 Welcome to Much More On Medicine. I'm your host, Catherine Norr. You may notice that I'm not in the think tech studio. I'm at my office due to the governor stay-at-home order because of the COVID-19 pandemic. My law practice is an exempt business and so I'm still able to go to my office and conduct the business of helping people during the crisis. For those of you who are in Hawaii and other parts of the world, I'm sure you're aware of the challenges faced by healthcare professionals and residents of New York. Today I'm pleased to be talking with Dr. Nicholas Chiao, a New York physician who not only suffered from the effects of COVID-19 as a patient, but also treats those who have the diagnosis. The topic of my show today is caring for COVID casualties, lessons learned for patient care as a doctor becomes the patient. Dr. Chiao is a primary care physician, clinician, educator, and assistant professor in the Bronx at Montipour Medical Center. He received his medical degree from Temple University in 2010 and his master's degree, master's of science degree in 2015. He is originally from Hawaii and graduated from Punahou. Dr. Welcome. Hi, Katherine. Thank you for having me. All right. I understand that you unfortunately experienced COVID-19 for yourself as a patient. Tell us about that. I did. It's a little surreal. It was a little surreal at the time because we were hearing about cases from China and actually our clinic as well as the rest of the country. We were following guidelines saying, okay, we're screening for the, you know, the travel history and we're screening for these hallmark symptoms, which at the time were cough, fever, and, you know, shortness of breath. I think maybe my algeas, body aches. And at the time I was telling my, at the time I was suffering from my usual annual sinus infection symptoms. So I was like, okay, I just got to watch myself and make sure I don't get a fever. Well, then I got the fever. And then, so I called out and I got, then I then lost the taste of smell, the sense of taste, I had the my algeas. And, you know, from there, all throughout isolation, I just kept on monitoring my symptoms. I think that one of the things that is hard to kind of just describe in medical papers and to describe just in broad research terms is the type of anxiety that individuals can go through while infected with COVID and while in isolation. And being in isolation in general can be anxiety provoking. I have plenty of patients who, even without COVID, live by themselves and have fears of going outside and such, which is a whole set of problems. But every single day as I'm going through my countdown when I can get out of isolation, I'm thinking, am I going to get worse or am I going to get better? And on some days I felt better. And on some days I felt worse. It was almost like a alternating day sort of thing. And I had some pretty, I had pretty common COVID symptoms. As I mentioned, the loss of taste and smell. I had fevers. I had my algeas. I had a cough, which fortunately wasn't that bad. Never had shortness of breath. Thank goodness. I didn't have any of the lower abdominal symptoms. The other thing which, you know, as a physician becoming a patient, it was quite scary for me to go through my countdown because when I was starting to feel better at the end of my first week, I knew that typically we, you know, day seven through nine or 10 could potentially get worse. Worse, meaning my breathing could get a lot worse. I could develop higher fevers. I could start to really have, you know, really bad, you know, nausea or vomiting that can not tolerate anything. The fortunately that didn't happen. My fevers did linger on through day 10, but besides that, I generally just got better and better. One thing I didn't mention was the, you know, kind of dealing with the, like the anorexia of the disease, which some people have, which is just no drive to eat. Some people when they don't, you know, in general, that's not uncommon in other illnesses, but it just, with the lack of taste and smell to it just puts a stop on everything that you want to do. Like you really don't want to drink much. You really don't want to eat much. You just kind of want to sit around and because you're fatigued, you know, there are day, there's, you know, you can try to sleep all day, but there's only so much of that you can do. And there's times when your body is exhausted and you can't, but you don't want to sleep. Like your body is awake enough and energized enough to not sleep, but you're exhausted, too exhausted to watch TV or too exhausted on the phone, too exhausted to talk with family or whatnot. And so that. What was the timeframe of you starting to have symptoms? What do you remember the date it was? Was that in March? Yes. March 20th was the day that I started my fevers. If I were to be truly honest with myself, the kind of exhaustion and the exhaustion and the chills kind of mostly started late on Thursday, the day before I actually called out sick. The reason I didn't call out sick was our criteria for calling out sick included having a fever. So I was just trying to push through saying, no, this is probably a sinus infection. And then the night that I got the fever, I'm like, no, this is not just a sinus infection. So March 20th was when I went out. So when you started having the symptoms where you identified it as COVID, it was already pretty much a world emergency. Is that right? Yes. You know, it was a world emergency, but it was at a time when all these testing options were just in New York were just beginning to be made to the public and not and made to the public in the sense that they were not just for the sickest of the sick. I'm not sure how close you followed the New York news, but we have a town in our county called New Rochelle. They had a high density of cases. So they set up a drive through testing center. That's actually where I got tested. My own institution as well as a lot of other institutions were still building theirs, but the National Guard staffed this particular drive-in testing center. That's where I got tested. How long did you have it before you actually got tested? When I went out on a Friday, I got tested by Sunday. And then how long did it take before you got the results? Again, I was very lucky. My turnaround time was 24 hours. Okay. Did any of that ability to get tested and turnaround time of results, did that have anything to do with you being a physician or was it just you being a patient? No, that had to be with me being a physician. The drive-in center that I went to was not requiring an appointment for healthcare workers. So I was able to just drive up and get that done. Okay. Were there other healthcare workers who were getting sick that you were working with? Yes. Several of my colleagues got sick. A lot of our nurses got sick. And this speaks to the virulence or the ability of the virus to infect people. Just the previous week before, we were seeing patients. And in fact, earlier in that week, I went on a Friday, that Monday, and I was seeing a full day of patients. And then by that Friday, we had significantly cut down on my patients. But I still saw three or four patients face-to-face. When I looked back, I didn't see any evidence of them having to go to the hospital or anything. But for argument's sake, I might have gotten some of them sick. That's how fast this was moving. That's how little virus. All these things about the smell and the taste, that didn't come out until after I was well into my isolation. So that's a good almost week later. Okay. I saw a tip from a nurse in New York where she was smelling something every morning just to see if she still had her sense of smell. Do you think that that is at all helpful for people so that they have any indication, perhaps, that they might have it? Let's put it this way. I don't think it's going to hurt. I think that some of the early indicators also can include headache. And for me, an early indicator was kind of just like extreme exhaustion. If anyone's had the flu, it's actually probably even worse than that. But the level of exhaustion that someone could get with the flu is pretty similar to what I had before I got my fever. And to be honest, some people don't even have fevers. So yeah, at this point, the list of symptoms is very long. And here in New York, our threshold to diagnose somebody without a test is very low. I've been diagnosing people on the phone for weeks now because there's just so much variability in the symptoms. Hmm. Okay. And so did you have someone caring for you during that time or were you taking care of yourself? Yes, extremely fortunate. So my wife is also a physician and was still working for the entire time, would care for my two daughters that she was doing morning and evening. And then my amazing in-laws who live downstairs from us were watching the kids throughout the day and kind of looping back a little bit into being a patient because this is not unique just to me. But the guilt and the fear of infecting other people in my household was very, very significant. So people who are suffering with COVID alone have one set of anxiety and fears, which are very real and very understandable. And people who have family members who they have to then isolate either with or away from have a different set of fears. Because I was isolated in a room. I'm fortunate to have a room to do that. Many of my patients in the Bronx don't. You have to just wear a mask and cross their fingers. And what I speak of in terms of the guilt and the and the anxiety of all this is that I do nothing I can do because I'm isolating myself to not get to my wife's sake or my kids' sake because even if they have the mild disease, I don't want that to be passed on to my in-laws. Sure. And one thing that's similar with Hawaii and with New York is that oftentimes people live in really small spaces. And they don't have that opportunity to, you know, isolate in a, you know, in a separate room. But, okay, so at this time we're going to take a short break. I'm Catherine Norr. This is much more on medicine on the ThinkTech live streaming network series. We're talking with Dr. Nicholas Chiow about caring for COVID casualties. Aloha. I'm Lillian Cumick, host of Lillian's Vegan World, the show where we talk about veganism and the plant-based diet located in Honolulu, Hawaii. I'm a vegan chef and cooking instructor and I have lots of information to share with you about how awesome this plant-based diet is. So do tune in every second Thursday from 1 p.m. Aloha. We're back. We're live. I'm Catherine Norr and this is much more on medicine on the ThinkTech live streaming network series. And we're talking with New York physician Dr. Nicholas Chiow about caring for COVID casualties. Doctor, when, before we had a break, you were telling us about your experiences with COVID-19 as a patient. How did you, did you have any anxiety or depression as a result of being ill? Yes, I did, Catherine. Like I think, while it's not clinical depression, certainly a lot of anxiety, a lot of guilt. And there were days where I had very, you know, you call it dysthymia or very low mood. You can call it depression, you know, just for the sake of other lack of a better word. But it was, and it was, it was tough because as I mentioned, I mean, it's not for a lack of people reaching out to me, texting me, calling me, and trying to see how I'm doing. But it's more of a matter of just feeling just trapped and kind of hopeless and not knowing how the disease is going to progress, how, you know, and, you know, hearing your, you know, your children cry, you're not being able to comfort them, that kind of, that kind of anxiety. So what I, what I ended up doing, and this is why I have, I share this a lot with my patients, I share my diagnosed, almost all my patients, because the anxiety, the pressure they feel is very real. And I think that actually may become another, we'll call it an epidemic pandemic, once COVID gets under control here, because the, you know, we'll call, you know, post-traumatic stress syndrome, all the financial and emotional ramifications of all this going on will probably launch either worsening of existing diagnoses or people developing them. And I used one or two hotlines just to talk to somebody, you know, that wasn't my family member, because I think that these trained individuals who volunteer their time to, you know, listen to people in time, either time of need, are really helpful and really special. You know, there's, the ones I use were specific to New York, but things like that, you know, the national crisis hotline, the national suicide prevention hotline, those are all, those are all wonderful resources for people to reach out to. And they make you really feel as if you're not, you're not alone. And they kind of offer you an objective here to listen to, you know, in addition to the family members that are there for you. Oh, that's fantastic. And so, Dr., how long were you off work? So the 14, basically the 14 days that I was in isolation and then a weekend, so maybe like 16 days or so. Okay. And then I was back at work. Okay. And then how did this translate, this experience translate into your going back to work and then treating patients? Right. That's a great question because I think about it in two different ways. I have, I had this, even before I got sick, I had this sense of mission of, you know, my colleagues are out there in the hospitals getting sick, getting out, some of them being hospitalized. I have to go to the hospital. I have to help treat some of those patients. So a week after I came back to work in the clinic, I went and got deployed into our hospital that's associated with Montefiore. And I was very fortunate that, you know, we had plenty of PPE. The institution was doing its very, very best to keep up with, you know, with the changing protocols, the changing demands of the patients there. We fortunately had the ventilators, we had the beds. And so I think Montefiore as a whole did a good job trying to adjust to this very sudden tumultuous change. But with my patients specifically, I made it a point to tell a lot of them, look, I got sick too. And while I didn't end up in the hospital, this, you know, the, you know, because a lot of them would say, would tell me, you know, I'm, you know, I'm very, I'm scared about what's going on because now they've gotten sick enough where they're in the hospital. And me telling them, look, I got sick, you know, this is what we're going to have to do day to day. It let me also be honest with them because I can't tell them, oh, you're going to get better. It may not be true. And it wasn't true for all of them, but for a lot of them, for them to hear that doctor went through what they're going through to some extent and then say, hey, I'm going to be here to help you work through this. I think made them a little bit, made them feel as if, you know, it's more, it's more than a masked face. Now, we had to all wear masks and all that. I decided to put a picture of myself kind of hanging from my splash shield, just so that they knew what my face looked like, just because they felt like they're speaking to like an identifiable human being. And, you know, I think that also I was fortunate to have a good team. Like I worked with a physician assistant and my residents who made multiple calls to family members on a daily basis because remember, then the Hawaii folks, you know, hopefully don't have to experience this, but when loved ones end up in the hospital because of COVID, there's no visitors unless the person's terminally ill, in which case you get one visitor for about 10 minutes. And so, you know, I remember thinking about this with a patient who eventually passed away, but the last thing he unfortunately heard was, you know, the beat was beeping and yelling as people were like, you know, trying to press on his chest. So, you know, it's, I try to, I try to share these experiences with people because I don't expect everyone to be able to have that kind of experience of that kind of perspective. And especially for the people who are not being case hard, it can be hard to figure out, you know, hey, like why are we doing all this stuff, you know, businesses are failing, government is infringing upon our infringing upon my liberties and everything. And people are people are going to feel the way that they're going to feel, but, you know, here in New York, this is what we're, this is what we're going through. And the difference that the, the, some of the differences that we're seeing here because of the, you know, with the flattening and now as our cases are dropping is because enough people have decided to take this seriously. And I do appreciate that, you know, Hawaii decided to kind of look at other places and start to really kind of try to act early rather than wait for courage to climb more. Sure. And we haven't had a significant problem in Hawaii, but I wonder how's New York, have you seen there be changes like, is it getting better now? Yes. Well, okay, let's put it this way. The number of cases, the number of people getting put on ventilators, the number of deaths are all decreasing. But they're still like on the scale of a couple, a few hundred people dying a day, which is a lot. It's a lot. From what I should say, it's a lot because it's one thing that's killing them. Right? We're not talking about 200 people from a mixture of car accidents, heart attacks, strokes, diabetic thing, you know, diabetic complications. These are people dying from respiratory failure from one infectious disease. And that's frightening. It is. Wow. Are you concerned about there being a second wave? Yes, I am. Most of the experts are hinting at it. And I'm preparing for it, meaning mentally preparing for it. And also preparing in the sense that I'm going to try to mentally keep up with the social distancing, the masking and whatnot. Because as the summer hits, we just had a great weekend and people just kind of came out. And I myself include, I went for a bike ride in the park. And the park was big enough where, you know, people were maybe half the people wearing masks, but everyone was being distanced appropriately. So maybe that wasn't quite so bad. But maybe in other parts of New York, as my friends were telling me, you know, you've got people that are like now clustered together with masks down and then, you know, smoking cigarettes and stuff like that, because people just so tight and pent up. So yeah, I am going to expect a second wave. You know, some of the things that we're that we're tracking as scientists are like the mutations that are happening, whether or not those mutations are going to lead to a different type of virus that is more transmissible. We don't see that yet. But that's why it's so important for us to just to keep track of the, you know, keeping track of things. But at the same time, I do want to caution everybody, not just lay people because I myself could be a victim of this, but reading reading a headline and saying, Oh my gosh, this is what's going to happen. There was a LA Times article recently which discussed that scientists recently discovered a more transmissible strain of COVID. And the original paper doesn't really say that that's been confirmed. I mean, that may be the case later, if they prove it, I'm willing to change my mind for that. But as of right now, when that paper came out, and a couple of virologists that I that I kind of read up on, we're just basically saying that these are mutations that they're following, it may lead to more infectivity. But we're not sure yet. So jumping at headlines is something that we all can all fall victim to, but I just encourage people to take like five seconds to say, from the headline with the article, if you can get through the original, you know, research or the original paper, try to read through that, and then try to weigh yourself before you kind of react to it. It's hard to do. I've been guilty of it. So do you, do you feel that now that you've had it that you have antibodies and that you're protected from future COVID exposure? I do have antibodies. I got, well, let's we trust the tests. I do have antibodies which prove I have exposure. I do not know if I have immunity. I would like to think that I have some. The experts assume that we have at least some, but just like the flu, by the pen and depending on which mutations accumulate in the in the subsequent variations of the virus, by the time the fall rolls around, we may have a different virus and that those, those antibodies, which may still be that may not be quite as effective. Okay. Well, you know, you've been, it's been so interesting having this perspective because in Hawaii, we don't have as many cases. We have less than 700, 700 confirmed cases and we have about 17 deaths as of today and but you know, we're really locked down and it's a practice for people to wear masks. So hopefully we'll be okay. But you know, I thank you so much doctor for being here today and sharing your experience. But we're about you're welcome. We're about out of time and we'll have to wrap it up. I'm Catherine Norr. This is much more on medicine on the think tech live streaming network series. We've been talking with New York physician Dr. Nicholas Tiao about caring for COVID casualties. Thank you for joining us today. Please take care of yourself, wash your hands and be kind to one another.