CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING.
For the past several months, the majority of us have only left our homes for essential errands or to go to work. Now that most states have lifted restriction orders, many people are wondering what life will be like post-quarantine. Cleveland Clinic’s Interim Chief Safety and Quality Officer, Dr. Aaron Hamilton, discusses the biggest changes we can expect to see and how to determine the risk of some activities and events. He also offers advice on how we can continue to protect ourselves as we learn to live with COVID-19.

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Life With Coronavirus: Moving Out of Quarantine with Dr. Aaron Hamilton

Podcast Transcript

Cassandra Holloway:  Hi. Thanks for joining us. You're listening to the health essentials podcast brought to you by Cleveland clinic. And I'm your host Cassandra Holloway. We're broadcasting virtually as we are practicing social distancing. We're joined virtually by Cleveland clinic's interim chief safety and quality officer Dr. Aaron Hamilton. Thank you so much for taking the time out of your day to speak with us today, Dr. Hamilton.

Dr. Aaron Hamilton:  Yeah, you're most welcome. Good morning.

Cassandra Holloway:  Before we dive into the podcasts, we want to remind listeners that this is for informational purposes only and does not replace your own doctor's advice. So today we're going to be talking about moving out of quarantine into a new normal, which might not look like the normal that we're all used to. So as many States and businesses open back up, many people are concerned and many people aren't really sure what to expect. So today we want to provide listeners with some insight and some knowledge to help keep themselves safe as we all learn to live with COVID-19. So, Dr. Hamilton, I first want to start off by asking you how you're doing during the pandemic. And if you'll tell us a little bit about your practice at Cleveland clinic, especially during these times.

Dr. Aaron Hamilton:  Yeah. That's a great way to start. No, I'm doing well and my family's doing well, and these are kind of unprecedented and unusual times. And so in that way in meaning I have a family and at home, I'm just like anybody else. So I've got little kids and a wife, and we're just trying to manage it on a day to day basis. And it is a new normal, and we're trying to find that new normal. So that's what home life is for me. And on the work side I serve as the interim chief safety and quality officer. So most of my days over the past several months have been focused on how we're managing quality, keeping our caregivers and our patient’s safe and how we're making sure that we're continuing to deliver high quality care to all of our patients in the hospital and outside the hospital, all the different care settings that we deliver care.

I also am a hospitalist, so I do inpatient adult medicine at several of our hospitals. And so that's what I do when I'm wearing my white coat. And there's a lot of COVID that's still in our community and in hospitals. And just recently last week I was visiting one of our COVID units and they're doing really well. Our caregivers and our patients are actually recovering, but we're not done with COVID at this point. It's still there and is very much a part of our lives and healthcare, but also very much a part of our lives outside of healthcare. And I think we all feel that when we go home or when we have a day off.

Cassandra Holloway:  Absolutely. Yeah, the threat is still there and we're still dealing with it on so many different levels in healthcare, in our professional lives and in our personal lives as well. Do you think that the threat is still going to be there for months and months until we basically have a vaccine? I feel like there's a sense of optimism here as the economy starts to open. What are your thoughts around how long this will last?

Dr. Aaron Hamilton:  Yeah. Well, a couple of things. I tend to think of this as a pre vaccine era that we're managing with COVID and then a post vaccine era. And I think those two areas will likely look quite different. You had a question about how long. It's really hard. My crystal ball has been foggy and clear and foggy and clear over the course of the last several months. It's a little bit foggy, but I do think that we do have a sense and a reason for some optimism. Particularly in Ohio, we were effective in flattening our curve and that helped societally, it helped healthcare to be able to manage the critically ill patients that we needed to, but this is not going away over the course of the summer. I don't think that's the situation that we're working with.

And so in the meantime, there's a whole series of interventions that kind of help keep us safe societally and help make sure that our healthcare workers and hospitals and clinics are safe. And those boil down to barely simple things. And we can talk more about them, but things like hand hygiene and washing your hands, things like wearing a face mask, even a cough face mask in public, or when you are not by yourself. I'm in my office now by myself. I want to disclose that's why I'm not wearing a mask right now. Otherwise, I would be. And then maintaining social distance or physical distance when possible. I tend to prefer the term physical distance because in many ways, socially we remain very close. We've got all kinds of ways that we're connected. I was doing a Zoom meeting with my over the weekend and some close friends. And so we're still very socially connected, but we do need to keep in mind what physical distancing means for us. And that's an important part of managing a pre vaccine COVID

Cassandra Holloway:  You've touched a little bit about, what this looks like, I guess in terms of wearing a mask and practicing that physical distancing. What are some other big changes we can all expect to see and just expect when we're out and about as quarantine and sheltering in place is lightening in some places and we're allowed to kind of be a little bit more lax. What are some of the big changes that people should be aware of kind of going back out into their communities?

Dr. Aaron Hamilton:  Yeah, I think it does look different and some people haven't really been out of their homes for a couple months. It's a big deal. And so what to expect really is, first you'll expect to see signage. That maybe might seem strange to you if you haven't been out of your house for a while. So things about maintaining physical space, waiting a queue or a line, that's spaced out over time. And I think there's a distinction there. There's kind of what you might see at the grocery store or the salon or somewhere else versus what you're going to see in healthcare. I think that those distinctions are important and we shouldn't confuse the two because they're different. In healthcare, we have sick patients coming to us. They're very vulnerable, frail. They might have weakened immune systems. And so the precautions that we take in healthcare might look a little different than your grocery store.

I can give you a couple of examples when someone enters the doors of our hospitals or our clinics, they're going to get temperature screen as they come in. They're going to be asked a series of questions that assesses the risk of infection. They're going to be asked to wear a face mask and they will be provided one. You might not get that in other settings. And there's all kinds of marketing and signage about creating space. And we learned that pretty early on that people need visual reminders. Now, if you go to a store or you go to the salon, you're going to see different versions of the same kind of precautions. Many employees in retail or out in the community are wearing masks. They're asked to wear masks by their employers. There's some heterogeneity or there's some differences amongst customers wearing masks.

And I guess some people do some people don't, and it's a personal choice, but I like to remind people, not outwardly, but just remind people that the reason we wear the mask is actually a gesture of caring for others. It's protecting others by wearing the mask. And when we all wear masks, we all protect one another and we're all safer. But life does have to go on and we do have to find our new normal. And I think there are guidelines, the CDC and the state and industry, they create guidelines. And those guidelines typically around hand hygiene, they're around wearing face coverings. They're around physical distancing, they're around disinfecting surfaces and things like that and cleaning. You might see if you go to a cash register to check out, a little plexiglass barrier that helps protect those people that are helping us check out. Those are just parts of our new norm.

I think absolutely in a pre vaccine era, those things are going to stick. And I encourage people to have empathy for others, both those that are wearing masks and those that are not. Maybe if you're wearing a mask, the thing I worry about is that somehow wearing a mask becomes like this marginalized thing. And really, I want people to think about why that person's wearing a mask. It's really to help protect you. And I want you to think about what that person might be going home to. They might be going home to an elderly frail loved one. Or they might be going home to a baby that doesn't have a strong immune system. And so I really think about that greater good when we think about how we protect one another through maintaining distance and those things.

So I think, yes, if you were out in the woods for several months and then you came back, you'd probably be pretty shocked at what you're seeing. Fortunately I've been able to get eased into it over months and not everyone has that luxury. And so I just ask that people kind of find that new normal, and that they consider the recommendations very strongly as an effort to continue to keep COVID at a place where we can manage it together until we have treatments that are effective and vaccines that help to prevent the disease in the first place.

Cassandra Holloway:  I did want to ask you specifically about face coverings or face masks. You mentioned, it's the new normal, they're, they're going to become a wardrobe staple, our pre vaccine kind of era was what you're talking about. I feel like my team has seen a lot about celebrity face masks or designers releasing these face masks. And I just want to ask you your opinion kind of also with the CDC recommendations of a face covering. A face covering doesn't have to be super expensive or super designer quality for it to be effective. Can you just remind us of what we should look for in a face covering? How to wear it properly? That sort of thing.

Dr. Aaron Hamilton:  Yeah, absolutely. That's great. I was chuckling because yesterday I was at a meeting and somebody was talking about how they had like a designer bag that matched their face mask. I was, Oh, that's nice. Yeah. So just a quick reminder. And then we can get into kind of this kind of society fashion side, I think is interesting. They key with a cough face mask is that there's two layers, cotton or cotton blend that it covers your nose, your mouth, and typically rests under the chin on the bridge of the nose and under the chin and as security there around the ears or with elastic straps or ties. Basic. Okay. It doesn't have to look pretty. I know a lot of people want it to look nice. And that's great. The other thing that's important is that these you should treat them as kind of like clothing. You wash them after you use them. Don't just keep it and reuse it every single day without washing it. And it's just one normal article of clothing.

I had said early on, I think that it's very kind of American generally to make a fashion statement with things that you wear. If it makes people more comfortable wearing a mask that it looks nice or matches something, or has their favorite sports team that they're not able to watch, then I'm all for it. I've gotten Ohio state mask. Literally around my desk, I've got a bunch of different masks. My mom is a quilter and so she's made hundreds of masks and we are the beneficiary of many of those. And then I share them with friends and they're all different designs and it kind of makes it fun. And I have little kids, so they like it too. You mentioned the fashion design, they got like ones that have mustaches on them and sharp mouths and things like that. So I think you have to make it fun. And in the end it's about protecting others, right. So that's kind of should make people feel good anyway.

Cassandra Holloway:  Absolutely. I love that message and think about why you're doing it. You're protecting others, first and foremost. So here's the million dollar question for you. Dr. Hamilton, as the stores and restaurants are opening back up and shopping centers. Is it safe to go into these places?

Dr. Aaron Hamilton:

It's all relative. And you think about, it's on a spectrum. It's less about safe and not safe. It's more about layers of risk and everybody has to do that risk assessment for themselves. So this might seem really obvious, but the safest thing to do the absolute safest thing is to stay at home with your family, your family unit. That is the safest thing. At home indoors with your family unit. All the way to the most risky thing are large indoor gatherings. So across those spectrums and you can say out outdoor gathering and then outdoor not large gathering or the kind of the rest of the spectrum.

Throughout that spectrum, the core ways to lower risk stay the same it's face mask, it's physical distancing of six feet, it's hand hygiene. And it's also just using common sense. If you're sick, don't go out. If somebody else is coughing and sneezing, you might want to create distance there. And then there's a whole discussion about, shared food. We're a society that shares. And if that time of year, Memorial day weekend, July 4th, mother's day, several weeks ago, we get together. We barbecue, we share potato salad. It's very communal.

I would advise. And I think the experts would advise that you have your own food. You're not sharing food or drinks between people. And look, I understand that's hard. It's not what we're used to, but it is the right thing. So I think your question was, is it safe? And I think the degree of safety depends on the degree to which we comply with those things that matter. If you go to the hair salon and everyone's wearing masks, then people are using hand sanitizer, maintaining distance. And when they can, and when they can't, then everyone's wearing the appropriate coverings and things, then I think it can be safely done. But that is an example of a riskier type of behavior. And you can say, gosh, I don't want to do those risky behaviors every day, maybe. So you're talking about cumulative risk.

If I am going to a barbecue and I socially distance outside, it's somewhat risky. But if I do that once a month, that's different than if I do that every day or every week. And the same thing with indoor things. You have a wedding say, those happen. They happen through pandemic times as well. And let's say it's really important to you. And that's your one thing you do over the summer. But if you're going to a wedding every week, that's a different level of risk. And obviously if there are health issues that you're dealing with personally, with your immune system or your diabetes or other things, that increases your own personal risk. And so you want to make those decisions.

Cassandra Holloway:  Absolutely. I love your idea on, think a bit like a spectrum and how risky the behaviors. Is it medium risk, is it low risk or is it high risk and kind of balancing out where you're comfortable falling into those categories and still, like you said, I think some great pointers keep those core values in mind, wear a face mask, practice physical distancing, wash your hands, don't touch your face. Everything we've been told, still applies to these new situations that we're in.

Dr. Aaron Hamilton:  Absolutely. Yeah. And you might say, oh, well, you work in health care, it's easy for you. But I have an extended family that's not in health care. And so we're having these dialogues all the time. And I think where we get into trouble or where it's hardest is if we take a very firm line and we just say, you absolutely can't go and get your haircut or you can't go to the grocery store. And it's more about assessing the risk and making the decisions. And then when you make the decision exhibiting the behaviors that we know work. And society has been fairly good in accommodating that. Making sure that, masking is okay, that we create the physical distancing, that we provide hand sanitizer and places to wash hands differently. And I think that's actually a really good thing that's come out of. This is that we've shown flexibility and malleability as a society to accommodate what we need to do to keep one another safe.

Cassandra Holloway:  Sure. Yeah. You said it's a personal decision and you have to kind of weigh how comfortable you are and you brought up, don't be afraid to say that you're uncomfortable or don't be afraid to leave if you're in a situation that people are practicing social distancing or physical distancing, it's okay to say something and to leave.

Dr. Aaron Hamilton:  Of course. In healthcare, we talk about speaking up for safety or speaking up if you have concern. And I really do think that that is important conceptually, to apply in your workplace no matter where it is. If you have a concern about something or you see something that's making you uncomfortable, find a safe way to bring that up in a respectful way, in a curious way. Gosh, I saw this, I was wondering if this might be a better approach or I want to understand a little bit more about why we decided to do it that way. So you don't want to set up a hostile environment, but you do want to express your concerns because ultimately you're going to perform best when you're comfortable. And when you feel safe and so sharing that with whether it's your friends or your employer and maybe they're both.

It's really important to guide and say, this is what makes me feel comfortable. What are your thoughts? Or I saw this made me feel uncomfortable. I think that's really important as we move forward. And we manage these uncertain times right there. We've learned a lot from the very beginning of the pandemic. And so sometimes our recommendations change on what is safe. And I've seen videos on social media about making fun of that and there they are funny videos, but the reality is that we are making recommendations to keep people safe with the best possible information. And that information changes and has changed over time. And as we've learned more, we've made adjustments. So it can feel like everybody's kind of waffling and going back and forth, but really it's about as we learn where we adjust. It's a really important part of how we keep one another safe.

Cassandra Holloway:  Sure. Yeah. And I think you brought up a good point of there's conflicting opinions everywhere you look. And it's all over social media. And if someone's in a situation where maybe it's their boss, or maybe it's a friend,, maybe they didn't think, COVID was a big deal to begin with. Or maybe they're at a point where they're just over it and everything's flying out the window and they're not taking it seriously anymore. I think it can be really challenging to navigate these situations when you're still aware of the threat and you are still trying to protect yourself.

Dr. Aaron Hamilton:  Yeah. Cassandra you're absolutely right. COVID is a big deal. It just is. And people get exhausted with all of the news and the suffering that people have. It's a lot to manage and it's hard, it's sad, it's stressful. And we just kind of have to give all those emotions a big warm hug. And just embrace it and then decide what's right for you. But it is hard. And it's been hard. The uncertainty of it's been hard. These are unprecedented times. People with kids, who knew that we would all be schoolteachers and helping to support our teachers by doing home learning. And I mean, there are just a lot of new things. It's a lot to take on. It's hard.

Cassandra Holloway:  So I want to ask about traveling in 2020, and you can talk a little bit about that. Is it still okay to plan a vacation anytime in the foreseeable future at this point?

Dr. Aaron Hamilton:  Yeah. It is. It's kind of a corollary of, is it safe to go out type of thing, is it safe to go here go to a salon? So yes it is. And please think about what are those safety measures that you can do? And this is my personal opinion. I think flying is something that's basically out of bounds for me, unless it's for a mission critical thing and you define mission critical for you. Hopping in the car and taking a family vacation to the campground or going to a place where you can get good physical distancing. I think that's totally in play and people need time off if you're privileged enough and have the means to take a vacation, then I encourage people to do that. And I encourage people to do that in the context of everything we've talked about to this point. What does the beach look like?

I don't know and if you're going to be in a condo or a hotel or a house, it kind of gets into that spectrum of risky, this that we had talked about. But I can just tell you personally, I'm planning a vacation towards the end of the summer with my family and we haven't set up so that depending on the circumstances, maybe we'll just be at the house and if it's really good news at the end of the summer, then maybe we'll take a couple of trips to the beach and make sure we get our towel and tent set up in a pretty private area. But the world has to go on. We still have to do things that bring us joy and vacations for many of us bring us joy. And I don't think we take that away from people, but I do think that we help them to make informed decisions about what a safe vacation with your family or with your loved ones.

Cassandra Holloway:  Absolutely. So I think I know the answer to this next question, but I'm going to ask it anyways because I feel like it keeps coming up in my life and, and people I'm talking to, is it safe to drive in a car with someone outside of your household?

Dr. Aaron Hamilton:  It's something that I would avoid. And if you have to do it due to some kind of circumstances that, life happens, is really important to wear masks and that hair face covering in that situation. So we talked about that spectrum indoor gatherings are in the kind of moderate risk to high risk. A car or a vehicle is a pretty tight indoor space. And so I would say it's on the less safe spectrum. I would personally avoid it. Like I have little kids that do lots of carpooling for all their sports and things, and we're just having to find a way to not do that. And we're making it work. I think there's two parts to it. One is, I don't think it's the safest thing. I also don't want to put another family in a position where they feel like they're letting me down if they're not bringing my kid to some kind of activity. And so I would avoid it. I don't know if that's the answer that you were assuming you'd get, but that's what I would say.

Cassandra Holloway:  Yeah. Just from what we've talked about today, kind of the avoiding the enclosed spaces. I feel like that is if that's a car, basically. There's no way to, to practice that physical distancing basically in a car. So I want to end on a little bit of a high note here. In your opinion, what are some positive things that can come out of this situation? What can we learn in terms of healthcare and in terms of our everyday personal life at this point?

Dr. Aaron Hamilton:  Yeah. Well, I think I reflect a little bit on this from a personal perspective. I mean, I think this is helped me and my family find different ways to spend quality time together. We took a staycation and we built a garden in our backyard. It was a big deal. And it was a way that we came together and probably a way we wouldn't have in a pre pandemic world. And you know, we're going for walks and hikes a lot more than we would have before. And I think that's been great. I think I'll continue to evolve a little bit on the family side and then I'll talk about work. Our kids are amazingly resilient. All of our children are just really resilient. And so they found a way to make online learning work.

If they're doing Zoom meetings and different things. And I was, wow, you guys are doing it. This is great. And so I think it helped them with adaptability and malleability and embracing technology. That's a nice way to pivot into the workspace. I mean, we've been talking one of the great things is we've been talking about virtual health and virtual visits for years, and we've just never really been able to get to this glass ceiling. That's pretty low in terms of making our caregivers and our patients comfortable with it. We saw explosive exponential growth in virtual health, and that's just not going to go away. And it's a good thing. And actually our patients like it and actually our caregivers liked it, but they needed to get over the hump. This actually helped people get over the hump.

I think the second thing is, and this was not surprising to me, but the pandemic really brought out the best in our teams and how we come together and set aside other things that aren't as important and really focus on something, keeping our patients safe, keeping our caregivers safe, opening up a thousand bed COVID hospital that thank goodness, and hopefully we never have to use and I'm knocking on wood. Those are things that really, I think it galvanized the pandemic and COVID helped to really galvanize teams and that's in healthcare and that's probably in a million other places, but I think that's a really positive thing. So the virtual side, and then how we came together as teams really is heartening. In particular on how we care for others.

Cassandra Holloway:  Sure. Yeah. Lots of silver linings that are there. If we look at it. And sure it's a new normal, but it's, we don't have to be afraid of that new normal I think it is really something to think about for our listeners.

Dr. Aaron Hamilton:  Yeah. Well said.

Cassandra Holloway:  Awesome. Well, thank you Dr. Hamilton for taking the time to speak with us. You offered so many valuable insights and some information that I think our listeners will really be able to take to heart as the summer progresses and we move forward in this pandemic. So thank you for your time today.

Dr. Aaron Hamilton:  Oh, thank you, Cassandra, it's really my pleasure and be safe and be well. We're in together, societally and as our teams. So thank you for the opportunity. I really appreciate it

Cassandra Holloway:  For the latest news about COVID-19 visit Clevelandclinic.org/coronavirus. If you want to listen to more health essentials podcast, featuring experts at Cleveland clinic, subscribe wherever you get your podcasts from or visit Clevelandclinic.org/hepodcasts. Don't forget. Follow us on Facebook, Twitter, and Instagram @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.

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