CORONAVIRUS Q&A WITH DRS. GOLDSTEIN AND MCBRINE

Session Transcript: 16-03-2020  

Smith for State Rep: Coronavirus Q&A with Drs. Goldstein and McBrine

Printable version of this transcript: https://drive.google.com/file/d/11piSvGPzADcLo66R0Dpy0F-EYy9tWS8f/view?usp=sharing

Note: This transcript was created live during the video conference held via Zoom. The transcript has been edited, but errors may yet be found. The content of this transcript is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something included in this transcript. We assume no duty to correct or update the video conference nor to resolve or clarify any inconsistent information.

Dr. Robbie Goldstein (Robbie for Change) is a candidate for US Representative for the MA-8 (which includes many South Shore towns including Weymouth and Hingham). More information about Dr. Goldstein and his candidacy can be found here: https://www.robbieforchange.com/. Donations to support his campaign may be made here: https://secure.actblue.com/donate/robbieforchange

Dr. Katie McBrine is a Hingham mom and pediatrician practicing in Scituate. She is also the campaign manager for Melissa Smith for State Senate. More information about the Smith campaign can be found here: https://votemelissasmith.com/ Donations to support the Smith campaign can be made here: https://secure.actblue.com/donate/votemelissasmith

For more information about COVID-19, please see:
Centers for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/index.html
Mass Department of Public Health: https://www.mass.gov/resource/information-on-the-outbreak-of-coronavirus-disease-2019-covid-19

Melissa Smith: All right, it is 8 o’clock. Thanks everybody for joining, I am Melissa Smith. I am running for State Rep in the 4th Norfolk, which is Hingham and Weymouth. And I’m going to bypass that because I want to get to all the questions. Tonight, we are so lucky to have Katie McBrine, who is a pediatrician and my campaign manager, and Robbie Goldstein who is an infectious disease specialist running for Congress. I am so excited that they are going to be here and use their expertise and help us better understand the coronavirus. We are recording, so I’m going to start the recording now that I have let everybody know that this is going to be recorded. And we also have captions. Real quick, if you want to look down at the bottom of your screen, if you have the closed caption option up, it will say CC down at the bottom, and you can expand that and see captions will start. We have a live transcriptionist who is working right now and throwing my words up on the screen. If you have questions, the button just two over, if you click that you can send me a message with any kind of a question. And so we have a Zoom group chat you can type in your questions. Let’s go ahead and get started. The first thing, I want to throw this out to Robbie. Just give us the basics, what is coronavirus? Why is this so serious? What is happening right now? Give us a basic overview. Thank you.

Robbie Goldstein: I will go all the way back to basics as I feel like most people at this point have probably watch the news or read some article that tell them about the coronavirus but just to pull everything back, coronavirus is a virus not a bacteria, similar to the common cold which is often times caused by a coronavirus, this particular virus seems to be a mutation from the SARS coronavirus which we heard about a decade ago coming out of China. The difference between the SARS coronavirus and this current coronavirus the one we are seeing in this pandemic is that this seems to have more sustained human to human transmission. Meaning the previous coronavirus that happened a decade ago was very difficult to transmit one person to another and really required an animal factor, something else to transmit it into humans. We did not see that human to human transmission happened in China and from beyond China to other countries in the world. For this coronavirus, which is causing the disease COVID-19, this particular virus, it is very efficient in transmitting from person to person, similar to how the common cold is very efficient from transmitting from person-to-person it is very easy for someone who is a call to then transmit it to their friends, to their spouse, to their children, the people in daycare. This seems to have the same level of transmission. Because of that, we are seeing this widespread so many people being affected by the virus. The one thing I will say about the basics of the virus, this is true for almost all viruses, viruses often times can cause a wide range of presentations for some people they are completely without symptoms, they are completely fine and they are carrying the virus and for the people they can be very symptomatic and end up in the hospital and be in intensive care units. This parish is showing the same spectrum we often times see with viruses where many people the vast majority of people are mildly symptomatically and a runny nose and sore throat may be a low grade fever and a small percentage of people are very symptomatic, high fevers, in the hospital’s, severe pneumonia very bad respiratory distress requiring to be in intensive care units. It is very similar to many of the other coronavirus we have seen that it is also, this one is unique in its ability to transmit from person to person and the range of disease that it presents with.

Melissa Smith: Thank you so much for that, I did not realize that was the difference here that it transmits from person to person. We have a lot of questions actually about transmission. Before we get there, with questions about risk groups. Katie, could you give us an idea about what we are seeing in kids and pregnant women and just other risks, what are the highest risk groups with this?

Katie McBrine: The silver lining to this seems to be that it is mild in kids. We are not seeing the severity that we are seeing in the older population, we are not seen that in kids, which is great. They still can get it, it’s not that they are not getting it, they are, but it just does not seem to be severe in them and the same thing the data showing that pregnant women seem to not be at an increased risk which is an interesting to me because usually pregnant women are always in at increased risk categories for everything but it seems to be okay in them. The same thing we are not necessarily seeing transmission to the baby. There has to be a caveat and everything we say is that this is a new and emerging virus. I feel like everything that we say today may not necessarily be true tomorrow. And things change a lot as we get more and more information. That seems to be the information right now. The groups that seem to be at highest risk tend to be the older population starting at 50 and 60 and above. Then of course those with chronic medical conditions which seems to be heart problems and lung problems like asthma and stuff. Then of course immunocompromised always fits into that we are dealing with any sort of infection.

Melissa Smith: What about testing? Do we have tests yet? Who is getting tested? There is very confusing information with hospitals and pharmacies saying they do not have tests and to call your doctor. People are very confused about this.

Robbie Goldstein: I will start, I will explain from the hospital perspective. I work at a general hospital so I’m at a large academic medical center that has access to its own microbiology lab, and in some ways we are very able to do some of the testing that some of the smaller clinics all across the state do not have access to. I think there are a couple things a point out. What is the issue around testing is a huge issue, there is a limited number of tests and we are trying to roll out as many tests as possible to get as many people tested. As of right now, the numbers have pulled up, the Department of Public health here in Massachusetts has run 1092 tests, they are doing the bulk of testing in the state of Massachusetts. Most people who go into an urgent care clinic go into the primary care office, go into a walking clinic in a hospital, their test is going to be sent probably to the Department of Public Health. There are tests that are coming out through private companies, things like LabCorp and West diagnostics, total so far, that those independent laboratories have done around 200 tests in the state of Massachusetts. Just about 20% of what the state lab has done. Then the large academic centers are building their own tests. We have worked really hard to get a test out so that we can use it, it is very limited in its capacity and so we are still relying heavily on the department of public health to run the test that we feel really need to be run we can use our in-house test for additional tests or the Department of Public health may not be able to take the sample or that may be a backup of the Department of Public health.

Melissa Smith: Which of the tests are the ones that “really need to be run?” Katie, how do you decide who is the right candidate to get one of these tests, since they are in such limited supply?

Katie McBrine: The Department of Public health actually came out with a revision of who should be tested. Last week it was different than I think this email came out, I don’t know, the 13th. We are talking three days ago now. Previously, it was just people who had known COVID-19 positive test or travelled into a country and had the bright symptoms for it. Now it has been expanded to eight different things, six of which go to the Department of Public Health. Massachusetts is going to run those tests and the seventh and eighth which tends to be broader of testing, one of them is people you feel who are at risk, and had symptoms, you can get tested. Those are recommended to go more to commercial labs, send them to Quest and stuff. But I will take it from the clinical perspective, we don’t have enough protective equipment to protect ourselves when we do testing for a person we are concerned about. In order to test someone for this, you have to take a Q-tip swab and stick it in their nose and twirl it around and take it out. It causes them to cough and spew all of the stuff at your face. You need to have a face shield on, you need to have a gown on, there is a lot of personal protective equipment, PPE is what we call it, that is in short supply and clinics as a matter fact, we have five of them. While we would want to run tests that fit some of this criteria, we can’t do it safely in our clinic. Which is why we are hoping that places set up these tents, South Shore Hospital in the process of setting up a tent to have people come to get tested so that they will have the personal protective equipment and do it in a safe manner but it is not up and running not at South Shore Hospital, it is not up and running right now.

Melissa Smith: That actually leads into question that somebody had, specifically referencing the South Shore Hospital instructions saying call your doctor if you have respiratory symptoms. And so, if you are having genuine respiratory distress or losing consciousness, are you supposed call the doctor first or not supposed to go to them or call 911? And what if your doctor has closed the office, and maybe Robbie, you can help us there. What are you supposed to do?

Robbie Goldstein: First and foremost, we should remember if you are sick and not feeling well, you should do what you have done through or three months ago. If you are feeling unwell you should go to the hospital room. You still need to be evaluated by medical providers and get the care you may need for whatever may be going on whether it is COVID-19 or the flu or something else that may be driving all of that. I do think that we have to remember those things I remember the people do need to get medical care for anything that may be going on during the face of this pandemic. I think were the question is getting at is what we are trying not to do is overwhelm clinics and overwhelm hospitals and bring people into a setting where they may be exposed to people with COVID-19. If it is during the workday, and you feel your symptoms are mild enough that in a normal situation, you would have called your primary care doctor and stayed home and maybe not gone to work for that day and see if it might have gone away, it is recommended you call one of the hotlines the hospitals are setting up or call your clinic office in order to get instruction about where you might need to go, have some triage done, and figure out if you need to be going to a testing center, if you need to be quarantining yourself at home, or if you need to come in to the clinic for an evaluation.

Melissa Smith: Great, thank you. We have some very specific questions about transmission. First, take out from restaurants is still allowed and a lot of us want to support local businesses, we want to do this and have take-out deliveries we can make sure people stay employed people stay in business. Is this a safe thing to do? Katie?

Katie McBrine: Yeah, that is a real hard one to say yes or no strictly. Everything that you do in life has some sort of risk-benefit analysis you are going to do, right? The benefit is helping small businesses and keeping things up and running, but the risk is if someone is handling your food and someone is bringing it to you don’t necessarily know the health of that person doing that. And so, you would, this applies to anything, you don’t necessarily, that is where we have all of these rules for people who are handling food. They should not be doing it when they are sick, and they should be washing their hands and we don’t want them to spread anything into your food. I don’t think there is necessarily an increase risk per se and what we would normally see, but then I would ask you, Robbie, if you think this is more risky now and anything else that we would potentially spread, doing it correctly.

Robbie Goldstein: No, I think that there is certainly a risk and there is a risk everything we do, but I think there are many things we can put in the place to try and decrease the risk. For instance, if you are going to order takeout, you don’t need that person who comes to necessarily deliver the takeout to open the door and shake their hand and get close to them, you could have them leave outside the door and trying decrease your overall interaction with the person who is delivering the food. I would get the food and bring it inside, open of the packaging and then wash your hands. That way, you could decrease the risk of getting the virus from whatever may be on the outside. This is all about trying to decrease your overall exposure to the virus which may be on the surface that you are going to touch. Obviously, food is really high risk situation because you are taking whatever is there and it is going into your mouth and that is really how the virus is going to be transmitted by getting it your face and going across the mucous membranes in the mouth and the nose in the eyes. You want to be very careful and wash your hand to do your best all the things you my touch. I tend to say, I do think we need to support local businesses, we need to remember this is going to be really hard for them and the more we can do to support them, the better this is going to be for us overall the entire economy and everyone. I don’t think it is time to say no more to go, but it is time to just take some additional precautions.

Melissa Smith: Along that same line, we had a question about can we make things for our neighbors, drop it off outside, and another question, can we mail them letters, can we mail them things? Is that safe? Does it go along with what you are saying before about touching outside and then washing your hands and open the envelope and wash your hands, are we safe to keep participating in mail or to drop things off?

Robbie Goldstein: I would say yes, Katie, as you said earlier, things are changing everything the day and we are learning more about this virus. From what we know, the virus will last from hours to maybe, maybe a day, probably less than that on surfaces. As things are going through the mail, obviously people are touching it, but you are going to open up the mail and read whatever it is and then you are going to wash her hands afterwards. If the virus is on your hands, that is not affect everyone, it is whatever goes on your hands, you touch your eyes and your nose in your mouth and you are able to get across the mucous membrane. I think as long as you are very good about washing your hands every time you are at risk every time you expose yourself, you are going to do the most you can to protect yourself. Don’t think it is time to stop picking up the mail or making things for neighbors, don’t stop reading magazines. All of those things are still safe as long as you are very careful about washing your hands.

Katie McBrine: I will add we still need to continue to reach out to people. This is a very tough time and very isolating time. I think doing those things that we can do for each other is really helpful, right? This is very stressful receiving bread from someone would be great, that would make my day, right? And so I think we need to continue to do those things. I think that is just really nice thoughts.

Melissa Smith: Thank you. What about going to the park? Can I run and walk outside safely, or should we stay at home and exercise indoors?

Robbie Goldstein: Go outside! It is nice. Yes, you can go outside. Don’t stand right up on someone, I would hope you would give people space to begin with, and we definitely need to give people space.

Katie McBrine: Social distancing or “healthy spacing” is a nicer term that I have heard. Is that I think the space is somewhere 3 feet 6 feet or 10 feet, whatever you feel comfortable with, some sort of feet away from people so that if the cough is not in your face. Go outside, because it’s not in the air to get you.

Robbie Goldstein: I will say I went for a run this morning and I think it is totally fine to go outside. It is really important, we have to continue to get physical activity and fresh air and all those things, and we don’t have to sit in front of our computers all day, it’s all can go well.

Melissa Smith: Moving on to that to something you already touched on, Katie, someone sent in this message: “I am reading about this my anxiety is really high. How do I talk to my kids and how do I preserve my sanity through this?”

Katie McBrine: We really do have to have a conversation about everybody’s mental health because of this. This is highly stressful time and people are going to start feeling very isolated we do have to keep reaching out to people in various different ways and making sure that everybody is okay. And that is helpful for also yourself, personally. I feel better when I am helping someone. And so, that will help with my anxiety about the whole thing is making sure that I am doing good things for other people. I think talking to your kids about this in an honest way, kids pick up information all the time, they pick up your anxiety, you have to practice self-care and do you need to do in order to decrease your anxiety levels to make sure you go outside into your runs and exercises very helpful. Make sure you do arts and crafts or whatever you do to again make yourself feel better, because as your anxiety level ramps up your kids pick up on that. It’s also important to talk to them about it and how they are feeling. Kids can say the darndest things and talking to them you will have a better understanding of where they are at and you can help judge what they need for that. Robbie, what would you say about the mental health aspect of this?

Robbie Goldstein: I think it is incredibly important. It has been a really wild three days in the state of Massachusetts. I think the decisions and the rapidity of closing schools, closing restaurants, all of the things, I think they are increasing our anxiety overall. Appropriately in some ways, I think we do need to be very cognizant of what is going on, be very vigilant about making sure we don’t spread the virus any further. We have to recognize that with that anxiety we had to find a release. That is why I went for a run this morning and that is why people go for walks and that’s why people are able to turn on the TV and Netflix and chill. We got to do something that allow us to bring the anxiety level down. And I think if we were talking about, talking to kids is so critical. This is day one of schools being closed tomorrow will be day one, schools being closed. This is going to go on for a very long time and kids need to understand this is not an extended spring break, it isn’t a snow day. This is a time when we are all going to be a home and we are doing this because of our public health emergency and what that means and why we are doing it. I think there is an educational piece here and apiece I can help kids really get through this to understand why they are home for two months.

Katie McBrine: You [to Melissa Smith] had a very nice cartoon on your site [www.votemelissasmith.com], it is a nice way to cut a direct and go through talking about what this is with kids. I thought that was really kind of a nice way to look at it.

Melissa Smith: It is a good comic book. It is on my Facebook page. Or my other social media. It is really good. I showed it to my son tonight. It helps them to understand what is going on. Switching gears a little bit to drugs that might interfere with being able to recover. I got a question about steroid inhalers, do they weaken the immune system and also Flonase may be weakening the immune system. If people who are using those, should they stop? What are your thoughts, Robbie?

Robbie Goldstein: We are talking about this a little bit before the call started. I think the bigger fear is if somebody has uncontrolled asthma and then gets the virus. It will be quite severe, their overall presentation. I think it is really important we control some of the underlying medical issues that people are facing, asthma, COPD and emphysema, high blood pressure, anything like that, diabetes, we need to make sure we are controlling those things. I would be much more concerned that somebody would stop their medication and have a bigger issue than someone staying on their medication and that causing them to get the virus. It is true, I will say it is true that steroids lower your immune defenses a little bit so you will have a little bit of a weaker immune system on an inhaled steroid or Flonase but I think overall it is much greater for people to stay on those medications.

Melissa Smith: Great. And what about ibuprofen? There are some things going around social media about taking ibuprofen, that is going to interfere. What you know about that?


Robbie Goldstein: Katie and I were talking but this yesterday. Whatever research I could do to try and figure out where that came from, it seems like it came from social media without any real evidence behind it. There was evidence from folks in China or folks in South Korea or folks in Italy were taking a lot of ibuprofen and therefore had complications. I think what I could find is that people are saying if ibuprofen is something that works well for you to break your fever or help with the muscle aches you have, to help with you overall feeling unwell, it is totally appropriate for you to continue on ibuprofen. For the time being.

Katie McBrine: I just want to say ibuprofen thing was perpetuated in a lot of physicians’ groups. There is just a lot of information that is being thrown around, and it can be really hard to figure out what is accurate and what is not. I would urge people to just stay on sites that have known accurate information, the World Health Organization or the CBC would be sites I would look at, I would also recommend people’s mental health to limit the amount of time that you are looking at this stuff, we can all get sucked in on this and continue to watch it. But it has been recommended that maybe you only pick two or three times during the day think you are going to try and get updated then stay off of it the other times because that again, this constant exposure to this information can really increase one’s anxiety.

Melissa Smith: What about, routine visits to the doctor. I have a question that says, “I have type I diabetes and I am scheduled to have an A1c check this month, should I postpone while this is going on?” Robbie or Katie?

Robbie Goldstein: Yeah, the answer to that question is yes. I think this pandemic, the response that we have two it, it is really challenging our views of what is necessary, what type of medical care we need to do, every single month. And what can be deferred. I say that because the worst thing we can do is to bring a really healthy person in for a routine visit to get their air once he checked and then they are exposed to someone in the waiting room who has COVID-19 or exposed to someone walking through the halls of the clinic was COVID-19, and we have created another case by bringing that person known to the public. There must be a discussion with your provider, you should talk to your doctor or your nurse practitioner whoever it is managing your diabetes with you that I think that it is totally reasonable to miss your lab checked this month, as we can to figure out when you become safer to go back to the normal healthcare routines that we are so used to.

Melissa Smith: Okay. That actually goes into our question that just popped up in the chat about how dangerous hospitals are relative to other public locations. Are they especially, should we avoid them at all costs unless we actually need to go in? How dangerous are hospitals?

Katie McBrine: Well, I mean, we don’t want to say don’t go to them because, you know, if you need to go you have to go, it is going to be the safest place for you. If you need medical care, get medical care. You suffering at home can then make matters worse and we definitely do not want that. Right? Don’t go to the hospital for ear infections, call your doctor if you think your kid has one. Don’t go to the hospital if you think you have a sore throat it could be strapped. We want to limit the things for emergency rooms and things that are emergency because it is going to be people who are sick and you are going to be an increased risk. Don’t avoid them entirely if you need them because that is not going to be good for you either.

Melissa Smith: Alright, hospitals. Here is a question about the viability of the virus, a lot of people are using the word viable on surfaces, does that mean the same thing as infectious?

Robbie Goldstein: Yeah, I think what problem people are probably getting out there is how long does the virus remain on the surface and being able to transmit to you, that you can then get the virus if you put your hand down and then touch her mouth or if someone sneezed or coughed somewhere and you sat there and had your lunch. The answer to that is not entirely known right now because this is a new virus so we don’t have all the answers on how long it exists on surfaces, but we are sort of extrapolating for we know from other coronaviruses and from other viruses. Somewhere in the order of four hours to may be up to a day that it will exist on a surface. It is clean, you are able to get rid of it if we use appropriate cleaning supplies. We should not be concerned if we are cleaning things appropriately, and we are washing our hands with soap, using hand sanitizer. We will be able to get rid of this virus. It is important to do that kind of hygiene and to really try and protect yourself.

Melissa Smith: Alright. Here’s a question about tests. If we had enough tests and could test everyone, but just knowing how many people actually have the virus and who doesn’t help slow the spread, does that go to flattening the curve, and if we were able to test everybody in the US, with just having that information help us contain this?

Katie McBrine: I think having that information would be really helpful to our numbers, right? Right now we are only testing the super sick and those numbers make it seem like it is more dangerous than it actually is. If you are only to see the people who are very sick and those of the people that are dying, then your mortality number goes up and it seems worse. We are not testing the mild people, which would increase the numbers, and give us a more accurate representation of how dangerous this virus is. That I think would be helpful for that, just help prevent the spread, the more people you know, the more you can quarantine them. Robbie, what is your take?

Robbie Goldstein: Now, I completely agree, in every country where there has been huge numbers that we see, we don’t have a great sense of what the asymptomatic or mild cases, what that number is. And so, because we are not capturing those people who have mild disease or completely no symptoms at all, it looks as if the severe complications are very common, the mortality is very high these individuals. And so we need to sort of test as broadly as we can to get a better sense of how severe is this illness and how severe—how likely our people to end up in the ICU or end up in the hospital if they have it. In the second part, as you say Katie, if we knew everyone who had it we would say those people, you need to keep a healthy space from everyone in the rest of you can go back to work or you need to stay home and the rest of you need to go back to schools.


Melissa Smith: Okay. Here is one that just came up through the chat. In terms of patient’s testing positive, how is Massachusetts trending in comparison with the rest of the US? Are we consistent with the country or are have flattening the curve measures started helping? And what is the bottleneck for testing? How could this change as testing expands?

Robbie Goldstein: I have to say, I have not gone and looked at all of the numbers state-by-state in terms of how we are doing in Massachusetts compared to a state like New York or California. There have been a lot of comparisons in numbers, our numbers seem to be 11 days behind the numbers of Italy, which means that as Italy ramped up and now has had just yesterday had over 350 deaths from coronavirus, that was all sort of, it seems as though we are heading in that exact same direction in terms of the total number of people that are infected and potentially the mortality that we are going to see. I think one of the problems in Massachusetts is that really, social distancing and the quarantining and the closing of restaurants and schools did not really start in earnest until today. And so even yesterday there were people out at restaurants and on the streets and in large groups. And so even in the state where we have implemented very appropriate public health measures to decrease overall contact, we still are going to have this huge flag of people that have been exposed for a long time and we are good to see the numbers move up after that. It is good to be really hard to know if our measures are working. probably a week or two to see if everything is coming down.

Melissa Smith: I guess we don’t have the test for this at the moment, so this is probably not a possibility, but is there a role now for surveillance testing? I guess that is sort of what we talked about earlier about that we could test everybody. What would you like to see surveillance testing for the asymptomatic people?

Katie McBrine: I would like to see testing, I would like to test. We are not even at the point where clinics are able to test symptomatic patients, let alone a symptomatic one.

Melissa Smith: How do we support doctors? And nurses? And other medical professionals who are on the front lines of this pandemic?

Robbie Goldstein: I think the number one thing you can do is social distancing, washing your hands, and keep yourself from getting sick because if we can, as you talked about, flatten the curve and spread of the numbers, it is going to make everyone in healthcare settings, it is good make their lives so much easier. This is going to be challenging, it is can be really hard to get through, but if we completely overrun the healthcare system over the next month, it is going to be very hard for the healthcare system to respond.

Katie McBrine: Going to reach out to all of the medical professionals you know and to ask them about their mental health, this can be very stressful for them when the start ramping up. We all go into this field because we love people and want to help them. Sometimes the detriment of our health will just keep going and going and working long shifts and continuing to do this. Remembering to reach out to those in your family and to make sure that they are doing okay and do what you can do to help relieve some of their stress. It is nice. It is good.

Melissa Smith: Along that same line, what do people in the disabilities community need to do regarding personal care assistants regarding their visits? Are there more steps we need to take beyond everybody wash their hands?

Robbie Goldstein: You know, I think it is very challenging when you work in the healthcare setting. I think we all who are physicians and nurses and personal care assistance and medical assistance and all the people who are working on the front lines, we do this because we want to care for people. We do this because we want to help people through these types of situations. And so, those personal care assistants are still going to have, they are so can be needed and still have to go into those homes will stop what we need to do is try and protect them as much pecan. Some of that is going to be to make sure they have the personal equipment they have or investment from the state and federal government to make sure we can get more personal protective equipment. Some of that is recognizing that these are the people we need to test and when the test becomes more widely, we need to make sure those healthcare workers who are going in and out of homes all the time have access to the tests so that they are not spreading the virus we go from home to home. I think there is a lot of support we need to give to healthcare providers and in particular, those that are just so on the front line, medical assistance.

Melissa Smith:
Yes. All right, great. There are a couple more questions rolling in. What are your thoughts on the federal government’s response to this pandemic and are the things the government could have done sooner to decrease the severity in the United States? I guess, since you are running for Congress, Robbie, I will let you take that one first.

Robbie Goldstein: So, I will say I think that we are now at a point where the federal government has woken up to recognizing this is a pandemic that has the potential to affect millions of people across this country and lead to a large number of deaths and a lot of people who will end up in the hospital. I think the response we have seen over the past 48 hours from state and federal government officials has been really, really important to begin to stop the spread of the virus. I think we do have to recognize, and we probably will about 2 to 3 months after all this is over. That some of what we are seeing right now was quite predictable. Over the past eight years, there has been systematic defunding of our public health infrastructure, there has been a dismantling of our emergency preparedness response to pandemics like this, to infectious threats that might come into this country, those decisions have consequences and the consequence is we are seeing our we are living now. We are experiencing what happens when the CDC and the National Institutes of Health do not have the resources they need to stop the virus before it gets to our shores. Right now, all hands are on deck in order to prevent the spread and to mitigate the effect of this virus, but if you must when this is all over I think we have to have a very serious conversation about how we need this country and how were we invest our money so we can prevent the next pandemic.

Melissa Smith: And Katie, to sort of follow that, how do we in the future, how are we going to get our leaders to pay more attention and to plan for a pandemic and to make sure that we have the resources in advance of a real problem like the one we are seeing now?

Katie McBrine: Elect new people.

(Laughter)

Katie McBrine: We do need people, I see this all the time, more diverse, we need more diversity in our government, we need people who are medical professionals, we need people who are, who kind of understand working middle-class jobs. Right now we just have a lot of lawyers, which are great, but we don’t need any more because there are chunks of knowledge that are missing and they can’t be experts on it, and that is why having different people in office would be better, and we need to push or people who are in office to do more outreach. I think people have been really, again, there’s so much information that is going out and it is really hard to decide what is accurate information and what is not accurate information, and people look to the people that they have elected to be their leaders to tell them what they should be doing. I think we need to have better leaders who are coming out and coming up with pamphlets that are easier to read, or videos that people can watch because people learn things in all different ways too not everybody gains knowledge by reading a really long post regains knowledge by watching something. We do have different platforms so that we can reach across two more people in whatever way they learn to understand information.

Melissa Smith: Great. All right, another question that has come in. Are we building more temporary hospitals like they did in China, I think we are talking but the tents earlier, Katie. If we are not, is that a good idea so we can have more beds to treat more people as this comes on?

Robbie Goldstein: At least so far in across the country, of building additional hospitals, there are these surge areas that hospitals are trying to bring in to do testing outside of the doors of the hospital, to try and decrease the number of people that walk in. I have not heard yet that we are opening up new facilities, there has been talk about now the all the schools are closed, we need to use the schools for hospital space, stadiums, things that you have seen in the past. For right now, that is not the case, but I think we are at the beginning of this pandemic. We have to remember that though this is not something that will go away tomorrow when wake up. We need to actually plan for the next probably 60 weeks of a sustained increase in numbers of new people that are affected and people requiring a hospital and because of that, we from now we may be looking at a place that the hospital beds we have available are no longer enough and we need to expand our capacity to school or to a stadium or something else to make it made more care for everyone.

Melissa Smith: We have one specific question: “I work as a staff member at a college in Massachusetts and we are supposed to come in. I don’t feel safe to go to work and expose myself. Why are staff not being told to stay home? Is this safe? How we flatten the curve if nonessential employees are coming to work, and what should I do?”


Katie McBrine: Anything we can do to decrease people coming in contact with each other is ultimately what we want to do, right? Just because it is necessary does not mean it is easier. When I spoke with an epidemiologist, that is what she told me that really stuck with me. If you do not feel safe going to work, then I think tell your work you don’t feel safe. I understand that, and work should hopefully understand that. We have to do all the things that we can do, having said that, Dell’s got to be paid in life has to go on. And we still have to do the things that we have to do in life, again, it is risk-benefit analysis. If you cannot go to work, then don’t go. But that is very individualized that can you do it, what is all the things you have to look at in your life in order to make that decision to do that or not? Then that’s what makes this really so complicated to of closing schools, yes, that is what we need to do, we have to get kids and spread everything to everything else, stop hanging out with each other, but that is a whole host of problems is what we do with childcare, how to healthcare workers now have their kids get watched because the staff to be on ground zero for this pandemic. We still have to answer those questions, we still have to have the conversations about those questions and figure those answers out. But I mean, to answer your question of should you go to work, if you don’t feel comfortable, don’t go, and everyone not going to work is more healthful for not spreading this.

Melissa Smith: Alright. I don’t know if either one of you would know this, but how much of a ventilator shortage are we facing nationally and in Massachusetts? I think we heard earlier today, that it has been suggested that states supply their own ventilators or figure out where they are going to get them. Can they do this before the outbreak peaks? How bad is this?

Robbie Goldstein: I think there is a larger question here. There are just around a million hospital beds and around 35,000 ICU beds in the country. We are expecting or modelling that somewhere around 120 million people may be affected by the end of this pandemic here in the United States alone. Even if only 1% of those people had to get admitted to the hospital, that is more than the number of hospital beds we have available. Even if less than half a percent are needed for an ICU bed that is more than we have for this country. There is a theoretical shortage of these beds and of this equipment, and that is something we have to recognize now which is why it is so important early on to think about testing the viability and to give out social distancing a think about the public health measures to try and flatten the curve and spread the so for as long as we can. We can absorb a million hospitalizations over time but we can’t do it all at once because we will end up with not enough beds in our hospitals.

Melissa Smith: Right. All right. I think it kind of leads to this next question. How are we treating undocumented people in this pandemic? The mass health extensions don’t seem to cover undocumented people. Can they get treatment and testing if they show up to the hospital?

Robbie Goldstein: In the state of Massachusetts, they absolutely can. They will cover those that are undocumented in the state and will make sure that they have the coverage they need in the hospital for their care. But I think there is an enormous concern that I have about very vulnerable populations and their ability to get the care they need. I think immigrants of this country are one of those populations and we heard over the weekend about a worker in a detention facility in New Jersey who tested positive for COVID-19, which increase the risk for the rest of the facility being contaminated. Across the state and what we are going to do if shelters begin to see transmission of COVID-19. I think we’ll have to think about seniors who are living in senior living centers and in nursing homes where the epidemic in Seattle hit hard in nursing homes across the city. In huge numbers of people came in we have a confluence of people living together, people who are elderly with weakened immune systems and a virus that spreads very easily and the time that they did not know anything about it. These populations are very vulnerable and we need, we certainly need to take care of everyone in the common law believed to have a dedicated task force that will address how we need to care these people in these populations.

Melissa Smith: So, we do not have the dedicated task force?

Robbie Goldstein: I don’t want to take anything away from the public health commissioner and the various health commissioners. I think they are doing a great job. But I think we are anticipating a huge number of people who are in those vulnerable areas. Another when I think those who use drugs that are going to methadone clinic are forced to go in and socialize with other people they are going to be a risk for getting this virus. We are going to see that some of these, the prior academics that we were seeing in the state are going to play out with this COVID-19 for many months to come.

Melissa Smith: And so, we one more question, this is kind of a long one here: “I know that with other viruses, there is an issue of viral load. Some people are really contagious at certain time, maybe after initial exposure, and they are more infectious and contagious. If exposure to low amounts of the virus, does that mean your immune system or your immune responses can more readily handle that? Why are immune responses so different in different individuals? Is it about the exposure or their physiology?”

Robbie Goldstein: I think a little bit about both, I will start by saying that certainly people are more infectious when they are very symptomatic, when they are seizing more and coughing more and when they have higher fevers, when they are kinda bringing out more and more of the viral particles that they are more infectious of the time. In the height of one of those infections is going to lead to more risk of getting the virus. But there is also, there is a part of this with people’s immune systems. Someone who is younger and healthier and has a better immune system is going to be much better off at fighting the virus and someone who is older and has a weakened immune system or whatever the reason may be and we are seeing that play out, that is what we saw in China and South Korea and Italy and that is what we are seeing here in the US as well, it has a lot to do with your underlying immune system and how well you fight it.

Melissa Smith: Katie sort of a wrap up question: Which systems should trigger us to call the doctor immediately and try and figure out how to get tested?

Katie McBrine: I think call the doctor whenever you are concerned. If you’ve got a concern, call your doctor. There are not really any silly questions. The best I can tell you is that it is okay and you don’t have to worry about it. But I don’t want you to not call me if it is something serious because again, if you are ignoring something serious it only gets more serious than it is far more problematic for us to try and treat and get you better. The symptoms of COVID-19 are fever and about 80% or so and correct me if I have these numbers wrong, 80% it is coughed, typically dry cough, fatigue, muscle aches, and pains, just general unfeeling well, in a smaller amount, sore throat and smaller amount it is diarrhea. Those are kind of the things that we have seen for it. If you fever and you have cough and you have muscle aches, call your doctor. They could better triage what is going on with you and your medical conditions, or what they would be concerned about, again, testing keeps changing on a daily basis, maybe we will have the ability to test a view can go into the office and they can send you to attend so you get tested. Or if it is more serious you have a shortness of breath or trouble breathing, go to the emergency room will stop reading is pretty important so don’t mess around with breathing, if you have a hard time breathing, you just go in. That is kind of what I would say. There is a lot of grey area and I wish I could give you more definitive stuff, but I can’t. Everybody is a little bit different, but definitely call if you are concerned.

Melissa Smith: There is one more question here. If you live with someone who has high risk, should you consider yourself high risk as well and sort of behave that way to try and minimize the amount that you bring into the home?

Robbie Goldstein: I would say absolutely, if the person is at home with you or someone has a weak immune system the person whose home with you is your grandmother, your father, that is older, you should take the same precautions that you would want for that person. That is why it is so important that we all do this together. We are not social distancing us early for ourselves, we are social distancing for the people that we love to become into contact with.

Melissa Smith: I missed one online: “How do I tell my 15-year-old to stay home?” Tips for that?

Katie McBrine: I would just sit them down and explain how serious this is. Teenagers are great, they can process large amounts of information, and I think just sitting them down and explaining again, how we need to do our part for everybody. It’s not necessarily them, they will probably be fine. But how about their grandparents and how about everybody else? And kids are great, and they will get it. They will try. And they also try and sneak out of the house, too, but that is just teenagers.

Melissa Smith: Alright. We are almost at the end of the hour. And I need to tell everybody I am running for the 4th Norfolk, which is Hingham and Weymouth. I have my website and everything on my Facebook page which is where most of you guys came from. And Robbie’s links are there as well. You can make a donation to his campaign or find out more about his campaign. Robbie, would you like to say a couple of things about how people can get you elected to Congress?

Robbie Goldstein: I want to say thank you for inviting me to do this. I had a good time and hopefully people learn to something and feel a bit more empowered about their knowledge about the coronavirus. As you kind of heard as I was talking about, I think it is really important that in this year we elect people who understand the different perspectives that are necessary to govern appropriately and that includes people who come from the medical background and have a science background to think about the data and the evidence that are in front of us and make sure that we are putting forward policies that will make us safer and also make us healthier as a country. So much of what I talk about is about healthcare, it’s not just an insurance card in your pocket is making sure you are protected when you walk into the grocery store and making sure you are healthy everywhere you go. As you said, you can learn more about me for my website which is on the Facebook page which is Robbie for change.com. You can link your page to make a donation but what really matters to start a campaign to reach out to become a part of the campaign.

Melissa Smith: Thank you so much. And yes, government is how we take care of each other. I look forward to making that more of a reality in the coming year. Thank you all so much for logging on, if you continue to have questions, please send them to me I will pass them on and try to get the answer. And yes, you can get the recording, it will be posted tomorrow once we have the transcription melded with the video, the whole thing. Yes, I will post it tomorrow.

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