Lori Walsh: From antibody testing to the power of the personal mask, we continue to learn more about SARS CoV-2, the novel coronavirus that causes COVID-19. Joining us today for our weekly update about the virus, Dr. Kevin Post. He is chief medical officer with the Avera Medical Group. Dr. Post, welcome back. Thanks for being here.
Dr. Kevin Post: Yeah, thank you, Lori. Happy to be here.
Lori Walsh: Let's start with the fact that we know we have a certain number of people across the state in the hospital right now getting treatment. And what can you tell us about the clinical side of treatment, once people go to the hospital? Clearly the system is not overwhelmed right now in a way that we had feared, but let's start with what treatment is looking like. What are we learning about treating South Dakota patients who come in and need hospital care with COVID-19?
Dr. Kevin Post: Sure, Lori. Yeah, and that's good to clarify, because we have had some good advances and some significant encouragement as we see treatment. When we first made our modeling plans, it was based on a longer length of stay. So by improving our treatments we've been able to turn patients around more quickly and avoid the backlog of patients in our hospitals. So still the most common care is just supportive care, which means things such as IV fluids, giving additional oxygen therapies and thing you typically would do to help prevent and treat things such as dehydration pneumonia.
Some exciting therapies have developed, especially here at Avera with the use of convalescent plasma, which Avera is one of the sites throughout the nation in a study affiliated with Mayo. Basically what it is is you do take the plasma or blood product from a patient who has had COVID-19 and built up the appropriate antibodies, then the antibodies can then be harvested and then infused into a patient who is having severe symptoms or very high risk to develop severe symptoms. So we have been seeing some very positive trends there as far as being able to treat patients successfully and discharge them back home. So that's been very encouraging for patients and for the morale of the medical staff as well.
Other medications we hear frequently about in the news such as hydroxychloroquine, antivirals, things such as that, those are still somewhat more being under investigation and we're closely looking at what we do with them, always weighing the risk versus the benefits. Is the treatment effective? And we always have to be careful of side effects or interaction with patient medications, but overall some encouraging news there.
Lori Walsh: And one of the reasons I asked this question is because we were seeing reports out of New York City where people were afraid to go to the hospital. They were afraid of being put on a ventilator. They were afraid of getting sick at the hospital, of being alone and not seeing their family members. And so talk a little bit about people who do have symptoms and who might be hesitant to make that phone call and say, "I think I need a little more help." Why is it important for them to do that in a time frame that allows doctors, and nurses, and providers to actually respond?
Dr. Kevin Post: Yes, and this is a significant concern because we have seen that in our health systems as well, people at home with strokes, with heart attacks not coming in. In a lot of those conditions, stroke and heart attack, it is so time-sensitive that you treat it as quickly as possible in order for the best outcome. So I think for the public to know that at this time the health systems do have enough protective equipment for patients when they come in, they have enough equipment for their staff so that the risk of staying home with these conditions is much higher than the risk of coming in where we feel like we can adequately protect our patients and our staff, our front line nurses and doctors who take care of them. So yes, you're right. The correct answer is: Do come in when you need to and we can do it safely.
Lori Walsh: All right. Let's talk about those antibody tests that you mentioned before. And this has been a national cry for greater testing to see if you have the virus and then antibody testings to see if you maybe have already been exposed to the virus. Explain to people the difference between those two tests. And then let's talk more specifically about what we know and don't know about those antibody tests, including what we know about FDA approval of them and their accuracy. So first, for people who don't understand the difference between these two tests, let's start there.
Dr. Kevin Post: Yeah. So the first and initial test that we always hear for testing for COVID is more of a swab test. That is the most accurate when it's done in a patient that is currently having symptoms. So if we test someone before they are symptomatic, we can get a test that may be negative 30% of the time. So it's not always accurate on when eventually they will develop the infection. So there are some limitations there. That's the initial screening test that is commonly talked about and heard about in the news, initially.
Now these antibody tests, what that is, that's the measurement of your body's response if you have had an infection. So your antibody levels will rise, typically approximately 12 to 14 days after the onset of symptoms. And that can give us an indication of whether you have been exposed to COVID-19 and whether you develop an antibody response. But that test is a yes or a no answer. What's confusing is that it does not definitely tell us that for sure that patient will have immunity, even though they're showing they had an antibody response. So we're really trying to balance how to best use this when it comes to employees returning back to work, those that would qualify for donating plasma, for the convalescent plasma treatment that we talked about.
So I think a good way to think of it is both of these tests serve their purpose, one for an acute infection and one to see if patients have had it and how can we best use them. But realize they're all just like tools in a toolbox. They each have their purpose, but they also each have their limitations. So it's really a balance of how we use them, where. And we continue to learn more about coronavirus as well, so I think this will improve in the weeks and months to come.
Lori Walsh: So who is donating plasma now for some of the ... Who qualifies to make those donations for some of the people, who are more of the acute cases in Sioux Falls right now, to be part of this study that you mentioned in conjunction with Mayo Clinic?
Dr. Kevin Post: Yeah. So who qualifies to give it are those adult patients that have had the infection and really no other medical conditions that you would worry about risk of transfusing a disease to the patient. And then have they had the infection and do they test positive for the IgG antibody levels? Then they meet criteria. In general, that is the criteria that you would need to be able to be a donor for plasma to give that antibody. Those receiving it also need to be a patient that would be over 18 years old and generally reserve it for our patients with severe symptoms or those with very high risk medical conditions that make them very at risk for progressing quickly into severe symptoms. What's neat about this is we are able to use the very people of South Dakota as donors, as well as we've been working closely with the Sioux Falls Blood Bank, and the Red Cross, and Mayo to provide donors from across the country.
Lori Walsh: Yeah, but to be clear, those people who are able to be donors, that's not necessarily a free pass to ... We don't know if they're immune or not to getting infected again themselves. Talk a little bit about that, what we know and what we don't know. Yeah.
Dr. Kevin Post: Right, and this is a big point and I'm glad you brought it up. It is what we don't know. We are not sure, if you'd in fact have antibodies, if you are adequately immune. And there is a possibility, it's looking like, of reinfection. So we don't know if the first immune response is going to be adequate in all people to actually fight off a second exposure. It's much like you see with the influenza vaccine. Although it is very extremely beneficial and highly encouraged, some of us respond at different levels than others to that by our body's ability to make antibodies and how much of them, antibodies, we are able to make. So we are still learning a lot of what the antibody test means and how we can best use it.
Lori Walsh: It can be kind of maddening to me as I realize how much we don't know at this stage. Is it like that for you? Or is it pretty much like, are you looking at the research and saying, "Yeah, that's what we expect and it's progressing in a way that that is predictable. Science does take time." Or are you frustrated with just what we don't know about individual responses to this? Because that's the thing that is so puzzling, is that we know there's some people that are higher risk and then we see healthy people completely leveled by it. And yet some people have low levels of the antibody. Others have produced more. Is that expected to you? Or is that as strange to you as it feels to me as a non-scientist?
Dr. Kevin Post: Right. No, it is somewhat expected for something that we know so little about. So we do know the base of how a virus works, but for this particular virus we're still learning a lot. The way I like to think of it is is if you are driving a boat across the lake towards a certain point, you're in general heading to that point, but as crosswinds come up or new things develop, you have to constantly be adjusting so you end up at your destination. And that's how I see this is how rapidly our knowledge is changing and new information is becoming available all with this, it's just a constant adjustment and improvement of what we know. We think we're headed in the right direction, but we do not know everything for sure. And I think we have to be very willing to change and adapt as we move forward through this pandemic, so expect change.
Change is very expected as we move through this in order to process the information we have at the time and use it most accurately. But I can see why, like you say, I can definitely sympathize why it's very confusing. And why don't we know more? And why do these things keep changing?
Lori Walsh: Yeah, and one of the challenges right now, and I don't know if you've noticed this, that as states across the country talk about what does it mean to open up or as the economic suffering increases because of closures and the economic impact of social distancing, the pressure that people are under, people are getting to the point where they want things to look like something that's normal and are encouraged by how low our numbers have been in South Dakota, even though they do go up substantially every day. Help talk people through. What stage are we at for you? Is it time to double down on social distancing? Is it time to look at what life lived alongside SARS CoV-2 is going to look like? How do you process what people want to happen and what's realistic and what's responsible?
Dr. Kevin Post: Yeah, and that's good because I do think we're moving into this phase of thinking and I do think we need to economically, because we think of our friends, our neighbors, agriculture and so many businesses out there are all so involved. So how do we live with COVID as we move forward? And I think we have to accept that there is going to be a new normal, for sure, over the next 12 to 18 months and we do have to learn to function within that. So I think we will, we've been working closely with the state, the other health system in the state to do a cautious and gradual, very measured re-opening when it comes to businesses, when it comes to what we do for social gatherings. And I firmly believe it's the strength of the people in our region that our efforts have been blessed, that the mitigation, the isolation, staying at home has flattened our curve as well as our ability to decrease the length of stay in the hospital.
So because of that, we are now in a position where I think we should move towards gradually re-opening. It appears that we have the safety equipment to do it and also the hospital supplies, the hospital beds to handle these numbers because of the mitigation effort. So I really thank the public for their involvement with that, the responsibility they had. And I think we're going to need that going forward so that we don't regress back into the potential of a full surge. So I think if we handle this responsibility together as we have and we've proven we can do, we can possibly move forward into living with COVID as our new normal.
Lori Walsh: Let's talk about how we do that. What are some of the things? And first I want to ask you about masks because we got a listener question with almost a frustration with how many of these conversations we, I shouldn't say almost a frustration, a frustration with how many conversations we have about other social distancing practicing and then as an afterthought throw in this idea that yeah, it's probably a good idea to wear a mask. How powerful are masks? And if everybody was wearing them, how big of a deal could that be to help slow the spread of this when people are out in the world? What's the potential impact of masks? Is it that valuable or is it an afterthought? "Hey, it's probably a good idea."
Dr. Kevin Post: No, I do think it is a good idea if people are willing to do that and the reason why is like wearing a mask on public does several things. Of course, first it controls the spread of droplets from the mouth, so prevents spreading the disease there. But also a big way that a mask works is it keeps us from touching our face. So if we do touch a high risk contact, such as a door handle or a doorbell, elevator buttons, we then can't necessarily touch our nose or our mouth with our mask on. So it prevents us from possibly getting the infection, should we be exposed. I think initially there was such a shortage of masks, so that's why you didn't maybe not here so much initially. Now that we do have a greater supply built up through the nation and locally, we have more options to masks.
Another group I would like to thank is all of those private people in the area and the groups that got together to make cloth masks. They have made a significant difference, so thank you there. So I think as individuals, as we move into these new steps, it's going to be continue the good hygiene, physical distancing as much as possible, and then if you are sick, make sure you are just honest and stay home, and work with your employers on that. And then lastly, I think really focusing on our vulnerable populations, that is the elderly, those with high risk medical conditions, too. You still will be at risk if you get exposed to this. Although it appears we'll have enough resources to take care of you, this is a very aggressive virus, so if you are in one of those populations, please be responsible and stay home. And I understand how hard it is. Do the right thing.
Lori Walsh: What's the role for antibody testing going forward in just going back to what a new normal living alongside coronavirus looks like? I understand the potential and the power of the convalescent plasma in a clinical setting, but for the rest of us just going out into the world, do you see massive screening tests and do you see massive antibody tests being of use as we figure out what we can do and what we can't do? What's next for us?
Dr. Kevin Post: Yeah, I do think that will play a large role in our re-opening throughout the nation and also here locally. If we have the ability to test people prior to them going out to see if they have been exposed, it does give us some idea of how it has moved through a population, how it's moved through a region and how we can most safely re-open. Once again, it will not be a guarantee that you can not get it, but it's just another tool to say, "Hey, this person is likely low risk to return to work. It appears that they have antibodies," like that. The exact yes or no of how that applies is yet to be determined, as we talked about earlier, as the science continues to develop.
Lori Walsh: As regulations were lifted, some of those antibody tests that are out on the market are not approved by the FDA. So there is a caution there as well, isn't there?
Dr. Kevin Post: Very much so, yeah. And you will see that out there, some tests that aren't approved. And I think that can be hard to understand as well, for the public, because some of these tests are out there. They seem available. But as health care providers, we can't really trust them if they are not FDA approved, therefore we may not be able to make decisions based on that. So fortunately, here locally our testing capability has significantly improved. We have had some limitation in testing supplies and that has improved as well. So hopefully, for sure for our region here as well, we can implement some of these testing strategies to help us re-open and move forward.
Lori Walsh: Dr. Post, what do you wish you knew? What would be the next big game changer in this fight against COVID-19 that you would really like to see come forward and say, "That would make a big difference," not just in our ability to go back to life as normal, but in our ability to save lives? Because these people who are at risk or who are impacted by the disease so drastically, those lives matter deeply to so many people. It's easy sometimes to get lost in the numbers, to really forget about the lives that are lost. So what is the next big thing that you think would make a huge difference in saving people's lives?
Dr. Kevin Post: Yeah, two things, I think. One would be adequate treatment with an adequate treatment or medication that would treat the coronavirus and have it be available in a supply that is able to be maintained throughout the nation. So a medication to treat it effectively in addition to what we have now would be significant. And then more so than that, even, will be the development of a vaccine because if we can develop a vaccine and enough of the population does get even partial immunity, partial to full immunity from this, then really decreases the risk that this would surge through a population. That's why the coronavirus, not only is it more aggressive than, say like the regular influenza virus, but it surges through because this is new to all of us. We do not have any herd immunity among the nation. So I think those two things, new medications, and hopefully, development of a vaccine.
Lori Walsh: Dr. Kevin Post, thank you so much. We really appreciate your time.
Dr. Kevin Post: Thank you, Lori.