City of Plantation Podcast

Episode 23 - COVID19 Situational Report with RN Rachel Guran

August 07, 2020 City of Plantation Episode 23
City of Plantation Podcast
Episode 23 - COVID19 Situational Report with RN Rachel Guran
Show Notes Transcript

Thank you for listening to the City of Plantation podcast. In this episode, Cary and I have the pleasure of having Rachel Guran on our show. Rachel is an RN, Epidemiologist, and Infection Control Director for the Memorial Healthcare System in South Florida. Rachel will discuss with us the current state of COVID19 in the country as well as in Florida. Steps we can take to reduce spread, and other hot topics regarding COVID19. This Podcast is aimed at keeping the residents of Plantation informed of events and important information happening throughout our city. Please subscribe to this podcast, as we will be producing new episodes weekly.

Guest: Rachel Guran, RN, Epidemiologist, and Infection Control Director
Hosts: Cary Blanchard and Ezra Lubow
Produced by: Ezra Lubow
Music: Oakwood Station, c/o Epidemic Sounds
Art: The City of Plantation

Speaker 1:

Welcome to the city of plantations podcast. I am Carrie Blanchard, battalion chief of public affairs for the plantation fire department. Thank you for tuning in our podcast is designed to keep you up to date on all the latest happenings and activities in about and around the city of plantation on our episodes. We talk directly with the leaders decision makers and the movers and shakers who make plantation the great city that it is

Speaker 2:

On this episode of the city of plantations podcast. Carrie and I are pleased to be joined by Rachel Gran and RN who is also an epidemiologist and the infection control officer for the Memorial healthcare system here in South Florida. Thank you so much for joining us today, Rachel,

Speaker 1:

For having me. Thanks, Rachel. We appreciate you being here. Can you provide an overview where we are now as compared to back in March with this whole pandemic? Sure. So South Florida, we are just over the peak of our highest surge of COVID-19 cases that we have experienced , um , ever. So whereabouts , double, what we saw in March and July 20th was our highest peak, right? I mean, it's , we've seen a resurgence of cases since the intended reopening of things in the state, the country. Is this the second wave that dr. Fowchee has spoke of? Or is this caused by the reopening or is it a mix of both? It's definitely a mix of both. Um , we do have some reopening. We saw Memorial day weekend. So the end of may, there was a lot of people going out and not social distancing, and that could have been a cause for now this second wave or even just a continuation of a first wave. So a lot of experts are saying that these peaks and valleys, it will all be related to just one wave continuous wave.

Speaker 2:

So we're moving away from first wave second, wave third wave terminology, and looking at it more as a continuous process, that's going to have peaks and valleys. Is that accurate?

Speaker 1:

Correct. So we can see that the community spread of COVID-19 has kind of caused this continuous peak and Valley Eben surge of cases, as well as some of our increased testing that we have all across our community. And then just the opening reopening people who have been slow to uptick on the masks that we're all wearing together in this room and people who are still getting together at maybe nightclubs and bars and those kinds of closed area environments, or even the birthday parties, graduation parties , uh , funerals. Unfortunately those have contributed to an increase of our community spread in South ,

Speaker 2:

Right? I know as a community and even as a state and a country, we tend to be driven to focus on a lot of the negatives that are associated with our approach to managing COVID-19 and testing. And for the most part, every area of this pandemic, but we are making progress. Can you expand on the type of progress that we are making in our fight against COVID-19?

Speaker 1:

So, unfortunately we are not seeing the kind of progress that other countries have been able to sustain. The more time we have, we do have more treatments available that have been very, very helpful in our fight against the disease. COVID-19 we're seeing some of our treatments like REM desk , severe , um , and antiviral treatment. We're seeing convalescent plasma, which is using the blood of people who have recovered from COVID to help treat currently infected COVID patients. And then some other types of high flow oxygenation, BiPAP types of ventilation that we can do before you get very, very critically ill and then intubated on a mechanical ventilator. Those treatments have been getting better from the first time COVID has appeared in Wu Han in Italy and now subsequently in New York and South Florida.

Speaker 2:

Right? So I want to , I want to expand on that real quick, as far as the , the intubation in the ventilators, because the news has really put a lot of emphasis on being on a ventilator and a shortage of ventilators and my understanding, and I hope you can correct me if I'm not accurate, is that in the beginning, we were very quick to put patients on ventilators in the treatment of this. And now we are learning that that's not an initial intervention, but more so an intervention as a last resort or towards the end of the rest of the treatment regimen, not working. It is that accurate.

Speaker 1:

It is accurate. Unfortunately, what we're seeing is that there is a finite number of resources throughout our community in South Florida , uh , be it human resources, intensivists who are physicians who work in an intensive care unit, infectious disease physicians are registered nurses, respiratory therapists. So that in combination with hospital beds, in combination with ventilators and other types of medical equipment that we just spoke about before, all of that has the potential to reach a capacity, which is why flattening the curve with all of our preventative measures is so important. Right ? Okay. Just here, let's talk about the controversial stuff. Hydroxychloroquine what are your thoughts on that? We hear it on the news and everybody's on two sides of the fence here. What's what are your thoughts on that? Hydroxy chloroquine is an FDA approved therapy for many illnesses, including lupus and arthritis. They've used it years for those things. It is not a treatment that has been shown through the evidence based practice to affect COVID-19 when given for that illness,

Speaker 2:

Right. Let's talk about vaccines. Cause that's another conversation piece that seems to be very active in the news cycle. Do we have hope for a vaccine and horizon? And if so, what, what role will that play? Will they in your mind? Will that be, Hey, everybody must be vaccinated or else, or will it just be voluntary and individuals , I mean, and again, I'm , I know I'm asking you to hypothesize, but just your thoughts.

Speaker 1:

So I'm very excited because there is currently a two dose vaccine in phase three of clinical trials at the national Institute of health. So right now the trial is enrolling 30,000 volunteers at 89 different clinical research sites at areas that are hard hit from this virus. Um , so they're going to be able to use our own communities, epidemiological data, to see those high incidents areas, emerging hot zones. So maybe our South Florida area will be picked for that site. Um, and then vaccines are an effective part of a strategy to fight against COVID, but it's only one strategy to fight against COVID there's many of other behavioral modification, things that we can do in concert with a vaccine, which would require a large uptick of, of taking the vaccine in our community, right . Getting the flu vaccine would help stop the COVID. So we want to make sure people get their flu vaccine and potential COVID vaccine when it comes out.

Speaker 2:

Right. And I'm glad you mentioned that because we feel a lot of questions both internally from our personnel and the fire department and various employees throughout the city , uh, as well as externally. And the conversation always is , well, you know, I , I read that , um, the masks aren't effective or they are effective social distancing isn't effective, or it is effective. And there's always debates about these things. But if I understood your answer correctly, even with the vaccine, even with a solid treatment regimen, even with all of that, there are still some behavioral modifications that we need to make. And those would be what

Speaker 1:

Wearing a mask first and foremost is one of the best things any person can do to help prevent the spread of COVID-19 wearing a mask, covers your secretions. So me talking in front of a room full of people automatically just stops any spittle that we've seen people have before , uh , and that can help prevent COVID-19. The second thing is avoiding large crowds of people avoiding closed rooms and spaces with a lot of also, we don't like to say social distancing anymore because of the stigma of not being in touch with your loved ones and your friends. So physical distancing is so important to keep that six feet away and then being outside, if you can, as opposed to in a, in a small closed room and then handwashing , handwashing is something easy we can all do. Um, it's not the gloves that you saw people wearing and in February and March, because we know gloves have the tendency, people touch everything. And then that passes the cross contamination. So as soon as we wash our hands, either with soap and water or alcohol based hand sanitizer, that is a quick kill of any kind of bacteria and viruses on our hands. And that stops the chain of

Speaker 2:

Right. And I don't know if you feel the same way, but I'm amazed that it took COVID-19 for us to realize that hand-washing and that level of personal hygiene was important and it, regardless of COVID-19 right, it's always been important. So the fact that it's emphasized now, and there are so many people who this is maybe a newer concept is always kind of surprising to me, but yeah, so as a very social society in the United States, there's a going to be a learning curve because if all the experts are correct, this is a longterm situation that, that we'll be working to remedy, right? Yes.

Speaker 1:

And with our working closely with our partners at the health department, so our communities all across the country, and especially in South Florida to ramp up our testing, our fast access to testing with fast turnaround times. Um , and then the contact tracing that comes along with it, people doing their part to furlough quarantine, don't go out. If you're sick is one of the biggest things that we need to continue messaging. If you were potentially exposed to somebody with COVID supposed to somebody with the flu, you would want to stay home. So, so you're not spreading the

Speaker 2:

Right. Excellent. So shifting gears a little bit, but along with what we're discussing dr. Fowchee, you said that the COVID-19 is going to be with us potentially for a very long time, in your opinion, what do you believe are the short and longterm prognosis for this, for this virus? And I guess specifically, will this become seasonal eventually? Like the flu is

Speaker 1:

It could be, we don't know that's that that's the biggest issue with these new viruses. It could definitely become like other Corona viruses, which is the common cold and become cyclical like the flu. Um , it could become less and less virulent or strong and , and kind of Peter out. So it is just kind of like the common cold. So we need to have more research done on this virus to culture it, to see how long it lives, because the more research that's coming out, the more we're changing our protocols. So we've seen that in the past, we've changed our stance on masks and now throughout the rest of the world, we've seen that that actually is an effective way to prevent COVID-19. Um, the same thing is, is now we're changing our protocols with discontinuation of , of precautions, letting people go out, back into the world. And 10 days before we thought it was a longer time because people keep testing positive, but we're seeing through all of the research we're doing that. It's really only about 10 days you're infectious

Speaker 2:

And that, so that's really the reason why the CDC shifted a little bit, depending on your status. Like healthcare providers are addressed a little bit differently by the CDC as well as first responders, but for the rest of the population, is she , CDC has shifted a little bit away from a testing based regimen for return to work or returning to normal interaction to a symptomology based. Right? Correct .

Speaker 1:

So that's what I was referring to. And it's very similar to what we do for the flu or to other types of respiratory viruses. So we count about approximately X number of days after your first symptoms. So for COVID, they're saying it's about 10 to 20 days, depending on the severity of your illness and some of your other personal risk factors ,

Speaker 2:

Like being immunocompromised, which you've talked about before. Yeah . Okay. And then , um , asymptomatic people, are they presenting a little bit of a challenge because where do they fit in? So we, we talk a lot about amino compromise the severity of your symptoms, but then we kind of have to segue to talk about individuals who are asymptomatic. And it seems that that category hasn't really changed with the CDCs recommendations.

Speaker 1:

So that's another one where we're still learning and more research needs to come about. So we just have to err on the side of caution, which is another reason why we wear masks. We wash our hands all the time and we care for our fellow human beings because we don't know who is asymptomatic, who is immunocompromised. So we treat everybody the best way we can. The golden rule. I know there might not be enough information yet. I know this is all new, but is it possible to get reinfected? That's an amazing question. And that's still one. We have to wait for the research to see they're saying , uh , we should be looking at like a 90 day or three month time period to see if we shouldn't be retesting people to see if it's a new test, a new test, a new illness, either way we would want to look for new onsets of symptoms and not just the test, a new test coming up .

Speaker 2:

We didn't discuss this question beforehand, but I kind of want to throw it out there. And if you don't want to answer it, I understand. But we, we went the way of antibody testing pretty hard in towards the beginning of this. And then we moved away from antibody. Can you explain that a little bit to our listeners, how that worked out

Speaker 1:

Antibody testing is an important role in, in learning about COVID-19 and that's exactly what it is. We're learning more about it. So with the antibodies, some people might develop antibodies and that's good. They're seeing that you could have it for about three months. And that's the reinfection question that we just answered. Other people might not develop antibodies at all. We don't know why that is. So because of that, we can't really tell if the antibody test just, wasn't a good test, didn't pick up your antibodies or you didn't actually make antibodies. And then what that means. So it's just hard to tell what the antibody test will do for us yet,

Speaker 2:

Right? But we're still in a place where the PCR test or the guest for our listeners, the viral, the actual viral test is still what we're using to diagnose as opposed to the antibody tests , which would be used more for collecting data or maybe confirming the PCR test. Is that accurate?

Speaker 1:

Yes. So the viral PCR test, that's the one that people will get most likely all the way to the back of their nose that will detect how much virus is in your body. There's some new tests, the antigen tests that are now being done at the hard rock . Um , those will also detect how much viruses in your body, but you do need a lot of virus at that point, which is why they're encouraging only symptomatic people to get that test at those sites.

Speaker 2:

Makes sense, makes sense. All right . Besides individuals not wearing masks and not social distancing and maybe not washing their hands as much as they should, what do you think are some other factors that continued to create viral spread?

Speaker 1:

The reasons is testing. If we don't have accurate, efficient, fast testing with fast turnaround times, we can't get that information back into the hands of the people who went to get tested, which means those people can't do a lot of the behavioral modifications. We talked about. They can't, they , they need to stop going out into the community. They need to stop going to work when they're sick, they need to isolate themselves. So they don't spread the virus. If we do that, we can stop spreading the virus in this community. Awesome. Here we are like months later and I guess here at school starting, what are your thoughts on schools ? Opening? I believe the schools are mostly going virtual, but some schools are going to school. What are you, what are your thoughts on that? I have a lot of thoughts on that because not only am I a registered nurse and epidemiologist, I'm a mother. So I have a seven year old and a two year old. I'm helping with some of my kids' schools to come up with some of these answers, how we can do this safely right now, when there is a lot of spread in this area, I can't see how we can open schools in person safely to protect the most amount of people. And that's our job as public health professionals to, to offer those advice to the people, trying to plan how to go back to school. I do think it is possible. This is our new normal we're learning every day, how we can make this effective. But again, we need some of those things we were just talking about. We need people to be wearing masks at all times. Can't be just mandatory. We need a lot of hand-washing opportunities. We need space. So be able to do distancing if possible, and then we need the testing and what happens after the testing. So we need people to stay home. If they're sick, to let us know the stigma attached to a positive COVID diagnosis has to go away, right ? It just has to be part of our daily life. I have COVID my brother and my sister has COVID. So we're going to stay home, let people know. So everybody else can react appropriately. Once that happens, we can definitely reopen schools.

Speaker 2:

I think that's a really good point because one of the things that we saw when the CDC shifted from test-based return to work and to symptomology return to work his coworker saying, well, hold on. If that person is still testing positive, I don't want to be around them. And that became a challenge because we had to then sit down and explain, and really get, do a deep dive into the CDCs reasoning behind that and educate people to reduce that fear. I think that's a great point related to schools and the other good point. I think you make that's amazing is it's not just about the precautions to minimize the spread of the virus in the schools if we went back to face to face, but it's also having that extremely robust infrastructure in place for what happens when we do get a spread of infection in a particular school throughout students and teachers and administrators, and I could be wrong. I don't feel we're a hundred percent there in that infrastructure. What are your thoughts on that?

Speaker 1:

It would take everybody working together with the common goal of doing the right thing. So even on your , not at school times, what your family does wearing masks, washing hands, staying physically distant. Awesome. Alright . Is there anything else? I mean, we're kind of at the end of this, is there anything else that you wanted to add? Just that stopping the spread of misinformation is one of my all time favorite things to do. Um, it's, it's a huge goal in public health. Now we want to make sure that as many people as possible are , are spreading these messages, that masks work hand-washing works, social, physical, absolutely works, and we can all work together to stop the spread of COVID-19. All right, Rachel, thank you very much. We know that you're busy. So thank you for coming and educating and informing us. Thank you so much for having me. Appreciate you. Thanks. All right . Thank you everyone for tuning in. Remember wash your hands, wear your mask and stay safe. Everyone take care. You've been listening to the city of plantation podcast, restrict you , bring your accurate and timely information. Please continue to tune in to our podcast episodes and also catch up with us on social media, including Twitter, Facebook, and next door. If you have questions, send them to ask [email protected] and we will answer your questions directly. Thank you for taking the time to listen to our podcast and stay safe, everyone.