TWiV 595: Coronavirus update – Daniel Griffin MD in the parking lot

March 29, 2020
CoV cake

Daniel Griffin MD joins TWiV from a hospital parking lot to provide updates on COVID-19 diagnostics, clinical picture, and therapeutics, and then the TWiV team continues coverage of the coronavirus pandemic caused by SARS-CoV-2.

Hosts: Vincent Racaniello, Dickson Despommier, Alan Dove, Rich Condit, and Kathy Spindler

Guest: Daniel Griffin, MD

Click arrow to play
Download TWiV 595 (71 MB .mp3, 117 min)
Subscribe (free): iTunesGoogle PodcastsRSSemail

Become a patron of TWiV!

Links for this episode

Intro music is by Ronald Jenkees.

Send your virology questions and comments to twiv@microbe.tv

Leave a Reply

Your email address will not be published. Required fields are marked *

15 comments on “TWiV 595: Coronavirus update – Daniel Griffin MD in the parking lot

  1. Jerry Landers Mar 29, 2020

    Here are the List of States that have issued Stay at home orders as of March 29th 2020

    https://www.keloland.com/top-stories/list-states-that-have-issued-stay-at-home-orders-during-the-coronavirus-pandemic/

    DALLAS (NEXSTAR) – More than 25 states have issued orders restricting movement of residents in an effort to slow the spread of the coronavirus. Current restrictions include the three biggest cities in the United States — New York, Los Angeles and Chicago.

    Here’s a state-by-state breakdown of the current lockdown orders:

    Alaska

    Gov. Mike Dunleavy has ordered Alaskans to stay home and banned most travel within the state to combat the spread of COVID-19.

    California

    Californians awoke Friday to a new reality after the governor issued stay-at-home orders for nearly 40 million people amid the coronavirus outbreak. The move by Gov. Gavin Newsom was the first in the country in the effort to curb the pandemic.

    The order was a stunning development and further blow to businesses and workers.

    California is one of the hardest-hit states with more than 3,000 cases, reported KTLA.

    Residents have been told to stay 6 feet away from others, not gather in groups and wash their hands frequently.

    Colorado

    Gov. Jared Polis issued a statewide stay-at-home order that lasts until April 11.

    Many Coloradans, including the vast majority of people in metro Denver, live in counties where stay-at-home orders have already been announced.

    Polis said he is issuing the order to save Coloradans’ lives.

    Connecticut

    Governor Ned Lamont announced a “Stay safe, stay at home” policy, telling all “non-essential” businesses and not-for-profit entities to stay closed for an indefinite time period.

    He is asking that all businesses that can have employees work from home do so, according to WTNH.

    Delaware

    Gov. John Carney has issued a stay-at-home order due to the coronavirus pandemic, according to Delaware Public Media.

    The order went into effect earlier this week. It requires all non-essential businesses to close.

    Hawaii

    Gov. David Ige has issued a stay-at-home order for entire state effective Wednesday until April 30.

    Violations will be a misdemeanor with a punishment of up to a $5,000 fine.

    Idaho

    Gov. Brad Little announced a stay-home order for all of Idaho to last three weeks.
    The order requires all citizens of the state to self-isolate at home “if you can.”

    Healthcare workers, public safety and other essential personnel will be allowed to provide “essential services” while the order is in effect.

    Illinois

    Illinois Gov. JB Pritzker’s “stay-at-home” lasts until April . According to WGN, the order will mean residents can still go to the grocery stores, put gas in their cars, take walks outside and make pharmacy runs.

    All local roads, including the interstate highways and tollways, will remain open to traffic, as well. Delivery works should still report to work, the governor said.

    Businesses such as gyms, spas, salons, barber shops and tattoo parlors must close by Saturday.

    Indiana

    Governor Eric Holcomb is ordering citizens to stay home from March 25 to April 7.

    People must remain home except for essential work duties or for permitted activities such as taking care of others, obtaining necessary supplies and for health and safety, according to Fox 59.

    Kansas

    Kansas Governor Laura Kelly has issued a stay-at-home order that’s slated to run through April 19, according to WDAF.

    Kentucky

    Gov. Andy Beshear ordered all non-essential businesses to stop operating in-person services, according to the New York Times.

    “That doesn’t mean you need to cower down in your home,” he said. But “you stay at home, unless you are getting groceries or other supplies that you may need.”

    Louisiana

    Last week, Governor John Bel Edwards issued a statewide “stay at home” order.

    The order itself lasts through Monday, April 13, according to WGNO.

    Massachusetts

    Governor Charlie Baker has ordered all non-essential businesses to close, effective noon Tuesday, March 24.

    The governor also announced he and state health officials are issuing a stay at home advisory for the residents of Massachusetts.

    Both will remain in effect until April 7, according to WWLP.

    Minnesota

    Minnesota Gov. Tim Walz issued an executive order directing Minnesotans to stay at home for two weeks Wednesday afternoon. Walz made the announcement in a 2 p.m. address from his residence, during a daily update on the pandemic with state health officials. The stay at home order goes into effect Friday night at 11:59 p.m.

    Michigan

    Governor Gretchen Whitmer has issued a stay-at-home order for Michigan residents.

    The order is expected to last at least three weeks, according to WOOD-TV.

    Montana

    Gov. Steve Bullock on Thurday issued a stay-at-home order for all Montanans. It takes effect Friday at midnight.

    As of Friday morning, Montana had one reported hospitalization for COVID-19 and no deaths.

    New Hampshire

    New Hampshire issued a “stay at home” order until May 4. According to a report in the Concord Monitor, it’s the last state in the northeast to do so.

    New Jersey

    Governor Phil Murphy signed an executive order telling all residents to stay at home until further notice.

    The order includes some exceptions like obtaining essential goods, seeking medical attention, visiting family, reporting to work or enjoying outdoor activities.

    The order mandates work from home arrangements when possible and prohibits all social gatherings.

    New Mexico

    Governor Michelle Lujan Grisham issued a statewide “stay-at-home” instruction Monday, March 23, to help reduce the spread of COVID-19 in New Mexico. The “stay-at-home” orders run until April 10.

    To help stop the spread, “non-essential” businesses have been issued to close and have people work remotely. “Essential businesses” can remain open at this time.

    New York

    New York Gov. Andrew Cuomo is ordering all workers in nonessential businesses to stay home and banning gatherings statewide.

    He also says nonessential gatherings of individuals of any size or for any reason are canceled or postponed. The Democratic governor took the dramatic actions as confirmed cases in New York climbed to nearly 40,000 cases on Thursday.

    Cuomo says people can still go out for solitary exercise to protect their physical and mental health.

    The steps to contain the virus come as Southern Europe’s medical system is buckling. The pandemic marked a grim milestone with a global death toll that now surpasses 10,000. In Spain and Italy, patients are filling up sick wards and field hospitals are going up in hotels and a convention center in Madrid.

    North Carolina

    North Carolina Gov. Roy Cooper issued a “stay at home” order on Friday afternoon for the entire state. Enforcement begins at 5 p.m. on Monday.

    “This will save lives,” Cooper said.

    Ohio

    Gov. Mike DeWine announced that the Ohio Department of Health has issued a stay-at-home order for all of Ohio.

    DeWine made the announcement last week during his daily news conference to update on the spread of the COVID-19 coronavirus, stating that ODH Director Dr. Amy Acton has signed the order.

    “There is really nothing in that order, that we have not already been talking about,” said DeWine. “There’s nothing in that order, that I have not been asking you to do for the last week or so.”

    The order will go until at least April 6, when it will be reevaluated, according to DeWine.

    Cuomo says people can still go out for solitary exercise to protect their physical and mental health.

    The steps to contain the virus come as Southern Europe’s medical system is buckling. The pandemic marked a grim milestone with a global death toll that now surpasses 10,000. In Spain and Italy, patients are filling up sick wards and field hospitals are going up in hotels and a convention center in Madrid.

    North Carolina

    North Carolina Gov. Roy Cooper issued a “stay at home” order on Friday afternoon for the entire state. Enforcement begins at 5 p.m. on Monday.

    “This will save lives,” Cooper said.

    Ohio

    Gov. Mike DeWine announced that the Ohio Department of Health has issued a stay-at-home order for all of Ohio.

    DeWine made the announcement last week during his daily news conference to update on the spread of the COVID-19 coronavirus, stating that ODH Director Dr. Amy Acton has signed the order.

    “There is really nothing in that order, that we have not already been talking about,” said DeWine. “There’s nothing in that order, that I have not been asking you to do for the last week or so.”

    The order will go until at least April 6, when it will be reevaluated, according to DeWine.

    Oregon

    Oregon Governor Kate Brown has issued Executive Order 20-12, which significantly tightens social distancing guidelines. The order directs everyone in Oregon to stay at home to the maximum extent possible. It also adds a batch of new businesses that must temporarily close to prevent the spread of COVID-19.

    “I started by asking Oregonians to stay home and practice social distancing,” Brown said in the release. “Then I urged the public to follow these recommendations. Instead, thousands crowded the beaches of our coastal communities, our trails, our parks, and our city streets, potentially spreading COVID-19 and endangering the lives of others across the state. Now, I’m ordering it. To save lives and protect our community.”

    Pennsylvania

    Governor Tom Wolf announced a stay at home order starting at 8 p.m. Monday, March 23, for Allegheny, Bucks, Chester, Delaware, Monroe Montgomery and Philadelphia Counties.

    “You must stay in your home unless not leaving your home endangers a life,” said Wolf.

    Rhode Island

    Gov. Gina Raimondo issued a stay-at-home order until April 13, according to WPRI.

    Rhode Islanders must now stay in their homes unless traveling for essential purposes, such as work, food shopping, buying gas or picking up necessities at the pharmacy.

    Vermont

    Gov. Phil Scott ordered Vermonters to stay in their homes and directed all businesses to suspend in-person operations in response to the continuing spread of the coronavirus, according to WFFF.

    Washington

    Washington Gov. Jay Inslee has ordered non-essential businesses to close and the state’s more than 7 million residents to stay home unless necessary in order to slow the spread of COVID-19.

    The stay-at-home order will remain in place through April 6.

    West Virginia

    West Virginia Governor Jim Justice says he has declared a stay-home order to go into effect at 8 p.m., Tuesday, March 24th.

    Justice says people will be able to leave their homes to receive essential services, go to work at essential businesses, or go outdoors as long as they remain as a six-foot distance. Further details will be available on the governor’s website.

    Wisconsin

    Governor Tony Evers says he’ll sign an order that closes all non-essential businesses and urges people to stay home to slow the spread of COVID-19, according to WFRV.

    This story will be updated as additional states are added to the list.

    (The Associated Press contributed to this report)

  2. Keira Mar 29, 2020

    This is the Dutch “cdc” site.
    Covid-19 found in sewage.
    https://www.rivm.nl/nieuws/nieuwe-coronavirus-aangetroffen-in-rioolwater

  3. Gina C. Mar 29, 2020

    Thank you for this episode! I found the interview with Dr. Daniel Griffin is very helpful and practical! I’m a nurse practitioner in Philadelphia. I’m not yet assigned to take care of COVID patients yet but maybe soon. This interview provides a lot of useful clinical pearls and gives me some confidence if I need to take care of these patients.

  4. Cameron Rogers Mar 29, 2020

    Stay safe TWiV team! and Dr Griffin!
    I read the other day about doctors using clear ponchos as a shield when doing intubation, using them as a protective shield. Necessity is the mother of invention! They put their arms through the arm holes in the poncho to do the procedure, while the poncho covers the patient, putting all the items needed on the patients chest, seemed like a brilliant and cheap idea.

    I have to wonder if the reason that so many young healthy doctors and health care professionals are becoming so ill and even dying from SARS-CoV-2 infection, is just a factor of the huge viral loads that they pick up doing such procedures. I noted that Dr Griffin was saying in a previous podcast to intubate early at the first signs of respiratory decompensation, to avoid excessive exposure, that seemed wise.

    Stay safe people.
    Cheers,
    Cam

  5. Steve Hawkins Mar 29, 2020

    Wow: tell them not to spray their clothes with alcohol! It burns at quite a low temperature on your skin, but it will set fire to your hair and could burn your house down if there was a spark while you were spraying it or wet with it!

  6. Kim Mackey Mar 29, 2020

    Is a transcript of this podcast going to be available? Very important information in the first 20 minutes for doctors faced with covid-19 patients.

    • The following is what I copied, through about 7 minutes

      It is a viral illness that presents with the full spectrum of viral illnesses, but there are certain clinical characteristics we now know that can be predictive for a positive PCR [Polymerase Chain Reaction test].

      Based upon a study of 500+ folks up in Washington, if you take all comers, you have about 10% positives in Washington state, which unfortunately is not what we have here. But then if you add on coughs, fever, shortness of breath, it actually triples the number of positives (this should be triples the rate of positives). So there are some clinical predictors of who is going to have a positive. And another interesting thing, not only are there clinical features that predict positive rates, but there’s also certain clinical features that help us risk stratify. So the first one’s obvious. And it’s shortness of breath. Maybe that’s not obvious, but we now know that about a quarter of people don’t have a primary complaint of shortness of breath or don’t even notice significance[?], so those people are lower risk. It’s the 75% with shortness of breath that are higher risk. Also significant fatigue, headache, and abdominal pains. These are high risk clinical features. We keep reinforcing the clinical course, which seems pretty consistent, that the first week you might underestimate the virus, but it’s that second week – it’s that day 7 – 14 after symptom onset – when we might see people start to do poorly for us. Prognostic indicators . . . You always want to know what’s going to happen and who to worry about, and you worry about everyone, but there are some people you worry more about. So, a lot of this came out of the Chinese data and was distilled down and we’ve been validating it in the New York area, where age is a big discriminator – less than 50 lower risk – greater than 60 higher risk – and there’s going to be a gray area, the areas in between. Without any comorbidities, any other conditions, that’s lower risk, but if you’ve got particularly diabetes [obesity], cardiac artery disease [hypertension, heart attack history, heart failure, obesity], asthma, chronic lung disease [emphysema, chronic bronchitis], renal disease [dialysis, hypertension, obesity], active malignancies [current cancer], particularly people going to infusion centers [dialysis too], I think it’s a double whammy that’s also increased exposure there, and then people who are on immune suppressants. But then we have also the clinical outpatient indicator. If the person has access to a pulse ox [pulse oximetry probe], one of the first things that might go down, before they start decompensating, is the percent saturation of the blood oxygen. So, if that drops into the 80s, or is in the 80s, when they’re stratified, higher risk. If that’s above 92%, lower risk. The respiratory rate is actually helpful, and this is easy to get, and particularly when we have more telemedicine [doctor visits by video, rather than in person]. If the rate is less than 20, they’re lower risk. If it’s greater than 24, they tend to do worse, and as they get more critical it’s in the higher 20s.

      And then, this is my favorite, the neutrophil-lymphocyte ratio. Not just because I’m an immunologist by heart, or by trade, but if you take the absolute neutrophil level over the absolute lymphocyte level, and make a ratio, people less than 3 tend to do super-well. People over 6 you worry about. The 10 to 20 range, that’s your ICU, Intensive Care Unit, potentially needing to be on a ventilator. And when you’re above 20, from the Chinese experience, they haven’t had any survivors. We are currently working to make sure that we don’t have the same experience, and hopefully by next web, I’ll be saying that we’ve saved out first patient with an NLR [Neutrophil-Lymphocyte Ratio] greater than 20. And there’s other things we use. There’s procalcitonin, ferritin, C reactive protein [CRP], and D-dimer to sort of risk stratify and predict who’s at higher risk and who do we need to focus on. And then with that, what we can usually do is keep an eye on those people at high risk during the high risk window. And if you have a high NLR, a lot of risk features, you go from nasal cannula, so that’s just a small amount of oxygen requirement, up to 100% by face mask. Those are the people that we need to watch closely, that may require the support of an ICU and a ventilator. And if they make it through that window, and the NLR comes down, and the oxygen requirement comes down, we’re seeing people go home. Each day I’m discharging a few people to home, so that’s something kind of bright there.

      Diagnostics. Just yesterday [3/27/2020], the serology, the point of care 10/15 minute serology test became available in the US. And this is great, there are going to be millions of these coming in. And you can, in 10 minutes find out, by day 7 the IGM [ImmunoGlobulin M] comes up at 80% sensitive for the disease. By day 10 it is about 100% sensitive. Basically, people say, I want to know at day 2, but as a clinician, I want to know at day 7 to 10, when you might be decompensating and I want to see you, so I love the timing.

      How do you define day 7 – day from what?

      This is day from symptom onset. It’s not when I had trouble breathing, and this is critical, it’s not coughing. It’s when I started to feel like there was something wrong. When I felt crummy. It’s not when did you start feeling bad, it’s when did you start feeling like this started.

      Then there is a bit about a 95% accuracy with anterior nares swab method.

  7. Kateryna Mar 30, 2020

    Hi there,
    Hope u all stay safe and healthy.

    About masks sterilization.

    I might have a bit outdated knowledge… 20 years old to be precise

    To the best of my knowledge, sterilization of medical equipment (syringes, tubes, perhaps masks etc.) is routinely done with 1) X-rays and 2) ethylene oxide gas. These two will not destroy the masks. 3) what about treating masks in an autoclave… Not sure this method does not destroy the masks.

    X-ray sterilization. So, in theory masks could be deposited by the users in the zip lock bags, signed and sent to X-ray exposure. For example, some 20 years ago our local physics research institute earned additional money by sterilizing some medical equipment with X-rays (the source was radioactive cobalt and it glowed blue.. This is all I remember LOL) . I am sure, you have some institutes/universities in the USA that have those radioactive sources, which could be used for this kind of masks sterilization.

    In theory masks after treatment with X-ray might be used by anybody (different users). But I guess it might be more comfortable if medical staff does the same as we do in the labs with our coats. E.g., sign your coat and pick it up after cleaning. Well, yes, it is a lot of trouble to find your mask in a pile of them :)) Washing masks before X-ray exposure is too risky IMHO.

    About ethylene oxide gas.. I guess it might be done in bulk… If this kills the virus. I am not sure about that. Here again masks handling might be too risky.

    3. Autoclave use. Wrap your masks in a newspaper sheet and sign. Submit, done! Well designed for sterilization bags could be used as well.

    Stay healthy,
    Sincerely,
    Perished Scientist
    Kateryna

  8. Chris Mar 30, 2020

    Can u use ultraviolet to sterilise food or face masks & other things eg phone tablet. I’m a dumb electrician but I find ur podcast interesting even if i don’t understand most of it.
    Have been listening for 2yrs great job got my md to listen

  9. Clifton Baldwin Mar 30, 2020

    On episode 595, the hosts talk about “Viroholics” talks out of ASU with Grant McFadden at Friday 12pm Pacific time on Zoom but never supply the link in the show notes. Do any of the hosts know the link to see these talks? Thank you.

  10. Any contacts in taiwan which seems the only spot to envy with post sars preprations? And therefore way more intresting then china or korea

  11. This article appears with many question marks.. Attached..
    Any one could clear things up?

  12. Michael Irvine Mar 30, 2020

    ” The link below does not really answer the question.

    I think it’s understood that insects do not act as vectors for transmission in the sense that insects transfer infectious diseases through bites, stings etc. Insects would not transmit a virus that uses mammalian genomes to reproduce.

    I am wondering, given the longevity of the virus on surfaces of up to 5 days or more, if insects can transfer the virus around topically, that is on teh surface of their wings, carapaces, antennae etc.

    As an example, could cockroaches move the viruses around in an apartment building on the surfaces of their bodies. ”

    https://www.pestworld.org/news-hub/pest-health-hub/is-coronavirus-transmitted-by-pests

  13. William Cast Mar 31, 2020

    Why was the J&J not on the WHO Draft list of vaccines? Any thoughts?

Content on this site is licensed by Microbe TV, LLC under a Creative Commons Attribution 3.0 License