Doctors from Mayo Clinic, St. Clair Hospital address multiple facets of COVID-19
For at least three-quarters of a century, nothing has dominated the lives of Americans as pervasively as the SARS-CoV-2 virus.
Most know it better as COVID-19, and hear about it constantly. But the information tends to come at at a dizzying pace, with facts often mixing with opinion, conjecture and downright falsehoods.
For those confused over the vast amount of information surrounding the virus, perhaps professionals who have spent the past several months fighting the coronavirus firsthand can make matters clearer.
A recent virtual presentation, dubbed “The Frontline. Online,” featured doctors from the Mayo Clinic and one of its care network members, St. Clair Hospital in Mt. Lebanon and Scott Township, speaking about various facets of COVID-19 and answered questions from the public that had been submitted beforehand.
Transmission and safety
One of the queries addressed a contentious point head-on.
“Does wearing a mask really defend against getting the virus?”
Dr. Stephen Colodny, St. Clair’s chief of infectious disease, said COVID-19 primarily is transmitted from person to person, with “the most efficient method” being the spread of droplets that are expelled by activities such as breathing or talking, and in larger amounts, sneezing, coughing or singing.
“These droplets are fairly heavy, and they generally tend to fall to the ground within about six feet, and hence that’s our recommendation for social distancing,” he said.
In that context, covering the face adds a measure of protection, likely for everyone involved.
“There is starting to be some body of evidence that suggests that wearing a mask may prevent you from getting the virus from others, or in the event that you do become infected that you may have a less severe clinical illness,” Colodny said.
“So I still urge people to wear masks when they’re within six feet of others, particularly indoors.”
He confirmed transmission also is possible through contact with contaminated surfaces.
“It’s been shown in the lab that the virus can survive on various surfaces for some periods of time, but in general, they don’t survive for a really long period of time,” he said. “Things like ultraviolet light, heat or humidity may kill virus particles, and most importantly, 60% or greater alcohol kills viruses, usually within a minute.”
To be on the safe side, he advises proper hygiene.
“If you wash your hands frequently, especially after you’ve touched common surfaces – think of things such as doorknobs or light switches – it will help in preventing you from self-contaminating,” he said.
Staying safe during the pandemic extends to considerations beyond precautions against COVID-19, according to Dr. John Sullivan, senior vice president and chief medical officer at St. Clair.
The hospital continues to follow protocols adopted by the Mayo Clinic, from enhanced cleaning to taking temperatures of people entering the building, and has resumed elective procedures following their temporary suspension, with no viral transmissions observed.
“We are concerned, however, that the perceptions of risk in seeking care are still limiting how some people are accessing their routine care,” Sullivan said. “Early on, we even saw examples where people with symptoms of a stroke or heart attack delayed seeking their care. And as we all know, that can be very consequential. Delay in care in those settings, even by minutes and certainly by hours, can lead to worsened outcomes.”
A similar scenario applies to procedures such as colonoscopies and mammograms.
“In almost all cancer diagnoses, early detection is often associated with improved survival,” Sullivan said. “Some parts of the country have seen the decrease in breast cancer screening by almost 50%.”
And so his recommendation is to keep up with basic health maintenance.
“If you have any questions about this, contact your primary care physician to help guide the decisions,” he said. “Many of them are conducting visits via telemedicine to help you as a starting place.”
Treatment and vaccines
Since COVID-19 started wreaking havoc globally, more than 7.5 million cases had been confirmed in the United States as of Oct. 6, including 169,000-plus in Pennsylvania.
How patients are treated varies as the disease progresses, according to Dr. Stacey Rizza, Mayo Clinic executive medical director for international academic affairs. In the early stages, the common practice is to use antiviral medications in attempts to prevent the virus from replicating.
“Then after about a week, people either get better or they get what we call an immune response that’s overreactive,” Rizza said. “It’s essentially the person’s immune system reacting dramatically to the virus, itself. And that’s what causes people to become severely ill.”
At that point, she said, treatment tends toward “medications that block the immune system or change how the immune system is reacting to the virus.”
Overall, a major caveat is practically all of the drugs that could turn out to be effective in battling COVID-19 are in various stages of development and testing.
“Thus far, we really only have one therapeutic that has been proven to be efficacious in the appropriate randomized control trials, and that’s the antiviral medicine called Remdesivir,” Rizza said. It’s been reviewed by the FDA and given what we call emergency use authorization. We know that using it a little bit earlier, during that viral replication phase, seems to be where we see a lot of evidence that it works well.”
The use of steroids also has been the subject of study, although no control trials have been completed.
“But there is very strong evidence around them that keep showing that they do have some effect at protecting patients who are severely ill,” Rizza said.
“So they work more in that second phase, when the body’s immune system is overreacting and steroids are blocking that immune response.”
Perhaps of more interest to Americans in general is the progress of potential COVID-19 vaccines.
Dr. Andrew Badley, who chairs Mayo’s molecular medicine department, said testing is taking place on about 180 potential vaccines.
“What they’re intended to do is determine if it is safe, and if people who get the vaccine develop an immune response,” he said. “The hope is that the fact that you generate an immune response will translate into reducing the incidence of the disease or reducing the severity of the disease. But today, that is unknown.”
Prior to a vaccine’s approval by the U.S. Food and Drug Administration, some people may want to consider participating in trials.
“At that point, it will be experimental, and you’ll either get the vaccine or a placebo, Badley said, advising those who opt in to, “talk to the investigators. Very much learn about the potential side effects. And then you, as an individual, have to make a cost-benefit decision as to, do the risks outweigh the benefits?”
Approval of a vaccine is unlikely to occur before mid-2021, Badley said.
“When we’re in that situation, much more will be known about the vaccine,” he said, “and so you’ll be able to have a much more detailed discussion with your healthcare provider.”
Families and children
COVID-19 has prompted numerous discussions between concerned parents and Dr. Ruth Christoforetti, a family medicine and primary care physician affiliated with St. Clair Hospital.
And as the summer progressed, a primary topic was education.
“It’s been very challenging to make decisions about sending children to school in person versus keeping them at home as virtual learners, and neither really seems like an ideal situation for the majority of our children and our families,” said Christoforetti, a mother of three. “I think it is very important to keep in mind that there is no right or wrong decision, and each family situation is unique.”
She acknowledged attending school in an environment where other people are present “does increase the risk of transmission.”
“If the school is following safety precautions – such as spacing desks apart, requiring students to wear masks and frequently wash their hands, making sure that there’s adequate ventilation in the school, maybe having the kids spend some time outdoors – those things will help to reduce the risk,” she said.
“It’s also important to think about the school’s plan for if or when there is a case of COVID-19 within the school, and how they would manage that in order to keep other students and teachers and staff safe.”
Colodny fielded a question about the safety of scholastic athletic events.
“Obviously, it depends on the sport and the proximity of the children to each other,” he said. “It depends upon whether they’re outdoors or indoors, and it depends on the risk to other family members.”
He gave a reminder the academic year is relatively new.
“I think that it’s too early to tell whether, in youth sports and high school sports, how much transmission there will be,” Colodny said. “But I would say that running cross country is a whole lot safer than wrestling.”
Christoforetti provided a reminder of COVID-19’s impact on mental health.
“It’s widely known that there are increased rates of depression and anxiety during times of crisis, and this pandemic has been no different,” she said. “In these challenging times with tremendous stress, it’s important that we be kind to each other. If we notice a loved one is struggling, perhaps from depression or anxiety, that we encourage them to reach out for support from family and friends, as well as to seek professional help when needed.”
By Harry Funk, Multimedia Reporter – The Almanac