Dr. Gwynette: Hello and welcome to the Autism News NetWORK Podcast. My name is Dr. Frampton Gwynette and I’m joined today by Dr. Cam Mateus who is an internal medicine doc and a psychiatrist here at the Medical University of South Carolina. We appreciate you joining us today for this special episode of the podcast, which is part three of our Corona virus update. So Dr. Mateus, thank you for being here.

Dr. Mateus: Thank you so much for having me, Dr. Gwynette. It’s really is an honor to be able to be a part of this experience.

Dr. Gwynette: Yeah, this coronavirus series actually originated because of a conversation you and I had I guess last Friday about kind of the details of how coronavirus infects patients, how it’s spread, how we protect ourselves from it in the medical field, the way we test for it. And so here we are a week later recording our third podcast and we’re happy to have you here. So thanks for coming in.

Dr. Mateus: It is great to be here and I’m happy that we’re able to sit down and address this important issue that’s going on in our times.

Dr. Gwynette: Yeah. And so we are actually getting three doctors for the price of two today because you have double training. Can you tell the audience, first of all, what is, what does it mean to be med psych?

Dr. Mateus: Oh, that’s a very good question. I get that question asked all the time. It’s one of those combined dual residency programs. Basically you have to split your time in your residency between two different departments. In my case it’s internal medicine and psychiatry. It is a five year program and at the end of the five years I’ll be board eligible to be able to sit down for my psychiatry as well as my internal medicine boards.

Dr. Gwynette: Yeah, so you went to med school and then those five years or after med school?

Dr. Mateus: That’s correct sir. Yeah, absolutely.

Dr. Gwynette: Yeah, so he really knows his stuff. So we’re thrilled to have him here and hopefully this will be a real treat for our listeners. And we’re going to dig in now to some of the new developments in coronavirus. So Dr. Mateus, how shocked were you when you heard about the following cancellations, NBA NCAA tournament both men and women’s, NHL and major league baseball all have suspended their operations. Do you feel like… What’s your reaction?

Dr. Mateus: Well, initially Dr. Gwynette when I heard that there was this big outbreak of the coronaviruses happening out of China, I thought, “Well, what are the chances that it’s going to make a meaningful, significant impact in the States?” And I think that it really hit it home for me when I finally heard from the news that all these major sporting leagues were canceling all their events. It really brought to light that this is something that we should definitely take note of.

Dr. Gwynette: Yeah, absolutely. And are you a believer in the idea that social isolation and preventing these large gatherings, do you feel like it’s going to have an impact?

Dr. Mateus: Absolutely, sir. I think by limiting the amount of exposure to people who could be contagious with the virus will definitely limit the amount of spread and will definitely help us improve our public health.

Dr. Gwynette: Yeah, absolutely. There’s really some tragic data coming out of Italy where they have over 15,000 active cases now and over a thousand deaths in Italy. And there’s some concerns that despite the government’s warnings, a lot of those self isolating and social isolating precautions were not followed early on and now they’ve really got a terrible situation on their hands.

Dr. Mateus: And I think that kind of speaks to our culture here is that we really want to take things seriously and make sure that we’re able to control the outbreak as best as we can. And closing down some of these major events is a one of the ways that our government and our state institutions are doing that.

Dr. Gwynette: Yeah, absolutely. And to give the audience an idea of the situation in the United States, our total cases have shot up to 1629 so that’s 1,629. And that’s per the CDC. An interesting thing happened where the CDC actually leapfrogged Johns Hopkins in terms of the number of cases and they’re confirming. So we’re over 1600 cases, 41 deaths, and here in South Carolina we’ve been relatively unscathed. But we sit at 12 cases. When I recorded our first podcast in this series one week ago, we had zero. So we’ve gone from zero to 12 in a week and earlier before the show we talked about trying to anticipate where we’ll be 10 to 12 days from now. What are your thoughts if you had to predict?

Dr. Mateus: Well, the biggest thing Dr. Gwynette is that we can’t really have confirmed cases if we don’t have any test kits. So now that our state government and our hospital institutions in the state of South Carolina are getting more test kits and have the ability to screen and test more people, I anticipate that the numbers of people who are confirmed COVID 19 will increase. And with that it will probably start to look more higher than the good 20s or 30s of patients the next couple of days, I should expect or maybe even higher.

Dr. Gwynette: Yeah, absolutely. So we have been kind of watching this closely. In South Carolina it really hasn’t hit home yet, but we do have shortages of things like paper towels and toilet paper. That’s definitely playing itself out. But we haven’t seen the full impact, what we call that peak panic here in South Carolina yet. One of the ways that our local authorities are trying to test people is virtual visits. And do you know much about those? Have you heard about them?

Dr. Mateus: Yes. It’s a very interesting program and that in a way to kind of limit the exposure of sick patients in our ambulatory clinics, MUSC has developed a virtual care system where they can have people log onto the internet, put in a code so that they can log in and through their health insurance they can have a virtual visit with a COVID 19 provider that will screen them for symptoms. And then from there if they screen positive for the right symptoms, they will be offered a test where they can come over to our West campus in West Ashley and they’ll have a system set up where you can drive through and have a swab of your nose or your throat and get those tests sent off to see if you truly are a COVID 19 candidate.

Dr. Gwynette: Yeah. And that drive through aspect is… Actually both are kind of genius because I think the virtual visit uses artificial intelligence and kind of decision making based on the patient’s clicks and then the drive through for obvious reasons you can be screened and not have to endanger either care providers or other people waiting in line to be screened. So, I’m optimistic about that.

Dr. Mateus: Again, it’s another measure to kind of limit the contagion of this virus.

Dr. Gwynette: Yeah, absolutely. So we wanted to take advantage of your expertise because we have a unique opportunity here and without maybe painting the picture of too dark but what if somebody were to get COVID 19 and they would reach end stage? How does the virus progress in the body in a catastrophic way?

Dr. Mateus: Well, in many ways Dr. Gwynette as healthcare providers we don’t know exactly how this virus progresses in the body, but we are seeing a lot of cases where we do have people who develop severe respiratory distress. We have symptoms that start maybe three days into the virus of they’re on one liter of supplemental oxygen and then in the next couple of days they can progress into severe respiratory failure. Now the people who kind of develop this… We still don’t have a strong sense of how this progresses or who will progress in this manner, but we’re getting a sense that it’s targeting more of the older people and also people with significant comorbid medical disease such as cardiovascular disease, hypertension, diabetes, and not surprising, respiratory disease.

Dr. Gwynette: Yeah. So if you go into this epidemic with underlying medical conditions, you’re at higher risk and then age is also a factor, right?

Dr. Mateus: Absolutely.

Dr. Gwynette: Okay.

Dr. Mateus: Yeah. We’re seeing a higher proportion of people greater than the age of 80 who can develop some very severe consequences including death with this disease.

Dr. Gwynette: Yeah, and do you feel like there’s anything inherent about being old or is it just that older people tend to have more secondary medical conditions?

Dr. Mateus: It could be a little bit of both Dr. Gwynedd. It could be a bit that their immune system is not as robust and not able to fight some of the multiorgan failure that can happen with this disease. Something that’s also really notable to point out is that patients that had been admitted to ICU is in Washington state we’re trying to find out a lot of our data from areas in our part of the country or the parts of the world that have already kind of suffered from this virus. We’re seeing patients who develop myocardial… Sorry, heart failure from this disease and we don’t know exactly the exact mechanism. We’re still trying to gather data with any kind of inflammatory markers like C-reactive protein, collecting troponins and stuff. We’re not exactly seeing a myocarditis type picture, but we are watching people’s ejection fractions or the efficiency of the way their heart is pumping, kind of drop over time. And that is very concerning because it’s not a straight respiratory failure kind of picture either.

Dr. Gwynette: Yeah, yeah. So there’s a lot to think about. So people with heart conditions, hypertension, diabetes, breathing problems. You might’ve heard of COPD if you’re in the audience. Smokers, all these things can add up and make it more dangerous.

Dr. Mateus: Absolutely.

Dr. Gwynette: Yeah. Well, I wanted to pivot now and just talk about since the last podcast on Tuesday, there have been multiple public figures who have tested positive for COVID 19 including Tom Hanks and Rita Wilson. And have you seen any pictures of them?

Dr. Mateus: I have. They’ve posted a couple pictures on Instagram and I think they’re sending a optimistic message out to the world and I think that’s good.

Dr. Gwynette: Yeah, and I do too. They look great. They said they’re getting excellent care. They’re in Australia. And they’ve kept their sense of humor intact. I read a tweet from Tom Hanks just moments ago and he said, “We’re hanging in there basically and one day at a time, but we’re ready for anything.” And he said, “No matter what happens, remember there’s no crying in baseball.” From one of his old movies. So, Tom Hanks and Rita Wilson they’re in a great position that hopefully reassure the public that people are recovering. Not everyone passes away from this. And yet it’s a sobering reminder to be prepared.

Dr. Mateus: And on the other hand, Dr. Gwynette we’re seeing on Facebook posts about Betty White, she’s 98 years old and she’s fine and she’s out and doing her thing.

Dr. Gwynette: Oh, that’s cool.

Dr. Mateus: So I think it’s really reassuring that it’s not necessarily just because you have an older age that it’s targeting that population.

Dr. Gwynette: That’s right. Man, Betty White, she just keeps on ticking. Huh?

Dr. Mateus: Yeah, absolutely.

Dr. Gwynette: She is great. And then politically we saw… Well first of all, there’s been some deaths of Iranian leadership over in the middle East. And then the Prime Minister of Canada, his wife just tested positive and so she’s in isolation and he is as well. And there’s been some visitors to Washington in the White House who have been in peripheral contact with the president who have subsequently tested positive. So it really brings the question of how contagious are people and when are they contagious? Are you contagious for the two weeks before you show symptoms or the whole month after you recover? Do we have a beat on that yet?

Dr. Mateus: We’re still gathering some data on that. And I think most of it’s showing that people can be asymptomatic for a mean time period about five days. Which kind of makes this virus a little bit more scary because you could be around someone that looks well and they could actually be shedding virus.

Dr. Gwynette: Yeah.

Dr. Mateus: So, it would just be very helpful to kind of get a better sense of how quickly people can develop symptoms and all that.

Dr. Gwynette: Yeah, exactly. So if you were seeing a patient in your office and they were really worried about it, your recommendations as a doctor for your patients in terms of protecting themselves would be to do what?

Dr. Mateus: I would tell them to limit their amount of social gatherings around other people, especially any crowds greater than a hundred people. Making sure that they wash their hands. I’ve heard the happy birthday song could be helpful to make sure that you adequately wash your hands in enough amount of time. If they are sneezing or coughing to make sure they cover their face if they have tissues around just cover their face with their tissue. And then keep at least a six foot distance from any nearby person as much as possible to kind of limit any kind of spread. There have been some data that suggests that the spread of the virus is really droplet precaution, so you have to have someone who’s sneezing on you or has recently sneezed on a surface and the virus can live up to nine hours on the surface for you to be able to acquire the virus. So we’re getting more information on that and that’s reassuring in some ways in some ways, and some ways not.

Dr. Gwynette: Yeah, absolutely. In terms of that distance, you mentioned earlier before the podcast that this is having an impact on families, especially for let’s say elderly patients or senior citizens who are used to having their younger family members visit them frequently. What did you mean by that?

Dr. Mateus: Yeah. A lot of institutions, nursing homes or hospitals, rehab facilities are closing off their visitations to outside family members. Just to help to limit the spread of the virus and in such a way it maybe can have a psychological impact on the loved ones who are already estranged from their homes or their normal environments. And they’re so used to having a familiar face come to visit them weekly. That could definitely have a psychological impact on our community and the people who no longer have their family members and loved ones coming to visit them.

Dr. Gwynette: Yeah, absolutely. And in your psychiatry clinics, in a very general way, have you noticed a higher level of anxiety or awareness with respect to the virus?

Dr. Mateus: No, not really yet. We haven’t really encountered a lot of exacerbation in terms of anxiety disorders, specifically obsessive compulsive disorder in the psychiatry clinic yet. What I have noticed is that patients have been more mindful about not shaking hands with their providers or keeping their distance. And I thought that was a very altruistic of them to kind of keep that in mind as we’re considering what’s going on in our world.

Dr. Gwynette: Yeah. And it’s for those folks who are here in South Carolina or outside of the state, life is very much going on mostly as usual here with some extra precautions. But we are watching closely and I think ready for the worst if it happens but we’re praying for the best. So yeah, if you’re a listener, please stay tuned to our updates. We anticipate we’ll be recording again within a few days. I wanted to thank Dr. Mateus for coming in and his last name is spelled M-A-T-E-U-S.

Dr. Mateus: Cool. Yeah, and I wanted to be sure I pronounced that correctly too. So it’s Mateus and he is really a valuable resource for us here in the department of psychiatry because he has that extra training in internal medicine. So we wanted to thank the audience for listening. My name is Dr. Gwynette. You can follow me at Dr. Gwynette, that’s D-R. G-W-Y-N-E-T-T-E on Twitter and Instagram. We thank you for listening to the Autism News NetWORK Podcast and look forward to joining you next time.