Subtitles section Play video Print subtitles so I'm Dr. Christopher Greene I'm an assistant professor of emergency 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