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As the coronavirus outbreak worsens, doctors on the front lines are learning some surprising new things about symptoms and who’s susceptible to the contagion. Dr. Joel Fishbain, an infectious disease specialist with Beaumont, Grosse Pointe, joined us Tuesday on the Daily Detroit podcast to discuss what doctors are learning about the pandemic, how it sometimes contradicts early information about the fast-spreading novel coronavirus, and the wisdom of using unproven anti-malarial drugs that President Trump has touted publicly.

Dr. Fishbain described patients experiencing “terrible, terrible muscle and joint pain” as well as what he described as “robust diarrhea.” He added, “what is different, I would say, is despite what the articles said out of China early on, we’re seeing 40- and 50-year-olds needing oxygen, having worsening lung involvement, and then those patients are the ones sometimes being put on ventilators, which is not kind of consistent with the original information.”

Since we conducted this interview (transcribed below) on Tuesday, Beaumont updated its own figures on confirmed-positive cases to 441 inpatients across the health system, with four fatalities attributed to the coronavirus at a Beaumont hospital. You can find their daily updated numbers here.

Sven Gustafson 0:00
The most recent numbers posted on Beaumont’s website suggests that as of yesterday, there were 333 patients who had tested positive for COVID-19 and are currently admitted in a Beaumont Hospital. Nearly the same number of positive coronavirus cases were apparently healthy enough to be sent home. Dr. Fishbain, Beaumont CEO John Fox published an extraordinary blog post last week on Friday, in which he said in part that you guys have converted much of the entire health system over to coronavirus screening, testing and treatment. Give us a sense of what’s happening inside Beaumont hospitals today with this new reality.

Dr. Fishbain 0:40
So obviously, we’ve had to set up isolation wards where we put all of the patients who are COVID or COVID-suspected infected, we’ve had to use tremendous amounts of resources for masks, gowns, gloves, etcetera. Our ICUs are full of COVID patients. So we’ve had to expand our ICU capacity as have other institutions that have, you know, smaller intensive care units. So, elective procedures, as you know, have been curtailed at this point to make way for the, you know, resources that are necessary. So a lot of changes have gone on by senior leadership to make sure that we have the ability to provide care for these patients if needed.

Sven Gustafson 1:24
So with 333 patients admitted, I’m sure that number probably will go up when the numbers are updated for today. How is that comparing with your capacity to care for these COVID-19 patients?

Dr. Fishbain 1:37
Well, I only work at Grosse Pointe. So we have roughly around a 200-bed hospital, and we are able to keep all of these patients at least currently on one floor, and still have some ability to care for other patients on the other floors and keep them separate. The intensive care units have become obviously more of a challenge as these patients get sicker and they end up needing ventilator support. That actually becomes a greater challenge for space and capacity than really just regular patients.

Sven Gustafson 2:09
Yeah. We keep hearing about shortages in supplies — personal protective equipment, surgical masks, and especially ventilators. What’s the situation, you know, on the ground at Beaumont and Grosse Pointe?

Dr. Fishbain 2:25
So I actually don’t participate too much on the calls each morning for the critical care team. But I know we have ventilators available up to a point. I can’t give you a number. I don’t know those numbers. We do have some space for a few more patients who would need to be incubated and put on ventilators. So for right now, we would not say we were close to any additional ventilated patients. As far as the other resources and equipment. We’re kind of holding our own. Obviously the N95 mask related issue is a countrywide issue, not a local issue. Everybody is struggling, I think, to maintain sufficient supplies of the N95 masks, which is why they’re, you know, asking people not to buy them or turn them in if they have them. And we’re just waiting, I guess, for the production line and the supply system to be able to catch up to the demand. But that is the biggest challenge is making sure that all facilities have sufficient N95 masks for protection of the health care providers.

Sven Gustafson 3:26
What about testing kits? We’ve heard an awful lot about the shortage in tests for people who think they may have the coronavirus

Dr. Fishbain 3:35
We’re doing in house testing through a company and I have not been on any of the conference calls lately to hear about any shortages currently, or if we were going to have problems with continuing testing. That’s a good question. Last week, there was the potential of maybe a few weeks of available reagents, etcetera. But I’m hoping that they have solved that problem because next week would be the potential crunch time for maintaining sufficient reagents and test kits to be able to continue the kind of volume testing that we’re doing. It is really wonderful. We’re getting our test turnaround times in less than 24 hours. So, you know, we’re very happy with our laboratory and all the work that they have put in to get us up and running. They are to be really commended and applauded for their efforts. And it has been a tremendous help to us so that we can immediately get these people identified and treated if needed.

Sven Gustafson 4:35
So so far, you’re keeping up with the demand for testing, is that what you’re saying?

Dr. Fishbain 4:40
So far, we’re good with the demand for testing.

Sven Gustafson 4:43
Okay. We know the main symptoms of coronavirus — fever, cough, shortness of breath. Are doctors learning anything new or unexpected about coronavirus from the patients that you’re seeing so far? I mean, for example, we’ve been hearing one of the newest things is, we talked about it on our show yesterday, some people are reporting a loss of ability to smell or to taste foods or beverage. And I’ve also heard that some people, you know, their fever and their symptoms seem to go away for a while. But then they come back in sort of greater force. Are you seeing those kinds of things or anything else?

Dr. Fishbain 5:17
Right. So all I can tell you is based on experience; none of this should be considered scientific evidence or a cumulative data with some peer-review evaluation. So this is just sort of our experience here. You know, we’re seeing patients with mild symptoms, like people are reporting, who have been able to go home with no treatment and recovered. We’re seeing people who are getting more short of breath and require oxygen. But what is different, I would say, is despite what the articles said out of China early on, we’re seeing 40- and 50-year-olds needing oxygen, having worsening lung involvement, and then those patients are the ones sometimes being put on ventilators, which is not kind of consistent with the original information. But I do have a feeling we’re going to hear more and more from other places like Seattle and New York that their experience is the same. As far as other symptoms. We were a little surprised recently about this robust diarrhea that patients are getting, they report really profound diarrhea, multiple liquid bowel movements on a daily basis. And that was not really expected but clearly is consistent. The terrible, terrible muscle and joint pains — people just horribly in pain, even to the point that they can’t breathe because their chest hurts from the pain. So that’s a little bit interesting to see in some of our patients. And then the other thing is, so many say that food just tastes horrible. The smell is awful. They don’t want to eat anything. It just, it has a very bad taste. And they’re not eating and drinking very much. Nothing is appealing. So yes, that is correct. They’re probably losing sense of smell because as you know, taste and smell do go together anyway. And they are really reporting just horrible appetite, and food just makes them sick.

Sven Gustafson 7:09
Many people are still sort of dismissing COVID-19 as, you know, just another form of the flu. What do you say to that?

Dr. Fishbain 7:16
I was in their ballpark, to be honest, early on, but now I’m a believer that this is more than just the flu. And it’s more than just the flu because of what appears to be the sheer infectivity. I know that the experts in epidemiology are still trying to calculate what the number of infections occur, per exposure, what they call the “R naught” value and everybody, I’m sure you’re aware of, reports measles as being 14 to 15, which means for every case of measles, you get 14 to 15 additional cases. You know, the number that this disease is going to come out to be is still unknown, but it is truly amazing how people can be congregated at a birthday party or a celebration, and so many are coming in sick over the same period of time. So it is clearly a very infectious process and disease. And we’re also dismayed at the number of young people, and I say young in their 40s and 50s, who end up with bad respiratory failure on the ventilators. And they don’t come off quickly. So they’re staying on the ventilators for a long period of time, which means you can’t move them out of the intensive care unit quickly. So these are all things that I don’t believe that anybody really predicted or saw coming, and now we’re all believers.

Sven Gustafson 8:40
What kinds of steps are your clinical staff taking to try to safeguard against transmitting coronavirus both to one another and to other patients in the hospital?

Dr. Fishbain 8:50
Right. So, I mean, the standard infection control practices, you know, obviously include hand washing, hand washing, hand washing, and that would include the alcohol-based hand hygiene products. So those are important. We’re using masks, gowns and gloves, and we’re not using them between patients. And so that helps to prevent carriage on our clothing. We’re making sure that our health care workers are not at all sick. If they do think they’re sick, they are to stay home. And if they had an exposure, we have a process by which they monitor very closely their symptoms. They can work after exposure, but they’re supposed to monitor their symptoms extremely closely. So we’re all keeping our distance. We’re all doing what we need to do. And so far, you know, knock on wood, we’re doing pretty well as I think most hospitals probably are.

Sven Gustafson 9:40
Lastly, Dr. Fishman, we’ve seen reports of people taking some kind of unconventional anti-malarial medications that have gained currency as a possible cure for coronavirus. Is that a good idea?

Dr. Fishbain 9:57
So if you’re asking me should the average individual contact their providers to get a prescription for hydroxychloroquine and azithromycin to take at the first sign of fever, I would say absolutely not. And there’s a couple reasons. And so the long answer would be that, first of all the data clinically driving this treatment train is really kind of limited, but we’re going to get more information after this is all over. The culture data in the test tube would suggest that hydroxychloroquine and chloroquine work well, and the addition of the azithromycin probably, I’m guessing has an anti-inflammatory effect. But it is very clear that there is a lot of inflammation in the lungs from this virus. And the question is whether those two drugs really do impact the viral replication and shorten the disease and limit the complications, or is it anti-inflammatory, and again, you know, the dust has not settled at this point. But we have to caution people. These two drugs have an impact on the heart conduction system. And there are people who are maybe putting themselves at risk for a complication, which could include death. So we would not advise people to take this combination of pills without the doctor being very careful with the prescription and advising as well as understanding the patient and potential risks. But until somebody tells me, you know, these drugs work beautifully, and everybody should take it, we’re trying to be very judicious with their use. We are giving it to people who look like they’re going to get worse and have high levels of risk factors for getting worse, but everybody is definitely not getting this combination of drugs because of this heart related issue.

Sven Gustafson 11:47
Are there any, you know, over-the-counter drugs or anything like that, that have proved effective at at least managing symptoms or anything like that?

Dr. Fishbain 11:55
Proven, no. I think a lot of it, in our years of experience, you know, we talk about simple things: good nutrition, people talk about zinc, with shortening the course of the common cold. Melatonin has been thrown out there as an anti-inflammatory and as an explanation of why very young children don’t seem to get super sick from this, is because of the melatonin levels in children. So there’s a lot of rumblings out there about over-the-counter. You know, we would recommend obviously, acetaminophen, or Tylenol. It looks like the WHO, the World Health Organization, has removed that cautionary note about the non-steroidal agents like ibuprofen. And I think patients can, you know, get the sense themselves which one they want to use. They can ask their doctor if there’s any updated information. But you know, keeping the fever down, keeping the aches down, getting up, walking around the house, making sure they’re coughing, deep breathing, and if they get short of breath, come for evaluation. But it’s going to probably prove that most people could stay home and take these drugs for symptomatic treatment. But as far as one preference over the other, you know, we just don’t know.

Sven Gustafson 13:07
All right, well, great information. Dr. Joel Fishbain is infectious disease specialist at Beaumont, Grosse Pointe. Dr. Fishbain, thanks so much for sharing all your knowledge with us. We appreciate it.

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