COVID-19 Hope: Empowering Knowledge from a Frontline Cornell Medical Center Doctor

Apr 01, 2020

Protecting your family during the COVID-19 pandemic—a friends and family information session 

This must-see video features Dr. David Price, a critical care pulmonologist of Weill Cornell Medical Center in New York City, who has been on the frontlines of treating COVID-19 patients. He and the staff at Weill Cornell have accepted 20% of the COVID-19 patients in NYC and are seeing COVID-19 patients almost exclusively. In this emotional, raw Q&A, Dr. Price shares the wealth of information staff there have learned about the virus to help you and your family overcome fear and protect yourselves from COVID-19.

"The fact is COVID-19 IS in your community.

Doctors like myself are in a very unique position to actually empower people right now. . . . The reason I wanted to have this call is because I don’t want you to be scared.

The transmission of the virus is almost exclusively from your hands to your face.

We are three months into this and we understand this disease and so I’m going to go through ways to protect your family and then what to do if and when—and given the size of this call it is a when—someone gets COVID-19 and how to protect our circle.

You may hear a little inflection in my voice, like I'm emotional. It's not because I'm scared. It's actually the opposite. For the first time in a while, I'm actually not scared, and so I’m going to share with you why that is.

I work at probably the premier hospital in New York City. Our hospital is now almost exclusively a COVID-19 hospital. And what I want you guys to know is that every single day we're getting better, we know more.

And I am confident that the stuff I can tell you today should make you guys feel like when this comes to your community that you don't have to be scared and that you can protect your family."

In this fact-based video, Dr. Price stresses that it is not necessary to fear going out into the world right now, as long as you follow four simple rules to protect yourself and your family from contracting COVID-19:

  • Keep your hands clean. Wash hands frequently and use hand sanitizer to clean public surfaces you touch, such as elevator buttons, door handles, shopping carts.
  • Stop touching your face. We often do this without realizing it, so we must practice being more aware. Wearing a mask or bandanna will remind you not to touch your face.
  • You do not need a medical mask. Wear a homemade mask, so you can make sure the medical professionals have enough N95 medical masks.
  • Distance yourself from other people. Stand 3 to 6 feet away from other people when in public, and shrink your social circle to just a few people, such as your immediate family.

"Learn the rules, because as soon as you learn the rules, it is empowering. And then you can start living your life in a new normal."

 Dr. Price offers facts from the frontlines and answers many of the questions on the minds of people around the world. It is worthwhile to watch the full hour, but for those of you that don’t have the time, we have summarized, below, his family and friends Q&A information session on how to empower and protect your family during the COVID-19 pandemic. 

What is this disease?

This virus is from a common cold family, the coronavirus family. What’s unique is that the human body has never seen this virus before. It probably came from an animal and made its way into the human body for the first time.

What does the disease most commonly look like?

  • The most common symptoms are fever, cough, and sore throat, and then it goes throughout the entire body.
  • The most likely place it will affect is your lungs. 
  • For about 80% of the people, you just don’t feel well. You may have a mild cough, or maybe you have a little headache.
  • It lasts between 5-7 days and then you start to feel better.

How do you get COVID-19?

The overarching theme is sustained contact with someone who has this disease, which in the vast majority is people with fever and aches or someone who is about to get the disease in the next one to two days.

The transmission of the virus is almost exclusively from your hands to your face, and so it's passed either into your eyes, your nose, or your mouth.

There is also a small thought that it can be aerosolized, that it can kind of exist a little bit in the air. The thought at this point is that you actually have to have very long sustained contact with someone—and I'm talking about over 15 to 30 minutes in an unprotected environment, which means you're in a very closed room without any type of mask for you to get it that way.

To very simply state, the overwhelming majority of people are getting this by physically touching someone who has this disease, or will develop it in the next one to two days, and then touching their face. I think this is incredibly empowering and … that makes me smile a little bit as I know now that I won't get this disease because I know how to protect myself and so I just want to give you guys a few very, very practical tips to protect yourself.

What do you need to know?

The fact is COVID-19 is in your community. I’m going to say that again, whether you live in Texas, whether you live in Tennessee, whether you live in Florida, it is in your community right now. That is not to scare you, that is to just tell you, so that you can then take the steps to protect yourself and your family.

Why are so many getting the disease?

The reason why everyone gets this disease is because you have sustained contact with someone. So, say, for example, someone at a party has the disease and you shake their hand and then you touch your face. It's that simple, that is how you get this disease.

What steps should you take?

First thing ... We know if you keep your hands clean you are not going to get this disease.

  • Keep your hands clean and DO NOT TOUCH YOUR FACE. Know where your hands are and know that they are clean at ALL times. When you leave your home, Purell anything you’re going to touch and when you touch something, Purell your hands after. People are getting this mostly from sustained contact with people who have COVID-19. Out of an abundance of caution, we make sure that after we touch anything, we are cleaning our hands.
  • Wear a mask when you go out. COVID-19 is not a disease that you're most likely getting from the air. The reason to wear a mask is to start psychologically working on the connection between your hands and your face. It is not to prevent you from getting COVID-19.
  • You DO NOT need a medical mask. Frontline medical workers need the medical masks. The only time I wear a N95 mask is when I am in the room with a patient doing something that's going to make them have aerosolization of the virus.
  • Stay away from people.  If you do have to go out, physically distance yourself from others by keeping 6 feet away from them. 

With the four simple steps above, you don’t have to be scared of the outside world.

Dr. Price goes on to say that he has found it to be incredibly liberating that we don’t need to be afraid of our neighbors and others..

All of a sudden, the person at the store, is not your enemy, they are someone who's going through this with you. The delivery person is not your enemy, they're a hero. 

The heroes are those who must go out in service…the healthcare workers, the mailmen, the food delivery persons.

You must shrink your social circle

Throughout the world the vast majority of the spread of COVID-19 is through home and family transmission.

That's incredibly scary but it's also something that if you understand the rules is incredibly empowering.

What do I do if I develop a fever and am otherwise fine?

  • isolate yourself from your family
  • keep your hands clean
  • don’t touch your face
  • stay in a separate room, if possible
  • have your own bathroom, if possible
  • wear a medical mask if you interact with family

The vast majority of people are going to have a fever, body aches and not feel well for 3 to 5 days, feel a little awful in less than 7 days, and then they're going to start to feel better. You can start interacting with your family after 7 days, when your fever is gone. You're still going to be vigilant, you're going to be washing your hands.

What do I do if I have a mild cold?

Because COVID-19 is rampant, if you feel like you are coming down with a cold take the precautions as though you have COVID-19 for 1 to 2 days. If it is like the rest of the colds you have had throughout your life, then go back to normal. But the place we get into danger is people being too cavalier and exposing their family too early.

Can I have COVID-19 in my house and the rest of the family not get it?

Yes, if you follow the precautionary steps.

Are there exceptions?

Yes, if you have a vulnerable population. If someone in your home has COVID-19 and you have your lovely 95-year-old grandmother living in your home or someone who has had chemotherapy recently, you need to find another living arrangement for that person. Or practice incredibly strict isolation from the person that is sick. Simply being in the home will not make you sick. It goes back to following the precautions.

Who should go to the hospital, and when?

You SHOULD go to the hospital, if

  • You are feeling short of breath (i.e., you get up to go to the bathroom and feel short of breath) 

You should NOT go to the hospital, if

  • You have a fever
  • You THINK you have COVID-19
  • You continuously feel body aches

At Cornell a lot of the people that are coming to the emergency room we are sending home to live out the four or five days of the disease until they feel better.

If you get up to go to the bathroom and feel short of breath, those are the people that should come to the hospital to be evaluated.

What percentage of people who get COVID-19 develop shortness of breath?

Of the entire population of people who get COVID-19, about 10% develop shortness of breath. Of these 10% only 2% to 3% require admission to the ICU to be put on ventilators. The vast majority, overwhelming majority, come off the ventilators and they usually come off in 7 to 10 days.

The most common question I get is, if I get COVID-19 and go to the hospital, am I going to die? The important thing for you to know is that going to the hospital is not a death sentence. It’s a safe place for you to go to the hospital when you’re short of breath.

Should I get tested for COVID-19?

If you have symptoms like the flu, it is likely that you have COVID-19. Nothing that I have told you would change by knowing that test result.

Yes, you should absolutely get tested if your community has clear access to tests, because when it is negative, then in a day when you are feeling better, you can have full interaction with your family.

However, if there are limited tests available in your community, DO NOT jump the line in front of someone who is actually short of breath and really not doing well just to make yourself feel better. Just take the precautions I have shared.

How does the virus affect infants, newborns, and children?

We don’t think it is vertically transmitted. We believe it is after birth through direct contact.

The thing that makes a lot of doctors and parents very happy now is there are almost no cases of the disease in the population of 0 to 14. I’ll just state that again.

Kids are not getting sick.

There are some exceptions… in a pediatric hospital in WUHAN with 300 children, 2% to 4% had COVID-19 which really looked like cough or asthma. Kids are not dying, and they are not getting critically ill.

Are kids transmitting the disease?

That is a whole other debate and I think it is probably true.

As a healthcare provider, I keep reading conflicting information on whether COVID-19 is airborne versus transmission by droplet. Do they actually know for sure?

The vast, vast, vast majority is by droplet.

Translated that means hands to face. A droplet from the mouth falls on a surface and is then touched and put on the face. The only time we wear N95 masks is when doing something to the patient that makes them get secretions out or spit. Eighty percent of the time that the nurses arein the room with a patient, they’re wearing a simple surgical mask. In Hong Kong and Singapore, taking those precautions, there was zero transmission to healthcare providers.

Are healthcare providers getting sick?

We do have healthcare providers that are getting sick, healthcare providers on the frontline that are not protecting themselves. These were mostly general practitioners, early on, that three weeks ago didn’t know how to protect themselves.

What our experience is in our hospital, if you wear the proper protection, zero people get sick.

In NYC is it safe to go on a run or a walk, taking into consideration the social distancing measures?

Yes, please. If you are in the city you can go outside, just follow the rules. Don’t come within 3 to 6 feet of one another. Say hello, smile! But don’t get sloppy. It is safe in NYC and Philadelphia to go on a walk, just follow the rules. I encourage you to wear a mask, because as a society, we need to train ourselves not to touch our face and we need to tell people we are taking this seriously. A simple bandanna is a great idea for a mask. Because the surgical mask doesn’t prevent you from getting the disease. The mask is to help you remember not to touch your face.

What if you don’t have Purell?

COVID-19 is a wimp. You can kill it with any disinfectant. If you don’t have Purell, push the elevator button with your elbow. Open the door with your shoulder. And if you have Purell, only use a small drop.

Is it necessary to wipe groceries down in the house?

I think generally, no.

What if you are having food delivered? 

Have the person leave it outside your door. Pick it up with a glove.

Is it safe to get Starbucks coffee through drive-through?

It’s better to have your coffee at home, stay home. If not, follow the rules.

Do I need to wash my clothes as soon as I come home?

If you are generally going out and following rules, then absolutely no. If you are a healthcare worker, then yes. 

If I become sick, how long should I wait to go to the doctor or hospital?

Don’t go to the doctor or the hospital unless you are short of breath.

I encourage you to use telemedicine. 

Is there clarity of incubation period, dependent on exposure?

I think the incubation period is probably dependent on the exposure, so the incubation period can be a day to 14 days.

What age group does this disease effect?

It affects everyone who is not in the age group of 0-14 years old.

People who are 35-45 with no medical conditions are getting this disease and going on ventilators. There was a very evil narrative early in the disease that said that this was only a disease of old people and those with other medical conditions. That is not true. All I do is take care of patients and this hits the entire spectrum of ages. You can get this disease from age 16 to 105 and end up on ventilation. The younger you are, the less likely that is to happen, the older you are, the more likely that is to happen. It is not to scare you, you just need to follow the rules.

Is it ok to use ibuprofen?

We are NOT using ibuprofen. There is very interesting data from Germany that there are worse outcomes and people have more inflammation who use ibuprofen. So, the simple answer is, if you have a fever take acetaminophen, Tylenol.

What is it like treating these patients from the frontlines?

It is fascinating. They all look the same. Cough, they just have fevers, a lot of people are understandably nervous. If we put you on a ventilator, it is so we can take you off. So, don’t be scared to go to the hospital if you are short of breath. We will take care of you.

Do hospitals need home-made masks?

No, those are good to wear out in public. If you are sitting on N95 masks, you don’t need them, you should give them to the medical community that needs them.

Do you expect second or third waves – spikes in the disease?

Yes, social distancing will be four months to potentially a year. The first thing to do is flatten the curve, bring down the number of cases so hospitals don’t get overwhelmed. By human nature, people become relaxed, that will cause a second small spike and after that it usually comes under control in the population. So social distancing is something you just have to put in your brain.

If you are unaware you have the virus, can you infect other people?

Yes, this comes from the acute cruise-ship data. Yes, there was a big concern about asymptomatic spread, meaning people who never have symptoms of the disease spreading it to people who then have symptoms of the disease. It turns out that most of the people who receive the virus from someone else—the person who they received the virus from becomes symptomatic in one to two days so it's likely that people who get this disease are shedding the disease one to two days before they have fever. So, what does that mean practically? It means that if you develop COVID-19 and have a fever, know who the people are in your life or who you interacted with over the prior two to three days and let them know because then they can follow the rules, they can isolate themselves in their house, they can create a separate bathroom and then after two to three to four days, if they're not feeling symptoms they're probably not going to have COVID-19 disease. So, the simple answer to your question is yes.

Are people immune to COVID-19 after recovery?

Yes, people are absolutely becoming immune. The stories about rebound symptoms is usually the fact that they just have not fully recovered. The vast majority, so 81,000 people in China who got this disease, 76,000 have recovered with antibodies that prevent them from getting the disease in the natural course of this disease. That is that once the world sees the Coronavirus now as a pandemic, it will enter the circulation the same way a Rhino virus circulates. As it mutates, it will get milder and milder. Five years from now the Coronavirus will just feel like a cold. Just not the first time through the population.

Have you treated any pregnant women and is it more severe?

I have seen zero pregnant women in our ICU. The disease affects men and women, but we’re seeing a male predominance to this disease. But I don’t see anything unique to the pregnant population. Just follow the rules.

Is social distancing the new normal?

Social distancing is something that you need to just put in your brain. I think it is something that is just the way of life for the indefinite future. But now that you know the rules, it’s not something to be afraid of. It is just a different way of interacting as it becomes controlled over the next three to nine months. 

Learn the rules, because as soon as you learn the rules, it is empowering. And then you can start living your life in a new normal.

REFERENCES:

Sources and Further Reading:

Dr. David Price, Family and friends information session: Empowering and protecting your family during the COVID-19 pandemic (video). Weill Cornell Medical Center. March 22, 2020. Retrieved from https://vimeo.com/399733860.

Coronavirus (COVD-19). How to Protect Yourself. What To Do If You Are Sick. Center For Disease Control and Prevention (CDC). https://www.cdc.gov/coronavirus/2019-ncov/index.html


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