We have one of the world's leading COVID-19 experts joining the show. We are pleased to welcome Dr. Lisa Maragakis, Senior Director of Infection Prevention at Johns Hopkins University, to Business as Usual. Dr. Maragakis will update us on the latest COVID-19 data, how it continues to spread and what we might be able to expect around possible resurgences. In this interactive session, ask her your questions and concerns as we navigate the pandemic.
Transcription
So good afternoon and welcome to business as usual. This is Audrey Russo, President and CEO of the Pittsburgh Technology Council. I'm very thrilled by today's guests, very honored to have our guests who I'm going to introduce in one moment. She is senior director, infection prevention at Johns Hopkins University. So the topic is near and dear to all of us. And I'm also joined by Jonathan Kersting, who is vice president of visibility and all things media on our team. So I do want to give a shout out to Huntington bank, Huntington bank has been sponsor, since we started this series of Gosh, what 1516 weeks ago, hard to believe that we're doing this every single day but every day, we continue To get amazing guests and continue to have really important conversations that are affecting each and every one of us. So on that note, I just want to remind everyone that we've muted your microphones to make sure that any noise in the background is eliminated. And we also have a chat. So the chat will allow opportunities for you to ask questions of our guests. And, you know, we will see what we can do in terms of navigating all the questions that will come up. So I am very, very thrilled to introduce what's happening to our screen right now. Does everyone see the screen? Okay, good. I'm happy to introduce Dr. Lisa Merrick dacus. And she is as I mentioned before, she is at Johns Hopkins and B before we start and sort of dive into some of the questions here. I'd like to what First of all, welcome. Welcome, Dr. Merrick aquas to the show, and thank you for taking the time with us, but just tell us a little bit about About your professional background so people can understand exactly why we're so thrilled to have you here and the the capabilities and perspective that you're going to bring to all of this. So welcome.
Thank you so much, Audrey. I really appreciate the invitation. I'm so happy to be here. And I'm really looking forward to the conversation and to addressing everyone's questions about COVID-19. So I am a faculty member here at Johns Hopkins University. I'm an infectious disease physician, adult infectious disease and internal medicine. I came to Johns Hopkins over 20 years ago to go to medical school and have stayed in Baltimore and at Hopkins since that time. My area of specialty is infection prevention and specifically the prevention of healthcare associated infections. And I do this for our hospitals. For our entire health system. So before the pandemic came along, I was responsible for policies and procedures and interventions to really protect all of our patients from healthcare associated infections. And of course, outbreak investigation, epidemiology and infection prevention are very critical now that the pandemic is here. So, yeah, I think thanks again for inviting me.
No, absolutely. Thank you. Thank you for setting that up. So let me just start with from the outset of the current pandemic Johns Hopkins was actually thrust into the international Limelight for millions of people for looking for data, you know, really hard to try to find the data, what's the good source of data, real time data, etc, on COVID-19. So what I'd love for you to do is talk about the capabilities of Johns Hopkins and that has uniquely positioned the institution to really provide leadership during this type of global pandemic. And not just for the United States and for all the different states and regions, but also for the globe.
Right. It's such a good question. And, you know, I do think Johns Hopkins is an amazing place. It's part of the reason that I feel privileged to to work here and then I've stayed here. As a faculty member. We have amazing people who have research interests and clinical specialties in so many different areas. Our infectious disease department, specifically, of course, is front and center in the pandemic response. And we have an extremely strong and diverse faculty in infectious diseases. More specifically, to your question with regards to leadership, you know, I think we have been able as an institution to play a role particularly in providing data when it is so desperately needed and is really the currency by which We can measure our progress, both the the spread the transmission of the virus, its effect on populations, really being able to drill down worldwide to see the differential effects on different populations, as well as other important metrics, including the extent of testing the mortality rate and other metrics. So those that's just a flavor of some of the capabilities here. And I do think that Dr. Lauren Gardner and her team who put together the Johns Hopkins dashboard, the data dashboard that has been so prominent during this crisis is just really a jewel that we have been able to provide and we all rely on it. I think people really around the globe are relying on it for accurate, timely data. And then I guess another thing I would mention is just our experiences Handling infectious diseases and high consequence pathogens. So, here at Johns Hopkins, we do have a bio containment unit that was founded during the West African Ebola crisis in 2014. And at that time, we really made a strategic decision to designate part of our Johns Hopkins Hospital for the care of patients with highly infectious diseases, and to train a team to be prepared for expert use of personal protective equipment and policies and procedures in that space to keep everyone safe. And so as you can imagine, you know, Ebola certainly brings out fear and everyone and and so all of that preparation really served us well as we confronted the pandemic.
Gonna be interesting to know how many how many visitors are actually on that site every day, I can imagine from a technology standpoint, it's always up. It's always working. And there have to be millions and millions of visitors that are using that site. That's very dynamic that you're able to slice and dice and sort. So you are the go to place for that. So let's let's talk about us. As you know, in early March, you actually briefed members of Congress on the adequacy of testing and argued that efforts, at least back then, were not sufficient. So talk about the availability and reliability of tests that have evolved over this time we say time, it seems like a long time, but it hasn't been. And do you see improvements in antibody testing, for example? And that, are we ready for potential second wave? And what a second wave mean? So I've jumped out a few things and in that question, so if you want me to repeat that, or if you can just take a stab at it, that would be terrific.
Sure. Well done. There's a lot to unpack there. Specifically, with regards to the testing, I think everyone is aware that we really were very slow off the mark in the United States to have the availability of reliable testing. And, and just to be clear, when we're talking about that type of test, it's a PCR polymerase chain reaction, it's a direct detection of the virus in the back of the nose or throat. And, and this is the kind of testing that really has been so important around the world to it's one of the bread and butter tools that we have to identify patients who are infected with the virus and be able to take steps to isolate them and prevent further onward transmission. Unfortunately, we did not have adequate testing at the beginning. Both the the types of tests that were available had problems. Initially, all of the tests went to the CDC and how to Very long turnaround time, which defeats the purpose of quick identification and isolation. We were very fortunate here at Johns Hopkins, that our pathology colleagues developed an in house test and many academic medical centers, I think, had had the advantage of being able to do that. And so those were some of the first and only tests that were available for a while even before states got reliable ability to to test and then even even once the tests, you know, started to become available. We have suffered intense supply chain, disruptions for the reagents for the test and even simple things like the swabs to collect the samples. So it's really been a challenge for a long time. Very frustrating. Our own lab validated eight different platforms in order to make a patch work together to provide the capacity that was needed for our own patients here at John's house. Throughout our health system, and then to be able to augment for the entire Baltimore region, and provide testing to other healthcare facilities and the community at large, so I think it's still an even uneven across the country. And and if there's still a great need, particularly to improve access of foreign rural populations, and people who really need access to testing, you mentioned the serology test. So one good thing about the PCR test is at least it's very sensitive. Once you can get your hands on it, it's very sensitive and, and essentially, all the different types are fairly equivalent. Now, we've had progress so that some of them have a turnaround time that's much faster so you can get an answer and minutes rather than than days. Usually, though, it'll take hours before A typical lab will be able to give you an answer. And then the serology tests on the other hand, so that's the test. That's a blood test looking for antibodies. And there's a few things to say about that. Number one, there's a lot of different kinds. And they are in contrast to the PCR they're very variable. So it really matters which kind of serology test a lab is using. Some are more reliable than others. Some are looking for different types of antibodies. There is a concern and this is part of the variability is that there's a concern about cross reaction. So if you detect an antibody, is that specific for this novel, Corona virus or could it be a reaction that shows that the person had a different Corona virus with the common cold or something else? So we still have a ways to go with the serology. Honestly the serology is not that useful clinically because It takes a couple of weeks before a person's immune system kicks in to have enough detectable antibodies. So really in the throes of illness, you want that PCR test, the antibody test can be helpful if somebody really has symptoms that seem like COVID-19. But the PCR test for whatever reason is is negative, then we can check and see if they have evidence of antibodies. But other than that, it's primarily a research tool right now.
So what about the supply chain? Let's just stick on that a little bit. If you said Is it still on even? Is it Are there still issues in terms of the supply chain? I mean, you're talking about swabs. That was one example but I'm sure there's there's many others. How is that? No.
It is a problem still, it depends on what you're talking about. So for the reagents and and the swabs, there are still limited quantities. It seems to have eased somewhat But of course, the supply chain disruptions are really across the board. And it's one of the most surprising things to me about being in this position, and trying to respond to such an enormous infectious disease threat, and finding supply chain limitations for our personal protective equipment for our even simple things like hand sanitizer and disinfectant, and so we have really struggled, we are still and when I say we, I mean healthcare collectively. So at Johns Hopkins, we have been creative, very innovative. We've made a lot of homemade solutions. We have partnered with manufacturing and community partners and volunteers and a lot of cases to come up with innovative solutions, but but it's been a challenge that's ongoing.
Yeah. Okay. Well, that's that's good. So before we get to questions, I wanna, I want to ask you something about, you know, time has progressed, even though it's only been 16 weeks or whatever for all of us, it seems almost like a lifetime. We've learned more, you've learned more about COVID COVID-19 What is surprised you about the changes in the pandemic?
So, in addition to the supply chain, which was one of the biggest surprises, I think the other thing that is surprising and unfortunate, is just the complexity of, of this illness. And so as if it's not bad enough to have a respiratory virus, sweeping through and causing, in some cases very severe and, and unfortunately, in many cases fatal pulmonary disease. So respiratory failure, needing ventilation There are so many other health effects of this virus that we continue to discover. And it really raises even more questions and it's not as straightforward as, as one would hope of supporting someone through that. pneumonia and, and respiratory illness. So I'm sure many people have heard about the other health effects and we're discovering new ones that seems each day but there are neurologic effects, clotting disorders, effects on the, on the kidneys on the heart, much wider age range affected. So we're learning more about the effects and children and the inflammatory syndrome that can sometimes be quite severe and even fatal for children. So I think and now the most recent questions that we are really examining, have to do with the duration of viral strain shedding. So people who symptoms improve, but they continue to test positive for a number of weeks and really trying to answer the question of what does that mean? Some of them tend to relapse and have new symptoms. And so we wonder how infectious those patients are to other people. And really what what that means. So there's many, many research studies ongoing and many questions that are unfolding, but it's a complex virus and people's
response to it is quite complex.
Well, yeah, and there's no way that I'm going to do any favors in terms of the complexity of all of this, but I think one of the things that we're hearing again, hearing news media, you know, everything's changed. Anecdotally, you know, doctors are saying, and again, you can correct me on this, that the virus appears to be weakening right, to some extent. And perhaps becoming less lethal, etc. Is there evidence to even back that up? Is there evidence for that conversation? Or is it more about what you just said before that it's becoming more complex and we actually know less?
So, you know, I think that there have been a lot of questions about the fact that, well, let's take the United States data right now our cases are surging, we are seeing about a 40% increase over the last several weeks in our daily case counts are our average daily case counts, and yet the death rate is falling. So this may be fueling some of those discussions about whether the virus is changing and and those changes are responsible for the lower mortality rate. I would argue that that that is less likely to be the case. There are no analyses that are ongoing looking very carefully for mutations in the virus and to date, we haven't seen a large change in the virus itself. You can use genetic analysis to to track the virus and and some of that has been reported so that you can kind of see geographic areas that have led to introduction of cases into different areas. But those are very small changes, and not really something that we would say is affecting the clinical outcomes. What I think is more likely is that as the virus sweeps through populations, the most vulnerable do die unfortunately, and now we are seeing kind of second and third waves of I use that term separately from like the epidemiologic waves, but of groups of people that are younger, maybe have fewer comorbidities and are surviving Disease thankfully, at higher rates, so the mortality rates never,
ever, I don't think it's the right.
Right. And so yeah, I mean, I apologize if I was trying to be simplistic on it. I know that you're doing incredible amount of research, but people like to boil things down into, into, you know, an answer. And I get that. We do have a lot of questions. I just want to ask one more thing, love before we jump into a few questions, and then get back. So in a recent abc news piece, you actually talked about mass squaring is really being part of our social contract with each other. And I and I love that. I love that you're talking about this social contract in terms of mutual respect. And, you know, some people are skeptical, they're still skeptical about mascara and we see that and you know, many places, it's not just Pittsburgh, it's all around the United States. So with companies heading back to work, you know, in terms of You know, whatever that means back to work. You know, that's that's that's another lengthy conversation. But as people start opening and we move into in our region, what we're calling green, talk about the effectiveness and the combination of mask wearing hand washing and social distancing, in terms of prevention.
Sure, so, those things, those three elements are the fundamental basic infection prevention tools that we have to fight this virus and the way that the way that I look at it, that is really all that we have and and yet, they are very powerful, but they need to be used in combination, so that we are really attacking the transmission chain of the virus person to person so we go back to the science and know that this is a respiratory virus that is spread through respiratory droplets. That can be through coughing and sneezing, which is what we've always emphasized for respiratory virus transmission. But what we now know from the science too is that those smaller droplets that we all know, are associated sometimes with loud talking or screaming or singing, can also transmit the virus. And so that's the purpose of the mask. I recognized, I think we all recognize that it has been politicized and that it is also a major behavior change. It is something that in a very short time we have asked people to do that is unfamiliar, it's not part of our culture. Quite frankly, it can be uncomfortable and hot and it interferes with facial expression and communication. So there's a lot of things not to like about it. But really the masks are a physical barrier that contains respiratory droplets and And that's why I talked about the social contract. Because I do feel that when we see a lot of reports of people refusing to wear a mask or being Cavalier in their choice to not wear a mask, they may think that, that they don't care about themselves. But it's really that when you wear a mask, you're protecting the people around you. And that's why it's a social contract that if we all would do this, we would protect each other.
Right, right. That's very eloquent. So we have like, a whole bunch of questions here. So john, and I want to be able to get to that. And you know, we'll run a little bit longer because some of the questions are just graphic. And if that's okay, so I really would love to Jonathan, can you see from the top, I can see him all
pretty much. Yeah, let's
do some rapid fire and some fire.
Right. So first and foremost. Any thoughts on how South Korea's testing was so much more effective in our testing?
Yeah, so There are,
there are countries, South Korea and Germany I think are two of the best examples that really did a fantastic job of implementing widespread testing. They did it early. They did it at scale, and really used the answers of the test to take action to isolate and quarantine people who were affected to follow that up by notifying and tracing the the contacts and so that's that search and destroy strategy. But it needs to be done at scale. It needs to be done rapidly and really widespread availability and we've struggled to do that.
Absolutely. Seriously. Here's a two for one question. You can probably knock this out with with them with one answer. The idea of going back to school whether it's young kids are going back to college campuses and wearing masks and just getting back there in general. What are your thoughts on that?
Oh, that's a huge topic. And there's no, there's no easy answer. We've certainly been talking with a lot of schools and with our own university about this as well, I guess one thing that I would say is that, you know, I do think that it is possible to resume some normal activities, using the interventions that we just discussed. Environmental cleaning, hand hygiene, social distancing, and wearing masks. It takes a huge behavior change as we've discussed with the wet the mask wearing, so does social distancing, we just are drawn to each other and it's really hard to change those behaviors and, and stay away from each other separate chairs and, and redesign our, the way we interact in our space and sometimes the spaces themselves, to make it easy to do the right thing. So it's gonna be a huge challenge, actually, for schools for a variety of reasons. You know, it's hard For us to change our behavior, you know, children, I think varying ages will have different abilities to understand why that's necessary or to comply. There's a, you know, it's harder I think with children because we're not seeing well now we are seeing the the inflammatory syndrome, but we're not seeing as widespread symptomatic disease. But of course those children can take the virus home to their families and to people who are more vulnerable. So I'm very cautious and worried actually about schools reopening. And even college campuses because of the dorm living situation I think, have a lot of challenges.
To questions Jonathan, can you can you ask? Rich lunatics question, Milos,
you were reading my mind. Let's start with rich real quick. He said recently, Johns Hopkins published data comparing the number of new cases between the EU and the United States. The data show that you're that the European Union had a signal Again dropping new cases since Mark since March is maintained that lower level, however the US has not really seen that distinct drop. What are your thoughts on that? And what what could be causing this difference that they're getting lower and we're
getting higher?
Yes, I've seen those those graphs are striking is strikingly different. Because we have plateaued and now are rising, they, as you say, are decreasing. So it's a number of things. I think it's multifactorial, it gets back to the concept we've talked about, about testing that that strategy of testing and contact tracing. I think it has a lot to do with leadership, quite frankly, and nations in the European Union that were able to really comply and have strong leadership and direction. Our country has really struggled and had very uneven response. I think and and been very dependent on local leadership and policies. And we have seen a lot of different approaches in different states and even even in different communities and counties within states. So we are seeing the effects of that. I think there was a lot of skepticism, a lot of very rapid reopening. And one thing that I think we have not done well is related to what we just talked about around schools and that is reopening in a new way. Some some organizations have done a great job of this, some communities have as well. But we've seen quite a few communities, including entire states that have really rushed to reopen and treated it more like a switch so that you're either at home or now you're back rather than really emphasizing the public health messages. Okay, we can reopen we must reopen for economic reasons, but here's how we can do that safely? Well, you know,
we're talking we're hearing again, we're hearing this is not not scientific. So I asked for your guidance on this. We're hearing about an expected second wave and rising infection rates across the US and is it really a second wave? Or is it just a slope that we just decided to intersect at a particular time? So talk about what the data is suggesting and telling us right now, in terms of COVID-19.
Right, so unfortunately, as as those graphs show us, the discussion about the second wave, I think, was started quite early when we were first fighting the pandemic and recognizing that history tells us that prior pandemics have had second waves and so you you always have to remain vigilant about that. And that when a pandemic starts, as this one did early in the year that We know that when the fall comes around and all the rest of the respiratory viruses start circulating, that we would be at risk for having another a second wave that might even be bigger than the first. Unfortunately, for the reasons we've discussed today, our country is still in the first wave. I don't think we have gotten that under control yet. We're seeing sort of the the first wave moving across the country and moving into areas that were not as strongly affected at the beginning and now are really getting the brunt of it. We have seen isolated areas of success like New York, even here in Maryland, our graph really looks beautiful, but so in those areas, I think that we can talk about the second wave situation, but as a country, we're still firmly in the first
and in our region in particular, and I know this has happened in New York and other places, even in Washington State. The density the communal living in long term care in Allegheny County, where we're from right at the beginning, it was about 75%. And even in one county next door to us was 78%. were people who were in long term living communal environment. So nursing homes and long term care. Are we seeing any change now, in terms of any of those trends?
So unfortunately, what I think we saw was that the virus hit early and hit hard in those settings, long term care facilities were just inundated with a number of cases and unfortunately, so many people who died many of the nursing home long term care facility investigations have shown us a large number of of mildly symptomatic or even asymptomatic carriers amongst the residents in those facilities as well as the staff so it just swept through us Other vulnerable populations include prisons where there have been a lot of infections, and then persons experiencing homelessness and communities in which the housing conditions tend to be more crowded. And it's difficult for people who get the infection to really quarantined away from others. And so it tends to really sweep through those types of settings.
So, you know, we're at our 31 minute mark here, and we, you know, listen, we could stay as long as we have your attention, which is pretty amazing. What is your Is there anything to be optimistic about?
Absolutely. I'm always an optimist. And I think if we look to countries like South Korea, like Germany, if we look to states, like New York, and Maryland and others that have had some success Then we see that we can do this. It really takes patience, perseverance and, and attention to detail it's going to take doing things differently than we have in the past. But I really just think that so I'm very optimistic, from that standpoint that this is doable. It's going to take leadership and it's going to take us really getting people's attention on messages that are very clear and trying to help them do the right thing. New Zealand is another country I would point to that has done an amazing job. So this can be done, we can do it. We're just not doing a great job right now, as a country. Unfortunately,
we're not so we've got to do better. And we've got to take your advice. And we've got to also you have a whole bunch of data that is accessible and we'll put the link out on our site. So that people don't know about the Johns Hopkins data set and all the analysis they're doing in the dynamic information that they share. We'll put that out there. And we stay on top of that. Is there any other information that you think that you really want to leave us with? And you don't need to? You don't need to be so soft with us, because we need to hear some hard facts,
the hard truth, do it?
Well, I'm sure I'm sure that each of you, you know, I think I've said this before, I'm sure each of you or is involved in some way and decisions about reopening. And, you know, I do think that this is a time I am generally as I said, optimistic, and I think it's a time to really rethink how we do a lot of things. You know, my research my career as an infection prevention, I think if we learn the lessons that are apparent during this pandemic and take the right steps that we will will prevent other types of infections, you know, there is an argument to be made that if if we do the right thing for the pandemic for COVID-19, we may actually be able to have a very small flu season this year as well. And so what I would love to see is is as you know, really take some of the innovative things that have come like in healthcare, it's telemedicine, we're trying to figure out how we can utilize that for infection prevention, but also for efficiency and convenience and patient experience. So I think there's some good things that can come out of this, and maybe, you know, telework is gonna be one of those things, reducing the need for office footprints that are as big as we have them. So I think businesses really should take a look at what opportunities are here and how we can all be safer, but also may be more efficient and more innovative in the future.
This is Dr. Mark dacus. You have been more than generous with your time with us. You've given us some great information we are we're going to keep track of you, if that's okay, because we're in the tech community, we have we deeply care about all the things that you're talking about, and the partnership with Hopkins and and Highmark and h. n is very exciting for us here in the community. We have deep relationships with the leadership there. And Hopkins having having a little shingle here in Pittsburgh and partnering with the Cancer Institute and moving forward is a big is a big deal for us in Pittsburgh and we wouldn't have had you on the show if it weren't for our friends over there at at Highmark and Allegheny Health Network. So we thank them, and we give them virtual hugs. But we will take your advice. There were some questions here. We'll see if maybe we can shoot them over to you and get some answers to them. That would be great. And we'd love to have you back on. I can't believe that it's been 1516 weeks. And we're hoping that there isn't that second wave and that that upward, that upward incline that you talked about before. But I hope that you will stay connected to us in terms of the work that you're doing. We're a big champion of you, and being bold and being out there and reminding us that it is going to take a paradigm shift that we perhaps have not even embraced today. 1516 weeks later. So I can't thank you enough. We're going to keep track of you. I know that you're making your rounds and appreciate making time for Pittsburgh. We're mighty and proud here. And we do like to kick butt and we're going to continue to do that. So I thank you all. Thank you to our friends at HSN Highmark for making this possible Thank you, Dr. Merrick dacus for joining us today.
Thank you very much. I'd love to see all of you in person sometime so stay safe and thanks for the invitation.
Absolutely. Thanks everyone and come back tomorrow, same time.
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