Covid-19 Special Episode: Critical Insights and reasons for optimism from Mayo Clinic Infectious Disease Specialist
Dr. Rizwan Sohail
Dr. Cooper: 0:07
Welcome to the latest episode of The Catalyst Health, Wellness and Performance Podcast where we bring engaging evidence based practices to health and wellness coaches and others who are looking to improve their own lives and that of those around them. I’m your host, Dr Bradford Cooper, and today we’re incredibly fortunate to have infectious disease specialist Dr Rizwan Sohail of the Mayo Clinic to talk us through the realities and key aspects related to the Corona Virus. Dr. Sohail is a professor of medicine and the chair of cardiovascular infectious disease at the Mayo Clinic. He has published over 100 peer reviewed articles in major medical journals, speaks at a range of national and international events, and is a critical resource for so many at this time of worldwide confusion. We’re truly grateful for his willingness to join us today and for our former guest Dr Meeta Singh for coordinating this important interview.
Dr. Cooper: 0:59
By the way, if all of these recent developments have you thinking a little bit differently and you’ve decided it’s time, I’m ready to move forward towards this wellness coach certification. We’ve got some important news, a big update. We’ve launched an at home certification option through the Catalyst Coaching Institute, and it has been approved by the NBHWC. So this allows you to complete your certification without leaving your home and also qualify for the national board certification process before their requirements change if that’s a goal that you have. We just added three days to the calendar, as we still want to keep the personal small group format even though it’s online. All the details at CatalystCoachingInstitute.com. Or please feel free to reach out any time you want to discuss your specific situation and what that looks like. Email is [email protected]. Now let’s listen in as Dr. Sohail provides some critical insights about what we need to know and what we could be doing in the midst of the Corona virus situation. I think you’re gonna be encouraged. Just a heads up that if you’re new to our podcast, today’s episode is a bit more serious than normal for obvious reasons. But we’re glad you could join us, and we’re grateful for Dr Sohails time on this episode of the Catalyst Health, Wellness and Performance podcast. Doctor Sohail, it is very much a pleasure to have you join us. We know your schedule is insane right now. Thank you for making time for us.
Dr. Sohail: 2:33
It’s a pleasure to be with you. Thank you.
Dr. Cooper: 2:36
Things are changing on literally a daily basis when it comes to the Corona Virus.Could you summarize the latest insights we’ve gathered from what we currently know, or more aptly stated, what you currently know?
Dr. Sohail: 2:49
Alright. So as you stated correctly, the situation is changing over time and very quickly. What we know so far is that the virus started in Wuhan area of China and in the last 2-3 months has really spread across the globe. And we’re seeing a huge waive of patients being diagnosed in Europe and North America especially, but also Asia and Australia. So what we see now is that the certain group of patients at high risk for getting a serious illness with Corona infection, especially this includes patients above age 60 and much higher mortality, especially any age above 80. Then patients who are diabetic or they have heart disease or chronic lung disease or kidney disease, and those who have weakened immune systems seem to be high risk.
Dr. Cooper: 3:44
Is there information the public is missing in the midst of the literally nonstop 24/7 news cycle that we need to be hearing that you think might not be out there right now?
Dr. Sohail: 3:55
I think the most important thing the public needs to know is that there’s a sense of helplessness that there’s nothing we can do about it. It’s just gonna spread nonstop, and there’s this fear in public. And while there’s good aspect with fear that people are concerned, but I think there are lots of things that people can do to minimize the spread of infection and should be doing. And what we’ve seen with the numbers in China in the last couple of days, is that in the last 48 hours they recorded pretty much no cases, no new cases. So that’s quite optimistic that the epidemic can be stopped and the social distancing, the lockdowns, which appear quite radical and draconian at times, can be a quite effective way to curb the epidemic. I mean, China being the epicenter off the disease, and yet, with the containment strategies, the overall number of deaths in China were a little above 3000. Even in a city of Wuhan which has a population of over 10 million, it’s like Chicago of China. So I think there are hopeful signs that things can be done. On the other hand, it’s also quite obvious that if no mitigation strategies are put in please and we do not try to contain the epidemic, it will continue to spread and especially effect the most vulnerable portion of the population.
Dr. Cooper: 5:24
Yeah, you mentioned there’s things that we can do, anything that we’re not already hearing? That, you know, the washing the hands, the social distancing, anything else that we need to get out there to folks?
Dr. Sohail: 5:36
I think a lot of it is focused on social distancing and cleaning the hands and avoiding close contact. But I think one of the things that people need to prepare for is that currently a lot of the lockdowns or advisories for social distancing are for the next 2-3 weeks. However, based on what we’ve seen in China, it took them several months to stop the epidemic. So therefore people have to also start thinking and preparing for a long term plan and adjust to maybe a new way of doing business and going around like, you know, socializing. That people who have the ability to work from home if they’re an IT or finance or industries like that, you have to think of long term plans. Parents that, you know, have kids in school or colleges, they have to start preparing and figuring out how to best do the distant learning until the summer, when we expect that with all the mitigation, social distancing and everything, the curve starts to flatten and go down. And then perhaps we could start to go back towards more of, you know, the usual way of doing business.
Dr. Cooper: 6:54
So let’s talk about that a little bit. Let’s go best case and worst case. How long do you see again on both extremes, this current status that just as you noted, it just feels extreme. This social distancing. How long do you feel like that’s gonna need to continue? Best case scenario, worst case scenario.
Dr. Sohail: 7:14
I think the best case scenario is that if people actually follow the advice of the government and actually avoid large gatherings of more than 10 people and stay at home if possible. And if they’re sick, especially then avoid contacting other folks, then we could look towards the tail end of the epidemic in 3-4 months. However, looking at the news and the fact that people are still in many states and locations going to the bars and restaurants and beaches and crowded places. If that trend continues, then I think it could be trailed to 18 months before we’re able to go back to the with the way things were before the epidemic.
Dr. Cooper: 8:00
Okay, so you’re bringing up a lot of questions here, so end of the epidemic in 3 to 4 months. But are you seeing that as the social distancing is going to need to continue during that entire time? Or is this two week focused time that everyone’s talking about right now, will that start to be able to loosen up a little bit at that point? Or is it just a wait and see? We’ll just have to reevaluate in a couple weeks?
Dr. Sohail: 8:23
I think pretty much all of the above, because to me it seems that the 2-3 weeks gives us time to first of all, try to flatten the curve, not end the epidemic, but to flattem it. So we don’t see an exponential increase in cases. However, 2-3 weeks will not be enough time, in my opinion, to see the end of epidemic. I gives us time to prepare ourselves. It also gives us time to figure out what are we going to do after the 2-3 weeks of the intense lock down. It also gives us the ability to be able to do testing more frequently because one of the biggest problems from a health perspective in the US is that we’re struggling with, is we just don’t have the capacity to test people as much as we would like and therefore we are trying to rush in and only cast the high risk individuals and those with, you know, clear symptoms. Well, we know that the 80% of the patients who get infected have mild or minimal symptoms and while they may not be sick themselves, they can continue to spread to others. But in 2-3 weeks, if we ramp up the testing capacity, then anybody with symptoms will be able to quickly assess if they have Corona or some other respiratory illness. And if they do have Corona, then they’ll be able to isolate them and quarantine them. But until then, everybody needs to be isolated. Because how do we tell the difference between a regular virus and Corona virus? And we can’t, that’s the limitation.
Dr. Cooper: 10:03
Okay, so with the testing, maybe this is a service we can provide for our listeners, it sounds like with this limited number that are available currently, it’s gonna change in 2, 3, 4 weeks. But with a current limitation in the ability to test the number of people we’d like to test, if you’re a young, generally healthy individual, should you hold off on testing at this point and instead simply follow the two weeks of self quarantine guidelines?
Dr. Sohail: 10:29
Yes. So I think at this point in time, everybody, whether with symptoms or no symptoms, should try to practice the social distancing and not go to work if they don’t have to. Especially, even if you’re young and healthy and just don’t feel well, even if you don’t have typical symptoms of disease, then definitely stay at home, do not visit friends and family at this time. After 2-3 weeks, when we have enough testing capacity, then we’ll be able to screen the patients who have symptoms, and then if they’re negative, then they could continue to do the work.
Dr. Cooper: 11:07
Okay, okay. So for right now, in this moment, if you’re young, healthy, you don’t have immune issues, hold off on going to get tested because they need those tests for folks in different situations. That advice will change in 2 to 3 weeks because we’ll have the capacity to test. Am I hearing you correctly?
Dr. Sohail: 11:26
Yeah. At the moment we’re quite optimistic, with multiple labs developing their own test results and the rush diagnostics. So we think that in the next 2-3 weeks they’ll definitely ramp up the testing capacity. And with that, we’ll be able to screen individuals fairly quickly, to see if they have respiratory symptoms and if they do test them, get the same day results and let them know if they had Corona or not. And that would give us an ability to let people go back to work if they are otherwise healthy and have no symptoms, that even if they have symptoms but they’re negative for testing and we could diagnose they have some other cause for their fever or flu like symptoms.
Dr. Cooper: 12:19
Now, to me, that sounds like outstanding news because right now it just feels like we are doing the right thing, really shutting everything down, pulling back, social distancing, the whole thing. But you’re saying once we’re able to test and we’re able to give almost immediate results to anybody who needs to be tested, then we can let the air out of this extreme level of social distancing. And people will be able to get back not to normal life, but to a more normal life. Again, am I hearing that correctly? Because that sounds encouraging. I know you don’t predict the future, but it sounds encouraging.
Dr. Sohail: 12:53
Yeah, I think depending on how much testing capacity we have, we’ll be able to loosen some of the very strict guidelines for social distancing. What honestly our worry is that because even though a majority of people are trying to follow the social distancing guidelines, there’s a sizable minority which are not, and they may continue to spread the illness and therefore we may see multiple waves of infections. So I think it’s really important that for the next three weeks, people really try to adhere to the current guidelines, the social distancing. And once we have the test, I am hopeful that we’ll be able to quickly test people with symptoms. And then they could start to resume some of the normal activities.
Dr. Cooper: 13:47
Okay, good. That’s very encouraging. Thank you for sharing that. Could you walk us through some of the typical timelines, in terms of the symptoms once infected, what would someone initially notice? How would the symptoms then change? And how do they know when it’s resolved?
Dr. Sohail: 14:04
Yes, so the majority of the patients will develop symptoms after 4 to 6 days of being exposed to an acquiring virus. There’s a range of time, though. Some people start to manifest the symptom as soon as 2 to 3 days after acquiring infection, and it could be up to 12 days. Now there are some reports of people getting symptoms 2-3 weeks after the exposure, but at the moment it’s unclear if the initial exposure caused the infection or let’s say, I got exposed to somebody with Corona today and then got exposed to someone else again, which I did not know had Corona, two weeks from now and then in four weeks I get the symptoms. It would be really difficult to know if the initial exposure caused the infection and the symptoms did not appear for four weeks. Or was it a different exposure? In terms of symptoms, the most common symptom is fever. It’s reported that somewhere, you know, close to 90 to 95% of the patients do have fever, so that’s the biggest, screening tool that we have right now. This is followed by cough, which happens, you know, somewhere between 50 to 80% of the patients, and it’s usually dry cough. And this is followed by a shortness of breath, which is seen in 1/3 of the patients. And then there are a host of symptoms of headaches, could be having some nausea, vomiting, sore throat. An interesting finding that has been reported is that very few patients based on what we know, have sneezing due to Corona virus, novel Corona virus. So the patients, or the people who are sneezing around you are less likely to have this novel Corona virus and more likely to have some other seasonal respiratory virus.
Dr. Cooper: 16:06
That’ll be encouraging to the folks that got sneezed on today. Okay, What aspect of this whole process has been the biggest surprise to you?
Dr. Sohail: 16:17
I think the biggest surprise has really been how infectious this virus has been and how quickly it spread. The other surprising part is that while we understand that there’s some group of people above age 60, especially above 80 years, immuno compromised, those with organ dysfunction which are at high risk for infection. There are several reports of otherwise young people, healthy adults with the normal immune systems between age 16 and 60 who certainly get sick enough to be in the hospital, some of them also requiring intensive care and being on a ventilator. And that’s really unclear as to why that happens. Because the reported death rate in this kind of healthy adult population is you know 0.1 or 0.2% while the overall death threat may be 0.5% in best case and to 2% in the worst case scenario. Why are these people getting sick? It’s really unclear. There are some reports that there are two different kinds of viruses being circulated, one with the higher mortality of like 70% or so, and the other one with the mortality of less than 30% in patients who have severe illness. So maybe there are different strains being circulated. Or there are other things we don’t know why some otherwise healthy adults, and there are reports of healthcare workers or otherwise healthy physicians, nursing staff, respiratory therapists, getting severe infection as well, with no clear reason. So this is what’s surprising to me is that one is the rapid spread and the other is how some otherwise healthy people, young people get really sick, requiring intensive care. And we can’t really pinpoint the reason. Hopefully, we’ll learn more as we move forward.
Dr. Cooper: 18:11
So coming back to this whole process with life, it sounds like a vaccine won’t be available for at least a year. How does this play out until that time, you talked about after we have the ability to test more people then we can test, you know you’re clear, you can go back to a somewhat normal life. How do you see life playing itself out 3-4 months from now? We have plenty of opportunity to test the curve has been flattened. The healthcare facilities are able to meet the demand that’s out there for treatment. Now what? What do you see happening three months from now, with travel and work and restaurants and all these other things when those capacity issues have been taken care of?
Dr. Sohail: 18:53
Yeah, I think one of the big unknown factors is what’s referred to as herd immunity, which means that when a majority of the population gets exposed to a certain virus, most of the healthy adults develop an immune response to it, and then it really limits the spread of infection. And how the herd immunity will play out in this Corona virus outbreak is yet unknown. But I think it would play a role. You know, this is similar to what we see in, for instance, for the vaccine preventable diseases or the natural immunity that we see, for instance, in chicken pox. So before the chicken pox vaccine was available, it’s a highly contagious virus, but a lot of the otherwise healthy children got chickenpox and they were immune. And because they were immune, they would not get the infection from someone and then transmit to someone else. Similarly, for the vaccine preventable illnesses. If there are like 100 kids in one class and 90 have had the vaccine for that illness, those 90 themselves would not pick up the virus from someone else and then transmit to others. So then it would protect those 10% of the kids who are unvaccinated due to various reasons and the overall disease spread goes down. We’re hopeful that something like that will be seen with the Corona outbreak as well that healthy adults will development immunity. And then if we had 50, 60, 70% of population exposed were themselves immune and not in mechanism to transmit to others. That would certainly limit the disease spread. But it is something we cannot say that will definitely happen. But I expect we’ll see some of it. So I think a similar experience, maybe seen in Europe as well. I mean, right now everything seems very doom and gloom scenario because we’re reaching the peak of the epidemic in the next couple of weeks. So right now, we’re kind of in the worst case scenario at the moment, and it’s difficult to be too optimistic. But I think we’ll start to have some normalcy by summer.
Dr. Cooper: 21:20
Let’s spin off this for second away from Corona virus to the flu, since you brought up this idea of the herd immunity, which I wasn’t familiar with. Can you talk to us, the folks listening to this, health wellness performance is very important to them. Obviously, there’s a lot of controversy about the flu shot. I’m a big believer in it., personally. Can you talk to us about how that might help or hinder the herd immunity? Any related concepts of that you’d like to share with us while we’re on this topic of vaccines?
Dr. Sohail: 21:49
Yes. So I think one of the challenges and unique thing about the influenza virus itself is that it changes every year. So every year a new vaccine has to be made and the vaccine is made based on the best guess of what’s circulating in tropical countries during summer. And we expect that something like that will circulate in another hemisphere in winter time. So a lot of, like modeling is done, and we try to predict what would come and therefore the influenza vaccine in some seasons is really effective and other seasons may not work well because we just didn’t predict what strain we’re going to get. And the other thing about the influenza vaccine is that there is good data to show that it prevents severe disease and hospitalization and death due to influenza. Although it may not always protect from getting, you know, quote on quote flu itself. So some people feel like, oh, I got the influenza vaccine and still got a flu. But I would say like if you didn’t die from it, then the vaccine worked.
Dr. Cooper: 22:57
Yeah that’s a pretty good tip. So what about doing the flu vaccine to protect others? You know, we’re talking about this Corona virus and the social distancing, even if you would be fine. One of the reasons for following that guidance is to protect those who don’t have strong immunity. Does that concept play itself out at all with the flu vaccine? Is one of the reasons to get it, maybe not to help me, but to help those people that I’m around? Or am I going down the wrong path here?
Dr. Sohail: 23:26
You’re absolutely right. And you know, that’s one of the reasons we mandate that all the health care workers get influenza vaccine even if they’re healthy, and most of them are. You know, we have residents and fellows in the training programs who are young. It’s really to protect their patients because if an otherwise healthy adult were to get influenza, most likely, they will just get a mild disease and get better. However, if at risk people like elderly, immuno compromised, patient with multiple diseases get influenza, they could die. And you know, we don’t want to downplay this epidemic of Corona virus, but we need to remember that every year, like 30 million plus Americans get influenza, up to 500 thousand are hospitalized due to that. 50 to 60,000 die just in the United States, with influenza related complications. And globally, so far, we’ve seen, like, you know, at present up to maybe 10,000 deaths due to Corona virus. So still on a daily basis, more people are dying with influenza related complications globally every week then all the people have died due to Corona virus in the last three months or so.
Dr. Cooper: 24:43
Wow. Wow, that’s good perspective. Really good perspective. Just two more questions. What are we learning as scientists and as a society as a result of this Corona virus outbreak?
Dr. Sohail: 24:54
Yeah first of all, I think what we learned is that we’ve learned to be humble us because we are able to quickly stop the epidemics and that we are relying a lot on medicines and technology to stop the epidemics. But now we’re in that situation where we’re going back to how we used to deal with epidemics before all these vaccinations and everything was available and which we’re taking for granted these days. The other thing that you’re learning is that in times of pandemics, selfishness and, you know, living in bubbles and defining us versus others, and you know, this is their problem and not our problem, can really, lead to a much more difficult and worse situations. These are the times people need to come together. You know, have a sense of equity and community and solidarity, and one of the unfortunate things that has happened in the last several decades, especially in the last decade or so, is that globally, there has been this mistrust between governments and the populations and the scientific community and the general population, and I think that that is a big problem that we need to address going forward. The rise of the fake news, misinformation, disinformation people spreading untrusted, unreliable information on social media. And we need to somehow, as a society, need to figure out how do we deal with this going forward?
Dr. Cooper: 26:41
Very well said, very well said. Last question, wide open. What words of wisdom would you have for health and wellness coaches or others who are acting as sounding boards for a lot of frankly nervous people right now?
Dr. Sohail: 26:54
Yeah, I think first of all, be safe yourself. You know, practice what is being told by the government, which is, you know, cleaning hands often, staying at home if you’re sick, then covering coughing and sneezing, wear a face mask, surgical mask if you’re sick and you need to go outside. Clean and disinfect surfaces. But also, I think people need to remember that just because there is a guidance to restrict social gatherings and large gatherings of more than 10 people does not mean they just sit on a couch and just watch TV all day. They can still go out and jog, if they’re not like crowded places. They can exercise at home. A lot of people have equipment at home that they can use to exercise. Continue to eat healthy, you know, read books, get information from reliable sources, get good nutrition, don’t panic. And if you feel unwell and call your health care provider and see if you can get tested and if that is available, then definitely get tested just to make sure that you don’t have the disease. But in case there is not enough testing capacity available and you feel unwell, then just stay at home. At least for the next few weeks as things get better,
Dr. Cooper: 28:13
Doctor Sohail, I am so appreciative, you got this scheduled in in such a short time period. Again, I know your schedule has got to be crazy right now. Outstanding information, I think reality, but also encouraging. So thank you so much for joining us today.
Dr. Sohail: 28:28
My pleasure. Thank you so much for having me.
Dr. Cooper: 28:37
Thank you, as always for joining us. This is an important time on a global level. We will come through this together, but we need to avoid the noise and focus on what is truly credible. That has always been our creed at Catalyst, to do our very best to help you avoid the fads, avoid the headlines and dig into the evidence. Now more than ever, that is mission critical. We’re grateful you trust us to be a resource for you. In the midst of all this craziness, this has actually been a pretty groundbreaking week for our podcast. We launched the five minute Monday Morning Catalyst to start your week off on the right foot. We shifted the release of our traditional episodes to Wednesdays, and we introduced our new podcast artwork. Thank you very, very much for your support that brought us to this point. It’s a big point. It wouldn’t have happened without you. It means a lot, and we hope you enjoy these updates. As always, if you ever have questions related to health and wellness coaching, whether how it fits into your own career pursuits or as a way to enhance your organization’s employee wellness program, please feel free to reach out to us via email. It’s [email protected] or our website CatalystCoachingInstitute.com. This is Dr Bradford Cooper signing off. Make it a great rest of your day and I’ll speak with you soon on the next episode of the Catalyst Health, Wellness and Performance Podcast.