Consider This from NPR - Q & A: Pets And COVID-19, Ventilators, And The View From Wuhan

Episode Date: April 18, 2020

Public health experts and NPR journalists answer listener questions on 'The National Conversation with All Things Considered,' NPR's nightly radio show about the coronavirus crisis. Excerpted here:- NPR's Emily Feng discusses China's next steps.- Emergency Physician Richard Levitan addresses skepticism about the effectiveness of ventilators.- Veterinarian Krista Miller answers questions about pet care and adoption. If you have a question, you can share it at npr.org/nationalconversation, or tweet with the hashtag, #NPRConversation.We'll return with a regular episode of Coronavirus Daily on Monday. This episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

I'm Kelly McEvers, and this is Coronavirus Daily from NPR. Today, we'll hear more listener questions about the coronavirus. Our colleagues on the radio show, The National Conversation with All Things Considered, have been talking to NPR journalists and experts to answer questions sent in by listeners. Later, we'll hear a conversation about the effectiveness of ventilators, and a veterinarian will talk about adopting and caring for pets. But first, All Things Considered host Ari Shapiro starts off the conversation. No one knows exactly what a return to normal life will look like, especially here in the U.S.,

where each state is more or less making up its own rules. One place that's beginning to take a few steps back to normalcy is the country where the coronavirus outbreak began, China. NPR's Emily Fang is in Wuhan, China. She joined me to answer questions about what life is like there today. Let's just dive right in with this question from Natalie Preston in Florida. What is happening in China? I understand that they are now in a position to where they are doing better and maybe coming out of the social distancing and having to isolate at home. So how are they doing it? Emily, you've been doing some great reporting in the city where the coronavirus was first identified. What is daily life like there? It is, and I'm happy to report we're turning back

to normal, but in stages. So Natalie asked about social distancing. Social distancing is still very much in force in the city, and people do it without being asked at this point. It's just habit. So if there are lines, people naturally stand one meter apart. Everyone still goes out with a mask. It's quite common to see people wearing goggles, gloves, full protective gear even if they're just going for a walk in the park or going grocery shopping. So that kind of personal protection is still very common. I think what Natalie is referring to are these lockdown measures, these quarantine policies that were put in place across the country. Those have lifted in some part in Wuhan, the city that I am, but that doesn't mean other cities have lifted their measures.

In Beijing, where I normally am based, restrictions there are actually tightening because of the concern of imported cases, travelers who are bringing the virus with them back into the country. And all of this loosening is happening, even in Wuhan, with extensive digital contact tracing. So people are going around with these government-sanctioned apps that show if they've had recent contact with a sick person or an infected area. And if your app turns a certain color, you will not be allowed into a public space like a grocery store. Oh, interesting. I know

there's a fear that as social distancing rules let up and the lockdown decreases, that there could be a second spike in cases. Is there any evidence or fear of that in Wuhan where you are? There very much is. Doctors here that I've spoken to, directors at hospitals say they're not letting their guard down and they're preparing for a possible second wave this fall. They have not totally dismantled all of these makeshift field hospitals that they built in the city because they're preparing for a second wave. And there's still extensive testing going on, even though that's not free anymore. People pay out of pocket for that. Let's go to another listener question. I'm Stephen Stolzberg. I live in Portland, Oregon. China is saying that the virus is not

spreading anymore. However, it seems unlikely that a billion people have developed herd immunity and that there are no carriers traveling around the country. What do you think? Emily, how trustworthy is the information coming out of Beijing right now? There are significant reasons to take the statistics coming out of China with a grain of salt. They've covered up previous epidemics. They've shown themselves very willing to make up other kinds of statistics, mostly economic ones. But on the whole, I think the numbers coming out of China about the new coronavirus, although not perfect, illustrate accurately the trend of what's happening, which is that domestic transmissions have fallen dramatically. But there are still

people getting sick in China. And the reason for that is people who are traveling back into the country, getting infected from places like Russia and U.S. and UK, and bringing that illness home and potentially infecting other people. One of the biggest sources of the virus this week has been Russia. China sealed off its land border in response, and they've actually put a tiny border town next to Russia on lockdown, similar to what they did in Wuhan. So you see, again, they're lifting downs on one city, but placing them on another if they see another flare up. Another big concern about why the numbers may not be completely accurate are these asymptomatic cases. So people who carry the virus can be infectious, but they exhibit no symptoms.

So people don't know who to test. It's really hard to find them. China does not include these asymptomatic people in its official case count. It only started disclosing how many they were discovering each day on April 1st. They've never disclosed the total number. So the real question now is how many of these asymptomatic cases are walking around and traveling in China and potentially infecting other people. The officials here in China say that you're required to report yourself if you think or another person is asymptomatic. With regards to herd immunity,

doctors here in Wuhan say that is absolutely not a thing. One director at a hospital told me that he tested 3,600 healthy hospital staff in early March, and he found that only 2.4% of them had some kind of antibody resistance to COVID-19. These are people who probably had contact with the virus over the last three months, and only 2.4% of them had developed some kind of natural resistance. All right, one last question here from Stacey Dufresne of Denver, who wants to know what lessons can we learn from China's recovery? What do you think, Emily? Is what China is doing right now replicable in the States? Are there lessons that we should be taking from the Chinese? Well, the first lesson is you cannot have economic activity and social distancing at the same time. China just completely shut down for nearly two months and their quarterly GDP data comes out this Friday. The forecasts for that

are negative. They're somewhere between negative six and 10 percent. So China's economy contracted immensely because of their social distancing and quarantines. The second is China has been reopening, but in stages. So it's going to take months in the U.S. And the third is, if you want to open up, you need to have extensive contact tracing to know immediately if there is some kind of flare up. I mentioned before these government-sanctioned apps. They're clunky. They don't always work. There are definitely privacy issues, but they've been central in getting people back to work quickly. NPR's Emily Feng in Wuhan, China, thank you so much for your reporting.

Thank you, Ari. Next, my colleague Michelle Martin leads a discussion about medical treatments for patients with coronavirus, and specifically about the effectiveness of ventilators. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit WISE.com. T's and C's apply. Now we'd like to turn to your questions about treating COVID-19.

Doctors and nurses and therapists on your questions about treating COVID-19. Doctors and nurses and therapists on the front lines fighting COVID-19 have learned a lot about how best to help patients. And as dire as the death tolls are, we're finding that most people do recover from the disease, with help from doctors who have been learning as they go. To help answer your questions about treating COVID-19, we are joined by Dr. Richard Levitan. He is an emergency physician who teaches airway management to healthcare workers around the world. And he's just back from 10 days treating patients at Bellevue Hospital in New York, which means, searching for a way to say this without being cliche here, doctor, you've been in the eye of

the storm. So thank you for taking time to talk with us. Thank you for having me. It's great to be on your show. I've been a longtime fan. Oh, I'm so glad to hear. Well, what has it been like treating patients with COVID-19 in the ER? What has troubled you and what have you found that's worked well? So my experience in New York was unlike anything I'd ever seen. It's basically a slow mass casualty event with enormous numbers of patients, but instead of traumatic injuries, almost every patient has the same diagnosis. They have COVID pneumonia with low oxygen. The ER is normally a mix of patients, things like heart attacks, minor trauma, gunshot wounds, strokes, cuts, orthopedic injuries, overdoses, and other things. In New York now, it's almost entirely one disease. About 95% of patients who

came through the ER while I was there were there for COVID pneumonia. Wow. Well, what have you found that's worked well? Well, when I originally went to New York, I expected that essentially almost every patient who we were treating for COVID pneumonia would require a ventilator. And what has happened over the last several weeks in New York is the realization that a lot of patients can avoid having to be intubated, can avoid having to be put on a ventilator. And overall, I believe that the vast majority of patients who present with COVID pneumonia can be treated without a ventilator.

You know, we have a lot of questions about that. Let's just jump into them. Sarah in San Francisco had this question about ventilators. Recent information suggests that the survival rate of those going on a ventilator is very low, and those who do survive are often physically and mentally impaired. Why not offer less problematic options or palliative care and use the energy and money spent to get more ventilators to access more useful tools such as testing. So doctor, what about the survival rate? You were just alluding to that there may be options other than ventilators, but what about the survival rate? Is the premise of the question accurate and what about other options? Well, so survival rate on a ventilator is very difficult to answer in aggregate.

You know, it really depends on the patient. Most of the patients who I saw and who New York has reported having died on ventilators are nursing home patients or elderly with significant pre-existing serious underlying illness. And they're often brought to the hospital late in the disease course. So that kind of skews the data and it makes the overall death rate on ventilators appear awful. But in some patients, specifically younger patients who don't have significant other illnesses, survival rates are actually quite high. The message has gotten out to the public

that ventilators won't save you with COVID pneumonia, but actually very few deaths as a percentage of all COVID deaths have occurred in patients under 50. The case fatality rate from COVID pneumonia is estimated to be less than 1 in 300 if you're under age 50. So it goes up dramatically as you get older. But the notion that a ventilator means you're not going to survive is not necessarily the case. It's obviously much worse in the elderly and those who have underlying lung disease. I wonder if I can play these next two questions back to back because they're similar, but I just want to play them both so you can understand that there is a lot of concern about that. The first question we got is from Paul in Florida, and here it is. There seems to be a lot of pandemonium about getting the ventilators and using them.

We even have states that are sending the National Guard out to confiscate some. So I wondered, well, are these ventilators actually effective? And what's going on with them? And here's a question from Anne in Washington, D.C., similar question, and here it is. Do experts have any data from the past few weeks about whether use of ventilators significantly improves the chances of surviving a serious case of coronavirus after the lungs are inflamed and have stopped working? And are there clear statistical differences in the success rate by age or other conditions,

or how long the individual's been suffering with the virus? So you see, doctor, there is a lot of concern about this and a lot of questions about this, and you've been giving us some information about it. Could you just expand on that? Yeah. So let me just address, though, non-ventilator management, because that's important. I think people don't appreciate that a lot of management of COVID pneumonia is with nasal cannulas, face masks, systems called CPAP, and a variety of patient positioning maneuvers. The area of the lungs that are earliest and most severely affected by COVID are in the lower lungs. And it turns out that simple things like turning

people onto their stomach and turning them to their left side, their right side, sitting them up can improve oxygenation significantly. Most patients, regardless of therapy, are going to need one to three weeks overall of oxygen with or without a ventilator. But, you know, I just want to point out Boris Johnson was brought into the hospital because his oxygen saturation was slightly low and they were able to avoid intubating him and he was discharged after a week. In terms of the overall need for ventilators, we have to use ventilators in the sickest of patients who present with respiratory failure or impending respiratory failure. Those are patients who we can't correct their oxygen

or they're just too tired out to breathe. But overall, the net intubation rate, the number of people on ventilators in New York State has flattened. At the beginning of the month, every day, 300 patients were being added to ventilators. As of April 7th, they were down to 21 new patients being put on ventilators. So social distancing is playing an enormous role in flattening the curve. We're decreasing the acute demands on the health care system. And I think what we've learned in New York is that many patients can be managed without ventilators. This is Michael and Santa Rosa, who had a question that seems to be on a lot of people's minds. Let's listen. What does recovered mean? Does it mean being on a ventilator and now being okay? Or does it mean having a positive test and now don't test

positive? Or you just felt ill and now you feel fine? What does it really mean? Doctor? Yeah, that's a complicated question. And I think it depends on the agency reporting it. Very few places I know are determining if COVID patients are still shedding virus after treatment or after they've been in or out of the hospital, for instance. For instance, in New York City, healthcare workers who I met who had tested positive, they were back at work, and the CDC advised that after no fever or symptoms for three days or after seven days from the first symptom onset, they could return to work. There have been patients who, even four weeks out, are still shedding virus. Ultimately, I believe that the antibody test will be needed

to determine who has truly recovered. Dr. Richard Levitan, thank you so much for joining us. We really appreciate it, and I hope you'll come back and see us. As you know, there are many, many questions for you, so thank you so much. Thank you. I'm Scott Simon with our last excerpt from the National Conversation with All Things Considered. Many pet owners are wondering how to take care of their animals, and prospective pet owners wonder if this is the right time to adopt.

Johanna Humbert is the executive director at the Humane Society in Indiana, and you may be surprised to learn they've seen a huge increase in demand. We normally have five or ten animals in foster homes at any given point in time. When the stay-at-home order came down, we were able to move about 65 animals into foster homes in about a week. You've sent us so many questions about pets and the coronavirus. Veterinarian Krista Miller is here. She's a veterinarian at Thrive Affordable Vet Care in Baton Rouge, Louisiana. Dr. Miller, it must be. Thanks so much for being with us. Thank you. Let's get right to the questions. One from April in Salt Lake City.

Many shelters have been looking for fosters and adopters, but is there a risk of contracting COVID-19 from adopted or fostered animals that may have been in contact with someone who is carrying the disease? A sound question because this disease, of course, was first transmitted from animals to humans. What have you seen? So based off the results, even in the beginning transmission where there was possible indication of transmission from animal to human, there was now a concern of whether or not it transmission from animal to human, there was now a concern of whether or not it went from animal to human and there was just some sort of mutation that now caused it to be primarily person to person. So just like any other aspect of the disease transmission process that we're being trained on as veterinarians, as people with the

stay-at-home order, it's going to just be profound enough that you wash your hands and follow the normal precautions of every day. But there is not a risk at this time or any concern about people adopting pets and having a transmission of COVID-19. Next question from, I think the name is Ari in the District of Columbia. My husband and I are in the process of adopting a dog. We are both working from home right now, which is great. And my question is, what can we do to gradually prepare the dog for the future when we're both going to be working at the office most of the day? Of course, our own Ari Shapiro, but a valid question nonetheless. A lot of people we know are thinking about adopting a pet. What should Ari and his husband know? So one of the best things to do is to consider the age of pet you're adopting. A lot

of times with puppies, crate training is a great thing to do if you're going to be away for work once you start back. So crate training can have a great positive experience of getting a pet used to their crate and it becoming a happy place, a positive reinforcement, not a place where you send me when I do bad things. So when you're away, they learn that that's their place of comfort, their place at home, and they're used to being there. Even in addition to that, considering adding an item of clothing, something you've worn that night or that day, add it to their crate or their space. It kind of gives them a sense of comfort and will help them to adjust to the change. However, pets can develop separation anxiety when things change, but just like any other person or pet, it just takes some time. Another question for veterinarian Krista Miller, this from Marshall in Charlottesville, Virginia. So I have a dog and I was wondering, based on the case in New York City with the tiger

at the zoo that had very similar symptoms as humans do with COVID, is this a concern that we should have in the future and how should we deal with this instance of disease being prevalent in more than one species? Very good question. What do we know about diseases that go from species to species? So at this time, there's not a huge concern regarding that. When you look into the article closely about the tiger, you'll find that the zookeeper was once infected with COVID-19. A lot of times with animals, in the case of the tiger, when he was exposed, they found the articles that are the things that could have been present to say that he was exposed. But there is not a huge concern in species to species jump at this time. It's still being explored, still being studied.

So at this point, definitely not a concern. We have a question from April in Salt Lake City, Utah. So I have heard that in response to economic decline due to COVID-19, many pet owners are giving up their animals or abandoning them. Is this true? So there are instances where that is happening, but the biggest thing is being educated about the virus itself. There is not a reason a homeowner or a pet owner should be giving up their pet because of the COVID-19. If anything, there's only concern when a person is already infected and super ill, so you're more concerned about immune system and other diseases animals may carry, but not COVID-19. And we know your state has been hit very hard by the virus. A lot of people have found it

difficult to care for animals and or their owners all at the same time? So ironically, where I actually work, I found an increase in the number of visits that I've seen here for the past few months. And I think it's just genuine concern for people and their pets, whether it's sneezing and coughing. And I think a lot of people are on a kind of panic mode and forgetting that it's also allergy season. So most of these pets are coming in for allergy issues with coughing and sneezing and things like that. So the biggest thing for owners to remember is we have to test for other diseases first because COVID-19 will not be the first thing that we even think about. There are a lot of steps to take to confirm that and most of the time we

just approach it from a normal standpoint of allergy season. And veterinarians offices are open aren't they? They're essential business in this country aren't they? Yes we definitely are essential because we help to prevent any other animal diseases that are zoonotic that could potentially spread from animals to humans because they get a lot of things that we know that are zoonotic. So we try to prevent that as much as we can. We are very grateful they're open. I don't mind saying our family and I had to take our beloved dog to the vet, but that's because she ate a cupcake. Oh, wow. They do love those cupcakes. And it had chocolate in it, but we were grateful. Apparently only a trace amount of chocolate. So Krista Miller, she is a veterinarian at Thrive Affordable Vet Care

in Baton Rouge, Louisiana. Dr. Miller, thank you so much for being with us. Thank you for joining us on the National Conversation. That's it for today. If you have a question, send it to npr.org slash national conversation or tweet with the hashtag NPR conversation. You can join the National Conversation with all things considered weekday evenings on your local public radio station. We will be back on Monday. I'm Kelly McEvers, and this is Coronavirus Daily from NPR.