UC San Diego Doctor Weighs In On Role Of Underlying Conditions In COVID-19 Deaths
KPBS Midday Edition Segments / May 18, 2020
The COVID-19 death toll in San Diego County is now over 200 people. Most of the fatalities involved patients with underlying health conditions. This has led some to question whether people who have chronic illnesses and succumb to COVID-19, should actually be counted as COVID-19 victims.
Speaker 1: 00:00 Governor Newsome said today that hospitalizations have declined 7.5% over the last two weeks and ICU patients have declined 8% he says the state has distributed tens of millions of masks and trained an extra 500 tracers bringing the total to more than 3000 Newsome leader new guidelines that counties must meet if they are to move into the next phase of reopening. Previously, counties were prohibited from reopening if they had reported coronavirus deaths in the last two weeks. Mayor Faulkner and others said those were too unrealistic expectations. Now new some says regions can reopen additional parts of their economy if they have stable hospitalization rates have no more than 25 individuals diagnosed with covert 19 per a hundred thousand people in 14 days and see rates of positive tests at no more than 8%
Speaker 2: 00:48 we estimate roughly plus or minus. Again, it's a dynamic number. Roughly 53 of the 58 counties would be eligible to move into this phase. Again, not everyone will move into this phase a and that eligibility is conditioned on the criteria, uh, that we're putting out
Speaker 1: 01:08 so far. 24 California counties have reopened at a faster pace than the state as a whole. Accounting for about 5% of the population Newsome says pro sports. We'll start again in June without spectators. He says he is working with face based leaders so the congregations can eventually meet again within weeks rather than months. The San Diego County board of supervisors is expected about Tuesday on an accelerated reopening plan
Speaker 3: 01:34 as of Sunday. The coven 19 death toll in San Diego stands at 209 people. Most of the fatalities involved patients who had what's called underlying conditions which made them more vulnerable to the life threatening effects of the virus. This has led some to question whether people who have chronic illnesses and succumb to Cove at 19 should actually be counted as covert. 19 victims, San Diego County supervisor Jim Desmond has reportedly been among those questioning the death toll. Here's Desmond on K USI this weekend
Speaker 4: 02:07 only six were due purely and solely by covert, but what that tells us is those were the underlying conditions. Need to have all these protections in place. We need to have all of them, but not everybody.
Speaker 3: 02:19 Joining me is dr Francesca [inaudible], the medical director of infection prevention and clinical epidemiology at UC San Diego health and dr [inaudible], welcome to the program.
Speaker 5: 02:30 Yes, it's a pleasure to be here. Now can you
Speaker 3: 02:34 clear this up for us? How do doctors determine if covert 19 was the cause of death?
Speaker 5: 02:41 It's a question of did it contribute to the death? Not so much. What did it cause the death, meaning that if a patient is admitted, uh, with symptoms and signs related to COBIT and then that's status becomes critical, the patient deteriorates and then needs to be, for instance, admitted to the ICU and then dies. Then what we discuss is the contribution that this infection may have had to the death and clearly their underlying conditions have a role in also contributing to the worsening.
Speaker 3: 03:30 Just so we're clear, then there's been talk about people dying with Corona virus versus those dying from Corona virus. Is there a distinction to be made between those two?
Speaker 5: 03:42 Clinically? As I said, we really look at the contribution that a disease or an infection may have on death. And so we don't, we don't see it as dying up. We see it as a contribution. I don't know if I'm explaining that correctly because it's never black or white. It's really multiple issues leading to a demise or leading to a worsening. It's not just one single cause or one single vulnerability that leads to death. So for instance, one may be infected with Kobe and come in, but actually one may have a heart attack at the same time or a stroke at the same time. And, and it is difficult to tease out if one died of the heart attack or one died of Colby. But because these two events happened at the same time, we talk about contribution,
Speaker 3: 04:52 well did the covert 19 cause the heart attack or stroke,
Speaker 5: 04:56 it might be associated but cause and effect is a really difficult, it's once again it's not completely black and white. They may be from both cysts, they may be hypercoagulability. But whether that is a cause, a direct cause is, is a different, we don't explain it like that.
Speaker 3: 05:20 How do you explain it?
Speaker 5: 05:21 So it's not a direct cause, but that it's simply accelerated a process or just made the process happen because they are these underlying conditions and the infection just accelerate these underlying conditions or makes these conditions more more likely to happen.
Speaker 3: 05:43 And what a death of that kind be counted as a death in San Diego County. That was a Corona virus death.
Speaker 5: 05:53 Yes. If somebody dies with an infection, that would probably be counted as a Corona virus there.
Speaker 3: 06:02 And remind us what kinds of underlying conditions make people more vulnerable and why that is.
Speaker 5: 06:07 We found, so at the beginning when reports came out from, from China and Europe, underlying conditions such as diabetes, hypertension, so essential hypertension, cardiac disease and renal disease and, and liver disease and pulmonary disease. So chronic pulmonary conditions such as obstructive pulmonary disease that is seen as a consequence of uh, smoking or other pollutants. What we saw in the United States, which I think is very interesting, is that obesity was added as a possible risk factor for complications of, of Colby.
Speaker 3: 06:58 And so considering obesity and high blood pressure and some of the other risk factors, many of these underlying conditions are pretty common, right? That is correct, yes. Why do you think questioning the cause of death of these Corona virus victims has started? Is there a controversy in the public health or medical profession arenas or is it political?
Speaker 5: 07:20 I couldn't say political. I think that for us as physicians, clearly we want to assign a contribution and once again, it's not causal. It's really a contribution. Did COBIT 19 contribute to the death as we do it for the flu? Right. For influenza, uh, we always do it because that is a part of how we then respond to these risk factors and how we try to mitigate for these risk factors. So I, I truly don't see it as a political issue. I see it more as, as an understanding of where the vulnerabilities are. And so trying to prevent, for instance, maybe people with hypertension or with a heart disease or with the chronic pulmonary conditions would be the ones receiving vaccines before others.
Speaker 3: 08:22 Now, if someone has no underlying conditions, should they feel safe from getting a bad case of the virus?
Speaker 5: 08:29 No, I think that we've had rare events with people who had no underlying conditions who had a bad outcome. The majority of people. So about 80% of of persons infected with COBIT 19 will never need a hospitalization and then 20% will need. And I think that the key information that has to get out is if we are diagnosed or if we have respiratory symptoms and these get worse, we should not wait at home. Right? We should seek care when we feel that there's a worsening. And I think some of these hospitalizations and then bad outcomes in young people are people who waited for a long time before coming into care and uh, and, and that affected the course of the disease.
Speaker 3: 09:31 Let's talk about where San Diego is in terms of controlling coven. Most days we are still hearing about covert fatalities. And just over the weekend, more than 170 new cases were reported. Are we able to say that we're past the peak?
Speaker 5: 09:47 I think that what we can say is with the public health measures put in place, we are at the top of the curve but we're not decreasing. But we are containing, there are several challenges that we are less able to control, which is a situation at the South of the border that is very difficult and we are trying to help with that clearly with a lot of cases coming in from the border of uh, citizens who, uh, are coming down with the disease and who choose to get their care, uh, in the United States. And so that is where we're seeing the majority of our cases, cases also are coming from Imperial County. And those are also the majority of those are also people who are living in Mexicali and, uh, who are crossing the border to get treatment. And so the situation South of the border is a delicate and, uh, several of us are trying to give help to that situation. But overall, I think our public health measures have been very effective. And so continuing some of those public health measures may, uh, help us to restart, uh, the economy gradually and carefully.
Speaker 3: 11:23 Finally, doctor, uh, you travel around San Diego and you see some people wearing masks when they're alone, maybe out walking their dogs. Some people are not wearing masks, some people are in groups with some wearing masks and others not. Can you remind us what we're supposed to be doing? So
Speaker 5: 11:41 the County or the is very clear. When we are out in public and we enter in contact this, this must not, this doesn't need to be close. We should be masking. And that is to protect others from the possibility of us infecting them, but at the same time to protect ourselves from possible exposure. And so I would say that the key to the success of this program is really that the population follows very carefully what the orders are and fields fields informed and that it is very important that each of us, our civic duty is to protect others from the spread of this disease. We know that we went from one person infecting nearly five persons at the beginning of the curve to now one person infecting less than one person. So really being protected and we want to keep that so-called are not really no below one so that we are controlling the spread of this infection and we can restart the economy and we can restart some of our lives, but our lives will be with masking going forward until a vaccine is not found. They will be with social distancing because otherwise we won't get out of this.
Speaker 3: 13:14 I've been speaking with dr Francesca [inaudible], the medical director of infection prevention and clinical epidemiology at UC San Diego health. Dr [inaudible]. Thank you once again.
Speaker 5: 13:25 You're very welcome and thank you for inviting me. [inaudible].