Interview with Dr. Wolfe

Well, it's a virus, so it needs our cells. It needs humans to survive. Different viruses get spread [in] different ways, but this one in particular is spread through the respiratory tree primarily. So what that means is it's going to go from my airways to yours. There are different ways it can do that, but the majority, the most common way it does that is in fact on tiny little microscopic droplets that we exhale every time we take a deep breath or a decent cough. When you breathe onto a mirror or a window or something you fog it up actually with the mist that you sort of microscopically create. That's the kind of particles that COVID can travel on. So, where it travels to on our breath is where our sneezing or coughing is where you can tell passes. It can happen [in] two ways. You can either be so close to someone that you could breathe in or inhale their little microscopic droplets, that is probably the most common way is that you know people typically within 6 feet of each other which is thought to be the concerning distance and that within 6 feet if I breathe your exhalation I will inhale the virus inadvertently at the same time. The other way is probably less common but still does occur is that the virus is particularly resilient to living on surfaces. Most viruses, when you breathe them out, stick to the table or the door handle the virus will die very quickly. They are not able to live on surfaces for a long period of time. The problem with COVID is that it can actually live on surfaces for quite some time, and so let's say you come up to a desk, and someone might have been sitting there 20 minutes ago that coughed a lot on the desk. There is probably a living virus on the desk at that time, so if you were touching that deal with your hands, or there is food on the desk, and the virus gets to the food, then that becomes [an] indirect route for the virus to go from one person's respiratory system to another. It's usually through the droplets but occasionally through touch.

There are some theories on it, but nothing is proven yet. The theory is that because there are a myriad of different coronaviruses that live in animal populations, but not in humans. So we are not really used to those viruses. What happens is we get into close contact with animals that have the virus and those animals happen to throw their respiratory secretions on us--they cough on us or we eat them. We [then] inadvertently acquire an animal virus that becomes quite capable of spreading in humans. There is strong evidence that this virus emerged near the city of Wuhan in China. The theory is that the virus itself came from a bat population, which is really interesting because bats can actually carry many different viruses and live quite happily with those viruses in their body. Their immune system is really quite different than ours. It can tolerate the virus very easily, and if we were to eat or consume bats or even run into bat droppings, we would come into contact with an infected bat. Then the virus could come in contact with humans. The problem is [that] once someone came into contact with the virus, they spread it to lots of people.

Mainly cough and fever are the two biggest ones. Chills, sometimes. Often people have a really dry cough, and they don’t make a lot of phlegm. You do get headaches, and occasionally a little bit of diarrhea. When the COVID gets really severe, which is when people have to go to the hospital, is when the COVID moves into your lungs and gets in the way of your normal breathing. So they have a lot harder time getting oxygen levels in and need oxygen support. The thing that is unique about this illness is that people who get it can also lose their sense of smell, and smell is linked very closely to our tasting. So when the coronavirus took away a lot of people's sense of smell, they also lost [the ability to] taste. So some people come in [and say,] “You know, I have this cough, but now-- Oh, I can't taste my food anymore.” It’s almost always COVID.

It depends [on] how bad your symptoms are and what your health conditions are. If you’re otherwise healthy and a teenager, then usually what we would say in that situation is, “Make sure to take some tylenol if you need to, keep your fever down, make sure you keep the body fluids up, and stay out of the way of other people. You're going to get better.” I tell people if you’re older, or have a lot of medical issues, or if you're really starting to get breathless, you should probably come into the hospital. Because maybe you’re really going to need some care. Make sure you get the medicine you need at the hospital. Most people who get the virus can manage themselves quite well at home. They need to just remember that when you’re sick, you’re also infectious. So, as much as possible, you should stay out [of] the way of other people. Don’t go to work, don’t go to school, just stay home and recover.

Lots of different ways, actually. We try really hard to screen people at the front door, both patients and employees. We also ask about any signs or symptoms they may have, and if they have any, [we] would send them home and get them tested if they are a staff member. If we get a patient coming into the emergency room, and they have a fever or a cough, we will identify them at the front door and move them into a special room where the air actually gets sucked out of the room and out through some vents so that they can not infect anyone else if they cough or sneeze. We also wear protective clothing when we go into work, and protective clothing mainly stops breathing transmissions. So we wear special masks, goggles, or face shields to stop us from getting the virus. We also wear gloves and special gowns, which we take on and off every time we go into a room. That way we sort of minimize the risk of exposure. Sometimes, the really hard part of the coronavirus is that you can be sick and infectious and yet not have any symptoms, so that's really tricky. We make all of our visitors and all our staff members wear a mask every time they come into the hospital. We have been trying to do that since April, when we first realized that lots of people did not have any signs or symptoms. They did not know they were sick and they would not do the right things to get out of the way of other people. So now we all wear a mask.

Most of the meetings are, in fact, over the telephone or the computer. We don’t meet each other nearly as much because we don’t want to get each other sick. Patient meetings are often done down the telephone, too, or down on the computer screen. I also Zoom with some of my patients. Patients in the hospital, I often look at them through a glass window and talk with them on a phone. If I have to go into a room with a patient, we wear all sorts of protective gear. It’s much more spaced out, with a lot of people working from home. We try really hard to not have large meetings.

That’s a good question. I mean, surgeons obviously have to be there to perform operations. You know, one thing we did that we did for a while when we were trying to figure out how to run the hospital better, [was that] we allowed people who needed critical surgery to come in. But if something was less urgent, then we would defer it to later. So now I think most surgeries are happening, but still, we try to do as many possible virtual things either down the phone or on a Zoom call. When you would go to the primary care doctor for a check-up, now that’ll be done down Zoom or down the telephone. So we realize that we can do most things well virtually. So a lot of our social workers, for example, our pharmacists, and some of our doctors, even, can do their work from home. [In] some circumstances, you have to come in so people can do antibiotics. There are just some things you have to do in person. So in that situation, we try to keep the patient and doctors as safe as possible.

For starters, we will see everyone around the hospital wearing masks. Secondly, we want to minimize the chance that we infect people working here as much as possible. For example, people who may come in to have planned and scheduled surgeries will actually get a COVID test before they come in to get their operation, whether they have symptoms or not. So we can make sure that when they go to the operating room, they do not infect anyone. The other big change is that if you think you are symptomatic with COVID, we prefer that you do not come through the hospital and infect other people, so what we do is we get them to drive through some big tents where they will get their COVID test, and then they can drive home again. Then we can get their results while they just stayed in the car and not had the chance to infect anyone. The last big one is that we have needed to make a lot of extra beds for people who get really sick. We have a whole extra extensive care unit just now set aside for people who have coronavirus, [those] who are really sick and having a hard time breathing because we want those people to have a bit more space so that they can get extra care while not making our nurses and doctors sick.

I think if you remember the kind of ways that the coronavirus is spread, it’s spread by close proximity to other people, by coughing, sneezing, or breathing on people close to you. What can you do to stop that? Well, number one, you choose activities that are spaced out. And so it was really easy for us in the summer, and it’ll get harder coming up to the winter. You can choose to go to the park, walk on trails, or maybe be outside and kick a soccer ball around, as long as you are intentionally spread apart from each other. [When you go out to eat,] choose a restaurant where you can eat outside and the breeze is enough to blow someone's COVID away from you, even if they didn’t know about it. The other thing to do is that we wear a mask, [but] some people sometimes laugh at it because it looks strange. At the end of the day, it’s a big deal to keep the patients or people around you, the folks you hang out with, safe. The third thing we always talk about is [that] a lot of the stuff you normally want to hang out and do involves catching up with a whole lot of friends. Like hanging out in big groups, or going to the cinema, doing lots of things that involve gathering together. The problem with that is that this virus loves gatherings. And so I encourage people to think about picking activities where there are small groups of people, not large groups. That you are outdoors when you can and maybe you can do things online, or pick things where you can wear a mask.

Boy, it’s changed a lot. I guess I’m in charge of the trials where we try to figure out which medications might help the most. So a lot of the time I spend is following people’s progress in the hospital and seeing how quickly they get better, or if they get worse. And I try to learn from that to see which [medicines] might be the best to treat them with. Beyond that, I spend a lot of time trying also to help folks at the university or folks in the hospital to come up with defensive strategies to make the hospital still work and protect the staff. And so those are kind of some of the things we do. And that’s not what I usually used to do. I usually just look after patients who have many other different infections. So this year I had to put that on hold, because there's so many people getting sick with this [virus]. It takes up all of my time.

We don’t really know, to be honest. Some people clearly have an immune system that responds to the coronavirus in a way before it causes a big impact. We have not yet learned who exactly that is. We know some of the risk factors, [though, and] clearly the older you are, the less likely you are to deal well with the virus. Particularly people in their 70s or 80s have a really hard time with this problem. People who have diabetes, problems with obesity, or heart and lung conditions really struggle to bring the virus under control. It’s really hard to tell if there are patterns between symptomatic and asymptomatic people. There are a bunch of people who never get symptoms, and we haven’t figured out why that is. So the thing is, people below the age of 20, like kids, get symptoms that are really brief. They feel sick for a couple of days, then feel better. But they can still have the ability to transmit the virus to other people. We don’t fully know why that happens.

Yeah, for sure. I guess if you had it before, you may have immunity against it. If I had vaccinated you, they [would] be immune to it if they were exposed. And then sometimes it depends on how much of the virus you're exposed to. And you're more likely to get sick if I cough and cough and cough in your face repeatedly than if you pass me in the corridor and maybe inhale a few of my oxygen particles; you can get rid of the virus easily. As well as people who are healthy have a stronger and quicker defense so they don't get as sick.

There are a couple of things that are really important. First of all, the schools need to be really good at checking everyone before they come in. To see if they have a fever or any [other] symptoms. In the past, your parents would send you to school if you had a bit of a fever and you weren’t feeling good. Because chances are you actually feel okay, you just want to stay home. We need to be really careful here that we are not sending symptomatic kids to school so they get other people sick. I think the second thing is that the schools need to think very carefully about the way they space people out. Some classes that fit 25 kids to a room may not be that safe for the time being. And similarity, certain activities where there are lots of people huddled together, such as the dining hall, may need to be thought about differently. Maybe people could go through different phases to keep everyone spaced out. The third thing we need to think about is making sure all students and teachers are wearing face masks or face shields in a way that keeps them safe. Like I said at the beginning, not everyone that has COVID has symptoms. You can turn up at school and feel well, but still be infectious.

The vaccines are not yet approved. There are a myriad of different vaccines that are working their way through development. Some of those that are nearing the end of final testing should be available hopefully in a month or two. What we hope they will do is that they will find different ways of stimulating your immune system so that [it] remembers what coronavirus looks like. So the next time you see it, in real life, you will know exactly how to fight it off. If you get sick from the coronavirus today, your body has to take a few days to learn to fight back. But during that time, the virus can be spread, you can get sick and it can transfer to all of your different body parts. But if you’re vaccinated, it’s like your body is getting a really big head start. So when you see the virus then, your body is ready to respond and it does not let the virus take ahold of you; you don’t get sick. We don’t yet have proof that they will work, but we sure hope they will. Right now, some companies are in their last phases of trying to prove that this is how they work and that they give us good protection. Sometimes people can still get sick even though they have been vaccinated, but the virus will go away much quicker, and they can’t affect as many people. That happens with other viruses; for example, you can still get the flu after getting a flu shot, but your body is ready to fight back. It will be a much shorter illness.