Today we’re interviewing Kevin Pham, a doctor and a contributor to The Daily Signal, about COVID-19. How real is this threat? How is it like and unlike seasonal flu and the swine flu? When do you need to call a doctor if you have symptoms? How soon can we expect a vaccine, and how likely is it that our hospitals run out of beds and ventilators? Is there any hope for better treatments? Pham answers all these questions and more. Read the transcript, posted below, or listen on the podcast:
We also cover these stories:
- President Donald Trump says he won’t stop referring to the Chinese origins of coronavirus.
- The Trump administration announces financial assistance for Americans.
- More states shut down businesses.
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Kate Trinko: Joining us today is Kevin Pham, a medical doctor and a contributor to The Daily Signal. He’s also a former graduate fellow in health policy at The Heritage Foundation. Kevin, thanks for coming on.
Kevin Pham: Pleased to be here.
Trinko: OK, so before we get into the coronavirus discussion, tell us why did you decide to become a doctor?
Pham: Well, it was kind of funny. In undergrad I was actually deciding between becoming a biology major and becoming a humanities major. And those two—
Trinko: There’s quite a gulf there.
Pham: Yeah, they seem pretty juxtaposed to each other. But the truth is, medicine is based in science. We treat people based on science, but in the end we’re actually treating people. There’s a very human aspect to clinical practice. You can’t really relate to a person unless you understand the person.
And I just felt like medicine was the best intersection between humanities and science that was available. And I think it’s a really noble profession for that.
Trinko: So how serious is the coronavirus threat?
Pham: It is certainly serious. It’s probably one of the more serious things that I’ve been alive for. I was still an undergrad when the H1N1 pandemic hit …. H1N1 was very serious, but the thing is, it was less lethal based on the current available data that we have for COVID-19. H1N1 was less lethal than COVID-19, and less transmissible.
What we’ve seen with COVID-19 is that its reproduction rate, which is how fast it can infect another person, seems to be between two and four, based on available data. Most of this comes from China, so it’s pretty good data. There’s a lot of data coming out of China right now.
It’s two to four for COVID-19, but H1N1, which was a serious threat, that one was between one and two. So as you can see just from the transmissibility, it was anywhere between two to four times as much as H1N1. So it is certainly a serious threat, and we should certainly be taking it quite seriously.
Trinko: So you mentioned in a recent op-ed you did for The Daily Signal that COVID-19 is not just another flu. Can you explain why the coronavirus is different from the flu? Because of course, tens of thousands, if not more, people do die from the flu every year. It is contagious, but we don’t take the sort of measures we’re taking now.
Pham: Right. So first off, COVID-19 is literally different from the flu. The other pandemic that I mentioned, H1N1, that is another influenza, whereas COVID-19 is a different coronavirus altogether.
As far as how it has not yet reached the deadliness of the influenza virus, the regular influenza virus, that comes from a couple of things. The first off is that it’s new. It’s new to us as a novel strain. So it hasn’t had a chance to sweep through the entire global population yet the way influenza has. So when this is all done and over with, hopefully it does not, but it may reach the kind of deadliness that the flu does.
But the other thing is, is that influenza is already throughout the world, so it would be impossible for us to stop the flu now because the flu, it mutates, it reasserts itself. That’s what H1N1 is. There’s also H1N7, and all sorts of different combinations of the two H’s and N’s. And so for that reason we can’t stop it, but we haven’t necessarily seen that yet with COVID-19, so there is a chance that we can actually stop it. And if we have the opportunity, we should definitely take the opportunity to stamp it out.
Basically with the flu, we’re behind already. We cannot catch up to the flu. But if we can catch up to this, we can save a lot of lives, and it’s worth chasing that goal because we’re seeing that the coronavirus is leaving, it seems like it’s leaving permanent damage to organs after the illness. People out of Hong Kong are reporting difficulty breathing that’s persistent, even after they recover and heal and get discharged from the hospital.
Furthermore, the influenza usually stays in the respiratory system, whereas with COVID-19, what I’m starting to see a lot of is that it also attacks the heart, in some cases attacking the liver. So it’s getting to a lot more places.
In fact, a lot of the people who are dying in Seattle, they’re not dying of the respiratory illness. They’re dying because their heart has developed a bad rhythm. Essentially, they’re having heart attacks, is what they’re dying from.
It’s different, not just literally being different, but it’s also different in how it affects people and the kind of ramification it has for a person’s health going forward.
Trinko: So you mentioned that we still have a chance that we could stop the coronavirus. What does that mean? Do you mean, is there a chance that we could be in a position where literally no one in the world has it anymore, and therefore it’s not contagious? Or what does that look like stopping it?
Pham: I think that would be optimistic. I think it’s technically possible, because the new cases coming out of China right now, I think they’re down to the double digits, which is … a huge reduction.
If we just stop having new cases in general, then it might be the case that the virus just stops infection. Again, that’s extremely optimistic, but we could get it to the point where it’s essentially like incidences might be not observable to surveillance organizations, kind of the way polio is in the United States, although that’s making a comeback. Smallpox has been eradicated, a little different situation, but it might be possible.
I think it’s unrealistic to stop it out like that. But I think it is realistic to get to such a low background level that it becomes essentially a non-factor in daily life.
Trinko: So you just mentioned that China’s number of cases have gone way down. Italy, Korea, and then of course China, they’ve been grappling with the coronavirus longer than we have. Are there lessons to be learned? Are there things to be avoided from what they’ve done and haven’t done in those nations?
Pham: Yeah, unfortunately, I think we mostly have cautionary tales coming from them because we’ve already missed the window.
South Korea has had a pretty good response. They had very aggressive testing early on. They had very aggressive contact tracing, which is finding people who have been infected and then finding everyone that they’ve been in contact with and then quarantining them. I think we’ve missed the window for that. That would’ve been February.
But as we’ve seen from the issues that we had with testing, we’ve essentially lost February as far as being able to do anything about containing the spread.
Out of China, again, it’s a cautionary tale. We should be upfront, honest, and transparent about what’s happening with this. I’ve seen a report that it was known to Chinese authorities back in November and they didn’t really acknowledge it until December, and the world didn’t really start taking it seriously until January. That’s three months of lost time that could have been spent stopping this virus before it becomes a full-blown global pandemic.
Italy is another. Italy is an extremely unfortunate tale just because they have exceeded their health care capacity. And what we’ve seen with most countries is that the case fatality rate has decreased, case fatality being the number of people who are infected who die from the disease.
Most of the world, as they’re testing more people, they’re seeing more people who were infected, and comparatively fewer people dying from the disease. That’s because they’re still able, for the most part, to get into treatment if they need to.
But Italy is beyond that. And so what you see with that is, not only are people dying because they’re not getting treated, but we’re also seeing people who get infected because they’re at the hospital, and there’s not enough resources to properly isolate them. And so they’re potentially spreading the infection further inside of the hospital.
And we see that a lot with health care systems that will get overwhelmed. Once you reach a certain critical mass, then it becomes really difficult to put a lid back on it, and then you start getting this growing, escalating case fatality rate.
Trinko: What do Americans need to do to halt the spread of this disease?
Pham: This is something that everyone needs to take part in. This is a worldwide, national, and local issue. Every community needs to be responsible for preventing the spread of disease. And to that end, I think the administration has been pretty good about putting out the guidelines.
The [Centers for Disease Control and Prevention] just put out guidelines recently … essentially it’s limit the amount of time that you spend with other people, and that includes limit time going out.
Anybody who has symptoms or illness of any kind should stay quarantined and isolated for the 14 days and anyone who is very sick should call the provider see what needs to be done and if they’re severe enough then they should be admitted to the hospital.
And that’s a good point to make, actually, is that before going to the emergency room, for instance, it’s best to call a doctor first, and then possibly avoid having to go through the emergency department because the emergency department is still taking regular emergencies.
So, if someone with COVID-19 walks into the ER, then they stand a chance to spread the disease to a bunch of people who are in there for other reasons. And we really want to avoid that aspect of it.
This is a little bit more difficult to gauge, but if you, if you’re out there and then you know that you’ve been exposed to someone who eventually tested positive, then it would also be worth it for those people to call their doctors and see if they can get tested as well.
Because as we’re seeing, there’s a lot of people who are asymptomatic but have the disease, or at least have the virus. They may not develop the disease that goes with the virus, but for a period of time they are asymptomatic but infectious, and so they’re walking around, they feel fine, but they’re able to transmit the disease to somebody else. And so, that’s the reason, the justification, behind asking everyone to create a social distance between them and the next person.
Trinko: So on that note, in terms of social distancing, how severe does it need to be? Can you have a friend over? Can you see family? Is it something that … I mean, people still have to run to the grocery store. Should it be that unless it’s really urgent, you avoid doing it even if it means you’re cutting back on things you would normally do, or how should people handle this on a practical level?
Pham: So as far as how much distance we have to create socially, it’s as much as you can manage. If you need to go to the grocery store, you obviously need to go the grocery store, but, for instance, I usually buy my groceries for a couple of days at a time, but I bought enough for about, well, by now it’s about a week and a half, but when I bought it was about two weeks worth of food. That way, I’m going to the grocery store half as much as I did before, maybe less than half or, yeah, even less than that.
So, social distance is different than isolation. Isolation is no physical contact with anybody. I think it’s OK if you have friends who have also been keeping a good social distance between themselves and others, it’s OK to have them over, and then see each other once in a while. I would limit that, but we can’t have people going crazy. There needs to be some kind of human contact because we are still human creatures.
Among healthy people, it’s not that bad of an idea to see each other once in a long while. Maybe not too long, but limit it, but you’re not absolutely barred from seeing people. Certainly no house parties right now. That would be a bad idea. But having one or two friends over and keep it in a small circle. That way, in your group, you are isolated.
Family is OK per what I just said before, but so long as they’re not over the age of 60, honestly, I would go the age of 55 or so. If you’re above 55, I would just try to limit any physical contact but make sure you stay in contact with them electronically.
We have all these ways of keeping in contact with one another, and so we should do that to stay grounded during this time. But other than that we should definitely try to minimize human-to-human contact.
Trinko: You mentioned that you should call your medical provider if you think you might have COVID-19 rather than go straight to the ER. We’re seeing a lot of charts going around now, how do you tell if it’s allergies, the cold, flu, or COVID-19? What’s your advice to people on when they need to be concerned and when they probably don’t need to call their doctor?
Pham: So, differentiating between the seasonal allergies and COVID-19, that’s going to be important. If it’s seasonal allergies, then you don’t need to be worried. You’d start needing to be concerned about your health if you start developing a fever. That’s probably the most common and the most distinguishing factor from COVID-19 and seasonal allergies.
Unfortunately, it’s going to at first feel a lot like just the seasonal flu. But if you do get the flu, then you should also be isolated anyway because that’s also very contagious. And as we mentioned before, it’s also deadly to people. So if you develop any respiratory symptoms and you have fever, then definitely make sure that you stay inside.
The point where you start seeing a doctor is when you have trouble breathing. You shouldn’t be gasping for air. Maybe call them a little bit earlier than that, but when you start having trouble breathing, chest pain, and you just can’t move around very much, then that’s a sign that you need help from somebody else, and you should call your doctor for that.
But short of having difficulty breathing, your lungs, they should feel heavy and they should be like developing a lot of … It should feel like there’s fluid inside. Essentially, what I’m saying is that when you get pneumonia, then you should be admitted to the hospital.
But if it feels like a common flu, then we’ve dealt with flus at home before and you should deal with this at home because most people … develop only mild to moderate symptoms. When it becomes moderate to severe, that’s when you go to the hospitals.
Trinko: What do we know about a possible vaccine for COVID-19? How long will it be before we have one, and do we even have assurance that we will be able to develop one?
Pham: So there’s one that’s currently in development. It just went into phase one testing on Monday, I believe. Yeah, Monday this week, which is record time. The virus was first introduced to American shores mid-January, and then to have an approval for testing by mid-March is blazing fast.
It is in phase one testing. It’s a process that takes three phases. They might try to expedite it, and then they might modify or omit one of the phases. But essentially what the phases do—phase one is to test to make sure that the vaccine is not harmful to healthy people.
Phase two is to make sure that it’s not harmful to the people who would probably need it. So it would be testing on healthy people who are above the age of 60. Those are the people who are most likely to develop severe symptoms so they want to make sure that the vaccine, since it’s going to be most beneficial to them, they want to make sure that the vaccine does not harm them.
And then, phase three is seeing if it actually works as advertised. We expect the vaccine to be available in about a year’s time. So it’s still a little ways out. But like I said, they may try to accelerate and cut some corners, and I do say cut corners. H1N1 vaccine came out pretty quickly as well. But people did not trust it necessarily. I think it was fine. It was ultimately fine. H1N1 is vaccinated in the seasonal flu vaccines, I believe, nowadays.
But they may try to shortcut some things, but in the end, I think it’s going to be safe because the last phase of testing, they’re going to see if it, so long as it doesn’t hurt people. That’s one of the things that they’re most looking out for. But like I said, they’re trying to go fast and it might be out within a year.
So we’ve talked about flattening the curve. If we can find the curve to about a year’s time, then we should be able to get out of this.
Trinko: So speaking of flattening the curve, the premise is basically that we don’t want to be in a position where there are more patients than hospitals can handle in the United States. And we’re hearing about that happening in Italy.
So what kind of capacity do U.S. hospitals have? How many ventilators do we have? And do we have any options whether it’s turning other buildings into hospitals or ordering more ventilators to increase capacity, or what can or can’t be done now?
Pham: So we’re seeing, in remarks made today, the administration is trying to get more ventilators made. I don’t know how many ventilators there are in the country. There’s a decent amount in stockpiles around the country, but I am not too worried.
If we all do our part to prevent the spread of the disease, I’m not too concerned about capacity just yet because the example that I’ve been looking at is New York state, [which] currently has … I think, around 1,300 confirmed cases today. And based on … data coming out of China, about 20% of people who are hospitalized require an ICU bed, which is, when you need a ventilator, then you’re in the ICU.
So 20% of people need ICU beds. If 100% of all the patients, all the confirmed cases in New York state, required hospitalization, 20% of that is still less than the capacity that they have right now, which is 600 beds. It would be about 200 or 300 beds, if everyone needed to be hospitalized in New York state.
So we still have excess capacity right now and we probably will for the next few days. Looking beyond that, it requires all of us to do our parts.
So if we can flatten this curve out to beyond the time it takes to develop a vaccine, then I think we’ll be good. I don’t think that we’ll reach that critical mass that Italy has.
Trinko: A new study is out from the Imperial College London, and it’s full of pretty scary predictions, including the possibility that 2.2 million Americans could die. Have you had a chance to look at this study, and if so, what do you think of it?
Pham: I’ve been looking at that study. It is definitely scary. I believe the 2.2 million figure is if we do nothing, which is obviously not the case.
First off, I want to say that their modeling is very good. They take a lot of things into consideration. If we do absolutely nothing, then 2.2 million, that’s probably accurate. That should really underscore the seriousness of this pandemic, that millions of people could die.
I do think it’s a little bit on the pessimistic side. I tend to be a little optimistic about this. I think that we’ll get through this OK if everyone does their part. It requires everyone doing their part.
I just want to point out that, based on their modeling, they’re using a 30% critical care rate, that is, 30% of hospitalized patients requiring an ICU bed. From the numbers that I’ve seen, from what I’ve read, it’s more like 20%, so that I think their capacity figures are going to be a little bit inflated. But other than that, it’s very good modeling, and it takes into account different localities with different population densities. So I think it’s pretty accurate.
It does not account for … Since it uses probability, it doesn’t really account for active behaviors. It just takes the amount of contact you would normally get in a certain setting. If you take a policy to prevent that, it takes out that possibility. But humans are notoriously difficult to project, and we’re notoriously unreliable creatures one way or the other.
I think that if we make an active effort to not spread the disease, I know I keep hammering this, but if we all do our parts and not spread of the disease, I don’t think it will be as bad as they predict. If we continue to be cavalier about it … For instance, we saw the picture of a Florida beach that was just covered with people. Over the weekend, there were downtown areas that were just completely crowded out with people. If we continue acting like that, I don’t think we’ll hit the 2.2 million figure, but I think we will achieve something kind of close, and that’s not something that we should try to achieve.
Trinko: On that doing our part, I think many of us have been somewhat stunned by the speed of which state and local governments have ordered businesses to close or said restaurants can be delivery only, have said that people need to work from home. The San Francisco Bay Area, everyone’s now sheltering in place, and New York City is considering that as well. Do you think these kind of measures are truly necessary right now?
Pham: It’s difficult to say what is truly necessary. What I will say is that they will certainly help. They seem kind of draconian.
For instance, if there’s a saloon in the middle of Ohio, I don’t think that they really need to be closed, but the major metropolitan areas, San Francisco, for instance, LA, New York City, Seattle, I think that it would … Not just that it only helps, but I think it’s kind of necessary at this point to prevent further spread. It would’ve been nice if we can all just voluntarily not go out, but it doesn’t seem like that was the case.
These really heavy crackdowns on activity, they will certainly help. I don’t really like talking about the necessity of them, because whether you think that they’re necessary or not, they’re not the wrong choice. They will do what they are supposed to do, which is prevent the spread of disease.
Whether we should be doing them or not, I think that’s a question of political philosophy that we can answer later on once we’ve gotten out of this.
Trinko: Are you in touch with other doctors now? What’s the general attitude among the medical community about COVID-19?
Pham: A lot of doctors are very concerned that people are not concerned enough. It’s a lot of frustration when we see these pictures of people going out into large crowds, but a lot of that’s been cut down, so there’s a little bit of a sigh of relief there. A lot of doctors I’ve seen are asking for a federal nationwide lockdown. I think that would be too much because that would violate the whole federal system that we have.
But it’s a lot of frustration with people’s behaviors. Doctors who are actually treating COVID patients, they are sort of exasperated at the disease itself because it starts off as a respiratory disease and it seems to progress to a cardiac disease. It’s kind of a running gun battle with a virus trying to keep it from killing your patient.
Because the thing is, we know how to deal with it. This is something that the medical community knows how to do. A respiratory disease comes in. If it’s very severe, they go to the ICU. If they stop breathing or having respiratory distress, they get put on a ventilator. If organs fail, you start doing supportive therapy. We know how to do that.
It’s just that this virus seems to deliver each organ system one by one, and you have to deal with it one by one until finally the patient gets to go home, and even then it seems like patients who are going home, they still have some long-term sequelae from the disease itself.
One of the things that’s been really helpful, I think, about this … It’s not helpful about the pandemic, but helpful during this pandemic, is social media.
I see a lot of doctors are collaborating. There’s a Facebook group of which I’m a part of, and it’s got almost 100,000 doctors all throughout the country, not just doctors, but also nurses and PAs and other people in the medical community. This one has 100,000. There’s one in Europe. There’s one in Italy. There’s also a lot of people who are in multiple groups, so there’s a lot of information getting shared really quickly.
There’s also publications that go up that … They’re not getting peer-reviewed first, but at this time we don’t really need peer review. What we really need is just firsthand experience, and that’s what we’re getting a lot of. On the medical community, there’s a lot of talking going back and forth, and this has been really good.
For instance, one thing that I saw is that hydroxychloroquine, which is a drug that is used for rheumatoid arthritis and some other, it’s also an anti-malarial drug, there’s some people who are seeing success using that against COVID-19.
It’s been used clinically in China and South Korea, and based on some evidence, it seems to shorten the length of the disease. I’ve seen other people who have tried to use it and it doesn’t seem to work, so we don’t know for sure. But if there’s a chance that something might work, it’s giving people the chance to try it. That’s a very promising thing about the response to this pandemic.
Trinko: That’s great news. President Trump mentioned earlier this week that he thought we could be dealing with COVID-19 into the summer, into July or August. I know predicting the future is a fool’s errand, but any sense of how long Americans could really be facing daily life being affected by this?
Pham: Yeah, so the CDC is asking for 15 days to … I forget what word they used, but basically 15 days to cut down the disease burden of COVID-19. We can cut down the disease burden, but it’s going to be with us for quite some time.
We have thousands of people who are confirmed cases. We have at least two to … I forget what the range is, but multiples of other confirmed cases right now are infected and are not yet showing symptoms, and they will. During this time, before they develop symptoms, they will spread it to, on average, two to four other people.
We’re in the growth phase of the disease. The worst is still yet to come, but I think we’re prepared for it.
I think he’s right saying that this will go until the summer, but there’s also some evidence that warmth and humidity decreases the spread of this virus, which is a little bit similar to seasonal influenza, which that’s great news for us, because as the summer season heats up a little bit, if we get less spread, we’ll get a little bit of reprieve, and then hopefully that will give us some time to really ramp up the necessary infrastructure in time for fall.
The disease won’t go away over the summer and it’s likely to ramp up again during the fall, but hopefully by that time we’ll have the infrastructure in place to deal with another surge. And hopefully a couple months after the fall, a vaccine will come out and then we’ll be able to vaccinate people who aren’t infected already.
This will go on. We’re not in this for the short haul. This is a war effort, and we all need to participate. It’s not going to go away anytime soon. But I think there is reason to be optimistic, so long as we’re all doing our parts, again, so long as we’re doing our part.
Trinko: OK. Well, again, Dr. Kevin Pham, thank you so much for joining us.
Pham: Yeah, thanks so much for having me.