What You Need to Know: Coronavirus and People with Spinal Cord Injuries, Brain Injuries or MS

In a new podcast with Shepherd Center Radio, Michael Yochelson, M.D., MBA, chief medical officer at Shepherd Center, and Jesse Couk, M.D., infectious disease consulting physician at Shepherd Center, discuss COVID-19 and its symptoms, precautions and preventative measures for those with spinal cord injury, brain injury or multiple sclerosis.

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Melanie Cole (Host): Welcome. This is Shepherd Center Radio. I’m Melanie Cole. And today, we’re discussing the Coronavirus. Joining me is Dr. Michael Yochelson, he’s the Chief Medical Officer at Shepherd Center and Dr. Jesse Couk. He’s an Infectious Disease Consulting Physician at Shepherd Center. Dr. Couk, I’d like to start with you. Tell us what is the 2019 Novel Coronavirus? What does Novel mean? What is this Coronavirus and how did it start really in Wuhan, China?

Jesse Couk, MD (Guest): Coronaviruses cause infection in people. Typical Coronavirus will just cause mild symptoms like the common cold. However, there are Coronaviruses in animals and when those viruses are transmitted to humans, they can cause severe disease. And the Coronavirus that we first saw in China, we are now calling COVID-19 appears to be one of these viruses. We initially discovered it in Wuhan China. Patients were becoming particularly ill and developing pneumonia. And that’s what’s different about this virus from most Coronaviruses is that it can cause severe disease with pneumonia making patients very ill and requiring hospitalization. It has similarities to SARS which caused an outbreak in 2003. It does not appear to be as fatal as SARS with mortality rates about 1 to 3%.

Host: Well thank you for that explanation. Dr. Yochelson, there have been a number of deaths and as Dr. Couk just said, maybe not as many as SARS but there have been some deaths among people who are young and as far as we know, otherwise healthy. Does this reframe who we think is at risk? I’d like you to speak about the risk factors. Are some people more at risk and especially there at Shepherd Center, are people with spinal cord or brain injuries or MS more susceptible to this virus?

Michael Yochelson, MD, MBA (Guest): Yes, so certainly in those specific patient populations that you asked about and the ones that we treat here at Shepherd Center like multiple sclerosis, spinal cord injury and brain injury; it is likely that there is some increased susceptibility or at least that if they were to develop it, that they may have a more severe illness. In general, it seems to be that with COVID-19, it is the patients who have some other immune system diseases or illnesses or other medical problems, the elder population tends to be getting more severe injury and higher rates of mortality. Although it certainly is affecting some younger people as well.

The challenge that we have particularly with multiple sclerosis is often they are on medications that may cause some immunosuppression and in brain injury and spinal cord injury population, particularly spinal cord; if they already have underlying respiratory disease; they are more likely to have a very severe case if they do develop it. So, they need to make sure they are taking every precaution to avoid getting it.

Host: What about if they use a ventilator Dr. Yochelson? Are there any special precautions you’d like them to know about that?

Dr. Yochelson: So, there aren’t really any special precautions for someone on a ventilator other than they should certainly use every precaution that we possibly can and again, these are precautions to getting the disease in the first place. So, it is a respiratory disease so avoiding respiratory contact. If somebody, if they have a known person with the Coronavirus; they certainly should not be around that person, travel to areas where it has been noted to be more prevalent and then washing hands is probably the most important thing that anybody can do. Because the droplets, the respiratory droplets, if somebody coughs or sneezes, can then get on surfaces which then the virus can live for a period of time. And then the person can touch a surface, their wheelchair, a table, a door handle and then they touch their own face and that’s one way that it can be spread. So, really just taking every possible precaution to avoid getting the disease in the first place.

Host: Before I move on to Dr. Couk, for some more of those precautions, Dr. Yochelson many people with brain and spinal cord injuries have caregivers. What if the caregiver gets sick? What would you like them to know about that interaction with the person that they are caregiving for?

Dr. Yochelson: I would strongly suggest that they make plans to have a backup caregiver and if their caregiver is sick, their caregiver should not be taking care of them during that period. One of the challenges, of course, is that they can be infectious slightly before they become symptomatic. But their highest period of being contagious is when they are most seriously ill. And this is true not just with Coronavirus, with anything. Even with the flu. Which is going around a lot right now. It’s so important for these patients not to get the Coronavirus or the flu or any other illness and so, it’s best if they can just avoid using that caregiver. If that is not possible at all, and particularly if their caregiver is a family member or household member; using a face mask for the caregiver so that they are not spreading the virus as they cough or sneeze and again, both the caregiver and the patient using precautions such as the handwashing or the sanitizing gel.

Host: Dr. Couk, tell us how it really spreads. We are hearing about hand washing. We’re seeing people wearing masks. Does it live on surfaces? How far away do you have to be? You are an infectious disease specialist, tell us a little bit about how it spreads.

Dr. Couk: Yeah so, COVID-19 is spread by droplets. So, when somebody coughs, for example, those droplets can get on to people and surfaces and then if they are inhaled, those droplets are inhaled or if somebody touches an infected surface and then touches their face or eats food without washing their hands; then they can potentially infect themselves. That’s primarily how it spreads. It’s not airborne. It’s not like measles where you can walk into a room after someone was in that room and get infected. You need to be exposed to the droplets from an infected individual to get this disease.

Host: Well I’m so glad you cleared that up for people because that’s been the big fear and Dr. Yochelson, when we’re thinking of preparing and precautions, especially for people with brain and spinal cord injury; can you please address the need for medication supply, the need you already addressed the need for caregiving. Tell us a little bit about other things you want to make sure that you have on hand.

Dr. Yochelson: Well, I would certainly suggest that you have on hand as much as possible of any cleaning supplies, personal toiletries, things like that, toilet paper in your home, partially because if you have a caregiver who gets sick and you can’t get out to the store or if this becomes more prevalent in the community and you don’t want to risk going out of your home; you want to make sure that you have whatever you need in the home. So, again, personal items, cleaning items, and then from a food supply standpoint; obviously keeping as much as you can, nonperishables in the house so that you can go longer periods of time without having to go to the store. In terms of medications, there is concern and we are already beginning to see this at a very low level, but there is concern that there may be some issues with medication supplies. Because so many of them are made in China and other areas that may become impacted and therefore can’t produce at the same volumes as we need. And so we begin to have a supply issue. So, it’s not only their ability to get out to get their medications but also potentially the availability of the medications themselves.

Host: Dr. Couk, if somebody does have a cough or they start to feel sick; everyone wants to know, should they run off to the doctor. Should they go to the emergency room? Are there enough test kits available? Tell us a little bit about what we should do if we feel sick and where’s the best source of information that you would tell us to get the latest updates?

Dr. Couk: To begin with, with there to find information, both the CDC and the Georgia Department of Public Health have great websites and I definitely strongly recommend using those resources. I think when you use the internet, it is easy to find misinformation and so if you use those resources, you’ll get not only will you get accurate information, but up to date information as well.

Symptoms of COVID 19 include fever, cough and fatigue. Those are the most common symptoms. Severe disease is characterized by pneumonia and you would see that with shortness of breath, and then some people have reported muscle aches, headache, sore throat and chills. And those symptoms are similar to other respiratory viruses, the common one being flu. And for most patients, who get the flu, it is recommended to stay home. Don’t go out into the public. But if you are concerned, if you feel particularly ill, then I would definitely recommend calling your doctor and for our patients at Shepherd Center, where something like the flu can be a risk to their health; then I do recommend calling your doctor if you have any of the signs of the flu. Regardless of whether you are worried about Coronavirus or not.

Host: Dr. Yochelson, as the Chief Medical Officer at Shepherd Center; tell us what Shepherd Center is doing to help reduce the spread of this and flu and other viruses. What are they doing when interacting with those infected, doing to protect other patients and providers?

Dr. Yochelson: So, we are currently screening all patients who are coming in for outpatient visits. We are screening them for travel as well as any symptoms of the flu or Coronavirus. Anybody who has traveled in any of the areas that the CDC is listing as a level two or level three alert for Coronavirus within 14 days of travel. We are not allowing them to come into the hospital. If they have symptoms, or if they have contact with someone who has traveled in one of those areas; we’re not allowing them to come in. If it is somebody who has to come in for medical reasons, we can’t delay their appointment because they have a procedure or need to come in for medical reasons; of course, we will make an exception and allow them in, if it is the flu. Coronavirus is different. But if it’s the flu, but we still need to be notified and we will take appropriate precautions with protective equipment, PPE such as masks, gloves and gowns and make sure that we get them right back into an exam room so that we are not spreading the flu to others in the area.

We are also limiting visitation to – for our inpatients to immediate family members and caregivers and we are also limiting some of the outside activities because we at Shepherd Center do bring in a lot of people for various activities here at the Center, so we are limiting that. Those that we can’t cancel, we’re screening everybody in advance of coming in using the same criteria. Although for anyone coming in, who is not a patient; we are actually expanding to any international travel, not just the high-risk countries only because we know if they’ve been recently flying on an airplane; you never know who you are sitting next to and who may be sick or who you have been exposed to.

Host: Dr. Couk, last question to you. Tell us what you’d like us to know about this Coronavirus, it’s a little confusing, a little mysterious, a little scary, but clear it up for us. Tell us your best advice and what you’d like us to know as an Infectious Disease Specialist about Coronavirus, things we can do to protect ourselves from possibly getting sick.

Dr. Couk: Most people are not going to get Coronavirus. And I really want to underscore that. And most people who get Coronavirus are not going to get severely ill. About 80% of patients, they get this virus and they get over it. And they don’t have to go to the hospital. I think that it’s important to realize that and remember that when we get concerned or scared about this virus. The measure that we take to try to prevent ourselves from becoming ill are the same measures we should be taking every year during flu season. So, things like washing our hands, trying not to touch our face, trying not to touch our eyes. We probably should not be shaking hands and that’s something that I’m trying to get out of the practice of doing. It can be uncomfortable for those of us who are used to it but it really that’s an effective way to spread germs and we don’t want to be spreading germs especially during cold and flu season and particularly while we are worried about this virus.

So, again, to reiterate, you are most likely not going to get Coronavirus and if you do get it, you are most likely not going to be severely ill from it.

Host: And Dr. Yochelson, do you have any final thoughts for us?

Dr. Yochelson: Well I agree with Dr. Couk. Certainly, the best thing we can possibly be doing is just overall prevention and that’s really the same whether we are talking about the flu or the Coronavirus. The one thing that I would add to that although I agree with Dr. Couk, it’s highly unlikely that any individual is going to get Coronavirus, but if you do think that you are at risk for it because of your travel or contact history as well as fever and respiratory symptoms; before just going to the emergency room, I would advise you to call the emergency room and let them know that you are coming so that they can be prepared. Because the last thing we need is for somebody who does have Coronavirus to walk into a waiting room and spread it to other people in the emergency department.

Host: Well that’s great advice. Gentlemen, thank you so much for coming on and discussing this with us and sharing your expertise. It’s so important for people to hear this really good quality information. That concludes this episode of Shepherd Center Radio. Please visit our website at www.shepherd.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Shepherd Center podcasts. I’m Melanie Cole.