(upbeat music) – Welcome to our Facebook Live, where UC Davis Health experts provide information that you want to know Good morning, I’m Rebecca Badeaux, and joining us this morning is Dr. Dean Blumberg, Chief of Pediatric Infectious Disease at UC Davis Health Today we will be discussing everything we’ve learned up to this point about Coronavirus, and what the future looks like, at least for the next couple of weeks If you in our viewing audience have any questions, please leave them in the comments below We will leave some time at the end of our discussion this morning to get to a few of your questions So, good morning Dr. Blumberg – [Dean] Good morning – Now the last time you gave us an update, it’s hard to believe it probably seems longer, but it was March 31st So what are some of the things that we’ve learned about COVID-19 since then? – I don’t know, I mean everything’s changed, hasn’t it? I mean by the day, by the week, everything is different, and we are learning more and more every day, and yet we don’t know enough is the bottom line We’re still learning so much, but we’ve seen in this country, in the U.S., we’ve seen these dramatic number of cases in New York, Detroit, New Orleans In California we’ve been relatively spared, and we’ve seen social distancing that’s really been these dramatic actions that have really proven to be successful once they’ve been instituted – I know that with an increase of testing, obviously there are more cases then that are legit, you know, legitimate and tabulated, but is the virus still spreading at the same rate, or does it appear to be slowing down any? – It does appear to be slowing down We are testing more and more people, we’re pleased that we have more tests available At the beginning we really had limited testing availability and that was hampering our efforts to really know where the virus was, and how much transmission was taking place But even with the increased testing, what we’re seeing is that it is slowing down, the transmission is slowing down, and that’s likely due to all these dramatic social distancing restrictions that have been in place – You referenced New York, New Orleans, Detroit, some of those where we saw that really big spike, what are we looking like here in Sacramento? I mean, do we think we’ll see a big surge like that? – So in California in general, we were one of the states that very early on, once it was circulating in our state, that we had the restrictions, the social distancing restrictions, that came into play, so they were early and aggressive And so what we’ve seen in California is that we really have seen effective decreasing number of cases, decreasing transmission, this has been most dramatic for the whole state, but then in the bigger cities where there’s higher population density where you’d expect increased transmission, Los Angeles and San Francisco, they still had significant cases, but they’ve decreased And in Sacramento, with lower population density, we’ve been relatively spared We’ve got really good hospital capacity, with all the hospitals in the region, so we have not had that big surge that was so dramatic and sad to see in like New York, where they just didn’t have enough bed spaces, and they were concerned they didn’t have enough ventilators You know, that didn’t happen with us – You talk about Los Angeles, I did notice this weekend that there were quite a number of people out on the beaches in Southern California We’ve been hearing that this virus might hibernate once weather heats up Is that the case? – Well, we’re not quite sure is the easiest answer, is to say I don’t know, actually What we know is that these viruses, the Coronaviruses in general, they’re winter respiratory viruses, so they’re gonna be transmitted more in the winter than in the summer, and they usually take a break during the summer They don’t disappear altogether, but there’s less transmission This is similar to like influenza, that’s more of a winter respiratory disease But we know during 2009 with H1N1 influenza, it was novel, and we expected that after that started in the spring, that we might get a break in the summer, and we didn’t get that break, and so because it was so new, because the whole population was susceptible, we had continuing transmission throughout the summer And so we’re hopeful that the summer results in decreased cases, but we don’t know that that’s gonna happen, and so we could have continued transmission

during the summer The heat, the sunlight, the humidity in the summer, all those favor decreasing viral transmission, and actually people being outside favors decreasing viral transmission, because people are less crowded than they are indoors, and outside really, the air getting like all that dilution of virus is really great But there’s so many factors, it’s hard to predict – And that begs the question then, could we be looking, once we get into cooler weather, come December, January, February, that there could be a resurgence of COVID-19? – Yeah, we fully expect that We fully expect there to be a second wave in the fall and the winter What we’re not sure about is with relaxing social distancing requirements as you mentioned, if you see a bunch of people interacting on the beach, we start relaxing these social distancing issues, are we gonna see a second wave earlier than the winter? – So how has testing been so far, especially here in California, even here at UC Davis Health? How has our testing capability been? – Well we’ve had gradually ramping up capacity for testing so if you’re at UC Davis, we’re able to test anybody that we want to, we’ve got that capacity, we don’t have the limitations And several other hospitals in the region also have ramped up their testing capabilities so that they can test whoever they want, so that’s really really an advance over a month ago – So even during the summer, testing will continue, even if some of the social distancing, or some of the stay at home orders are loosened? – Absolutely, we’ll be able to test throughout the summer, and we’ll be able to test going forward and even have increased testing capability in the future – So I heard Governor Newsom talk about the staged, phased approach, versus a one time open approach in testing, talk to me about the difference and the benefits there – So this is really prudent, and so what you don’t wanna do is just say, “Okay, we’re gonna go back to normal tomorrow,” because what happens is after you have increased social interaction, you have the potential to have increased transmission and another surge of patients And so because of that you don’t want to do everything at once because there’s gonna be a delay between when you make those changes and when you get that increased circulation, because the incubation period of the infection is on average six days, so you’re gonna see a delayed effect from changing these recommendations So you don’t wanna do anything too fast because that could be a disaster I mean, that would be just like stepping on the accelerator and not looking where you’re going I mean, you wanna do this slowly and measured, and start taking away some of these social distancing measures that have been in place We know it’s been very hard on everybody, we know it’s hard for us mentally, socially, we know economically people have been making really huge sacrifices, but it’s worked and these sacrifices have resulted in saving lives and decreasing infections So once we go back on them, we need to do so very carefully – Obviously long term goal here is to create a vaccine, but what do you make of the, of the reports coming out now that people who were infected have the opportunity or the possibility of perhaps getting reinfected? And we talk about vaccines, so is this more flu like, where you can get the flu shot every year and still catch the flu, or measles, mumps, rubella, chicken pox type vaccine, what do you make of that? – Well we’re not sure yet We know with some infections that you can get them over and over We know with some infections, you get immunity that lasts for months or years or sometimes a lifetime It just depends on the infection Every infection is different, and the immune response is different So we think in general with Coronaviruses that the commonly circulating strains that cause the common cold, that we think you get immunity to those for maybe a few years, and so we’re hopeful that if you do get infected with this Coronavirus, with COVID-19, that you do get at least protection for a few years, but we don’t know that yet, and so we don’t want to make any assumptions We’d like to test that and follow people who’ve had the infection, and see if they can get it again And so that’s just something we wanna be careful with With a vaccine, obviously we’d like to develop a vaccine that provides long lasting immunity,

hopefully lifetime immunity, but that’ll depend on the response to the vaccine, the formulation of the vaccine, and we’re just starting to study the responses I mean the vaccines first started in clinical trials just last month and it’s gonna take months to years to get some of this information – And it’s interesting because, because of this unique pandemic, or unique to our time, it may not be so unique to 1918, but it feels like we’ve been in it for so long, but as an infectious disease expert, you’re saying this is just a blip on the radar for the long haul? – I mean this virus was first discovered just in January and really it probably first started circulating maybe in November, certainly in December So it’s only been around for like six months now and we don’t know everything about it And look at other diseases, like Ebola for example When we had the outbreak in West Africa in 2013, 2014, and we really wanted to develop a vaccine, it took five years to get an FDA approved vaccine even though a lot of effort went into that So we know that there’s these diseases that have been around longer and we still haven’t been able to solve them HIV, we don’t have a vaccine for HIV yet Malaria, we’ve got, just starting to get vaccines for that These have been around forever, and so this infection has only been around six months, and we really are just starting to learn about it – That’s really good perspective, thank you for that If you are just joining us here on our Facebook Live at UC Davis Health, we’re discussing COVID-19 with Chief of Pediatric Diseases, Dr. Dean Blumberg, we welcome your questions and comments, and we’ll save a little time at the end of our broadcast to answer some of those Okay, so you just talked about, we are on it for the long haul Are there any treatments right now that are promising at this stage? – Well many people may have heard of a lot of the different treatments that have been tried, and so one of them is an antiviral called Remdesivir, and we really just had some early reports, some have suggested that it looks promising, others have suggested that maybe it doesn’t work so well, and so we really need to sort that out, and it may depend on at what stage of the illness that you first start treating with this antiviral Many people have heard of one of the antiretrovirals that’s been used for HIV, Kaletra, and Azithromycin, a common antibiotic, these have been looked at I would interpret the early reports with use of those as not very promising at this point The antimalarials chloroquine and Hydroxychloroquine, those look really good in the lab, but the clinical experience with them that’s starting to come out now, it’s just that the side effects probably make them more risky than they’re worth in terms of any benefits, and they can have serious side effects And then we’ve also heard of convalescent plasma being used, so patients who’ve had infection and they’ve already developed an immune response, in taking their plasma and giving it to another patient who’s infected, and those results also look promising but very few patients have been studied But all these things are being looked at – Look at and disseminated, there’s so much information out there, it’s information overload, especially for adults But with your pediatric lens, what’s the best advice to discuss this with children? Yeah, it can be really stressful for the whole family and children are gonna appreciate that stress, they’re gonna sense that, and so for children I think what’s important is to talk with them and to be available for them For older children, for teenagers, they might have really specific questions because they might’ve heard stuff on the news, the same thing that adults are hearing, and so they might wanna get an in depth discussion about things, about like the epidemiology, who’s being infected, resource utilization, mask policy, the social distancing issues, so they might want to have these discussions, it’s a good opportunity to talk about what society as a whole, and how we’re dealing with this crisis, and what it means to be a member of the community and what we can all do to help Whereas the younger children, they might just sense sort of the overall anxiety and not understand why their lives have been so disrupted, why they’re not going to daycare or school, why they’re not seeing their friends, why they’re not going to the playground or seeing grandparents And for them I think it’s important to respond to what they want to ask you, what their concerns are I wouldn’t like just assume to know what their fears are or what they’re thinking I mean I would ask them what they’re thinking, “What questions do you have,”

more open-ended kind of questions, and then make sure that you’re available to them, have some time that maybe is unstructured so that if they have a question that’s difficult or awkward for them to ask that they still have that opportunity – So let them lead the conversation and then make it quality time I mean we’re getting a lot of quantity time together right now, but I’m hearing that quality piece is important as well in that conversation – Exactly, and un-rushed sort of time, and that could be something like taking a walk or just sitting and watching the sunset, something like that – That actually brings me to my next question when you mention taking a walk We know about, we should wear masks, we should keep the six foot distance when we’re out and about, but when you come in from outside, should we be putting that clothing directly in the laundry bin, or leaving it out in the sunshine, taking our shoes off before coming indoors? – Well the primary way that this virus is transmitted is via the respiratory route, so it’s the droplets and it’s the coughing and the sneezing and sometimes even speaking, people who are infected and speaking get that virus out there So the primary means of decreasing transmission is the social distancing, ’cause the droplets in general don’t last, don’t stay in the air for more than three feet, and certainly no more than six feet So that’s why that six foot rule comes into place The masks help as a secondary measure, but the distance is the primary thing that matters And all the other stuff, the contact, the touching stuff, the maybe contamination of clothes, that has very very little risk of transmission It’s not zero, so it’s still important to wash your hands, especially before touching your face, very important to wash your hands, but it doesn’t matter as much as the social distancing, as the six foot rule And then in terms of clothes and shoes and other issues, you know if somebody coughs and gets a droplet, say, on your sleeve, I mean you would have to, that would have to remain infectious, you’d have to touch that specific area while it’s infectious, and then you’d have to touch your face without washing your hands, and that whole chain of transmission would be highly unlikely So I’m not recommending changing your clothes as soon as you come in the door In terms of shoes, I wouldn’t change whatever practice you have A lot of people take off their shoes before entering their house or somebody else’s house, they can continue to do that or not, whatever your usual practice is, but I’m not recommending any changes to that right now – What about all members of the same household who have been hunkered down throughout this, you know, stay at home period, and no one’s tested positive, hugging and kissing those members, does that maybe increase some transmission there? – I think in a household you’re gonna have close contact no matter what, and if you’re a family, hugging and kissing is really important Maintaining that social contact is important Hugging has a lot of really positive effects for people, so I would continue that in the same household I wouldn’t do that in between households though, we’re trying to make sure that we have social distancing in between households – We have a question from the audience, “Can anyone get tested or do they have to have symptoms?” – Yeah, anybody can get tested but you need your doctor to order that test, and so you would have to see your doctor, and most doctors wouldn’t order the test unless there was a reason to suspect that you are infected For example, if you’re symptomatic or not – What leads to a quicker relapse of COVID-19 as opposed to other viral infections? – I don’t know that you actually have a relapse with COVID-19, most people just have a linear, sort of they get sicker and then they get better, but what can happen is they can get very sick compared to other infections that cause colds, and the reason is instead of just causing infection in the upper respiratory tract, in the nose, in the throat, in those areas, it gets down into the lungs And once it gets down into the lungs, it causes pneumonia, and that’s what causes the shortness of breath and the patients that need to be admitted to the hospital for oxygen, or maybe even into the ICU to be on a ventilator That’s what makes this more dangerous – Okay, we have a question, and it’s a term that I’m not familiar with So let me read it to you, “Are children with repaired CHDs, “or who have had surgery, “more susceptible to COVID-19?” So what is a CHD? – So I’m thinking they’re referring to a common abbreviation for Congenital Heart Disease

So that could be kids who are born like with a hole in their heart, that might need surgery to fix that, and then there’s varying severity of different types of Congenital Heart Disease So anybody with underlying heart or lung disease or kidney disease, any kind of chronic disease like that, is at increased risk for more severe infection They’re not more susceptible to infection, so they don’t, they’re not gonna be more likely to be infected, but if they get infected, they do have an increased chance of having a more severe course and having to be in the hospital or in the ICU – Thank you I know when this first started, we thought that folks with other, you know, comorbidities, diabetes, high blood pressure, hypertension, or immunosuppressed, systems might be more at risk And then we keep hearing these stories about fit 24 year olds who get it and are knocked down for two weeks and feel like they can’t get any oxygen When will we know, really, who’s the most at risk for something like this? Do you need a huge body of research to start kind of underlying what the commonalities may be? – Well we are getting that research, that’s some of the first stuff that’s really coming out that’s very useful to us, some of the clinical characteristics And what we’re learning is that anybody can have a severe disease, just like with influenza We commonly talk about the elderly being more at risk and they are more at risk, but we know that on an average year, a hundred kids in the U.S., over a hundred kids in the U.S will die from influenza So we know that anybody with any infection can have a severe course, but those that are highest risk for a severe course are those who are elderly, especially those over 60, and the older you are the higher the risk, so if you’re over 80 you’re at higher risk than somebody who’s 60 Anybody with a chronic disease such as heart disease, lung disease, diabetes Obesity is a risk factor for more severe disease, and then among children, the very young, those less than one year of age maybe have a more severe course compared to older children – So are we thinking that we’ll need to continue wearing masks and taking those precautions and the social distancing precautions, once some of these stay at home orders are loosened a bit? – Well it’s very difficult to predict the future, but I would anticipate that we’re not gonna go back to life as normal like anytime soon So I think, I’m not exactly sure what the differences are gonna be in different states for relaxing the social distancing, but I would imagine that things like large events that have like 500 or 1000 or 10,000 or 100,000 people, you know like sporting events or concerts, I imagine those are like out for the foreseeable future I would imagine that other optional gatherings such as like a crowded bar would be out for a while But maybe a bar could be open with table service, so that people aren’t crowding the bar That maybe a crowded hair salon is not gonna fly, but maybe one on one with a lot of distancing between people so that you’re like one on one with your stylist, maybe that would work with one or both of you wearing a mask So I imagine those are the kind of things that will start happening, and then we’ll learn which ones we can do without increasing risk of a second wave, and which ones that we maybe went too far with relaxing some of the social distancing – I think a lot of people like the thought of being able to see their hairstylist again, because I’ve seen some crazy haircuts during this period I’ll ask you one more crystal ball question Are you optimistic that there will be a vaccine created to tackle this? – I’m very optimistic that we will have a vaccine, and there’s been a lot of research already into this, before this even happened Because when SARS occurred, SARS-1, the first one that occurred in 2002, 2003, there was frantic work on a vaccine Remember that was even more deadly in terms of the case fatality rate, the number of people who died compared to who got the disease, about nine percent of people died who got it, whereas with this, SARS-2, with COVID-19, it’s probably closer to, probably closer to a half a percent but we’ll see, those numbers are still coming out So there was a lot of work for vaccine then, and there were some very promising vaccine candidates, and right when those were gonna go into clinical trials, the funding was pulled because public health, you know, the money just, when there’s not an epidemic, people withdraw funds, that’s one of the lessons that we’ve learned time and time again,

is we need to keep investing with our public health measures But we know from that, the vaccines that were developed that looked promising in animals, in animal models, and we knew what part of the virus should be included in the vaccine, and so those efforts are being duplicated now with this virus, with several different vaccine candidates being developed, several of them already are in clinical trials, but you have to realize that with a clinical trial with a vaccine that first you want to get the dose right and so you might have to do several different groups with dose ranging, and then you draw the blood, and the earliest you see an immune response is probably two weeks with a peak maybe four weeks later, and then you wanna see how long that response lasts, so you wanna follow those patients for six or 12 months, and you want to make sure this vaccine is safe, so you’re gonna want to then ramp up the clinical trials with more and more people in each vaccine group to make sure it’s safe, because when this vaccine is released for the general public, you’re gonna want to make sure that you have confidence that it’s safe and that it’s effective If you don’t have that confidence, you don’t want to release this vaccine, you don’t want to give it on a widespread level, because we don’t want people to lose confidence in it if it turns out there’s some side effects we didn’t know about, or if it just doesn’t work So to do all that, minimum, is gonna take 12 to 18 months, I would think And I shudder to think if this is like rushed through the process and released earlier, because if it doesn’t work, you know, then people are going to be wary about a new vaccine that maybe is better studied So I think 12 to 18 months is the earliest we’re gonna see that So we’re, we’re gonna still be doing this next winter, and you know, hopefully we’ll be able to relax some of our social distancing restrictions and interactions and people can start going back to work, hopefully that’ll happen soon I’m anticipating maybe in the next couple weeks, the information we’re getting from Public Health in California has really shown that people have done a great job with the social distancing, we have seen the curve flattened, so I’m really hopeful that we can start getting closer back to normal in the next few weeks – We’ll have fingers crossed that that is actually the case and, and I’ll end there on a positive note I will say that we are so appreciative of everything that you’re doing and the team at UC Davis Health, that we can confidently consult your expertise in these times when information is so fast and furious, so thank you so much And we’ll mention your Kids Considered podcast as well – Yeah, it’s really, I’ll have to say it’s been a lot of hard work but it’s really been a privilege to be able to use our knowledge and experience in the teams that we have, it’s really been a privilege to work in these times – Well thank you so much Dr. Blumberg, for joining us today Thank you for joining us here on Facebook Live If you think that this would be beneficial to anyone in your friend or family group, please share this recording with them, and also continue to ask questions in our comments and we will make sure that our experts get some answers to you in this time where there is so much information flying around For more information on COVID-19, you can always log on to Health.UCDavis.edu/coronavirus and until our next Facebook Live, we want to thank you for joining us and we hope that you stay healthy and safe (upbeat music)

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