- (female announcer)
Production funding for
Behind the Headlines
is made possible,
in part, by
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the WKNO Endowment Fund,
and by viewers
like you, thank you.
- How Memphis is
fighting coronavirus,
tonight, on
Behind the Headlines.
[intense music]
I'm Eric Barnes with
The Daily Memphian.
Thanks for joining us.
I am joined tonight
by two doctors
from Le Bonheur
Children's Hospital,
Jon McCullers,
Pediatrician-in-Chief
at Le Bonheur,
and a Senior Associate Dean
at the UT Medical School,
thanks for being here again.
- Thanks for having us Eric.
- And Nicholas Hysmith
is a doctor specializing
in pediatric infectious disease,
thank you for being here.
- Thanks.
- Along with Bill Dries,
reporter with
The Daily Memphian.
I'm gonna start with
you Dr. McCullers,
and we'll try to go
through, sort of,
all kinds of things,
about social distancing,
about the state of testing,
and about the symptoms,
and what do you do if you
feel like you have symptoms,
and so on, so try to
hit all those things in.
And other issues, as we
go through this today,
and try to stay as focused
as we can on Memphis
and Shelby County,
but obviously
this is a national
and global issue.
For right now, the
social distancing,
and we'll define that, it
seems to be the thing that
in the last week and a half...
You and I ran into each
other, in a restaurant,
a week and a half
ago and chatted about
where's this gonna go.
I don't think that restaurant,
I think they're
doing takeout now,
I think most restaurants are
in the process of closing,
people are working
from home, schools,
I think every school,
public and private,
and so on has closed.
How far does this go, from
hey, let's stay apart,
and let's not gather in places,
to the end of the spectrum
where it's shelter in place,
don't go out unless
it's an emergency
or you need to get food.
I mean, how far does this go?
- So, we can think about it in
maybe three different phases,
and one would be doing just
some simple social distancing,
protecting those who are
immunosuppressed or at risk,
and saying, "Hey, wash your
hands and stay, you know,
a little bit distant
from each other."
And let's just try
to not infect those
who are at most risk.
We're now in kind of a
phase we call mitigation.
Which means we're
really doing many things
that are designed to stop
the spread of disease.
So, you know, not
gathering in large crowds,
working from home when you can,
staying away from, you
know, the grocery store,
and you know, practicing that
six-foot social distancing.
Cancelling many events that
we might otherwise have done.
The third phase which,
you know, you refer to
as shelter in place,
we call suppression,
and that is really where,
you're just trying to do
every single measure you can
to prevent social contact
and to keep the virus
from moving at all.
- And do you think,
from your point of view,
we will or we need to
end up at suppression,
shelter in place, that stage?
- It's a very
interesting argument
as to what is the degree
to which suppression is better
at this than mitigation,
and then what are the
costs of suppression?
So, what are the
consequences on the economy,
and on people's lives of
that sort of strategy?
Versus one where, maybe
it doesn't work as well.
You know, we really don't
know enough about this
to say, I think, what
the best thing is.
Which is why, many
municipalities are erring
on the side of, well let's do
the maximal thing possible,
for the good of the people.
- Dr. Hysmith, bringing you in.
Your sense, in terms
of, and we'll come back
to some of these
social distancing,
but I wanted to get you
in on, maybe on testing.
And obviously, there's
a lot of frustration
and confusion about
testing, that you know,
the State got 500
tests, which seems...
is obviously
wildly inadequate.
What are you experiencing
within Le Bonheur,
within the medical system,
in terms of your ability
to get people tested?
Can you get all
the people tested
that you wanna
get tested?
- So right now, the
answer is no to that.
We cannot get everyone
at this time tested
that we need to have tested.
I think early on, when we
saw this happening in China,
and we saw it happening
in Europe, we were all,
the health departments around
the country were looking
at ways that they could ramp
up their testing abilities.
And when we had one or two
cases here, in our community,
communities across
the United States,
that was adequate, we could
test those individuals
and then sort of trace who
they had been in contact with,
and it wasn't using up a ton
of our testing
resources at that point.
Now that we have ongoing
community spread,
in a lot of the communities
in the United States,
and we will most certainly
have that here in Memphis.
I think we definitely need to
ramp up our testing
capabilities.
We've seen some of the
commercial labs come online,
however they are severely
backlogged right now
with all the tests from
across the country as well.
So, I think, working on
getting a test here in Memphis,
in house, in some of our
facilities here in Memphis
is gonna be critical
going forward.
- Let me get Bill, we
have obviously have
a lot more questions on that.
- So Dr. Hysmith, for now,
it's not community spread
with the cases
that we know about.
So, there is tracing who people
have been in contact with,
which seems to be a necessary,
but a tedious, process.
Do people you contact about,
okay, tell me everyone
that you came into contact with.
I would imagine, they
can't remember that,
in all cases.
- Yes, that's true.
That's a very tedious
process, and I can say that,
as of this morning,
here in Shelby County,
we have had cases that
have all been acquired
somewhere other
than Shelby County,
and they've come in here.
So, when I say we haven't
had community spread,
we haven't had community spread
here that's been documented.
- And I should also
note, we're taping this
Thursday morning, just cause
it is a fast moving thing.
Back to you.
- Yes, true.
I think that that will
change, and I think
there has probably been
community spread already
in Memphis that we
just haven't recognized
cause we're not doing mass
testing waves at this point.
- So, at that point, when
you have community spread,
you don't trace, you simply
begin to treat and deal with
what's gonna be a
locally spread virus?
- So, yes to that question.
There has been some,
that's sort of what they've
started doing in some
other parts of the country.
They have stopped the
contact tracing element,
and they have simply
ramped up their testing.
If you have symptoms,
you stay home.
Don't go out into public,
practice social distancing,
and in areas where they
have large amounts of tests
that they're able to
perform, people can go to
these testing stations
and be tested.
- Let me go back to you,
Dr. McCullers, and talk...
Have you administered a
test, yet, to someone?
- Not during this outbreak.
- Not during this.
But if you had,
let's take that from,
there's a box or a swab,
like walk through the
minutia of testing.
- So, testing in this context,
you're trying to get a piece
of the virus from out of
a person's mucus membrane.
So, what we would do is,
the person would typically
be in a setting where the
healthcare worker's protected,
so either they're
going to the home
and they're wearing all of this
personal protective equipment,
or now we're seeing
the drive-bys
where people stay in their car,
and the healthcare
worker's wearing
their personal
protective equipment.
You then would have
a little test tube,
that would be full of what
we call viral transport medium,
something the virus
stays alive in,
and is stabilized in.
You would take a swab,
and either swab their throat
just like you're used
to with the strep test,
or you would swab
through the nose
and hit the back of the
throat with the swab.
It then goes in the
transport media,
you swish it a little bit,
break it in half, cap it.
You send it to the
testing facility,
where they're then gonna
run molecular tests
which look for the genome of
the virus within that sample.
- Right now, those
tests are being sent...
There are two
commercial labs, I think,
in Memphis, is what's been
reported that are doing it.
A lot of them are
going to Nashville.
I mean, in an ideal
situation, would they be done
you know, at Methodist,
at Le Bonheur,
at the hospital itself?
Is that where
we're trying to get,
in terms of the
speed of testing?
- So, there's at least two,
right now, commercial labs.
There's others that are coming
up in the very near future.
And, to varying degrees,
they have to send 'em
to other places in the
country because the model
is of course
centralized testing,
and then back out to
the different locales.
So, some of these are actually
going to California
to be tested.
And you can see, with all the
travel issues we're having
that that creates it's
own supply chain issues,
and it takes five or six
days to get a test back.
So, ideally, and this is
what we're hoping to do
at UT within the next two weeks.
We'd have a test here locally,
the test only takes
about four hours,
so if you're running it
a couple of times a day,
you can get results
back in 12 to 24 hours
that are actually
useful for somebody
like Dr. Hysmith to use.
- Who, in an ideal world,
who would be tested?
Cause right now it's a
pretty high bar, right?
I was talking to one
medical professional,
who was saying, "Look, you've
gotta meet the CDC guidelines,
having been in a
level three country,
you have to have been
exposed, it's a very high bar.
You might have some symptoms,
you might have a fever,
but you're not gonna
get tested right now
in Memphis, by and large.
Ideally, who would be tested
if the test were fast
and readily available?
- So again, depends a little
bit on what the scale is,
and how much new tests you have.
Right now, we'd love for
doctors who are worried
about a patient
having coronavirus,
to be able to test 'em.
So, that would be the
first line of that.
- And not have to, you
know, hoard those tests
for only the worst, most likely,
- And you'd like it--
- Dangerous people.
- To be easy to do,
you'd like it to be cheap
or free to do is
another big case.
And then secondly,
you'd like to be able
to test contacts maybe.
So, somebody's been in
contact with somebody,
maybe they're a critical
healthcare worker,
test 'em, say they
don't have the virus,
they can go back to work, right?
- Before I go to
Bill, your sense,
and I didn't know this, but we
were chatting before the show,
you've consulted with the CDC,
you've trained other
people who've been,
you know, flu specialists.
You've seen this on a national,
global scale, and so on.
Your sense of when we will
have tests at that scale.
The amount of tests that
you all, as professionals, need.
- I think within two weeks.
- Within two weeks?
Within two weeks, okay.
Let's go to Bill.
- Dr. Hysmith, some people...
are taking one view that
this is the end of the world,
some people are taking the
view that, what's the big deal,
this is just flu like we
experience all the time.
This is not your
normal flu, is it?
- No, yeah that's
a true statement.
I think that we
have seen examples
of this in Europe already,
we've seen it in the
United States already,
in some of the experiences
some of the
communities are having.
Simply, the amount of
healthcare resources
that this is requiring is
really not something that we
see normally, with influenza.
The severity of the illness
in older individuals,
or those with chronic diseases,
has put a real strain
on the healthcare system
in many parts of the country,
so I think that we definitely
need to take this seriously.
I think that young,
healthy individuals
still need to practice
social distancing.
We realize that we
have severe disease
in those individuals as
well, but the big thing
is transmitting that to
someone that is elderly
or has an immune
compromising condition.
- Dr. McCullers, what
about a vaccine?
And does the development
of a vaccine suggest
that COVID-19 is
not going to vanish
when this is all over?
- So, we know the
virus isn't going away.
It's spread enough
around the world
that it's gonna be here
for some time with us.
Vaccines are really,
really difficult to make.
Let me just say that.
We've been working on SARS
vaccines in the United States
and worldwide for 17 years,
we don't have a vaccine.
We've been working
on a vaccine for RSV,
which infects babies, for 50
years, we don't have a vaccine.
So, I think there's hope
that we can develop a vaccine
to this, but it's not assured.
Now, the good thing about
the SARS experience,
is we do have some
vaccines that are coming
into very early, you
know, human trials.
So some candidate vaccines.
We're able to
rapidly adapt those
because the viruses
are so similar,
and get coronavirus vaccine
trials for the new strain
into trials very, very quickly.
It still is an 18-month
to two-year process,
even if it works,
and we're not assured
that it's gonna work.
- So Dr. Hysmith, your
thoughts on a vaccine,
and also, a bit about
hearing the word vaccine,
and kind of looking at that as,
oh, okay, well
that's on the way.
So, we don't have
to change behavior.
Quite obviously, we are
having to change behavior.
- Right, yeah, I think that
definitely in this point
we have to change
our behavior, if not,
we're gonna overwhelm
our healthcare system
with the illnesses
that the elderly
and those with chronic
medical conditions will have.
I think the vaccine is
great, and that's something
that we can look forward
to in the future.
But right now,
we have to deal with
what's going on currently.
And if we don't
practice these measures
that the CDC has
recommended, we're going to
overwhelm our healthcare system.
- Do you think this changes
our healthcare system?
Aside from the virus,
aside from the medicine,
is the structure of our
healthcare system changing,
or should it change
as a result of this?
- That's an
interesting question.
I think I would like
to see it change
as a result of
this going forward.
I think there definitely
can be opportunities
for more collaboration,
around the community,
amongst all of our
healthcare facilities,
and amongst our
healthcare enterprise
as a whole in the city.
I think that for a
long time we discussed
the healthcare system
in the United States,
and I think this is
the perfect opportunity
for that to change,
going forward.
I can't say how it would,
but I think that this is the
perfect opportunity for that.
- Mhm, Dr. McCullers,
your thoughts on that?
- So, I think this is an
opportunity for us as a country
to kinda revisit how
we do healthcare.
We have been divesting in the
public health infrastructure
and in primary care
since the 1940s
when we really rallied
around tuberculosis
and preventing
transmission of that,
as well as
mosquito-bourne illnesses.
And, particularly in the
last 5 to 10 years,
we've seen a divestiture
and really a lack of respect
for, and acknowledgement, of
the public health officials
and the experts that
really would help us
prepare for this sort of thing.
So, 15 to 20 years ago, I
worked with the US Congress,
with WHO, to work out
pandemic preparedness plans,
our strategic
national stockpile.
Since that time, there's
just been a degradation
of our ability to respond.
So I think this
is a call to say,
after we get through
this, we really need
to build that back up and
make that our primary focus
to prevent this sort of thing,
and prevent just the normal
chronic diseases
that we see everyday
that are preventable if
we put the resources in
up front, instead of
waiting till they're present
and trying to treat
the results of them.
- I was thinking about this
as we were getting
ready for the show.
It has felt, over the
last, I don't know, weeks.
It's like a slow motion Katrina.
Where you kind see
the storm coming,
it's like, oh yeah, we
get storms all the time.
We get flu outbreaks
all the time,
we always live through those.
And then people, as
it's getting closer,
start saying this is a
different kind of storm.
And then it hits.
And suddenly, and you know,
I remember with Katrina,
there was this sense
that everyone was waiting
for the federal
government to come in,
for some days, and then
suddenly the locals realized,
they're not coming.
We gotta do it ourselves.
Is that where we are,
where you feel like we are,
in Memphis,
in Shelby County,
as a state,
that it's really up to
Memphis and Shelby County
to make the good
decisions, and get help
from the state and federal
government where it comes.
Whereas I think, people
seem to have expected
the federal government
was gonna lead on this,
and you all would
follow their lead.
- So I think there's
some elements of that.
Certainly, we were
supposed to have
a strategic national
stockpile that had, you know,
95 million and 95
masks for instance,
and it did at one time.
It now has 12 million,
because Congress
has not appropriated
to fill that up.
We don't have enough ventilators
at the federal level.
We've had a very
poor federal response
the last three months.
Those are all very, very true.
And we're having to do many
of those things now locally.
In terms of, setting
up our own testing.
Okay, so you would have
thought the federal government,
through the health
departments would have
been able to manage that,
well they've not been able
to manage that, we're
having to do it ourselves.
At the same time, you
don't want every town
and municipality
making their own rules
and doing their own thing,
because we are a country
and a population that has
so much interconnection
that if my neighbor is
doing something crazy,
it's going to impact me.
And again, we should be
having the federal government
help us make those decision
and set some of those rules.
- To that end, well
let's talk about
Le Bonheur for a second.
Le Bonheur, they announced,
like maybe it was yesterday,
sometime this week,
that their visitations
for people who are in
there for whatever,
a broken leg, or whatever
they've got going on.
Only two healthy
adults and caregivers,
y'all are gonna screen
them before they come in
to make sure their
temperature and so on.
The volunteer program at
Le Bonheur is shut down.
Postponing elective surgery.
I thought that was interesting,
you've heard that nationally,
why is that important,
postponing elective surgery?
Go ahead.
- There's been a bit of debate
about postponing
elective surgeries
and how far you go with
that, and what really is
an elective surgery, right?
So, if we don't do an
elective surgery right now,
does that person then
develop a bad outcome
because of the timing of
the surgery is disrupted?
Does it become an
emergent surgery,
where it's much more
difficult to deal with it.
So, there's urgent, versus
non-urgent surgeries.
There's unnecessary,
or nice surgery,
like cosmetic
surgery for instance.
That you maybe
don't need to do.
But then really,
where's that gray area,
where you need to do it, but
do you need to do it now,
and do you have worse outcomes
if you don't do it now?
- And I ask that in
part, not that I know
where that bar should be,
but back to this notion
of a coordinated response.
That's Le Bonheur's
rules, but I mean,
are those the same
rules for Methodist,
even though y'all
are under Methodist.
Is that the same
for Regional One,
is that the same for
Baptist, and so on.
I mean, are different hospitals
having different rules,
and is that problematic?
- I think most of the
hospitals are following
the idea that you're gonna
cancel elective surgeries,
but they're leaving it
up to their experts,
which are the surgeons
themself to say
which of those are essential
versus non-essential.
Which do we cancel,
which do we not cancel.
I think that's pretty
much uniform doing that.
The one little
difference is, you know,
hospital based surgery
versus outpatient center.
Do we wanna keep some of the
outpatient center surgeries
going so you don't have those
get into the hospital later
and fill up beds, that's
one of the debates
we're having right now.
- Okay, about seven minutes
left, go back to Bill.
- All right, I wanna
go back to one of
the more basic
points about testing.
Does everyone need
to be tested in this?
In other words, should
an employer send
all of their employees in,
once there are enough tests,
or as we get more tests.
To have everyone tested
to make sure the workforce
is safe, because I would
imagine that's no guarantee
that someone's not gonna
get this in the future.
- Right, true, and
I think this is
a highly debated issue about
who all should be tested.
I think you raise a great point
with the healthcare workers.
One thing we're looking at
pretty intently right now,
intensely right now,
is when we have,
so we will be screening at
all our Methodist facilities,
we'll be screening
all the visitors
and all the associates
that come in.
So, if we have an
associate that is
screened positive
for an illness,
we need to be able
to rapidly determine
that that associate does
or does not have COVID-19.
So that's gonna be one
key piece of the testing,
and I would say that all
associates that have symptoms
should be tested, that
way we can get them back
into the workforce
as soon as possible.
With regards to our community,
I think that is a debated issue.
I think that there are
some communities that are
looking at, sort of,
you have symptoms,
stay home, unless
they're severe.
But, I think there
are other communities
that are looking at
everyone with symptoms
should be tested, that
way they can sort of
stay away from, you know,
grandma and grandpa,
and young children
and things like that.
And I think that that's
probably the way we're headed,
is testing the majority of
individuals that have symptoms.
And I think that that's one way
to sort of, better get
the spread under control.
- Hmm.
Strategically, should
we deal with COVID-19,
the novel coronavirus,
outside of the hospitals
to ensure that the hospitals
are not overwhelmed?
- I think to the
best ability we can,
we should try to manage it
outside of the hospital.
Obviously, if you have
a severe enough illness
that you need to come
into the emergency room,
you're having trouble
breathing, that sort of thing.
Then, obviously, that
follows a different criteria
and you will have hospital
care at that point.
But I think, for the
most part, this should
be something
that we can manage
on the outside of the hospital.
- And by outside, is that
sort of screening tents,
and screening locations?
I mean, what is outside,
if it's not inside,
what is outside?
- Let me clarify that, I was
thinking of your question
as being should all
of these individuals
come to the emergency
department, that sort of thing.
And that is definitely
not the model
that we are proposing.
It would be more of these
outpatient screening-type
centers, where we're
not directing these
people to come to the emergency
department for screening.
- Five minutes here.
Let me walk through
just some basic stuff.
And people have read this,
but I think it's helpful
that somebody who is
maybe their neighbor,
and from a local
hospital to go through.
Just, so...symptoms.
What are those
symptoms that should
concern someone, or
not concern someone?
- So one of the important
things to realize,
the symptoms are
fairly distinct.
It's fever, cough, and
then lower respiratory
difficulty breathing,
or chest pain.
Really lower respiratory.
This virus doesn't have
a lot of the typical
runny nose and congestion,
things that we see
with flu and some
other cold viruses.
- All right, as we
tape this on what,
March 19th, I think here,
if you feel those symptoms,
what should you do?
- You should call
your physician,
or you should call into
somebody that you trust.
And if it's mild, you're
gonna be told stay home,
manage yourself at
home, don't come
to the doctors office,
don't go to the ED
If it's serious,
you can't breathe,
you're having trouble with
your breathing, you're worried,
then you go to
the ED, but call ahead
to the ED to tell
them you're coming.
- Difficulty breathing,
just to clarify,
is different than a cough?
Just, for a layman, layperson,
the difference between a
cough, even a bad cough,
and the lower respiratory
that you're talking about?
- All right, so a lot of
us are coughing right now
because allergy
season is coming in,
we got some nasal drip
and things like that.
So you're gonna have a cough.
Difficulty breathing is
typically chest pain,
difficulty getting your air out,
fast breathing,
labored breathing,
is what we're talking about.
- If you don't have a
doctor that you can call,
who do you call?
- Well, I would normally
say the Health Department,
but the Health Department's
being overwhelmed
with calls right now.
So this is again, is
one of our gaps in care
we have right now, that
we have so many uninsured
and who don't have a physician,
they don't have
somebody they can call.
- Are the organizations,
and I'm not endorsing here,
but like Christ Community,
like Church Health Center,
some of those, are
those places that people
without insurance, or
without a regular doctor,
should turn to?
- They're really stepping up
right now, so I do
think, you know,
what we call our
federally qualified
healthcare organizations
like Christ Community,
and others, are great
places to think about.
- Is there a list
of those that you
could send people
to, do you go to
the Shelby County
Health Department,
they have a list of
other alternatives
for people to go, again, if
they don't have a doctor?
- I don't know that there's
a comprehensive list.
I have one myself,
so I will put it up
on our UTHSC
coronavirus website.
- Okay, and let me,
if you were exposed
to someone, if it turns out
your child, your mother,
your girlfriend, your
husband, whatever it is,
has it, you are exposed,
what should you do?
- Well first of all,
I wouldn't panic.
All right, so, we know
for most people
under the age of 60 this
is fairly mild disease.
If you're over 60,
maybe there's a risk
for a more severe disease.
So, I would not panic, I would
keep doing the same things
we're doing with the
social distancing,
and with you know, trying
to take care of yourself
and wash your hands, and
then if you get sick,
make sure your healthcare
provider knows you were exposed.
- If you get it, and
people in Memphis have,
and more probably than
even know have it, right?
That's part of the mystery
and the murkiness
of where we are.
What are...
It runs it's course, I'm
acting like I'm a doctor here,
but it runs it's course.
What are the long term
consequences for people?
I mean, I've had the flu before,
I've had the flu multiple
times, is it like that?
That it's a really
miserable period of time,
and then you just
go about your life?
Or is it long term damage?
- Well, we think for most people
it would be like the flu,
and you're gonna be okay.
There are some cases
we're seeing now,
including in young healthy
adults who have it,
where they're
suffering lung damage
that probably will be a
chronic, respiratory issue
for the rest of their lives.
So, again, we're not
seeing a lot of deaths
in young adults, but we
are seeing infections,
we are seeing severe infections,
we are seeing some
of this damage.
- Okay, just a
minute left, Bill.
- All right.
Nobody alive now in our
city has any memory...
firsthand memory of what
the Yellow Fever
epidemics were like.
From what you've
both read about this,
is this similar to that?
- It's similar in that
we're having to do
the kind of social distancing.
During Yellow Fever, everybody
moved out to the country,
for instance, and got
out of the downtown.
It's a little different
in that we do have experts
who can talk about it.
Back then, nobody
knew it was carried
by mosquitoes,
they worried about
the miasma from the sewers
and things like that
being responsible.
And so I think there was a
lot more fear of the unknown.
We still have that
here, but I think
we're hopefully able to
mitigate that somewhat
by going on TV and talking
about it with the experts.
- Dr. Hysmith, your
thoughts on that?
I mean, it's the
first thing that
comes to mind for
many Memphians.
- No, I think that
Dr. McCullers says it spot on.
I think that we just need to
let our healthcare providers
and our professionals
in the community
sort of guide the
response to this,
and know that there
are people out there
who are working
on this very hard
for the public's behalf.
- All right, that is all
the time we have this week.
Thank you both for being here,
particularly in this busy
time, we really appreciate it.
Thank you for joining us,
that's all the time
we have this week.
Remember, you can get
past episodes of the show
at wkno.org, you can also
get the podcast of the show
on The Daily Memphian
site, iTunes, Spotify,
or wherever you
get your podcasts.
See you next week.
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