Recorded on Tuesday, March 17, 2020
Provided by Victor Gaxiola
Dr. Jason Bellak of the Oklahoma Institute of Allergy, Asthma, and Immunology joined me to discuss the Coronavirus Pandemic. Jason is an old friend from my undergraduate days at UCLA and offers insights on Covid-19 and what to expect in the weeks and months to come. What follows is our recorded interview and transcript from the video below:
Victor Gaxiola: Hello, this is Victor Gaxiola with TechGirl Financial and joining me today, we have a very special guest- Dr. Jason Bellak from the Oklahoma Institute of Allergy, Asthma and Immunology. Hopefully I said that right. I always massacre it, but thanks for joining us today, Jason.
Dr. Jason Bellak: Thank you Victor.
Victor Gaxiola: Jason and I have known each other for many, many years and I really appreciate him taking the time to share his thoughts based on his position, working with his patients on talking about what's on everyone's mind right now, which is the Coronavirus pandemic. So thank you for joining us Jason.
Dr. Jason Bellak: Pleasure.
Victor Gaxiola: Before we get started, tell us a little bit about yourself and your practice?
Dr. Jason Bellak: I am currently living and practicing in the Oklahoma City area. I also have an office in Norman [OK]. My area of practice is allergy and immunology. And what that means is I care for patients with a range of diseases from environmental, drug allergies asthma and other chronic lung diseases and importantly in our discussion here, patients with immunodeficiency diseases- So those are patients that have difficulty fighting infections, the immune system and touches many fields of medicine. But it's important to know that my wheelhouse is really patients that have trouble fighting infections, normally versus say a rheumatologist who cares for people that have autoimmune disease. I'm trained in internal medicine and practiced general medicine for 10 years in rural central Wisconsin before practicing allergy and immunology full time at my practice. I also am the vice president of the practice and in the past I've been a medical director of emergency departments as well. So I've been on the front lines of issues in healthcare, acute issues in healthcare in the past and have seen and been part of disaster preparedness as well.
Victor Gaxiola: So I know a lot of things that you'll be sharing with us are obviously from your opinion and no one should take this as medical advice, but I do know that you are working with your patients and that a lot of it has to do with allergies as we approach allergy season and such- What are you telling your patients about the Coronavirus pandemic?
Dr. Jason Bellak: Thank you for clarifying that. This is all my opinion and shouldn't substitute for medical advice that you would get from your own personal physician. One of the most important things that we all need to remember is that- the patients that do the best when they get sick, whether it's from the current Coronavirus epidemic or other illnesses are patients that are in good shape to begin with. So, one of the most important things that we can all do is make sure that you're keeping up to date with your normal health preventative health care. And for my patients, for example, with asthma and allergies, immune deficiency disorders, making sure that, they're being seen regularly and having updated action plans for these types of scenarios. So it's important that if we use asthma as an example, is that their baseline asthma is well controlled that they have an action plan in place, if they are to get sick, what they can do to self treat based on that action plan. And then if they are not getting well on the action plan, when to contact us. So, that's the most important thing. I think we've done a much better job as healthcare providers, for the most part, of keeping patients well. And then the very sick patients often need tertiary healthcare, for example, ICU beds and in some cases ventilator care management. And that's the current issue with the very sick patients with the Covid-19 illness. Even though I am going a little beyond what you asked, we have done a great job of increasing those ICU, that's because in general, those are the patients that we're getting hospitalized a lot of times. There are times like this that could potentially overwhelm the healthcare system, the amount of those ICU beds. So, circling back. It's important that they stay well, follow previous action plans and that we all listen to our public health specialists, which are on the front lines of identifying the risk associated with emerging illnesses including the Covid-19 and following the recommendations closely. I have a the utmost respect for the folks at the CDC, the World Health Organization and the NIH including Dr. Fauci who been on about every news channel, and as been on the front lines of emerging illnesses starting with HIV in the early eighties. So, I think it's important that we follow their recommendations including the social distancing.
Victor Gaxiola: I think that a lot of the conversations and the things that people have been sharing are, you know, what to look for and how the Covid-19 differentiates from a flu, from a common cold, from a fever. And the thing that strikes me is that one of the key differentiators is that dry cough, you don't have a runny nose, but you do run a fever. So it would be hard to detect initially cause it does seem to emulate a lot of the typical flu symptoms or common cold symptoms. You know, at what point should somebody get concerned and think that maybe I should seek medical advice or get tested?
Dr. Jason Bellak: Yeah, that's a great question. We are in the peak of my normally busy season. Trees seeds are pollinating, so there's a lot of itching and sneezing and dripping and we're also in the peak respiratory viruses. So it's kind of the tail end, of the normal influenza season but, it's also the busier season for your common cold viruses, including rhinovirus and something called a dental virus. So it can get tricky- in your typical season when we're trying to differentiate as allergies or, or cold, certainly fever. Even though when we call allergies hay fever there's no fever, temperature increased- typically involved. So, and fever for just the most strict definition is greater than a 100.4 degrees Fahrenheit. And I'll say, you know, in general, adults don't get febrile illnesses very much. It's much more common for kids. So an adult with a febrile illness, means something's going on, and this time of year, I would still think even though the Covid-19 illnesse is the current pandemic, it's still more common to have a common cold, an influenza than it is Covid-19. So, a fever would be the main thing now. A dry cough makes me think more of a viral illness or somebody that may be having an asthma or COPD exacerbation. So the combination of fever, cough and shortness of breath- anytime you're short of breath, that's going to be concerning. So the first thing that people need to do if they have those symptoms is to contact their medical professional and like a lot of practices the Oklahoma Institute of Allergy, Asthma and Immunology has a tele-health program that we've initiated for sick patients or other patients that need health care visits that maybe can't or shouldn't come into the office. Also as a resource, the CDC has listed, the 24/7 hotline numbers for the Department of Health in every state. If you contact that number, they'll give you directions on necessary testing if it's appropriate and give you information where and how to do that. I know many healthcare systems that have started doing Covid-19 testing using commercial labs. And that's been a big relief to everybody because we can do more testing. But in general, when you have this illness or any of the illnesses that are currently going around the influenza, a common cold- staying at home is important and doing general supportive symptomatic care. So rest, increased fluids, Acetaminophen for fevers and aches and headaches. There's some controversy about non-steroidal anti-inflammatory use- Ibuprofen, Neproxin, things like that and potential worsening of the illness? And we just don't know that yet. There's, no good definite data. But I'm advising my patients if they don't have liver disease or have some other reason not to take Acetaminophen or Tylenol to take that instead. Hopefully that answered your question.
Victor Gaxiola: Absolutely. All good things to consider. I mean, I think a big part of it and a lot of the concern from the healthcare community is not wanting to overwhelm the system, which is one of the main reasons why isolation, social distancing is really important. And here in the state of California, specifically in Northern California, the seven counties around the Bay Area, we had been placed on a “shelter in place” mode, which is to say that we are encouraged to stay home, to not go out unless it's absolutely essential- you know, to go to the bank, grocery store or fill your car up with gasoline, but to try to minimize the amount of gathering. What would you say to someone that says that we're overreacting?
Dr. Jason Bellak: Well. We all have a social responsibility for our neighbors and our family members and in particularly our older patients or family members with any, especially any comorbid diseases like kidney disease or heart disease, etc. You know, the thought of this just a month ago or two months ago would have been outrageous, to anybody. I think this is always something that public health officials have had as an idea, but you know, what was called draconian, or what I've heard has been called draconian in China, has really suppressed and mitigated the spread of Covid-19 disease. I think the most recent I heard was one new case in Wuhan yesterday. And that's unbelievable. There's this whole idea of that everybody's heard of flattening from the curve, which not only hopefully decreases the amount of disease, but how quickly or how high that that peak gets. So we spread out the cases and decrease the impact that it has on the healthcare system and the ability to care for patients. So, there are patients, there are folks that don't show many signs of the illness. They tend to be younger, healthier. And again, going back to what I initially said, I think we would all do better fighting any illness. The healthier we start off and when we're fighting something, there's this thought that sometimes, especially in younger folks that they're indestructible and it won't bother them. I saw this on a news program today of how important it is for our most vocal Millennial patients and friends and children that they really use the power of their presence and social media outreach to be supportive of complying with these difficult recommendations. But, I think they're absolutely necessary and you know, the shelter place is more prohibitive than other places in the country, but because of your disease activity, I think you're ahead of the curve there. And that's more likely to happen in additional communities rather than not in the next several days.
Victor Gaxiola: Yeah, as we were discussing before the recording, for one thing, I think what has provided some comfort, and I'm always amazed by the resolve, you know of individuals, especially after [tough] times – and we've lived through 911, we've lived through the financial crisis. We've lived through you and I, the Los Angeles riots when we went to UCLA.
Dr. Jason Bellak: Earthquakes!
Victor Gaxiola: Earthquakes! Right.
Dr. Jason Bellak: Well, interestingly I think we are as prepared in certain ways for something like this to happen than never before. Just the fact that we can have this conversation from several thousand miles away and you're sheltering in place, but you shouldn't be socially isolated. We've had the ability to pick up phones and call a video conference, and do kind-of the business as usual more than I think we give ourselves credit for. So, I think that's important that we continue to do that, and continue to have social and professional contact and use the technology that we have, which is such a great resource.
Victor Gaxiola: Oh, I agree. And really for me, and I think that this is the feeling I'm getting from friends and family, in this area, is that we're all going through this together and at least having a direction, a shelter in place is providing a prescription that whether you have the disease or not or you know, if you're suffering from it, everybody knows what they need to do and how they can be responsible about it.
Dr. Jason Bellak: Absolutely, and I think the President, just today, you know, the 15 day plan- that's available on the .gov website as well as the Corona, specific Coronavirus website on the CDC. And they're all very simple, practical, common sense things that we all need to do to get through this quicker and more safely.
Victor Gaxiola: Well, if nothing else it's introduced, good habits, you know, we're all washing our hands more, we're being more mindful of our neighbors. I certainly will try very hard in the future never to run short of toilet paper, I don't know where that came from. But my big question here is- Jason, in your opinion, when will we know that it's over or that we are at the tail end of this?
Dr. Jason Bellak: Yeah, that's a fantastic question. And you know, it's rapidly developing. They're doing very sophisticated modeling based on previous outbreaks, including the previous SARS outbreak. So, what's important to know-you know the terminology kind of gets muddled, but SARS CoV-2 is the virus, Covid-19 is the disease from the virus. So the analogy is HIV and AIDS. So HIV is the virus, and AIDS is the disease. So, if we look at the previous SARS outbreak that lasted really until July- I think that's where the most reason government announcements have come from. A typical virus season, that I spoke of earlier, that we typically see this time of year is over by the end of May typically. The flu season, which typically peaks December through February, and then you have some common cold or viruses, et cetera, and that generally ends by – end of April, May, and coincides with warmer weather. Now there's theories of why that may happen, including older dryer air may increase the ability for droplets to spread and things like that. But, I think it's important to know that we've made these recommendations, including the shelter in place and that people don' get worried when the numbers are still going up. Because it's lagging behind the recommendations. And of course there are sometimes where patients are asymptomatic before they're diagnosed. So, there's going to be some worse data coming out before that improves and knowing that that's going to happen and that's typical and to be expected. So once we start to see that peak, and we're not exactly sure what that's going to be yet, and those numbers go down after we've instituted some of these more strict social guidelines- then we'll know things are getting better. And knowing that once people are getting better there's another few days of social distancing where they still may have viral shedding and they may need to stay at home. But it's also important to know that 80 plus percent of people that get the SARS CoV-2 virus recover without any significant issues. And it still remains a mystery. But thankfully our, our youngest ones, including infants, we're not exactly sure about pregnant females, but they're always considered high risk, there really hasn't been a significant disease burden in those folks. Well, we don't know if they're vectors or carriers and transmitters. So that's why it's important that schools are closed. And you and I both have daughters who are Seniors in high school and it's a difficult time. And even my teenage daughter, I think is coming around and understanding her social responsibility- that she understands that we're doing this for a reason. And the sooner we all do what is requested of us and follow our social responsibility, the sooner this will end.
Victor Gaxiola: Yeah. And it's one of these situations where it's going to take all of us, I think, in order to resolve this and to start seeing the light at the end of the tunnel. So, Jason, I know that you're very active, unlike many other doctors who are not, but you're very active on social media, you're constantly, or very regularly on the media, being interviewed. And so we really appreciate you taking the time to share your thoughts with us. We'd love to get you back on the program maybe as these things progress. But before I let you go, if people wanted to get in touch with you, your practice or understand, you know, some of the information that you're sharing, what would be some of the best resources for that?
Dr. Jason Bellak: Well, I'll throw in a plug for my national organization. So the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma, Immunology. Both have a “find an allergist immunologist” on their website. So if you need a local, a specialist, that's the first place to go. And I'm also on there. You could also find me on LinkedIn and on Twitter (@JasonBellakMD) and direct message me there. Those would probably be the easiest ways to get ahold of me. My company website is OKAllergy.Com. Ok- For Oklahoma. We're great allergist over in Oklahoma, so you can find us there. And I wish everybody well and we will all get through this.
Victor Gaxiola: Yes, we will. And this is coming straight from the man who coined the “Ragweed Tsunami”
Dr. Jason Bellak: Ragweed Tsunami…. In August. We get through that.
Victor Gaxiola: We'll get ready for that. Well, Jason, thank you so much. All the best to Jen, Izzy and the boys. Please send them our love and hopefully you are well.
Dr. Jason Bellak: Thank you. And the same to your family and Kim. Kim is incognito, and she's missing in action?
Victor Gaxiola: She's probably taking a call right now.
Dr. Jason Bellak: All right. See you bud.
Victor Gaxiola: Thank you.
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