Dr. Panagis Galiatsatos admits he tends to be rather conservative when it comes to approaching health and medical matters. “But I’d rather be laughed at for being over-reactive than yelled at for being under-reactive,” he says.
Dr. G. — as he’s known — is a pulmonary and critical care specialist at the Johns Hopkins Bayview Medical Center in East Baltimore. He participated Mar. 25 in a virtual Chizuk Amuno Congregation community information session on COVID-19. The Q&A program was hosted and moderated by the Pikesville synagogue’s Rabbi Joshua Z. Gruenberg, with occasional surprise cameo appearances by Dr. G.’s two young daughters.
“We’re not just trying to stop the spread of the virus, but also the spread of misinformation,” said Dr. G. “You all are the frontlines. As critical care doctors and nurses, we’re really the last line of defense. The best line of defense is you all. We need to make sure people are getting a streamline of the most up-to-date and honest information. It’s highly important in this pandemic moment we’re in.”
A Pikesville resident who grew up in East Baltimore’s “Greektown” community, Dr. G. has helped organize the “Caregiver Café” monthly program at Beth El Congregation’s Soul Center, for community members caring for loved ones.
He is co-founder and co-director of Medicine for the Greater Good, a Johns Hopkins Bayview program established in 2013 with the goal of training health care professionals to actively engage with communities for better health outcomes.
Does the medical world generally prepare for pandemics?
Dr. G.: The short of it is I could say we do, but the quality of cooperation is not what we’d hope it to be. Nobody’s gone through it before, and to play out all of the different types of infections that could cause a pandemic could take over a year of practicing. I can tell you since graduating medical school [in 2010], I have about 14 hours of training for a pandemic. For about an hour a year, we practice for pandemics. So we’re all trying to put together all of this professional chaos at a chaotic moment. Bear with us while we go through this all together.
What makes COVID-19 different from other viruses?
In ‘The Art of War,’ [the Chinese warrior and writer] Sun Tzu recommended, ‘Know your enemy.’ Pandemics need key ingredients to be effective. With COVID-19, its mortality rate is 1 to 5 percent, which is very high. One percent of the American population puts you in the millions. And its symptoms can be from one to 14 days. The average is four or five days. If you get infected, you may not know it and be spreading it for four or five days. That’s what allows the exponential growth of its infection.
What are the symptoms?
In some cases, the symptoms are milder in that you might dismiss them at first in everyday life. Obviously, not with shortness of breath, but a dry cough, fatigue and tiredness. Of course, a fever is hard to dismiss, and that’s an important symptom to remember.
I don’t want to alarm people but I urge you, if you feel any of these symptoms, to call your physician or health care professional to do a screening. We have to be incredibly conservative right now, and my training has taught me to be conservative.
So with a fever with a temperature of 100.4 or more, chills, the dry cough – that’s highly important because COVID-19 transmits through aerosol [means]. Be wary of the cough.
How does COVID-19 compare to the seasonal flu?
The mortality rate for this is much, much higher.
Who should be tested?
Unfortunately, we can’t test everyone. So we want to test people who have a high probability of having the virus. If you came into contact with someone or have the symptoms I discussed – fevers, dry cough, shortness of breath. … We want to test people who will likely end up in a hospital or who live in a situation where they would likely infect others.
So if you have the symptoms, talk to your health care professional. They will either screen you or triage you for testing.
What about quarantining and isolation?
The general recommendation right now is to quarantine everyone. We’re asking you to stay socially distant to assume you won’t spread or get the virus. If you develop symptoms but are not sick enough to be in a hospital, we ask for isolation. Find a room in the house that’s just for you and wear a face mask – it could be a bandana or a scarf or even a shirt – so that if you cough, the droplets will be stopped. After an hour or two, get a new one and wash the other one. You need to keep doing that until you’re removed from isolation.
What should you do when you go to the grocery store?
If you go to the grocery, you don’t have to wear gloves but wash your hands afterwards and wipe down products in plastic with Clorox wipes. With paper, we don’t see a lot of life expectancy [for the virus droplets]. Your mail should be fine. Just wipe down plastic and steel with Clorox wipes. When you go out, try not to touch you face. I know it’s hard. Just wipe down as much as you can.
What should you do if you develop symptoms?
The best therapeutic management for a virus is supportive care. If you develop COVID-19 symptoms, stay well-hydrated and well-fed. There’s nothing to prevent you from getting infected, but your job is to minimize the symptoms you get if you develop the symptoms for the virus. So stay well-hydrated, well-fed and well-nutritioned.
For more dire cases, we have to use breathing tubes on patients, and unfortunately they don’t fare well. The intensive care unit is our last line of defense, and the outcomes are not usually good because that means the COVID-19 is really ravaging someone’s lungs and bodies. Medications are our last efforts.
Supportive therapy is by far the best way for this virus to be handled, as opposed to giving medications, even if they have decades-worth of well-seeking measures. We still don’t know how a large population will react to them, so talk to your physician. We usually give medications as a last effort.
Are the elderly and those people with preexisting conditions truly more vulnerable?
Infections always do worse with the elderly population and those with preexisting conditions. COVID-19 is no different. People having an underlying pulmonary disease, from COPD to asthma, seem to do worse. High blood pressure has been linked to COVID-19, but we’re still in the infancy of collecting that data. What I’m saying now could not be true tomorrow. We’re all in this together and going on the best information we have right now.
Quarantining and social distancing is what we can do to make sure this virus doesn’t infect in an exponential fashion. We just don’t have enough facilities to manage over a million patients. We actually believe that a lot of the mortality around COVID-19 is not due to the infection but because a lot of the life-saving interventions weren’t given to certain populations because hospitals couldn’t give it to everyone and were rationing.
Do we really have to practice social distancing during Passover?
Yes. We cherish everyone’s life, regardless of creed or race. I know that social distancing is not a natural condition and that we are social creatures, but it is needed now more than ever to stop the spread of this virus.
Last Friday night, our family participated in a Zoom Shabbat, from Dallas to New Jersey. So I welcome others to take on that [kind of practice] until this pandemic is behind us.
And grandparents can’t visit their grandkids?
The data showcases that kids are not in the highest numbers [of cases], but there have been some with dire consequences. It seems children have milder cases or become symptomatic. My fear is that these children could have [COVID-19], but not the symptoms. So if they hug their savta [grandmother], they could spread it to her.
I don’t know if you’ve ever told a Greek grandmother or a Jewish grandfather not to see the kids right now. I know it sounds cruel, but the intention is to save their lives. Visits should be virtual for the time being. I apologize to all the savtas out there.
If you are elderly or living with preexisting conditions and need to go shopping, how should you proceed?
When you go to a grocery store, check out their designated hour for the elderly or those with a weakened immune system. Go to those stores and take advantage of this opportunity, and remember that the average grocery cart is an appropriate social distance barometer. Stay a grocery cart apart from people. I’m not talking about one of those Trader Joe’s shopping carts for kids, but a regular shopping cart.
Also, find wipes or hand sanitizer at the store. Hand sanitizer is the most effective. And twice a day at least, try to wash your hands. That’s still the gold standard of killing this. In addition, make sure you wipe down your car – steering wheel and car seat. But only if you regularly use your car
Do we need to wear face masks and gloves while shopping or being outside?
Only if you have symptoms. Remember, a face mask won’t keep the virus from getting into you. It just keeps it from getting out of you.
When can we stop practicing social distancing? When can we go back to our old way of life?
As health care professionals, this is not an easy thing to implement and execute. Every day is more tiring than the next. Right now, the best I can tell you is that our curve seems to be paralleling Italy, and they haven’t even seen the worst yet. So it’s very hard for us to give a good answer to when it will be behind us.
My suspicion is that this will continue to grow and grow. We’re probably going to see the quarantining request grow and grow as the virus continues to spread. A lot of it is because as we test more patients, we see more and more people have it.
What should you do if you test positive?
Talk to your health care professional. If you happened to be somewhere that someone tested positive, tell that to your health care professional, tell him or her your symptoms and who you live with. If you live with someone from a susceptible population, let them know. That might buy you a green light to get tested.
Are Baltimore area hospitals ready for waves of COVID-19 patients?
We’re not taxed out yet, but we should be prepared. From a hospital standpoint, the issue is not yet a case volume or quality issue at this time. Right now at Bayview, we’re moving people to a bio-dome area for COVID-19 patients. It exerts a lot of effort on the health care system. But our hospitals are not taxed out, I’m happy to say, but we’re getting there.
Right now, as far as the supply of ventilators, we’re OK. But at the pace we’re going, we’ll be short in four to eight weeks. It’s incredibly heartbreaking to not have that equipment as health care professionals. Please don’t put us in that heartbreaking position to make those tough ethical decisions. We should be your last line.
Can Baltimore avoid getting slammed with COVID-19 cases like New York?
It depends. New York has a larger population and they’ve done more testing. With the mass transit system there, the ability for that to spread rapidly was right there for New York.
I think we’ll be hit hard, not like New York but similar to the influenza viral outbreak we experienced here in the ’60s. But I do think we’ll be hit hard. I always try to be conservative, and what I’ve seen so far has not been promising.
What can we do as a community to help?
Community gatherings like this, to hear about the pandemic from a trusted source, are important. Also, the recommendations we make – social distancing and quarantining – when you hear these things, talk to the leaders in your community and households. In my case, that’s my wife. Talk about how you can do these things most effectively.
You have to come up with novel strategies in a unique time to help us overcome this moment we’re in.
Dr. G participated in another Chizuk Amuno virtual session on Wednesday, Apr. 1. For information, visit https://www.chizukamuno.org/virtual/.