Matthew discusses the current pandemic with Dr Mohomid Al-Ibrahim, an infectious disease physician. They go over many of the questions and issues surrounding the COVID-19 virus.
Be sure to read and download the transcripts to this episode. Click on the tab above.
Check back often for more episodes pertaining to health and wellness and issues concerning the COVID-19 pandemic.
Please send your questions to goingviralpodcast@gmail.com
Website: https://goingviral.buzzsprout.com/
Thanks for listening and please share this episode.
Matthew discusses the current pandemic with Dr Mohomid Al-Ibrahim, an infectious disease physician. They go over many of the questions and issues surrounding the COVID-19 virus.
Be sure to read and download the transcripts to this episode. Click on the tab above.
Check back often for more episodes pertaining to health and wellness and issues concerning the COVID-19 pandemic.
Please send your questions to goingviralpodcast@gmail.com
Website: https://goingviral.buzzsprout.com/
Thanks for listening and please share this episode.
spk_0: 0:05
Hello and welcome to the going viral podcast. I'm Matthew's Ender, a certified registered nurse anaesthetist. I'm in Advanced Practice Nurse that specializes in the practice of anesthesia. Scope of this podcast will explore health and wellness from the broad to the specific. My aim is to educate while offering a unique perspective, Thank you for joining me today and let's get right to the show. So today I talked to a physician who specializes in infectious disease, and obviously it's very timely to discuss the Corona virus with him. His name is Dr Mohammed Al Ibrahim, and he works at a pharmaceutical research company called Farmer On. He gives many good insights on many of the topics that are discussed quite often in the media and online. Unfortunately, there are a lot of misconceptions out there, and that was one of the things that I wanted to address with him. Now, as you listen to this, please bear with me again. This is all new to me. I'm trying different platforms for recording these shows, one of which is a platform online called Squad Cast. I'm also using a recording platform for Skype. We actually did Skype this interview and Dr Ali Bream is sitting in his kitchen, so you will hear some background noise of his family because he is at home, as we all are. Our most of us are. So you will hear some background noise. I apologize for that. I'm also going to keep working on it to see if I can clean up the sound a little bit better, even on my end, because I know there is a little bit of an echo, so but I do appreciate you bearing with May. I also really appreciate the comments that I have gotten from people that have listened to the podcast. It really does help me improve things. It helps me come up with questions for the interviews, and it is nice to know that some people out there listening so thank you very much for that. I have also got my act together a little bit. Maura's faras communications concern. So if you want to email me any questions or constructive comments, you can go to going viral podcast at gmail dot com and email me. And there is also a website that holds all of the show's altogether and a player if you want to listen to it that way, and that is going viral dot buzz sprout dot com Buzz Sprout is actually the platform that holds the uploaded recordings. So with all that being said, please continue to share this And without further delay, here is my talk with Dr Al Ibrahim. Okay, so today we are talking with Dr Mohammed Al Ibrahim. Er and I just wanted to start with having you tell us a little bit about your background and then we can get into the discussion.
spk_1: 3:07
Thank you. Meant on the physician. I graduated from the University of Baghdad College of Medicine, came to the United States to do a residency in medicine and a fellowship and infectious diseases. I have Bean, a infectious disease practitioner, and spent most of my career at the University of Maryland's School of Medicine in a variety off the rolls. I was professor of medicine at that institution and associate dean for Veterans Affairs. In 2000 and six, I joined the a company of start up called Shin Nippon by Medical Laboratories, which was a clinical pharmacology center for drug development. I have worked since that time on probably 200 research projects, mostly early phase research. Two years ago, the company was acquired by Chinese, a pharmaceutical company called Farmer On. And I have Bean, the senior research physician for Farm Run since 2000 and 17. Still, that's where I am.
spk_0: 4:32
Obviously, this is, uh this situation right now with the Corona virus that's affecting the world is quite timely. And your expertise, I'm sure, is has been tapped by many sources. You and I have known each other a few years now and work together, so I appreciate your time very much on this and any information that you might have. Thio, add Thio, help people understand this a little bit better. Uh, I could start with our discussion with really generalities. Meaning, What kind of insights might you have on how this virus is different than what one might just be used? Thio discussing or dealing with?
spk_1: 5:17
That's ah ah, good to start. We, of course, know a lot about the the family of viruses, the Corona viruses. We know, of course, that they are the most common viruses that cause the common cold. However, every down again they have caused a very serious disease. We're not the kind of mild symptoms of the common cold, but with responded three complications leading to death. So we had was called SARS one, which is a Corona virus that caused fairly severe disease. And it was the the early 2000 era. We also know another Corona virus that causes severe symptoms called Nurse, which stands for the Middle East and response to three Central. This virus is different in several respects. First of all, it's much more infectious than sours and murders. Many asymptomatic people can disseminate this virus. The other thing about this virus is that is also much more serious than the common coal. Ah worldwide is causing between 1.5 and a 2% mortality in some countries, much more so than others in the, uh, comparison with influenza virus, which causes death in less than 0.1% of cases. So this is several orders of magnitude more serious, as faras mortality is concerned, that influences. And as one can see from our own country as well as from the rest the world, it can be fairly explosive.
spk_0: 7:25
One of the things that I'm seeing, you know in a lot of the news and the literature out there and the little bit of research that has been done in the short amount of time that that researchers have had to put things out for US papers, a concerned one of the things that is striking about this particular virus is the lack of symptomology and the inconsistency of symptomology, and it's actually starting to come out. Correct me if I'm wrong. You know, in the beginning, they were saying, Well, this is an old person's disease. You know, you're only gonna have trouble with it if you are over 60 or 65 or you have a preexisting condition. But now, as we're into it a little bit Maura month into it or more, it's showing that is not the case, is that correct?
spk_1: 8:10
Yes. Uh, part of the problem about drawing conclusions is the fact that most countries, unfortunately, especially in the United States, we have just not tested enough people to get a true idea of the number of asymptomatic people off. For example, we That's why we have not been able to identify and manage the clustering of cases very well. We've always bean two weeks behind the Times is this work, so that's a huge problem. But somewhere the inner 40 50% of people, perhaps have no symptoms, are so little in the way of symptoms that they don't recognize, and then the rest do have symptoms. Majority of them are symptoms that are relatively mild or moderate. But then, in some 15 to 20% of cases, what it seems to be is that there are more severe and may require hospitalization. The runny nose, sore throat headache maybe very mild. The more serious is when there is shortness of breath, um, and chest pain, which can be due to a variety of causes. Uh, the pneumonia and many individuals seems to be peripheral towards the pleural surfaces, which is more symptomatic, causing chest pain. But then there are often other possible causes for the chest pain like pericarditis, for example. And, uh, then the more severe symptoms are severe shortness of breath, sometimes confusion. Sometimes, Uh ah, people turn actually blue because of cyanosis and high proxy mia. And of course, that's that's extremely serious at that point. So one of the challenges is people are advised to stay home as long as possible when they have symptoms. The challenge is, at what point is there danger? And should they should be immediately going to the hospital or seeking professional medical care?
spk_0: 10:49
And at that point, that's pretty much when people are having respiratory distress.
spk_1: 10:54
That that's correct. Yes,
spk_0: 10:56
right? So at what point do you think? Or in your opinion of a person, has experienced the telltale symptoms? Let's just say they were not tested because of the shortage of tests. But they had the fever. They had the shortness of breath. They had the chest pain pretty much. Let's just say it's textbook and they did the right thing and they self quarantine for two weeks, and they started to feel better at those two weeks. At what point would you say that it's okay to and Rick warranting?
spk_1: 11:26
Yes, that's a good point. There are several recommendations. Part of the problem is that we we don't have the clear cut mechanisms of testing. So, for example, the CDC has has recommended two kinds. One of them is nuclear Gassid testing, which is the usual diagnostics test with the PCR kids that there would be two negatives before somebody is considered that allowed to go back and are free from virus. The other is based on a resolution of all symptoms and 14 days from the beginning of illness and resolution of all symptoms for three days, including fever and all the other things. So that's where we are right now is impractical to test somebody twice. We're lucky if we can get the dates at once, right? So that's a huge
spk_0: 12:30
problem. So pretty much the the idea would be free of symptoms. So So we haven't really seen. So we know that some people can be carrying it free of symptoms or have no symptoms. And then, you know, for up to five days, I think if is what I've been hearing and then you know and that's why the spread is so bad cause you were carrying it without knowing that you have it. Then you may or may not experience symptoms after that for a period of up to two weeks. But has there anything has anything been shown on the back end meaning Could you have had it? Ah, and your symptoms resolve. And could you still be a carrier after you've already had the symptoms in other words on the back end.
spk_1: 13:13
It's really is unknown. It's a likely by our experience with this type of virus. They're not usually carried. One is doesn't see carriers for weeks and months. What we know, for example, is that and that information comes from China as well as with others is that you might be able to detect virus viral are in a and people for us long as 2122 days. But it's not known whether that actually these virus are UNAIDS are infectious or just reminiscence a virus that can be picked up by these probes.
spk_0: 14:00
So it stands to reason that it may be a good idea to continue a quarantine at least for a few days, even after you're free of symptoms, just because of that unknown.
spk_1: 14:11
The recommendation is that the people are quarantined for 14 days and for at least three days after they become symptom free.
spk_0: 14:21
Okay, and what is your opinion of whether or not a person is immune after experiencing it
spk_1: 14:28
well again, we we don't know what we do know about Corona Bar. At least we don't know accurately about this girl of ours, but what we do know about previous Corona viruses is that immunity generally is not long lip. So it may be on the order of months or a year, but not forever. It's not like a, you know, a yellow fever. Or, uh, the weather is from natural infection. Of course we don't have. We've never had a Corona virus vaccine. Still, that's an unknown to
spk_0: 15:11
which is part of Ah, Why this has become so difficult, I guess, is all of the unknowns and how new this is.
spk_1: 15:17
That's correct. They're happy in previous efforts to work on a Corona virus vaccine with SARS one and with MERS. Unfortunately, the the the funding for continued development of these vaccines stop when the outbreak stop.
spk_0: 15:40
Uh, for what? Ah, some feedback from ah listener actually wanted to know a little bit more detail, and I thought you would be the perfect person to ask this. But, uh, obviously it's intuitive as to why everyone, every news outlet, every piece of literature out there is saying, Wash your hands constantly wash your hands, but it actually can go a little bit deeper than just the concept of washing the virus off your hands. Doesn't it.
spk_1: 16:08
Well, the virus is pretty fragile. It has a lipid, uh, covering and with detergents like so that actually d natures and removes that lifted, if you will, protective covering. So they die. They're fairly die fairly quickly, and the other kinds of compounds are there. Many of them also affect the lipid like alcohol, for example. And that also is a kills the virus.
spk_0: 16:51
Now, when it when a person uses alcohol as opposed to soap and water, like a kind of the pure l or even just straight rubbing alcohol, I actually, Carrie and I used to carry this around even before this all started. Just because, uh, I'm a health care provider and like to have clean hands. But I've always carried a little tiny spray bottle with me in my pocket with straight 91% isopropyl alcohol with some essential oil in it. And I spray that on my hands a lot. Is the rubbing still absolutely necessary, as you would need to do when washing with soap in hands? And if so, is it still the 20
spk_1: 17:30
seconds 20 seconds Seems to be a good time. The old the old experiments with hand washing, which mostly looked a TTE bacteria, as opposed to viruses, showed that the detergent and effect of so removes much of the, um, stuff that is stuck to our skin and with it also the bacteria and the noxious things. So soap has a defect that goes beyond the rubbing of alcohol for two seconds. Three seconds. If you if you grew up without call yes, it is effective, and especially if you wait till it dries so that the effects is and you rub it well between your fingers and everywhere. But washing with soap is very effective at removing all of that sort of little microscopic debris that germs hang on to. And then, of course, it has the effects of the germs themselves.
spk_0: 18:47
Right. Okay, so and I you know, I keep going back to this subject and, uh, any any of regular listeners of this podcast will recognize this because I am concerned about it. And that is the cold concept of healthcare providers going in to take care of covert 19 patients. And they're following all of the proper procedures with personal protective equipment. Let's say they work in a hospital with everything that they need, and then they're they're protecting themselves properly. But then there, finishing their shift and they're going home and they're thinking nothing of decontamination. In other words, they're going home, probably with it. One them. It's just not on their radar to think about decontamination, cause we've never been trained in it. I used to work in the surgical intensive care unit 25 years ago, but you know, lots of things happened there that you would consider probably contamination related, and I would just go home and I change out of my scrubs and I jump in the shower and I'd be done. But in this case, this is so much more serious. And in a couple you know previous episodes to this. I spoke to a hazardous materials expert, and he believes that there should be hazardous or has Matt tents set up outside of every hospital for health care providers tow walk through to go through a step process of decontamination, which is obviously doesn't exist right now, eso Maur the more than just washing hands. It's ah, it's something of a concern because health care providers could be inadvertently leaving their facilities and infecting themselves or their families Or, God forbid, they go to the grocery store on the way home. Something like that.
spk_1: 20:28
Yeah. Many healthcare providers ah, are going the extra mile. They go home, they wash all their clothes, the war. That day, they make sure nothing touches other surfaces because we know that this virus can survive on surfaces for as long as 72 hours, depending on the surface itself. Now, it is true that by 72 hours there is only a fraction of the virus left from the beginning. But it's still there. And while we don't know how effective the leftover viruses in terms of the amount, uh, we we do know that it can be detected. So until we know better, we have to presume that you can carry this around with you.
spk_0: 21:28
I'm wondering what your thoughts are. One just kind of the concept of how this is transmitted obvious. You know, we did kind of already touch on how it lives. On service is how you can pick it up with, you know, your hands, or you could pick it up when your clothing, or depending on how protected you are or, you know how your observing, social distancing. But this is a an airborne illness, and I'm just wondering, you know, for people that are wondering, let's say you're standing in line at the pharmacy or standing in line at the grocery store, and someone is doing something as simple as breathing. Can you walk through a cloud of virus and that respect? Or is it someone that would have toe cough? Or is six feet enough for the virus to go from that aerosol cloud to the ground before you get to it?
spk_1: 22:20
When I think all of us have stood two or three feet away from somebody just talking normally, Sure. And sometimes you get splattered with a little bit of bread. So so we know that happens. I'm sure that droplets can travel for six feet. Obviously, there has to be some practical distance that you say to people keep away from each other. It's not gonna be possible to do it 12 feet away, so there's a lot of discussion about this in terms of how much virus could be carried in the in the in the ambient area to someone who is infected and how long droplets will Hang on. This is very basic but very difficult kind of science. There's Ah, uh, something actually here at the University of Maryland who has done research on influenza transmission by getting people together in a room that how many people are infected? Donor I e. That is donors of the virus to recipients who are naive and who have not been infected. What kind of contact for surfaces as well as the air. And and these are very difficult studies that there aren't really enough of them. Two give us a very accurate idea. But there is, I think, from a very infectious virus. Um, there is concern that we are not, for example, using masks, even surgical masks when we leave our houses. As you know, the Chinese use that and they were sticklers about it. And personally, I believe that this makes a lot of sets. The CDC has finally come down and, uh, or come out with recommendations for people to do that when they go to the store when they leave the house, even for going on a walk, where you expect to see somebody on the way and and that's most of certainly most of urban life, it's impossible not to have somebody go by, Um, so even without knowing precisely that science, I think that is something that we should follow, why we're following all of the other strict distancing strategies.
spk_0: 25:19
And it's an interesting point that a lot of people think, possibly that if they were to wear a mask, a surgical mask specifically or a scarf, there's lots of D I. Y masks now that are coming out. You know, they're trying to make sure that people understand that that mask protects others from you. It does not protect you from others, but if everyone wears one than everyone is then protected. But it requires a community response on dhe and participation, whereas if you were aware technically technically, where an n 95 mask and where it properly then that would protect you from others. But again, there's the shortage, and you have to leave that those available masks for the health care providers because of the highly dangerous environment that they're working in. But if everyone did as a community, participate in this than they would be protected or everyone would be protected because that mask is holding in whatever germs a person may have, whether it's the virus or not.
spk_1: 26:22
Yeah, I was very proud. I talked to three patients earlier today who are at home, and they are all using homemade masks when they go out.
spk_0: 26:34
That's very good. Yes, as far as treatment modality. I mean, where are we headed when it comes to that? You know, I know there's a lot of there's a lot of rumor. What are your thoughts on treatments, if any. And then also, if you could comment a little bit on where we might be with vaccine and then, of course, that you know the convalescent serum.
spk_1: 26:57
I think it's fair to say that at the moment there is no proven treatment. So treatment is based for the most part as supportive therapy. So to go through quickly. The list of possible treatments. As you mentioned, Hydra Clark with Hydroxy Clark Win, which is anti malaria drug, is also given in other situations. For example, bloopers. There have been reports of early viral clearing. There are trials going on. It has not been proven to be effective at this time, and that's it. The case with other treatments the most promising antiviral treatment right now is one drug this called Grimm's de Vere, which is made by Gilead. It's being given to about 1500 people all over the world, but it's, ah, the proper scientific trials. Um, randomized, double blind. I have not bean completed, and we don't have the the data from those there are other. Uh, there's another antiviral that is made by Japan by, um, a company which is known to be a, uh, in the photography industry, Fuji. But they are not now pharmaceutical company also, and that's ah ah, drug that is an anti influence of drug, that there were some reports that it might be beneficial. But again, the randomized trials are ongoing, and we don't have data from that. Um Then there's the There are other anti virals being considered, but again, uh, no clear cut dater. The plasma transfusion, where plasmas taken from individuals who have had the virus and who have antibodies, is a new old world kind of treatment. It is still, by the way, even in the modern era, useful, it was given to theirs. Ours ve responded freeze and city or virus immunoglobulin that we used to use it a lot for preventing hepatitis A when there was no vaccine. It's also given to one of the few things that are available for treatment of Rabies, so that is now actually ongoing trials. The biggest style that I'm aware of is in the mail clinic where they are using. This is complicated by the fact that, uh, it's only it's possible when there's a large pool of immune people to collect this from Also, what we know about this kind of passive immunity is that it's more effective when given early in the disease and not when you are overwhelmed. So it has that kind of, uh, potential, but that kind of draw back at the same time. Then there are other issues about treatment, which is, should you give non steroidal anti inflammatory agents? Because there has bean some reports that people seem to be worse when they let's say, taken ibuprofen or naproxen. Um, we we really don't know. Many practitioners are staying away or recommending staying away from that just on the basis of those kinds of reports. Similarly, with steroids, steroids could be helpful and some of pneumonias if we treat normally. But again, the fears that the depression of the immune response could be the serious this virus again, we don't know. So so there we are. And, of course, everybody is looking forward to development of a vaccine, which is a different kind of story.
spk_0: 31:54
Best guess on how long that might take. I'm hearing 18 months.
spk_1: 31:58
Yes, Uh, so I would imagine at least that there are, I would say probably about 30 companies that are in the process of making a vaccine to have actually being have been started already. One in the West Coast and the other one and, uh, Philadelphia. And so the general format for development of the vaccines that you go through a phase one where you have increasing in small groups of people like six or eight people in each group. So Group one will get the very small amount of the dose of the the investigational vaccine, and that increases. And then there would be first of all, safety. So the first, the first course would be just safety. Enough efficacy. Although, of course, the antibodies this would be generated or not generated, but they would be measured. And then, uh, once it is established that a high enough dose of vaccine that gives a high enough tighter that is believed to be protected. Then you go to the efficacy trials. You go to a face to the phase three where you are, then, uh, looking at the protective effects of these vaccines. Typically in the past, these have taken 234 years to develop. Ebola created a need for the for a very rapid development, and that took about a year and 1/2 2 years. So we're thinking that maybe we can accelerate it even faster to a year or year and 1/2. That's the current thinking.
spk_0: 34:05
What is your best guess on how long it's gonna take for us to get completely to the other side of us?
spk_1: 34:12
Yeah, I think that that's a really good question. We should be thinking about a vaccine for the second wave or the third wave of diseases won't come after 2020. So the development of an antiviral, maybe within reach before that, hopefully that within the next six months we may have data to show that this or that antiviral might be effective, or at least helpful.
spk_0: 34:47
Why are virus is hard to treat in general.
spk_1: 34:50
One of the things that's unique about them is they. They come and hijack ourselves to make themselves. And, uh, that's very kind of difficult to treat, you know. So there is the entryway, which can be if you have a successful vaccine, it can prevent the entry of the virus to the cells and hijack it to make more virus. The other is that because it's in ourselves and basically all over the body, in most situations, it's hard to get a chemotherapeutic to kill it and not also be very toxic. 22 cells.
spk_0: 35:41
Well, Doc, I I really appreciate your time very much. Is there anything else that you would want to make a point of or get across at all?
spk_1: 35:50
I still, I think that it's what to emphasize that the the quality with which we, um, mitigate getting infection is one that's eventually just down to each person and that the more individuals who take this seriously, then the more the common good would be.
spk_0: 36:21
My question really is at this point, how much longer are we gonna be? Ah, experiencing this very surreal time were all in. I can tell that you're working from home just like just like I am. That can only be so long Sustained a cz faras The economy is concerned. So hopefully we will all come out the inner other end of this safe and healthy, but at the same time back to as much of a normal capacity as possible.
spk_1: 36:52
We hope so.
spk_0: 36:53
So thank you very much again for your time and your expertise. I will look forward to talking to you again.
spk_1: 37:01
Thanks, man. Thanks for having me.
spk_0: 37:03
Okay. All right. Bye. Thank you. So thanks for joining me on this fifth installment of the going viral podcast. I appreciate it very much. Please remember to share this with anyone who might be interested or anyone who might benefit from the information. Please stay tuned. We have many episodes coming up, including a new interview with an arrow biologist who will actually talk aboutthe science behind how this virus reacts in the environment. I'll be talking to an orrin who has been teaching his colleagues how to don and take care of personal protective equipment because he has experience taking care of Ebola patients. And he'll also talk about that experience. Plus, I will be talking to both a C or A and an anesthesiologist who are both in the front lines. The Sierra is actually going to be working at the Mount Sinai Hospital in Manhattan, and the anesthesiologist is working in the Carolinas. Both are going to be on airway teams coming up here in the coming weeks. And I know I keep promising to do some episodes on stress management techniques. So I do promise that they are coming up is well, so thanks very much again for listening. So that'll do it for this episode. I hope to see you at the next one. This is Matthew's ender and the going viral podcast. Please stay safe and stay well.