Coronavirus (COVID-19): Panel discussion at EVMS
10
March

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , /


We’re really happy to see such a great
turnout on it what is a really important topic. Tonight we’ll have a panel of
experts speakers here for you, and they’ll go through their presentations
and then after their presentations, we’ll have roughly about 30 minutes for Q&A, so
if you can hold your questions until the end, just don’t forget them, and we’ll
make sure that we get a good dialogue going. So let me run through some brief
introductions for you. The first speaker is Dr. Edward Oldfield. He’s a physician
here professor of medicine at Eastern Virginia Medical School in microbiology
and molecular cell biology. He is our go-to infectious disease guy, and he’ll
be providing a medical update. In the empty seat next to him, coming down the
aisle, thank you, yeah I was trying to wait for yo, this is Dr. Demetria
Lindsay, and Dr. Lindsay is the director of the Norfolk Health Department and
also the Virginia Beach Health Department. She’s also a physician, and
she’ll be talking with us tonight from the public health department perspective.
Next is Dr. Joel Bundy. Dr. Bundy is a physician and is the Chief Quality and
Safety Officer for the Sentara health care system, and he’ll be talking
about the hospital’s response, so from a health service provider response
standpoint. Next is Mr. James Redick. Mr. Redick is director of the Department
of Emergency Preparedness and response for the City of Norfolk and so as you
can imagine that’s a big undertaking to prepare cities and so he’ll be speaking
from that perspective. And last but not least, on the end, is Dr. Glenn Yap. Dr. Yap
is a faculty member in the Master of Public Health Program, and Glen will be
talking about the economic impact of the Covid-19 or coronavirus. So, I think we
have a pretty broad spectrum of panelists for you with expertise and
will give you some great background. Without further ado, we’ll get started
with Dr. Oldfield. Thank you. Good evening that we’re gonna do an update on Co vid
19 it was initially called the novel coronavirus but obviously that can’t
last very long so they named it the SARS coronavirus – it’s got about a 90%
genetic sequence homology with the original SARS fire so it’s really
considered in the same species and like we have HIV the virus and AIDS the
disease the disease itself has called covin 19 for chrono virus disease 2019
so our virus here and the disease first reported case December 31st they really
traced it back to probably December the first to date over 95,000 reported cases
I would suspect you can multiply by ten or twenty to get a closer estimate of
what’s going on 3200 deaths now about 220 outside of China in importantly 1800
cases in health care workers in China with six fatality so about 3.5 percent
of all of the cases or healthcare workers now we have 13,000 cases outside
of China and 81 different countries you wonder about a pandemic it’s a pandemic
one WTO says it is 81 countries is a lot this is a seventh straight day with more
transmission outside of China and inside China South Korea and now has more cases
every day than China China only had a hundred and twenty some cases reported
yesterday iran’s up to 3,000 cases in italy 2,500 for the US when i gave this
talk at 3 o’clock it was a hundred and twenty-eight cases now it looks like 149
cases 48 were repatriated they were diagnosed overseas and brought back
including 45 from Diamond princess we have now cases from 14 states with 11
deaths and we have a case in North Carolina that actually visited that
nursing home in Washington state that was diagnosed in Wake County’s but this
actually was yesterday 104 cases you can see how markedly
this changes and ramps up just over a short period of time but the bulk of the
cases are in California and Washington State the cases in Rhode Island were a
group of students who were on a field trip to Italy who became ill and brought
it back there have been four different countries that have had tourists from
Egypt diagnosed with kovat 19 and you wonder if they’re hiding the epidemic so
it doesn’t impact tourism this is this going on in Washington State now that’s
obviously the 27 cases nine deaths is different already but the first case
that was ever diagnosed in the United States actually it turns out that a case
about six weeks later they had essentially identical viruses so the
feeling is that this virus has been circulating in Washington State for six
weeks without being discovered the outbreak is unfortunately centered at a
Life Care Center an assisted-living which is the worst scenario you could
have with people with comorbidities and older and they’re at least 50 residents
and staff that are ill and are hospitalized also we see person a person
spread in Northern California to areas that have no connection to any other
cases and also in Oregon I mean incubation is about five point two days
the 95th percentile is 12 and a half days and that’s how we got to that 14
days of quarantine this has a doubling time of seven days and a basic
reproductive number of 2.2 so every patient on average index to point to
more people if you have reproductive number one or
less that’s going to be self-limited over – you’re going to have an epidemic
you can bend that curve if you do source control you quarantine people you do
contact tracing but right now we’re certainly at least at 2.2 this all
started in Wuhan Wuhan is a city of 11 million people larger than metropolitan
New York City and it’s the capital of who
a province with 58.5 million people that entire province has been completely
locked down nobody in nobody out early in the outbreak they were going
through a hundred thousand single use isolation suits a day you can imagine
what this is going to do to protective equipment for physicians if it gets
going here they’ve taken 25,000 medical personnel
from outside who Bay and transferred them there to help and the central
government built two 1,000 dead hospitals in less than two weeks so this
is what who Bay looks that comes through hon and where did it all start
it started in what we call a wet market basically it’s called who a non-market
it’s a really scruffy complex thousands of stalls spread over the size of ninth
in football fields selling numerous species of wild animal civets bamboo
rats ostriches there have been 33 positive Crona virus isolates from the
western part of the market where they keep the mammals Chinese law actually
allows the raising of 54 different species that sell for consumption that
market was closed on January the 1st all these wild animal markets in China were
closed on January 26 I have heard that the Chinese government is going to ban
them for reopening but this is so intrinsic to traditional Chinese culture
that I don’t think it’s going to happen and I think as long as those wild
markets are open we’re going to do this over and over so this is what it looks
like this is a pile of bamboo rats for sale here that’s what they have is these
cages filled with mammals a different species stacked on top of each other and
the keepers will sleep on top of the cages or next to it you can see it’s a
perfect milieu for transmitting viruses from species to species
the original SARS outbreak was traced back to a civet cat these are considered
a delicacy in China and the Chinese believe that you get some kind of
transference of the spirit of the animal when you eat them and the longer they’re
alive before you eat them the more transference so they
like to keep the animal alive so these were kept alive in the restaurants and
they wouldn’t be slaughtered until you ordered them but the real source for all
of these coronaviruses are bats this is a Chinese horseshoe bat which was the
source of both the SARS virus and our new SARS
– also we were in the midst of an outbreak with the MERS outbreak in Saudi
Arabia in the Arabian Peninsula this is a situation where the virus Kona virus
has been transferred from bats to camels and now camels to humans and this
outbreak is still going on right now with over 2,500 cases and a 35 percent
mortality now the closest we can come to the source of this virus is the penguin
and a penguin is an armored anteater these are considered a delicacy the meat
in China and the scales are used in traditional Chinese medicine it’s the
most trafficked of all endangered species in the world you can see them
here in cages right up next to cages full of snakes but that’s not all bats
have over 500 different coronaviruses have been found in bats they’re also the
source of rabies Marburg Ebola Hendra virus nipa virus SARS and mers-cov and
I’m sure it’s not going to end there so what a little bit about coronaviruses
there have been seven Brona viruses that causes these in humans there are four
that basically are endemic in the United States and they cause the common cold
about ten to thirty percent there SARS we talked about ten percent mortality
and MERS with thirty five percent what about transmissibility the feeling
is that almost all of the transmission is by droplet so we’re talking three to
six feet we’re talking about contamination of surfaces get on your
clothes your hands and then self inoculating we cannot rule out airborne
but it like by far the most is droplet
transmission this slides very interesting on the y-axis you have
mortality and you can see at the top you’ve got MERS Ebola and bird flu on
the bottom you’ve got the common cold and then on the x-axis you’ve got
contagious you notice measles as a reproductive number of 15 to 18 versus
to this that’s incredibly airborne contagious in that little box are the
estimates of both the mortality and the infectivity for the seasonal well let’s
go back to pandemic flu in 2009 mortality was 0.02 percent the two
deaths per 10,000 cases seasonal flu is about point two so two per thousand it
looks like kovat 19 is about two percent this is a real issue here if you have
cases that are fatal or they’re really sick they don’t excrete virus until they
get sick and you can get them do source control contact tracing and you can
literally control the epidemic like SARS but if you’re at the bottom of this
triangle where you have large numbers of asymptomatic people that continue to go
around about their daily business and are infectious and you’re not going to
control it and that’s where we are with covered 19 so this is just one example
here this was a business meeting in Germany person attended from China
infected patient one she was completely asymptomatic patient two and then
patients three and four were infected by patient one no symptoms in the original
case so according to the first major report from China about 80 percent of
cases are mild with very large quantities in the upper respiratory
tract especially in daenerys in fact quantitative viral counts in the Nerys
and asymptomatic people are as high as those with severe sentence about 15
percent require hospitalization three to five percent end up in the ICU and it’s
about a two percent or tell about a quarter in the IC you’re going to end up
actually in China they’ve ended up on ECMO or extracorporeal membrane
oxygenation but what about clinical the incubation is about the same for all
three of these coronaviruses fever in the symptomatic ones and almost all but
notice only 44 percent on presentation Koff is very common myalgias fatigue if
you’re gonna get sicker usually about 8 days you start getting short of breath
and then full-blown get respiratory distress syndrome about nine days
diarrhea relatively rare and very common or bilateral CT involvement usually
described it’s ground-glass this is a patient on day 8 with these
multiple ground glass and filtrates and on day 15 obviously much more severe
so the patients who have died in mainland China over 80% or older than 60
75 percent had an underlying condition so this in younger people is going to be
more like influence or the common cold for people my age it’s going to be a
serious disease if you break this down you can see that below 50 the mortality
is very very low but then it ramps up 4% and 8% and over 80 is 15% and then
comorbidities cardiovascular disease 10% mortality diabetes 7 chronic lung
disease 6% so the worst case scenario was what we saw in Washington and
Kirkland where we had an assisted living facility with people with chronic
diseases and they’re older and most of the people who have died in that
facility were 70 and 80 years old so diagnosis turns out that actually nasal
swab is just as good as oropharyngeal and as good as lower respiratory samples
only about 30% even have a cough and you really you know if you’re gonna induce a
sputum or do a bronchoalveolar lavage you’re gonna have aerosolization so for
my money I would do a nasal swab for PCR you want to collect acute convalescence
serum and we do not want people attempting viral
culture if you feel you might have a suspect case you want to contact the
public health department in your local city testing is going to be done at
state public health lab at DC LS and Richmond although I can tell you they
don’t have many tests or kits their results are going to have to be verified
at CDC and then you want to contact your local center lab so they know how to
handle the specimen and how to ship it current testing is by PCRs who were
directly testing for virus antibody tests are being developed those will be
important to determine prevalence go back through a population see how many
people actually got infected initial test kits or PCR were did distributed by
CDC in February and they were faulty they all had to be recalled and then
redone and sent out again CDC had done 3,300 tests as of March the
1st they’ve shipped 47 cases kits around the United States about interesting on
Monday they removed all the data on their testing from their website you
wonder if it gotten so political about the number of tests and their
capabilities that they just stopped it vice president pence told reporters and
off-camera of briefing we’re issuing clear guidance that subject to doctor’s
orders any American can be tested and this afternoon it looks like the CD web
website was changed in a way that would suggest that although it’d be
unfortunate if we had a lot of worried wounded demanding to be tested by their
doctors and overwhelming the testing for the people that really need to be so
from my perspective I would still follow the CDC guidance which will go over the
original guidance so treatment none is proven effective steroids no effect on
mortality they do delay viral clearance although it’s becoming clear what’s
happening to people it’s not bacterial post infection it’s really a cytokine
storm they have just astronomical levels of multiple different cytokines and
that’s what’s killing them sending them into a RDS and septic shock so I don’t
know if steroids could possibly benefit ribavirin by
itself is not very good interesting the the protease inhibitor for HIV colita
and really good activity and there was a there were studies and SARS that showed
good activity so if I had a case now I would treat them with kaliesha depending
anything else and ribavirin is synergistic with khaleja Ramdev severe
is an adenosine analogue that is experimental that they’re now trials
going on in china and fava P Revere is a antiviral broad-spectrum that looks like
it’s having good activity in China though infection prevention and control
I think this is really important this Tale of Two Cities this goes back to the
original SARS in Vancouver they had a case come in and within 15 minutes full
respiratory precautions were instituted and that’s called source control gave a
mask put him in a private room transfer them to a negative pressure isolation
room then admitted to the ICU and negative pressure with full precautions
during that whole episode only one nurse was infected and she did not wear eye
protection there were no secondary cases there were three more imported cases of
SARS in to Vancouver with no secondary transmission contrast that with Toronto
the initial woman was exposed to a doctor and nephrologist in Hong Kong
she returned to Toronto she died at home her son went to the emergency department
spent 18 hours in an open observation area receiving nebulizer bunam also
there’s your air civilization and died in the ICU five days later two people on
each side of that patient and the IDI were infected went out and had clusters
associa with them and eventually 27,000 people warrantied for 238 cases of SARS
and 44 deaths it’s all about recognition and source control so this is an
interesting comment the management of cases evolve through a period and this
is for SARS of profound fear and emotional distress experienced by health
care workers with potentially fatal nosocomial transmission after
implementation specific rigorous protective measure
there were no no no Zico mule transmissions of SARS there the 211
health care workers in the ICU so with proper use of protective equipment I
think we can prevent transmission to healthcare workers but we want source
control that’s by far a key number one before arrival actually the best thing
would be and since there’s no treatment if the patient’s not seriously ill and
needs to port of care do just stay at home if they do need to come in then
before arrival instruct the patient to call ahead wear a face mask which they
can pick up in the lobby and I think we all need to make sure that those face
mask stands are not being robbed by people trying to get their own stores
you wanted here to cough etiquette coughing a tissue if you don’t have a
tissue cloth into your elbow a hand hygiene they’re talking about washing
our hands 10 to 12 times a day ensure that they do not wait among other
patients he can care isolate them in an airborne infection isolation room if you
don’t have one of those and put them in a single room you need to keep a log of
everybody that goes into that room as far as health care providers we want to
use airborne precautions with an n95 mask interesting whu-oh is still
recommending a surgical mask you want contact precautions gowns gloves you
want i wear protection either a face shield or goggles eyeglasses are not
adequate and high in hygiene either an alcohol-based product that’s 60% alcohol
or more or soap and water for at least 20 seconds these are the current
guidelines for testing basically if you have symptoms on the left hand side and
you’ve had close contact with a laboratory confirmed case last 14 days
history of travel from one of the affected geographic areas and we’ll show
that on the next slide but CDC is recommending and then for severe
respiratory illness that there’s no source of exposure that you’ve been able
to identify so these are the areas where you want to take a good travel history
China Iran Italy Japan and South Korea and I think we could probably add
Washington State Seattle area to that certainly that’s what they would say in
North Carolina with their case so just a few sidelines 50% of surgical masks are
produced in China we only have 17 million and 95 masks in the u.s.
stockpile and about 5 million of those are already expired estimated we’ll need
300 million and 95 masks for this if there’s an outbreak there’s already been
a hundredfold increase in demand for these respirators and gowns 20 fold
increase in price and 4 to 6 month backlog in production interestingly
Purell last summer for 8 ounces with 785 on Amazon yesterday as 115 on and today
it’s not available so it’s estimated that a severe influenza pandemic would
require mechanical ventilators for seven hundred and forty thousand people
our country has 62 thousand full-featured ventilators and most of
them are in use there are 10,000 in the strategic national stockpile but
certainly not enough so basically what we have now we have an outbreak we
certainly have an epidemic we’ll have a pandemic when whu-oh decides to declare
it what we’re concerned about is this virus becoming endemic and then
basically we have a recurring outbreak every year like we have the other four
except a much more severe disease so this is cross the species barrier it’s
made one step to mankind let’s hope it doesn’t make the giant leap to all and
kind and I’ll just end with this this you notices from 2006 uncertainty during
a pandemic will drive many of the outcomes we fear including panic among
the public unpredictable and unilateral actions by governments instability and
markets and potentially devastating impacts on the economy the need for
timely accurate credible and consistent information that is tailored to specific
audiences is we have to keep the information timely
accurate credible and consistent what that’ll stop and I think we’re going to
hold the questions till the end I was asked to speak to you on the
public health response to this outbreak a number of the slides that I covered I
thankfully dr. ole feel has already covered so I’ll be kind of moving along
through some fairly quickly I just wanted to make note that you know we we
are facing a an outbreak in a different world than in the past we have a global
society where you can move around the world and in ours so this place is a new
factor on the potential for spread of these infections and dr. o Phil talked a
bit about pandemic criteria the fact that we don’t have an absolute
definition of when we have one and don’t have one but these are some of the
criteria that we are concerned about the fact that it it is a new agent that has
infected the human population so there’s virtually no immunity by anyone
it has having the potential to cause severe illness and death the stain
person-to-person transmission both of which we are seeing and the potential
for worldwide spread dr. o fill covered this this is a comparison to covet 19
and also MERS and SARS infections and here I just wanted to point out that
we’ve talked about the case fatality rate the estimation of it based on what
we know currently but also in terms of transmissibility even though we’re on
the lower end of the spectrum and kind of moving forward here as we talked
somewhere around the transmissibility of influenza I don’t know how to back up obvious
apparently no here the number of total cases has far exceeded what we’ve seen
with stars and moving along I want to talk about on a national scale the
strategic objectives identified by the World Health Organization focused on
identifying isolating and caring for patients early reducing transmission
from the animal source understanding the nature of the virus dr. o field talked
extensively about what we do know about the nature of the virus at this point
communicate critical risk and minimize social and economic impact then moving
to US public health response one of the the major things that you’ve been seeing
coming out from the public art travel nose notices and suspensions at this
point entry to the US by foreign nationals from China and Iran who have
been in those countries within the past 14 days has been suspended also US
residents and citizens and their family members who were in China in the past 14
days must go undergo health monitoring and may have movement restrictions
airport screening has been basically funneled through 11 US airports and
those individuals must go undergo health assessments if there’s symptomatic they
will undergo further evaluation isolation and treatment as indicated
asymptomatic travelers from the who Bay Province must undergo mandatory
quarantine as you’ve seen in the media and asymptomatic travelers may be
allowed to continue on to their final destination for public health monitoring
which is where we come in i’ve note here in terms of steps that have been taken
wanted to point out that on 2 7 of this year of february 7th the state health
commissioner dr. norman oliver declared a public health communicable disease of
public threat for the state of Virginia based
on the current the state at that time of kovat 19 outbreak that allows the state
to access certain measures under the Code of Virginia which includes
involuntary quarantine and also the potential to access needed resources to
fight this outbreak the public health response in Virginia has been extensive
and it’s revving up and precedes and changes every day we have established an
incident command management teams at both the state and local levels with
incident action plans daily and weekly sitreps
and it’s and reports with a very wide distribution many of you may have
received letters or notifications there’s coordination at multiple levels
with operation briefings and also person under it under an investigation or Pui
case management education and preparation for potential further spread
there has been a comprehensive public information campaign initiated including
a two on one call center a webpage targeted communications to clinicians
and targeted education efforts the ones des pause for a minute and talk a little
bit about isolation and Quarantine most of us are familiar with isolation even
if we may not know the term we do it every day you see it in hospitals with
signs this represents the separation of the ill are those who are known or
expected to be ill with some type of communicable disease however and in
addition to hospitals we also do it at work when when an individual is advised
or chooses to stay at home from school or work it generally is the type of
isolation is based on disease transmission
currently we are advising standard airborne and contact precaution for this
outbreak quarantine is a bit different it is used less commonly and it involves
restriction of the asymptomatic who appear to be well but may potentially
have been exposed to a communicable disease involuntary quarantined is used
often by Public Health in such settings as tuberculosis our efforts are to use
the least restrictive type of quarantine that may be effective in voluntary
quarantine requires the authority of the state health commissioner under the the
Public Health the declaration of a public health threat and then the local
public health response involves human surveillance and investigation on a
regular basis we receive required potable reportable disease reports from
labs hospitals and clinicians so most clinicians are familiar with this this
is another outbreak that does require reporting by clinicians we are also
receiving on a twice daily basis CDC travel listings of individuals who may
have come into the country from affected areas with travel advisories
particularly mainland China and Hebei province also surveillance syndromic
surveillance looking at levels of hospital admissions for various types of
syndromes or emergency room visits supports of clinicians has been very
active in it has ramped up significantly since this outbreak
we’re in continuous consultation with health care providers regarding cases of
and patients that they are seeing approval is required from the Health
Department of or any lab testing which as dr. Oldfield
mentioned is currently being done at DC LS prior to this weekend it could only
be done at the Centers for Disease Control with a recent ability for DC LS
to conduct those lab testings we’ve gone from a turnaround time of approximately
two days to a week for lab results to three to five hours and also in support
of physicians that we are providing regular updates to hospitals and
physicians I’ll talk a little bit more about EUI case management and
coordination with hospitals dr. ole ole Phil went into this this is what we call
patient under investigation criteria a patient under investigation is an
individual who may be symptomatic or meet this criteria for which we would
approve testing and you’ll note there that it does include the consideration
now of cases in which there may not be an an actual confirmed contact or
geographic history but suspicion based on the clinical history and those
individuals can be recruit proved for testing on a case-by-case basis I’ll
move on here and talked about that surveillance and investigations
currently we have no cases of kovat 19 diagnosed in Virginia you can see here
and total number of 11 patients have been tested most of those are in
northern and central Virginia and here I’m going to move on this is kind of a
breakdown of the exposure risk criteria movement restrictions and travel
restrictions I will move on from this in the interest of time to local monitor
movement and monitoring activity so as I mentioned at the local level the
Public Health Department is responsible for monitoring those individuals who may
have had some type of risk identified when they entered the country or for
other reasons inside the country who are not at high risk but at medium to low
risk this is usually self monitoring or supervised monitoring it involves an
initial interview to identify the patient’s history assess their wrists
and symptomatology and also to ensure that we review procedures for them to
understand what things to look for how to monitor their temperature and other
symptoms to report that information out and to know what to happen if they
should develop symptoms they are advised to call ahead either to the health
department or to advise 911 or the hospital that they’re coming in if they
develop symptoms also the hospital department is responsible for ensuring
that it’s if a patient is under active monitoring either under generally under
voluntary quarantine we must ensure that their basic needs can be met and that
includes whether or not they have a housing whether or not they need food
medication anything that they may need to ensure that they are able to comply
with the quarantine status operations travel monitoring this is just a
breakdown of individuals who have been monitored and how many currently there
are 218 individuals who have completed monitoring in Virginia and 95 that are
currently under monitoring this is a list of interim guidance set and I would
encourage you go to the CDC website for specific information so we are at a
point really that what we’re doing is as much as possible trying to slow
transmission within the community to prevent
possibility of sustained community transmission in the u.s. it is a high
likelihood that we will eventually have sustained transmission we want to slow
that process as much as possible until we have treatment options available so
building on pandemic preparedness in the past this is something that the health
of the public health has had a lot of experience with this is a new agent
there are lots of things that we still need to learn but it appears to be
spreading in similar fashion to pass flu epidemics that we’ve seen we’ve had
extensive experience with preparedness going back since 2004 and that includes
such efforts as the h1n1 outbreak an actual event regular almost yearly
exercises also includes those drive-thru flu shots or flu shot clinic events
those are all designed to be able to prepare for a large-scale outbreak vdh
reviews pandemic flu plans and guidances on a regular basis and we also work with
our partners to ensure that they are up-to-date on their plans as well dr. o
fill covered this so non-pharmaceutical interventions are what we have at our
disposal to try to slow this epidemic want to emphasize that this preparedness
and the effort right now is a is a responsibility of our entire society not
just public health not just the hospitals or first responders and want
everyone to take what steps they can to reduce the potential for transmission
and include schools businesses local communities as well as our health
professionals so what can partner agencies do maintain open lines of
communication with your local health department review emergency operations
plans and pandemic flu plans of applicable and continuity of operation
plans want to emphasize that as we important to review workplace policies
particularly around sick leave that’s not just a formal policy but also
thinking about the informal messages that we communicate and our workplaces
in terms of whether or not an individual should take sick leave if they are ill
in many cases we see individuals who feel that they are in disposable and
can’t take leave when they’re ill they come to work infect others and we end up
having more people out more absenteeism due to presenteeism from those
individuals maintain situational awareness through tests trusted sources
information is constantly changing I would encourage you to use the vdh
website or the CDC website to be up-to-date on current information
take-home messages the current risk of CoV covet 19 infection to the American
public in the immediacy is considered low but we do know that the risk of
widespread community transmission in the in the future is a risk it is a rapidly
evolving situation and interim guidance will continue to change the information
that I have in terms of numbers was changing throughout today today and
every day I do presentation it has changed we advise individuals to
maintain vigilance frequent communication and coordination because
among partners is critical and promote flu and respiratory infection prevention I’m going to move on from this these are
some of the the the knowledge gaps that we have now there’s a lot that we have
learned we have had some challenges with getting early information out of China
but we are progressively learning about this in
affection and how to fight it but we still have more to to learn in terms of
the pathogenesis and virulence evolution of the virus the dynamics of
transmission viral shedding in terms of transmission the role of fecal oral
transmission is something that has come up based on some cases in China the risk
of factors for infection and seasonality of this outbreak wanted to take a minute
to point out that we are still at widespread activity for influenza and
this is probably our biggest immediate threat however the steps that one would
take to slow transmission are the basic measures that we need to follow for this
and other outbreaks frequent hand-washing coughing in covering coughs
including coughing into the sleeve rather than your hands where you may
transfer the infection to other services and reviewing as a mentioned workplace
practices so I’ll stop there good evening everybody I would just say
that one of the most important things that we’re doing at Sentara is we’re
talking to our partners and our team talking to everybody at the front of
this table here and we’re doing that every single day and I actually thought
your old field was presenting to one of our groups earlier today and I was
struck by the fact that his slides were up-to-date when he spoke to us and he
had to change them by the time he got here so things are rapidly changing
every single day one of the things that we realized at Sentara
was that what we had to do we had to think of our patients but not just the
patients the people that work for us our employees and the medical staff and
everything we do regardless of how we’re working through that we have that top of
mind so how do we make sure that we keep our patients safe and we keep our
employees safe and we keep our medical staff safe so when we started to do this
it was three weeks into over nineteen we said you know we need to really get our
arms wrapped around this because if we don’t it’ll be here and we won’t be
prepared so we put together a multidisciplinary team pretty early on
in January and on that team we have operational leaders we have physicians
we have nurses infection prevention we have very very importantly materials
management to make sure that we do have our supplies that we have our PPE
everything that we definitely need there we have pharmacy and lab and we have a
process improvement engineer because we realize that things that we were going
to do we were going to have to change it I will tell you that we meet every
single day a team of us meet every single day and we make plans and we
implement those plans we have put them into practice very importantly and from
those who study high reliability organizations we have to listen to the
people that are actually doing the things and so they give us feedback and
so the day I was on calls emergency physicians and they said you
know what it’s really not working out that way
we need to pivot because we want to make sure that what we do and what we think
is the right thing we can actually do operationally again keeping in mind that
we want to keep our patients safe and our employees safe and our medical staff
safe so you put together this team and we said well we’ll contain things and I
think you’ve heard that containments hard we can try to do those things so we
will contain and we’ll try to mitigate as best we can we do really really good
job of making sure that we identify patients so in epic when you come in
doesn’t matter whether you’re in your ambulatory practice or in the hospital
we have a travel navigator that pops up and ask these questions so that we can
actually remember on each and every patient to ask what’s your travel
history have you been in and the CDC pushes that to epic epic pushes it to us
and so those things are updated on a frequent basis we’re trying to if
someone comes in and we do have a patient we will have a patient we’re not
going to transfer that patient to a specific hospital because we believe
that the care that they need is really care that we can all render so wherever
that patient is we’re gonna take care of them there and you heard from dr. old
Phil the things that we need to do and those are the things that we can do in
all of our hospitals centerra has 12 hospitals we have seven here in Hampton
Roads and of course a big Hospital flagship Norfolk general but the things
that we need to do we can do in each of those hospitals but we also need to
think about the future so things are changing and you’re seeing that patients
are popping up all over the place Wake County yesterday in North Carolina just
a matter of time before Virginia well what if it’s one patient whether it’s
five patients whether it’s 20 patients so one of the things that our team is
doing is flexing our our thinking what I’m going to do if we have more patients
than maybe a one or two so putting those things and our plans into place
communicating communicating communicating not too much we don’t want
people to panic but make sure that people have the right information at the
right time so we communicate to all of our employees our members of the team
you okay to our physicians and again we have
these meetings where we actually listen to them and they can give us direct
feedback on things that are working or not of course we need to monitor
healthcare personnel for exposures and that’s not been a case now but we will
and I think that what you heard was if we use appropriate PPE that shouldn’t be
an issue one of the things that we learned with Ebola is that people know
how to dawn their PPE but sometimes with the doffing of the PPE they don’t do it
right so again we will go back and we’ll educate and we’ll train and we’ll train
and will train to make sure that people understand exactly how to keep
themselves safe then of course managing impact on our patients on a staff our
medical staff and impact on operations because we don’t want to completely stop
operations to take care of a patient if the other 25 people that are coming in
with COPD exacerbation or having an mi we can’t take care of them so we’ve got
to make sure that we flex to take care of all of these patients so again we
monitor the situation 24/7 our emergency manager I go into her cube every morning
she’s got six screens up there and she’s looking at everything and we have a
debrief first thing in the morning there’s something going on at night I
got a text the other night at 3 in the morning it’s we were always looking
always trying to understand what’s happening what’s changing and of course
talking to our partners because our partners will give us information about
what we need to do or to change differently we put together a field
guide it’s a pretty large field guide that sort of walk step by step by step a
bit of a checklist for what do you do if someone shows up what do you do if
someone shows up in your office what do you do if someone calls you from home
what do you do if someone shows up in the IDI so we sort of have tried to plan
for those things so that our physicians and providers and nurses know what to do
when those patients show up and again I think
we do travel screening for everybody I think that’s very very important it was
easy at first you know if you’re coming out of China and then now it’s well if
you’re coming out of maybe Iran if you’re coming out of South Korea Japan
the Washington State you mentioned that so you know we need to think about who
do we screens or so I think everybody is on high alert and people are very
sensitive to that and I would also say it’s not just screening for people that
are coming to us but what if what if I decide you know I want to go to Italy
for a great trip in Tuscany and have some great wine well is that putting me
at risk is that putting my team at risk if I go there because I may be
asymptomatic and I come back so those are the kinds of questions we have to
think through so again the exposure to other patients and visitors and staff
you know we have been collaborating every day with Eastern Virginia
healthcare collaborative of the understanding what are people doing
what’s the military doing in this area what are the other hospitals doing we
talked to the Virginia Hospital and Health Care Association the Virginia
Department of Health we’re on calls with a CDC trying to understand what people
are saying because we want to have a unified response I spoke to a physician
yesterday said it’s really important for everybody to have the same response
because if I go the Riverside in the morning and Mary Immaculate in the
afternoon then to Sentara that evening I want to make sure that we’re doing the
same thing because it’s very very confusing so we want to make sure we’re
on the same page and I think we’re doing a pretty good job of talking to each
other the other state agencies as well and if someone comes in and where there
are Pui then we actually will do the appropriate things that the Vth and CDC
is telling us to do we isolate those patients who do the needful and we keep
ourselves safe and we keep our staff and employees safe and of course we have to
look where people are going so if I decide to go to Italy then I need to
make sure I check in when I come back and we just do a screening with instant
to make sure that was what we don’t want to do is we don’t want me to bring it
back and expose the rest of our team again just reinforcing the importance of
talking to other agencies talking to other people talking to experts dr.
Oldfield has graciously agreed to again talk with me and other physicians on
Friday again he was with us that earlier today I’m hearing him talk tonight and
I’m sure that when Friday rolls around things are gonna be different but that’s
okay as long as we have our subject matter experts sort of giving us advice
on a day-by-day basis looking at the cdc website talking with people at b th and
the vb v HHA I think we’re gonna be pretty good on top of these things thank
you good evening my name is Jim Redick I’m
the director of emergency preparedness response for the City of Norfolk and I
suspect my presentation will probably a lot more technical than the ones to my
left I was a joke so I will be brief our role from the city we plan for
disasters all the time in fact to define what Emergency Management is the
elevator answer is typically we tell people things they don’t want to hear to
spend money they don’t have on things they don’t think will ever happen so we
are always focused on what if so from messaging we want to keep it real we
heard that earlier we want actionable timely accurate accessible information I
can tell you that public health is the subject matter expert for this so we
rely on their messaging and that’s what we relay but in the background we’re
always thinking what if what if we get that first case when we get that first
case how bad can it be and then we work through those processes I can tell you
and I probably won’t rely too much on these I can tell you one the plant the
hazard for which we plan natural all-hazards natural technical and
man-made all have a health component to them I think we’d all agree with that I
can also tell you that we work with public private not-for-profit higher
education military in the faith community so what I would like for you
to know is one we have a plan we have a plan that has been built on previous
incidents like Ebola like SARS like all these other things and the plan gets
better and better each time the guidance that we get we update our plans we
updated our plans this morning based on the latest guidance and those plans are
all of our plans so those plans that we have are online
so if you go to norfolk.gov and search for team Norfolk plans
you’ll know what we know you’ll know how we’re gonna do things and the whys
behind it because Amanda Ripley I don’t know if you know her the author who
wrote the unthinkable those who survived disasters and why it’s all about
ensuring everyone understands the plan it would not be right for us to tell you
that we’re gonna do isolation and Quarantine based on dr. Lindsay’s orders
and and just to be clear our mission is to support Public Health’s mission so
obviously they’re not resourced to do everything that they may need to do and
that’s when we bring the team of partners to bear so again Amanda Ripley
is unthinkable we want to explain the whys in the house so you understand the
wisenhouse and hopefully make good decisions based on that information
again I don’t want to be a hoarder of information I want you to have the
experience give me the information on which you need to make your decisions at
your household level your business your faith community wherever else that
you’re gonna have to decide on what you’re going to do during disasters we
want to share the same information and resources that we have with you so these
are some of the things that we plan for so again we appreciate the blue skies
peacetime blue skies but we’re always planning for those worst-case scenarios
we do have we do have the plans all hazards and we have a team so team
Norfolk to me is that combination of public private not-for-profit higher
education military in the faith community when you consider when I look
into this crowd and when I consider our community as a whole the talents the
resources the expertise we have a lot of things a lot of excellence in Norfolk in
the Hampton Roads region so again when I say this is our plan I mean our plan and
I would love to hear what you could bring to the table based on the
resources and the responsibilities in these plans but our local emergency
planning committee is a group that meets semi-monthly and we are always focused
on the latest information we have a it’s funny because we have a calendar of
events for every month we’re going to meet but life happens and so whatever
that that incident is that’s going on that’s what we’re going to talk about
we’re gonna go line by line through our plan
to make sure that everyone understands likewise we’re looking at other areas
that are experiencing a greater impact of the coronavirus right now so King
County King County did a webinar earlier today I’m watching that to see what we
can learn from them what are some of the things that they’re doing what are some
of the things that we can learn from that they’re not doing but again if
we’re not taking advantage of those opportunities they were wrong because
they’re opportunities to improve our plans as a community level I do want to
share with you some of the partners with whom we plan train and exercise and
respond and I won’t read all these but I want you to know that it is not solely a
government response it can’t be a government response we’re going to do
the best that we can but we’re reliant on and we work with and have most
importantly relationships with somebody from every one of these organizations now just to stop right here because one
of the other things that I’m focused on our barriers over 20% poverty in Norfolk
that’s a barrier one of my focuses is on what if folks can’t meet their most
basic needs like feeding their family paying their bills and alike
so when I go out and say get flood insurance that’s a self-fulfillment need
and it’s it’s really a dream that you know realistic so we’re trying to reach
those who are out in the community working with our CSB our community
services boards Department of Human Services our Neighborhood Development to
find out really help identify what’s been termed the least last and the lost
so we can make sure that they get the assistance that they need folks who are
resourced we hope make good decisions based on the information that we give
them some folks are not in a position to make those decisions and we have to help
them during peacetime blue skies and hopefully while we do that we build
trust and relationships so then again we’re all in the same page when there is
a disaster Oh case in point meals on wheels those who are homebound
and reliant on home delivered meals for their sustenance what happens when there
is you know an order for social distancing or the like is that operation
impacted we work with Sentara Meals on Wheels and senior services of Southern
Bruce other Virginia and others who provide those services to make sure that
we don’t have a disaster within a disaster but folks not getting those
basic needs so again that’s from AES f6 a mass care housing and Human Services
perspective that is a huge concern of mine is making sure that folks can meet
the most basic needs so eventually they get to the self-fulfillment needs of
disaster preparedness the more of our partners probably a lot of them in this
room some traditional some non-traditional how many of you
were students in here I’d love to work with you and not only work with you and
build that that bench strength during a disaster get you experience on your
resumes as well the opportunities are there it’s just a conversation and a
plan so we have that in advance of a disaster during the disaster is not the
time to come to the emergency operation center or ask how you can help because I
can tell you there are affiliated volunteers and there’s unaffiliated
volunteers affiliated volunteers and I’ll get to that slide we know who you
are we know the organizations with whom you’re working typically there’s
background checks we know the tasks tasks that you’re able to do and we make
those specific requests unaffiliated volunteers we have no idea who you are
what your intentions are good bad or otherwise and essentially you’re going
to sit on the bench until we figure out how we can connect you to someone so
you’re going to be frustrated because you’re not doing what you want to do
we’re frustrated because you’re consuming the resources that we have for
the survivors of the responders so we need to get you affiliated now so we can
get you plugged in so you could be part of that that effort when the disaster
does come I apologize for the acronyms obviously Norfolk State University Old
Dominion naval Operating Base Naval Station Norfolk as well as joint
expeditionary base little creek four-story so again various sectors and
levels of government with the intention of unity of effort and unity of message
speaking of messages so External Affairs Larry Hill where are you back there so
that is a gentleman you want to speak with as well recognize Larry Hill from
the Virginia Department of Health their public information officer so again the
information I get from him and dr. Lindsay is what we are relaying and we
would ask you to relay that as well I mean that that is the official source of
information on which we rely and spread out in the community but again we have
to have consistent and unified and accessible messaging to put Ben Franklin
and I’m sure none of you are around during that time we must all hang
together or we’ll hang separately so if you can imagine us sending different
messages from different agencies the perception rightfully so would be that
we don’t know what we’re doing I will take
this opportunity to again recognize our media partners thank you for the work
that you guys do and helping get the information out and also making sure
that we replace any fear or confusion with factual information you guys do a
great job during this and other incidents as well and then the
affiliated volunteers again this is not a complete list but these are a lot of
the agencies organizations with whom we work we know who they are and I can’t
tell you the value that they bring to the team I’ll speed by this because dr.
Lindsay already mentioned this but part of our role in emergency management is
to understand what’s going on from all the different agencies we read
everyone’s plans to make sure that there’s no duplications there’s no
conflicts and we have that overarching plan that you have access to because
it’s all of our plan so you would know when you read our plan
what public health is doing in terms of surveillance
you know what the Coast Guard is doing Norfolk public schools what the airport
is doing as well as 911 calls 9-1-1 and they’re expressing symptoms of then
there are specific questions that we ask for our first responders so they don’t
become impacted as well so dr. Lindsay already explained how we work together
she mentioned the incident command system and it’s all about unity of
effort one team one fight so we break down those silos of excellence we put
together one structure so there is flow of information
up-down horizontal we’re all on the same page we all have shared unified goals
and objectives we all have one message from Larry and dr. Lindsay and make sure
that we’re all working together so again regardless of sector or level of
government you work into this structure and that establishes that all may we may
serve as one and obviously even it gets expanded based on the incident it’s
being used because every locality in Hampton Roads and mostly through the
nation formally adopted the National Incident Management System and ICS in
particular the incident command system in order to receive homeland excuse me
homeland security grant dollars so it’s required at our level the governor
already adopted it at the state level and required it through executive order
and it’s also required at the federal level so that is the game that is the
game by we all work in the same sandbox together
that’s what we should be using and that’s what we’re using here in Norfolk
and of course it was mentioned a situational awareness making sure that
we’re sharing the information among our partner agencies as well as the
community and there are tools that we have for that that we use for not only
coronavirus but also hurricane durian Florence the winter storms that we do
get or don’t get we’re all about sharing information as frequently and as
effectively as possible so with that I’ll end and feel free to contact me
with any questions after this event or certainly during the panel thank you for
your time it’s a good evening so in the interest of time I’m going to go through
my slides very quickly as a result the exam that we were gonna have at the end
I have cancelled it so I’m gonna leave as much time as possible for your
questions here and first I want to also recognize my colleague Bob Alpina who
helped me work with this presentation here so Bob if you want to just raise
your hand real quick there we go okay we’re gonna go through this it’s gonna
be really quick first of all Wall Street Journal three point six trillion dollar
wake-up call this is what the stock market lost in like the seven day
trading days up through this past Monday as the market value of investments wiped
out why is China such a big impact and how we’re doing it we’ve already heard
we’re in a global environment China is the world’s second largest
economy ours is the first in 2003 with SARS China only made up 4% of the global
economy now it’s 16% global cost of SARS was
estimated at 40 billion right now experts are predicting China’s economy
will contract by two to three percent in the first quarter and their annual GDP
growth is gonna cut in half from 6 to 3% China’s also the world leader in exports
and goods and services as many of you probably suspect they have the largest
consumer base 1.4 billion people to consume things we have about 1/4 of that
so really what the impact is the RuPt disruption in China’s mass
training manufacturing capacity greatly impacts the world supply chain they make
a lot of different things to include automobiles automobile components key
thing here 15% of all cars manufactured in the US probably have parts from China
they also do a lot of uh new technologies bottom bullet 80% of the
supply of antibiotics in the u.s. comes from China
80% okay Chinese exports the US you can see they’re really quick impact to the
world and the US economy took ovid nineteen will have a larger impact than
SARS World Bank estimates something like this could cost five hundred and seventy
billion dollars global GDP growth is going from 3 to 2.4 percent in a
contained scenario not a full-blown okay our GDP scheduled to drop or predict a
drop from two point three to one point nine percent and remember two-thirds of
our gross domestic product is consumer spending what folks in this room spend
each and every day price of crude oils drop 20 percent in this year alone
interest rates have hit record lows Travel industries you can imagine
typically impacted some estimates are saying a hundred billion dollar impact
on travel including airlines hotels you name it major conferences being canceled
at this point factories around a rule may start shutting down due to
interruptions in global supply chain there’s always already discussions and
stories of some car manufacturers having to go and personally fly people
suitcases get parts from factories keep their manufacturing lines productive
exports of China real quick Virginia 1.2 billion dollars
of exports to China 2018 port of Virginia their number-one trading
partners China they predict a six to eight percent decrease in shipping
volumes right now as a result to compare that LA Airport is 25% at
this point so much better for us here’s what we export to China on the left on
the commodities and export markets so China’s number two we export a lot of
things to China what’s the impact of course soybean prices down wheat prices
down corn prices down cattle prices down hog prices down all these farmers in
Virginia are suffering because of this Millfield foods if many of you don’t
know is owned by Chinese company so we’re their impact on academics
international students 41 billion dollars to the US economy China is the
largest source of foreign students in the US so a lot of recruitment abroad
and study of our programs have been suspended I was talking to dr. Dobrynin
about Virginia Wesleyan pulling all their students back as you can see
37,000 American students studying in Italy in 17 and 18 and 12,000 students
studied in China so overall Virginia 20,000 international
students 758 million dollars here’s some local universities look at the very
bottom the estimate every seven international students creates three US
jobs the if the flow of international students tops it could have a serious
impact on the academic environment lastly impact on consumers some positive
lower gas prices lower mortgage interest rates lower cost from some agricultural
products the negative potential job loss to do supplying disruptions and slower
consumer spending that’s really going to be the key if the consumer stop spending
we are gonna really feel it stop market drop negatively impact investments for
all those year here of 401 k’s in retirement plans you’ve probably seen it
and lower interest income on retirees that’s a negative that’s it so hopefully
i know but by quick but want to leave as much time for your questions thank you so we’re we’re not going to get our 30
minutes in obviously I want to thank our panelists if you give them another round
of applause here one of the things you may may be aware of is that they were
asked to present on some very in-depth detailed information in a very quick
amount of time so each of them did an excellent job with that we’ve got this
being live-streamed so we’ve got some folks online that might have questions
we’ve got two microphones dr. Campbell’s on that side and I’ll hang on this one
and we will start taking questions I have an online okay this is an online
question I’ve seen things going around on social media stating certain races
are immune to the virus does this have any truth to it I can say no and there’s
a lot of misinformation going around on social media it’s really sad actually
what’s what’s being said and it’s it’s detrimental there there are books that
have come out that are completely erroneous I mean it’s a lot of you have
to watch out for this misinformation good evening my name is Jordana brevin
Johnson my husband Larry Johnson is in hospital he has lots of complicated
issues first of all he’s a zollinger-ellison patient which he had
therapeutic endoscope procedure on December 13th dr. Park Perec we removed
that tumor and his body does not absorb stop well enough second of all he has
mice anywhere obvious which alone lowers his immune system and in
and he also is back in for the second time with crypto meningitis currently as
I am here because I promised him and I have a question it’s gonna be streamed
through the hospital networks of my husband can see this not okay all right
the crypto meningitis for the second time and he has not had a vaccine and
I’ll explain that in a minute but currently he’s receiving a bolus he’s
already happening knees him which is one of 41 allergies for my husband and part
of the reason he hasn’t had a flu shot Normie is because he cannot take live
vaccines there are 41 if you don’t know for my students there’s 41 allergies
right now currently he’s receiving the bolus and this is our last night here
thank God we go home and we’re going to go to the beach which is another
question on Sunday in we live in North Carolina so he’s receiving the bolus
then he’s receiving amphotericin B and then the bullets tonight he had also had
potassium replaced and his magnesium which is very dicey with a myasthenia
gravis patient it’s on one of those 41 allergies it was so low today and two
days ago and whatever days ago the danger with that is they are monitoring
that very carefully and I’m trying not to take too much time because the danger
is it can cause heart issues which he has up proximal tachycardia if it goes
too low if it goes too high he can have muscle weakness we’re going on vacation
we live in North Carolina we’re going to Atlantic Beach Sunday but I need to know
what steps I need to do take care of my husband and you think
right now there’s very low risk in North Carolina of kovat 19 there’s only the
one case in North Carolina so far so I think the risk is very minimal he’d be
more at risk of influenza which has very high activity in North Carolina right
now so he wants to do you know cover his page he wants to do social distancing
you wouldn’t want him around crowds things like that maybe maybe what would
be best is after the presentations we can have you come up and maybe speak
with one of the physicians here about your husband’s case thank you yes ma’am
we were just told that 80% of the antibiotics are manufactured in China my
concern is what about other medicines are we going to have a shortage of other
medicines that are so necessary for people to take so the question is the
antibiotics what about others there most of the generics are made in China for
blood pressure etc and the more disconcerting thing is most of the ones
that aren’t made in China made in India and India announced today that no
exports of generic drugs could be made without government approval because
they’re afraid they’ll be in a situation where they won’t have access to generic
so it’s going to be much worse than just what’s lacking from China we’ll take one on thank you first of all
for the wonderful presentation it was very great information I’m here for from
anthem corporation I’m an alumni first of all so it’s great to be back here
seeing all the great work you guys are doing
we have about 2500 employees in that one building and a lot of people travel and
we have people from different nationalities I’m here on behalf of the
company to take notes which I’m gonna present tomorrow in addition to what
you’ve told us is there anything you know immediate that you would recommend
like I have a team of 40 people that are reported to me but they travel you know
we have remote teams and they travel at different places is it recommended to
kind of put a freeze on travel and kind of promote remote work what’s your take
on that I would recommend it you stay up-to-date with the CDC website and
follow look at the travel advisories there and and take that into
consideration and the basic practices that we you know we discussed in terms
of hand-washing covering cough social distancing staying away from people may
be ill but beyond beyond that no specific recommendations for travel to
specific areas except what we see from CDC it is important to stay very current
and follow that closely because it is obviously a very rapidly evolving
situation so one of the other plans that we’ve been working on for the city is
our continuity of operations plan and I’m hoping every organization
represented here as one where you look at your your essential functions so if
you do have an impact on staffing you know where you really focus your efforts
on but I’ll speak on behalf of our information technology director who
almost had a heart when I told him how many people in the
organization wanted the telework so I would just encourage folks to have that
conversation with their IT department to see what that bandwidth capability is
for having a potential unrealistic expectation that everyone would be able
to do that telework okay I have an online question from Miriam what is the
procedure if you travel to France or Germany currently not classified as
level two or three but relatively close to Italy and return to the US should you
self quarantine prior to returning to work even when you are not feeling sick
I personally would not self quarantine unless I went to an area with active
known transmission if I was returning from northern Italy Milan something like
that I would definitely consider it the same thing Iran we’ve already had
imported cases into New York City from Iran we’ve had imported cases into
Florida and Newport Rhode Island from Italy so those are the areas those four
big areas are where I would consider self quarantine any individual returning
from another countries welcome to call the health department or for updates or
questions if they have concerns if they are coming back to their home
destination from an international origin and it is a country felt to be affected
by community transmission they will be hearing from us and they will probably
be hearing from someone as they enter the country as well with that basic
screening for symptomatology and travel history hi my name is Monica Clark I
have three questions how was China’s water contaminated how did China dispose
of those contaminated items and in those bodies all those people that died
and how long does this virus stay on the surface well we know it can survive on
surfaces for a limited amount of time it depends on the humidity the temperature
whether it’s ours or not but I’m not aware of any water contamination in
China it was an issue I don’t know how those those bodies were disposed of hey my name is Glenn hooky I’m a
resident physician here at EVMs my question is about the seasonality of
past coronaviruses and how they might be applied to this coronavirus weather when
we might expect our cases to the curve might Bend based just on seasonality and
my second question is reinfect ivities once we have any data on people who get
the disease are they immune afterwards we don’t have any data yet on immunity
we’re presuming it’s me the same as others that if you survive you’re gonna
have durable immunity we don’t know how long
as far as coronaviruses the other ones remember we said that if you are have
significant symptoms you don’t excrete virus until you become symptomatic you
can control it so with SARS it was controlled in five months that was the
classic let’s go back to pandemic flu which might be more like this in 2009
the first u.s. cases didn’t even occur till April so there’s nothing magic
about viruses in April it then continued through the summer a decreased in late
summer and then there was a second hump and you often see that for you have a
winding down and then it comes back and it continued through November at a very
high level and then that was when we got the band I’m in flu vaccine and it
slightly went down but it didn’t really go away till May of 2010 so pandemic flu
circulated for thirteen months and now it’s endemic and it’s estimated would
have a hundred million cases of pandemic flu at the h1n1 as it recirculates each
year and so it’s unpredictable with it’s going to do but I can’t imagine it’s
gonna follow seasonality I’d like to know if this event has been recorded and
if so if it will be made available to the public and how so and my second
question is I know that in 34 35 states price gouging is illegal do any of you
know if the price gouging that was described in this presentation the
Purell for instance on Amazon if anyone is
taking action to prevent price gouging so my understanding about the Amazon
issue and I’m afraid to correct me if I’m wrong but Amazon actually took those
off to prevent the price gouging and when price gouging takes place during
any type of disaster the Attorney General’s Office in
Richmond would certainly address that and there’s opportunities or ways by
which that could be reported I can’t speak on the recording though on the
offering yes I can speak on that so the the event is being live-streamed some
people RSVP for the online version of this and you see the questions it is
being recorded so we can therefore post it what we’ll need is to be able to get
to you where that posting is so if you RSVP’d to this event then we have you
already if you signed in legibly I might add and the sign-in sheet and you put
your email address then we can contact you that way if you haven’t done either
of those make sure you do that the second one on the way out hi
I’m glad of this young man over here asked about the seasonality of the virus
because the only thing that came to mind for me was what the city of Virginia
Beach may do in terms of preparation for something in the water which is
scheduled to happen in about seven weeks and what you know discussion of it’s not
a matter of when or whether or not if coronavirus will continue to happen but
more so when a little nervous because I already paid my money for those tickets
so having all those people really everyone’s really pretty much gonna be
at risk so can you touch bases on you know what the city of Virginia Beach or
perhaps other neighboring cities are paying preparing for with such a large
crowd that you know will likely attend for that week of festivities no okay so
this program will be edited right no I mean there’s really no secret it’s too
early to tell if there would be any type of cancellation or not but we would be
doing our due diligence if we look ahead on the calendar of what special events
are occurring and having a threshold by which we would make that decision
certainly don’t want to speak on behalf of Virginia Beach but I know we’re doing
something similar and that is again just yeah taking an inventory of what special
events are coming up and having a process once decisions are made from the
health department you know what would need to be canceled
and whatnot so that is just one event of many that we would be looking at so as
director of the Virginia Beach Health Department as well cancer and I can tell
you that we are working with other emergency responders and planners and
the city to plan and look at head at what steps we may need to take in the
event or when there is community level transmission in the country as well as
in our state also I’m a part of a group that is working at the Virginia
Department of how state-level looking at issues like
events and how we might want to think through that process and monitoring our
active monitoring of disease activity and knowing where and and when
transmission has evolved in our state and across the country will be an
important part of that as well as other triggers it’s not as straightforward as
just knowing numbers and transmission to make that determination our specific key
objectives that we’d be looking at trying to achieve through social
distance and distancing and looking at whether or not that would be an
effective measure so we’re not at that point yet of making a decision of
whether or not that specific event or others would be canceled thank you I
think we’re gonna need to stop here there I know we didn’t get to everyone’s
questions but we do have some folks that would be I’m sure willing to stay and
answer some things want to thank everyone for attending tonight and thank
you once again everybody be safe remember all these protective measures
you can take thank you for coming


One thought on “Coronavirus (COVID-19): Panel discussion at EVMS

Leave a Reply

Your email address will not be published. Required fields are marked *