COVID-19 Latest Updates with Dr. Talmadge King Jr. | B-Well Together | Salesforce

Hello, hello, hello and welcome back to Be well Together where we continue to just focus on all aspects of your health and your well being, from yoga, cooking, finances to Covid updates and healthcare disparities. And today's session is just that. It's exactly what the doctor ordered, like literally with a focus on the medical side of well being. Today we are privileged to welcome Dr. Talmadge King Jr. He is the dean of the UCSF School of Medicine and the Vice Chancellor of Medical affairs and I think very relevant. He focuses his research on inflammatory and immunological lung injuries. He has been the recipient of the Trudeau Medal, the very highest honor that the American Lung association and the American Thoracic Society has. And he's co edited books and done over like hundreds and hundreds of publications and he's just been absolutely everywhere. So we are really, really fortunate that he is joining us today. He's going to help us understand the latest updates on COVID 19 and in particular how it's been impacting our communities of color. So we also today are very happy to have Ifosa Agboma who is our global finance chair of boldforce. Hi Afosa. He's going to be my partner in crime here, my co host with the mostest and with that, Dr. King, I will turn it over to you.

Good morning and thank you. I'd like to share my screen if I can and start there. I want to share with you five things today. One, I want to define what COVID 19 is. A lot of people heard a lot about it, but I want to tell you set the base. I want to talk about the trends in the pandemic that's occurring now. Especially things are changing. I want to talk a little bit about healthcare disparities, a little bit about potential treatments and then I want to re emphasize the importance of the three W's. So COVID 19 stands for Coronavirus 2019. It's caused by a Coronavirus disease. 2019. It's caused by a virus called SARS COV2. The virus first appeared in late 2019 and has quickly spread around the world. The incubation period from exposure to beginning of symptoms is somewhere around four to five days, but it can extend to 14 days. And about 98% of people who develop symptoms from this disease will have those symptoms within the first 12 days. The symptoms in patients are many, but the most common ones are fever, cough, trouble breathing. You get a combination of these and then you can get a combination of other things as well. Myalgias, headaches, sore throat, Diarrhea and then there's a rare things. And there have been a couple things that people talk a lot about, but they're actually uncommon. A loss of smell and a loss of taste, which is quite interesting. The next thing that happens really the virus attacks the lung, the heart and the kidney. And that's very mercurial about the virus. And it's been part of making understanding how to manage these patients a little bit more difficult. So here's Medical School 101. So when you go into the hospital with symptoms in the emergency room, one of the first things they will do. Now, the first thing we'll do is test you for COVID 19. They. I'll tell you about that in a minute. But in terms of understanding your illness, they will take a chest X ray. These are two normal chest X ray just to set the pace. The one on your left is about a 55 year old man and the one on the right is a slightly younger man. The findings here are the lung is everything here in black. So all of this, this is the longest impact. These are the diaphragms at the bottom. And this is air in your stomach, this is the heart in the middle. And then all these shadows that you see are your ribs, front and back. And so this is more or less what a normal chest X ray looks like. So when you come in with COVID 19, one of the first things that happens is you have a shadow that appears on the X ray. This is one patient seen over seven days. So on day four, he came in and you can see the lung here is relatively normal, but there are abnormalities here that the radiologist would diagnose that something's going on. And then two days later, you can see two things have happened to this patient. This is the lung, this is how big it is. And then two days later, look how big it is. Here's a diaphragm. It's a lot higher up than it was before. So that person's lung is shrinking. Why is it shrinking? He's getting more and more infection in his lung and there's not air in his lung anymore. He's getting, he has pneumonia in his lung. And all these shadows, these white shadows are expanding in the lung. And 11 days later you can see it's almost all white. The techniques are basically the same. These are the clavicles, by the way, and you can't. And I'll just tell you, he has a tube in his throat now. So. So over these days he went from no oxygen needing oxygen to needing A mechanical ventilator. And the ventilator is there because his lung is shrinking. And you have to actually help him breathe. You gotta push more air into his lung. And so if you see his lung here on day 11 starts to look about the same size as it was on day four because we're forcing more air in the lungs. So oxygen, you're giving that oxygen so he can get more oxygen into his blood as maximum he can. And you're using a mechanical device to force air in the lung, the ventilator. That's allowing him to breathe better, and it helps him. The other thing is when you get this kind of illness, you get very fatigued and you can just stop breathing because you just run out of gas. You just. You don't have the energy. You. If you imagine running a marathon 24 hours a day, seven days a week, that's what happens when you get pneumonia. And the mechanical ventilator helps you get past that. And here's. Once you've done the. I'm sorry. Once you've done the chest. The chest X. Once you've gotten really sick, another test that can be done is a CT scan. And I'm just projecting it. A slice of the CT scan chest X ray is just one picture. A CT scan can be hundreds of pictures, but just shows in more detail that he has pneumonia here, pneumonia here, relatively normal lung here, but this is really, really bad pneumonia. This person's survival would be in question when you have this kind of disease. So when people talk about what's happening in the emergency room and why people are going into critical care, the first thing that happens is this bad pneumonia that makes the lungs really stiff, hard for you to breathe, and you have to help them breathe, and you have to give them more oxygen so they can get the maximum amount of oxygen in their blood. Then you diagnose the disease by two different ways. One is you diagnose the current infection and asked by nucleic acid tests. And then you can diagnose if somebody was infected previously by doing what's called serology. So I want to tell you a little bit about that because this is going to be important as we live out the rest of our lives with this virus. The first, if you have an infection and you want to diagnose an infection, you do something called pcr, use a nucleic acid test, and you take. You do the swabs in the nose and you do the swabs in the mouth, and there are other secretions you can take as well to find the virus. So when you infect it, let's say you're sitting on a plane next to somebody who has COVID 19 and you're fine, and they expose you to it. Five days later, seven days later, you get sick. So as the virus is replicating in your body, you get sicker and sicker. And so your symptoms will start about a week after you've been exposed. And this period right before you get symptoms and over the next week or so, is when you are most infectious. This is when you will give it to someone else. So the virus rises and then your body starts to help, Your body starts to defend itself, and the viruses will slowly go down. So the virus usually will disappear after about 14 days, as I said earlier. And this PCR test is a genetic test that tests for the virus, genetics. So it's highly accurate when everything is performed correctly. So that's how you diagnose the current infection. And that's what every. This is what everybody's talking about. We need more testing, more testing, because you can figure out if people have the virus in their body, right? Then after you have been infected, your body fights it off. And the first thing it does is that it makes antibodies against the virus. This is the body's response to the infection. So this was the infectious period. And slowly, basically, right after you get infected, your body starts to make antibodies called IgM. And my way of thinking about it, these are the marines. They hit the beach first and they go in, they try to protect you from the virus and they, they start to wane fairly quickly. And then the, the army comes in next and they, they then come in and actually have a longer, more sustained defense system for you against the virus. Those antibodies come in very slowly, but they stay around for a long period of time, maybe even a lifetime. We don't know for sure what will happen in us with this virus because we've never seen this virus before. But we expect, like in other cases, you will have antibodies forever if you've been infected with it, that protect you from this particular virus going forward. So this is a blood test. They take blood, they measure two different things. They measure for IGM and igg. So that's, that's how we diagnose it. We can diagnose current infection. You're infected today, you can infect others. We can diagnose past infection. You've had it. You're not likely to infect anybody now, but we can, weeks later prove that you had the disease by doing these antibody tests. So Those are the two ways we are diagnosing this disease now. Trends in COVID 19 so things have changed dramatically. So right out of the gate then the big cases were we had this big rise in cases throughout the country. This is a seven day moving average of us, Europe, Canada and Japan. And in the US you can see like these other countries, particularly Canada and Europe, we had this real rapid increase in number of cases. Almost all of these were in the Northeast, New York, New Jersey, Connecticut. And then those people started to recover. So our cases nationwide actually looked like they were going down. But hidden over here was the fact that a lot of things happened. We started to act like things were better. And the rest of the country now has started to rise again. And you can see this rise is as steep as it was in New York and Connecticut at the beginning. And unlike other countries who've gone down and pretty much staying down, the U.S. the infections, the cases that being identified has gone up. And if you look at where new cases are in the country, 45 of our 50 states have an increase in the number of cases day over day over the last week or so. And this is just about 30 of them showing that we had this earlier peak. It never really flattened out. We never had this big decline. We had a decline, but it never went away and now is spiking even higher than it was the first time. So this has gotten everybody in the healthcare field extremely nervous that this is definitely getting worse rapidly and is happening all over the country. So the massive outbreak across the Sun Belt and into the west coast is primarily due to the way we opened back up. And what's striking is that everybody heard at the beginning that this was the disease of older individuals. And that was true because when it attacked initially, especially in New York, it attacked the most susceptible population, which turns out to be older individuals. But now it's attacking younger individuals. And the median age, instead of being 60, 70, 80, is now 40, 50, 60. So the age of the people being affected by this virus is much younger. And I think we're up to more than 40,000 reported cases a day now. So it's exploded, particularly Texas, Florida and Arizona. And as you know, the east coast has now mandated a 14 day quarantine. If you travel to New York, New Jersey or Connecticut, you have to be quarantined for 14 days from pretty much every state in the union now, including from California. So the cases are going up. The deaths, the deaths haven't actually started to go up yet, but it's just a matter of time. And the deaths will slowly start to rise as more cases appear across the US In California we are seeing another spike. So our seven day average has fallen a lot in California. But in recent days, certainly in this month, we've seen a rise. And fortunately in California we haven't seen a rise in deaths, but deaths haven't gone away. We had this long plateau and deaths, most of the cases are in Southern California. But we've had. And the reason why we've seen this increase is that community transmission has gotten worse because we lessen restrictions in a number of places. We started opening back up. There were protests. There are a lot of things that were going on that put people in contact with each other. So that's caused an increase. That's probably the biggest reason. Essential workers from high density neighborhoods. I'll talk about that a little bit later. And there are institutional outbreaks. We absolutely predicted this. We know it would happen. If you want the best place in the world to have an outbreak of communicable disease, prisons and penitentiaries are ideal settings. And we are seeing an explosion in the prisons in California. I think they're now up. They're predicted to be like 2,000 cases in San Quentin, for example. If we don't get this turned around very quickly, we're also doing more testing and more targeted testing. So that helps us identify more people. And there was an opening, a partial opening of the border between California and Mexico. And so expats are coming back home to get medical care. And that has increased our cases in Southern California. So things have changed. And this is a state prisons throughout the state. And There are over 1000 cases at San Quentin right now. So this is one area where we're very frightened about what will happen to those men and women who were in those in those prisons. So the other issue is healthcare disparities. This is a crisis within a crisis, people. One of an example of the kind of problem that's occurring in communities, high density communities, communities that are poor community, working class communities all around the country is that they seem to have more infection. The primary reason I'll show you in a second, but there was a study done by a group at UCSF and San Francisco General, Zuckerberg, San Francisco General Hospital. Looking at the Mission District, A densely populated census tract in the city is predominantly a Latinx community and a working class community. They tested almost 4,000 people. There were 83 positive tests, which is about what you would expect in a population that's not sick. About 45% of them were Hispanic or Latino. Yet when you looked at the people who were positive, those who had a positive test, 95% of the positive tests were among Hispanics and Latinos. And so the question is why? And. And it's explainable. The factors that seem to impact this disparity is that these people could not work from home. 90% of them said they could not work from home. They had to go into work. Many of them were essential workers. They were traveling on public transportation. They were being exposed in their workplace, so they could not stay home. Most of them were at the lower economic ladder, lower part of the economic ladder, making less than 50,000 a year, 90% of them. And they lived in households that were relatively dense with usually small apartments with anywhere from three. With three or more people and almost 90% of this population. So there are socioeconomic factors that were playing a role in why they were getting so many infections. And this kind of event happens a lot in this community where these other factors play a role in why people are susceptible to infections or why they can't get the best medical care that's available. So then just a word or two about treatments and I'll stop. I see that my time is running out, but there's no antiviral treatment. So we don't have a way of treating this disease. Remdesivir and people who are really sick, you can have quicker recovery. It's an expensive drug. There's a question about whether it's worth the price of saving a few more days and getting better. If you're sick. The answer is yes. But as a society, we're gonna have to decide that. There's a lot of talk recently about steroids. They decrease the risk of dying. That's a very complicated study, and we are questioning that. Chloroquine and hydroxychloroquine and antibiotic azithromycin. We think it shouldn't be used to prevent or treat the infection. There are more adverse effects than treatment effects. The best treatment. One other comment is that the disease is worse than men, which has been very interesting. It's three to one, men versus women. More hospitalization, severe disease, higher death rate. So there's something about male hormones such as testosterone, that allows the virus to get inside the cells. So we've started. The people at UCSF started looking at trying to figure out, are there sex hormones that we can use to manage this disease. So that's going to be an interesting study to follow over time. So how do you end the spread of this disease and this Is the three W's. You got to wear a mask, got to wash your hands, and you got to watch your distance. And I want to point out that what we learned from history Is that we learn nothing from history. 100 years ago, we figured this out in San Francisco. You must wear a mask because it'll save a life. This is the influenza pandemic. We knew then that it worked, and yet we didn't do it. When you cough, you, droplets are in the air. When you talk, they're in the air. When you use a mask, you protect others. When you use a mask yourself. And so when someone says they're not going to use a mask, they don't respect you, they don't care about you. They don't care about the community. They're talking about their own independence, and it has. And they don't care about the rest of us. There's no empathy. So if you want to protect the people around you and you care about them, you have to wear a mask. And it helps you. You got to watch your distance because the further away you are from people, the less likely those droplets will be inhaled. And you should avoid touching. So keeping your distance. And you should wash your hands regularly. Soap and water don't touch your eyes, nose, or mouth. And basically keeping your hands clean is really important. So I'll stop there. And thank you very much, all of us are responsible for making this better.

Holy moly. That is how you give a presentation. That was amazing. I am really, really grateful for all of the just the straight information and knowledge. It's wonderful to hear from an expert like yourself on this. So thank you. I have a question or two. One question that I have, which could be very selfish given my age demographic, But I'm wondering why the disease, when you said that it had started and really hitting the demographic of people in their 50s or 60s or 70s, because they were more vulnerable, but now it has moved down into the 40s, the 50s. Is that because the disease is mutating or like what kind of happened? Because I would assume that it was the same and it could have hit every one of all age demographics equally in the beginning. So I'm just kind of curious as to what changed that it now is hitting more people? Is that reflective of the protests and everyone kind of trying to return to normal and that demographic maybe is more exposed and now it's hitting them more, or has the gene itself changed and gotten stronger?

Yeah, we have. We have no evidence that the virus has yet changed. Virus will change. And that's the trick that they have. But I think it's just opportunity. So at the beginning, the opportunity was in places where people were congregating and the exposure was high. So that's why it happened in nursing homes. It was just the opportunity was there and there was no shelter in place for them. They were just stuck in a nursing home. And they're the most susceptible for a whole lot of reasons. Sadly, the older we get, and I'm in that age group, the older we get, the more susceptible we are to many things, including infections. And there's a biological reason for that that we now understand. And so I think it was really just opportunity. And so more recently, we've given more opportunity for more people to be exposed. So they're now getting infected.

Yeah. Okay, that makes sense. My other question for you, and then I'm going to turn it over to Efosa, is we hear about people getting the disease, we hear about the recovery or we hear that they die. But I'm curious to know if are there long term for people who recover, are there long term health implications that they now have? Do their lungs fully recover? Do they have scarring? Do they. Are they more susceptible to other ailments because they've had this.

Yes. So the X rays I showed at the beginning, especially the one where they got over seven days, where it got worse and worse, I will predict that that person will never be normal again, that the lung has been damaged and he will get better and leave the hospital and maybe off oxygen, but won't be able to do the level of activity that he did before he was sick. The lung has been injured and scarred and you're not going to get back, you're going to be impaired. And we'll document that for. So it doesn't go away. So that's fine.

It doesn't go away. And is that true for the majority of cases for recovery?

No, the majority of people who have. It's just like when we have the flu. You get better and you're fine and the lung completely recovers. 80 some percent of people will have no residual at all.

Okay.

It's just a few that have the severe disease. They will more than likely end up with long term impact.

Okay. All right, Efosa, I give the floor to you.

Thanks, Charity. I have a question or two here. Dr. King, how can we continue to educate ourselves in terms of the world changing and COVID 19, as you stated, changing, especially when it comes to those underserved communities?

Well, I think that we have to keep Getting the message out and that about the three W's, honestly, because I think if we stay with, if we do that, the things that we absolutely can do, it's been proven to allow the virus to be the pandemic to be slowed and eventually stopped. And I think people have to understand that. And we have to actually help protect people, especially our essential workers, so that they have what it takes to protect themselves and their protected in the environments where they work. And as long as we do that and keep communicating and we have to put our communication, we have to do our communications in a way that people can get it. One of the big things that upset us at UCSF is we had all these testing sites and there were testing deserts in the community where people were most vulnerable. So that's why they went to the missing district. There was no way for them to get a test. And they, and those are the kind of things we have to do to protect these communities.

Can you elaborate on that last point there? Testing deserts, I hadn't heard that.

So the test was, you had to drive into a test downtown San Francisco. And the people we're talking about don't have a car. So how are you going to get there? So take the test to them. Right. That's what I mean.

Okay, that's a very good point. And then I would say, I think one question that we have from Chatter is how long after possible infection should you get tested to get the most accurate results?

Well, if you're trying to diagnose that you have an infection, you pretty much can identify within the first 14 days for sure, by five days in, like if you were exposed and you think you now have it, within the first four or five days, the test will be positive.

Okay, makes sense. I think we have time for one more question. There's been a lot of questions around, like wearing masks. To your point, of the three W's, where and when should people wear masks? Like when they're out at the beach grocery shopping, like highly.

Yes, especially coming in in America with this Fourth of July holiday. You know, if you, if you, if you have a family over in your backyard, should everyone be wearing masks? Is it. I think that would be.

So you should wear a mask when you're with other people. And especially people you do not, you have not been living with, because if you've been living with them, you've been exposed. But if these are people you don't know, because people can be asymptomatic and spread the virus. So when you're around other people, you should wear the mask, and you should. And when you're around them, you shouldn't shake their hands or, you know, exchange things as much as possible. Keep the surfaces clean and don't shake hands. But the mask will save lives. And, you know, when you're six, more than six feet away, and you can take the mask off and you can even pretty much talk with that, but the best thing is to keep the mask on at all times. If I'm in the grocery store and I'm walking down the line and there's somebody without a mask, fortunately at the grocery store I go to, I have not yet run into anybody without a mask. Well, a little kid. But if they're not, I stop and I go down the other aisle. I'm not risking it.

Words to live by. Thank you so, so, so much for being here. This has been very, very enlightening. I think you've given us all a really good dose of facts which are not necessarily easy to figure out what's real and what's not. So thank you for your time and for your very, very thoughtful presentation.

Thank you very much. Take this seriously, guys. Be safe, be healthy.

Will do. Be safe, be healthy, be well.

Bye. Bye.