March 29, 2020

COVID-19: What We Know About the Novel Coronavirus

Show Notes

On this bonus episode, Chuck Gaidica is joined by Dr. George Kipa, deputy chief medical officer at Blue Cross Blue Shield of Michigan. Together, they discuss the current state of the novel coronavirus (COVID-19).

“If you’re high-risk (for contracting COVID-19), stay at home. If you’re healthy and well, follow the social distancing recommendations. It’s very important to watch what you’re doing, think about what you’re doing and lower your risk.” – Dr. George Kipa

In this episode of A Healthier Michigan Podcast, we explore:

  • What is COVID-19?
  • How does it differ from the flu?
  • Precautions to take
  • What makes someone high risk
  • What are the symptoms?
  • Surfaces the the virus lives on
  • Disinfectants to combat the virus
  • When to seek medical attention
  • Resources to manage stress

Resources to stay up to date on COVID-19:

Transcript

Chuck Gaidica: This is A Healthier Michigan Podcast bonus edition. We’re recording on March 27, 2020. On March 10, 2020, you may know Michigan reported its first two cases of coronavirus and the next day the World Health Organization known as the WHO called COVID-19, the coronavirus, a global pandemic. Day after day, it seems like we’re inundated with an influx of information. It’s pouring through news outlets, social media, well-meaning friends, relatives, neighbors. Everybody’s hearing things from different sources. And remember, we’re in a 24-hour, 24/7 news cycle now. So you may see one expert last hour and another expert the next hour, and sometimes that information doesn’t all jive. There’s so much to take in, and it seems to become overwhelming at times.

Chuck Gaidica: On this episode, we want to talk about the current state of coronavirus, clear up any misinformation that we’re aware of. And we’re starting to hear things about potential treatments and lots of information coming our way, stuff we’ve read online. We want to offer you the most up-to-date information possible, so we are enlisting the help of someone from Blue Cross Blue Shield of Michigan, Dr. George Kipa, who is the Deputy Chief Medical Officer there. Well, how are you, Dr. Kipa? Good to talk to you again.

Dr. George Kipa: I’m doing very well, Chuck. Good to talk to you also.

Chuck Gaidica: Thanks so much. So much happening right now. And again, we’re recording on March 27th, so we’re several weeks into this cycle in the state of Michigan where so much has changed. But there is also misinformation that’s coming out, so maybe we can start with some of the basics. What is COVID-19, so we understand it?

Dr. George Kipa: Well, Chuck, COVID-19 is the disease. It’s the disease that’s caused by a virus, a coronavirus, a new novel coronavirus. The technical name of that virus is SARS-CoV-2. And the coronaviruses are known to us. Some of them cause what we call the common cold and they’ve been around for a while. And also in the last 20 years, we’ve had a couple of outbreaks of coronaviruses that were significantly more severe than the common cold. In 2003, the SARS or severe acute respiratory syndrome, which was a coronavirus, started in Asia. And in 2012, we had MERS, the Middle Eastern version of the same virus. Both of those were significant outbreaks of severe disease from coronaviruses.

Dr. George Kipa: But what’s happened now is a novel coronavirus that started in Wuhan, in China, probably sometime in December, as you know caused the pandemic in the world. It’s spreading globally, and it’s unfortunately reached a point of global spread. But if we think about it in a normal season, we’d be thinking about the common cold and the flu of course. But this is very different because for the flu, you’ve got vaccines, you’ve got treatments, but now we have a situation where we have a novel virus that there is no immunity out there in the population. So it’s a very different sort of situation.

Chuck Gaidica: So how does it really differ from the flu in the sense that we hear flu start and is it really because we aren’t getting inoculations, and as you say, we don’t have any built up immunity to it? Is that what the differences are here? And I don’t mean the difference in symptoms, I mean just the difference in how it’s attacking the host, which is us, human beings.

Dr. George Kipa: Right. Well, yes, those are two key differences. But in terms of how it’s attacking the host, there are also some differences in it seems to be more contagious and exactly why that is is still being researched. But certainly the rapidity with which it’s spread makes it different from previous coronaviruses, and there is a difference in terms of how it seems to be so contagious. And it has something to do with both the manner in which it’s being spread and the rapidity with which one person can give it to another. So with COVID, it seems one person typically gives it to three other people. Whereas with the flu, it’s more like one person gives it to one more person or slightly more than one person if you catch my drift. So epidemiologically, there’s a difference in how it’s spreading and how it’s contagious.

Dr. George Kipa: On the other hand, we think it spreads mainly by respiratory droplets, which is probably similar to how the flu is spread, although there is some talk about a study that showed that it might be airborne, but we really don’t know yet exactly what that means. The main spread is when someone coughs, those droplets can land on somebody else, and that’s the reason you got to stay six feet away from others. Or if those droplets get on your hands somehow, somebody gets those droplets on a surface and you touch that surface and then you touch your face, that’s another key way it spreads. So there’s a lot of similarity in how the flu and the COVID spreads, but there are some differences in the epidemiology just based on the contagiousness that we’re seeing.

Chuck Gaidica: I want to come back to that contagiousness in a minute, but let me just go back just one place. Because as a science geek, when I see an article that says, “Oh, scientists found six new species of butterflies in the Amazon,” I’m always like, “Wow, how did we not know they were here?” Why is this virus novel? Does it just come from nowhere? Does it morph from SARS into something else? Like why have we not known it was there or that it was coming until it got us?

Dr. George Kipa: Well, it depends who you’re talking about. The epidemiologists knew it was coming. Anyone who’s taken a Master’s of Public Health, I’ve spoken to a number of students including my own daughter has a Master’s of Public Health, and she said that she was terrified after listening to her lectures, and that was about five years ago.

Chuck Gaidica: Wow.

Dr. George Kipa: So in terms of what’s coming. I mean there are over 200 species of viruses out there that cause human disease. And in terms of the common cold, there are probably over a hundred of those. They include rhinoviruses, adenoviruses, and also I mentioned the coronaviruses. We knew they were there, but what we didn’t know was that a virus like this when it would happen, but it did occur. And what’s different about this virus in terms of, again, I mentioned the fact that we don’t have the herd immunity, but this virus is somehow beating our immune system even in the non-specific sense. Our immune system has a non-specific arm and a specific arm, and somehow it’s getting around that first part and leading to the tremendous variation in symptoms that we’re seeing.

Chuck Gaidica: So as a precaution, we hear a lot of things. We see people walking around. If they are going to the grocery store, some are just walking in and they’re wiping off the cart with some kind of sanitary wipe. Some people are wearing gloves, masks. What is it that we should be doing? What is your advice about precautions we should be taking?

Dr. George Kipa: Well, I would say this: Given the fact that in Michigan, there’s community spread at this point, especially if you’re in the high risk area, you should not be going out. You should be staying home. And for those essential activities, for the healthy, well people out there, follow the social distancing recommendations. Definitely very important to watch what you’re doing and think about what you’re doing and lower your risk. And as I said, if you’re high risk, you have to take extra special precautions, but everyone needs to do all those things you’ve heard about. Wash your hands frequently, clean surfaces frequently. And if you’re out there, think of what you’re doing, if you’re touching something or you’ve been out there, don’t touch your face. And if you’re out there and then you have available a hand sanitizer, use it. And in terms of common sense precautions, interestingly enough, we should have been doing this all along even for the common cold in some respect. We should be thinking about what we’re doing. And I’ve got a feeling this will change social habits going forward. But those common sense things you’ve heard out there repeated multiple times on all media that’s coming through, listen to them and do them.

Chuck Gaidica: Well, you said something that’s interesting and I think it dawns on a lot of us, if we were not in our home hunkered down and we did have to go out for some essentials, we’ve got kids, we’ve got to get some groceries or something, if we saw a person cough for whatever reason, we’d run for the hills. So it tells me that this virus has got, if someone has coughed, if it got airborne and we’re not near anybody, but yet it’s still being picked up within a community, there is some kind of shelf life to this thing, that once someone breathes or coughs and that germ is out there. Do you any insight about when it lands on plastic versus paper? If the temperature is higher or lower? Is there anything that you’re seeing that seems to be real science that points to, I guess, I would call it the livability of the coronavirus?

Dr. George Kipa: Right. Well, the older research comes from what we know about the coronaviruses as I mentioned with SARS and MERS. There’s been some recent research that looks at, and actually I think it was reported in the media recently. So in terms of surfaces like glass and plastic, it may actually survive for several days. Paper or porous substances seem to absorb the virus, so it survives a lower period of time, maybe just a few hours. But the good news in all of this is it’s very susceptible to disinfectants. So the standard disinfectants that most people use are very good at eliminating the virus on surfaces such as glass, plastic, or metal. The other key question was, does it survive in the air? And these recent studies have said it may actually survive for several hours in the air, but there is no specific evidence of spread through airborne at this point. It’s been found in some vents in hospital rooms where there’s negative pressure, or I’m sorry positive pressure where it pushes the air into these vents, but nothing that’s actually shown that it can spread that way from one person to another airborne.

Chuck Gaidica: Well, in my lifetime, I remember various outbreaks, SARS, MERS, I remember back in the day of Legionnaires that got big news when you talk about something being stuck in the duct work, that could be living in there. So the disinfectants you’re talking about that have the high probability of taking this thing out would include the alcohol that’s in the hand sanitizer and then anything that has a bleach product in it, like the wipes we may use on the kitchen counter. Are those the two best defenses?

Dr. George Kipa: Those are excellent defenses. Make sure that alcohol has a high alcohol content. They used to say 60, and I’ve been hearing 70 or more in terms of percent. And we do have a link to that on our mibluesperspectives.com and it links to the CDC list also of the preferred compounds if you want to get specific. But what you mentioned is exactly correct.

Chuck Gaidica: When it comes to who is high risk, we hear that age, we know that seems like a pretty sensible thing to think about. But what would be the list of things that people may have in their life that could make them high risk?

Dr. George Kipa: Well, yes, I agree that age and the CDC says greater than 65. The World Health Organization says greater than 60. But if you have chronic conditions including certainly lung conditions, I would probably put at the top in terms of asthma, COPD. Lung conditions are thought to increase the risk of getting severe disease from COVID since very high morbidity occurs when it hits the lungs. As far as other cardiovascular diseases also increase risk. And of course since we’re always worrying about our immune system and in terms of anyone who’s immunosuppressed for any reason, if you’re taking medications that can decrease your immunity, if you’ve had a organ transplant certainly, if you’re taking certain rheumatological medications that are known to affect your immune system, that’s very important to consider. So anyone who has a chronic disease should definitely take extreme precautions. Everyone should be following social distancing and all those common sense approaches we’ve discussed and are out there on the media, but those who are in the high risk categories definitely should take extra precautions.

Dr. George Kipa: And the CDC constantly updates the list. They’ve asked questions such as, “Well, what about pregnant women?” And even though there’s no specific information saying that they’re at greater risk, certainly anyone early in the pregnancy should be careful. And I think that I would probably also put them in the take extra precautions list.

Chuck Gaidica: Regardless of your body’s state of wellness at the moment, let’s just start there. How does this coronavirus attack us? How does it affect the body? What is it doing when we first touch it, maybe we touch our face by accident and we get it? What’s it doing?

Dr. George Kipa: Well, it’s thought to get into our mouth, into the oropharynx, into the nasal mucosa. And when it gets in there, it tries to get into our cells. And while it’s doing that, remember I mentioned we have two arms to our immune system. So the first arm is called the innate immune response. And we have, actually it’s interesting, about 5% of our genome is dedicated to recognizing what we call pathogen-associated molecular patterns or PAMPs. And so our innate immune system is looking constantly, what is this? Is this something new that’s trying to attack us? And so somehow the coronavirus figured out a way to get by that aspect of the immune system. The other aspect of the immune system is the adaptive arm. That’s where we make antibodies to any pathogen that comes at us. But it takes time to do that.

Dr. George Kipa: So the problem here is that in the time that this virus is getting by our first line of defense, we have to give it enough time so that our second line of defense can recognize it and start making antibodies to it. That’s where vaccination comes into play. If you have a vaccine, you’ve already gotten memory cells that are ready to shoot out those antibodies early, and that’s what’s missing here. So the virus is figuring out a way to sneak around the first part of our immune response. And because we don’t have that second level of adaptive immunity, it’s going to take a week or two to get that moving. That’s a key approach in terms of whether or not we can defend our body against the virus.

Dr. George Kipa: And in terms of how any pathogen affects us, our body is constantly vigilant. And when the first part of that immune response, it starts sending out cytokines to the rest of our body or signals that say, “There’s something going on, let’s send some of our defenses.” So it sends certain kinds of white blood cells that non-specifically try to attack. But this virus is getting around that piece.

Chuck Gaidica: Is it getting around in everybody? Because we hear of folks that are getting mild symptoms and we’re hearing of people that are getting severe symptoms. And you would expect that if you’ve got a preexisting condition, you may be more severe, et cetera, and age of course is playing a role. Why is it that some of the cases are less severe or mild? Is it because that person’s immune system is doing a better job?

Dr. George Kipa: That’s one of the great mysteries that this virus presents, and actually that’s also another difference between it and the flu. The flu can hurt very young infants and children, and this virus seems to be not as effective there from its point of view. So the mystery of why, for instance, we’re seeing a lot of 21 to 44 or 45 year olds getting it and why some are more severe than others, there’s a lot of thinking going on on that. But I think there may be, I mentioned that innate immune response and adaptive immune response, it may have something to do with both genetic and environmental influences on that first part of our immune response.

Dr. George Kipa: For instance, one theory is what they call lymphocyte depletion. All viruses, even the common cold, cause our lymphocytes to go down. If you get that common test, the complete blood count with differential, if you look at anybody with a virus, you’re going to see a decreased lymphocyte count typically, and an increased neutrophil count. Neutrophils are the white blood cells that non-specifically get in there and start attacking the virus, whereas the lymphocytes are the more specific arm and they bring in the neutrophils so to speak. So it may have something to do with perhaps, again, genetic or environmental differences with that.

Dr. George Kipa: And there may be other things that we’ll learn about that help us to figure this out. So that’s the start of it, and in terms of why some people are completely asymptomatic, it may be that there’s a feature of their innate immune response that enables that arm to keep the virus from doing more than perhaps just sitting there and not doing much. There’s also something else in the lymphocyte depletion. It’s thought that as you get older, your cells can only divide so many times and that may be part of the reason why age plays a role.

Chuck Gaidica: Oh, well and to be fair, if you have an autoimmune disease and you’re aware of it, you’ve got lupus, you’ve got something else, you know that you’re having issues with your immune system. But for the rest of us who are walking around every day, we’re not quite sure. We’ve never tested to see, is the oil filled to the brim? Do we have eight quarts or seven quarts? And so we don’t know exactly what’s going on if we’ve never had symptoms. So that’s an intriguing thing about this question of mild versus severe in terms of how some of the cases are presenting. What are the symptoms that all of us should be looking for? I mean, the initial things that are happening because some of these cases we’re seeing are so mild, someone may get a little cough or something and within a day … they never even felt pokey. I mean, they were just going about their day and they didn’t even know they had it. But what are the symptoms we should all be mindful of for us and for the loved ones around us?

Dr. George Kipa: That’s a great question. Because you’ve heard a lot about the fact that when you get fever, a dry cough and if you add shortness of breath that’s increasing, that those are the big three symptoms associated with COVID. However, there’s a great deal, again, a variation going on here. We already said that a lot of people can have it and have no symptoms at all. Maybe some will just have a little runny nose, a little bit of a scratchy throat. Maybe you feel tired and fatigued. One problem is, let’s say you have a condition that does give you symptoms already. Let’s say you have allergies and you’re sneezing a lot, and so you’re still at risk for getting COVID, so you can have sneezing as a symptom too. So there’s a wide variation.

Dr. George Kipa: So one role of the physician is to listen to your whole story, knowing your background history. That’s why it’s really good if you’ve had a primary care physician that really understands and communicates well with you and knows your history, that they’ll be the best individuals that can help you sort things out. But certainly if you’re, in terms of severity, if you’re getting those three cardinal symptoms and increasing shortness of breath, that increases the level of suspicion.

Chuck Gaidica: And I’ve also heard that that shortness of breath is leading to a lower oxygen level within the blood. And that’s been one of the tests, which is very simple, by putting the device, the oximeter, on your finger, which a lot of us have had when we’ve been hospitalized or you’re going for a checkup. So is that something that you’re seeing as well, that that ox level is coming down in people that have COVID?

Dr. George Kipa: Yes, in the emergency rooms, that has been one way they are checking. So normally if you put on one of the pulse oximeters on your finger, you should be running about 97, 98. If you’re down below 90 in the 80s, that’s an important signal to check out what’s going on.

Chuck Gaidica: So without mentioning names, I have to tell you again, we’re recording this March 27th. But as of yesterday the 26th, we have a dear friend of the family who said her husband may well have COVID. He was tested. Now here’s what’s interesting. She’s in the same home. She’s got no overt symptoms at all. And because of the lack of tests available or the prioritizing, they are not giving her a test yet, but telling her to quarantine. So we’ve heard of some of these situations as well. But if you’ve got a person who has tested positive in your family, in the household, what are we all supposed to do? Because for many families, they don’t have the option of just evacuating and going to stay with somebody else. And probably that’s not what they should do anyway.

Dr. George Kipa: Yes, well that gets from the definition of quarantine and isolation. With quarantine, you should stay away from other people in your home. But when you’re positive, you’ve got someone with a positive test, they should be in isolation. That gets a little more tricky. They really should be separating themselves from even other members of the family, stay in a separate bedroom let’s say. Hopefully, there would be a separate bathroom facility that they can use. They shouldn’t share utensils or any items such as that. You should very carefully disinfect any surfaces that they might touch. So isolation means really you have to supercharge the social distancing that we’ve talked about.

Chuck Gaidica: Yeah, that’s a good way to look at it. And then when it comes to the actual, and again, as of this date, what are you hearing from your end of the funnel about the face masks, the plastic covers, the stuff that is needed by those brave men and women, the doctors and nursing staff and all the hospital staff serving on the front line? Is stuff getting in the pipeline like we here it is? Or are we still scratching for onesie, twosies of masks and things like that?

Dr. George Kipa: Well, when you think about it, the standard protocols require you to change your mask and change your gown when going from one patient to another. That’s basic, basic infection control. And what I’m hearing is there’s quite a bit of distress out there that there is not enough of the supply of these materials. So they’re being used, they’re not being changed, and I’ve even heard that some doctors and nurses are being issued a mask and told, “You got to use this all day and then put it in a bag and go home and then bring it back the next day.” So that’s a little scary.

Dr. George Kipa: Unfortunately, the tremendous increase in volume is such, even the deliveries that have been occurring, and I’ve talked to individual doctors who have not been able to get any supplies at all. And I talked to one surgeon who says that a patient whose life he saved came in and brought 24 masks to the practice, apparently he got them from an industrial source. So there are issues with the availability of personal protective equipment, especially because if you use it according to protocol, it gets used up very rapidly. And so some of those protocols are being relaxed. And in terms of infectious disease control, that’s not a very good thing. So we definitely need improvement in how that supply pipeline is working for that.

Chuck Gaidica: Well, one of the headlines I saw, I guess it was either yesterday or maybe it was just this morning, was talking about as of this date again, March 27th, that the intent was now to focus on a tighter grid of county by county across America. Because if you look at some of the states and even within Michigan, some of the counties not affected, you may not need to be dropping 2,000 pallets of face masks in Montana if it’s not an issue, so that versus New York. And so I appreciate the idea that somehow somebody is thinking ahead to try to focus on resources instead of just a mass mail-out to everybody. That would seem to make a lot of sense.

Dr. George Kipa: Given the current situation, prioritization and using data to distribute correctly is extremely important in my opinion.

Chuck Gaidica: So let’s just bring it home here to you’re sitting at home, maybe you’ve been listening to this or you’re sharing it with friends and family within your circle. And again, we encourage you to do that. You do not have to be a member of Blue Cross Blue Shield of Michigan to get this information and go to mibluesperspectives.com for up-to-date information. What should you do? What are the decision-making factors, again Doctor, to decide that you should go to either see a doctor or go to the hospital?

Dr. George Kipa: Well, I think there’s several levels of that, and I’m going to bring it back to the fact that remember the common cold is still out there. All those viruses we mentioned aside from COVID or the SARS-CoV-2, they’re out there. So if you’re experiencing very mild symptoms and you just need to talk to someone, many places have a Call A Nurse as does Blue Cross, but many, many, I think that’s nationally established. Also, if you have a means of talking to your doctor by telehealth, that’s being increasingly utilized out there. So those would be good things. And I think in terms of if things are getting serious, certainly anyone who is experiencing difficulty breathing or let’s say chest pressure, some of the cardinal symptoms that something may be going wrong, if you have some bluishness around your mouth or something like that, you’re short of breath, and any change in your ability to … if you’re confused, anything like that, those would all be emergencies.

Dr. George Kipa: One key thing is if you’re actually going somewhere, don’t go to the emergency room if you have very mild symptoms and you wouldn’t have done it before anyway let’s say. And if you’re going anywhere, always call ahead. Now, if you have those emergency symptoms, that would be a reason to, for instance severe trouble breathing or if you think you’re having a heart attack and that sort of thing, obviously you need to call 911. But also inform them of upper respiratory symptoms so they know what to be prepared for.

Dr. George Kipa: So remember that it can still be something else that’s doing it. So the worried well, so to speak, there are many, many ways of getting information without putting an extra strain on our healthcare system. And then the other question is, let’s say you’re just having very mild symptoms and you want to be tested. In the best of all worlds, there should be a test available for you to do that. But right now, there is a shortage of testing out there in terms of materials for various reasons. It could involve the personal protective equipment, but it also seems to be involving the availability of testing resources. So that’s why right now, those who are severely experiencing relatively severe symptoms, but right now those are the ones that are mainly being tested still, even though I hope that will change soon.

Chuck Gaidica: Well, we do too. As you, again, are hearing things from a different end of the funnel, you’re in touch with information that’s coming to you from people you know and trust and otherwise you’re seeing this across the world, we’re hearing these bits of information. Quickly touch on for us the idea of the malaria drugs, this cocktail of a couple drugs that have been used for other purposes maybe that somehow in different parts of the world, people are trying this and there seems to be some success. What are you hearing?

Dr. George Kipa: Well, going back a little bit, the hydroxychloroquine or Plaquinel, the malaria drug, it’s well-known to be used for even prophylactics or prevention when you’re traveling somewhere where there’s a high degree of malaria spread by mosquitoes. So it’s the drug that’s very well-known to have anti-inflammatory properties. And actually back in about 2003, there was a key article in Lancet that described the fact that this hydroxychloroquine, which is also being used right now by many, many patients for rheumatological and autoimmune conditions, let’s say like lupus or systemic lupus erythematosus, a lot of people are relying on that right now. And back in 2003, that Lancet article said this is a great drug in terms of having anti-inflammatory and anti-pathogenic properties, and we may one day have to use this drug for a viral epidemic. So that was 17 years ago and that was a widely-circulated article in the medical literature.

Dr. George Kipa: And so there’s definitely a precedent for that. In China, they were trying the hydroxychloroquine and azithromycin in addition to various Chinese herbal medicines. And there are anecdotal reports on patients there that there was improvement using that. So there is information, there’s a unpublished report that’s circulating that describes 20 patients in great detail. The limitation of these studies is they are observational, but yet they do point to the fact that there may be some utility in these drugs. The key issue though is how good is this data, and as Dr. Fauci has pointed out, we need to be able to discriminate between observation and actual evidence-based scientific knowledge that the drug actually helps. That’s the dilemma we’re facing. Those kinds of studies are very difficult to do in a pandemic situation.

Chuck Gaidica: Well, let me ask you this as we start to wrap things up. If I’ve had it and I didn’t even know I had it or I did know I had COVID-19, are the antibodies now in my system where I have resistance to the next exposure like you were talking about with the flu that we build up our antibodies? How will that work for the future, for the next go-around, if there is such a thing?

Dr. George Kipa: Well, one way to preface answering that question is, let me briefly describe the difference between two types of tests for COVID. The first one is the one we’re doing now, which is the RT-PCR test. That’s a reverse transcription polymerase chain reaction test that is highly specific to recognize the genetic material from the pathogen itself, from the COVID virus. So if you’ve got a positive test, you know you have it. The other kind of test looks for your antibodies. So I mentioned that two arms of the immune response, if you’ve had it and you’re totally asymptomatic, the odds are that your system has had enough time to make the antibodies. It starts usually with IgM, then switches to IgG, but it varies in how that works.

Dr. George Kipa: And so the question of how protective those antibodies are, first of all, those little symptoms that have got through this probably have a kind of protection even at that preliminary stage that I mentioned before. And once they had the virus, they now have the antibodies that you could check with these tests. And I’m going to mention one other thing, the antibody test is not as sensitive and specific as the PCR test. So there’s some variation and some limitation to that. And as clinicians, we are careful where we interpret the antibody tests, that’s a key point here.

Dr. George Kipa: The question of are these protective antibodies remains to be seen. Theoretically, they should be. Let’s say that someone had mild to moderate symptoms and came through and did fine as the majority of patients who have those do. So at that point, the fact that they do have these antibodies in their system is very likely to protect them. But the problem is obviously that’s our theory looking into the future, the data of what actually happens will let us know if that’s true. So I think it’s very probable that that’s true, but we don’t absolutely know the answer to that question.

Chuck Gaidica: I mean, we wish we had the answers. And I think that’s one of the issues that all of us are facing here, not just because we’re Americans and we need things done quickly and we want to get from A to B fast, and we’re kind of wired some of us to be type A, but you just wish we could get a handle on the answers. And I think that’s leading to a lot of stress as well. This is something that seems like a bucking bronco. It’s so unwieldy for so many people psychologically. We’ve been talking about the medical side of this, and there’s the psychological part about being cooped up in your house and all the rest of it.

Dr. George Kipa: There definitely is a tremendous psychological stress on the fact that everything’s changed so dramatically. One day we’re going about our daily work, mixing with people, going to stores, using transportation. The next day suddenly everything is different. And that definitely increases the stress on people who are very well-adjusted and doing great before even. But certainly if you add to that any additional stresses in terms of family, friends, work, worrying about finances, there’s a tremendous amount of really unprecedented stress out there.

Dr. George Kipa: So it is a good time to take advantage of the many materials out there that help to deal with that. Again, that website I mentioned earlier, mibluesperspectives.com, has a great deal of information on how to do that. CDC has good information links. I would imagine that every public health department of every state now has help available to give advice on how to minimize your stress, how to take a deep breath, how to think about what the good things are that gives you time to reflect perhaps. There are things that you can do to help relieve stress in that manner. The fact that I mentioned before that now we can get ourselves connected to health professionals through telehealth and telemedicine approaches. There are mental health professionals that are available through that approach that I would certainly take advantage of those or recommend that to anyone who is feeling unusually stressed here.

Chuck Gaidica: And Dr. Kipa, I want to mention, I’ve been trying to post this myself. Out of all of the dozens of episodes we have at A Healthier Michigan, we’ve got so many, I would think it’s over a dozen that have different angles about your healthfulness when it comes to your peace of mind; mindfulness, less stress, eating properly, working out at home versus going to a gym. I mean, we’re faced with those changes that even for those among us who thank God are healthy, we’re still having to change our routine, but those stressors can be important. I had someone who I know and love say to me the other day, “It’s going to be amazing when we’re coming out of this thing to see how many people were stress eating.” They went for the cookies and the milk, and they’re going to come out with a different kind of health issue on the other side they weren’t even anticipating; weight gain, diabetes issues. So this has got a lot of fingerprints on many different aspects of our healthful lives.

Dr. George Kipa: No question about it. And actually you reminded me, one of the new things that the CDC posted is the BMI over 40. So certainly those who are considered highly obese, they’re also considered in that high risk group. And the reason for that probably is also the fact that when you do gain weight tremendously, that can bring about a condition we call metabolic syndrome, that can affect your immunity. And that may be one of the characteristics also that we’re seeing out there in the population that increases susceptibility.

Chuck Gaidica: So Dr. Kipa, what is Blue Cross Blue Shield of Michigan doing in addition to help all of us?

Dr. George Kipa: Well, Chuck, Blue Cross Blue Shield of Michigan in conjunction with the Blue Crosses across the nation, wanted to make sure that we weren’t going to put our members into additional stress of worrying about their finances of healthcare in addition to worrying about getting the COVID test. So one thing we’ve done for fully-insured Blue Cross and Blue Care Network patients, we’ve waived the copays and deductibles on the COVID test itself. We’ve also waived prior authorization treatment and testing related to COVID consistent with CDC guidance. We’ve also increased access to prescriptions, so you can get a 30-day refill early, you can get a 90-day refill if you were previously just getting 30-day refills so you wouldn’t have to go to interact with the pharmacy as often.

Chuck Gaidica: Oh, that’s great.

Dr. George Kipa: And we’ve also increased the access to telemedicine, and much of it is available without a copay or deductibles again for fully-insured Blue Cross Blue Shield patients and BCN patients who have the telemedicine benefit. And so in addition, Blue Cross is working with our providers through our valued partnerships and PGIP groups. We have been meeting with our provider groups through the physician organizations every week through PGIP. We’ve worked on helping them with the personal protection equipment. We’ve helped them to understand the testing, what’s available, any way we can in our arrangements with the various laboratories and we’ve also tried hard to inform them of all the new changes in the medical policies and benefits that help us deal better with the COVID crisis.

Chuck Gaidica: Well, we can’t thank you enough for taking time to be with us, Dr. George Kipa, who is with Blue Cross Blue Shield of Michigan. He’s the Deputy Chief Medical Officer. What a treasure trove of information we’ve gotten from you, Dr. Kipa. Thanks so much.

Dr. George Kipa: Thank you, Chuck.

Chuck Gaidica: Good to talk to you again and be well.

Dr. George Kipa: You too, Chuck. Thank you. Stay healthy, everyone.

Chuck Gaidica: Thanks so much, Doctor. We’ve got a myriad of resources for you. We’re going to put these in the show notes so you don’t have to memorize them if you’re listening to this at home, but you can check it out online. First of all, here are a couple of websites, cdc.gov, WHO, the world health organization, who.int. And then Blue Cross actively updating information on mibluesperspectives. You can find links again to all of those websites in our show notes. And ahealthiermichigan.org has got all kinds of podcasts for you that are available.

Chuck Gaidica: So really use that as a resource. You’ve got time right now or you should have some time. If you need to de-stress, if you need to think about your diet, some of these other angles that we sort of touched on, we’ve got a lot of podcasts that are available for you. We want to thank you for listening. Please stay safe, stay healthy and stay informed, there’s so much that’s changing. And just be aware of your surroundings. Take those precautions Dr. Kipa was talking about. Wash your hands, don’t touch your face. And if you’re not feeling well, obviously we know we should be staying home if possible, but make sure you really think about the severity. If you see the symptoms coming up in someone you know, if you think you have this COVID-19, your symptoms are getting worse, call your doctor immediately and take advantage of the resources that are available to you. Take good care and be safe.