Good morning everyone and welcome to today’s live blog with pulmonologist Dr. Qanta Ahmed.

The first question is from Nelson S:

Doctors and government officials have said that we may have to take temperatures of people before letting them in places as a way to get America back to work. How effective would that be given the fact that some people are asymptomatic but can still spread the virus?

Dr. Ahmed:

Fever is the earliest and most common sign of active coronavirus infection occurring in 88.7% of patients needing hospitalization. Certainly anyone with a fever should be separated and evaluated for causes of fever and it is a sensible way to exclude possible actively infected individuals from a shared workplace. It doesn’t account for all means of eliminating spread of the virus ( including from asymptomatic people who will not always have fever) but actively infected and toxic patients will have the higher viral load, higher viral shedding and carry greater contagion- also they would benefit from early evaluation and treatment for better outcomes. Also some asymptomatic patients can have fever and be unaware.

Steve C.:

If hydroxychloroquine has such dangerous side-effects surely there are statistics on how many people suffer from them. Could you tell me how many people actually die as a result of using hydroxychloroquine and how many suffer these other dangerous side effects?

Dr. Ahmed:

Hydroxycholoroquine – the trade name is Plaquenil- is a tried and tested drug with a known side effect and drug- drug interaction profile because they have been used for decades for malaria and lately for certain kinds of arthritides (various forms of arthritis). We began using this in Covid 19 infection because of its prior use in managing patients in the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak of 2003 (also caused by a different coronavirus). We believe the drug has anti inflammatory and immune modulation capabilities. The side effects of Plaquenil can be readily found and most are not serious and would not cause death. However the serious side effects we closely monitor for and where I use them in the intensive care unit we monitor specific and detailed EKG complications – changes to the heart rhythm- daily to the level of changes in the heart rhythm pattern measured in milliseconds. The most lethal side effect is prolongation of the Q-T interval but that is readily measured and detected. And the drug is stopped if we see that developing.

It is not possible to list all the side effects of hydroxychloroquine here but it is easy to search for. It is not possible to list the number of causes of death attributed to the drug and even less possible in the setting of the coronavirus pandemic- patients who may die during this pandemic on these drugs are not likely to die because of the drugs but because of their disease. In the general population that is also likely to be the case unless there is deliberate and intentional overdose with the Plaquenil. Also in contrast scientific studies have found beneficial properties on survival seen with the use of Plaquenil in other inflammatory diseases.

Jodi L.:

I am immunocompromised and like others who are, am unable to receive live vaccinations. Is the initial research for a COVID-19 vaccination pointing toward it being a ‘live’ vaccination?

Dr. Ahmed:

The search for a vaccine is underway at record speed and scale with over 115 vaccine candidates at the moment. We have known the genetic sequence of SARS-CoV-2, the coronavirus that causes COVID-19 since 11 January 2020. The first COVID-19 “ vaccine candidate” started human clinical testing on 16 March 2020.

Both live and attenuated vaccines are undergoing development and the expectation is that more than one vaccine will ultimately be developed because the populations at risk are so different- the elderly, people with underlying conditions and people with reduced immunity. Stay tuned. I also think there will be other strategies that do not involve vaccination possible and we should look towards the use of convalescent plasma as a possible option for other people but not on a mass scale. Finally I believe the ultimate goal will be for vaccination of the entire global population which we have achieved for both small pox in entirety and also nearly entirely for polio. That would mean at risk immune compromised people would also ultimately be protected by herd immunity.

Lana M.B.:

So, let’s say in a perfect world every American could be tested, including all asymptomatic people. Just because I can test negative today, doesn’t mean I won’t test positive tomorrow does it? Perhaps I was exposed 3 days ago and won’t test positive until tomorrow, at which time I may or may not have symptoms?

Dr. Ahmed:

That’s correct Lana. But key is that most people who contract COVID-19 will be asymptomatically infected and remain well, or experience minor symptoms and resolve at home. The best thing to do is if you think you are exposed, separate from close contacts and self isolate, Do the same if you think you have symptoms. If you are in any doubt seek medical attention first via virtual online platforms and via your own doctor and if needed through emergency services. The true rate of infection will not be known until we are able to extensive population testing looking for convalescent antibodies known as IgM antibodies which tell us that the infection was there once upon a time and our body has cleverly mounted a successful immune response within us to mop it up and eliminate the virus.

Gary B:

With such a shortage of the N-95 masks, how come health care workers are wearing them instead of respirators with particulate filter, which are much more safer and filter more?

Dr. Ahmed:

Thanks Gary. The N95 mask IS a particulate filter and has a very high grade ability to filter out 95% of particles that are 0.3 microns in size or larger.

It is also carefully fit tested to each individual worker and tested for its seal and capability at eliminating the flow of airborne and aerosol particles from entering the workers’ airways.

The coronavirus is very small measuring 70 to 90 nanometers. In microns they are 0.06 microns, and the largest are 0.14 microns. So much smaller than the ability of ANY mask – whether it eliminates 95 or 99% of particles to be able to prevent.

However, the virus does not float ‘naked’ but instead is transported in suspension with an aerosolized droplet which is big enough to be caught in either mask type. Additionally working in the intensive care unit where we have the most severely infected with high viral load viral shedding and high risk procedures which can aerosolize the virus we also wear protective facesheilds and major PPE that are impenetrable. The N95 alone would not be sufficient other PPE are needed. Remember that your eyes are another pathway, so glasses or goggles may be prudent and we tend to wear them in the intensive care unit as well.

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