 Okay, we're back. We're live with think tech here on a given Friday with a special show more, much more on medicine with Dr. Sarah Park of the Department of Health, state epidemiologist. And it's an important show because we have important events happening around the world on coronavirus. Welcome to the show Dr. Park. It's great to have you here. We appreciate you taking the time off and what must be a very busy time for you to discuss this with us and the public. Thanks for having me. Yeah. So what is the status as far as we know, you know, it's funny that at the beginning of this, every headline was, you know, worth looking at everybody was getting concerned. And the world was reacting in every which way, articles in all the newspapers and so forth and every single media. And now it seems to have subsided. There's not as much. You don't hear all that emergent talk. And I wonder, you know, what that means, maybe it means that the media cycle is over and it's going to get quiet until the next remarkable thing, or maybe there's good news on the horizon. What do you think. Actually, that's news to me that there's a lull, because it seems like it's just to constantly, there's something constantly coming out so that would be news to me I don't think that we're out of the woods yet by any means. What, when will we be out of the woods me from a medical point of view from an epidemiological point of view. I mean, you have two possibilities. One is a vaccine is developed but everybody says that'll take a year. And thanks to the Chinese for sharing the genome with us because it helps to have the genome in order to make a vaccine. They may have done other things wrong but that was a good thing if they shared the vaccine, or rather the genome and the other possibilities that burns itself out as all epidemics ultimately do. Which do you think will happen first and how will we know when we're out of the woods on this, Dr. I, you know, I have no idea which one will actually go first but I think it's important to stress that the outbreak in China is still ongoing that there's new disease being identified and they're actually 27 different countries now is my understanding and you know, everyone's monitoring the situation very closely. At this point the World Health Organization has deemed it not yet a pandemic in that they feel that pretty much all the disease activity can or most of it can be still traced back directly or indirectly to China. And I guess gather what they're waiting for it is to see that they start to see disease that isn't directly or directly traced back to China. My understanding is that they feel that the tactic that the world has to employ right now is to try to contain the virus in China. But there is always a distinct possibly I mean this is a respiratory pathogen. So it is transmitted primarily through what we call respiratory droplets, basically when you cough and sneeze. And if you think about the regular flu and how quickly that spreads during the traditional flu season which we're in the middle of, then it's not really a stretch then to think about how easily this virus could potentially take hold and, you know, end up being more widespread beyond China's borders so it is concerned worldwide still. You know that's what I meant when I said we're not out of the woods yet and that everyone's still leaning forward still monitoring the situation closely. In the meantime, many countries, including ours are instituting travel bans and other measures screening procedures to essentially help with containing the virus in China but also to slow down, basically create a bottleneck for any potential introduction into our country. I think it's important for people to understand that screening at the airports is not an absolute control measure and that we all recognize that there is still the potential for individuals still still to be infected and come into our country, but it is a way to slow it down and slow it down enough so that our prevention measures can effectively control any introduction and prevent it from spreading further than potentially even that one person may be just a small cluster. And those measures are really those things that you hear us talking about every flu season, every time there's a respiratory disease outbreak, or, you know, anything related to really any infectious disease. But, you know, it's stay home when you're sick. You know, I think that has to really be the primary message right now for all of us across the globe. As well as, especially in Hawaii is that we need to really practice staying home when we're sick. And that means not going to work, not going to school, not getting on the bus, not going shopping, not running errands, you know, really stay home until we're well and getting our employers to enforce that, so to speak. And that would go a long way, honestly, towards preventing anything from happening here or anywhere else, that in addition to hand washing. And then if you are sick, cover your cough and sneeze, basically keeping your germs yourself. If we can all, as a community, practice these simple infection prevention measures, then we could go a long way in terms of preventing anything from, you know, being introduced then spreading more widely in our community. Drilling down on some of that, Dr. Park, so I'm home. And that's the wise thing for me to do if I feel I have some kind of respiratory thing happening. But my family may be home also. How do I prevent my family from getting infected and then going out into the community and delivering it, you know, second hearsay kind of way. Alright, so to the extent possible, if you have any respiratory disease like flu, flu is a great example, right. And again, we're in the middle of flu season and flu disease and flu deaths still cause much, much, much more illness in this country than this novel coronavirus, which is not widely circulating because there are no indications of it really circulating in our communities at this time, although we continue to monitor because again it is respiratory disease. But the flu is a great example. If you think about when someone in your family is sick with the flu, some things that we have to think about are exactly those prevention measures, especially particularly actually washing your hands. Because those respiratory droplets are so key in how we get infected. It's keeping your distance from the sick person, from washing your hands all the time as frequently as possible and remember 20 seconds under the water and rubbing your hands really well, not just like letting the hands, letting the water, you know, just sort of wash through your hands. You really have to rub your hands front and back for 20 seconds. So good hand washing and then being mindful of, you know, not touching our face. So basically the mucus membranes are what are that lining inside our mouths, inside our nose, our eyes. Those mucus membranes are what's susceptible to being infected essentially from not just this novel virus but the flu from any pathogen. And so we really want to try to avoid touching our face with unwashed hands. And that is probably one of the hardest things for all of us to do and myself included. You know, it's something we all need to really think about, really consciously think about. And that would probably be one really effective way if we could really prevent that from doing that, prevent ourselves from self inoculating, if you will, with your pathogen, whether it's the novel coronavirus or flu or other pathogens. Well, what would you suggest really is that the world is full of pathogens and they don't necessarily go away in the sense that somebody puts his hand down on a surface or droplets fall on a surface and then you put your hand down there and you touch your, you know, face mucus membranes the like. You're going to transmit it. So I think you have to, this event teaches us that we have to see the world perhaps in a different way. We have to see every surface out there as a potential point of infection. And that includes being at home. So I also hear you saying that even if you are at home, you don't feel well, you're not going to go to the office, you're not going to work today, you're not going to go out of the community and you're going to be with your family. And you're infected and your family is not affected. It is not a foregone conclusion that you will spread this disease or any infection like this to the people at home. You can prevent that even at home. Am I right? Right, right. To the extent possible. I mean, we also recognize that some people may not realize they're ill with this. You know, I mean, how many people actually take themselves to the doctor immediately upon getting ill. You know, you tend to sort of try and shoulder on and not, you know, not go see your doctor and so you don't know that what you have is could be, you know, the flu or anything else. And so you may not be as careful or your loved ones may not realize you're sick, you know, there could be any number of reasons. But this is where I would argue that we all need to be really mindful. And as soon as we start to feel ill to start taking those precautions and even before being starting to feel ill, we need to make these kind of prevention measures second nature, so not touching our face, washing our hands, cleaning surfaces. And on that issue, I just want to mention that, you know, these are, this is what we think it, we think it's a coronavirus like any other coronavirus and that it's not likely to be hanging out on services for hours and hours. I mean, it is susceptible to environmental, you know, sort of stress as I suppose if you could call it that. But it these things, these viruses will not be lasting there for hours, it's more a matter of someone is, you know, it's just like flu someone sees their costs on their hands unfortunately, instead of into the, you know, crook of your elbow and then touches a doorknob or picks up a phone or picks it or starts typing on a keyboard, and you come by, you know, maybe a few minutes later after they've left and then you start, you know, and maybe there's still a little wet and you don't really realize it might be moist or something and and then you pick that, and then you absentmindedly while you're doing something scratch your nose or scratch your eye, you know, rub it your eyes. That's how we normally infect ourselves with these. But you do have some personal control over it. So, to be back to the home where I live with my family, I'm not feeling well I some kind of respiratory thing. It sounds like it's a good idea to keep the house really clean all those surfaces clean and stress out to regular sanitation agents it's you don't need anything special to clean surfaces for this it's not norovirus. You know, we're not talking about Ebola, we're, this is like many respiratory pathogens so her cleaning products, you know, regular hand washing and, as I said, is you know just being mindful not to touch your face. But I mean backing up a little, you know, we're talking about, hopefully something that won't happen down the line. And because we're talking in the theoretical of like, when and if this virus is actually circling circulating the community. Right now it isn't as far as we can tell, but it is and that's the ideal moment where I mean this is the ideal time when we should be practicing the prevention measures now, before we're aware of anything because we make it second nature, you know, and we practice these measures, then it's makes it even less likely that we'll see, you know widespread circulated disease. I mean if you imagine flu, flu, right, our flu season right now, the traditional flu season that we're in the middle of. Imagine how much less disease there would be here in Hawaii on in the nation. If people stayed home definitely stayed home when they were sick you know didn't go to work or school. If they actually did wash their hands appropriately every time that they, you know, coughed and sneeze or they handled something and that they didn't touch their hands, their touch their hands to their face. You know, absentmindedly rub their face, you know, after touching something else, you know. So, I mean, if you just imagine if people did that on a regular basis, I would, I would guess that we wouldn't really see a lot of flu out there, you know, so it's something to think about. Yeah, and especially going forward where these kinds of infections we may see them on a regular basis, depending on how the world works, but in a large complex world, it could happen again, like SARS, like MERS and now this one they could be something else next year. Dr. Sarah Park, a state epidemiologist at the Department of Health, we're going to take a short break, we'll be right back and we're going to ask Dr. Park. What's the difference between coronavirus and flu? And we're going to also ask her, you know, what happens when you do feel sick and you feel like you might have it? What do you do then? We'll be right back. My name is Mitch Ewan, I'm from the Hawaii Natural Energy Institute, and I'm the host of Hawaii, the state of clean energy. We're on every Wednesday at four o'clock, and we hope that we have interesting guests who talk to us about various energy things that are happening in Hawaii all the way from PV to windmills to hydrogen, most of my heart, electric buses and electric vehicles. So please dial in every Wednesday at four o'clock on Hawaii, the state of clean energy, aloha. Okay, we're back with Dr. Sarah Park, state epidemiologist at the Department of Health, talking about, you know what, coronavirus, the new coronavirus. So Dr. Park, I just wonder what is the difference in terms of the, what do you call it, infectability, that's probably not a medical word, of this virus and the standard household annual flu? Well, first off, I'm glad you qualified and said this is a new coronavirus, because there are common, what we call common coronaviruses that, you know, that actually are regular laboratory tests. If you ever get tested for what's called the respiratory viral panel by your doctor, you get a nasal pharyngeal swab, a swab down your nose, and the doctor sends it off. And it happens to come back positive and says positive coronavirus. It is not this coronavirus. It is not the novel coronavirus. There is currently no clinically available, commercially available lab tests that can detect the novel coronaviruses. Common coronaviruses we know about usually cause more of a cold like symptoms. So it's kind of lumped together with like the rhinoviruses and sort of the symptoms it causes. But this is very different. And it is different also from the flu. The flu viruses are well known to circulate, at least in most of the rest of the world, seasonally. You know, the traditional flu season being from May of, I'm sorry, September of one year to May of the next year. For Hawaii, we see flu year round. It causes basically aches and pains, fever, cough, you know, can occasionally lead to secondary bacterial infections. And, you know, most people do recover, fortunately, but after being, you know, laid up for at least a week. Some people, unfortunately, like those in the extremes of age, those with underlying illness, you know, pregnant women can be at risk for more severe disease and unfortunately death. And this season we've seen quite a few of those nationally. Still, it's still around. This novel coronavirus is something that's exactly what the name says it's new. It's not been in the human world. It's presumed to have crossed over very recently from the animal world, which animal we're not yet sure it's not been discovered. It, but it has its origins in the animal world and then mutated and came over. Any time you have a new virus, these, such as this one just like with SARS, MERS-CoV, 2009 H1N1, you know, basically when you have a new virus, what that means is none of us have immunity against them. We've never seen it. So our immune systems are like babies immune immune systems in that we've never seen it. So we're all equally susceptible. The interesting thing right now is that some of the data coming out about you asked about infectability or we call that the R0 in epidemiology. So for, you know, everyone person who has a particular infection, you know, the question is from, you know, what is the R0? How many more people will that one person infect? We know for flu, the R0 is about just about one. So for every person who has flu, they'll most likely infect one more person. So we have some background. I think Ebola, I want to say Ebola is probably around four or five or something like this. I can't quite recall, but measles, which is the granddaddy of the, you know, infectious diseases. It has an R0 of somewhere around 18. So measles can infect up to 18 susceptible individuals. So that's coming out right now. There's been one paper that suggested that the R0, and I have to caution it is still way early, you know, in this sort of understanding of this new virus. But there was one paper that suggested that based on the available data the R0 for this virus might be closer to just a little bit above two, so that everyone, everyone person can infect at least two individuals. And SARS was somewhere around that four or five. So it basically what it means is the severity of illness of this virus is likely to cause and the scope of the infection is probably somewhere between the flu and SARS. But we're just not sure exactly where it is. And again. What about lethality? What about lethality? Is this more lethal than ordinary garden variety flu? It is still very early in trying to understand, you know, this virus, the data right now suggests that it does potentially carry a high what we call mortality, but not for everyone for certain groups. It has been interesting, the data that's coming out suggesting that somewhat older individuals, not necessarily elderly, but somewhat older individuals and those with underlying illness may be at more risk. But again, it's early. We don't know. So mortality, you know, if you recall with SARS, the deaths that were reported with SARS, it took several months before those deaths were starting to sort of be identified or tend to occur. And so if you had, you know, asked in the first couple months, what's the mortality for SARS, you would have, you would have a very different number compared with four, five, six months later. By the same token, if it is, if the disease doesn't actually cause as many deaths, you know, and everyone is just really hyper aware in the beginning, it could be that we see the death rate sort of level and that mortality rate isn't as high as we thought. Some people get this disease and they don't really even show it. Some people get this disease is very mild and they get over it. But if you are, if you are, but you're talking about asymptomatic infection, and actually, I think there was a paper in the New England Journal that a bunch of German authors claimed that an individual with asymptomatic, no symptoms right infection infected for other individuals and of course everyone became very concerned because the assumption is that for any disease that asymptomatic infection probably plays a very small role in transmission, if any. And so there was a lot of concern until most recently, a few of those same German authors came forward and actually admitted that they had neglected to talk with the actual, actually talked to the individual, an interview the individual who was quote unquote asymptomatic had subsequently found that that individual was not asymptomatic actually had aches and pains and fever and had been taking what, you know, paracetamol, which is acetaminophen or Tylenol for their symptoms so seemed like they had no symptoms but actually did. And that that makes more sense that they infected someone else. So it is, you know, every disease has what I like to say a spectrum of severity. Disease that sort of curve varies if you say that on the, you know, the zero point is like the very minor asymptomatic to the, you know, the maximum point out to the right would be, you know, deaths, you know, and then you know numbers across the way axis and you, you have a nice smooth bell curve you can have a shifted one where most of the cases are severe or you can have everyone up in the front where mostly mild. We don't know where this disease is going to fall with stars we presume is more shifted towards a severe. Yeah. Again, it's a new virus. So we're all susceptible which doesn't doesn't speak well for, you know, being, you know, the case that we're likely to see. I suppose, you know, I mean, suppose, as the newspaper has said, ultimately there's a fair chance we're going to see it pop up here. Simply because we have people coming from infected countries and quarantine is only so long and for you know it as an infected person. The quarantine and self monitoring is quite generous. It's not that that is not the issue. The issue is other, you know, potentially other ways it gets here that you know people who are not recognized and potentially, you know, not in monitoring or in quarantine. We don't know exactly the incubation phase that that phase when when you're infected or exposed to when you actually start developing symptoms. But based on no data for all coronaviruses. That's where that 14 days comes from because that is the maximum incubation period recognized for most coronaviruses. So that's not, it's not likely that someone who's been appropriately monitoring quarantine is going to transmit to others. It's more Assume for whatever reason. Where I recognize before they were put in monitoring our team, and maybe, you know, transmitted someone else but that really is immaterial. It's more about, you know, we need to focus on the prevention measures that I was describing earlier and really about staying home when you're sick about washing your hands appropriately about making sure right now. Let's assume for a moment that you're that you've taken those steps. But nevertheless, you have a respiratory ailment that won't go away and you are getting very concerned about it and you think maybe maybe you're having a bad day and you got it. You somehow got it right here in Hawaii. It's possible. So at that point, you're not sure. You don't know what to do. You stay home, but you feel threatened increasingly. What do you do? Do you ambilon down to the hospital? Do you do you call your physician? Do you go to a quarantine center? That wouldn't sound like a good idea. No, no, there are no quarantine centers. First of all, and second of all, that we do not have circulating virus here so that, you know, you start to feel ill with fever or cough or shortness of. More likely issues you've got the flu and it is a good idea to call ahead to your clinician, your healthcare provider to sort of let them know about your concerns and schedule appointment as needed. If you are really having that shortness of breath and really having emergency, then you need to call, you know, obviously the emergency medical services folks, but, you know, right now the risks are for travelers from China. That's what we are looking at. That's what we're working collaborating very closely with our federal partners. And those people, it's very critical for healthcare workers. That's a very critical question to ask of anyone who comes in with what we call a febrile respiratory illness is where have they traveled in the last 14 days. So if we're in China and specifically Dubai province, then obviously we'd have a concern and we'd have to consider this particular infection. But for everyone else, we're seeing plenty of flu activity by the way we're seeing an increase of the way we are, as I mentioned, repeatedly we're in the middle of flu season, the traditional flu season. I, you know, before all the attention on what's going on in China, if you recall back in early December or November. There was a lot of media coverage over the fact that the mainland was suffering one of the worst flu seasons on record. And suddenly everyone switched gears to cover what was going on in China. Well, I'm here to tell you that just because the media is suddenly shifted focus does not mean that flu disease suddenly went away. The facilities on the mainland as well as here are still seeing plenty of flu and the way flu presents with the symptoms, you know, that fever cough aches and pains. It's going to be very similar to this virus and, you know, when this virus is, you know, finally actually in US communities. And you can imagine if we're not vaccinated, vaccinated against flu, if we're not practicing our good infection prevention measures. I mean, then we're going to be, it's going to be very problematic. We're going to see this incredible burden on our health care facilities, trying to manage not only this now new concern but also existing flu disease. Well, thank you, Dr. Park. Dr. Sarah Park, State Epidemiologist at the Department of Health. There's so many more questions and I hope we can catch up with you again. I know it's going to be busy for you while this is still in the newspapers and so. But I hope we can catch up again and keep current on the status not only in the world but in Hawaii. Thank you so much.