Coronavirus in Massachusetts: 5 takeaways on COVID-19 from a conversation with a pair of infectious disease experts

Reporters and editors from The Republican met Friday with Baystate Health president and CEO Dr. Mark A. Keroack and Dr. Andrew W. Artenstein, the health system’s chief physician executive, for an update on the outbreak of COVID-19 in Massachusetts.

The doctors — both of whom have extensive backgrounds and training in infectious diseases — said the new coronavirus is likely already present in the Pioneer Valley, even if no cases have yet been reported in official data from the state Department of Public Health.

Here are five key takeaways from the discussion; portions of the interview have been lightly edited or condensed:

You can transmit the virus before you realize you’re sick.

Dr. Keroack: “It’s now clear that somebody who’s infected with this coronavirus can carry a large amount of virus in their nose and mouth well before they feel very sick. Because infectious individuals are hard to detect, and because the entire population is naive — not immune to this new virus — we expect that we’re soon going to be dealing with a large number of patients with either expected or confirmed infection. … We know that the virus spreads on airborne droplets, when you sneeze or when you cough. It also can be spread when someone touches their face, gets it on their hands, and then shakes hands; then that person may inoculate their own nose, or mouth, or eyes.”

If you have symptoms, call your doctor, hospital or clinic first — don’t just show up.

Dr. Keroack: “We have developed a variety of screening protocols for medical practices and the emergency department, which are our front doors. We’re trying to get people to reach out via telehealth or by phone, first, before coming in physically, so that they can be screened over the phone about whether they need to come in or not. This is to basically keep people who are infectious at home, and also to protect our employees.”

Dr. Artenstein: “The answer to this is not to walk into an emergency department or walk into a doctor’s office. That might be the answer under usual conditions. ... The truth is, it’s really important to prevent the spread of infection ... that folks, especially those that aren’t highly symptomatic, those who are mildly symptomatic, follow other procedures.”

Dr. Andrew W. Artenstein talks with reporters and editors at The Republican on March 13, 2020. (Don Treeger / The Republican)

The lack of testing is creating uncertainty.

Dr. Keroack: “There has been a lot written about the test kits, and problems with the test kits. There has been a shortage for the CDC to produce them, and that’s meant the Department of Public Health in Massachusetts is experiencing shortages, and they’re having to ration them to people who are most severely ill and at greatest risk. That means that oftentimes when we call up to get a patient tested through the DPH we’re told the patient doesn’t fit those criteria, because of the shortage. We then will send the testing to a commercial lab … but the turnaround time there is three to four days. We’re told that it might be several weeks before we have the reagents we need to start doing testing ourselves at Baystate, which typically would just be a four-hour turnaround.”

“There are some countries that are testing 10,000 people a day. Unfortunately the CDC was kind of slow to get a workable test kit out, and they’re trying to catch up quickly. I hope they get there soon. But other countries are really testing a lot more people; they’re testing at a level we would love to test at today.”

Dr. Artenstein: “This thing is moving very quickly. Again, the testing … that’s a big issue. It makes clinical decision-making difficult, because a lot of it is based on the available information, so it adds uncertainty.”

Closing schools isn’t a silver bullet — and it may have unintended consequences.

Dr. Keroack: “For me, of all the various social distancing methods, this is the one that probably I wouldn’t immediately go to. ... Prior attempts to contain viral spread by closing schools — flu, for example, which does affect kids a lot more — have not been successful for a number of reasons. Once you close the schools, then what happens to the kids? They either start congregating in homes or daycare centers and they start spreading stuff around anyway. And then you’ve taken out (of work) all the people who would be watching those kids — many of whom are health care workers. So it would not be the first thing I’d be thinking of.”

Dr. Artenstein: “It’s a domino thing. In an area where health care is one of the key employers, you can expect that there’s a lot of parents of young children who work in health care systems locally.”

Dr. Keroack: “Right in the middle of the winter our health system is running near peak capacity anyway, so we’re looking at ways of — how do we open up more beds, get more staff online. If we needed 100 new beds, 200 new beds for whatever scenario comes down the Pike, we’re starting to do that planning now.”

Baystate Health President and CEO Dr. Mark Keroack talks with reporters and editors at The Republican on March 13, 2020. (Don Treeger / The Republican)

What the doctors are doing — and what you can do to help prevent the spread of the disease.

Dr. Keroack: “I’ll tell you what I’ve done. We have suspended all meetings, at Dr. Artenstein’s instruction, of more than 20 people. There are a number of community meetings … that I’m not going to be going to. I’m trying to stay away from crowds. Every Friday I go to dinner with my wife; tonight we’re going to do takeout. I’m in my 60s, and a man, so I’m a higher risk group of getting really sick if I get corona. ... I’m hopefully going to stay clear of this for the next few weeks, but I don’t know. It’s so easy to pick this up. I have modified my behavior a lot.”

Dr. Artenstein: “Reassess your own situation. If you’re in one of those higher risk groups, certainly take serious stock. And if you’re not in one of the higher risk groups, still take stock. I like to think about this as temporary. It’s not pleasant, because it’s not the way we like to go through life in a free society. … But, on a temporary basis, especially for the global public health — which benefits all of us, our families and our neighbors and everybody else — it’s wise to take certain precautions. … Make some modifications if it makes sense. And, obviously, we do need to retain our health care workforce, and that’s a vital concern of mine because again, those are not replenishable resources in the short term. … So that’s why we’re really hoping people take seriously the social distancing, some of the individual responsibilities and things people can do in smaller groups. That’s why I applaud cancelling or changing meetings to virtual meetings, and gatherings in the short term, if it will diminish the risk of further transmission.”

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