I’ll be publishing a number of articles on Covid-19 over the next few weeks, but today 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. The complete transcript of his entire 57 minute talk is at this link: Edited Transcript of Dr. David Price video, “Empowering and protecting your family during the Covid-19 pandemic”
Here’s the link to the original talk: 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.)
I’m going to post a few excerpts from his talk here, and you can find the entire transcript here: Edited Transcript of Dr. David Price video, “Empowering and protecting your family during the Covid-19 pandemic”
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.
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.
What is Covid-19?
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.
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.
The second thing is you have to start psychologically working on the connection between your hands and your face.
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.
Four important points (the Rules):
- 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.
- 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.
- 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.
- 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.
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!
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.
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.
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.
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 the 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.
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.