Local Doctors Talk COVID-19 with Branson Medical Club

On Thursday, April 30, Branson’s Medical Club was joined by two local experts on COVID-19. Dr. Steven Hao, father to Spencer Hao ‘21, is an electrophysiologist at CPMC in San Francisco and President of Sutter Health West Bay. Dr. Celia Golden, mother to Adriana Golden ‘20, is currently serving as a Marin County Public Health Officer working on monitoring COVID-19 in Marin County specifically within vulnerable populations.

Dr. Hao and Dr. Golden joined the Medical Club for a 30-minute virtual discussion where they answered students’ questions about their work in the medical field and the current COVID-19 pandemic. Here is an excerpt of the conversation (remarks have been modified).

How has COVID-19 affected your work?

Dr. Hao: A lot of medical practices and procedural areas of the hospital have shut down like the rest of the economy because we want to preserve PPE (personal protective equipment) and we don’t want to expose patients to COVID-19 by having them come in for procedures and appointments. We’ve moved much of our work to virtual care. Concurrently, there’s a lot of planning taking place to prepare for a potential overwhelming surge of critical COVID-19 patients, the worse-case scenario. We’ve had to prepare to expand our ICU and our supply chains. The day-to-day work of a physician has slowed down, while the work as an administrator has really ramped up.

Dr. Golden: All my work is related to COVID-19; there are so many issues going on related to COVID in Marin. I’m focusing on caretaking homes and facilities. We’re working on the response to the outbreak. We’re doing a lot of hand-holding; we want to make sure that caretakers who work in these facilities have resources, are educated about COVID-19 and don’t feel like they are risking their lives in order to do their job. We want to make sure they feel safe enough to stay with their patients.

How is COVID-19 different from SARS and other viruses? 

Dr. Hao: Coronaviruses are actually very common. They’ve rotated through our community for many years; coronaviruses are the cause of a common cold. The real difference with this virus is that it’s novel (new), so everyone in the world is susceptible. One of the real major issues is that everyone can get infected at the same time, and that’s why we are worried about overwhelming the healthcare system and our ability to save people who could be saved. The second thing that’s different is that it’s easily transmitted from person to person and the exponential growth of spread is very dangerous. And the third thing is that this virus has a propensity to attack the lower respiratory system which can lead to pneumonia. And obviously we don’t have a vaccine, so all of our current treatments are supportive; Even though we are hopeful about some potential options, we currently don’t have a proven therapy for treatment of severe illness from COVID-19. 

Dr. Golden: One of the tricky parts is that it’s asymptomatic. 25-30% are asymptomatic and don’t even know they have it. It is spreading and we have a very hard time identifying who has it.

The Bay Area was one of the first places to implement Shelter in Place. How has that affected the rate of spread in our communities?

Dr. Golden: It has been very effective. Our numbers of infections and deaths are flat or stabilizing and California, in particular, has felt more comfortable releasing some activities, like construction and landscaping. But in order to fully ease restrictions, many things need to be monitored like the rate of new infections, the occupation of ICU beds, the amount of PPE we have available, etc.

What weaknesses in our healthcare system and society has the virus exposed?

Dr. Hao: Our lack of hospital beds and the amount of ventilators and PPE available. We’ve also realized our dependence on a global supply chain. One positive is that the medical community around the world has really been trying to solve this together, but when the whole world is trying to take care of the same virus at the same time, people do tend to take care of their own patients first which can limit resources for others. 

Dr. Golden: It has also exposed the fact that we have a lot of inequities in our healthcare system, which come to the forefront during a pandemic. There are a lot of at-risk populations that have not received proper healthcare.

Do you think we’ll be more prepared the next time?

Dr. Hao: That’s going to depend on you! Often our memories are not as long as they should be. There was a push to keep researching different pathogens and prepare for future pandemics, but when nothing was happening people looked at the investment and thought we should be using it elsewhere. Hopefully, this pandemic has been dramatic enough that we’ll never forget this. It is a matter of when not if this will happen again, so we have to remember and continue to invest to be better prepared.

How is this going to change our lives going forward?

Dr. Golden: Face masks are going to be the new thing. Handshakes and European-style greeting kisses will be gone! Policy is going to be complicated. There will be more screening and testing going into facilities (jails, prisons, homeless shelters) and I think more attention will be paid to our vulnerable populations, as we’ve realized that what affects them affects all of us. I think contact investigations will be going on for a really long time, as well as oversight and quarantine. We are probably looking at a possible second round in the fall. 

Dr. Hao: And then, we need to get a vaccine - it will be crucial. I’m not sure we’ll go back to our old normal, but it will be a new normal. There will be an intermediate phase that will have to be in place to minimize severe infection until we have a safe vaccine, which we think will be in early 2021 – best case scenario – or mid 2021. We will have to behave differently and control our exposure so that we don’t overwhelm the system for an intermediate period of time, then we get a vaccine and we figure out that new normal. 

A huge thank you to Dr. Hao and Dr. Golden for taking the time to speak with us!