Insights from Dr. Mike Good on COVID-19

Michael Good

On the "U Rising" podcast, President Ruth V. Watkins engages in insightful conversations with students, staff, faculty, alumni and community stakeholders who are at the center of the state's flagship research university. President Watkins also connects with other leaders to give listeners a fresh take on top issues and innovations in higher education in Utah and across the country. You can subscribe to U Rising via iTunes, Spotify, Stitcher and other podcast streaming services.

Dr. Mike Good, senior vice president for Health Sciences, shares his insights on where Utah stands in its efforts to combat coronavirus, why antibody testing matters, what might happen this fall and the evolution in thinking about the use of face masks by the general public. Recorded on Thursday, April 16, 2020. Thanks to Brooke Adams and Dave White for technical assistance. Music by Taylor Hartley.

President Ruth Watkins: Welcome to the U Rising podcast, where you have the opportunity to meet some of the remarkable people who are helping us achieve new heights at the University of Utah. I'm Ruth Watkins, president of the university, and my special guest today is Dr. Mike Good. Mike is the senior vice president for Health Sciences. Welcome, Dr. Good.

Dr. Michael Good: Thank you.

President Watkins: I want to begin by expressing really sincere gratitude for what you and your health team have done over the past weeks in Utah. Your accomplishments have really been remarkable in patient care and in testing. Tell me a little bit about how our health providers are holding up under the pressure of the current moment.

Dr. Good: President Watkins, we really do have an amazing team of health professionals that make up University of Utah Health. I've just been so inspired and so uplifted by the tremendous things that are happening. First of all, many of us are wearing white ribbons to recognize those on the front lines, those that are taking care of COVID patients in our emergency rooms, our intensive care units, on our hospital wards. And they are amazingly resilient individuals. And overall, in perhaps the most challenging times I've ever seen in my three-and-a-half decades in medicine, I'm just so proud and can't say enough about our team.

I think they're holding up well. We have a wonderful Resiliency Center where professionals help us as a team stay focused on the positive, remember to take breaks, and to make sure we connect with family and all of the things that keep our lives whole and help put the current situation into the context of our human experience. So, between starting with a great team, and then having great professionals like our Resiliency Center, just couldn't be more proud of the University of Utah health team.

President Watkins: I am so pleased to hear that, and I want to join you in expressing that pride. Remarkable people. And, of course, we will succeed against this virus because of our health providers, so we're grateful for that.

Now I know everyone who's listening to this podcast wants to better understand this pandemic and is particularly interested in knowing where you think we are in terms of our fight against coronavirus. Can you give us your best insight at the moment about where you think we are in this fight against coronavirus?

Dr. Good: Yes. The state of Utah has come together in an amazing way—government, business, health, our university. Let me describe some numbers. So, when we started carefully tracking in mid-March, it's called the replication rate, each person who had COVID on average was infecting three other people, and those three people would then infect three more, and those nine would then infect 27. And you can see how you have an exponential rise in the number of people that are experiencing coronavirus infection or the clinical syndrome we call COVID.

We then implemented so many things. For example, you know here at the university we went to distance education, not having large groups gathered. And that happened in our community, travel restrictions, more recently wearing masks, all of these things that we've done. And we are now showing that the replication of coronavirus in our community is down under one, it's right around one. Which means that right now each person who has coronavirus, on average, is only infecting one other person. So, we've gone from three to one in kind of a runaway infection, certainly that we've seen in other cities in our country and around the world, to now where it's one to one.

What does that mean for the University of Utah Hospital? Back when the virus was moving around at one to three, we were estimating that 3,000 people would need to be admitted to University Hospital. Three thousand. We have 600 beds. And that was very frightening. And, in fact, when you saw these scenarios play out in Italy and in New York, New Orleans, Detroit, where the healthcare system just did not have enough hospital beds, ICU rooms, and ventilators to care for those with COVID, that is what we worried about.

Because of the amazing way our community has come together, and that rate now being down one to one, we're now estimating that if there was a surge of coronavirus, it would be right around 600 patients needing care at University Hospital. And with our surge capacity, we estimate that to be about 600. So, we've become confident now that we can take care of the COVID patients in our community. And so, again, as a community, extremely successful. And of course, now the challenge is how do we very systematically and carefully figure out what parts of our economy and our society can resume activities in a way prior to the restrictions that have gone in place and not let the virus run rampant through our community.

So again, I just want to thank everyone. I want to thank you for your leadership of our university. I want to thank our city and county and state leaders, because our approach here in Utah has really been exemplary. And I think a lot of people across the country, and indeed the world, have noticed what Utah's done in this pandemic.

President Watkins: It is so reassuring to know that physical distancing, which is difficult for all of us, is working, so thank you for that update. We know testing really matters. And I know that our ARUP Lab has been very instrumental in that effort, as have been the drive-up test sites that have made it possible and easy for people to be tested. Tell us a little bit about the status of testing, accuracy of testing, and then let's talk a little bit about what might be next in testing.

Dr. Good: We are so fortunate to have ARUP Laboratories as part of the University of Utah. For many years they've been a national leader, and they have really stepped to the forefront in this pandemic. One of the first sites to have the coronavirus test, that nasal swab where we actually look for the presence of the virus in the back of the nose and the throat, we were one of the first centers in the country to have high volume testing. And that's allowed us ... that's been part of our success in flattening the curve.

The key public health measure is to test and then to isolate those who have coronavirus so they don't inadvertently infect others. Test and isolate. We're currently No. 8 in the nation for tests per capita. Utah's No. 30 out of the 50 states in terms of population, and we're No. 8 for testing. So, clearly another example of Utah punching above its weight, and ARUP laboratories is one of the key reasons why we're able to do that.

We also were, I think, innovative in the way we set up our in-car, drive-up test sites. Those sites are at our South Jordan Health Center, our Farmington Health Center, Sugar House Health Center, our Redwood Clinic, and in partnership with Intermountain Healthcare. We have a joint testing center in Park City at the ice rink.

And I also really want to give a shout out and commend Intermountain Healthcare. They've been a big part of our successful combating of coronavirus in Utah. And in the specific case of testing, the Intermountain facilities that are located throughout the state have really been key to making sure citizens in all parts of our state are able to get testing. And Intermountain Healthcare has similarly set up testing sites both in-car and in-facility throughout the state.

The in-car is very helpful because it conserves personal protective equipment. The individuals are outside. So, obviously people coming there, many of them have coronavirus. And by staying outside we keep the virus outside, the virus doesn't do very well in outdoor environments, and our professionals are able to don one set of personal protective equipment and to continue to use it for their shift. To date, everything we've just talked about has been testing for the virus, who is having a coronavirus infection and who is not.

Last week, ARUP Laboratories, again, one of the first in the country to bring up antibody testing. In antibody testing, you draw a small tube of blood from a vein like we do for many other blood tests used in medicine, we draw a small tube of blood, and we look for antibodies against coronavirus. When someone has a coronavirus infection, about two weeks after they've had the infection, two weeks from the beginning of symptoms, they will develop antibodies, a certain antibody, it's called Immunoglobulin G, in their bloodstream.

And so, now we're starting to test it. This first week we've been really testing our health professionals, but in coming weeks we will begin to test in the community. And there is a belief, and, in fact in other parts of the world, many individuals who have coronavirus either didn't feel that they were sick or had a very mild flu-like illness. And with the antibodies, we know that they were infected, they just didn't realize it.

It's also believed that those that have antibodies are better able to ward off coronavirus if they encounter it again, either not getting sick at all, or if they do get sick, it would be a very minimal or a much less type of an illness. So, you're going to continue to hear a lot about antibody testing. It is an important part of our approach to dealing with this pandemic. And once again, ARUP Laboratories at the University of Utah is at the forefront.

President Watkins: It's an incredible point of pride that the University of Utah's ARUP Lab is able to do that important work right here with us. That will help so much as we better understand antibodies and immunity and begin to return to a version of typical operations as we go forward. And of course, on that front, everybody is wondering about the fall, from fall semester to fall football, to what we think will happen with this virus as we look forward. What's your sense of current thinking about whether there will be additional waves of COVID-19 and what we might think about for fall?

Dr. Good: That's a great question. Certainly, history has shown us that when particularly viral infections come into a community, and for which there is no vaccine, no therapy, until the population develops those antibodies, that immunity, the virus does tend to come in waves. And a lot of people point back to the early 1900s and the Spanish flu where there was a wave in the spring, a relatively calm summer, and then a pretty large wave of virus moving through communities in the fall.

I think at this point, my own thinking is we just need to think about how we monitor for, and respond to, if there were to be a subsequent wave of coronavirus infection. If that replication rate, if it started to go back up, how would we respond? State leaders and others have been thinking about this. And one approach, and it's an approach that's used in other countries, is to start thinking about stages. Some use color coding, for example, red, orange, yellow, green. Kind of red is where we're at now, stay at home, no travel, only essential businesses are open. And on the other end of the continuum is green, where large group gatherings are allowed, there are no travel restrictions, no face mask, so on.

So, I think the trick is figuring out what an orange status might look like and what a yellow status might look like. And that way, as a community, we can gauge our response should there be a small wave or a large wave of coronavirus come into our community. We can similarly gauge our response.

And so, to answer your question about what will the fall bring, I hope it will bring a nimbleness and an organization so if we start classes with groups gathering and we see the virus developing, we will be much more prepared to detect this virus and to see these waves coming. So, if we begin in a classroom setting and we see a wave coming, we may need to switch back to digital education or technology-enhanced education.

Same thing in healthcare. We're planning to be able to do face-to-face visits, but if a wave of a virus were to come through, we'd have to shift back to telehealth visits. And if we start with the distance education and the virus stays low, how would we transition back to important things in our educational programs, laboratories, performing arts, things where that physical presence is really needed. So, I can't exactly tell you what the fall will bring, but I hope it brings an organization and a nimbleness to be able to be responsive should we encounter future waves of coronavirus.

President Watkins: I appreciate that very thoughtful response. And like you, I'm confident in our ability to develop multiple scenarios and to be nimble as an institution, and I'm just as confident in the capacity of our researchers and the researchers around the world to help us understand better transmission and testing options and also treatments that will help us ameliorate the concerns around coronavirus and COVID-19.

One of the concerns that listeners may have is what your advice is about masks and wearing masks in public. There's been a little bit of conflicting information about that, and I think it might be helpful to hear from you what your thoughts are.

Dr. Good: We have evolved, as a health community, our thinking about masks. We start with how this virus is spread. The principal route that the virus moves from one individual to another is through a cough or a sneeze. The virus is in the respiratory secretions, and those include those in our mouth and nose. So, when we cough or sneeze, we get those secretions either on our hands or on a surface or potentially even in the air—although the current thought is most of the transmission is through contact, those secretions on hands, on surfaces.

And that's, for example, why the physical distancing recommendations are so important, why for this period in history we're not shaking hands like we used to. Because if I sneeze on my hand, if I cover a sneeze with my hand, and then 10 or 15 minutes later shake your hand, and then you rub your eye, that's how the virus moves from person-to-person, and it can also do that on surfaces.

So, the thoughts now with the masking is it helps slow down that many of us, particularly for the first day or two when we have coronavirus, we may not feel ill, we may not be aware that the flu is coming on. And so, the thoughts are masks help slow down the transmission of those secretions, particularly for the person that's coughing or sneezing. The secretions are caught in the mask and they don't get on the hands, they don't get on the surfaces. And probably to some degree, they also help the healthy not, if you will, inhale or bring those secretions into their mouth or nose or eyes. So, apologies for the very medical details.

But I do think ... and again, I mentioned the red, orange, yellow, green. I do think face masks have a role in some of those intermediate stages. There was a little hesitation early on because we did not have enough face masks for all our health providers, those who were on the front lines and interacting directly with coronavirus and COVID patients. But through amazing contributions of many—our businesses, our suppliers, our volunteers, our nonprofit organizations—we're in good shape for personal protective equipment. And again, for the community at-large, it can be a traditional face mask, but scarves and other face coverings work well. Again, we're trying to not share our respiratory secretions with friends and family. And so, even the face masks and scarfs and just any type of facial covering will help.

President Watkins: I think it is interesting that every one of these steps that we're taking, from physical distancing, to masks, to not shaking hands, to being very cautious about our exposures in the public, everyone contributes something towards lower rates of transmission. And it's difficult to answer what anyone contributes, but we know that collectively it's making a difference. I think anxiety for people is caused by a lack of information and fueled by misinformation. If you were guiding people about where to go for definitive sources of facts and truth, where would you point them?

Dr. Good: Well, again, compliments, President Watkins. I think the University of Utah has done a remarkable job trying to provide accurate and succinct information, both to our university community, but also to our broader city, county and state community. So, I really am pleased with the various websites and materials that are available from the university.

I, second, would refer people to the Utah Department of Health. We've worked extremely well with talented professionals in the Department of Health, and their website also has a lot of health information. And then thirdly, the CDC. The CDC site is long and voluminous, and so it can be a little hard to navigate. But those are the three sites I look to, our own university materials, the Utah Department of Health, and then the CDC.

It is very challenging. I try to watch about 15 or 20 minutes at most of the nightly news because it can be very confusing. One night there's a new test that's going to save everything, and the next night it's found not to be accurate. Everything has to be walked back. It is sometimes heart-wrenching to see what's going on in some of these other cities that have been so impacted. And so, I think it's a great question, and I would refer people to those websites and to watch a little bit of the evening news, but too much of that can also lead into that anxiety that you talked about.

President Watkins: I agree. Well, one thing that helps us all is to have wonderful colleagues and leaders like Dr. Mike Good, our guest today on the U Rising podcast, a remarkable, talented individual who also provides a lot of support to health and wellness throughout the state of Utah.

Dr. Good. thanks for being with us today, we appreciate it. Listeners, thank you for joining us today, and I hope you'll tune in for the next installment of the U Rising podcast. Thank you.