Facebook Live 5/20- Answers

I’d like to make one correction from Monday: incidents of deaths from COVID in the U.S. is 29 out of 100,000 people. In France, Italy and the U.K., the number is about 58 out of 100,000 people. Looking at a variable that has a stable denominator, the whole number of deaths is higher because our overall population is higher, however our death rate is better than most other countries.

Question 1:

What’s being done at daycares to keep children safe?


Daycares have been open this whole time, but not all of them. If you need to know which are open, there’s a link on my website that shows which places are open all over Richmond. They’ve developed procedures to keep people safe.

Question 2: What are your thoughts on public schools reopening in the fall?


I believe we can do it, and we can do it safely. We can learn policies and procedures that have worked elsewhere. With rigorous processes, we can decrease transmission. The Constitution of Virginia says that education is to be governed by localities, so the decision making is closer to the people. The local school boards have the power. I’ve heard three possibilities for schools: we start back with virtual education and transition to in-person classes at the beginning of the school year, I’ve also heard of students going back to in-person to start the school year, and I’ve also heard that there’s the possibility of a hybrid.

Question 3:

Does Northam’s reopening plan put businesses at risk for bankruptcy if there’s no risk of hospitals being overrun?


I think our businesses are already at risk of bankruptcy, and the longer we delay reopening, the more jeopardy is placed. I think we should’ve opened last week, and entered phase 1. I don’t like that we keep flipping back and forth. Good decision making makes things easier for everyone, an unpredictable market is the worst thing for businesses. There should have been the diligence of a vetted conversation. Businesses made many recommendations, but never heard anything back. This needs to be done in a more structured way so businesses know what to do. Businesses need a reliable expectation.

As for hospitals, from the projections I’ve seen, there doesn’t seem to be a big risk for a spike in the fall. We’ve been watching other states, and there hasn’t been a spike in those other states. My prediction is that we’re going to have an indolent course of new cases, hospitalizations, and deaths until we either figure out how to completely deal with this, or we have a vaccine. However, there should not be a catastrophic spike.

Question 4:

Why herd protection and not herd immunity?


This may be related to my comments on Monday about masks. I want herd immunity, but the way we get it is for people to get the virus, recognize they have it and not spread it to others. I’d suggest those who have a low risk do not go out and get the virus so they can build immunity because the unknown risk is too great. The risk of exposing the at-risk population outweighs the uncertainty. We will eventually learn who has immunity and who doesn’t, but it won’t be herd immunity. Herd immunity is around 95%. We need to focus on opening businesses, and to do that we should wear masks, watch our hands, and clean surfaces.

Question 5:

What about mucomyst?


Mucomyst is inhaled using an inhaler or nebulizer to get it into the lungs. It helps to soften and loosen up mucus and there is a trial looking at Mucomyst to confuse the viral function. It seems to be having some good results and lessens time on a ventilator, which is great. There’s not going to be one thing to completely treat this virus because the virus has different biochemical effects. One is respiratory, and there’s one way to treat those symptoms. The second issue is the inflammatory response when someone’s lungs get bad, which moves away from the infectious triggers. We’re going to have to keep looking, our results now are early and promising, but not definitive.

Question 6:

What’s my best guess for when we’ll enter phase 2?


I think we have to enter Phase 1 first. Phase 2 hinges on making sure there are no other spikes or increases in the percent positive or deaths as a result of Phase 1. The Governor predicts maybe 2-4 weeks in Phase 1, but that’s a hypothetical right now. I’m focused on opening right now.

Question 7:

Where do people go to get a free test if they don’t have symptoms?


I wouldn’t suggest you get a test if you don’t have symptoms. I’m not sure you can get one for free if you don’t have symptoms. The value of testing is from looking at the most likely population to be positive. The algorithm to follow here is to test people who have symptoms, and to test people who’ve been exposed. As more people get out of their homes, we’re going to need higher testing capacity.

For antibody tests, ReadyMed is doing antibody tests. Another out of Chesterfield is doing tests, they’ve gotten emergency approval from the FDA, and I’ll ask my team where you can get those.

Question 8:

Do ENT’s approve neti pots?


I prefer normal low-pressure saline flushes for my patients. You can get them at the store and it’s easy to flush through your sinuses, and it shrinks them naturally and draws out mucus. ENT’s do recommend them.

Question 9:

Is there more we can do at the state level to increase our testing capacity?


I believe we’re always working to secure more tests, we do have the capacity to test those we need to. We believe we’re going to need to test around 10,000 a day when people go back to work. It’ll be an ongoing battle, but we do have tests.

Question 10:

Did Virginia announce its first child with Kawasaki?


I’m not sure, but I’ll get back to you.

Question 11:

What do you think about being 65 and older attending large political conventions planned for mid-summer?


That’s a decision you’ll have to make for yourself. If you take appropriate precautions, there may be some risk. You’ll have to see for yourself what you should do.

Question 12:

What is your opinion on Listerine each night?


I don’t know, I don’t have any opinion on that.

Question 13:

Do you agree with Mayor Stoney not opening Richmond?


Absolutely not. I think it’s even more egregious that they changed their mind at the last minute. It is inappropriate, and not supportive of the data, and I think it’s wrong. Decisions should be made based on data. We now have to undo the extraordinary measures we took and open the economy.