Kevin Kavanagh, MD: “We can’t just bury our heads in the sand and bleed through healthcare staff and bleed through PPE, thinking that this is not going to be something that’s going to cause severe problems in these individuals, or that it’s going to magically disappear next week."
And that’s just for starters, says Kevin Kavanagh, MD. In a wide-ranging discussion, Kavanagh—a member of Infection Control Today®’s Editorial Advisory Board—says that the nation isn’t doing nearly enough to help those on the frontlines battling the coronavirus disease 2019 (COVID-19) pandemic. Kavanagh says that “these frontline healthcare workers are putting their lives at risk, and also the lives of their families and loved ones. And they need to be given support; at least proper protective equipment. In my opinion, they should get presumptive workers comp, if they start to develop problems. This is a significant problem.” The public isn’t taking the disease seriously enough and leaders are not leading. This puts infection preventionists and other healthcare workers in very tough spot. Kavanagh: “Right now, I can’t even give you an accurate number of how many healthcare workers have become severely sick or have died. No one is accurately tracking. National Nurses United has listed approximately 2000 healthcare workers which have died from COVID-19. CDC is under 800. But there have been incomplete data submitted. It could be as high as 5000. So, I mean, who knows?”
Infection Control Today®: Now, the article of yours that we have on our website, we’ve labeled it a viewpoint of course. But you certainly back the argument with a lot of data.
Kevin Kavanagh, MD: Well, definitely. The healthcare workers are really in peril at this point You just have to look at YouTube, where I feel that the videos have gone from being heartbreaking when you listen to nurses giving their testimonials to now, where some of them are just horrific when they’re describing the working conditions that they’re under. And I think the alarm was really heightened by the governor of North Dakota, when he all of a sudden announced that he was going to recommend that COVID positive nurses work in facilities taking care of COVID positive patients. Of course, this I think really does mitigate the infectivity of this virus. And it shows a kind of a lack of understanding of basic safety. It’s unacceptable, and he had significant pushback from the medical professions. He has recently now mandated a mask mandate—the wearing of masks up in North Dakota—which will be a step forward. But at some point, they may get forced to actually closing down again, because if that happens, mortality will absolutely skyrocket. And that will be extremely unfortunate. And we’re facing that in many different regions of this nation right now.
ICT®: We heard a lot about the shortage of personal protective equipment in the beginning of the pandemic and not as much these days. I assume because it’s not so acute as it was in the beginning. But you mentioned in your viewpoint that that could be a problem soon. Another shortage of PPE.
Kavanagh: Well, yes, and we’re already hearing this from many frontline healthcare workers. And we need to remember, its just not healthcare workers that need PPE. There’s a recent report out of BMJ, which reported 20% of frontline grocery workers in a grocery store—this was in Boston—are COVID positive, and most are asymptomatic. They’re younger individuals. I think about 76% were asymptomatic. But it does show that there are risks to both these younger individuals and, of course, to other people for spreading this virus. And I should note that there’s been too much focus on just the mortality of this virus. When you look at these frontline workers, you may say, “oh, they’re just asymptomatic.” But people who are asymptomatic or mildly symptomatic, often develop long-hauler syndrome, which means you can have persistent problems for months and months. And to be honest with you, we don’t even know if this is permanent or not. On previous talks, we’ve discussed about the long-term effects on the heart with myocarditis, possibly decades later getting into trouble. So, this is a virus that we should not neglect and say, “Hey, this is nothing to worry about.” We need to take it seriously. We need to get our workers protected.
ICT®: I think you indicated before that there is no consensus about how broad the long-hauler effect is and how long it might last.
Kavanagh: There isn’t. We’re getting frequent reports of this. There are frequent articles on the this, but there isn’t really a good indication yet because, the pandemic just hasn’t been here that long. But the number of individuals which report at least being partially dependent upon someone to take care of them … this is after they’ve had COVID-19. It’s approximately a third. This is something that’s very disturbing. And so, we really do need to look at this. And I think personally that we have to really take the virus seriously. Mobilize staff, mobilize the Defense Production Act, so that we can get PPE allocated to our staff. This is an extremely important thing that we need to be doing. Because we can’t just bury our heads in the sand and bleed through
healthcare staff and bleed through PPE, thinking that this is not going to be something that’s going to cause severe problems in these individuals, or that it’s going to magically disappear next week. We are on the upward slope of this pandemic. And in many areas, it is a vertical curve, or a vertical line on the number of cases that we’re experiencing. We have not peaked yet. Hospitalizations will probably peak 10 to 14 days after cases peak. Deaths will be two to three weeks after cases peak. This is what we saw with the the first and the second waves that we’ve had. This wave will be the same, and we haven’t even started to slow down. And to be frank with you, it is just the public is not responding well to following public health strategies. I don’t care whether it’s protests or its celebrations this week, and last week, there have been far too many large groups gathering, spreading this virus. It’s just heartbreaking. Because we need to save our celebrations till after this virus has been conquered. Right now, we are in, I think, significant problems. In addition, the infectivity of this virus has been underestimated. It’s, I think, much more infectious than many of our policies reflect. A recent study from the CDC was really quite disheartening in that it recorded almost 53% of household contacts becoming infected after they had a household member become symptomatic. And this occurred within seven days. That’s unbelievable: 75% became COVID-19 positive after five days that one household member started to develop symptoms. This is a highly infectious virus. And these frontline healthcare workers are putting their lives at risk, and also the lives of their families and loved ones. And they need to be given support; at least proper protective equipment. In my opinion, they should get presumptive workers comp, if they start to develop problems. This is a significant problem. And I think we need to support these individuals. Right now, I can’t even give you an accurate number of how many healthcare workers have become severely sick or have died. No one is accurately tracking. National Nurses United has listed approximately 2000 healthcare workers which have died from COVID-19. CDC is under 800. But there have been incomplete data submitted. It could be as high as 5000. So, I mean, who knows? No one is looking. No one’s tracking. These workers I feel are in peril with the surge. We need to get the Defense Production Act mobilized or enacted so that we can start producing PPE, N95 masks, and proper protective gear to protect our healthcare workers. That’s what they deserve.
ICT®: I don’t think you touched on this in your viewpoint piece. But do you think the argument that mortality rates are plummeting even as infection rates are going up plays into people maybe having more of a laissez faire attitude toward the coronavirus?
Kavanagh: Well, I think the overall stress on mortality was ill advised. You know, we talk about people recovering. Well, they really have just survived because as you learn how to treat a disease, your mortality rates are going to drop some. And when that happens, people think well it’s not as dangerous. But what you’re really doing is trading mortality for long-term disability. Similar if you have cancer, even a heart attack, you may survive the episode. But the treatment and the disease leaves you with long-lasting effects. And we don’t need to inflict this on our younger individuals. But as far as mortality is going presently, I mean El Paso has gone from four mobile wards up to 10. We have over 1000 patients dying each day in the United States from this disease. And the cases are spiking. Remember, mortality will follow the rates of cases by two to three, sometimes four weeks, but we have not yet seen that peak. And when I say spiking, it’s a vertical curve going straight up. We are in for a very dark winter. And the people are still continuing to drive the pandemic, these demonstrations and celebrations are inexcusable. And to be honest with you, the leaders have been largely silent condemning these. They should be. People should be staying in and not having any unnecessary contact with other individuals until this pandemic comes under control. Even if we stopped spread immediately today, we’ve got a backlog of so many infected patients, this pandemic and strain on our healthcare system is going to go on for weeks. And we’re likely to outrun our resources. And I need to state that we are still fueling the pandemic because people are not acting appropriately. Even a recent poll that looked at willingness to be sheltered in place or locked down has dropped from approximately the high 70s down to about 50% or less. And I don’t think lockdowns are going to be any sort of a solution to get rid of the virus because people have not adopted public health philosophies or strategies to hold the virus under control once you’ve locked down. It will just be surge. But you may need to do lockdowns if we outstrip our healthcare system. That’s just to keep the hospitals from being filled. Because what will happen is they’ll stop elective surgeries. And when you stop elective surgeries, you’re going to have collateral damage. Doctors will be unavailable to see patients in their offices. Again, collateral damage. Not that patients are scared to go in and get medical care. But it’s not available. I mean, I am to have a small procedure next week. I consider it safe to do when proper precautions are taken. But if the hospital beds fill, the ICU beds fill, they’ll start canceling elective surgeries. And that can affect everybody’s health. The COVID-19 pandemic death toll will skyrocket as measured by excess deaths.
ICT®: You talk about the public not paying enough attention to the dangers posed by COVID-19. Do you feel that has carried over to healthcare workers on the frontlines? Or do the healthcare workers on the frontlines just know too much about this and they’re not taking any chances?
Kavanagh: Well, and this is again, just from reading on social media, and we know how accurate that is. It’s hard to get any feel of what it’s like across the nation. But I do think that healthcare workers in some areas are starting to feel abandoned. And if they’re not taking precautions, which I think is extremely ill advised, it is more not from feeling that, well, this isn’t dangerous. It’s just that we don’t have the equipment to take precautions. It’s inevitable anyways. I’m just going to take care of the patients and hope for the best. It’s pretty hard to take precautions when you don’t have at least an N95 mask that’s new on every shift. You have to reuse your equipment. You’ve got patients that are getting into field hospitals or on wards where you don’t even have enough experienced staff to take care of them. It can be a very, very dangerous situation. I don’t think anybody should say that the care you get in a field hospital is going to be the same care that you get in a regular hospital. Yes, it may still be a bed but they’re running out of healthcare staff. And that is a huge problem.
ICT®:Now, you are sounding the alarm. Are others sounding the alarm? And who might be sounding the alarm that people will listen to? I think a lot of what you’re saying mirrors what Doctor Anthony Fauci has been saying.
Kavanagh: Unfortunately, because of the anti-science philosophy out there, there are a lot of people who won’t listen to healthcare professionals. But leaders need to sound the alarm. In my opinion, that would be leaders in the executive branch of the government, the political leaders, the president-elect of the United States ought to sound the alarm. But there’s been silence from everybody regarding these parties and celebrations or demonstrations. They’re ill advised. They weren’t advised back in July, when things were relatively under control. And I use that relatively, because we didn’t even have low rates then. But rates are skyrocketing. And I keep hearing it’s like a dial that you can turn back. No, it’s not a dial. This is like a freight train. If you put on the brakes, now, it’s not going to stop for miles and miles and miles. It takes a long time for this virus to stop because it is a protracted course once you get infected with the virus.
ICT®: As you know, a lot of what we have to do to protect ourselves from COVID-19 in some minds collides with our civil liberties. And now there’s talk about a national mandate, perhaps, that people wear masks. What are your thoughts as we approach the holiday season? Thanksgiving is coming right up. What are your thoughts about what we need to do or what healthcare professionals should do to A) protect themselves, B) protect their families, and C) to try and help patients as much as they can?
Kavanagh: Well, I think in view of the severity of the pandemic, a national mandate is needed. There are a number of Republican governors that have already mandated this; the latest we’ve just talked about is the governor of North Dakota. So, this is something that’s going to have to be done under necessity. It’s similar to World War II where you have to mandate that you keep your lights out at night, so you don’t get bombed by the Germans. You know, it has to be done. This is something that is a national security issue at this point. So, personal liberties can be curtailed when the security of the United States becomes in jeopardy. I think at this point we’re past that. That’s a discussion, for me, that was back in the spring when the virus wasn’t as bad as it is now. But with the infectivity appearing to be very significant, the virus raging, the masked mandate is going to have to take place and it’s going to have to be enforceable. I mean, people who can’t wear a mask because of health reasons…. Well, I tell you, I’ve, frankly, have rarely, rarely seen that. Even people in wheelchairs on oxygen I’ve seen would wear masks in airports, because it’s for their safety. If you’re that sick, you can’t wear a mask, you should not be out in this surge. Because if you got COVID-19, it would most likely kill you. It is far too dangerous. So again, they need to do that. They need to wear masks. If you can’t wear a mask, you need to shelter at home. People should be staying at home as much as they can anyway. Now as far as Thanksgiving goes, I read one op-ed which stated that if you mentioned anything about not meeting during Thanksgiving, you get the heat of 1000 suns. And I think that’s probably the case. But I hate to say this, it doesn’t matter what you’re meeting for. If people are getting together, you’re going to spread the virus. This is just like the celebration or protesting of the last election. It doesn’t matter what the reason is for, the virus doesn’t care. People get together, it will spread. So, right now I would be more worried about getting the family together for next Thanksgiving than this Thanksgiving. And if you’re going to get your family together this Thanksgiving, you may not have all members together next Thanksgiving, and that’s what needs to be remembered.
ICT®: And finally, what do you usually do for Thanksgiving, Doctor Kavanagh? And are you adjusting this year?
Kavanagh: Well, I usually get together with our children. This year, we are not. None of the children are coming to visit us in Lexington, Kentucky. We will be making a Thanksgiving dinner. We have two family households here in Lexington. And we will be taking some food there. Kind of like dine-out, trading food. We’re each going to make kind of a portion of Thanksgiving and trade it, but do so where we don’t get even close to anyone. We don’t want to get my 90-year old relatives sick with this virus. And of course, Thanksgiving dinners, you can cook in a microwave so you can re-sterilize them. The virus is fairly fragile in that sort of environment. And then we’re going to plan on playing an online game of Clue with everybody. You can log on and play and have a family event and if necessary, a zoom meeting, try to do things differently. But we’re not going to put people’s lives at risk. That’s not worth it. That would not be a very good Thanksgiving.
This interview has been edited for clarity and length.