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Dr. David Cohn on COVID-19: Separating fact from fiction and making the most impact in your community

Dr. David Cohn on COVID-19: Separating fact from fiction and making the most impact in your community

Dr. David Cohn, chief medical officer at The James, joined us on Pelotonia LIVE! on April 1 to discuss COVID-19 from the perspective of a medical professional. Together with Pelotonia President and CEO Doug Ulman, he discussed the best ways we can flatten the curve and how we can support the most vulnerable in our community, including cancer patients.

The excerpts below are just a few of the insightful points that Dr. Cohn made throughout his livestream. To listen to the full conversation, you can watch the video on YouTube.

Doug Ulman: Can you talk a little bit about that preparation and how you and the team have handled this sort of new, not so normal that we’re operating under right now?

Dr. Cohn: I think that’s a great description. The “new not so normal.” Every day is different. The way I would describe it is that we have some period of time before the surge, which is the large number of individuals that are going to be needing medical care because of COVID-19.

So, the longer that we have between today and when that surge happens, the larger the opportunity that we have to do all the preparations. And so, for anyone who has accessed the news or listened and seen what’s going on in New York, in Italy, as examples, you recognize that these healthcare systems have been overwhelmed.

And the reason why that probably is because that timeline between when they started preparations and when the surge happened was compressed. So Dr. Amy Acton, the Director of the Ohio Department of Health, has talked about “flattening the curve.” And what that in general concept means is that the fewer individuals every day that are diagnosed with COVID-19 that need medical care, the longer we have until that surge occurs.

If a surge looks like this with a lower peak, we’re going to have more time to respond in advance to make sure that we have all the medical facilities that are necessary to care for patients, to make sure that we’ve got all the beds that are necessary, to make sure we’ve got the critical care equipment, as well. And so the proactive steps that Mike DeWine, our governor in the state of Ohio, has taken have been really, really important. So that today, the number of cases that we have is estimated to be about one fifth of it, of what it would have been had we not instituted these changes just a month ago.

When you reflect back and think that it was merely a month ago when the governor made some controversial decisions to limit visitors to the Arnold Classic and how that was thought to be very aggressive… you look back now and say that that probably saved many lives and it saves the healthcare system the opportunity to prepare for what’s to come. So that’s what the preparations look like today. It’s going through exercises day after day after day to make sure that we’re prepared for when we have to execute on the plan to care for many more patients with COVID-19 than we have right now.

Doug Ulman: Let me give you a chance to once again emphasize what each of us can be doing today to help not only ourselves and our families, but to help “flatten the curve” so to speak.

Dr. Cohn: We all sound like broken records in many ways, saying the same thing over and over and over again about what to do. And that’s because it’s true. And so… hand sanitizer. You know, I think that most importantly, it is the principle of decreasing the risk for getting COVID-19 infection because the fewer individuals that have COVID-19, the fewer individuals that will subsequently get it from you, and then that chain will continue.

So that’s the flattening of the curve, having fewer individuals in our community that get COVID-19. So wash your hands with soap and water. It’s always around. If you don’t have that, consider hand sanitizer for whenever you need it. The physical distancing is really, really important because if you’re with your core family, you know them, you’ve been with them through this entire process.

Once you start to get individuals from outside of your core family in the mix, then there’s the risk of transmitting infection. If they’ve been somewhere, they’ve been exposed, and they may or may not have symptoms. You get infected, you give it to your family, they give it to others, and that just continues down the line until we have that peak that we don’t want to have.

So common sense things. If you’re feeling ill, don’t see other people. Take care of yourself, minimize the risk for infection with soap and water, hand washing, and then hand sanitizer if you don’t have access to that, as well. Obviously we need to shop, we need to eat, we need to do all these things, but do it as responsibly as you can to make sure that you’re not putting yourself or others at risk.

It’s the responsibility that each one of us has to make sure that our community doesn’t get COVID-19. So if we all do our part, then our community is going to be healthy and then our cancer patients will be healthy. Our staff, our faculty will be healthy and we’ll get through this a lot more quickly as well.

Doug Ulman: What can you tell us about the care that continues to be given and provided to people with cancer today?

Dr. Cohn: Here’s my take on how to approach the discussion about what care is being delivered to cancer patients. I think most importantly is the care that needs to happen is ongoing. And when you think about cancer patients, cancer care has to keep going because we’ve got the responsibility to our patients to maximize their survival, improve their quality of life. And so whenever we’re thinking about what care looks like, we’ve got to ensure that we’re in a position of guaranteeing that that type of care is ongoing.

And so there is a lot of discussion in the news from the surgeon general and from the governor in the state of Ohio, in many states, about canceling elective surgeries. And I think it’s really important to know that cancer surgery, by and large, is not elective. Things that need to happen will happen.

Chemotherapy that is intended to cure patients of their cancer to improve their quality of life, to diminish suffering… those are things that still have to go on and they are going on. But in order to do that, we’ve got to make sure that we do it in a way that’s responsible to our patients, responsible to their families and friends, responsible to our staff, and responsible to the faculty that are delivering this care.

And Doug mentioned the visitor policy. So, most hospitals around the state and around the country have gone to a really, really hard position of accepting no visitors within the walls of the hospital, except for in really unique situations as it relates to cancer. For those individuals that are having really difficult conversations at the end of their life, there’re visitors that have to be part of those conversations.

And that’s a very appropriate exception. Short of that though, there’s no visitors in our hospital because we want to make sure that those individuals that come into our system who may have COVID-19 are not infecting our staff, our faculty, and our patients. And likewise, at our outpatient facilities.

And I think that what I’ve learned about COVID-19 and how it affects our patients and affects our staff and our faculty is that there are trade-offs and there are trade-offs every single day. And so we’re trying to navigate a really narrow ledge. On one side, it’s the outcomes of our patients. On the other side, it’s the outcomes as it relates to COVID-19 and so we’re walking that narrow line.

I think we’re doing it remarkably successfully at this point in time. It doesn’t always feel good to have to say to a family member that they can’t be there with their loved one when they’re in the hospital a couple of days after a surgery or as they’re admitted with a complication from cancer or cancer treatment. That’s really challenging and nobody wants to be in that position. But this is our new reality and this is the trade-off that we’ve decided to make to maximize that balance between our patients’ outcomes and their risk for a COVID-19 infection.

Doug Ulman: Something that’s been in the news reported is that ibuprofen might have some counter interaction with COVID-19 or might make the situation worse. Anything you can share on that front?

Dr. Cohn: Really early on in the information that was gleaned about COVID-19 was a really small study that was put out that said that ibuprofen, which is a type of a nonsteroidal anti-inflammatory medication, negatively impacted the outcomes from COVID-19, and it was thought that maybe it was because of some inflammation, anti-inflammation, some lung injury.

Subsequent to that, that was shown to not be the case. So the answer to that question is there’s no problem taking ibuprofen or any nonsteroidal medications if that’s a medication that you’re able to take, that there’s no other reasons why you shouldn’t. And that you need to take it.

Doug Ulman: How can we help patients who feel isolated right now, who may not be surrounded by as many people, and maybe quarantined in some respect?

Dr. Cohn: I think that in many ways the social distancing is not the right term. I think physical distancing is really important. This conversation is great social interaction right now. The more we can do this, the better. So keeping engaged with our community, keeping engaged with our friends and family. I think I’ve had more Zoom meetings in work and out of work than I’ve ever had before. Connecting with friends that I haven’t seen in a while, connecting with large groups of college contacts. So these are really important things that we all can do, whether you’re in the hospital or not, when it comes to hospitalized patients.

Doug: What can caregivers do that are caring currently for somebody who’s in treatment? Because they are going to the grocery store, they’re providing a lot of support and they want to do so it in a safe manner to make sure that they don’t negatively impact their loved one.

Dr. Cohn: Whatever we can do to help our cancer community that’s not in the hospital is really key. So check in on your neighbors, say hello. You can bring them meals. That’s not a problem at all. You can help to shop for individuals if you’re a caregiver yourself.

Be smart about it, which means wash your hands before you go in there. Sterilize your cart with the wipes that are being provided. Use hand sanitizer. I think that the important thing is that there’s been a lot of talk about whether or not bringing things from the outside, whether it’s carryout food or whether it’s groceries into the house, can carry the risk of contracting COVID-19.

And it seems that the answer to that is no. As long as you’re doing the things that we just talked about: washing your hands, using hand sanitizer, as well… shopping for individuals who have cancer does not pose a risk. You don’t have to leave your groceries or packages outside for a number of days, weeks, or hours.

You can do your normal things and as long as you’re washing your hands and making sure that you’re not contracting anything from the community, then you’re doing everything you can. But just maintaining that social contact with our cancer community to see what’s necessary for them is really, really important.

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