May 14, 2020
David A. Wein, M.D. is the Chief of Emergency Medicine at Tampa General Hospital, System Medical Director for TeamHealth, and an Associate Professor at USF Morsani College of Medicine.
Rachel Elias Wein: Since our last interview a couple of weeks ago, we’ve continued to see a steady stream of news about flattening curves and efforts to reopen. Anything new in terms of preventative care, therapeutics or vaccines?
Dr. David A. Wein: No huge movement. The bottom line on all of these fronts is that we still need more data. Significant research into the potential efficacy of hypothesized treatments like Remdesivir and hydroxychloroquine is ongoing. At this point hydroxychloroquine is only indicated for treatment as part of a clinical trial. There’s some seemingly positive data in certain contexts for Remdesivir—at least initially—but we’re still a long way off from a fully safe and effective therapeutic or vaccine.
REW: At Tampa General, you’re participating in a prophylactic study with hydroxychloroquine. Tell us a bit about that. What do you hope to learn?
DW: As an academic medical center, Tampa General is enrolling health care workers in a national database called the Healthcare Worker Exposure Response & Outcomes (HERO) Registry. One of the goals is to figure out whether hydroxychloroquine can help prevent Covid-19 infections, not treat the disease after contracted.
REW: That’s a key distinction, right? Hasn’t some of the discouraging data about this medicine come from severely ill patients in later stages of the infection?
DW: That’s right. The randomized arm of this study focuses on frontline healthcare workers such as nurses, ER doctors, EMS personnel and others who are at higher risk of exposure. I’ll be going for my initial medical evaluation in a few days to participate as a volunteer. I’ll be given either a placebo or hydroxychloroquine as part of the study. While hydroxychloroquine may not work in later stages of the disease, it would be helpful to know whether it’s effective at preventing infection.
REW: Could you tell us more about the widespread antibody testing at the hospital as well?
DW: Sure. We’re offering antibody screening to frontline personnel. Approximately 1,000 people have already been tested, and we have validated the results in multiple ways.
REW: Are any trends emerging?
DW: So far, in our experience healthcare workers who have previously tested positive for Covid-19 have made antibodies, which is reassuring. In addition, the rate of those with positive antibodies and without symptoms—what some would call asymptomatic carriers—has actually been lower than some might have expected—on the order of about 0.5 percent.
REW: And of course, just because people have antibodies does not even mean that they were exposed within the hospital.
DW: Correct. Some of them may have high-risk exposures completely outside of the hospital setting. If you think about it, every hospital worker has two types of risk: those that are the same as everyone else…
REW: …like pumping gas or buying groceries…
DW: Right, or taking mass transit. Then they also have the risk that comes within the medical setting. And yet even in that higher-risk group, the rate of having positive antibodies without showing symptoms appears to be low. To be sure, there are some statistical considerations that potentially complicate the picture, and we’re continuing to collect data.
REW: But the suggestion is that healthcare professionals are creating a playbook for workplace safety. It’s social distancing, limiting the size of meetings, mandatory masks for everyone, temperature checks, and using the right sanitation protocols and products. There are some lessons here that could translate as businesses seek to reopen or partially reopen, right?
DW: Yes. Everything we do may not be fully replicable elsewhere. We obviously have infection prevention experts working with us daily, and we have learned a lot in the last two months. It isn’t easy to achieve the kind of stringent compliance that we’re able to maintain in a hospital setting. However, I do agree that some of these best practices could be helpful in other contexts.
REW: In retail and retail real estate, we are starting to see some coordinated efforts to widely share best practices. One example is Kroger, with its Blueprint for Business.
DW: Exactly. The Florida Aquarium partnered with us for guidance on its reopening. I will say, though, that I would like to see a more robust and concerted response on the part of federal and state agencies with respect to providing resources, guidance and training.
REW: To better support and assist private businesses?
DW: Absolutely. In some cases, they may know what to do but are unable to acquire, say, protective equipment. In others, they may face uncertainties about what to do and need answers from experts in public health.
REW: Speaking of which, do you have any additional thoughts on where we may land ultimately with this disease? As a society, are we gunning for herd immunity, or are we seeking to flatten the curve until there’s a vaccine and/or viable treatment?
DW: The fact is, we don’t know how this will end. SARS-CoV-2 could fizzle out like MERS or the previous SARS-CoV virus; we could get a vaccine relatively quickly, or this disease could be with us forever. And that’s part of the challenge: We’re running a race here, but we don’t yet know exactly where the finish line is. That’s why medical professionals are so focused on collecting and analyzing the data.