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