna touch your face, and get sick. Let them take care of themself as much as possible.

You shouldn’t be scared to stay at home with your family with a fever. If you have Covid-19 the vast majority of people are gonna have a fever, body aches, feel like shit for three to five days,  feel a little less crappy on day seven and then they’re gonna start to feel better. You can start interacting with your family more as you feel better, as your fever Is gone. But you’re still gonna be vigilant, you’re gonna be washing your hands. You’re gonna be a lot more confident 20 days out from the disease than you are 10 days after the disease.

The current recommendation from the CDC is that if I get sick and I’m feeling better I can put on a mask and go to work and so I think that that is a good indication to you that that’s when you can start interacting with your family. Is that you have Covid, and you’ve recovered, you’ve isolated in your room for seven days and you’ve been able to get food and when you’ve been with your family you have worn a mask, and you’re feeling better,  come back out into your family’s life. Keep a mask on, and wash your hands. That is a very simple way to do it.

I’m about to get to questions. I just want to make a few other small points because this is some stuff that’s come up as well, relevant to New York City, what do I do if I have a mild cold? And so I think given how rampant Covid-19 is at this point I think if you have something that feels like a cold or you feel like you’re getting sick is to take the precautions as if you have Covid-19 for 1 to 2 days. If after 1 to 2 days you’re feeling much better and this is like the thousand other colds that you’ve had in the past years because you have kids you don’t have Covid-19  you can go back to your completely normal living at home life with your family. So I think it’s just important the place we get into danger is people being too cavalier when they’re developing symptoms and exposing their family too early.

And when they get fevers and they are staying at home they’re having too much interaction with their family. You can have in Covid-19 in your house and everyone else not get it and be protected and be completely safe.

There are a couple of exceptions to that and I think this is important if you have a vulnerable population in your family, so if you’re living with your lovely 95-year-old grandmother, if there’s someone in your house who had recent chemotherapy and someone in the house gets sick you need to find another living arrangement for that patient or practice incredibly strict isolation of that family member.

We know that the older population is the sickest population when they get this disease and so that is the one caveat to whether you are safe to stay home with your family. If you have someone who’s incredibly vulnerable, you know set up a situation in the house where they’re completely isolated from the person who is sick. Maybe you could have another person take care of that family member in your house, so you have no interaction, but simply being in the home with someone with Covid- 19 will not get you that disease it goes back to the same three principles. It’s touching a person or a surface who has Covid-19 and then touching your face.

The question a lot of people are asking is if I get Covid-19 and I feel short of breath am I just gonna go to the hospital and die? 

This is where I’m probably the most qualified person in the country to comment on what it looks like when people are coming into the hospital and sick.

So first, who should go to the hospital?

If you’re feeling short of breath come to the hospital. That is the rule that is the clearest thing.

It’s not “I have a fever.”  It’s not “I think I have Covid-19”. It’s not “I can’t stop having these body aches.” It’s “I feel short of breath when I get up to go to the bathroom.”

Those are people that should come to the hospital and be evaluated. At Cornell right now what we’re doing is a lot of the people that come to the emergency room, we’re sending home to live out the four or five days of their disease so that they can feel better. We say “oh you look completely fine,  go home.”

But we’re also seeing is that people who feel short of breath who come to the hospital some of them go on to the floor and just are short of breath for five to six, or seven days and then they go home. So of the entire population of people who get Covid-19 about 10% need to go to the hospital because they get short of breath.

Of the 10% who are coming to the hospital about one to three percent of those are requiring admission to the ICU and should be put on the ventilator. So what happens when people get put on ventilators? The vast majority of people, the overwhelming majority of people come off the ventilator and they usually come off the ventilator seven to ten days later, but I think the important thing for you guys to know is going to the hospital is not a death sentence. It’s a safe place for you to be. Go to the hospital when you’re short of breath. Don’t go to the hospital because you have Covid-19.

And then I think the question that we’re going to get a billion times over and I don’t have a perfect answer for you at this point because it’s different in every community. Should I get tested if I have the disease?

If I’m a generic 35-year-old who’s sick I think it depends on the availability of testing in your community. What we know right now,  now that people are home is that if you are not having a lot of social contacts is that if you have symptoms like the flu it’s likely you have Covid-19.

And nothing that I’ve told you about your behavior, such as interacting with your family would change by knowing that test result. The caveat is if your community, whether that’s New York or Tennessee is testing a lot and you have clear access to testing, absolutely getting the test is a good idea because when it’s negative then in a day when you’re feeling better, you can have full interaction with your family.

But if you live in a community where there’s very rare testing going on at this point do not try and jump the line to someone who’s actually short of breath and not doing well just to make yourself feel better to know that you have it. Just take the precautions in your home that I said and then as testing ramps up then we’ll be able to get more people testing.

So I think I’ve discussed everything I want to discuss. I’m gonna switch over to questions and I’ll try and answer as many of these as I can.

How does this virus affect infants and newborns?

This is an excellent question. There have been reports of infants and newborns who have contracted Covid-19. We don’t think that is vertically transmitted meaning we don’t think that it goes directly from the mom to the fetus.  The suspicion is that it goes through contact. The thing that I think makes a lot of parents in this world very happy right now is there’s almost no Covid-19 disease in the population from age zero to age 14.

So I’ll just state that again kids are not getting sick. Now there are some exceptions, you know, there’s a recent New England journal article where they went into a hospital in Luan,  China, a pediatric hospital and in the entire hospital of three hundred kids, they found two to four percent of them had Covid 19 which really looked like cough or asthma. So kids are not dying. Kids are not getting critically ill,  kids are not getting sick. There’s a whole debate about whether kids are transmitting this disease, it’s probably true but I think if the question is, how is this affecting infants and newborns it’s really not.

I keep reading conflicting information on whether Covid-19 is airborne versus droplet transmission do they absolutely know for sure?

What we know is that the vast vast vast majority of Covid-19 transmission is droplet and what that means to all the people on the phone call who don’t know what a droplet means, it’s hands to the face so it’s getting a droplet so something that comes from your mouth either goes on your hand or falls onto a surface and then it’s very quickly taken up,  touched and put on the hand and put on the face. In our hospital the only time that we wear an N95 mask is to protect against airborne transmission, which is just getting it from particles in the air is when we’re doing something to a patient to make them spit a lot.

So when we suction them or intubate them, or we do something to disrupt them, that’s the only time we wear the N95 mask. The vast majority,  99% of the time, we are not doing anything that will create airborne droplets. Eighty percent of the time that the nurses are in the room with a Covid-19 patient they’re just wearing a simple surgical mask.

Only when they’re doing things that are going to make them have to get secretions out or spit which is called an aerosolizing procedure, are we using N95 masks.  So that direct answer to your question is there’s probably a small amount of airborne spread for nurses.

In Hong Kong and Singapore, doing those precautions, which is only wearing a surgical mask when seeing a patient and only wearing an N95 when doing an aerosolizing procedure there was zero transmission to healthcare providers.

We do have health care providers who are getting sick and they’re getting very sick. The people who are getting sick are one very clear population, which is health care providers on the front line who are having extensive contact with patients and not protecting themselves.

So it’s for the most part general practitioners who are in the office in New York three weeks ago who didn’t know that someone had the disease and spent 25 minutes in the room and then did a nasal swab, you know, check their nose and those are the people there that are getting sick.

It’s emergency room doctors who three weeks ago in New York City did not know the level of protection that they needed when they were interacting with people with active Covid-19 disease. What our experiences in our hospital (and we’ve been doing this now for three weeks) is that if you wear the proper protection you can interact with these patients indefinitely and zero people get sick.

We are wondering being in a city as it really safe to go on a run or walk taking in the social distancing measures? 

Amazing question. Yes, please. If you’re in a city, you can go outside just follow the rules. When you go outside purell your hands. When you’re going to press the elevator button, purell your hands. When you touch the door purell your hands, don’t touch your face. When you’re out walking in the city and don’t come within three to six feet of people. But say hello smile no one is giving each other this disease by walking through a city. If there’s a bike path you can walk on it, the only caveat is just don’t get sloppy don’t you know the problem with telling people they can do things is that everyone just assumes their old lifestyle. That is not what I’m saying, I’m saying it’s safe in New York City,  in Philadelphia to go on a walk just follow the rules.

I would encourage you to wear a mask not because you’re getting the Covid-19  from people when you’re outside. It’s because as a society over the next couple of months, we need to train ourselves to not touch our face and we need to tell people that we’re taking this disease seriously. It’s all back to the basic two to three rules, so yes go outside have a short walk, breathe, know that the world’s gonna be here and then go back inside and follow all the rules.

Do you need a medical mask or is a bandana okay? 

I think a bandana is fine at this point where the doctors and nurses don’t have enough face masks,  a bandana is a great idea because it keeps your hands off your face. These are not preventing you from getting the disease, this is only preventing you from touching your face.

What do you do if you don’t have Purell? A lot of places are out. 

I’ll get back to you on that, in terms of the absence of Purell. Coronavirus is a wimp. It dies as soon as you disinfect it but just generally any type of disinfectant. If you’re going out and you don’t have Purell press the elevator with your elbow, you know, open the door with your shoulder, you know, that’s not gonna get you Covid-19. Ideally, if you have Purell, you only use a small drop you’re gonna kill this. This thing doesn’t violate the rules.

Is a long car ride safe say 10 hours?

If no one in that car has Covid-19  you can drive for 200 days and so I think as long as the person if you’re driving by yourself, it’s completely fine if you’re driving with Michelle as long as Michelle has been fine and is fine drive forever.

Is it necessary to wipe things like groceries down with disinfectant when bringing them into the house?

I think the general answer to that is no. I think that you know if you live in New York City where there’s a lot of contact with stuff that you’re getting delivered I think it’s a reasonable idea to have the delivery person leave the food that they’re delivering to you outside your door. You could probably pick it up with a glove and then just open the bag and then all the inside contents are fine that’s it and an overabundance of caution I think is reasonable. What you don’t want to do is high-five the delivery man, you don’t want to shake the delivery man’s hand, you don’t want to pick up the plastic bag that you’re getting from the restaurant and have a huge long interaction with that bag because of course, it’s possible the delivery personal has Covid, but again if you follow the rules and everything you touch you just clean your hands, you will not get it. Continue to order food but no I don’t think you have to have routine groceries wiped down.

I’d like to know if it is irresponsible to go to Starbucks drive-thru.

I think that’s a complicated question. I think if the simple question is can both the Starbucks barista and you safely interact through that transaction, I think the answer is yes. Is it important that Starbucks and people who work there continue to have jobs? Yes. My general sense given that we’re all hunkered down is to make your coffee at home. If you’re gonna go to Starbucks drive-thru follow the rules wash your hands accept the coffee wash your hands and then drink your coffee. And what I mean is a drop of Purell or something equivalent to that. If you can make your coffee and stay home I would recommend staying home. You’re completely safe to go to Starbucks just follow the rules.

What about your clothes when you come home? I guess it’s beyond groceries but like you go out and come home should you be putting your clothes in the laundry?

Absolutely no, that is a recommendation for healthcare providers like for me who I live in rooms with Covid-19  patients, you know for 12 straight hours. For me, I will take off my clothes and wash them and I have a whole procedure for that. For people who are generally going out who are following the rules wear your clothes, no problem.

If you become sick how long should you wait before you go to the doctor or hospital?

So I think we loosely addressed it, but I’ll directly address it. Which is,  don’t go to the doctor, don’t go to the hospital. The only rule for going to the hospital is if you’re short of breath.

What is amazing now is the during the Covid 19 outbreak is the use of telehealth and so by far if you feel sick and you are a little nervous or contact your health care provider by telehealth, and they will tell you that you have nothing or that you have Covid-19 and you should stay home. So do not go to the doctor do not go to the hospital.

I would encourage you to use telemedicine which is completely rampant right now because we have a ton of doctors who are at home and we’ll take your call over the internet.

Is there clarity about the incubation period?

I think the incubation period is probably dependent on exposure. And so people who are exposed to a lot of disease like an emergency room doctor who interacted with the patient for a long period of time without any protection could be anything from a couple of days versus someone who has an interaction with someone with very mild symptoms and it can be upwards to 14 days. Which is where the CDC recommendation is for people to stay home for 14 days. And then there’s been the rarest of reports of it being beyond that so I would say if you had casual contact with someone and you don’t feel sick at 14 days then you are probably are not going to develop Covid disease.

Is there an emerging understanding or hypothesis surrounding contributing to why certain younger patients in the 30s and 50s have been having acute respiratory course compared to their peers? Are these patients truly healthy or do they have comorbidities?

Please listen to what I’m gonna say this disease affects everyone who’s not in the age group of zero to 14. So 23-year-olds, 35-year-olds, 45-year-olds with zero medical problems are getting this disease.

People like that are coming to the hospital people like that are going on ventilators. There is a very evil narrative early in this disease that said that this is only a disease of old people and people who have hypertension or people who have diabetes. That is not true. I can tell you, it hits the entire spectrum of ages so that includes older people who do worse,  we see a little bit more older people, we see a ton of 35-year-olds, and we will understand that someday, but we don’t understand it right now.

And so it’s not to scare you just follow the rules. Yes, you can get this disease from age 20 years old, maybe 16 years old all the way up to age 105 and you can get sick and end up on mechanical ventilation. The younger you are the less likely that is to happen,  the older you are the more likely that is to happen but we see young people who get really sick and we see old people who do just fine. I think it’s a great question and I don’t think we know exactly why young people are also getting sick.

But it’s just to say follow the rules. If everyone does it you’re going to be fine you’re not going to get to the disease. If you get the disease, follow the rules, you can protect your family most people will be fine. If you’re short of breath go to the hospital so I’m just trying to make it as simple as possible.

What are the symptoms? What to do if you have them? Is it okay to use ibuprofen with a fever?

I think I touched on what the symptoms are. The vast majority of people are gonna feel body aches, they’re gonna have a sore throat and they’re gonna develop a fever. Upwards of 90% of people are gonna have a fever.

Very interesting question about ibuprofen, we’re not using it in the hospital anymore there’s really good data from Germany that there are worse outcomes in people, more inflammation of people who use ibuprofen so that’s a simple answer which is if you have a fever take acetaminophen Tylenol, so don’t use ibuprofen use Tylenol it’s very simple.

I’d like to hear a bit about what it’s like treating these patients a couple of stories from the front lines on this thing.

It’s actually fascinating because they all look exactly the same. Everybody has a cough, everybody has a fever.  Most people come into the hospital and they just have fevers. A lot will be nervous which is completely understandable. They look like anybody else. What we see for people who get sick is they get short of breath and then over one to two to three days, they get more short of breath and then they get so short of breath that they can’t walk to the bathroom and then we put them on a ventilator. And then our experience has been that these people usually settle out over the next one day, and then between seven to ten days later barring a complication we’re able to get these people off the ventilator. At Cornell we’re 14 days into this,  our first patient was a 39-year-old who is now home. So he was a 39-year-old who needed mechanical ventilation, he is off mechanical ventilation and he is safely at home.

Dealing with these patients is for a doctor incredibly simple. They all do the same they all get the same treatment for them it’s scary and it’s our job to kind of make them a little less scared and when I tell every young person or old person that I have to put on a ventilator is “we’re putting your on because we are going to get you off” and I think that that’s true, so if you had people or you know, people who are sick and short of breath, you shouldn’t be scared, they should go to the hospital and we will take care of them.

Are hospitals accepting homemade masks or is that something like in my mind? I mean thinking is that something like that’s we should be sharing amongst each other now?

I think what I would say is if you what the main role for a homemade mask at this point should be for you to use it so that you can free up your medical masks so that you can give them to hospitals or friends who are medical providers, so if you’re sitting on a stash of n95 masks. You don’t need those masks you do not need those masks. So I would if you have a homemade mask or handkerchief and you can wear that that would allow you to give those masks to your friend who’s a doctor or a nurse or a respiratory technician so that their hospital is adequately equipped.

There’s a question about the new normal. How long until so there’s a vaccine will there be spikes as people resume life a related question, do you anticipate second and third waves?

Yes, so I think this is incredibly predictable and so I think social distancing will be for months to potentially a year which I know sounds like a lot but I think though the experience from Wuhan,  the experience from Singapore, the experience from South Korea, is that the first thing you do is you flatten the curve the first thing you do is you bring down the number of cases so hospitals don’t get overwhelmed. And then by human nature people will become a little relaxed with their social distancing.

And so there’s a then a second small spike and then after the second small spike, it usually comes under control in the population. So I think social distancing is something that you need to just put in your brain. I think it’s something that is just the way of life for the indefinite future but now that you know the rules it’s not something to be afraid of. It’s just the different way of interacting and as this becomes controlled over the next three to six to nine months in this country, then you’ll know exactly when you’ll be able to hug or touch, you will be able to feel better.

I’d say the first focus for everyone on this call over the next seven to 14 days is to learn the rules because as soon as you learn the rules it’s empowering and then you can start living your life in a new normal which will go on for three to six to nine months.

If you are unaware you have the virus during the incubation period, can you infect other people?

Yes, I think that the answer is yes, and so this comes from the cruise ship data. I think there was a concern, a big concern about asymptomatic spread,  meaning people who never have symptoms of the disease spreading it to people who then get the disease. What we know from the cruise ship data is that that asymptomatic spread it turns out that most of the people who received the virus from someone else, the person who they received the virus from becomes symptomatic in one to two days.

So it’s likely that people who get this disease are shedding the disease one to two days before they have fever So what does that mean practically? It means that if you develop Covid-19 and have a fever, know who the people are in your life that you interacted with over the prior two to three days and let them know.  Because then they can do they can follow the rules they can isolate themselves in their house, they can create a separate bathroom and then after two to three to four days if they’re not feeling symptoms, they’re probably not going to have Covid disease. So the simple answer to your question that is yes,  people transmit this disease but I do not believe that there’s this whole group of people out there who are giving this disease to everyone, and they themselves are truly asymptomatic, and they never develop symptoms. Most will get sick a few days later.

Are people becoming immune after they recover?

Yes, people are absolutely becoming immune. The stories you’re hearing about people having rebound symptoms is usually the fact that they just haven’t fully resolved the disease. So let me say that more clearly so we know that from a day or two before you have the disease until about 14 days into the disease that you’re spreading the disease to the environment.

We know that because scientists have done tests of the nose every single day to know which people are gonna spread the disease. What they have observed is that at 14 days people will not be shedding the disease from their nose, but then on day 16 they will be. We don’t think that that’s because they’ve relapsed in their disease or not developed immunity we think it’s just because they’re slowly coming down and the test is just picking up a little bit. The vast majority of 81,000 people in China got this disease, seventy-six thousand have recovered with antibodies that prevent them from getting a disease. The natural course of this disease is that once the world sees it coronavirus now is a pandemic is going to enter the circulation the same way rhinoviruses in our circulation the same way that respiratory sensitial viruses in our circulation, but as it mutates it’s going to get milder and milder so five years from now you’re going to get coronavirus this exact Covid 19 and it’s going to feel like a cold. Just not the first time through the population.

Two pregnancy-related questions. One from a nurse who’s treating patients regularly and she’s asking “Right now. I’m screening people prior to my appointment with them is that enough in combo with hand hygiene?” She works in wound and ostomy care 

I think that is the system that is important is screening people and hand hygiene. I think if you were doing ostomy care at the epicenter in, New York City in a hospital where there are many cases in the community you can argue a simple surgical mask would be helpful but if you’re in a community that hasn’t seen a lot of Covid disease,  screening and hand hygiene is everything. You don’t have to wear a routine mask and I think those recommendations in hospital systems are completely appropriate.

Is it more severe at all in pregnant patients?

I’ve seen zero pregnant women in our ICU. I think the data is that they’re behaving like any generic person of that age. We are in other words, we’re not seeing it more severe in pregnant women.

In our hospital experience, we’re seeing a male predominance to this disease. It affects men and women, but we’re seeing more men. But I don’t we haven’t seen anything unique to the pregnant population. They get Covid disease. That’s 100% true but it’s like a lot of people which is they get it,  they feel terrible, and they get better.

I wouldn’t treat a pregnant woman like I would a 95-year-old patient or a family member. I wouldn’t put them in seclusion, they still have to exist in society, you still have to take walks just follow the rules.

So if you’re walking and short of breath, you should go to the hospital. If you’re sitting and short of breath, you should go to the hospital. If you have a fever stay home.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.