Sep 04, 2020

Rex Degner Transcript from COVID-19: My Story, Episode 1

Posted Sep 04, 2020 6:35 PM

Dr. Rex Degner:

I found out mostly through news sources, commercial news sources, before it started coming out in the professional literature. The COVID virus was first recognized back in late 2019 and gets its name COVID for Coronavirus 2019. So that's when it was first truly discovered as a new entity, an entity that is separate from a very common Coronavirus, which is out there, which is the common cold is a Coronavirus. This is a separate strain, different breed of Coronavirus that showed new infectious qualities that acted very differently from the normal common cold. And again was first discovered in late 2019, it had to be early 2020 before I started paying any kind of attention and probably into February before it started...realizing this may become something that could be serious.

So, when we talk about zoonotic diseases, it's, you know, there's many diseases that we catches human beings, and there's also diseases that other animals can catch chickens, swine, bats and many of these are specific to their host.

And so something I get, I don't necessarily spread to my dog or to others. We're used to fighting off certain diseases and we know which ones commonly affect humans and our bodies can either naturally fight them off because we've seen them before, or we have the appropriate antibiotic treatments for that. Sometimes a disease will cross species, that it will start in one species that it can live with and has learned to live with, but then something changes in it just enough that it can infect another species and that species is not used to seeing it. So it spreads rapidly through that population and we believe that may be the case with the, with the COVID virus, that it started at another species, possibly a bat and jumped over into the human population and then was able to spread uncontrollably.

The coronavirus tends to latch onto cells in the respiratory system, in your breathing system. So your nasal cavities, your oral cavity, your lungs, it can latch into different types of cells in your body. Some of which we call the endothelial cells, a special cell type and it can latch on and grow there and then cause its complications. Every patient does tend to respond differently and we're still learning why certain patients respond one way and why the other. What's interesting about this disease is it infects people and they get common cold or flu like symptoms. And if that's all they ever got, then it would be no different from a cold or a bad case of the flu.

What happens with COVID in some of our population is that the body then starts responding to that. And it's actually a secondary response that the lungs fill up with fluid, have a big inflammatory response and that's what gets people into more trouble and so it's a secondary response of your body trying to fight off the virus that your body starts attacking itself to a degree.

A lot of research is going on into having more accurate tests that we can trust every time that we do it. So we need both accuracy, I want to know if I tell you what's positive, it's really this coronavirus we're talking about. And I also want to be able to say, if I say you're negative, then you have nothing to worry about. It's combining that with a test that we can find an answer out rapidly. The ultimate goal is going to be an easily obtaintable test, maybe not one that requires a deep nasal swab, but maybe one I can just use saliva or something like that, that I can get an answer that's reliable within 15 to 20 minutes so that I can act immediately.

It's an absolute game changer to be able to have a rapid inexpensive test that is reliable. That way I could test any number of people going to a large event at the time they're going there and not worry about one or two people that I could stop from going there. The problem we have with current coronavirus, the current COVID is that there appear to be many asymptomatic patients out there. They get the disease, but do not show the classic symptoms of fever and cough and flu like symptoms, but are relatively asymptomatic or completely asymptomatic. So, the goal is to get a test that I could give to a lot of people that are running around feeling fine, but are potential carriers for a brief period of time where they'll have the disease.

New guidelines are coming out. They're wanting to test all nursing home personnel twice a week, symptomatic or not. That can mean several hundred additional tests per week up to a thousand additional tests per week that we potentially would need to be able to do, and that's a very logistical nightmare in that the more normal quote, asymptomatic people I'm testing and the more volume I'm running through, it tends to back up the system. So when I have a patient that shows up, that's showing symptoms, those are the ones I want to find out right away and I don't want them to have to wait in line behind a large amount of screening tests. Our testing capacity is increasing monthly, weekly, and as we get deeper into the fall, we anticipate many more rapid tests available in the community and across the nation. There still is unfortunately, a supply chain issue across the nation of getting the number of tests to all the places that in a perfect world, you test everybody every day, but that's not realistic, and so it's the balancing act between the number of tests we have and who to most appropriately test.

The earlier you find out the more treatment options you have, and the understanding currently is that you are potentially starting to shed virus maybe the day before you start showing symptoms, but part of it relates back to how much virus is in your body that you're potentially shedding. And the thought being that until you're starting to show symptoms, your viral load is not big enough for our test to pick up. If I test you when you're asymptomatic, I may miss you because you just have a very small number of viral particles. By the time they become symptomatic, the thought is you've have more viral particles around. So it's easier for us to pick up one of those to potentially find it.

Part of it is the sensitivity of our tests and part of it is are we wasting resources that are somewhat limited on a population? If I think that I only have 5% of my population positive, do I waste 95 tests on asymptomatic people or do I wait and use them for the ones I really need? Most people, the vast majority of people come out of this disease just fine. And so, initially we saved all our tests for the ones that were in the hospital, potentially in an ICU intensive care unit, the ones that most need the most advanced treatment, if I'm relatively asymptomatic or completely asymptomatic, there is no treatment to take. And so, although I want to keep you out of the population and keep you from spreading it and that's very important, I also want to save my testing for the ones that really need some of these valuable treatments

From an infection rate standpoint, it is relatively easy to spread and so we do have community spread and it is by droplet. So some of the diseases we worry about if they're only bloodborne spread or something like that, that takes a very close, personal contact with somebody in this case, it just takes, you know, your droplets fall on me or it's something that I touch. It's not spread, I have very little worry, if I touch something that somebody has coughed on, as long as prior to touching my face, I've washed my hands. Skin is an incredibly protective layer that will fight off 99.9% of diseases that it touches. It's the fact that I have it on my skin and then touch it to an oral cavity, my eyes, my lips, my mouth, that's how I spread it. So the concern that I'm going to pick up COVID touching something in the grocery store, touching a door handle, although it's potentially there, it's really only potentially there, if after I've touched that I haven't washed my hands prior to touching my face from a disease prevention perspective.

I mean, I agree. I find masks annoying to my life. I look at my phone and it won't recognize me. I've got to punch in the number, it's inconvenient. But, it is not only protecting me. It is protecting others. I do believe that they have an effect on slowing the spread in close personal contacts. And so they do have a use. It's really a small price to pay, to reopen the economy, reopen the schools, to go through this process til which time we have a vaccine, or we've had enough spread in the community that we develop what we call herd immunity enough people have had it that you, you don't spread it near as quickly.

As far as when a vaccine will be available, they're working on this worldwide, which is good. And I would hope that should any country develop it, the technology will be shared widely. It's my belief at this point that by late fall, early winter, that we have vaccines that are becoming available to the general public. Hopefully by the first part of the year, 2021, we are ramping up and ready to do it. I know they have a program where they're getting all the infrastructure, it takes an incredible number of vials and needles and things like that just to distribute that many vaccines. So they're rapidly working on that. So as soon as one is developed, they can mass produce it and get it out to everybody. I think the testing in a way is going to come first. It's rapidly ramping up, so that will be good.

As far as treatments, you know, our treatments for actual virus are only marginally effective. What we will improve on is treatments of the, what we talked about earlier, the secondary symptoms that you get, you get the virus, and I may not be able to treat the virus specifically, but I can treat your body's response. The one that causes all the big inflammation in the lungs, we're becoming much better at understanding that process and treating that more directly so that the COVID virus will act more like a common cold, or a common influenza and not get the severe secondary effects.