By: Aphrodite Kotrotsios, Publisher, Special to the Hellenic News of America. Denis Hadjiliadis, M.D., M.H.S., Ph.D., a pulmonologist at the Harron Lung Center Perelman at the Hospital of the University of Pennsylvania spoke to Hellenic News of America’s publisher,
Aphrodite Kotrotsios, on the Coronavirus pandemic that is sweeping through the world. He shared his thoughts on antivirals, the hospital setting, social distancing measures, and advice on how to stay healthy and safe. Dr. Hadjiliadis specializes in cystic fibrosis and is the program director of Adult Cystic Fibrosis at the Harron Lung Center Perelman, one of the largest programs in the country. He is also the Paul F. Harron, Jr. Associate Professor at the Perelman School of Medicine at the University of Pennsylvania. Dr. Hadjiliadis completed his undergraduate studies at McGill University in Montreal, Canada, and his M.D. at the University of Toronto, in Canada in 1995.
Aphrodite Kotrotsios (AK): How long do you think it will take before there will be a vaccine for COVID-19 and antivirals?
Dr. Denis Hadjiliadis (DDH): The vaccine will likely take a year or 18 months, as studies have to go from safety to efficacy (Phase 1 to Phase 3 studies) and that takes time, although vaccines would be the best solution. There are more than 70 potential vaccine efforts now, which makes it likely that one or more will succeed. Antivirals or other medications will hopefully be earlier; we expect results from some early trials in the next 4-6 weeks. However, unless we are really lucky, these will at best improve disease severity rather than cure or prevent. This is also very important because it could help avoid one of our biggest fears, which is overwhelming for hospitals with patients with COVID-19.
(AK): Are you hopeful with the antivirals being developed and have you see any clinical change in your own personal experience?
(DDH): Remdesivir, a novel antiviral had some very encouraging results presented this week, which could lead to its approval for use in COVID-19. Lopinavir/ritonavir, and hydroxychloroquine/chloroquine have had some hints of possible mild effectiveness; they also have reports that show they are not effective and might have some serious side effects (chloroquine/hydroxychloroquine). We will see more results soon from controlled trials that are large enough to tell us what they can offer. I have no personal experience, as my experience is second hand (I have not been a primary caretaker of COVID patients in the hospital).
(AK): Do you currently have enough ICU beds or are you currently filled to capacity?
(DDH): First let me say, that leadership has worked very aggressively in creating capacity, finding ways to make more ICU beds, creating units specializing in COVID-19, and putting teams together. I know other health systems are doing similar things. My hospital system has capacity at this time and assuming the mitigation efforts of social distancing continue and are effective, we expect we will be able to handle things. However, if things go uncontrolled like in Italy, Spain, or NYC, I do not think any health system can handle that. However, all these are done, while “sacrificing” elective or non-urgent cases to keep capacity for COVID-19, which is not good for patients in the long run. The challenge will be how to be able to safely do both, i.e. treat patients with COVID-19 and our usual routine patients.
(AK): Are all the patients intubated? What percent would you say?
(DDH): Between 30-35% are intubated.
(AK): When do you feel we will start seeing a decline in infected individuals?
(DDH): In places where things peaked out of control and quickly, there is a decline of new cases every day (Italy, Spain, New York); in the next 2-3 weeks as fewer new patients get infected and more patients recover and unfortunately a few die, the active case number will decrease. In places like Pennsylvania, where the new case numbers have not increased exponentially, it is more difficult to see the decline (although the number of new cases has now plateaued or slightly decreased); same is true for Greece, where there was never a clear peak, because they took measures very early. For these places, we might see the same pattern. However, to say things will be really safe, the number of active cases has to be really low. Until then, as we loosen up things there is a high risk of another spike in new cases.
(AK): What percentage do you feel are younger than 40 who are critical?
(DDH): Young patients are susceptible to infection too; in addition, some young people did not pay as much attention early on, so they might have had more infections than expected early on. The critically ill patients that are completely healthy young patients remains low (less than a quarter of total critically ill patients are young and even fewer have no underlying health conditions); however, even if one percent of patients less than 40 get critically ill and we have 200,000 young patients, that is 2000 patients. In addition, young patients always make the news, so we hear more about them.
(AK): Has that situation come under control with procuring masks and medical gear?
(DDH): It is manageable in our area, but would not say things are safe; there is still the risk of shortage; by reducing the daily infections and delaying the “peak” we are buying more time to have industry produce more masks, medical equipment, ventilators and other supplies.
(AK): What more do you feel the general population can do to help?
(DDH): STAY HOME; even when things open up do your best to stay home and use social distancing rules. Before any measures were taken every patient spread the infection to about 2.5 other people; as social distancing measures came on, the rate appears to have dropped to about 1.4 or even less in places like Washington and now New York and New Jersey and probably Pennsylvania leading to smaller increases and eventual decline of cases. If/when we manage to get this number to below 1 (each infected patient spreads to less than one person) then the pandemic will die out; this will be difficult to do, but would be the best-case scenario and would take many weeks.
(AK): What message do you want to communicate concerning the pandemic and COVID-19?
(DDH): This creates stress in many aspects of society and all of us; it also shows we can work together to mitigate this challenge; despite all the “bickering” among politicians, people have in general done well with distancing and the effects are being seen already.
(AK): How can we overcome the challenges we are facing from this pandemic?
(DDH): Helping each other out. Taking care of the most vulnerable. Providing emotional support to people around us who are isolated. Following recommendations from scientists and leaders based on the best available evidence. Not having treatments yet, is probably the most frustrating part, as when something is going on, you want to react, but sometimes patience is the best thing, until you figure out the best action.
(AK): What have you learned as a result of this crisis, going forward?
(DDH): We need a more centrally organized response to any pandemic with coordination with local authorities to be able to deploy locally as needed. Private entities cannot be expected to be stockpiling equipment just in case a pandemic occurs (as it could come in many different forms) and at the same time expected to be profitable. The public domain has to be the first to coordinate things the private entities can always jump in and provide volume and efficiency as soon as it is is needed. Greece, which has been maligned in the last ten years for many reasons, showed that a strong central coordinated response has led to one of the lowest rates of infection, morbidity and mortality from COVID-19 across all Europe.