With novel coronavirus (COVID-19) cases rising each day, medical professionals around the globe are volunteering their efforts and expertise—including our employees. Dr. Mark Sorrentino, MD, MS, Vice President of the Center for Pediatric Clinical Development & Center for Vaccine Research, and his wife Catherine are both contributing to the fight against COVID-19.
Catherine, who typically works in the oncology ICU at Johns Hopkins, has been reassigned to a COVID response unit. Mark, meanwhile, has spent the last few days at a COVID testing center at Maryland’s FedEx field.
Mark is one of three medical professionals at the testing site with the highest level of certification allowed to do physical COVID-19 testing. The National Guard provided infrastructure tents to harbor equipment, mess halls, and dining areas. Many National Guard personnel are on site, especially military police units who run several check-ins as part of their security. Medical personnel like Mark are required to wear ID badges.
This particular COVID-19 testing unit is for sick individuals who call into the County Health Department and make an appointment for a mobile test. By the time they get to the mobile test unit, medical personnel are delivered paperwork—containing important information like the person’s name, birthday, address, and phone number—from LabCorp. The paperwork also contains a list of all the people who will need real-time reverse transcription polymerase chain reaction (rRT-PCR) tests.
Patients drive up to an administrative tent, where their documents are checked, and their appointment is confirmed. If they don't have a mask, they receive one at the tent. From there, they drive 100 yards up to the testing site. A runner exchanges their paperwork with officials, ensuring the paperwork is never in the car with the potential COVID-19 patient.
A health professional then tests the patient using a five-inch, dacron-tipped, flexible kind of Q-tip. The patient is asked to tilt their head back, forewarned that the test is uncomfortable, especially for those with labored breathing.
The Q-tip is inserted all the way to the very back of your nose, right where your nose and your throat connect in the nasal pharyngeal airway. While this method may seem strange, it’s a typical sampling method for respiratory viruses. Whether it's a bacterial infection or a viral infection, there seems to be a large harbor at that airway junction, so deep nasal pharyngeal swabs are necessary.
The Q-tip is then spun around for a few seconds and pulled out. It’s immediately placed into the culture media onto dry ice packaged with the patient’s paperwork. The tube is wrapped with a label from the paperwork and is shipped off to LabCorp for testing at the end of the day.
A major downside to this test is that it makes almost every patient cough, putting the medical staff at high risk of exposure, despite the incredibly thorough sanitation routine they perform between each patient.
Additionally, the testers cannot take any form of a break, including bathroom breaks and breaks to eat or drink until lunchtime. At that point, testers go into a doffing room where they take off their personal protective equipment (PPE), including a gown, face shield, and mask, dispose of them properly, and scrub up before eating. After their break, they put all of their PPE on again and repeat the testing process.
We spoke with Mark about his experience on the front lines of COVID-19 testing.
Can you tell us something positive or inspiring that you saw on the scene, as well as something challenging?
I think the most inspiring thing about being at this testing site is the group of professionals we have here. It’s a combination of people from our local health department who are here as part of their employment, and another group of people on Maryland’s medical reserve corps called Maryland Responds. I’m part of the latter.
We’re a division of the national Medical Reserve Core. We’re all volunteers, so it's always nice to see a group of health care workers and people who are interested in public health come together. We’re essentially running the whole operation. That gives me hope that there are people willing to step forward in times of emergency.
I did, however, see some people who were pretty sick. Normally, you’d probably recommend that these people go to the hospital. In this case, the recommendation is for them to have a conversation with their personal physician, hopefully by telemedicine, unless they're feeling quite short of breath. They should try to stay home as long as possible and out of the hospital, where there are the sickest patients.
One challenge is that some people are just super sensitive with anything around their nose. For some people, it was difficult to even administer the test. There were a couple of people who grabbed at my hand to pull the Q-tip out. Remember that they're in their vehicle during this whole process. They have to stay in their car. I asked them if they could hold on to the steering wheel or something so that we could get a good sample.
This is definitely a first for me and it's a little strange. One guy pulled up, rolled his sleeve up, and put his arm out the window. I guess he hasn’t been watching the news. I said, “The good news is I’m not going to be taking blood from you today. The bad news is, I'm going to stick a five-inch Q-tip all the way to the back of your nose.”
During your time on-site, did you notice any indication that the situation might be improving anytime soon?
So far, this county has many more negative tests than positive, which I suppose is a good sign. Of course, we'd like to see the testing broadened out further than that. The site is full each day they’re open. This center is open Monday, Wednesday, and Friday and they take 100 appointments a day.
People receive their results in three days. The health department calls them and lets them know whether they are positive or negative, then offers suggestions for quarantine and interacting with others. They ask some questions about the individual’s current health and assess whether or not they need further medical help.
Assuming that the other sites are also full, there are still many people experiencing symptoms.
The good news is that even though those sites are full, the people that show up didn’t make the decision to go to the hospital. We have a governor who’s supportive and was an early adopter to stay at home policies. We’re probably better off here in Maryland, and it looks like we're better off than some of the surrounding areas.
In speaking to my wife’s experience, though, it unfortunately doesn’t seem to be slowing down in hospitals.
Now that you've been on the front lines of this fight, what do you want people to know in order to continue to stay safe?
We had a few minutes of interaction with some patients and we asked them how they were feeling. Some patients said they've felt bad for a week, they have high fevers, and they just feel absolutely horrible. They told me to imagine the worst flu I’ve ever had.
Many of them talked about the coughing and shortness of breath. Most people with obvious symptoms looked purely exhausted. I’m sure that’s not just from their illness, but everything else going on as well—being off of work, for example, or being quarantined in their homes and away from loved ones.
What all this has taught me, now more than ever, is this: stay home. There’s nothing the public can do more to keep the virus from spreading. Those of us who don't need to be out should stay away from public areas unless it's absolutely necessary. Look for other ways to get your groceries or your news sources. Try to have things delivered to you. Find more creative ways to go through your daily routine, but stay away from other people so we can allow the virus to circulate and finally get out of here!
Were any of your patients asymptomatic? Are there any myths you've heard that you could debunk or clarify about the virus?
The vast majority of the 100 people that we saw did have symptoms. These people call the health department to ask for a test. One of the things that the health department requires for those that ask to receive a test is that they are symptomatic. This site is not receiving asymptomatic patients.
I know that there are some commercial tests available, and some physicians’ offices are receiving those. Asymptomatic people can get a test, but obviously the goal in the future is to make those tests widely available. Maybe some of the antibody tests out there will also help tell us whether an individual was exposed and now has immunity. Those with immunity can then get back to a more “normal” routine.
The expectation is that those with immunity would probably be protected from getting it again, at least for a 12-month period—although again, we aren’t 100% sure of that yet.
This brings up a huge important issue. We know now that one out of every four people who tests positive is someone with no symptoms. Of course, that's likely the person who doesn’t worry so much about their social distancing measures. They probably aren't wearing a mask like they should be. These people worry me the most, because they’re out there and transmitting the virus silently without feeling any symptoms.
As far as myths go, there's thousands of conspiracy theories that we won't get into. I'll say people should do their best to comply with the guidances in their locale. Even if your locale isn't that strict on social distancing guidelines, you personally should be anyway. That’s our only chance at “flattening the curve” and keeping those spikes of hospitalization at the lowest level possible.
Think about your PPE. People should at least keep a cloth mask on when walking outside. Of course, nobody believes that a piece of sewn sheet is keeping the virus from being transmitted to you or from you. But when you do have your face covered, people see that you can't touch your mouth. That’s a good thing because we know that the through the mouth is one of the easiest ways to get the virus.
While face coverings aren’t necessarily completely preventative, it can help you and others remember your social distancing cues. Those are the biggest reasons to wear any type of face covering at all, even if it's not one that will necessarily filter out virus particles.
There seems to be two strands of COVID-19. Are people who have one type of the virus able to get the other strand, and vice versa?
That information is unfortunately just too early to know. That's very similar to what happens with the flu during a flu season, along with other respiratory viruses.
Often, there's more than one strain circulating during any given season. Sometimes one is more virulent than the other. Sometimes one might give you antibodies that is somewhat protective against the other. I haven't heard of any of those with COVID-19 yet. We will have to wait until the end of the pandemic, when virologists have time to dive into what's been circulating and how we're going to prevent that in the future.
What stage are we at with finding a treatment for COVID-19?
My team is excited to be a part of all sorts of proposals that are coming in. The number of proposals is absolutely staggering. I just asked them today—on clintrials.gov there are now over 350 trials listed for COVID-19, and that number continues to grow. Last week it was 249, so it went up by 100 in a matter of seven days.
Much of this work looks at drugs that have already been approved for a different use. We’re seeing a lot of that work on the vaccine side. I think the first vaccines will go into limited human testing early this summer. I would say my best guess is that this fall, there will probably be some larger vaccine studies performed in health care workers.
Again, we need to understand that this is most likely a seasonal virus that we believe is cyclical and will come back again in the fall. Everyone wants to be much more prepared for it than we were this year, when it was a novel event. The first step will be to get health care workers vaccinated. Obviously, there's a process to make sure they become protected. As soon as that is established, then we can start rolling out larger trials.
As you probably know, vaccine trials tend to have anywhere from 2,000 to 15,000 patients. There’s more than one vaccine candidate out there and a portion of the population will be able to get into the clinical trials next year. I would hope by fall 2021 that there’s an approved vaccine that’s easily distributable to everyone, just like we have with influenza.
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