Lori Walsh: Since the novel coronavirus was first reported in South Dakota, we've been asking for your questions regarding the virus, hospital capacity, testing and contact tracing, and recovering from COVID-19. You have sent in hundreds of questions. We continued to ask the experts on In The Moment and on South Dakota Focus on SDPB TV. SDPB journalists are working on stories every day to answer the things that you want to know and keep those questions coming. Send them to In the Moment at sdpb.org or text us at 605-956-SDPB. Dr. Wendell Hoffman is with us today. He is an infectious disease doctor with Sanford Health and he's here to answer some of those questions about the virus. Dr. Hoffman, welcome back. Thanks for being here.
Dr. Wendell Hoffman: Nice to be here. Lori, thank you for hosting these important informational segments.
Lori Walsh: And, thank you to all the healthcare systems, Sanford, Avera, and Monument for consistently showing up and answering these questions, especially as the facts continue to change. So my first question on Monday is always this one, what do we know about this virus that we didn't know last week? And for people who are frustrated by facts changing, it's worth reminding them that this is such a new thing that papers are just now being released about new discoveries and new research. So, Dr. Hoffman, what are we learning that maybe wasn't clear just a week ago?
Dr. Wendell Hoffman: Great question. And I think the metaphor drinking from a fire hose, it doesn't even apply anymore. I think we're drinking from a waterfall. It's just been staggering. And I think it points out a couple of major things. First of all, this is a coronavirus pandemic, not an influenza pandemic. I think that's important for the public to realize. We've had what, 10 pandemics over the last 250 years. To my knowledge, all of them were influenza pandemics. We had the two other, the SARS and the MERS, but they were not pandemics. So this is a unique thing that we're facing. And what we're learning is just how unbelievably contagious this virus appears to be. And, our understanding has definitely changed over the last week or two.
And so I think what we know now is that the reproduction number called the R naught or the R0 was initially thought to be kind of in the low-two range, 2.2 with the information coming out of China. Several groups have now re-looked at that data and suggest that in fact, that R0 or reproduction number, which is the number of people who can come down with an infection from every positive case, it's more like between five and six, kind of in the six range. So, it appears to be much more contagious than was initially kind of recognized. And so, that I think is a big change.
And I think that's reflected in another important point and that is the early serial prevalence studies, which is basically the antibody tests being done in certain different populations, like for instance, Santa Clara County in California, a small study from Massachusetts, and others from Chelsea, Massachusetts are showing us that in fact, this virus has likely been here for some time and that there is a significant asymptomatic spread going on in the population. A friend of mine with his master's in public health, an infectious disease physician estimated that based upon the Santa Clara data that maybe 98% or so of these infections are going undiagnosed at least based on that particular study. Now we're going to learn a whole lot more about exactly what the prevalence is of this antibody in the population as we go forward.
I see that Governor Cuomo from New York State just announced yesterday that they're undertaking a massive serial prevalence study in New York City and in the greater state of New York. And so I think what's going to come fast and furious to use a perhaps not the best metaphor, but what's going to come very quickly is an increasing understanding of who exactly may well have been infected.
Lori Walsh: And, that's terrible news and good news at the same time, it feels like. Because if more of us have been infected, does that mean more of us are already immune? If you could wave a magic wand and find out that there were 98% of us that had been walking around with it, that's bad because those are the people who said, "I don't have symptoms. I don't have a fever." Or they were screened at the front door of their office. They didn't have a fever, but they really had it. But then also, it gives you hope that I'm maybe a lot more people are immune or is that totally wrong thinking? I'm trying to be optimistic, Dr. Hoffman.
Dr. Wendell Hoffman: I don't think there's any wrong thinking right now. I mean, the problem is, even as I cite these two examples, I'm already in trouble because the phrase, it all depends weighs in. So, we have to be careful in our interpretation and here's why. Those people out in Santa Clara, for instance, may have been more likely to volunteer for a test because they simply wanted to know if they already had COVID-19. So there may be a selection bias going on, which is kind of my point. So we have to be very careful.
But, to your point, Lori, I mean the good news if there is such good news, but I think it is good news, suggests that the bottom of this pyramid, if you will, the denominator is going to be much higher. And why is that good news? Because it plummets then the mortality rate overall. And so this mortality rate may be ending up much lower than what the earlier projections were. So I think that's the good news. The bad news, if I can be so bold, is that this virus may be marching along despite many of our best efforts. And so that's the key.
Now, do I think that these mitigation strategies are working? Absolutely. And I think what we've done here in South Dakota and what we've watched all across the country are varying degrees of attempts to flatten the curve, mainly from social distancing. Because if you think about it, we're just simply depriving the virus of a host. That's the whole basis behind social distancing. We are not allowing the virus to spread from person to person as much as it would be if we were just out and about meeting in larger groups and so forth and so on.
So, that's the kind of the good news, bad news story. But I think the overall good news is that our social distancing strategies are working. I mean, just look at the reports even this morning from South Dakota where we're now, I believe it was 50 cases reported today, which is continuing to come down. Now, does that mean it's an overall ... Are we past the peak? It's too early to say, but I think it is encouraging. And also, the number of the employees from the Smithfield plant are dropping as well. So I think all of these numbers, wherever we look, the strategy of social distancing works.
But here's the kicker. We have to figure out as a culture how we can live alongside this coronavirus because everybody wants to cite the science of COVID and how social distancing is so important. But there's another area of science that you haven't heard as much about, and that's the science of unemployment and what it does to suicides, what it does to social unrest, even within four walls, what it does to our other patients in terms of delay of diagnosis and not pursuing elective surgeries, and all of these things that also have a scientific basis to them. So I think we need to be careful in throwing the word science around, that we need to have a science-based strategy, which I certainly agree with. The problem is the science is quickly changing. And we also have this other challenge as healthcare organizations is how do we take care of everybody else that we've been taking care of for years and years and not neglect them? I think those are the major questions that we need to really struggle with in terms of how we approach this.
So I think we're going to have to learn how to quote-unquote live alongside coronavirus because more likely than not, this is going to be here and we have to figure it out so that we can simultaneously flatten these curves but also begin to reopen up.
Lori Walsh: I want to clarify something that you said about the mortality rate might not be as high as we thought, too soon to say possible, but when you say that, does that mean that the number of deaths would also decrease or just the fact that we'd have the same number of deaths, but that would be a lower case fatality rate overall?
Dr. Wendell Hoffman: Yes. So, same number of deaths, but a lower case fatality rate. I mean just think about it. If you're only looking at the tip of the iceberg and now you finally have a mechanism for seeing the entire iceberg or at least a much bigger part, that tip gets smaller and smaller, relatively speaking. So it's, yes, it's the mortality based upon actual infection, not on the number of tests that are performed. And that is really, really very important for the public to see. Is it an encouraging piece of news? I think so.
The problem is even when you have a relatively small group of people, and what I've been saying is a small percentage of a very large number is still a large number. And when you take even that small percentage of a very large number and you push them through the healthcare system over several weeks to several months, that's why we can overrun the healthcare system, as opposed to influenza, which is spread out over months and which a lot of our patients have immunity too, and so that's why even as significant as influenza is on the population, and by the way, I'll always push the notion of getting your influenza shot and you're, going to have to look a look at it next year, but I think you kind of see the point.
Lori Walsh: Yeah. I want to ask a couple questions from listeners here, and one of them is that we keep getting questions again and again about takeout food. And we keep saying that it's safe to get takeout food, clean off the containers if you can. The biggest challenge is the interaction with the employees at that moment. But specifically, someone asked if someone with coronavirus sneezes onto my food and then I eat it, if I'm trying not to touch my mouth, can I get it from food? We know it's not foodborne in that sense, but can a person who's preparing your food, infect you?
Dr. Wendell Hoffman: So, I think there is no evidence that this is transmitted through food and water. Now, is there a theoretical possibility that the virus could live on plastic containers, and on cardboard, and on paper? I suppose, but we just have not seen that epidemiologically. So, I think our food and water is safe. And I will say it again and again, the risks of going to the grocery store have to do with the exposure to other grocery shoppers, not to the food that you're picking up off the shelves. But again, we have to say that there are some data, a small study that indicated, your listeners probably know, that the virus can live theoretically on things like plastic, and steel, and cardboard for up to a couple of days.
But is that the main means of transmission? Well, no, I mean there is an environmental component. But it's that environmental component that's related directly to a person who is close to you and where you're having a longer period of contact, and so that's that kind of six-foot perimeter. And it's those kinds of environmental surfaces that you should consider cleaning and don't be paranoid about the groceries that you're bringing home.
Lori Walsh: People are asking about the warm weather. As it warms up, what are we learning from places across the globe about whether or not this virus reduces its transmission during warm times, higher temperatures, humidity, that sort of thing?
Dr. Wendell Hoffman: So, great question. And, it still is an unknown. What we're kind of seeing is that there may be a trend towards lower infections within the temperate zones, the Singapore's and Hong Kong's of the world, so to speak, and maybe higher in the cool temperate zones just because this virus tends to, I think, thrive in that kind of 55 to 80-degree temperature. We also know humidity does affect the coronaviruses. And if we go by the larger category of coronaviruses, we know that they do drop off as the cool weather subsides and as the warm weather shows us an uptick.
But here's the point with a virus. With a virus this contagious, I mean, let's say that that reproductive number is close to six, which is what the group from California suggested when they reanalyze the data. And if you have a virus that contagious, you're still going to get propagation even as the temperatures are going up, even as the humidity rises. And so I think that that is the fly in the ointment here, is that we overall may see fewer infections as the climate warms in our region. But the problem always goes back to the contagiousness of the virus, that even in those situations, we think that the virus is going to continue to spread to a certain degree as we come into the spring and summer.
And we also know based upon that example of the 10 pandemics in the last 250 years, what's interesting there is that literally all of those pandemics that they didn't all arise in the winter. They're pretty much evenly distributed through all the seasons. So you have some beginning in the winter, some beginning in the spring, some of the summer, some of the fall. And we know almost to a pandemic that we can anticipate a second wave about six months after the first wave. That's been pretty consistent. And so, if this coronavirus kind of holds to that, that we can expect that there will be a second wave. But, it's always yes, but on the other hand, as we try to tackle these questions.
Whatever happens this fall is going to be a whole lot different than what we're experiencing now. And why is that? Well, it's because as we said, there's going to be a whole lot more people who have had this coronavirus, SARS-CoV-2, the cause of COVID, which are different names and sometimes confusing, and we're going to have much more testing, rapid testing, serology testing. And so, we will be able to handle whatever second wave comes in a completely different manner than we're struggling with right now just because we don't have all of those tools in our tool toolbox right now. And so I fully expect that while many are worried about, well, it's going to come around again, it may well but, but we're going to be able to handle it in a much more efficient kind of side by side, a way that I referred to, living alongside this coronavirus is going to be key in our understanding.
And so, I think the weather question is somewhat uncertain, but we have some data that we can use to apply, but it's really going to depend upon our collective work as a team, as a massive team of teams if I can use that phrase, where we suppress this thing until we have a vaccine, hopefully, that will really provide individual immunity. Until then, the communities have to function as the immune system. We have to protect those who are most vulnerable. And it's an easy thing for the public to understand, that the more I do as an individual, the more I strengthen that immune system, which protects our most vulnerable colleagues, and neighbors, and patients who are among us. So I think that's an apt description that we can all join, truly a herd immunity of its own.
Lori Walsh: The community acts as an immune system for the vulnerable. I really like that analogy. Dr. Wendell Hoffman, one more question before I let you go, and it goes back to what you said about tools in the tool box, and Sanford announced today the first use of convalescent plasma in a critically ill patient, I believe it was in North Dakota. But talk to people a little bit about the promise of, and I know SAB Biotherapeutics in South Dakota is researching a similar therapeutic which has to do with an infusion, only not from humans who have recovered, something that they're manufacturing through their bovine herd, but talk a little bit about the promise and the not so fast, let's not relax yet about convalescent plasma and how that might work.
Dr. Wendell Hoffman: Yeah. It's really an exciting, I think, area of convalescent plasma and then producing high levels of antibody from other sources as you've referenced. I think what we've seen thus far, just individual case reports are exciting. And I think that as this ramps up and I think what we're going to see is individual systems with their own individual blood banks, even being able to hopefully, procure this and be able to offer it in the sicker of our patients. And so I think it really is a very exciting kind of development. We've known about passive immunization though for decades. We've seen it used in other pandemics and other critical situations, other dangerous outbreaks, and so forth and so on. So, yes, I think it is very exciting, as is this report coming out, I believe it was Chicago for this IV drug called remdesivir. So I think there are some very hopeful signs.
The caution is how quickly can we get all this ramped up? How quickly can we be able to offer passive immunization to patients who would benefit from it and how quickly can we see drugs like remdesivir potentially being expanded. Although we don't have a large study regarding that drug but certainly, it's promising. And then there are other questions that are still out there, the hydroxychloroquine question, and there's a whole series of questions there. Many are both asking for it. We are using it at Sanford, as you know with that prophylaxis trial, which individuals will be able to sign up for. By the way, I think it's on April 23rd. It's a prophylaxis study. So I think all these things are hopeful I think.
I think we have to feel positive and hopeful as we go forward in terms of new therapies that we're going to be able to throw at this thing as well as optimistic about the great work that our colleagues, our communities are putting forth. It's just so gratifying to see. I mean, just think about how many people have stepped up and are making these cloth masks. I mean, it's just really heartening to see that. They're not perfect, but I do believe in them. And you can say, "Well, I thought you guys said a month ago that we weren't supposed to use them." Well, yes and no. We've always wanted to keep masks primarily to prevent it from spreading to the healthcare workers. But now that the prevalence has increased, and now that we understand more about how contagious this is, it really makes sense for the public to wear cloth masks.
Now, I'm speaking to the many, many people that I saw over the weekend when I was running my own errands, I saw a lot of people not wearing them. And I'm pleading with the public, you can now buy cloth masks at some of the grocers here in town, please do that. Because while it's not perfect, it will help contain respiratory secretions from you. And so it's really kind of more of a selfless act and a self-protective act. What you're doing is trying to prevent your own respiratory secretions from going to someone else. It's not going to be as helpful to prevent these small mini-micron viruses from getting through a cloth mask. We don't pretend that it does.
But we do say that there is value. So I'd love to see a much higher percentage of our community wearing masks. Do it. And the people that I see doing it are the people who are actually at risk. The people I don't see doing it in general, this is a soft view in terms of what I've personally seen, but it's the younger-age individuals. And so I really would encourage that as a community-based strategy along with our social distancing. But if you have to go out, use a cloth mask.
Lori Walsh: Dr. Wendell Hoffman, infectious disease doctor was Sanford Health, we appreciate your time, be healthy and thank you so much for all you and your fellow healthcare providers are doing. We appreciate it.
Dr. Wendell Hoffman: Thanks, Lori, and be safe, to everybody else. It's kind of like all together or not at all, right?