Vinny Messana (VM): To give a proper introduction, Dr. Rajeev Fernando, an infectious disease specialist at Stony Brook Southampton Hospital. Thank you for your time and helping combat this deadly disease that has turned everything upside down.
Dr. Rajeev Fernando (RF): It is a pleasure and honor. When we get into medicine, this is what we get in for. I am so happy to be on the front lines and I know everyone in our hospitals are working so hard too. It is really a team effort so, thank you.
VM: It hits close to home for me. As you know, my fiance works at the hospital so she should be home in a minute. She’s been doing 13 hours days. It’s crazy. I hear everything that is going on and it is not an exciting time. We got a lot of kids that sent in questions.
First, you see a lot of misinformation spread, especially on Facebook, with some parents angry they are not going to see their kids play. Could you dispel the notion that this is like the flu.
RF: The flu, we know, has been around for years– centuries really– and we traditionally have three to four strains of flu in society. The good thing with [treating] the flu is there are treatments and vaccines. For COVID-19, there is no stain of treatment. There is experimental investigative therapy out there but it is not licensed right now. Plus, there is no vaccine. So put that in perspective that you don’t have those two options which makes it even scarier. With the flu, the mortality rate is .1 percent. For COVID-19, the mortality rate could be as high as 3 percent.
The reason I am saying as high as 3 percent is since America got off to a slow start testing and in that one month we lost a lot of people that weren’t even tested. That is something that I think about and there are probably way more deaths than that. I am glad you brought that up, Vinny, the more you keep hearing “it’s just like the flu,” it is nothing like the flu.
VM: I remember the H1N1 scare when I was in high school. Even though that was more deadly, I feel like that has not impacted as many people as this has. Can you talk about what differentiated these other pandemics [from COVID-19]?
RF: This one comes from bats and is from Asia itself– very common in China. The H1N1 was a classic situation that we call “triple-reassortment” between a pig, a human and a bird. When genetic material was shared through, that’s what happened there. Now this is a completely different problem. To put this in perspective, coronavirus lives in bats very hormonally. They have no problems and live well together. The problem is when coronavirus from bats spill into a human being, that is when the human does not know what to do. Coronavirus has been around for centuries and live in harmony with bats.
What has happened in Chinese markets is all these animals in one cage– I’ve seen this myself– bats, snakes, cats. What happens over there is they mix each other’s genetic material and when the human takes it, that is the problem. I had a suspicion this would happen but not to this degree. So when I planned to go to China, I heard about this situation before from SARS. It was the exact same story. When people came to me and said “wow, how did you predict this,” I said “No, I read about this from the newspaper.”
This is it, Long Island! This is our week where we are going to have a lot of destruction. So it is very important to stay home and kind of ride it through.
I know this is for Axcess so I know it’s hard for you guys– you are out playing one day then you are made to be at home. It has to be incredibly frustrating.
VM: Yeah, the Division-I guys played about three weeks but the high schoolers didn’t even get through tryouts so I know I can empathize with those kids that went through it. They had to watch the fall sports and they didn’t even get a season. Right now health comes first for everybody. My other question is we all heard “Oh, this affects older people and underlying health issues.” Recently, you are hearing a lot more concerning stuff coming out about 35 year olds and people with no conditions. That is really scary for people since there is no telling who it can affect. So why is it coming out now about young people?
RF: I’m so glad you asked, Vinny. It has been misconstrued that this disease does not affect young people and only the elderly get it and die. That is a complete misconception. Younger people, a lot of times don’t get sick from it. 80 percent of young people with it just get a little- *cough cough*– and that is it. It goes away in about a week and it’s done. A lot of people don’t even think it is COVID-19, they are like “I just had a cough.” You may get sinuses, headaches, body aches but that is all that happens.
For elderly people, about 10 percent of the people get really sick. These are the people that enter the hospital. They have pneumonia– “Will they make it out alive?” It is hard to say. And the last 5 percent is critical care so once they get put in ICU and ventilation, it is hard to say. I want our viewers to know 80-85 percent of people have a very mild symptom of it. Most Americans who get this will do just fine.
VM: When you get it, are you immune to it?
RF: My thought is that you will be immune to it. That is what happens in general with a virus. When you get a viral infection, the virus attacks you but the body produces antibodies that protect you from the virus, kill the virus and save the day. That is probably the way it is going to go. Alternatively, if the virus starts to mutate, then the body does not recognize it anymore and that is really the problem. If it mutates then you think the body is not going to protect you anymore. So when does it start to mutate? It mutates when the survival starts to dwindle so right now, there is no need to mutate since it is attacking on all fronts. There is no stopping it right now. In order to make a big change it is going to take a big number of mutations.
VM: Another thing you are hearing a lot of is the masks. The CDC is recommending that people who aren’t even infected walk around in them. So what is the difference between the basic medical masks and the N95?
RF: The basic medical masks are called the surgical mask that is specifically made for respiratory viruses. The rule of getting infected within 6 feet is made for viruses that have been very well studied for years. Viruses like influenza and other respiratory viruses have been studied for years and we can confidently sit back and say, bro, you are not going to get infected,” and it’s done. Now the problem really started in countries like China where the people really don’t care what the country is telling them in regards to wearing those masks.
While the government said [No, do not worry about it], everyone was wearing masks. But here, the government said no and people just followed it. I said there has to be some truth to what’s happening in Asia and now, unfortunately, we are late to the game. People have probably given it to others which we could have prevented but now the CDC clearly said it’s different.
Surgical masks are probably the easiest way to go but I have seen T-Shirts, and all kinds of designer masks out there. The concept of the mask is to wear some kind of protection– some kind of barrier. The N-95 offers better protection but I am not sure it is needed. But health care workers are using it for extra protection. So for people on the street any kind of mask is appropriate.
VM: Today it was in the news that the New England Patriots owner [Robert Kraft] brought over one million masks. Is that enough? How many are needed?
RF: It really depends on how much we social distance. If we do really well then we flatten the curve. If we keep doing what we are doing now and not listening, then it is a problem. It is hard to say how many– if we go by the number of cases predicted then we are going to run out really soon. That’s why the CDC said to use protective clothing for [non-essential workers]
VM: With baseballs being touched by almost every player on the team, how do we keep kids safe?
RF: Anytime you touch anything, baseball, basketball, anything can be infected. Once you touch the ball, you have to wipe the surface very well with Clorax or Lysol and then you have to wash your hands. For baseball the ball is changed more often but in softball you tend to use the same ball. For frustrated kids that want to go outside, I think soccer is a great idea. The only threat would be to a goalkeeper trying to catch or throw the ball in the field. But, kicking the ball around is good exercise.
VM: Switching over to lifestyle questions, something that is in the talks is baseball potentially going to Arizona to play. We heard the virus is susceptible to warm weather. Is that the case, that warm weather can help?
RF: In certain periods it sounds fantastic. It’s not just about weather but about the humidity. Viruses love warm weather, they thrive in that weather. That’s why respiratory viruses thrive in those temperatures. High humidity is a really good way to knock this out. A lot of people ask me about food and coronavirus and I said, “Well if you microwave the food, you will be able to get it off.” There is not a lot of data surrounding this but a lot of physicians are on board with this. It is a rough time for people since we don’t have a lot of data and we use the best we can based on small studies. I’m sure things will evolve in the next few months.
VM: As far as high school goes you are dealing with younger kids that may not be carrying the virus. Is it possible they could start a season and not have the parents there and just have players play? Is that smart?
RF: I think that is a great idea but let me modify a bit of what you said. Kids can carry it. Asymptomatic transmission occurs in about 30 percent of cases which is sort of like the guy with the [cough] infecting people. A lot of people don’t even have any symptoms and are passing it around. A lot of time people are passing it around and can definitely be transmitting the virus.
I think you posed a brilliant idea with the season coming up. Having empty stadiums is a good idea. The virus loves small crowded places, if you have one, that is when it dominates. If you have limited people in the arena spread out very nicely then you should be okay.
VM: So you think it was a very good idea that they didn’t get March Madness in
RF: No absolutely not.
VM: Just a quick question here from Thrillcats. It says, “Wouldn’t wooden bats need different cleaning compared to aluminum.
RF: Yes. The macdaddy item I want you to think of is Clorax and Lysol. Wipe anything down– anything. I’m serious. If you look at the label there it kills upwards of 99.5 percent of coronavirus bacteria. So clean, scrub use it. Coronavirus can stay on any sort of stainless steel and plastics for up to 72 hours. Get into the habit of that. Hygiene is the most important thing to prevent this.
VM: We always hear about the peak is approaching. Looking at the data of Italy and Spain, when they hit their peak they still levelled off. It wasn’t like 800 people died and then 300, it was still around the same number. Once we hit that peak, there will still be some devastation for the few days after that.
RF: Absolutely, it is important to realize that. Once you hit your peak your cases are going to stabilize for a while and the number is going to go down but the number of deaths are going to go up. The number of infections when people come in are diagnosed with it but it takes a while for the patients to die. The prognosis is poor but they stay on the ventilator for about 12-13 days. So the cases level off but the deaths start increasing. It is so difficult to say this but it is really important to plan aggressive social distancing for a couple of months. These are outrageous times and measures but it is the best I can say.
VM: Now, Governor Andrew Cuomo mentioned the possibility of developing a test of who has it out of the entire population and out of those results, sending people back to work. Do you think that is a possibility?
RF: Absolutely, the real problem we have right now is the test system we have is deplorable. First, it is not a good test. If one person is getting tested, it can miss about 30 percent of the time. The swab you are doing in your nose could be a false negative about 30 percent of the time
VM: That’s scary.
RF: We hear it all the time that “I had this, I had that but the test came back negative.” You probably had it but you got better and dealt with it for about a week. This testing has been a big failure for the United States, honestly. We started testing about a month late and the tests are not perfect, but it has been horrible. The tests they have are tests that result in 15 or 45 minutes. The problem is every hospital in the U.S is ordering these tests. So we have to wait and now I don’t even get excited. I call in and say “hit me up when these tests get through.” Testing is [also] being denied so people probably go home and probably have it but don’t qualify at the moment to get tested.
VM: Gotcha. When you look at the projections– the Imperial College predicted 2.2. Million deaths globally. We then heard maybe 1.1 so why is there such a variety in these projections?
RF: These are projections based on a mathematical model and the numbers you hear are the absolute worst. We have to have hope if we are going to win this. If we keep seeing these numbers which may not be true, it’s very demoralizing. But, I want people to have hope. We will beat this. We have great researchers working around the clock to beat this.
I think also people want to be on the safer side so they go on the higher side. It is hard to say how many deaths there will be. I don’t project the 2.2. Million deaths. I think there will be a lot more interventions before that. Our scientists and researchers will give us a lot more knowledge– of course, the combined their efforts on what we see on the floor and the patients. We talk to them and work on “this pathway.”
VM: What are your thoughts on the hydroxychloroquine, does it show promise?
RF: Yeah, it has been used around the world to great success. It has been used in the U.S. for two weeks. We need to use it more and wait a little longer to see its effects. It’s very promising as of now– people are not dying, let me put it that way. People being treated are doing pretty well, they are hanging in there. I can’t say it conclusively but it is working for our patients.
VM: Last question, everyone here is a sports fan. What do you think is the correct course of action and what do you think we are going to see professional sports do in 2020?
RF: I think it is going to be way late in the year, towards the end of the year. Unfortunately, it’s impossible to know. Even after we hit the peak these cases are going to come down very slowly so I don’t anticipate anything in the summer. It’s so tough to say “Okay it’s over, stop social distancing,” it is never going to happen. I got contacted by an international destination wedding company and I said “I never thought I would be working as a wedding planner but now I am.” They asked if they can host their weddings here, what is the safety. Everything has changed and I think we are definitely going past the summer and we’ll talk from there. I’m sorry all you guys out there but like you said, there are certain sports you can do. Avoid contact sports but kicking around is very helpful. For all you athletes out there go around on a run in your backyard but not much more. Soccer and running is probably the best way to go.
VM: Thank you doctor, I know it’s not what everybody wanted to hear but we are in pretty unprecedented times right now. We are all in this together.
RF: Thank you for having me and I am always around to answer more questions.
