Episode 9: South Carolina Coronavirus Update: June/July 2020, Dr. Wendell James, III, MD
Transcript For This Podcast
James Crawford: Welcome to Episode 9 of HealthLinks Podcast. My name is James Crawford. Today, I’m joined by Dr. Wendell James of Prisma Health to give you an update on the COVID-19 situation in South Carolina.
We recorded this episode last week. And at the time, we had seen mostly an increase in the Upstate, although I do believe as of now, Tuesday, June 30th, we have begun to see it pop up in other areas in the low country.
So, this episode serves as your update and we take a look at what the mask ordinances mean, how can we continue to stay safe and live our lives at the same time, as well as how doctors are responding, how businesses are responding and what we can expect going forward? I ask him about the best-case scenario, about the worst-case scenario and a lot of things in between.
So, thank you for listening and thank you, Dr. James, for giving us an update and helping provide some clarity to this challenging situation.
Thank you so much, Dr. James, for joining me today. Right now, I think people are seeing things changing quickly in regards to COVID-19 and they just want an update as to what is happening in the upstate. Can you give us some clarity?
Dr. Wendell James, III, MD: Well, I hope they’re seeing things change and I hope they realize the importance of what they’re saying, because the concept of we’re opening up the economy, we’re opening up the community again is leading people to think that this is no longer a problem.
The virus is not going anywhere. All we did initially by the social distancing and the isolation that we did early on was stop the spread, which made everybody feel very comfortable with this. And they mistakenly essentially thought that it’s over when we started opening up the economy and opening up the community.
That’s not the case. The virus never left and it’s still just as contagious as it was to start with. It is still just as much a potential problem as it was to start with. And I think the public just needs to understand that we understand that we can’t lock everybody in the house and keep them home for six months. But we do need them to partner with us in the health care community here and let’s try to do the right thing for the community so that we can continue to open up our economy and our businesses.
But what does that mean? It may be careful, use hand sanitizer, social distancing yourself. One of the huge things is if you are sick, do not go to work. Get a test and see if you have the COVID virus.
James Crawford: Testing has been expanded, right? There are a lot of mobile units. It’s pretty easy to get a test right now.
Dr. Wendell James: It is very easy and we have a virtual visit that you can go online, get an order. We test between five and six hundred people a day in our drive through at the Greenwood Memorial campus. We’re the process of standing up at least one mobile drive though site.
We hope to have open early next week in Greer and we’re looking at some over towards easily, but we’ve got to find facilities and traffic flows that can tolerate it.
James Crawford: Yeah.
Dr. Wendell James: So, we’re trying to do our best at Prisma to do what we can to give everybody easy access to tests so that if they do become sick, they can find out if they are positive for it. And if they are, isolate yourself. Stay home for 10 to 14 days. You’ve got to stay out of the community, away from your family members. And we can stop the spread of this.
If you look at the numbers that we are seeing over the last two and a half weeks, we’ve tripled the number of hospitalized patients in three weeks. And that’s because people have ceased to do what we’re asking them to do.
Wearing a mask is hugely important. If they’ll just do that when they’re in a group where social distancing is difficult, certainly the elderly should always be masked when they’re out in public or in any kind of social environment, even when social distancing is going on.
People that are susceptible to this disease are certainly those that are my age and up, people with comorbidities. Obesity is one thing that we’re seeing does very, very badly with this disease. And that’s in every age. We’re talking the 20s up.
So, we would like very much to partner with the public in this, have them reinstitute and reconnect with us with respect to using the hygiene, the distancing, the masks, the isolation things that we’re telling them to do. And I think we can, as a community, if we do that, we can stop the spread, stop this rise in the occurrence of the disease, and we can continue to try and normalize ourselves again. But it’s a new norm.
James Crawford: Dr. James, do you think part of the resistance to this comes from, you know, back in March, it seemed like at first a lot of people were on board. We were kind of coming together and then there seemed to be something that happened. And I don’t know if it was due to misinformation, if it was due to people losing trust in some of these organizations. But there’s definitely been a shift in tone.
I’ve heard people talk about this over the past month, all the way from, “It’s a complete hoax” to just, you know, I’m sure you’ve heard it all.
How much of this is attributed, this this lack of concern for what’s happening right now, how much of that has contributed to misinformation and what can we do to get people on board? What’s the right thing to do?
Dr. Wendell James: I think a little bit of everything you said is the problem. It’s obviously a political year. Some of this has been politicized. There’s been confusion. And a lot of the initial confusion as to what to do was honest confusion, because any time you deal with the critical new event, things change very, very fast. And whether it’s a natural disaster or it’s a pandemic, as you move through the episode or the crisis, you obtain more and more information and you learn more and more about what’s working and what is not working.
And what we have seen, as we’ve gone through this, is just like everything, especially in medicine, you learn as you go. And as this has been a very, very fast learning curve for everybody. But it has been a very productive learning curve. We’ve learned you met modalities for treating this that have been very successful. We’ve learned that some of the things we thought to begin with and we felt like might not be working actually weren’t working. Masking is a good is a example of that.
James Crawford: Yeah. And I think that’s a good thing to point out, too, because that was some of the back and forth, which almost seemed like flip flopping on whether people should wear masks, whether people should not. And people just seem to have just had this distrust for any kind of organization, pointing them in a certain direction because there has been so much conflicting information.
What do you say to someone who hears that we may end up going to another shutdown or that hears this, but also is like, “Hey, I need to get back to work. I need to keep my business open. And some of this assistance from the government is running out?” How can people operate within this and still be safe while still earning an income and taking care of their family?
Dr. Wendell James: We do not want to shut things down. The worst-case scenario is nobody pays any attention. We continue to spread this very, very rapidly. And we could theoretically, I suppose, get back in a situation — Well, not suppose, we very likely could get back into a situation, in worst case, where we had to do something fairly extreme like we did initially. Nobody wants to do that.
This country has resources nobody else has. We have a very intelligent population, as a rule, but we’re incredibly independent. And we don’t like people telling us what to do. Which is a little bit of the yin and yang there. But the fact of the matter is, if they would look to their medical institutions in their areas for the source of truth. Prisma is no different than any of the rest of them. I’ve talked to the CEOs of every health system in the upstate once a week, and we are all trying to give the public the information they need as consistently across all platforms. Like Prisma, Spartanburg, St. Francis, AnMed and Greenwood. We all meet or have about an hour and a half talk, once a week, to make sure we’re telling everybody the right thing.
James Crawford: I think that’s incredibly important because the people have seemed to lose trust in some of these organizations; the CDC, the WHO and the government. So, it is important for organizations like yourself who have personal relationships with the community to share this information, because it seems like that trust factor is there more, which is part of why we’re doing the podcast. That doctor-patient trust really is important here and people need to be listening to maybe the primary care physicians and organizations, such as Prisma, because they’re all saying the same thing.
James Crawford: We are very, very much concerned about the health care and the health of the community and providing health care to everybody that needs it. We’re very much concentrated on COVID patients, but the community as a whole has to be taking care of all day, every day.
And our biggest concern with COVID is being able to continue to provide that care safely in addition to the COVID with patients. And so, it is more than in our best interest to make sure the public understands; we can take care of everything you’ve got going on your normal health issues. We can do that very safely.
From the comfort perspective, when you stack them on top of it, we just need the people to help us manage the spread of the COVID virus. And if we can do that as a community; work together, take the measures we’re asking you to take.
And they’re so simple. Like I said, use hand sanitizers, wear mask when you’re out in a crowd. If you are susceptible or more susceptible, you need to always wear a mask when you’re out. And I do; I’m not susceptible beyond anybody else, but it’s just good practice to do that.
James Crawford: Yeah.
Dr. Wendell James: To socially distance. If you think you’re sick, remove yourself from your work environment and your home environment to the extent you can and come get tested and let us see. If you need to isolate, according to the guidelines, we’ll provide for you. It is in our best interest to make sure that you all, as a community, are taking care of; COVID, non-COVID. Whatever.
One of the things that I will give the politicians in this state credit for is they have come to the health care institutions around the state and said, “We need you to help us spread this these instructions. We’re not trusted. We know that.”
I mean, for them to look at you and tell you that, they’re concerned.
James Crawford: They don’t like to say that.
Dr. Wendell James: They’re trying to get honest information to the public and they want us as Prisma and AnMed and St. Francis and St. Martinsburg and Greenwood and all our Midland’s Prisma facilities and all of them. They just want us to give the public the information.
And we appreciate people like you allowing us to do that, because we got something we can manage through, but we have to all partner up and do this. This is a partnership of the community and the health systems around their communities to do this. And we’re smart people and we can manage through this if you’ll just follow some simple instructions.
James Crawford: Yeah. And hopefully, it creates this environment where the health care industry and population is moving in lockstep. Because this moves beyond just COVID-19, flu season, things like that. There’s so many things where if people take personal responsibility and if they lean on the experts and they lean on the relationships they have with their doctors, we could really see, in the end, this could end up being a good thing if people approach it right and the way things move beyond COVID-19.
Dr. Wendell James: It very much could be. This has been a very acute exercise in population health and we are learning a lot about how to manage crises in the population’s health. But we’re also learning a lot about how the population looks at what we do and how we deliver information. We also have had massive shifts in the way we practice. We’ve gone to virtual visits at a scale and rate that is unheard of. I mean, we were seeing 30 percent, sometimes, of our visits in a day were virtual visits.
And what we found and the public has found is they like that. I’ve got some physicians that say, “This is something I should have done years ago. I’ve got a lot of people out in the public that have said for years, “Why do I have to go to an office to get this taken care of? There’s some things, absolutely, we need to see you in person for. But there are a lot of things that we’ve historically seen you in person for that on a video conference, like we’re doing right now, could easily be dealt with and in the convenience and safety of separating the individuals.”
And it’s something that the virtual visit platform has evolved into today that we can, hopefully, help manage the spread with. I think we’ve already got the tools in place for the second round of this, which is what we’re looking at now.
James Crawford: Yeah. So, let’s talk about that second round, the second wave, if you will. You said a minute ago that hospitalizations have tripled over the past two weeks.
Dr. Wendell James: For COVID, they have.
James Crawford: For COVID. What do you attribute that to? Is it that we just opened back up too soon? Because it’s as simple as that.
Dr. Wendell James: We were going to always have to open up at some point. Okay? Too soon, too late; it’s just you pick a point that you have to do it.
James Crawford: It’s unsustainable. You can’t keep going forever.
Dr. Wendell James: What we were doing was unsustainable. But from a purely epidemiologic standpoint, it was the perfect thing to do. Everybody stayed home. Nothing spreads. We all get well and everything goes great. You can’t realistically take a 200 or 360 million people and lock them down because there has to be somebody provide food for these people. There has to be somebody providing the energy for these people. The lights have to come on and the hospitals have to operate. So, there’s no way to shut an economy this massive down for the length of time it would take to completely stop this virus. So, there was not going to be a point where we didn’t have to open up and run a risk of this happening.
But the risk is mitigated by the public’s behavior. The public is in total control of how good or badly this goes. The more they participate in maintaining their distancing and following the instructions they are being given, the more smoothly and less problematic this will be for everybody. And more smoothly it will go.
James Crawford: Is there any understanding of why it seems to be increasing more so in the upstate?
Dr. Wendell James: I think the upstate is kind of a neat demographic, when you look at it, but it is a very independent demographic, when you look at it. And we have pockets of ethnicity around the county that have had issues, because of lack of understanding, which we have all the systems are very aggressively dealing with and it’s mitigating the issue.
But when you look at the majority of the people that we’re seeing in with positive test now, it’s not the elderly like it started. It’s the young people. They’re not listening and they’re not following the directions they’re being given. And part of it {indistinct 16:56} is because a lot of people have lost faith in the genuine nature of what’s going on.
To your point earlier, people don’t know who to trust. Some people think it’s a hoax. It’s been politicized in some areas to the point where nobody knows what to think. And so, it’s kind of a mosh pit of problems that all lead to noncompliance with the safety measures.
Back to my point there, the public is totally in control of their destiny here. We can manage through this, from a hospital system standpoint (health care standpoint). If we can get the public to trust us (at least us as) a source of truth and follow some very minimal and truly minimally intrusive instructions, it can help mitigate this.
Until we get a vaccine, this will run through the population until we get a vaccine. Once we get a vaccine that’s effective, I think we can start controlling it. But right now, all you can do is mitigate the effects of it. And that means we all have to do what we need to do with respect to the preventive measures we’ve consistently delivered to the public.
James Crawford: So, tell me about the masking ordinance.
Dr. Wendell James: Oh, we were thrilled to see them asking our audience here at Greenville. And I know the Midlands market leaders were as thrilled as we were, because it meant that the politicians were recognizing what we were telling them, that this is beginning to rise quickly and we need to put mitigation or something to mitigate it in place.
One of the things that I have noticed in the last few days since the masking ordinance, and it may just be wishful thinking or just wishing it to be, but it seems to people can spread out a little bit. And I think the masking ordinance, could it have been stricter? That would have thrilled us, too. But I think it’s a good start. And I think it would have—
James Crawford: What is it? Like what the specifics? It’s in certain counties –
Dr. Wendell James: Some types of businesses, particularly grocery stores and pharmacies. I mean, those are places that people with pre-existing disease have to go. You’ve got to get groceries and you’ve got to get your medicine.
So, they felt like that was, I think, the place to start. In certain type of gathering situations, you got to wear a mask. If you cannot maintain adequate social distancing in a situation, then certain people have to be masked.
I think that we could be a little bit more aggressive with it. I would have liked to seen that, but I think it’s a great start. And I actually called the mayor and told him I appreciate him supporting us with that. I would be more than happy if he’d made it stricter.
James Crawford: Add a little bit to it.
Dr. Wendell James: There’s a limit to what you can do. And I think in the situation we’re in right now, just getting public’s attention and understanding of where we are and what needs to be done to try and go to something really, really strict would have been difficult to do so.
James Crawford: Yeah.
Dr. Wendell James: But it’s a good move. And I think this got a lot of support from the medical care community. I know, but the docs that are dealing with this with me every day, they said, “Finally, somebody is trying to help us here.” So, it was a good thing. And I hope the community sees it and will do it in the — Basically, the way it was intended was to protect them, and I hope they will take it that way.
James Crawford: Yeah. Would you recommend everyone get tested?
Dr. Wendell James: Testing is an interesting puzzle. For me to test everybody today, all that tells me is who has it and who doesn’t have it, today. If you have it, it’s good to know. It’s more important for those that have it than those that don’t have it. If you’re tested is positive because you have symptoms, you’re sick or you don’t feel good, then it tells you what you need to do to mitigate the spread to anybody; your parents, your grandparents and children.
If you’re not positive, testing didn’t do anything. So, if it scares you enough to get a test to follow the instructions and get on board with preventative measures within the community, then it might be a benefit. But global testing of all the people at one time waste a lot of tests that you would need to truly diagnose and manage it when people became ill. Does that make sense to you?
James Crawford: Yes. So, you’re saying that people if you feel like you have symptoms, it makes sense to get a test.
Dr. Wendell James: Absolutely, come in.
James Crawford: If you don’t, it’s better to focus your energy on taking preventative measures; washing your hands, social distancing, wearing a mask, things like that, than it is to go and get a test necessary.
Dr. Wendell James: A test does not give you any immunity, obviously, to the disease, but it may give you a false sense of security at the end. I’m not sick.
James Crawford: Yeah. So, you feel like you’re not sick. And so now it’s like, “Oh, okay. Well, I’m fine. I’ve been around everyone.” People may even have the erroneous belief that they’re immune to it for some reason and they wouldn’t be —
Dr. Wendell James: One thing we’re finding is there are fewer people in the community that thought they had it that were immune to it than we initially believed. You will be symptomatic, most likely, if you get infected with this.
James Crawford: So, asymptomatic; people who have it. So, it’s very rare for people to be actually be asymptomatic. Because I know that was something we heard a lot, that there are tons of people who are asymptomatic. Are they finding now that that’s not really the truth?
Dr. Wendell James: It depends on what you call asymptomatic. I’ve had the flu and I’ve had had the flu. And when you have the flu and you kind of get a little achy, you kind of just drag you for a few days. You say, “I’m good.” That’s still symptomatic. Okay? But I didn’t pay any attention to it.
When you have the flu to where you’re literally in the fetal position on the floor because you hurt too much to move, are you too sick to get up, that’s the other extreme for the flu short of you being in the hospital on a ventilator. And they haven’t been from one extreme to the other. They are just short of the hospital. All of it was a symptomatic presentation of a disease. It was just the degree of the symptoms.
What does that mean? It means somebody might consider themselves, “I didn’t really show any symptoms”, but their expectation was they would be really, really sick, even though they ached all over for two days and ran a low-grade fever.
That is symptomatic enough to where you probably should maybe seek out a test. And if you test positive for this, then isolate yourself because your spouse or your mother or your grandparent may not be fortunate enough just to ache couple of days. They typically will show significantly more symptoms with the same virus. It’s just you don’t know who is going to have that really bad reaction.
James Crawford: So, testing for antibodies. What does that mean? And is there any science behind knowing that if you have the antibodies, that means you had it and does that make you immune to it or is all that still up in the air?
Dr. Wendell James: A lot of that is still up in the air. We have what we call RGG. There’s RGG and RGM antibodies. The body makes lots of antibodies. Having RGG antibodies does not necessarily mean you have RGG antibodies to COVID.
The only thing we’re finding relatively consistent is if somebody test positive for COVID, the people that we are seeing consistently have RGG antibodies, when they have RGG antibodies for those. But they don’t all show them. And it’s been inconsistent.
There’s a new antibody test for RGM coming out, which is a different type of antibody. It’s a little bit more cute; that they think might be more accurate. We don’t know right now if we even get lasting immunity to this. We think we do or may get some degree of it, but that’s a whole another set of problems if we find out that you really don’t get lasting immunity to this virus. And then we have another issue.
The best thing we’ve got going for is to kind of mitigate or eradicate this to the extent possible is a vaccination that is effective. And even then, you’re going to have a group of people who are adamantly opposed to being vaccinated for anything that certainly have a right to do that. But then it puts them at a significantly higher risk than the general population that does vaccinate.
When you start talking about vaccinations, that’s a segue to what we have to deal with coming up in the next several months, which is flu season. The one thing we do not want to see happen is our normal patient population, with their chronic diseases, stacked on top of COVID, stacked on top of the bad flu season.
James Crawford: Yeah. That’s a huge crisis.
Dr. Wendell James: Any two of those with a little help from the public is manageable. But stacking all three on top of one another could be very, very difficult. So, we’re working on trying to make vaccination as simple as we can for the people in the next several months. We’re going to begin our vaccinations earlier than we normally do, as soon as we can get them. And we’re in the process of evaluating whether or not we can, in some way, stand up a drive through vaccination center, which is still yet to be determined. But that has a whole different set of issues and logistics than a drive through testing center does.
But we want everybody that is willing to be vaccinated, be able to get them. Because the more people we can vaccinate the better.
James Crawford: What is the worst-case scenario?
Dr. Wendell James: All that stacks on top of themselves.
James Crawford: That we have a terrible flu season?
Dr. Wendell James: A bad flu season, a bad COVID resurgence and a bad — you just have your usual chronic disease in the community that we manage. That would be a worst case.
James Crawford: And I know we’ve gone over this many times, but I think it’s worth repeating. What do we do to avoid that worst-case scenario?
Dr. Wendell James: Take care of yourself. Get your flu vaccine. Follow the instructions we’re giving you in the community to mitigate spread of this virus. And if we can do that, go see your doctor for your chronic illness. Don’t ignore your blood pressure problems. For God’s sake, don’t ignore diabetes because diabetics and this disease are bad combination.
So, get your regular care on your regular schedule. We have plenty of ability across all of these platforms in the upstate to do that. And we’ve seen a lot of people not do that. And it is beginning to snowball a little bit. But that’s kind of quieted down over the last week.
But we need people to continue to seek the regular care. Do what they can to mitigate spread of this COVID virus, because if they will do that, it minimizes the overall burden on the health care system across upstate, and we can manage everybody much more effectively.
And get vaccinated for the flu. I know if you don’t have religious or moral reasons that you don’t want to be vaccinated and you haven’t in the past, if you would this year, just get yourself vaccinated. We’re going to do everything we can in the upstate to make sure that everybody that can be vaccinated for the flu, can get a vaccination.
Those are the three really big things that can help us; seek your regular care on time, mitigate virus spread by doing what we’re asking you to do and get a flu vaccine. None of that’s hard to do.
James Crawford: Now, what is the best-case scenario?
Dr. Wendell James: Best case scenario is this would go away like the swine flu and some of these other viruses that were very, very, very, very — Excuse me, man, it’s been a long week.
James Crawford: It’s all right.
Dr. Wendell James: The more virulent the virus.
James Crawford: Well, those are two hard words to put together. Very virulent.
Dr. Wendell James: By Friday afternoon I’m getting tongue tied with money. But the virulence of the virus, when you see a virus like we’ve had in the past, swine flu and some of these, we were developing vaccines for a lot of this stuff and they just vanished. They just disappeared. And we don’t know why.
I mean, the virus could have mutated into something that we were not susceptible to. It could have kind of mutated into something that the environmental factors helped kill out faster.
This virus is not doing that. That’s the one thing we’re not seeing. And we’d like the best case to happen that magically, this goes away. But we’re not seeing that, I don’t expect to see that and the timing of this is becoming more concerning because we’re starting to ease into flu season which looks like a second wave of the virus.
James Crawford: Seems like we have this small window that we really need to be diligent in focusing on what you’ve said.
Dr. Wendell James: No, absolutely. What you’re saying is correct. We have a small window here for everybody to do what we’re asking them to do. Let’s mitigate the viral spread, let’s get vaccinated and let’s take care of ourselves like we normally would do.
Prisma has the capacity. I know the other system CEOs were telling me they’ve opened up capacity to take care of patients like they normally would, and we can get that back on track. And all of those things take the problems with managing the population’s health. It lowers the disease burden in the overall community. And by doing so, it makes it a much safer next several months.
But like I said, we want to be your partner out there in the community. Work with us and let’s get through this and not have to go back to where we started here.
James Crawford: Of course. Is there anything else you want to share before we go, Dr. James?
Dr. Wendell James: No. I’ll try to get virulence down better next time.
James Crawford: Okay. All right. I’ll practice that too.
Dr. Wendell James: Anyway, I appreciate the chance to talk to you and hopefully somebody is going to listen to us.
James Crawford: Yes, absolutely. Thank you, Dr. James.
Dr. Wendell James: Have a good weekend.
James Crawford: You too. Thank you.
Dr. Wendell James: Bye bye.
We are going to continue to bring you information as it develops; as the COVID-19 situation evolves. And hopefully we will begin to see it evolve into a more positive situation. And that, according to the experts, can only be done by us coming together and doing the things that they recommend.
So, I hope you’re staying safe. I hope you’re taking care of yourself, taking care of your family. Until next time, this is HealthLinks Podcast. My name is James Crawford.
