Q&A: Dealing with COVID the Chameleon

Since the beginning of this world-altering pandemic, one of the main problems with coronavirus disease 2019 (COVID-19) has been the fact that we just don’t know. We’re still learning. We’re learning about what organs it can attack and how long the symptoms might last. We’re learning that some people might exhibit symptoms for months. We’re learning that some people have been reinfected. These are the known unknowns. Are there unknown unknowns, as well? What we do know at the moment is that mortality rates are going down, while infection rates have been soaring. Younger people are getting infected and younger people are less likely to die from the disease. But nobody should let their guard down, and that includes infection preventionists and other healthcare professionals, says Fibi Attia, MD, MPH, CIC, the infection prevention coordinator at Penn State Milton S. Hershey Medical Center. “I know everybody is tired of being in quarantine or taking a lot of care going outside shopping or they’re not going to parties,” say Attia, who is a member of Infection Control Today®’s Editorial Advisory Board. “They’re not allowed to be with a lot of people at the same time. They are tired. Some people are starting to get together, especially now with Halloween parties and coming into Thanksgiving, Christmas. Hopefully everybody will take care.” Indeed.

Infection Control Today®:There have been two major changes since the beginning of the COVID-19 pandemic: mortality rates are plummeting, and younger people are getting infected. And possibly the two are connected, because younger people are less likely to die from COVID. Are those fair assumptions and what else are you seeing on the ground?

Fibi Attia, MD, MPH, CIC: They are fair. What we are seeing is that we know a little better than earlier through the pandemic. We know more about COVID-19. How it is transferred, how to protect ourselves. We are on the learning curve. But we are better definitely than in March and April. And I believe that’s why the mortality rate is decreasing. Although a lot of infection rates are there. And that’s because we have a lot of tests being done. We are offering everybody with symptoms; they can go to the PCP or they can go through a walkthrough. Drive by and get tested. That’s why we’re seeing an increase in the number of people being infected with COVID-19. Another thing about the younger people. I know everybody is tired of being in quarantine or taking a lot of care going outside shopping or they’re not going to parties. They’re not allowed to

Fibi Attia, MD, MPH, CIC, Infection Prevention Coordinator, Penn State Milton S. Hershey Medical Center

be with a lot of people at the same time. They are tired. Some people are starting to get together, especially now with Halloween parties and coming into Thanksgiving, Christmas. Hopefully everybody will take care. But the thing that I see that people when they know you, they assume that you’re not infectious. But they are extremely cautious when they don’t know you. And that’s in general. I believe it’s everywhere. But I’m saying that somebody you know, well, he can be infectious and he wouldn’t show any symptoms. And that’s why younger people are being infected a lot nowadays.

ICT®: Has there been any change among healthcare professionals working in hospitals from the beginning as opposed to now? I’m assuming that maybe there was more fear in the beginning and now there’s less fear.

Attia: Yes, I agree. There is less fear now. We’re getting numb to COVID-19. OK, it’s here. It has been here since March. I’m well, I wouldn’t get infected. So why not get together? You know what I mean? It’s hard.

ICT®: Do you see any hospital personnel or healthcare personnel still getting infected or basically has that been cut down to zero?

Attia: Ah, no, it’s not. And that’s because they are normal people. So, they go outside. They are in contact with others with no precautions other than in the hospital. In the hospital, they’re taking very good care because they know that patients may have COVID-19. But outside, they get together. They’re like other people. They act normally outside with minimum precautions, I would say. We’re getting some infections. Yes.

ICT®: What’s the testing protocol at your hospital right now?

Attia: So, employees, if they are having symptoms, they call employee health and they get tested. If there is any exposure for any employee, we offer them testing within five to eight days after the exposure. And that’s when the symptoms would come up or a positivity rate seen. It would be good to be detected.

ICT®: Two-part question: Is it mandatory for employment at your institution that employees get the flu vaccination? And how important is getting the flu vaccination during COVID or any other time?

Attia: It’s not mandatory at my institution, although we strongly recommend that everybody would get their flu vaccine, especially during this season with this pandemic. Because of course, if you’re somewhat protected against flu, then the possibility of you getting sick, if you get exposed to COVID-19 is much less than if you’re not protected against flu. And you can get both of them together. And that would be a very bad thing.

ICT®: Now, you’re the infection prevention coordinator at Penn State Milton S. Hershey Medical Center. Are you and other department leaders meeting right now and talking about what your plan of action will be when a COVID-19 vaccine comes along?

Attia: Yes, of course. There is a daily meeting where we talk about the possibility of getting those COVID vaccines and where are we going to store them. How are we going to distribute them? How many doses do we need? Those kinds of things are being discussed on a daily basis, maybe. Yes.

ICT®: The COVID vaccine in particular?

Attia: It’s the COVID plan. It is about COVID. So, if there is a surge, if there is a vaccine, how we would manage if we have some employees quarantined? Those are the kind of things that we discuss, and we put a plan together. We can be prepared if something happens.

ICT®: How much of this plan was created just from what you learned back in the beginning of the pandemic?

Attia: I would tell you that the plan has changed a lot since the beginning. Because every day you hear about something different. And how to protect yourself. What’s required to wear when you’re going into a room with a patient who’s tested positive for COVID. What if this patient is severely sick? What if this patient is OK? Not that sick? What if you’re immunocompromised? What if you’re pregnant? So different scenarios. And the plan has changed a lot. I will tell you that every month, maybe, or less than that, we update our policies. We update our plans to be going together with what we hear from the studies being done.

ICT®: You yourself have not gotten COVID-19, right?

Attia: Myself? No.

ICT®: I guess that when you have the time, you delve into the literature about COVID. What in particular about the pathogen itself worries you that you’ve read about? There are a lot of things that have been coming out about COVID. That it doesn’t only attacked the respiratory system. Some studies have shown that there are so-called long-haulers. There might be waves, and this might be a spike in the first wave rather than the second wave itself. What worries you about how the pathogen seems to be acting on human beings?

Attia: The thing is that the COVID-19 symptoms are very different. You may get the infection and be totally asymptomatic. You may get fever, you might not. You might get allergy-like symptoms, which would be OK for this season. And it’s usual to get an allergy-like illness in this season. It’s very different. And it may be so severe that we would need a ventilator. That’s the problem with COVID-19. Because if I’m young and healthy, I would get the infection but show no symptoms. I would not know that I got the infection, although I’m going outside with other friends, partying together, doing whatever. But “oh, yeah, I’m not getting the infection.” No, you did get the infection. And some people, we just discovered that they have the infection by doing swabs for other reasons. And then they’re saying, “We don’t have any symptoms. How did we get these infections?” It’s very different. It varies. So that’s the problem. And being healthy with no symptoms, makes one think that it’s OK to have the infection. No, it’s not. Because there are among us, in our households some people who are immunocompromised. We have elderly people. We have a lot of people that may catch the infection, and it would be dangerous for their lives.

ICT®: What are you proud of most about how your hospital in particular, and the healthcare system in general, reacted to this crisis?

Attia: I’m so proud that we have implemented the facemask and the face shield or eye protection for everybody dealing with a patient. A facemask for everybody. Even when they’re not dealing with patients. Once you enter the hospital, you have to put your mask on.

ICT®: Do you think what we’re experiencing now is a spike in the first wave and there’s a second wave coming? Or is this a second wave?

Attia: Yes, there is a second wave. And we are experiencing an increase in the numbers. Of course, nowadays, it’s like…. It settled down for a little but then we’re seeing an increase. We’re prepared, hopefully. You always make sure that you anticipate that the person in front of you may be infectious. You have to protect yourself. You have to disinfect everything you’re touching. You have to sanitize well. You have to put your mask on all the time. So, you’re not transmitting or getting the infection. It is a source control. And your mask protects you. My mask protects you and your mask protects me.

This interview has been edited for clarity and length.