Dr. Paul S. Auerbach, emergency medicine physician and professor emeritus at the Stanford University School of Medicine, answered questions posed by Rotarians at the Rotary Club of Los Altos’ virtual Zoom meeting last month.
Following is a selection of members’ questions and Auerbach’s responses.
Q: Why do young, healthy-looking patients die from the COVID virus?
A: This virus has a predilection for tissue in the deep reaches of the lungs where essential oxygen-carbon dioxide exchange takes place. This particular coronavirus sometimes destroys certain lung tissues, allowing fluid to leak into the lungs, which causes pulmonary edema. We are learning that the coronavirus also might affect the kidneys and heart.
While a more serious clinical course is seen in elders and persons with chronic, significant pre-existing medical conditions, such as COPD and other forms of lung disease, young, healthy people can become infected and suffer.
Persons of all ages should protect their lungs from the effects of smoking, vaping and bad-air days, such as are associated with wildland fires.
Q: When will the COVID crisis abate?
A: We still don’t know when, but we are beginning to get a better handle on the curves that define the spread and rise and fall of COVID-19 in populations, and are using predictive modeling based on the current and prior pandemics. These models take into account factors such as population density, socioeconomic situation, travel restrictions, adherence to public health safety recommendations, and so forth.
Q: Are we flattening the curve locally?
A: To flatten the curve of infections and resource utilization, there should be fewer people getting sick, a decreasing rate of infection and sufficient intensive care beds, staff and supplies to care for the patients. Disaster planning accounts for a possible surge in patients. Therefore, we need to support the people who are working around the clock to acquire and manage resources. We must work together.
Q: Will herd immunity benefit the Swedish population?
A: Too soon to know. When enough people survive infection and develop an immune response, hopefully augmented by vaccine therapy, and there is effective testing for protective antibodies they might have developed, we may learn if immunity is widespread enough to be considered herd immunity. This is hoped for but not yet proven; population studies must be followed over time. We remain vigilant and optimistic.
Q: Is testing to protect the uninfected improving?
A: Yes, the number, accuracy and turnaround time of tests are improving every day. We have gone from waiting days to waiting hours to receive the results of tests, depending on the tests and availability.
Q: Is clinical information being shared?
A: Yes. In contrast to protecting information as intellectual property, people are generally sharing to help get through this crisis. The global medical profession is being very generous with time and expertise as it shares data and observations to help patients and the people caring for them.
Q: How is caregiver protection handled?
A: We need primarily to avoid unnecessary contact with the virus, similar to what occurred during the Ebola crisis. How we enter and exit patients’ rooms is important. Health-care providers are concerned about bringing home the virus, so take great precautions to use protective techniques in and out of the workplace.
Q: How is this crisis changing us?
A: Going forward, I hope we will continue to be mindful of hygiene, helping others, generosity and recognizing what is truly important in our lives. We need to take care of each other and our planet.
Marlene Cowan is a member of the Rotary Club of Los Altos. For more information, visit losaltosrotary.org.