[TBS eFM Interview]
This Morning with Alex Jensen
- Monday, March 16
Guest: Dr. Krutika Kuppalli, infectious disease physician and fellow at Johns Hopkins Center for Health Security
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◆ Alex Jensen: With coronavirus concerns continuing to mount in the United States, we welcome Dr. Krutika Kuppalli, infectious disease physician and fellow at Johns Hopkins Center for Health Security. Thank you for joining us.
◇ Krutika Kuppalli: Thank you for having me.
◆ Jensen: We've been hearing about some of the travel chaos of people trying to return to the United States and there's been a lot on President Trump's conditions, he tested negative for COVID-19. What's the situation like in the United States? How bad is the outbreak at this point?
◇ Kuppalli: Currently, the U.S. has 3,244 cases and 61 deaths as of today. I fully expect that with testing capabilities and capacities increasing over the coming days that those numbers will go up. Where I am in California, there are 247 cases currently with over 11,000 people self-monitoring.
◆ Jensen: COVID-19 cases are rising in the face of efforts by the government, by President Trump to take this far more seriously than they seem to be doing a few weeks ago. What do you make of how effective this travel ban might be?
◇ Kuppalli: I think the travel ban is being put into place for a couple of reasons. I think one of the things that they're trying to do is decrease the burden on the health care system here in the United States. We've seen before that travel bans don't work, however, they can help to slow an outbreak as you are trying to ramp up your health care system. So it sound like from what I've heard, the plan is to try and help prevent more positive cases from coming into the country. So, it helps decrease the burden on the health care system because the United States needs some more time to prepare.
◆ Jensen: The other thing that is happening is that major events are being canceled, sport for example, and also all manner of cultural events are being postponed or canceled altogether. Is this also something that is very helpful at this point?
◇ Kuppalli: I think that canceling events is a good idea especially because the thought is we are moving more and more into a mitigation approach. So we want to try and promote social distancing. I think people are hearing this term more and more, so really trying to keep people away from each other. So, by canceling sporting events or NBA basketball, NCAA tournaments and things like Broadway shows, it doesn't give people a choice about whether or not to go, the choice is made for them.
◆ Jensen: One of the biggest criticisms on the medical front has been testing kits and whether they can be relied upon and whether there are nearly enough. President Trump said 1.4 million test kits will be available within a week and 5 million within the next month. Where does that leave testing and the situation at this point?
◇ Kuppalli: Testing has definitely been the biggest challenge thus far. Testing is getting better but we're definitely not where we need to be. Part of the reason testing has gotten better has been not just with more public health watch coming up. We now have commercial labs and also numerous academic centers that have developed their labs. There are various ways to get testing and now it's a plan of coordinating this and being able to manage the high demand for testing and getting patients tested.
◆ Jensen: There have been priorities in testing, focusing on people with severe symptoms. Does that in itself skew the overall figure?
◇ Kuppalli: I think hopefully this week, we will be able to get more testing up and going. I think we'll have a better idea of what's going on. If you don't test, you don't know. We need to get those tests done. We need to get a better idea of what's going on in our communities and need to have better health intervention to try and slow the spread of the disease.
◆ Jensen: Do you have any educated guess or forecast of how significant the outbreak might be beyond what you mentioned earlier at this point? Some officials have gone on record with big numbers. Are you hesitant to do that personally?
◇ Kuppalli: I am. I'm hesitant to do that personally for a couple of reasons. One, it's not my area of expertise. I'm not a forecaster and second, without knowing what our numbers are right now, I think it's hard to make some of those projections and I think that these public health measures, part of the reason we have these public health measures and we try and promote them and put them in place is to see if we can help prevent the spread of the infection.
◆ Jensen: We haven't seen the kind of hoarding at supermarkets in the U.S. here in South Korea. But what we have seen is the hoarding of face masks and certainly queueing up for a long period of time to buy face masks. Face masks as a term is not very accurate but really I'm talking about N95. Anything below that seems to be acceptable for people who are trying to get a hold of anything. What's the U.S. feeling on masks at the moment?
◇ Kuppalli: That's another hot button issue that I tackle almost on a daily basis here. There are two types of main masks, the N95 mask and the surgical mask. It's an overall feeling at least here in the United States that as it is, we touch our faces at least 13 to 23 times an hour. So, rather than wearing a mask, which can sometimes be ill-fitting and uncomfortable and can actually serve as a way for us to infect ourselves by doing so, it's one of the reasons why we are very keen on promoting good hand hygiene. That in itself is the most important thing and the feeling is that when you wear a mask, you can actually cause a false sense of security and people may not be as adamant about keeping their hands clean and being mindful about not touching their faces. Finally, surgical masks don't prevent droplets. If you look at somebody wearing them, the sides of them are still open and so droplets can get in from the sides and for N95 masks, to actually be protected, you have to be fit-tested for them every year. When they're worn properly, they're actually tight fitting and not very comfortable. Most of the people I see wearing them out and about in public aren't wearing them correctly and again they offer a false sense of comfort. But probably most importantly, we have a shortage of these valuable resources at this time and we really need to make sure to conserve them for our frontline workers so they can protect themselves. So, we have these valuable people to help care for the sick.
◆ Jensen: I wonder whether your attitude would be any different if you were a health care professional in this country, a country that has a capacity to make 12 million masks a day and is looking to increase that capacity and where people are already quite familiar with the idea of protecting themselves from air pollution.
◇ Kuppalli: When you're talking about it from an air pollution standpoint, that's a completely different issue that you're thinking about. People here are wearing them because they think it's going to protect them from an infection. So those are two very different things that you're talking about. If you are sick, it's helpful to wear a mask. The wearing of a mask when you're sick is to prevent your respiratory droplets that are contagious from getting to other people. Obviously the culture is different in Korea than it is here. However, I do think I would be making the same recommendation even if we had an endless supply of masks because it's the same thing that we recommend for other respiratory illnesses.
◆ Jensen: Let's talk more about the government's response, for example President Trump declaring COVID-19 a national emergency at the end of last week. What practical impact has that had and will it yet likely to have?
◇ Kuppalli: What President Trump did on Friday was he invoked what we call the Stafford Act. This is the government's main mechanism for responding to disasters and emergencies. In this particular case, it allows him to tap into monetary resources that are currently more than 40 billion dollars so that they can do things like buy medical supplies and equipment. It allows state governments to set up emergency treatment operation centers, direct hospitals nationwide to activate their emergency preparedness contingency plans and allows the health secretary, Alex Azar, to waive regulations that could hinder health professionals response capacities. This has also helped activate FEMA, the Federal Emergency Management Agency, to help with logistics such as transferring residences needed, putting up temporary medical facilities, which are all very important at this time.
◆ Jensen: Are there any other particular concerns that you would like to address for us? Can you leave us with any lasting impressions of where you would like to see improvements?
◇ Kuppalli: I think there are always a number of things that we can continue to improve upon. I think we need to think about how to better utilize our health care system, how we're going to handle the large number of patients, making better information more accessible online, having better guidance, I think that will ease some of the confusion. I think one of the big challenges we're facing here is younger patients don't seem to think they're at risk for getting the disease and I think we do need to emphasize that even that other populations are at risk, younger people can still get the disease and also they can be carriers and potentially transmit that to their parents or grandparents. And so, we really need to take a communitywide approach at this point if we're going to contain this outbreak. And lastly, I think we also need to think about our disenfranchised patient population. We have homeless populations here who are at risk, patients who receive dialysis, prisoners, we need to think about those people as well.
◆ Jensen: Thank you so much Dr. Kuppalli for joining us today.
◇ Kuppalli: Thank you.■
<Photo: Yonhap News>
