Local AdventHealth doctors give an "insider's" look at COVID-19, respond to rise in cases, share lessons and advice

By Denise Badger-Connell, Publisher

AdventHealth's Morning Briefing to local media this week focused on the current state of COVID-19 in Central Florida and what our community can do to help minimize the spread of the virus.

Dr. Vincent Hsu, an epidemiologist and AdventHealth’s infection control officer, and Dr. Eduardo Oliveira, executive medical director of critical care, spoke about the increase in COVID-19 cases in Florida, the impact on our community and the latest in science.

AdventHealth Morning Briefing June 25, 2020: Dr. Vincent Hsu is in the center, and Dr. Eduardo Oliveira is on the right

Fielding questions from reporters, the physicians presented information on COVID-19 not often discussed.

Here are the questions and highlights from their interview:

Asked to comment about the rising number of positive COVID-19 (COVID) cases, the doctors shared the following:

“As the number of cases increase in the community, we are seeing that also in our hospitals,” said Hsu. “We are unfortunately at an all-time high with respect to hospitalizations, but we are well-prepared to handle this. We are not in crisis mode. We want to do what we can in the community to keep these cases as low as possible.”

Dr. Oliveira continued, “We have more availability of treatments now, and we’ve learned more advanced ways of treating those patients. The younger population tends to be more resilient. They have less co-morbidities, other illnesses or diseases that tend to make the virus more lethal.”

They assured the community that AdventHealth has enough personal protection equipment (PPE) and staff, and they have learned how to better handle COVID, in hindsight from working with it; they are more prepared and can better assess which patients need to be tended to first. Right now, they said, they have enough beds and staff coverage… though they cautioned if they get an increased demand, it could become an issue.

The patients they’re seeing now with COVID are not nearly as sick as those who got it at the beginning of the crises, largely due to younger ages contracting it. While they are seeing patients from all ages, including those in their twenties, the average age they’re most frequently seeing now in AdventHealth facilities are ages 40-50. According to the doctors, younger aged patients are more resilient and don’t have as many preexisting conditions that exacerbate COVID symptoms to a lethal level as occurs with the elderly, which means the younger patients also don’t utilize ICU and ventilator services as much as older patients do.

While positive COVID cases have increased, the doctors noted that the death rate is lower right now, again, because they’re seeing younger population getting it, but also because they are learning more effective ways to treat the patients coming in. For example, when a COVID patient is on a ventilator they’ve learned how to better position them and treat for protection against getting blood clots and other serious complications that in the past increased the risk of death. While patients today have the same symptoms as they saw back in March, what is different is how the hospital is responding. Having learned from working with COVID patients over and over, they are now more proactive on these measures than before.

The doctors pointed out that while COVID is most threatening to the elderly, with a higher rate of mortality, they stressed that it does affect every age group. Even with younger patients in their twenties they have seen these patients wrestle with very severe illness, including having to be in the ICU, go on ventilators, and having to receive several aggressive treatments in order to get through it… and this is not an “infrequent” occurrence.

When asked about the commonalities they have seen in recovering patients, the doctors had one main point:

It can take months to recover. And while it is too early to determine what the long term effects of getting COVID will be, they know patients who experience muscle weakness and persisting symptoms even after they are through the worst of it.

The doctors shared three main lessons when asked what they have learned from working with COVID patients.

First, because of the sheer number of COVID patients they’ve been dealing with and the rapid learning curve they’ve been on, they reported that even just "a month ago feels like a year".

Lesson 1: Social distancing makes a difference on a large scale. They recognize that no one wants to go back to sheltering at home, but they emphasized there are “smart ways” to deal with COVID, which means heeding the advice to wear face coverings and social distancing.

Lesson 2: Hospitals have learned to get creative with how to treat COVID patients and innovating with technology. For example, they discovered how to reposition patients for better breathing, learned how to conserve PPE, and experimented with moving equipment outside a patient’s room. They believe these lessons will establish changes that will continue into the future and even affect how hospitals will be designed and built going forward.

Lesson 3: They have learned first-hand that asymptomatic patients – those who don’t exhibit symptoms such as loss of smell, taste, or headaches, etc – those with zero symptoms – do indeed get it and transmit it to others. This, they said, is well documented now.

When asked specifically what they would say to those who doubt the effectiveness of wearing masks or social distancing, they responded:

These are unusual times, but the medical research is clear: keeping social distance and mask wearing reduces the risk of getting the virus. They see this need for the foreseeable future until we get a vaccine.

They were asked about antibody testing, specifically what does it do, and they explained the following:

SEBASTIAN KAULITZKI / Getty Images

While there is a positive indication that the presence of antibodies can potentially protect you from getting COVID, it is still too early to draw conclusions, and still much to learn.

The testing for antibodies is typically used to indicate the percentage of the population that has been affected by a virus, and who are supposedly immune to it. However, with COVID, long term studies are needed. While some studies indicate antibodies can be a marker of immunity, there are other studies that have shown that some patients with no antibodies have been protected as well. So again, they reiterated the need to be careful with drawing conclusions on studies that are in process and not yet FDA approved. They acknowledged that they are very much still learning about COVID as it is a virus that behaves differently than other viruses, and in ways unlike anything else, with nuances and exceptions.

The moderator inquired about the use of ventilators with COVID, asking what they could tell us?

The rate of needing mechanical ventilators in the ICU is around 10-15% now, down from the 20-30% of patients needing them as they saw earlier in the pandemic. A patient is put on a ventilator when they are in a much more serious condition, when their lungs are inflamed and they are having breathing difficulties. The drop in ventilator use correlates with a younger population coming in with COVID. The younger aged patients typically can withstand the damaging effects of COVID, having more lung defenses that allows them to endure before needing to go on a ventilator. And too, the doctors have learned new therapies that decrease the need for going on a ventilator.

While it has been rare that they have seen patients who had the virus, recover from it and leave the hospital and then return back again with a second bout of COVID, they have seen patients who had it, stabilize while in the hospital, and then develop more serious COVID symptoms while still there. There is a typical cycle that takes place with COVID – a patient gets the virus, it replicates in the body, develops into inflammation, and then does damage to the lungs and becomes a more serious respiratory issue.

Recovery time for patients who end up needing a ventilator is on average between 12 – 15 days, though they have seen patients that have needed the ventilator for up to 28 days. However, while it takes “quite a long time to recover”, the good news is they are seeing recovery, even with many of those who stay longer on the ventilator, they are seeing recovery.

When asked 'what therapies are you using that are working?', they shared one type of therapy, and expanded into what damage is done by COVID, and the importance of research:

Convalescent Plasma Therapy: This isn’t a new therapy for treatment of viruses, though it is in the experimental stage with COVID. How it works is that blood is taken from someone who has had the virus and recovered, it is filtered for the plasma, and then the plasma is transfused into a very ill patient with the hope that it blocks the virus from damaging the cells.

Has it worked for COVID patients? While the doctors are using this therapy with qualified patients – patients who are seriously ill with COVID and eligible through the FDA – they explained that as medical professionals they need to wait for the studies to be completed. While they have seen some positive results with some patients, and while they themselves are part of the FDA studies, they cannot draw broad-based conclusions until the studies are completed.

They are seeing two types of damage from COVID: (a) damage directly to the body, and (b) inflammatory response that goes “awol”. Some of the medicines they are utilizing now are used to (1) block the virus directly, (2) reduce the inflammation process, and (3) block the inflammation markers.

They are learning from multiple studies, including studies shared both locally and globally. They are moving as fast as possible in the medical field but want people to understand it still takes significant time to really make sure a treatment works so they don’t have to recall it later. However, sharing data in a transparent way only helps. They are learning from the medical community and scientists around the world about what is working and what isn’t regarding plasma, medicine, changes in medical practices, and they shared that it’s very exciting to work together and is so important. The research needs to be vetted, and to make sure we are treating patients in an ethical manner – so debate is good.

One reporter commented that in the summer it’s really hot and asked if children should be required to wear masks out in the summer heat?

While the doctors acknowledged that sunlight kills COVID, that the virus is more easily dispersed outside than in, and that the risk is less when outside than when indoors, they urged every parent to decide what is best for their children. However, they cautioned: if you get a lot of kids together, it’s going to increase the risk, so again, the more social distancing you do, the better it will be.

When asked if they had any advice on air travel, they said definitively:

“If you don’t need to travel, don’t.” Air travel has its risks, from being in the airport with lots of people, to being in the airplane, an enclosed space.

However, they recognized that there are people who will need to travel or who decide to travel, and so to do this they advised: (a) do assess the level of need for travel, and if you decide to do it, (b) travel smart, which means keep socially distant, wear face masks, wash your hands frequently.

As the flu is seasonal, they were asked if COVID would be seasonal as well?

The doctors repeated that they are learning much about COVID still, and they didn't know specifically with this virus if it will be seasonal like the flu... though they did state that they believed we will see it happening in the same way. At the very least they said we need to be prepared for it to be seasonal. According to Dr. Hsu, the flu will resurge in the winter, and it would “not be a good thing” for someone to get the flu and COVID at the same time. The doctors strongly encouraged people to get the flu vaccine, to wear face masks, and to social distance, which will also have some affect on the flu as well.

And finally in closing, the doctors were asked: What is the most important message for the community to know?

Dr. Hsu took this one and responded, “Know that your actions – what you do – affects other people. There has never been a time in history when this has been so important. Adhere to the continued guidance of the health agencies and scientists. Avoid activities where it puts others at risk.”

The doctors urged that while wearing masks and keeping social distance may feel tedious and constant, we should not lower our guard.

They closed by stating that getting COVID is avoidable: If we stay at it, we’ll get through this as we wait for the vaccine.