Dallas doctor gets real about COVID-19 cases

(DALLAS, Texas) At 133,811 confirmed cases and 1,497 deaths, Dallas County has become a COVID-19 hotspot, with Harris County being the only other Texan county to have more cases and deaths. Doctors, nurses, and healthcare officials are scrambling to meet the needs of the public and combat an ever-increasing spread of Coronavirus. VNN’s O’Neil Hesson sat down with family physician Dr. Rajan Kohli, MD, in Dallas and discussed the city's current pandemic situation, how effective masks are, and what the public needs to do to help mitigate the rise of COVID cases. O’Neil: “There’s been numerous misconceptions about the effectiveness of masks. When, where, and why should the public continue to wear protective gear.” Dr. Kohli: “Let’s start with when you should not wear a mask. If you are in an empty room by yourself, if you’re driving a car and there’s nobody else around you, or if you’re walking outside and there’s nobody around you; there’s not really any need to wear a mask in those circumstances. Now if you’re in a room with other people then masks [are] the best strategy in addition to social distancing… There’s a lot of misconception amongst the public and [often] it’s politicized which is quite unfortunate.” O’Neil: “It’s funny you say that because there’s talk from anti-maskers that breathing in your own C02 can affect your lung health. Is that true?” Dr. Kohli: “No it really doesn’t, historically for the last 100 years plus, surgeons that are in operating rooms have been wearing masks all day every day for most of their adult lives. There’s no data that shows that [masks] have adversely affected their longevity in any form. The only time [it would negatively affect your health] is if you have an allergy to the mask or if you have severe asthma or lung conditions like advanced COPD in which you’re struggling to breathe. In those cases, you shouldn’t be out anyways.” O’Neil: “If we can trust the effectiveness of masks, what are your thoughts on a statewide mask mandate. Do you think the policy should be pursued?” Dr. Kohli: “I think that’s a very difficult answer because what ends of happening is… you have to balance out the commerce, the politics, the science, and all these different things. Clearly it can be perceived as tyrannical if the government is imposing that view on you. The community is best served if the patients or general public takes it amongst themselves to [wear] their masks and really the purpose of wearing a mask is not to protect yourself, but to protect other people from yourself. That’s really the mindset… The mode of transmission from the majority of these cases are being spread by asymptomatic or pre-symptomatic carrier. Meaning… in the first three or four days, you’re a carrier and you’re not showing any symptoms, but you are shedding the virus. So, in those beginning days when you’re negative PCR or positive PCR, in between that time, you can give it to your loved ones and something bad can happen to them. So really the act of wearing a mask is a selfless act not for you, but for the other person.” O’Neil: “With the talk of mask mandates and lockdowns, has the state and local officials made your job easier or harder when servicing the public?” Dr. Kohli: “I think Dallas County has actually, overall, done a pretty good job in managing the crisis. Our infectious disease doctor at the hospital is on the Dallas County COVID phone calls on the regular basis. Even amongst the local politicians…they’ve done a good job with navigating this business while upholding public health. Creating effective policy can oftentimes be murky, especially since people are losing their jobs and can’t feed their families. My sense is that, if everybody is wearing a mask and adhering to social distancing, it becomes hard for the virus to spread. It spreads when you let your guard down or purposefully ignore guidelines as an act of defiance; which is a very selfish way to live.” O’Neil: “So essentially what you’re saying is that as long as we acknowledge the threat of COVID-19 we can still maintain our individual freedoms.” Dr. Kohli: “Yes, I’m all about it. I was speaking with someone today, which was an ongoing dialogue for months and months, that they are arguing that statewide shutdown mandates are bad, tyrannical, and all these things, but I think the way our politicians or public health officials have to make these decisions is based on the number of ventilators that are available. That’s really what it boils down to. The number of ICU beds and ventilators that are available in the community dictate when it is the time to shut down. Every five hospitalizations [will amount to] at least one or two ending up in the ICU. It’s a pretty significant number. So for instance, say Dallas county only has 1,000 ICU beds, and say that its projected that there’s 900 [ICU] beds that are full; There has been 1,497 deaths in the county so if we’re projecting that in Dallas county it’s [the death count] going to increase to X times 1.4 or 1.5, then we can model it and see that in two weeks we’re going to need 1200 beds. If we run out of beds, the only way we can curb the spread is if everyone does nothing. If people would stay away from each other and limit social interaction, that then would dramatically reduce the spread of the virus. So those are the draconian measures that unfortunately our public health officials have to make to stop the flow of the virus.” O’Neil: “So basically, the main reason we would experience a second lockdown is because we started running out of ventilators and ICU beds.” Dr. Kohli: “That’s it, not even the hospital beds. There are plenty of hospital beds, but there’s always more COVID patients that need ventilators than those who would be admitted with regular pneumonia. So, since there’s such a disproportionate nature of COVID respiratory failures, you need a much larger volume of ICU beds. That really dictates the closedowns. So, when these guys are considering closedowns, they’re basically looking at the ICU beds.” O’Neil: “That’s very interesting I didn’t know that. I want to talk to you, however, about how this pandemic affected existing health of Americans in particularly. We know that comorbidities can range from having asthma to being overweight. How does an individual’s existing health conditions exacerbate the effects of COVID-19?” Dr. Kohli: “That’s a good question. From what I see is that it’s [COVID-19] unraveling the health, or the lack thereof, in America. The number of people who have died from COVID is disproportionately high for a first world country. We have more deaths per capita, more hospitalized per capita, and it’s because of the chronic condition of Americans. That means in America, there is more chronic conditions than any other developed nation and a root cause is diabetes and obesity. Obesity is driving the lack of health in America. Majority of these patients fall into a couple of categories. They have obesity and hypertension. That’s the majority of patients. Second category, they have undiagnosed hypertension; they don’t have the resources to seek healthcare. We’re seeing a lot of this in East Dallas especially amongst the Hispanic population. It’s very common that we witness the trend of a significant amount of patients who either have poorly controlled diabetes, undiagnosed diabetes, or undiagnosed hypertension… Just poor lifestyle [choices], lack of accessibility to healthcare, poor diet, or lack of education to know what’s good for them and what’s not. The third category is the unfortunate young healthy person that will end up in the hospital with nothing wrong. How COVID works is—first it’s the virus that affects you. So, the initial four or five days, it’s the virus that’s causing the problem, then what’s more dangerous is the body’s immune response to the virus. The body’s immune response is triggered…and that’s what causes the lung damage and the different systems in the body to shut down.” O’Neil: “Moving away briefly from just discussing this pandemic, there seems to be a disconnect with the public and medical professional recommendations. What more can be done to increase public education on this matter?” Dr. Kohli: “So I think social media drives this a lot. If you take the fake news or the misinformation out of social media, you know the people propagating the anti-masks or anti vaccines and push the federal government to police social media so people don’t give non facts on these platforms. A lot of people are misinformed and either don’t know or want to know. It has to happen at all levels and it needs to start at the top. So, it starts at the president, his cabinet, at the school level, the parents, church [leaders], hospitals, and doctors. It’s really all hands-on deck. Everybody has to be engaged and educated. I think really the lesson here is that we need to get healthy. We are a very unhealthy country. We live in a quick fix band aid medicine type of situation. The way out of this crisis is to get to a better place in terms of health. I always tell my patients don’t go to aisle one through nine in the grocery store because it’s all junk. There’s only a couple aisles of real food. Lots of vegetables, low meat, low carbs, healthy fats, and lots of exercise. If you get COVID while having a strong immune system; typically, bad things don’t happen. There’s some challenges in this country because diversity. There are so many ethnicities, so many races, cultural issues, and political issues… the messaging gets lost because of all these things. What the medical professionals are telling you, if you listen to the medical professionals… they come from a place of knowledge and they come from a place of science. Don’t listen to the person on the side of the road who doesn’t have experience in medicine, because there’s a good chance their knowledge is coming from social media.” O’Neil: “I appreciate your time, but I only got one last question for you. Dallas counties COVID cases have been increasing. It’s the second worse in Texas. Dallas is a big city, what could be causing this, and do you think the end of the pandemic is near?” Dr. Kohli: “A lot of these transmissions are happening in schools from the kids that are asymptomatic, and I think the schools are still opened, but they can carry COVID and spread it to their families. That’s one issue, then the restaurants and bars where transmissions are still happening. Then just people congregating for parties especially over the holidays. If I want to do a thanksgiving with my parents, I’d have five of us sit in a large room away from each other and just make it a short-abbreviated experience. Or go home and do it virtually; I know it’s a difficult thing for a lot of us and we want to congregate and socialize. I do think the end is near. I’m a very optimistic guy. I think by next July we should be in good shape for the vaccine, but I think we’ll have one more year [of COVID] before there’s enough immunity in the country where it will be less of a hazard. I think we’re kind of stuck with the masks and social distancing for at least another year. We’ll probably see another year of the same…slightly less hopefully, but we should expect this to not go away until at least 2022. Right now, the data is about 5-10% of the country’s population have been exposed or has antibodies. By next summer, between the normal infections and the immunizations, majority of us should have antibodies. That ought to help us quite a bit.”