 Welcome to Think Tech Hawaii's Hawaii Together. I'm your host Kaley Iakina. Well today is June 8th 2020th and we are in the midst of the coronavirus pandemic. Now which side are we on going into it or coming out of it? Well there's nothing certain in these days but we're we're certainly in transition. Maybe you've been in sconce at home for a while, maybe you've been working from home. I think we're in the midst of opening up our economy but where are we going and how are we going to get there? I think the one of the most important questions is how do we stay safe and so I'm delighted that my guest today is an expert in keeping people safe with the coronavirus. His name is Dr. Tony Trivkovsky and he is a practicing clinician here in Waikiki in Honolulu. He's also a medical expert and he brings together these backgrounds along with his entrepreneurship. He's been faced with the question of how do you innovate at a time like this? How do you keep people safe? How do you come up with solutions and how do you keep a business going? And so I think we're going to learn a lot today from Tony. Maybe you've seen him on the news already. He's well spoken on the issue. Dr. T, Aloha, welcome to the program. Aloha, I think you're having me on the show. Well I'm just delighted. Tell me a little bit about your background. You founded a clinic in Waikiki called Doctors of Waikiki, I think. Yes, me, myself and Dr. Wu, who's my co-founder and partner in this project for Doctors of Waikiki, founded this clinic in about a year and eight months ago at the Princess Carolina Hotel. Now who do you service for the most part? Is it generally tourists? So initially when we launched, we generally took care of tourists. Say 80% of our clientele were tourists or another 20% were locals. And then that kind of grew as we evolved as a practice, or maybe 60-40, 60% tourists, 40% locals. But then when coronavirus came about, it was a deep lip in how we dealt with our practice. So you're primarily treating locals and keep providing a testing site? Correct. So now what did you think when the coronavirus pandemic began to spread across the world and Hawaii shut down? What were your first thoughts? My first thoughts were, oh my god, this is going to be crazy. I mean, we're going to be dealing with something unprecedented that we've never seen before. You know, we've had little scares in the past, but nothing like this. And the way it was growing and the numbers was terrified. We had no anticipation of how bad it was going to be. We just knew that it's not going to be good. We had no idea what way is going to evolve and what should we do. And we had no tools to deal with. Now the government was faced with a public health crisis and began to take some very big actions from the start. But I remember seeing you on the news, you were a major advocate for testing, testing, testing and more testing. Tell me a little bit about that and why that's important. Well, when you're up against an unknown adversary like a virus and you do not have much information, you do not know how well spread it is and what you're dealing with, you use the tools you only have at hand. The only tools that we had at that time were some types of barrier protection, where we wore shields or masks and gloves and gowns. But then the other aspect of how we figure out who's sick in the community is testing. And so we only had a very limited way of testing the community, but that's what we had. So we should have done and what we've been doing is testing, because it's important to know who was infectious to pull them out of the general population so they don't infect other people. And then how do you do that safely? How do you protect yourself from a disease you don't know how infectious it is, but not getting very sick and not becoming a statistic, not a caregiver? What are some of the things you've learned from testing? Now, you've done an extensive amount of testing at your own clinic and you have been able to not only test for the coronavirus itself, but for antibodies as well. Correct. So we've tested over, definitely over 4,000, I think we're close to 4,500 individuals. We've tested in different ways, meaning we've done antibody testing, we've blood antibody testing, we do PCR virus testing from the nose swab, or from the oropharyngeal from the mouth. And we do venous antibody testing. So all in all, we do three different types of tests to help assess the patient. So we give them a better answer so that they, you know, and we can know what the problem is so we can isolate them from the community. It seems that from the beginning, the government was very concerned about a concept called flattening the curve. In other words, acting in such a way that we brought down the incidents of coronavirus or kept it down so that we would not overwhelm the medical facilities. We wouldn't overwhelm ICU units or we wouldn't run out of equipment and so forth. What are your thoughts about that guiding principle at that time? Well, we go back to what my initial conversation was when we first were confronted with this unknown virus that was going to be spread throughout our community. So the statistics were concerning due to the fact that they felt like it was going to be much more deadly and infectious. And so the only way to deal with it would be prepare. And so they were hoping that they could get the facilities prepared enough so that when this influx of patients would come in, they could handle that and deal with it safely and accordingly. And flattening the curve meant the less infectious patients you have in your community and your population, the less likely that the infection will keep on at the same pace roaring through the community and causing more and more illness and then overwhelming your healthcare system. So flattening the curve was very vital so that the disease will still be there. It just spreading out the disease over months instead of over a week makes a big difference in how we can deal with it. It's kind of a fire, a small fire that you can control as opposed to, you know, an inferno. Well, it seems that we started out with that idea in mind of flattening the curve and whether it was the result of government action or not, it seems that we were rather successful in maintaining a community in which medical resources were not overwhelmed. But then it seems as if government switched gears and began to really go after just eliminating the likelihood or the incidents of any COVID-19 in the community. And we established a quarantine system. We established a 14-day quarantine for those traveling in and out into Hawaii and between islands and so forth. What is your assessment of the government reaction, both pro and con? What do you think government has done well and what do you think we probably didn't do so well? I think the government is handling the best of their ability. I don't, I think under the circumstances since the fact that we have so many unknown variables about the virus, I think they dealt with it the best way they could. I think the pros were, I think closing the, I think it could have been done a little bit sooner, that would be a con, but I think the pro was actually closing Hawaii to outside people. I think that made a big difference. I think us closing our borders or just restricting flights, I think is very important and vital to us suppressing the transmission of the disease. So initially, Dr. Wu and I, when we started dealing with the coronavirus, every case we had was because of outside travel. And it wasn't tourists, it was locals that were taking advantage of very inexpensive flights to go to places all over the world and then they'd come back sick and they were bringing the virus with them. And that's what you saw in your own clinic as well? Yep. And then there was some interpersonal spread, but the initial cases were people, they brought it to Hawaii through travel. And that's how it all began. And so I think shutting the borders or controlling the flights coming in for travel was very key, very vital to us controlling this infection. And I think that was very smart of our politician by doing so. What other things I think they could have done is the testing could have been done a little bit more smoother. We had very high suspicious cases coming in initially in the first week or so of the illness. And we would have to work at that time in conjunction with the Department of Health. And we had sent samples to the Department of Health of people that were even from Wuhan. But according to the Department of Health, they didn't test them through the fact that they said they were out of the window the testing. Again, they made assumptions and I don't know if that was correct or not, but I would have tested everybody from the onset irrelevant of what I was told and not told to do. So I don't know what happened there, but I think the earlier we could have had access to testing, the better, not just the Department of Health, but the medical community. But I understand there was some difficulties with that because they didn't have the ability to do so and understand that. But I think we should have focused on trying to get testing no matter which way or how into the hands of the medical into the medical practice. I had that common complaint from many other physicians in the emergency room and in the hospital. They were really frustrated because they couldn't get the tests done or completed through the Department of Health. Dr. T, there are various theories as to how we should approach and combat the coronavirus situation. And one of them is based upon an idea known as herd immunity, sort of like what we learned here in the United States through the years with children growing up with chicken pox and so forth. Sometimes if a family has children who have chicken pox, then their friends would all come over so their children could catch it and get it over with so that an immunity could develop within them that would benefit them and protect them the rest of their lives. Talk a little bit about the herd immunity thesis and how it might apply to this coronavirus situation. Well, the theory of herd immunity is when you have a certain percentage of the population that has antibodies that protects them from being infected, that would help again flatten your curve. So the more people that have the illness and that have antibodies, that would help tremendously because the person spread would decrease and then you can control the infection in a sense. It would be small outbreaks, not large outbreaks. But the problem here again is we have an unknown virus and we're not even sure if there is any immunity. We think there is, but we're not sure. And so as time evolves, we're hoping that there's some form of immunity. We're hoping that they can create a vaccine and we're hoping that it doesn't mutate. So you might have a virus that gives you some type of immunity, for example, like influenza. There are two types, but every year they change and every year we have to come up with a new vaccine trying to prevent as much as we can large outbreaks of influenza. But even though we have a vaccine for influenza, we still deal with the flu and its ramifications every year. And even if we have a vaccine for corona, more than likely the coronavirus will not go away, we'll be dealing with again, similar to the flu, corona season and flu season, and they'll probably go hand in hand. It sounds as though we will continue to need to be cautious and take appropriate measures, but at the same time, I don't hear you sounding the alarm that we should be absolutely frightened to move forward and open up the economy and get back to work. How do we know where the balance is and where do you think we are here in Hawaii at this time? Well, I think the balance would be us coming up with logical and scientific approaches to controlling the spread of the virus and to helping the people feel more at ease because of these applications that we put into place to help people from getting the virus. So for example, we're already practicing social distancing, which is not a bad thing. We're practicing more hand washing, we're wearing masks outside, and when we're going to certain places, we're kind of limiting our activities, especially if we're at high risk if we're older and we have other illnesses that increase our chances of the human really coming really sick. So we're modifying our lifestyles. Now, what else can we do? Well, when we come up with ways of screening the community more, so we know where people more or less have higher infectivity rates or industries have higher infectivity rates, or we check another way by assessing the tourists or other people as they come into the island by various means to make sure that we're somehow screening everyone in the aspect that we know who's got a fever, who has a cough, who has this, and that way it might become a way of life in the future for the whole world that we need to be more aware of viral illnesses and the problems they can cause. Well, Dr. T, we're going to take a very short break and when I come back with you, I want to ask you about ways in which individuals can make sure that they remain safe and ways our society can make sure it stays safe as we move forward. As well, I want to ask you about something that's going around in terms of the talk about antibodies and what they may represent if they are in our system. I'm Kaley Iakina with Think Tech Hawaii's Hawaii Together, and we will be right back with Dr. Tony Triplowski in just a moment. Don't go away. Aloha. I'm John David Ann, the host of History Lens on Think Tech Hawaii. History Lens deals with contemporary events and looks at them through a historical perspective or what we call a history lens. The show is streamed live on ThinkTechHawaii.com. Thanks so much for watching our show. We look forward to seeing you then. Mahalo and aloha. Thanks for sticking around. You're back at Think Tech Hawaii's Hawaii Together. I'm with Dr. Tony Triplowski today, founder of Doctors of Waikiki, and we're talking now in this part of the program about how to keep yourself safe and how to keep Hawaii safe, how to keep businesses safe as we begin opening up. But just before we dive into that conversation, I want to have a tail end discussion from last segment. Dr. T, people are coming to you to get tested for antibodies to see whether or not maybe they have already been exposed to the COVID-19 and whether they've developed the capacity to be immune within their own bodies. Is that based upon sound science and what are the values and the limitations of that? Yes. I believe there's a place for antibody testing, and it's a good way to do mass screenings and look at your population's possible herd immunity by looking at their antibodies. So if you want to do an assessment of a large population and to see if they've had exposure to a virus, you'd look at their antibody. You wouldn't just look at their actively infected. You'd look at antibody. So then you would have kind of a story of how much exposure to this virus the community has had. They do not necessarily mean that they're all going to get sick. They might have had exposure with very minimal symptoms, but this way you get a better story, a better idea of how widespread it is in the community. So we have been doing this five-minute blood test. It's a capillary blood test. You get a drop of blood. You put it on a cassette. It's from a company that is localized here in the United States, and we've had amazing results, and we've been very pleased with its specificity and sensitivity. If somebody has the antibodies present, does that mean that they have any kind of immunity or a period of, would that be for a period of time or how does that work? You don't know, but we're guessing that, yes, that they have some form of immunity. How long would you not know? But we're hoping that, like I said earlier, that it's lifelong, but we don't know. That's the scary thing about this disease. We're in the process of learning until we get to the vaccine. So until we get to the point where the vaccine is widely available, what can people do? What can you and I as individuals do to remain safe? So in general, we keep on talking about the hand-washing. We talk about the masks. We talk about social distancing. We talk about avoiding situations if you're a high risk, such as being older, have other illnesses that put you at risk, not to go to events where there'll be lots of many people gathering and that you might increase your risk for infection. You might get sick. And those are things that everyone should be practicing. I mean, there are other ways that we can do this. I came up with this shield that you can wear in the general community or you can wear while at work as a physician or in a restaurant, people that are serving the food, they can protect from the spray from their mouth. They'll go on you if they're sick and they'll actually not get into your eyes or get into your mouth. Well, I've seen your shield used with a double protection, both a mask on and the shield. And would you put that over your face again? I want to take a look at that. What is it called? True Hero Shield. The true hero shield. And you began manufacturing these for first responders originally at a massive pace of 6,000 or more a day and it's really taken off over the country. It leads me to what I wanted to ask you about. What can businesses start doing now? And I know you're involved in that. What can they start doing now in order to make sure that they're creating environments that are safe for their employees, for their customers and aren't going to get a bad write-up on Yelp. Well, it's not just a bad write-up. Who wants to be that business where they're spreading the corona? Absolutely. Nobody. That'd be the worst thing for business ever. So what we're providing at Doctors of White Conquay is what we're calling risk assessment mitigation. Being medical professionals and we are currently, I'd consider experts of coronavirus for Hawaii, we actually would come to your workplace, do an assessment and the assessment could be antibody testing, PCR testing, or venous antibody testing. And we can sit down and look at your workflow and give you ways to control the risk of spreading the virus amongst each other and to your customers and vice versa. And not only to be a testing, but there's barrier protection. Like I showed you, the shield that I created, you could wear in a restaurant setting and you could serve food and it'd be a lot safer and the customers would feel safer. Another would be the masks. Another would be setting up things in your workplace that will help decrease the viral infection in the room. They're ozone machines and other items that you could also put in your restaurant or in your place of work. And then there's thermal scan. Thermal scanners are cameras that you can mount in specific areas in the business and as customers enter and employees enter the business, they will actually tell you if they have a fever. And then you can isolate them and say, hey, if it's an employee, hey, you're sick, go see a doctor, go to Doctors of White Conquay. But if you're a customer, they'll say, I'm sorry, you have a fever, we feel unsafe with you or we think you should go see a physician first before you come to this restaurant or whatever it is, go see Doctors of White Conquay and let them test you. But there are many ways that we should be looking at the open businesses safely and effectively in Hawaii and the rest of the world. And I think by doing a risk assessment, by looking at your staff and seeing how many of them have exposure, so if many of them have antibodies, that means you have our high risk staff. Why? We can get into that in detail later. But let's say you test all your staff and none of them have antibodies. Well, that tells me right away you have a pretty safe, clean staff. And so the likelihood of them after going through the worst scenario we had with the coronavirus didn't have it, they're not going to probably get it later either. And then you come up with methods to prevent them from getting sick by barrier methods, masks, washing hands, social distancing and all that. And then you get into what you're dealing with customers. Again, like I brought up temperature assessment, symptom assessment, assessment, you can go as far as whatever you'd like to do depending on the situation. We've been testing throughout the community so many other businesses and we keep on growing because these businesses are reaching out to us because they want help. Well, it sounds as though it's possible for businesses to open up without causing harm to the community and without endangering their own employees. And when we'll open the economy it's not necessary to make a choice between throwing caution to the wind on one hand and we have the means you say. So businesses would have the incentive to go out and practice some of the things you're talking about. That sounds excellent. I think so. I'm happy to provide these services. I think we're the only ones doing something. Well, we just got a minute left. Any last words you'd say to the general public or to the business community out there? I want to offer the business community a way to open up safely. And if they want a consultation, all they have to do is go to our website and give us a call. And I want to offer to the community that we should be still very aware that the virus is out there. We shouldn't let our guard down. We should still be very cautious on how we're dealing with other individuals by washing our hands, still doing practicing social distancing as much as you can, and barrier protection. Well, Dr. T, we're at the end of the program and we take questions from the audience. We have one that has just come in. Let me know if you think you could respond to it. The viewer question is, what do you know about COVID sniffing drops? Apparently been successful, this writer says, in finding virus and antibodies. Any thoughts on that? The dogs? COVID sniffing dogs. That's right. Well, dogs, they really have a magical nose. I mean, who knows what they'll be able to uncover. So, yes, it's possible. I've not seen any studies, but I wouldn't think it'd be too far fetched. Dogs can diagnose. We have dogs now, they use for diagnosing certain cancers. So, if a dog can diagnose cancer and he's not looking inside your body via smelling your breath or your body, he maybe can diagnose corona. Well, very good. And viewers, if you have any other questions, I'm sure Dr. T would be glad to respond to them. Could you give us your website again? It's doctorsofwaikiki.com. Doctorsofwaikiki.com. Well, Tony, thank you very much for being on the program today. It was very informative and I thank you for the work you're doing in our community. Everybody, great. Everybody else, I want to wish you a wonderful week. Until next time, I'm Kili Akina on Hawaii Together on the Think Tech Hawaii Broadcast Network. Aloha and stay safe and well.