COVID-19: What We Know Now with Dr. Kristin Englund

Podcast Transcript

Cassandra Holloway:  Hi there and thanks for joining us. You're listening to the Health Essentials Podcast brought to you by Cleveland Clinic. My name is Cassandra Holloway and I'll be your host for this episode.

Today, we're broadcasting virtually as we are practicing social distancing during the coronavirus pandemic. We're joined virtually by infectious disease expert Dr. Kristin Englund. Dr. Englund, thank you for taking the time out of your day to speak with us.

Dr. Kristin Englund:  Of course. Good morning.

Cassandra Holloway:  So it's been about nine months since the world first started to hear about the 2019 novel coronavirus, COVID-19. The virus was first reported in China in late December of 2019 and has since spread worldwide and has changed our world as we currently know it. Today we'll be talking with Dr. Englund about where we currently stand in our fight against COVID-19. We'll discuss everything from vaccines to the upcoming flu season and uncover the truth surrounding some myths that we've been hearing, especially when it comes to what we've seen online and shared on social media. We'll do our best to answer the answers we have now and also discuss some of the pressing questions that still remain. But before we dive into this episode, we want to remind listeners that this is for informational purposes only and is not intended to replace your own doctors' advice.

So Dr. Englund, I imagine you've been quite busy these past several months dealing and managing coronavirus so how are you doing with everything?

Dr. Kristin Englund:  Well thank you for asking. Things were pretty concerning back in March and April as we saw the numbers rising and we didn't know where they were going to go. Thankfully over the last several months we've seen numbers of cases and certainly number of hospitalizations declining. I think that is a strong statement to the way that people in Ohio have been reacting to the recommendations and certainly bodes well for what we're looking forward to. We're anxious about the fall and winter months but hopefully we can keep doing as well as we're doing.

Cassandra Holloway:  Absolutely. So we have so much to unpack in this episode so I want to dive right into testing as kind of our first topic here. So I know there are so many different variations of tests, the tests that you get results in a couple days versus couple hours, and then I've recently heard about a test that you get results in like 15 minutes. So I just want to pick your brain, where do we currently stand with testing?

Dr. Kristin Englund:  So we have several different types of tests that are available. The first tests that were made available were the swabs that you have to go through the back of the nose, the nasopharyngeal swabs. They're really uncomfortable to have done, trust me, been there, done that. That test is done with a ... Where we look for the nucleic acid or part of the virus itself and that has to be done on a special test called a PCR test so that's something that has to be done within the lab setting. They say it can come back pretty quickly. Typically we found it's about a 12 to a 24 hour turnaround time. In some places where labs were overrun it was taking a week to get lab results back because they had too many samples to be able to run at any one time so that is what considered a gold standard right now because it actually looks for particles and parts of the virus, but it does take time for those test results to come back.

Another type of test that we have is called an antigen test. So it also looks for kind of some pieces of the virus itself but this is a test that can be done very simply. It doesn't require all the laboratory machines, so we can get those test results back even as quickly as 15 minutes, so that's the test that you've heard about more recently. So those tests can be done on the same nasopharyngeal test which again is not something you want to have to do. You can also do it with just a simple swab, cotton swab of the lower part of the nose. We're now starting to get some samples where you can get of saliva so you can basically spit into a cup and they can use that same testing available for doing both the antigen or the PCR testing for that.

Cassandra Holloway:  Lots to go over with testing for sure and I feel like we've ... Since the beginning in March and April, we kept hearing about testing was limited resources and they still are, but do we have more tests now than when we did I guess in the beginning of the pandemic?

Dr. Kristin Englund:  We have more tests available first of all because a lot of the laboratories have been able to buy the equipment to be able to do those specialized PCR tests that we were initially talking about. Companies are also getting very creative in coming up with the new antigen tests and the saliva test makes it much easier for people to be able to get the samples. If I need to do a nasopharyngeal swab, so I need to get that test at the back of your nose, what I have to do is I have to have somebody, a nurse or a physician or a technician, in special protective gear so they have to have a face mask and a special mask and gowns and gloves because taking that simple is going to make you cough or sneeze. So there's a real risk that just in getting the sample, you could be getting somebody else infected. So that takes a lot of very specialized areas and equipment and personnel to be able to do that.

When we look at something as simple as spitting into a cup, that doesn't require any kind of special equipment, it doesn't require any kind of personnel that has to be able to specially get this sample from you, so it's much easier for us to be able to get more samples and more people tested. Sometimes universities are using this type of testing to be able to get a lot of students and a lot of their faculty tested.

Cassandra Holloway:  What should listeners know about kind of that self-swab testing? I know a lot of pharmacies are rolling out the self-swab tests. What should listeners keep in mind since they're the ones actually doing the swab themselves?

Dr. Kristin Englund:  Yeah. So the self-swabs are available not for testing, right? That they're at the pharmacy or there are some at home that you can do. You still have to mail it in and those are typically going to be your PCR tests so those are going to take some time as well to come back so you're not going to get an instantaneous result from that. It's going to take probably a day or two or even three for those test results to come back.

One thing you want to do is any test is, how accurate a test is depends upon the sample that you get. So if you're just kind of dabbing at the end of your nose to get the sample, it's not going to be the most accurate. You really want to follow the instructions and make sure that you're getting a good sample of the tissue that's in the nose so that we can make sure that we find the virus. If you don't get a good enough sample, it's going to be a false negative and then that's going to give you some reassurance that you don't have the virus when you really might.

Cassandra Holloway:  You bring up an interesting point too because I feel like we keep hearing how accurate are the tests, how reliable are they? I guess what would be your kind of advice to listeners about are these tests accurate, should we trust them?

Dr. Kristin Englund:  I do think that for the most part our tests are accurate at this point in time. If it's positive for the most part, you truly are infected. If it's negative, those are the times when we have some concerns, was the sample adequate, was it done too early to be able to detect it, was the sample collected appropriately and in some cases where it's not the saliva test, was it put into the right sample tube and taken to the lab in an appropriate amount of time? So there certainly is the opportunity for a negative to be a false negative and in that case you're really infected but the test was wrong. But if it's a positive test for the most part you can really count on that.

Now we've seen the case here in the state of Ohio with Governor DeWine who had a positive rapid test, one of those very quick antigen tests that then later on when he had the PCR test done showed he really didn't have the virus but that's a pretty rare occurrence.

Cassandra Holloway:  I'm curious with tests, I recently donated blood and the American Red Cross will test for these antibodies and I came back negative but it kind of got me thinking, what if I had come back positive, kind of like you were talking about with Governor DeWine. Does it mean that we were exposed to the virus, did we have it at any point, what if you do test positive for these antigens? What does that actually tell you?

Dr. Kristin Englund:  Sure. So the blood test that we do looks for the antibodies because what we're testing there is your body has seen an infection and just as with any infection, your body makes an immune response to it called an antibody so that you can fight that infection right then and then also in the future if you were to ever see that infection again. So when the Red Cross is testing your blood, they're looking for the antibody test. That generally will tell you that you've been exposed in the past.

Now what that means as far as moving forward, we still don't know yet and that's the problem with antibody testing is first off we don't know which antibodies in particular we should be measuring to try to determine if you're really protected as you're moving forward so if you get a positive antibody test, does that give you the confidence that you're not going to get infected again? Not at this time.

Cassandra Holloway:  Then thinking about the future of testing, do you ever think that we'll get to a point where there's like an instant test where before you go into a sporting event or a business that someone will be able to kind of test you, almost like the thermal scanners. Do you think that's ever a possibility?

Dr. Kristin Englund:  I'm never going to say never but I think at this point in time it's most likely that the quickest that we're going to be able to get is an antigen test where it’s like a pregnancy test. It's still going to take a little bit of time for that to be able to react and to be able to get a result and the quickest we've got right now is about 15 minutes. We may be able to cut down on the time for that. I'm not convinced we're going to have a scanner that's going to be able to help us out with that though.

Cassandra Holloway:  Sure. So many people had this idea of the coronavirus vaccine on their minds and kind of fast-tracking that vaccine and there's so many brilliant minds all working together to kind of get this vaccine into a state where we can take it. So I know we've seen hopeful and also discouraging news in the past several weeks about the vaccine moving to Phase III and clinical trials, so what are your thoughts on a vaccine and when do you realistically think one will be available?

Dr. Kristin Englund:  I wish we had a vaccine coming into this flu season and into this fall and winter but I'm not optimistic that we're going to get anything sooner than probably the first quarter of 2021. I think that's the most realistic. When you look at ... The studies that are currently in Phase III, and that's the final stage. We have three different phases of testing that we do on whether it's medications or vaccines at this point in time. Phase III is where we try to get tens of thousands of people to volunteer to get these vaccines to try and see what kind of a response we'd get from them, and then we'd also need to see if they go on to get either side effects from that vaccine itself or if it's even effective, if we get a good antibody response and we just talked about whether that truly means anything, and whether they go on to get infected. So there's a lot of data that needs to be collected on tens of thousands of people to make sure that this is again a safe and effective vaccine because we're potentially looking at giving this to seven billion people. So looking at tens of thousands of people seems pretty small but it's something that we have to do to make sure it's safe, and it takes time.

Cassandra Holloway:  Absolutely, and you hear a lot about people saying when a vaccine is ready, they don't feel safe taking it, they're not going to take the vaccine. So are health experts concerned about this at all?

Dr. Kristin Englund:  So I think there's a lot of discussion on what kind of data that we're going to need to see before we can kind of put a stamp on whether a vaccine is appropriate or not. Every trial has a data and safety monitoring board and those are usually individuals that are separate from the industry that is putting out that trial so you have to put a lot of faith in those scientists who are looking at the data and trying to interpret that data. The data's also going to have to then be presented to the FDA and then there's going to be a lot of scientific eyes on top of that as well, so making sure that as we see this information coming out that it is appropriate and that we are making sure that patients will be safe and that it will be effective. So I believe that even when it gets FDA approval, there's going to be a lot of different organizations looking at it. I'm a member of the Infectious Disease Society of America. I know we're going to be putting out statements and making sure that we think that this is appropriate or not as well.

Cassandra Holloway:  So when a vaccine is available and it's FDA approved and it's been looked by all the groups and organizations that you had mentioned, what does a post-vaccine world look like? Will everything kind of go back to normal pretty quickly or will it take a little bit of time for it to roll out to everyone else?

Dr. Kristin Englund:  It's going to take a while, certainly to be able to get hundreds of thousands of vaccines just in the United States alone. Again, we won't be having our pharmaceutical companies making it just for us, we're going to have to be able to supply all of the world. So seven billion doses of a vaccine are going to take certainly some time to be able to manufacture. Then we also have to look at how effective the vaccine is. So when we look at our influenza vaccines they generally run anywhere from 40 to 60% efficacy meaning that if you get the vaccine you're about 50 to 60% less likely to get the influenza. Now with influenza if I got the vaccine and I still get influenza, the vaccine will help me to have a lesser disease process so it's going to make me have much milder symptoms. So certainly we hope that even if the COVID vaccine is not 100% effective that you're going to be able to see people having milder cases if they get that.

So we look at how much vaccine is going to be available and how quickly, how effective that vaccine is, and then we have to look at the number of people who are willing to get the vaccine because that's the other huge component as to how we can make sure that we have people who are at risk being protected, that's the concept of kind of herd immunity is that we take somebody who is at risk for getting infected and would have a very bad disease process, would potentially die from it if they got it, and we have to surround them with people who either are immune because they had the infection or they've been vaccinated and that way we kind of surround them in a bubble of protection to keep them from getting the infection.

So if people are not willing to get the COVID-19 vaccine, that also really hampers us and keeps us from being able to get this disease under control. If we can't get it under control, then all of these measures that we've had to put in place to social distancing, the masking, that's just going to drag that out longer and longer and longer.

Cassandra Holloway:  Yes, absolutely, and a good reminder. We do this to protect everyone around us. We do this so we can slow the spread for sure.

Dr. Kristin Englund:  Absolutely.

Cassandra Holloway:  So we've touched on the upcoming cold and flu season a little bit here. So with the cooler weather approaching, especially in Northeast Ohio, should we be concerned about infection rates going up this fall and winter and why is that?

Dr. Kristin Englund:  So we have not seen that COVID-19 necessarily has a difference as far as the summer and winter cycles go with it. We see that a lot more with influenza, we're still seeing plenty of people getting infected with COVID during the summertime but as we get into the fall and wintertime, the problems that we're seeing is a) people are going back to school and then people are going back to work as their kids are going back to school and b) we're spending a lot more time inside so we don't have everybody out walking around, we're all kind of huddled around in our offices and in our stores together.

So there is a greater likelihood that we're going to see an increase in the number of cases just because of the transition from everybody being outside to indoors and congregating more together. Adding into that, we're going to see influenza as well because that's why influenza tends to worsen in the fall and wintertime as well.

Cassandra Holloway:  What about like drier air or drier mucus membranes for the virus to get inside your body? Is that a concern with cooler, winter months?

Dr. Kristin Englund:  It certainly is something that could play a part if we have more potential breaks in the nasal mucosa because it's dry. That certainly could potentially add to that but I think that we're certainly going to be able to get around that by the wearing of masks when you're around other people as well. That should really help to dampen the problems that you would see around the dryer air.

Cassandra Holloway:  Then what about sunlight? You hear a lot about the ultraviolet light and if the virus doesn't like the sunlight, how does that play into this?

Dr. Kristin Englund:  I think when we talk about the sunlight's effects on it, that tends to be more on the ... The things that we touch, so when you talk about being outside and you touch on a playground handle for a swing set or something, there's the concept that the light, the sunlight will be able to make that less infectious. Typically this is a disease though that is spread by droplets so it is spread by the cough and by the sneeze, less by touching other surfaces and other objects so I don't think that the change in the sunlight is going to have nearly as much of an effect as it is just basically making sure that we're taking care of covering our coughs.

Cassandra Holloway:  How does the flu shot this year play into protecting against COVID-19? Does it play into that? Does it protect you from COVID-19 or does it just protect you against influenza?

Dr. Kristin Englund:  Yeah. So there are going to be two completely separate viruses. Now while they might have very similar symptoms, the viruses are caused by completely separate viruses so we need protection against each one, each individual one. Influenza is not something that you want to get, all right? A couple of years ago we lost 61,000 Americans to influenza because we had a really bad influenza season. On average we have die about 20,000 to 40,000 Americans from it so every single year we deal with unnecessarily and unfortunate deaths from influenza. The vaccine can truly help us to decrease those numbers.

As we start to come into this fall, we want to make extra sure that we are protecting ourselves and our whole communities and our loved ones from influenza because we need to make sure that if we have more patients with COVID entering our hospitals and we have a lot of patients with influenza entering our hospitals, we're going to overwhelm the system and in that way it's very difficult to be able to get excellent care when your hospitals are simply overrun. So if we can protect against half of that by getting rid of all of the influenza cases or as many as we can, then we'll still have room for the surge of COVID cases that might very well come.

Cassandra Holloway:  What about timing of these flu shots? Is it important to get it early? How does that work?

Dr. Kristin Englund:  In the past, influenza vaccines have been available as early as August and our recommendations are at this point in time that August was a little bit too soon so hopefully people have been waiting until September and October which the CDC recommended so September and October timeframe is really when you want to be getting your flu vaccine. That will carry you through until May, June when we typically see the influenza season starting to wane. If you haven't gotten it by November, December, you still want to get it. Just because you've missed out on the September October window, that doesn't mean that you don't have to get it. I've been giving people flu vaccines as late as March just because I want to make sure that they're protected until the end of the season so it's never too late to get one. As of right now it's not too early because we're in that time window when you should be thinking long and hard about getting your flu vaccine.

Cassandra Holloway:  What about people who typically get the pneumonia shots every year? Should they still get those or should we seek those shots if we don't normally get them?

Dr. Kristin Englund:  So when we talk about the pneumonia vaccine, it's protecting people against strep pneumonia. There are certain classes of people that need to be getting that, people who have chronic disorders such as diabetes, who have lung disorders like asthma and COPD and anyone over the age of 65 needs to be vaccinated against it as well. So not everybody needs a pneumonia vaccine. I would talk to your primary care doctor about whether you need to be getting that vaccine, but everybody should be getting a flu vaccine.

Cassandra Holloway:  Dr. Englund, we've touched on a couple of these kind of precautionary things that we can do but just to remind listeners, how else can we protect ourselves this cold and flu season?

Dr. Kristin Englund:  Well I think as we've been talking about for months and months, when you're going out in public, make sure that you're wearing a mask. It's important to be wearing that. It's important to have hand sanitizer so that when you do touch objects, the tendency for me is to always then just touch my face and that's where I'm going to be able to spread the virus into my eyes or into my mouth so hand sanitizer, masks, and keeping that six foot social distance away from other people so that you make sure that if they are coughing or even if they don't have symptoms, they may still be able to spread that infection to you. So just very common kind of cough, hygiene and hand sanitizing practices.

Cassandra Holloway:  So I want to talk about everyone's favorite topic, face masks, which we've referenced a couple different times here so ... Everywhere you look, people have opinions on them. Are they bad for you, do they hurt your health, do they not do anything. Can you explain the science behind why we're now being told to wear a face mask in public.

Dr. Kristin Englund:  Absolutely. Masks are not going to hurt you. There is no way that wearing a mask is going to be causing you any difficulties. It is meant to protect you. So the certain different types of masks that we wear are for different reasons. I've got one mask here, it's a simple cloth mask, and this one is going to be protecting you from when I cough. So if I have a virus that's in my mouth or in my nose and I sneeze or cough, it's going to catch that inside the mask and keep those droplets from spreading over to infecting those around me.

Now to a degree it's also going to protect me because if you are coughing on me and it gets caught on the outside of my mask, that's going to keep it from being able to get into my nose and mouth as well. Now my level of protection is not as good as if I was wearing one of the surgical masks where they have smaller pores on them so that it allows less of the virus to be able to penetrate a surgical mask or if we go up to those N95 masks, those big white masks that you can see people wearing around. Those allow even less of any virus to be able to penetrate but this is still an excellent way for us to be able to protect each other so I'm protecting you and you're protecting me when you're wearing these masks. Key things are, you can have a mask but you have to be wearing it correctly as well. I cannot tell you how often I see people wearing it like this where it's not covering the mouth, it's not covering the nose, it's not doing any good at this point in time, you're not protecting yourselves or me. Certainly hanging off of one ear, it doesn't do a thing for you either. So it has to be worn completely covering your nose and your mouth and going underneath the chin. So like this. That covers very well and it's actually quite comfortable.

Now you may want to check on a couple of different masks or may you want to make your own mask and that's certainly an option. There are tons of different ways online. You can go to the Centers for Disease Control and they'll show you appropriate ways to be able to make a mask that can be comfortable and we do know that the number of layers of cloth is certainly important as well. If you have a cotton mask, cloth that has two layers to it, that provides you more protection than if it just has one layer but one layer is still pretty doggone good. So no matter what kind of a mask you can get, wear it appropriately and wear it all the time.

Cassandra Holloway:  Absolutely. It's interesting what you said about ... We hear wearing a mask is a gesture of caring for those around you and you're protecting those around you, but you said something interesting that I wanted to just ask you about. Does wearing a cloth or surgical face mask also protect the wearer or is it just about the people around you?

Dr. Kristin Englund:  No it definitely will protect you as well. A surgical mask will protect you personally more than a cloth mask will but the cloth mask still does offer some sort of protection as well. Again it allows those large droplets, if somebody happens to cough on you while you're out at a store, that will protect you from getting those large droplets inhaled in. Now some of the small amount of virus may still be able to get through but that's why it's important that if you're distancing yourself from somebody, you're less likely to get a lot of that onto your mask and onto your face.

Cassandra Holloway:  I'm curious, have you seen those face mask brackets? They're kind of like a silicone accessory that you wear underneath your mask and it kind of prevents you from sucking in your mask when you talk? I guess those are more comfortable to wear, I've never personally worn them, but it keeps the mask obviously from sitting directly on your skin. Do those work? Are those okay?

Dr. Kristin Englund:  I'm not aware that there are any studies necessarily comparing wearing the face brackets. There have been some studies looking at just the different type of mask material but not necessarily using the face brackets. I don't necessarily have a problem with wearing the face bracket at this point in time as long as you make sure that the mask itself is still covering the nose and still under the chin and still fairly plush against the face here. If it will allow people to wear masks for longer and encourage them to wear masks, then by all means, go ahead and use it.

Cassandra Holloway:  Then one last question about masks that I want to ask you. We keep seeing a lot about people working out and trying to find a mask that they can run in or go to the gym in. What's your advice for the best type of face mask to exercise in?

Dr. Kristin Englund:  So I think whatever mask you can find that is comfortable that allows you to be able to do your workout is certainly appropriate. I do taekwondo and I wear both cloth masks and then occasionally a surgical mask just depending upon what I happen to have available when I'm going there and it is a little bit more difficult I think to work out but it is certainly very doable. I can do a pretty intense taekwondo workout and still be able to keep that mask on and in place. What I don't recommend though are the vented masks, so those are the ones where you have a little bit of a vent here off to the side. Those really offer no protection for anybody. It's really meant for when you're working in dust particles and you breathe it and it keeps dust from getting in but it breathes out every little bit of mucus that might be in your mouth and in your nose. So it really defeats the purpose of wearing a mask when you have those vented masks.

Cassandra Holloway:  Interesting, I didn't know that but you're saying that, yeah, it makes sense, for sure. So I want to talk a little bit about treatment here. So obviously COVID-19 has been around for several months now and I guess what does treatment look like now compared to what it looked like before? How as it changed as we've learned more about the virus?

Dr. Kristin Englund:  Well thankfully we've been able to do some good control trials and be able to learn a lot on how this virus affects the body and how we can better treat people when they're ill with it. So for the most part we don't have any magic bullet to be able to treat this virus at this point in time. A lot of it is conservative measures so our intensive care unit physicians are superb at being able to manage patients with shortness of breath, with oxygen needs, with severe lung damage, so they use medications such as steroids to try and cut down on the inflammation that's going on inside patients' lungs and inside the rest of their bodies. We are looking at different what we call monoclonal antibodies to also try to cut down on the amount of inflammation that the body is reacting to this infection with and that inflammation while it can be good in some measures to fight the virus, it can also be too strong and then can start to affect other parts of the body, like the heart, like the kidneys, like the brain. So we need to find that kind of happy medium between being able to allow the body to be able to fight the infection but not let it get out of control.

We're also using a medication called Remdesivir which is an anti-viral medication. It's in the process of undergoing randomized control trials right now and we strongly recommend that any medication that we're looking at to treat this infection with, that we get it done under controlled trials because we need to know, we need to be able to get the data. It doesn't help me to be able to say, "Well, these 10 patients did okay and these 10 didn't." Well I'm not really sure who got what and where but a randomized control trial really carefully looks at when patients get a medication, when patients don't get a medication, and then we can compare it and be able to say clearly yes it helps or no it doesn't help.

Cassandra Holloway:  Can you walk us through the typical course of treatment for a person who is diagnosed with COVID-19 but they have a mild case of it? Kind of maybe they were exposed, they tested positive and now they're recovering from home?

Dr. Kristin Englund:  Right. So usually when folks are at home, they're not requiring any kind of medication at all, so it's a lot of just conservative treatment. The key thing is when you have COVID and you're recovering at home, you need to isolate yourself. This is the kind of time when we really don't want you going outside, we don't want you ... You're not supposed to be going to a store and you're certainly not supposed to be having house parties and having people coming over to your house. Isolating doesn't simply mean you have to stay at home. It means you need to keep yourself away from everybody so we're not spreading this virus.

So most commonly when people are at home, it's important to monitor your temperature, take some Tylenol to keep the temperature down. Maybe helping taking a cough medicine to try and control the cough. We ask people if they're able to get a specific kind of an instrument called a pulse oximeter where we can just clip it on their finger and a couple times a day just check the level of oxygen that's in their lungs and in their body and if it's doing just fine then they stay at home. If people get kind of a reactive airway disease and they're coughing a lot, we've sometimes found that giving them an inhaler to try and cut down on that reactive airway disease helps them to breathe a little bit better but for the most part folks staying at home just need to do like what they would do for the flu, take good care of themselves, keep themselves hydrated, and stay in bed.

Cassandra Holloway:  Always great advice. So it's on a lot of people's minds about schools and colleges heading back for in-person learning and obviously we've seen alarming rates of infection as school has been in session especially on college campuses. So I just want to ask you, is it possible for schools to get these outbreaks under control? Kind of what are your thoughts around that?

Dr. Kristin Englund:  This is such a difficult situation. I absolutely appreciate that students want to get back to school. I've got a 20-year-old and I just took him back to college campus. I want him to have that experience, but a lot of colleges are having to adjust how they have their own campus life and it's going to be different on every campus and how some schools have made the decision not to have students come back at all and do all virtual learning. If they're having students come back, sometimes they're having only half of the students stay on campus that they would have normally so students now have their own rooms and their own bathrooms and you're certainly not doubling up in rooms, you're not going to have a roommate. That's certainly one way to accomplish that but you're still going to have to feed students so they're going to have to get together to be able to get their food, they're going to mingle together, they're going to be going to the library together. Only if you get students really used to wearing masks and socially distancing and you have hand sanitizer all over the campus is this even going to be feasible.

So I think students have to understand that this is terribly important. If they want their school to remain open, it's in their hands, and it's up to them to be able to follow the rules to make sure that it happens. Now I know Dr. Fauci has also talked about the fact that when schools are testing students and some schools are not testing students at all, they're simply testing them if the student gets symptomatic, some schools have gone to the point where they're testing students twice a week.

So what do you do with those kids who are positive? The concern is is that if you find a student who is positive and you send them back home, then now they're taking that virus back into their hometown and the risk of spreading it in that area. If you can isolate them on campus, that seems to be the best option at this point in time so that we can try to keep everything contained. The schools have to be prepared though to be able to take care of that student while they're in quarantine and while they're isolated to make sure that they're getting food, that they're getting the medical care and observation that they need and that they have the ability to transition them to a hospital if the student needs to. So it's terribly complicated. I'm awfully glad I'm not a college president right now because these are some just devastating decisions that they're having to make.

Cassandra Holloway:  Yeah, it really is another part of the pandemic that just makes you sad that everything is different and things have changed for sure.

Dr. Kristin Englund:  Absolutely.

Cassandra Holloway:  So switching gears, I want to ask you about this question that we've been hearing for quite some time about how COVID-19 is affected by different blood types. So is there any research being done ... I feel like I've heard that Type O blood seems to do better in terms of milder cases. Is there any truth to this?

Dr. Kristin Englund:  There's some initial studies that are coming out looking at type ... I agree, looking at O positive blood and there seems to be some anecdotal evidence that folks if they're O positive tend to have a milder case but I don't think it's worth going out and getting yourself blood tested at this point in time to see what your blood type is. There's not enough hard evidence to be able to say for sure that you need to take more precautions if you're an A or a B. I just think everybody needs to take precautions no matter what.

Cassandra Holloway:  Absolutely for sure. So what's your advice to listeners about respecting the changing guidelines as we learn more and as we adjust? Why do we need to take the guidelines seriously and the changing guidelines seriously?

Dr. Kristin Englund:  So as you started this program off, you mentioned that we've been dealing with this for nine months. That's a short period of time in all honesty in trying to figure out a brand new virus that no one has seen. So to be able to learn as much as we have, as quickly as we have, and to be even on the cusp of getting a vaccine in under a year is remarkable. So the fact that the decisions that were being made in February are different from what we're finding out now makes sense. We're seeing that, we see that in every aspect of medicine. We see that in every aspect of technology, your iPhone from last season is different from your iPhone this season. Things get better, we learn more as we go forward. So yes, were masks appropriate back in March? Sure. Did we know that at the time? No. Do we know it now? Absolutely. It takes time to research this, it takes time to study it, and recommendations are made based upon the best information that we have at this moment. So follow these rules and is it going to change next week? It might a little bit, but for the most part, I don't think we're going to be changing our decisions at this point in time about the importance of wearing a mask, social distancing, and washing your hands.

Cassandra Holloway:  Yes, absolutely, and learning more about the virus is good. That's what we're supposed to be doing.

Dr. Kristin Englund:  Absolutely.

Cassandra Holloway:  Especially as we learn more about the long-term effects like you mentioned, on your brain, on your heart, on your kidneys and learning more about risk factors and who is at risk and I just think it's really important that it's not a joke. As we learn more, that's good, it's a good thing.

Dr. Kristin Englund:  Absolutely, and your point about these long-term side effects that we see with patients. We're learning more and more. It seems like every day I'm seeing more stories on news channels and in newspaper reports on patients who are having these effects months after they were diagnosed with COVID. So I think this again is not something that we should take lightly. You may have a mild case of COVID, but what does that mean six months from now? How are you going to be feeling six months from now? Are you going to be fully recovered from that? Are we going to start to see some of the long-term effects on the lungs, the kidneys, the brain? We don't know, so again, protect yourself from it. This is not a joke. This is not something that you can take lightly for yourself or for the loved ones around you.

Cassandra Holloway:  Absolutely and kind of going along those lines, here is my last question for you. The pandemic has been hard on everyone, so what's your parting advice to listeners regarding to exercise caution and working through this feeling of pandemic fatigue because I think collectively people are feeling anxious, they're feeling worn out by this, they have this caution fatigue. What's your parting advice for listeners?

Dr. Kristin Englund:  So I think in every aspect of our lives we need to find joy. We need to be able to try to get rid of that anxiety the best way that you can. Now we need to always exercise caution, so I'm never going to let you cut down on wearing of the masks and the social distancing and the hand washing, but in other areas of your life, find ways that you can try to de-stress and that means do you turn off the TV, stop watching the news, close your iPad, and go out for a walk. Take your dog out for a walk and just kind of decompress and let your mind go. I've been trying to listen to some just music that brings me joy. Find little ways throughout your life, whether it's finding a new recipe, learning how to cook with somebody in your house, just the smallest of things that you can make that change in your life where you're finally able to get rid of a little bit of stress and find a little bit of joy. Exercising is important.

I do think that's something that really can help us get those endorphins going and help to decrease the anxiety and you just feel better about yourself, but lots of other ways to do it, whether you prefer meditation, whether you prefer yoga, whether it's just ... Like I said, a good long walk just to help kind of decompress. Forgive yourself, my house is not as clean as it should be, and that's okay. I let myself know that I could either go out for a walk with my dog or I could dust. You know what? I'm going out for a walk. So allow yourself to just kind of decompress and find joy.

Cassandra Holloway:  I love that advice. Thank you Dr. Englund for everything you've shared with us today. I know you've said so many important things that I'm going to take seriously and I hope our listeners do too so thank you for your time.

Dr. Kristin Englund:  Thank you. I appreciate it.

Cassandra Holloway:  For the latest news about COVID-19, visit clevelandclinic.org/coronavirus. If you want to listen to more Health Essentials podcasts featuring experts at Cleveland Clinic, subscribe wherever you get your podcasts from or visit clevelandclinic.org/hepodcast. Also don't forget, follow us on Facebook, Twitter and Instagram at ClevelandClinic, all one word, to stay up to date on the latest news and information about coronavirus as well as your own health and wellness. Thanks again for listening and stay safe.