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  • so I'm Dr. Christopher Greene I'm an assistant professor of emergency

  • medicine and I'm the physician director for the serious infectious disease team

  • at UAB which is kind of overseeing the ED response to covid-19 among other

  • serious infectious diseases spell my name c-h-r-i-s-t-o-p-h-e-r g-r-e-e-n-e

  • "reporter question"

  • mean obviously we share the same concern for the folks in Washington and

  • Washington State the as far as our concern specific to the people in

  • Alabama we've made, we've been making preparations for you know weeks now the

  • but specific to the emergency department the things that we're doing are a couple

  • of things the first thing that we're doing is we are now cohorting patients

  • presenting with influenza like illnesses in the waiting room as they're

  • waiting to be moved to a treatment area and that is not not because we have seen

  • any covid-19 cases it's just in preparation for in the event that that

  • were to become we were to have an outbreak in Alabama so that we had that

  • capacity and that infrastructure in place to to be putting patients with who

  • are like who are more likely to have that type of an illness in an area and

  • away from patients where who do not have those symptoms the the

  • protocols that we've had in place already for screening for covid-19

  • specifically but also for Ebola and other things that are going on are

  • ongoing we have moved that the second thing that

  • we're doing is we've moved that some of that triage process out to the entrance

  • of the ED so that folks are being asked immediately upon entry to the emergency

  • department if they've had any any exposure risk that specifically its

  • travel history exposure to patients who have had been diagnosed with the virus

  • or if they have symptoms of covid-19 or other influenza-like illnesses and that is -

  • that's to help streamline that process but also to catch every patient who

  • comes through the emergency department who potentially could have some risk for

  • that virus for the covid-19 those are by the two most important things that

  • are most visible right now I've said we have a lot of we are we have an ED

  • specific plan for in the event we were to have a person under investigation we

  • have designated locations for performing patient care that would be compliant

  • with the CDC recommendations for minimizing risk for the rest of the

  • hospital and also other patients in the ED and we have specific rooms with

  • airflow capabilities and those kind of things and we are also dealing we're

  • also developing and have developed a more broader outbreak plan if we were to

  • have multiple or many patients which i think is an important part of planning

  • for an outbreak like this is having having plans in place for if we have

  • more patients than we have negative pressure rooms how do we deal with that

  • and I think that that's kind of how the whole country is responding

  • yeah I think that that's how I think all of the major institutions are

  • functioning right now is it we're planning as if it is going to happen I

  • think all of our hopes are that is that it won't you know certainly were

  • watching the developments in Washington State very closely and also

  • internationally because there are multiple countries that are dealing with

  • you know widespread and self-sustaining outbreaks and our triage process is

  • being updated multiple times a day based off of what is where those outbreaks are

  • and what kind of travel history or exposure history will be important the

  • "reporter question"

  • the the answer that question is a little bit complicated so the the UAB

  • specifically is making plans for if we have one or two patients if we have

  • dozens of patients and if we have hundreds of patients and those those

  • types of decisions obviously it would would be based off of or how we would

  • manage those cases would be based off of the number the number of patients or the

  • number of the severity of illness and those kinds of things the the right now

  • I think our plate we have we have a we have had and continue to have a solid

  • plan in place for managing a number of patients we're working on developing an

  • inpatient site for managing patients that could potentially be a covid-19

  • ward and there's a number of other a number of other specific

  • interventions that we're looking at how to manage the dozens to you know

  • hundreds of patients I'm the director of the division of infectious diseases here

  • at UAB I think I've met many of you before happy to be back do you want me

  • to just start out and make a few comments about where we're at?

  • sure Jeanne j-e-a-n-n-e Marrazzo m-a-r-r-a-z-z-o oh okay so I

  • think a few things are worth updating first of all as Dr. Greene just

  • emphasized we have not had a case here in Alabama of the Covid-19 virus we

  • have had cases reported in our very near neighbors namely two in Atlanta and at

  • least two in Florida that are maybe more right now so that's that's an important

  • point that said we are prepared with the kinds of procedures and protocols that

  • Dr. Greene mentioned which I think is is really good other big things that have

  • happened globally we're now at over 90,000 infections over 3,000 deaths and

  • the virus has been documented in 72 countries the hardest hit countries are

  • pretty much the ones we've been hearing about including Italy South Korea China

  • although encouragingly there are some evidence to say that the severity of the

  • illness that's presenting in China is slowing down a little bit which is

  • encouraging because maybe that's a harbinger of what might come for other

  • countries I guess the other important thing to know is that there's a very

  • concerning outbreak as I'm sure you've heard in the Seattle King County region

  • in the Pacific Northwest what's really notable about that is not just the fact

  • that they've had nine deaths reported there but they have gone back and tested

  • at least two people who presented to one of the hospitals there last week and

  • were from the long-term care facility that has been most affected by this and

  • both of those deaths were actually turned out it turned out to be due to

  • the covid-19 virus so that suggests that the virus in that community has been

  • essentially circulating for several weeks probably the very first case that

  • they detected there which was now about three weeks ago in Snohomish County

  • may have been the very first index case but there's been a lot of transmission

  • in the community so people are obviously very concerned there's a high level of

  • social distancing that's going on there is a school I know that's closed in

  • Seattle so we're all following that very very closely particularly as it relates

  • to the healthcare workforce because that's a really big thing and the

  • concern I think there as well is that you know if you start to have health

  • care workers get ill and then you start to have to quarantine health care

  • workers who were exposed without knowing it that's when we really worry about

  • undermining our health care force

  • I think Dr. Greene's emphasis on screening people outside the ER is great because

  • that's an immediate way that we can cut down the likelihood that that's going to

  • happen so really trying to to get that that early on so the Seattle situation

  • in the global situation no cases in Alabama the other thing that's really

  • big news is that the CDC has opened the floodgates for diagnostic testing you've

  • probably heard that we still are having very hard time getting people screened

  • we've only managed to screen about seven people here which is really hard even

  • though we've wanted to do more the process for getting the tests right now

  • involves filling out a form sending that to the Alabama Department of Public

  • Health that goes to the CDC and then we get a determination of whether we can

  • actually test that patient we anticipate that in probably four days

  • optimistically we may have access to the test to be done here

  • one of the major manufacturers of the test that we use to diagnose regular flu

  • as well as some other respiratory viruses has added the corona virus assay

  • The covid-19 assay I should say onto that swab test that we use

  • hopefully our lab will have that running up early next week we're also developing

  • our own tests here at Children's has an excellent virology lab which should

  • complement that and I hope we'll be online

  • early next week too so that I think and I keep reminding people that we don't know what

  • the true number of infected people is for this virus right the only people

  • who've gotten tested are the people who get through that gauntlet of asking CDC

  • to test right so you can imagine that there are a lot of people that we would

  • like to test that we haven't been able to test and when we start to do that

  • we're almost certainly gonna find some cases so I think people should again be

  • prepared and I think I said this last week I probably sound like a broken

  • record but be prepared as the testing rolls out just like we're seeing in

  • other states because a number of state labs are doing this test we probably are

  • gonna see an increase in the numbers that doesn't mean that there is rampant

  • wildfire spread it may just mean that we're detecting more cases as testing is

  • rolled out my impression is that it's been essentially two things first of all

  • CDC is completely overwhelmed with testing requests because they have

  • established themselves as the only place up until now that could do the test so

  • that's the first thing the second test the second thing is that in the initial

  • approach they're requiring a very rigorous confirmation sequence which is where

  • they got into trouble with having that required for every test so so they've

  • sort of loosened that process now and they've opened the door to other labs

  • doing it so that's really been the backlog

  • so the vaccine there are several vaccine candidates but there's one in particular

  • that is made by a company called Moderna that the NIH is coming very close to

  • being ready to implement in a Phase one vaccine trial and I'll tell you what

  • that is in a second this is a vaccine that looks very good in animal models it

  • has never been in humans before because we've never seen this corona virus

  • before so it's it's pretty remarkable that given the fact that we just heard

  • about this virus in December that we actually have generated a vaccine that

  • we hope will be active against this the way that you study these vaccines is

  • when you have a product that has never been in a human before you have to put

  • it into a small number of healthy humans and make sure that it's safe in a small

  • number and that it elicits some protective response so the very first

  • study which we hope will start up in April I think is safe to say probably

  • will have thirty to forty volunteers healthy volunteers if it looks okay in

  • that study then they will proceed to a phase two study which typically involves

  • several hundred people and you start to look at additional safety and you start

  • to look at measures of whether they're mounting an immune response phase two

  • study will probably not be done until at least a year and a half if that so

  • vaccine development can be quick but testing it and giving people time to

  • generate their immune response can take a while so that's where we're at I think

  • it's it's really important though to acknowledge how quickly this is rolled

  • out I've never seen anything come out of NIH this quickly and they're really fast

  • so this is good

  • "reporter question"

  • yes yes there have been some apparently bad fake media attempts to make it sound

  • like we have a patient here I think for us the plan would always be to respect

  • the patient's confidentiality always the patient comes first while being

  • responsible stewards of public health and and communication so I think the the

  • approach from my perspective and I'm speaking as a physician not a media

  • person so so the our spokesperson you know the approach would be to make sure

  • you have the situation under control you know what's going on with the patient

  • you get as much information as you can and then assuming we have everything

  • there done I think we would want to let people know and it's it's almost again I

  • echo Dr. Greene's point about I think this is a matter of when not if given

  • what we're seeing everywhere so I don't know that a UAB physician or a research

  • team claimed a role in developing this vaccine the vaccine that I am aware of

  • going forward to be tested is from a company called Moderna so they but they

  • are working with a clinical trial group so a research group that we are part of

  • here at funded through the NIH so we're connected to but not develop yeah

  • thanks for clarifying that did that answer your question about the positive

  • patient

  • yeah so I was on a plane in Atlanta last night was wandering around the Atlanta

  • Airport was interesting it would look actually pretty normal there were not

  • very many people with masks I guess my answer would be right now there are some

  • institutions and some companies that have restricted domestic travel for that

  • very concern I think that it is too soon to say from my own perspective I mean I

  • obviously travelled last night and I I felt safe

  • mostly because again in the next few days we're going to see an avalanche

  • I think of test results and we're gonna get a much better sense of what the

  • community burden of this infection is so if we find out for example that we have

  • a number of mild cases here in Birmingham which you know conceivably we

  • started testing a bunch of people we could see then whether you're here or

  • whether you're in the Atlanta Airport or whether you're in you know any place

  • doesn't doesn't really matter so much so I think we'll find out a lot more and

  • it's just really important to keep your eye on the news and try to get a sense

  • of what's going on I certainly want to emphasize again that I did have my hand

  • sanitizer with me in the airport I sterilized everything around me I used

  • it I wash my hand so remember again try not to shake people's hands if you are

  • around somebody who's sick or is obviously sniffling coughing looking

  • like they should be at home get away from them

  • or to mention is to let you know that the NIH is moving forward with a trial

  • of at least one experimental drug that has been developed I mentioned this

  • recently but there were some drugs that were developed for the Ebola outbreak

  • that turned out to be not so great for Ebola but look pretty good against this

  • virus in animal models again so we're very hopeful that that trial will get on

  • up and running soon and that will enroll people who are hospitalized with this

  • virus we hope to be able to do that here but more on that soon as soon as we find

  • out okay thank you

so I'm Dr. Christopher Greene I'm an assistant professor of emergency

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