From Washing Your Hands to the Importance Of Social Distance: A Physician's Guide To Combating The 2019 Coronavirus
Physician and ER doctor Arabia Mollette breaks down the 2019 coronavirus, the differences between social distancing, quarantine, and isolation, what immunocompromised means, and more.
As COVID-19 — more commonly known as the 2019 coronavirus — continues to make its way across the United States, it's understandable that many people are panicking in the face of this ever-growing pandemic. Which is why it's so important that we remain informed — and not misinformed — about what is currently known about the virus, and the preventative actions we can take against it.
There are a number of people at clinics and hospitals across the country that are risking their safety to not only help those who may have the virus, but to learn more about it in hopes of stopping it from worsening. Dr. Arabia Mollette is one of those people. As a physician and ER doctor at Brookdale University Hospital Medical Center in New York City (and host of the podcast series The Visit), Mollette hasn't only been caring for her usual patients — heart attack and stroke victims, as well as those who are just battling the flu — but those who may or may not have the coronavirus.
The fact that flu and coronavirus symptoms — breathing difficulties, coughing, high temperature — overlap has only complicated matters for Mollette, with variables such as a person traveling to any of the high-risk countries listed on the Centers for Disease Control and Prevention (CDC) or potentially coming into contact with someone who is positive with the coronavirus, separating flu season patients from coronavirus ones.
Mollette has also seen how ill-prepared America's healthcare system is as a result of coronavirus. That in a country of approximately 300 million, there are only approximately 100,000 intensive care unit (ICU) beds, and 65,000 of those beds are already filled with stroke patients, as well as those battling the flu or have severe cardiac disease. That there are only 160,000 breathing machines (mechanical ventilators) to both blow air into patients' lungs and maintain proper levels of oxygen in the blood. That many Americans lack access to an affordable primary care physician that they know and trust.
Despite these challenges, Mollette hopes to stop America from following in the footsteps of other countries like China and Italy, the latter of which has been hit by coronavirus so badly that health care workers may possibly be forced to prioritize treatment of patients whose survival is more likely over elderly patients. But that responsibility doesn't just lie on her and her peers — it also lies on us and being socially responsible, and understanding how we can curtail the spread of the virus through social distance (remaining out of mass gatherings like a club or restaurant). Just because our current presidential administration doesn't seem to be taking the coronavirus as seriously as it needs to be doesn't mean we need to follow in suit.
Okayplayer spoke with Mollette about COVID-19, what immunocompromised means, how America's mistreatment of Black bodies have contributed to our mistrust and skepticism toward the country's healthcare system, and the importance of having a good, 20 to 30-second song chorus in mind whenever you're washing your hands (like Outkast's "Ms. Jackson" for example).
Some news reports have referred to COVID-19 as the "novel coronavirus." What does "novel" mean?
Novel means new. So novel coronavirus, it's a new strand. The reason why we say novel or the new strand of coronavirus is because we, in the United States, have been exposed to three to four subtypes of the coronavirus here in our country, just as for the common cold. We've all been exposed to it so many times in our life so we're accustomed to being infected with the coronavirus, but not the new strand or the novel coronavirus.
Just to basically break it down, the coronavirus itself — the coronavirus family, is a family of viruses. There are different subtypes of the coronavirus, which is the new strand or the novel coronavirus. Then you have the three to four subtypes that we've all been exposed to so many times, which is the common cold and SARS [Severe Acute Respiratory Syndrome] as well.
In having dealt with different types of global diseases, how would you say this compares to H1N1 (Swine flu) or, even before that, SARS, and Ebola?
I will say that the rate of infections have decreased because of certain protocols, and the response of the government within those countries as well as globally.
The level or the rate of infection for both Ebola, as well as SARS, actually decreased significantly because of certain protocols, and things were said to address those issues. Unlike the new recent virus, the response was totally different. We knew that this disease was spreading. It started from Wuhan, China and it had spread from animals to humans. Then once humans got infected, then human beings started spreading it to other humans, and it was rapid.
Under the Obama administration, they took the warnings really quickly [for Ebola and SARS] and they established protocols throughout the hospitals in the United States very quickly — to screen people, to treat people, to admit people, to decrease the rate of infection, and to understand the disease itself. That, unfortunately, didn't happen this time.
How would you say Donald Trump's firing of the U.S. pandemic response team back in 2018 has affected your work?
I would say just that how it affects us overall is in the entire country, as far as the United States healthcare system. In actuality, the coronavirus definitely exposed the deficiencies in our healthcare system. We started to panic because we were getting warnings from Italy that if the government does not address the situation now, we are going to wind up having a similar situation to what's happening in Italy. Where we will have to decide who will live and who won't live. That's a major issue that Italy is facing right now; they don't have the capacity to take care of anybody.
There have been recent reports of people hoarding very necessary items, particularly N95 masks and surgical masks. Has that affected you at all?
I will definitely say it affected all of us [that are] healthcare personnel. Because when the news media was prematurely reporting about the coronavirus, patients were coming to the emergency department stealing boxes of masks. Also, other personnel from other parts of the hospital — as well as clinics — were coming into the emergency department. Or if they went into a clinic and they saw a box, they were stealing the supplies. This is where we realized we were actually running out of supplies ourselves for us to use and protect ourselves. Then, because of that, we had to line up whatever was left. We had to lock the masks up, and the only time that we would take them out is if the nurse is in triage and the patient came into our triage area and said, "Look, I'm not feeling well. I have a fever, cough, running nose, nasal congestion, nausea, vomiting, or difficulty breathing." He or she will receive the mask but no one else can. Or if it's a family member or caretaker that's with that patient, they also get the mask. This is how limited the supplies are because people were actually stealing the masks from the emergency departments and other floors in the hospital.
Who should be wearing a mask?
Depending on who you are and your age and where you are at currently, we are asking people not to wear the mask if they do not have the symptoms and if they are healthy. The reason why is because wearing a mask can actually increase your risk of infection. It keeps the droplets in but it doesn't keep the droplets out. The viral particles could still penetrate through the masks, and this is why we're encouraging people not to wear it. It does not make sense for those who are healthy and do not have symptoms to wear the mask themselves. Two, there's a limited supply.
The only time that we want people to wear the mask is if you have the symptoms. We want those people to wear the masks. When that person wears the mask, they're actually protecting others from developing those symptoms. Also, too, with us as healthcare workers, we wear a special type of mask which is the N95 respirator mask. We only wear that if we are dealing with patients that are highly contagious, so we do not wear it throughout the whole entire time while we're at work.
Another thing, too, and I want to stress this — someone also asked me, "Well, what if I live with someone who is positive for coronavirus?" Yes, wear a mask. If you're a healthy person, please only wear a mask if you're taking care of a person with suspected coronavirus.
Can you break down what immunocompromised means?
Immunocompromised means that, basically, your immune system is not able to fight off infections in comparison to somebody like yourself and myself, which is immunocompetent. So, we have an immune response to form bodies into our system, unlike those who are HIV positive or have cancer. Their immune system is very suppressed, so it will be harder for them to fight certain infections, as well as to build the immune response to anything that's foreign like an antigen or antibody that's introduced to their body.
Is that part of the reason why COVID-19 seems to be more harmful toward older people and/or people who are also immunocompromised, as well?
Right. Like you mentioned before, the immunocompromised — people who have diabetes, asthma — these groups of people are high risk because the immune system has become more and more suppressed. To be honest with you, I know we always focus more so on the elderly, the immunocompromised, the diabetic, and the asthmatic, but there has been numerous cases that have shown that healthy, young individuals have also died from this virus. What I'm seeing is that the vast majority of cases have been mild but the virus itself can progress very quickly, which can decrease survival. The difference between life and death does not always depend upon the patient's health status, age, and access to healthcare.
Viruses — and even bacteria — are known to mutate themselves, so the more mutations that a virus has, the more virulent it becomes, and the transability actually remains high. This is why we are urging everyone to please be socially responsible by focusing on social distancing. A lot of people get really confused about social distancing, quarantine, and isolation. Social distancing is about remaining out of congregate settings like church and avoiding mass gatherings like a birthday party or a concert. Basically, it's about maintaining distance whenever possible to limit the ability of the virus to spread. Quarantine or isolation restricts the movement of people within a certain area or zone to limit transferring and spreading of an infection.
If a patient is positive for the coronavirus, this is when we implement quarantine, because if that patient is positive and they go to a setting like an event or church or a concert, that person puts everyone else at risk. So we are advising people, if you are positive, stay home for at least two weeks to allow this to pass, because this is the chance for the virus to become more virulent and spread. Whereas social distances, it does not necessarily mean that, "Oh, well, he or she may have the virus." No, that's not what it is. We're just asking people to be mindful about going to mass gatherings, because there's a chance that people are positive. You may not know that a person is positive, and therefore you have to be a little more cognizant of where these mass gatherings are at.
What can people do to help either the older people in our community or the people who are immunocompromised?
In order for us overall to really understand the importance of preventative actions toward this disease, I would like for everyone to understand that the coronavirus can lead to death from lung and/or kidney failure because it ravages the lungs and it pushes our immune system into overdrive, and then it destroys our healthy cells. This is why we die fairly quickly. The vast majority of our cases have been mild and the virus has progressed really quickly, and could definitely decrease survival.
When you have that in your mind and understand that this disease can go from A to B very quickly within two to 14 days, then the preventative measures need to be taking place. Prevent the spread of infection by hand washing in warm water with soap for at least 20 to 30 seconds. A great article that I read said that if you sing a few of Outkast's songs — "Miss Jackson," that's one of them — it lasts about 25 seconds and it helps out a lot. Wipe down common areas with disposable wipes and use hand sanitizer if there's no access to soap and water. I know people are going crazy over this whole hand sanitizer thing, but I want people to understand that if you have no access to soap and water, that's when you use the hand sanitizer, but primarily you should wash your hands with warm water and soap. Warm water and soap kills the virus; it's more effective than hand sanitizer.
Do not travel to Italy, China, or any high-risk country that is currently affected by the novel coronavirus. I'm hoping that they actually put more of a travel restriction or ban not only on Americans over to these high-risk countries, but those coming from these countries and other parts of the world to come here. Now, we're considered high-risk as well. It's not fair to say, "Don't go over there." Let's also keep that in mind that we're a high-risk country, and we will also help spread the disease if we don't keep ourselves here in our homes.
If you become ill, seek medical attention immediately. It's extremely important that you alert the emergency department, a primary care physician, or a medical facility about your recent travels and exposure prior to arriving to the emergency department. I know it's very easy for us to say, "I'm going to the ER, I'm not feeling well." But keep in mind, if you have been exposed or if you have been around someone that is positive, you're putting everybody else in the emergency department at risk. So you need to let us know in advance so that we can better screen you and take care of you.
I had previously written about the false reports that Black people were either immune or resistant to the coronavirus. Why do you feel that there is always some type of false report when it comes to Black people and being immune to certain diseases? Because I feel this isn't the first time that has happened.
I think that part of it is because we've already been hit with so much in our lives historically. What we have to remember is that in the United States, African Americans have suffered at the hands of the American Medical Society since slavery. One of the earliest recollections is between 1845 and 1849, where black or African slave women were subjected to unethical experiments at the hands of gynecologist and slave owner, Dr. J Marion Sims. Then also later on, with the Tuskegee syphilis experiments, the Agent Orange experiments...I think what happened is that when we started seeing reports initially that only certain people or certain types of people were being infected with the coronavirus, I think it started off as a joke and people ran with it. You take one thing, you make it into a meme or you make it into a joke, but after a while, people started to believe it. It kind of reminded me of what happened in the '80s with HIV. Initially, HIV was known as the white man gay disease, right?
Then you started seeing Black gay men infected with HIV, so then it became the Black gay men disease. Until it started ravishing many of our family members and friends in our own community among heterosexual men and women, and then also ravaging other communities, this is when it was like, "Oh wow. This is not a joke, it can affect us." It may not be the same, but it kind of reminded me of that. Now, we definitely have positive cases of Black people infected with the coronavirus, as you can see what happened in the NBA with [Rudy Gobert and Donovan Mitchell]. We also have a 12-year-old school student that is infected with the coronavirus in the Bronx, and she is Black.
Before our actual conversation began you spoke on the Trump administration and how if he doesn't seem to be taking the coronavirus as seriously as he should be, how can we expect the rest of the country to. I wanted you to speak more on that.
We all follow leaders, right? Even though we tell our children don't be a follower, be a leader, we all follow a leader at some point in our lives. The President of the United States, he is the leader of our country. Technically, we do follow his rules and regulations, or certain protocols that were set under the current administration, whether we like it or not.
When the initial reports of this disease had arrived in the news media outlets, I felt like it was actually reported prematurely about what was happening in China and what this disease was. Initial reports were saying that the coronavirus is another type of flu; it's not, because it comes from two different families. Completely two different viruses, two different families. Then when Trump publicly said that this is the Democrats' way of trying to get back into the White House and this is a hoax — why would I expect the average person to actually take this seriously if the head of this country is not taking it seriously, and telling people that this is a hoax? That's neglect. That's negligence, and he did not take any responsibility for his actions. As a matter of fact, he didn't take any responsibility for even being around another leader that was positive for the coronavirus. So, how are we going to decrease the rate of spread of this disease if our own leader — whether we like him or not — is not following protocol?
Our "leader" just doesn't get it.
He doesn't get it. I read a report that said he was more worried about if the rates of infection in the United States increased, then it will look bad on his presidency and him getting reelected again in this upcoming election. I'm like, "That is the evilest and selfish thing I've ever heard or read in my life." That is not fair. Then another thing that I'm really concerned about is that the outbreak has brought unprecedented public attention to the lack of a mandate in the United States. Seventy-three percent of private sector workers have paid sick leave, but the remaining 27 percent who do not have it are concentrated in lower wage service jobs like retail, fast food, or if you're a freelance writer. It's places where you might not have the coverage or benefits, which is part of the sick pay leave. So, for many of these workers, they may not have the option to take a day off without losing their pay or losing their job. There may be people that are walking around that may be positive with the coronavirus, but they're afraid to get tested or screened because they're afraid to lose their job or lose pay.
That's been another interesting thing to see. If we didn't already realize the ills of capitalism, now they're right front and center in front of us as a result of this virus.
I'm going to tell you this — whether it's capitalism or socialism, each system has its own disadvantages and advantages. I lived in both systems: I lived in Cuba for many years, which is socialist, and of course I've lived in the United States for many years as well. So I can definitely see the disadvantages and advantages of both types of systems, and neither is perfect. What I will say is this: when I lived in Cuba I was diagnosed with dengue. It's a tropical disease called dengue, and it devastates many of the countries within the Caribbean as well as Latin America. It's a continental pandemic, for lack of a better word. Because of the fact that this disease is a tropical disease and occurs yearly throughout Cuba and other parts of the Caribbean and Latin America, there is a national response that takes place immediately in Cuba to decrease the rate of infection. Mind you, this is a country that also has limited resources as well, but they understand they have to take care of their citizens. Unlike here, where we have the resources, but we're living under a current administration that obviously didn't care or downplayed the entire situation.
Following Trump's address, what would you say is the focus now moving forward?
Well, I'm hoping that we will receive more funding to combat the coronavirus, and to actually help us buy more equipment to protect ourselves when we do interact with a patient that has the contagion. Also, perhaps setting up units where, if there are patients that are positive for the coronavirus, then they can be in those units and have a staff that can take care of them 24 hours a day. I'm hoping that more funding will go toward research as far as this disease as well. Again, I just think about the HIV/AIDS epidemic back in the '80s when the Regan administration pretty much blocked funding dedicated to HIV/AIDS. A lot of people have perished from the '80s and the '90s during that time, unfortunately due to lack of research and proper funding to find out what can help cure AIDS or treat HIV.
I'm hoping that this time around we can remember that history does repeat itself, and that we should do our best not to repeat the same mistakes that our forefathers have. That we need to do better at really supporting our physicians, our nurses, our inner-city hospitals, and our rural hospitals as well. It's not just inner city — in the rural areas of the United States, hospitals are closing down and people don't even have access to the hospitals. I'm hoping that more funding will properly take place in our healthcare system, and decrease the cost of healthcare. Also, increase the spots for residency so that medical students can have spots in residency so they can become doctors and also give aid to our communities at large.
You're on the front lines of this. When your day is done, what do you do to decompress and unwind?
We are black people, so I'm going to speak to it from a cultural perspective. I would say that, number one — pray, but take action. Faith without work is dead. What I mean by that is that we can have faith in God, we can pray to God — whoever your God is, what your religious beliefs are, we can pray, but you have to take action. Action meaning everything that I mentioned before about how to prevent the spread of infection. the people that I'm worried about, more so than anything, is the poor Black and brown community. I don't want us to be left behind in terms of research, in terms of funding, in terms of treatment. But I need my people to really pay heed to the warnings and to the instructions and to protocol. To really wash their hands as much as possible when they touch something, and to wipe down the surfaces with Lysol or disposable wipes. If there's a new protocol set by the CDC, please follow it and read about it. Let's not make up stories or rumors or just make up memes or these fake, pseudo-scientific articles on how to combat the coronavirus. We have no time for that now people. HIV didn't give us time, and I know that because I have family members that have fell and died because of HIV/AIDS really quickly. So we don't have time to be doing this.
We don't have time to make up regimens and tell people, "All you have to do is drink castor oil and it'll disappear," because I'm seeing that and I'm like, "No, that is not it." Take your vitamins, take your castor oil if need be — whatever you got to do to stay healthy. But also follow protocol and just love one another. See somebody that you haven't seen in a long time or call them up. Call your elderly parents up, call your elderly grandmother, your grandfather, your uncle, your elderly sister or brother. Call them, find out how they're doing, and make sure they have food in their house. Even if you don't know that elderly person, if you see them walking down the street, make sure they are good. Make sure that they are okay, ask them, "Ma'am, sir, are you okay? Do you have shortness of breath, chest pain, anything like that?" Make sure they get to the proper hospital. We've got to come together as a people, we've got to come together as a community, to fight against this.