RECAP: Answering COVID-19 Questions with Dr. Lenora Lee

Dr. Lenora Lee is an Infectious Disease Physician, Teaching Hospitalist, and Internal Medicine Clerkship Site Director for Medical Students at Kaiser Permanente. Dr. Lee has risen in the Sacramento community through her outreach during the COVID-19 pandemic to provide clear, tangible, and understandable information to our communities. Her PSA’s about COVID have been online since May 1st and all are signed, “Your friendly local infectious disease doctor.” Last week our 2019 YP of the Year, Verna Sulpizio, had the chance to sit down with Dr. Lee and hear, first hand, some useful information in a time of worry. Read on to hear her answers to all of your questions:

Q: Walk us through what a “normal” day looks like for you since COVID-19. 

A: Within the last 3-4 weeks COVID here has increased and that is my field. I will make my rounds to our COVID patients and get on the phone with the doctors who are seeing patients and collectively decide what kind of care that patient will need that day. I am kind of the one orchestrating their care behind the scenes and I have great ICU doctors and specialists who help me implement that. We have a very small department so I have been trying to do most of my work from my desk so I can get to all patients. I also spend time on the phone with patients’ families for consent. I have been doing a lot of history-taking and family calls over the phone since March. 

Q: How has it been for you as a professional not being very clear on what you have to do? 

A: It has been a rollercoaster. Here it is a matter of ‘What kind of protective equipment do we need?’ or ‘What treatments do we have?’ Treatments that I was shown in March have now proven unsuccessful so we have moved on to other things. Do I know if the ones we are doing now help? I hope so. Because this is still so new there are no FDA approved treatments for COVID yet. We go off of trials and preliminary data to guide what we do. This infection is like no other, to be honest. 

Q: We are seeing an uptick in cases for younger folks. Do you have any insight on that population right now? 

A: Absolutely. Initially, everyone took shelter in place seriously. Now, as restrictions have been lifted, people are starting to go back into the community and it is mostly young people. I’ve had patients come in who have been at bars, restaurants, gyms, anywhere that is open and a lot of people gather. This is what can happen. A lot of multi-generational families living together are seeing the effects. We are seeing instances of a younger person bringing the virus into a home with older family members and then multiple people in one home contract the disease. 

Q: Are we in the second wave or are we still in the first wave we have been in since March? 

A: It is hard to say. I think Sacramento was spared the first time around. Many of us didn’t personally know anyone who was directly affected back in March or April. If you ask people now, it definitely hits closer to home. I really don't know. Waves will keep coming; that’s what I anticipate for the next year or two. I can tell you it is definitely way worse in Sacramento now than it was back in March or April. 

Q: Can you tell us more about asymptomatic carriers? Is that something more connected with this younger age group? 

A: I don’t think so. I think any age group can be an asymptomatic carrier. Let’s take a step back and talk about the carriers. The asymptomatic carrier is the one that does not have any symptoms but can transfer the virus to another person(s). Presymptomatic carriers are those that contract the disease but do not show symptoms for a couple days but can still infect others. Many patients may experience symptoms but recover at home. Then you have hospitalized patients who have low oxygen levels and need supplemental treatment. You also have patients with severe symptoms who require a ventilator and longer hospital stays. Asymptomatic patients may never show symptoms but can carry COVID for extended time. I will say, kids 10 and under have shown to be less infectious and tend to carry COVID  the least. 

Q: Four to five months into this, what advice do you have for the younger generation who are growing their families in the eye of a global pandemic? 

A: We still don’t know that much. I would tell any pregnant women to be cautious. It is really important to be careful. There is some data now that makes note that the virus can affect in utero. No one wants this virus to affect their unborn child so just keep this in the front of your mind and take this seriously. 

Q: Who do we trust for information? 

A: The CDC website is a good place to start. I have been relying on the New York Times for vaccine updates and antibody information. I have also used UCSF YouTube channel as a great resource for doctors as well as the community. They talk about hot topics and it is a great resource to stay up to speed. 

Q: If you were to contract COVID, how soon  would you start feeling ill? And can you contract the virus at different severity levels? 

A: COVID is spread through person to person contact. Within 6 feet of an infected person for a 15 minute period of time. Once you contract the disease, the incubation period is anywhere from 2-14 days. You are most infectious the days prior to showing symptoms. Most infectious means that your droplets have the most amount of virus in them. Here is an example of various severity levels of the virus. If someone who is infected coughs on me, there are a number of droplets coming towards me in the air. If I take a deep breath in, I may become more severely ill than someone who touches a surface with just a few viral particles. 

Q: Does the severity of contracting the disease change if you are over 40, under 40, or have pre-existing conditions? Or is it relatively the same for everybody? 

A: An immunocompromised person or someone over 65 may be more susceptible to contracting the virus more severely. To be honest, there is still so much unknown and everyone needs to be careful. 

Q: Tell us about the GI symptoms related to COVID.

A: Honestly, diarrhea, nausea, and vomiting would be the three main symptoms. 

Q: Can the virus be transmitted through your eyeballs? 

A: Any mucosal openings can be portals of entry for the virus, so technically, yes. 

Q: Is there any debate on wearing masks? 

A: There should not be any debate. As time has gone on, there is so much data that proves they help. 

Q: Are there any kind of masks or cloth masks that you would recommend over others? 

A: I don’t think so, just cover up and wear them correctly. 

Q: Is it living on hard surfaces? 

A: Like any virus, it can live on any kind of service. The question here is: is there enough virus on surfaces to cause infection? I don’t believe it is the main way people are contracting the virus. 

Q: Talk to us about re-infection and antibodies. 

A: Re-infection is not proven yet. There have been patients with symptoms for almost 90 days but not yet reinfected. Antibody testing may give patients a false sense of protection. It is still so early in this pandemic we cannot prove how long the antibodies will last. It is also important to remember, there are all different kinds of antibodies; some are protective and some are not. From a personal standpoint in terms of immunity, I just don’t think we know enough yet. I caution people to continue to be careful.

Q: Testing sites are more available. Should we all be getting tested? 

A: When testing is available, people with ANY symptoms or reason to be tested should be taking advantage of testing. Don’t wait to get tested. If you have any symptoms for 24 hours you should be getting tested. Within the last week or two we have been struggling to maintain enough reagent and supplies to keep up with testing. 

Q: Let’s say I am not feeling well. Do I tell my friends this and let them know I am going to get tested or do I wait until results to let them know? 

A: I think it is important to be proactive with the information, especially because tests are taking so long to come back. 

Q: For patients who are hospitalized now, what are you doing for treatment? 

A: The main treatment is supportive care. Supporting the patient's body to let the body heal without having to work too hard. Steroids have also proven to be useful so we have been using those recently as well to help decrease inflammation. An antiviral medication called Remdesivir is being used as well. Many of the other treatments are all investigational. 

Q: Is it possible to be hospitalized but sent home to recover on your own? 

A: Definitely. We see that more often with younger people as many younger people are relatively healthier. 

Q: There is talk of a vaccine. What are your thoughts on that? 

A: I think it will happen. There will be multiple vaccines from multiple companies. Everyone thinks it will be the magical cure and it’s going to happen quickly. In reality, I don't think that's going to happen. Timing is going to be the issue. If we cannot keep up with testing, how are we expected to make enough vaccinations to solve this quickly? This will take time. There are trials in phase 3 right now and I am hopeful there will be a vaccine. I just don't think our lives will go back to normal promptly; it's going to take time for sure. 

Q: Can you define herd immunity? 

A: The notion of herd immunity is that a certain percentage of the population needs to have immunity to some type of infection to benefit the whole. So, it doesn't mean 100% of us will say yes to the vaccine or have immunity to COVID. If we get a great vaccine that gives 60-70% of the population immunity for an extended period of time, the other 20-30% will be fine because the virus will have limited people to spread through. 

Q: So this is our new normal? For at least another year? 

A: I think so. It will continue to be a roller coaster. 

Realistically, everyone can’t stay in their homes for an over extended period of time. I am going to give you specific scenarios and you tell us what you think. 

Let’s do it. I will say, there is no right and wrong. At the end of the day it is up to your own personal risk level. 

Scenario 1- I am invited to eat at a restaurant on an outdoor patio with friends. 

Opinion- I am all for outdoor activities. Probably best in smaller groups but I support that completely. When I am outdoors, I usually don’t wear a mask, just stay 6 ft. apart. 

Scenario 2- Joining friends indoors for a meal with social distancing. 

Opinion- I personally, do not do indoor meals. I do not even eat indoors with my parents. Only my husband and my two children but we mostly eat outdoors anyways. 

Scenario 3- Working out outdoors. 

Opinion- I have chosen not to work out indoors. Again, any indoor space is more risky. I would suggest getting outside for your workouts. 

Scenario 4- Outdoors at a park and children being on play structures. 

Opinion- If there are no other kids there, or few kids there, I would let my kids play and make sure they wash their hands afterwards. People who know me already know that my kids immediately change their clothes and wash their hands. 

Scenario 5- Changing our clothes. 

Opinion- I don’t know that it's necessary. We have seen research that shows the virus is not really present on soft surfaces. I know for those of us seeing COVID patients, we often change our clothes as a caution but there is no right or wrong answer here. 

Scenario 6- Children going back to school. 

Opinion- I would be sending my kids back to school if they were open. The data is just really not there for young kids to 1) get that sick or 2) spread it around to each other. I look at the hospital data and there are no kids under 10 admitted. This does go beyond the kids. There are teachers to worry about, disinfecting protocols, etc. It is a way more complicated situation than just the kids. 

Opinion- The biggest thing we shouldn’t be doing are get-togethers. The virus’s goal is to go from person to person. All it knows to do is replicate and cause infection. The closer we are to each other the more it will continue to spread. 

Q: What do we need to be doing to defeat this? 

A: Wear a mask, do not gather, stay out of indoor places. Think twice about our actions. We need to continue to find the balance. People just need to be smart about this and hopefully our curve will go down.