• Published on Sep 28, 2020

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. Today I'm joined by Dr. Saju Mathew. He is a primary care physician and public health expert based in Atlanta, Georgia. Dr. Mathew, thanks for joining me.

SAJU MATHEW: Thank you, Dr. Whyte, for having me.

JOHN WHYTE: I want to start off with, what are your patients asking you when they either come to see you-- and tell us, are they coming to see you, or are you doing it all telemedicine? What's on their mind as it relates to COVID?

SAJU MATHEW: There's a lot on my patients' mind. As you introduced me, Dr. Whyte, I'm a primary care physician. And I work in a fairly busy practice. I see about 20 patients a day. And of course, you know, I live in Georgia, where the positivity rate, unfortunately, is really high.

So patients do have a lot of questions for me. And I think most of them come from their anxiety and fear about what they are reading, what they see on news. It could be even some really dark questions like, you know, am I going to die, will I make it, how can I avoid getting the infection. And now with kids going back to school, Dr. Whyte, the big concern obviously is also the safety of-- of your college kids. You know, is it time to send them back out there?

JOHN WHYTE: And you're very active in the media world. You're on CNN quite often, you know, other news outlets. Why is it so hard to communicate health information as it relates to COVID? You've talked about your patients coming in confused. Is it because there's mixed messages? Is it because science is-- is difficult to understand? What do you see are-- are some of the problems that we're having?

SAJU MATHEW: I think that, um, you know, it's a loaded question, Dr. Whyte. There are so many layers to-- to that question. First of all, you know, for-- for a lot of us, this is the first time that we are actively in the midst of a pandemic. And it just seemed like our lives changed overnight from being able to do everything to almost not being able to do anything at all. And I think also with the virus, we're learning new information, it seems like, almost on a daily basis and-- and on a weekly basis.

For me personally, being a medical analyst on TV, this has been the most challenging story that I've covered. And I think part of that also has to do with the numbers game. There's so many numbers to relay to patients. And while our minds sometimes can react positively to numbers, there is a huge risk of communicating numbers in terms of fatality rate, transmission, asymptomatic. You know, so many words and numbers out there, I think, complicate the story.

JOHN WHYTE: Why are we using such complicated words? Asymptomatic, pre-symptomatic, symptomatic. Are we making it too complicated for the average patient?

SAJU MATHEW: I think so. I think that part of that responsibility also, Dr. Whyte, must come from us as physicians. You know, we're trained, uh, so heavily in the sciences starting from college to residency. It is, if you will, our lingo. So I feel like I need to take some responsibility as well to try to see how can you communicate the same information in layman's terms and just get people to sort of wrap your arms around this virus that unfortunately has such a high fatality rate and it's so transmissible.

JOHN WHYTE: Well, let's talk about transmissibility. And I-- I want to know what you're telling your patients. So you know, is it six feet? Some patients will say-- well, in Europe, they're saying it's-- you know, it's three feet or a meter. Um, you know, other places are saying it's airborne transmission, which could really complicate the rate. So how do you break it down for those patients that come and see you and ask about, you know, how much physical separation should they have?

SAJU MATHEW: You know, Dr. Whyte, I do try to make it simplistic. I'm a huge believer in using words like the three W's-- wearing a mask, watching your distance, washing your hands. A lot of my patients are going back to the gym. I do actually try to sort of increase that distance to maybe nine feet just because of the types of activities that occur in the gym that don't necessarily occur if you're just sitting down and talking to family or hanging out at the park. So I think I cater my-- my language based on the latest information. And I try-- uh, not always good at this, but I try to keep it very simple.

JOHN WHYTE: You're in Atlanta, home of the CDC. You know, the CDC had put out some information, about 6% of cases are strictly COVID. The others are-- are due to other reasons. I'm-- you know, I'm paraphrasing. As you know, there was a lot of misinformation as what they meant by that. We have the same issue in-- in convalescent plasma, the data that experts talked about. Subset analysis of a subset of a subset. Are these missteps in terms of communicating, you know, data in numbers hurting these pristine institutions, the CDC and the FDA?

SAJU MATHEW: Yeah, I think so. I mean, I did get my public health degree and did an internship at CDC, uh, right here in Atlanta. And I have such high regard for the Centers for Disease Control. As the words say, they are supposed to be the intelligence agency when it comes to controlling disease. But I have to say, Dr. Whyte, that I have been disappointed. I-- I still respect the institution very much. But I've been very disappointed with the rollout of that all of a sudden overnight change of the guidelines regarding who needs to get tested.

JOHN WHYTE: Let's remind, uh, viewers. This relates to symptoms as well as, you know, post-symptoms. So let's talk about those-- those revised guidelines.

SAJU MATHEW: Right. So before they revised the guidelines, it was pretty straightforward. If you knew that you were less than six feet away from somebody who had COVID-19 and you had spent a minimum of 15 minutes or longer, it was absolutely a no-brainer. You should get tested because your rate of being increased to the virus significantly goes up if you're in that close proximity. And that seemed to make sense to most people.

You can-- you can listen to that and say, you know what, that is not hardcore science. I can't wrap my-- my arms around that-- that measure. And then just sort of quickly, overnight, without a press release, without a press conference-- and I remember waking up to this, Dr. Whyte, and having to go through the pages, if you will, on the CDC website.

And much to my astonishment, they had basically said, guess what, even if you have been exposed to somebody with COVID-19, less than six feet away, more than 15 minutes, you don't necessarily have to get tested unless you have symptoms or, number two, you belong to that high risk group of people-- over 65, diabetes, and high blood pressure.

JOHN WHYTE: What do you tell patients who say, Dr. Mathew, isn't this all a hoax, I haven't met anyone who had COVID? What do you tell those persons?

SAJU MATHEW: Believe it or not, I get that quite a bit, especially when I'm on air and I get off air. I usually try not to read the comments on Facebook and social media. But yeah, a lot of people think that this is a hoax. And what I tell them is if you have not had a loved person that has been infected with this deadly virus or lost somebody for the virus, I can get it that if you're just out there, you're young and healthy, you don't feel like anything that's really changed. But if you just spend an hour with me, I can convince you.

In the last few weeks, Dr. Whyte, the number of patients that I'm seeing with COVID has gone from say 20% to 70% to 80%. And remember, I'm also seeing patients that may not necessarily have symptoms. And 50% of people with COVID-19 do not have symptoms. They are the drivers of the infection. Plus, you know, I also tell a lot of my friends and family members-- I share stories with them.

My-- my cousin is a ER, uh, intern in Chicago. And he had to hold the cell phone, um, right before his four patients were intubated so they could say bye to their loved ones. That's not a hoax. If people had a camera into what's going on in emergency rooms and in ICUs, especially in states where the positivity rate is high, nobody would think that, uh-- that this is a hoax.

JOHN WHYTE: Where do you think we're gonna be three months from now?

SAJU MATHEW: Unfortunately, and I say this a lot on air-- I don't want to be an alarmist, but I want to speak the truth. I feel like my job as a physician is to state the facts as I best know it. Unfortunately we're moving into the cold and flu season. Colleges are now opening campuses to thousands of students who, unfortunately, are turning positive. By going into the flu season, we're now going to be dealing with COVID-19 and flu simultaneously.

Now, we know this, Dr. Whyte, as clinicians how difficult it's going to be to distinguish who has flu and who has COVID-19. Unfortunately the symptoms overlap, and we don't have rapid testing. Now I'm-- I'm a huge believer in rapid testing. I realize it's not as sensitive as the PCR. But 80% of the time if your test is positive, you know for sure that you have COVID-19.

JOHN WHYTE: Well, there is debate about [LAUGHS] that just in terms of sacrificing accuracy, uh, for speed. And then those are things that, you know, ideally we, you know, can get better precision on for both.

But, Dr. Mathew, I want to thank you for sharing your insights today. Thank you for communicating, you know, these important public health messages. And we'll look forward to-- to following your advice on-- on the various outlets.

SAJU MATHEW: Thank you, Dr. Whyte. I have such high regard for you as a physician and your establishment, WebMD. So honored to be your guest.

JOHN WHYTE: And thank you for watching Coronavirus in Context.