What You Should Know About COVID-19 with Dr. Erlaine Bello MD

by Dina Pinos

Dr. Erlaine F Bello, MD, is a specialist in Internal Medicine and Infectious Diseases.  She graduated from the University Of Hawaii John A. Burns School Of Medicine and has been in longtime private practice.  She is on staff at the Queen’s Medical Center where she serves as the hospital epidemiologist in the Infection Prevention and Control Department and chairs the Infection Control Committee.  She is also at the University of Hawaii’s  Department of Medicine as an Associate Professor of Medicine.  She recently spoke to Honolulu Vibes about the Covid-19 pandemic in Hawaii.

Question:  With your already busy schedule, how has the Covid-19 emergency affected your daily work schedule?

Dr. Bello:  I have a 7 am meeting, 3 days a week at the Queen’s Medical Center with a multi-disciplinary committee to discuss everything Covid-19.  This group is responsible for COVID policies, overseeing research, product overview for PPE and other equipment, and daily updates on Covid-19 in the Queen’s Health Systems.  Now that we have the foundation for policies and processes, the work is a bit less intense than in March and April.

Question:  When Covid-19 first broke out in Hawaii, what were your initial thoughts and observations? What are the most common symptoms? Who are at higher risk?

Dr. Bello:  When Covid-19 first broke out in China, Hawaii was experiencing an exceptionally bad influenza season last fall that was earlier than the past 2 years.  The cases were initially reported as an influenza-like illness.  Due to the large number of Chinese visitors, it is quite possible that some of our bad flu cases might have been this new disease in China, yet we had no way to diagnose it.  In response to the flu season, we instituted temperature and symptoms screening early on.

The most common symptoms are fever, cough, and shortness of breath, but now we also know that gastroenteritis symptoms such as abdominal pain, nausea, vomiting, and diarrhea might even precede these symptoms by a few days. Loss or altered taste or sense of smell are also unique symptoms.  Unprovoked blood clots are another presentation. Some with the virus might have no symptoms at all.  Persons over 65, males, and those with underlying lung, kidney, cardiovascular conditions, hypertension, diabetes, immunocompromised due to disease or drugs are at higher risk of complications. Those with blood group type A have been shown in some studies to be at higher risk of severe inflammatory lung complications.

Question:  What are your thoughts about keeping tourists out of Hawaii?  Quarantining?  What is the average incubation time, and why quarantining for 14 days?

Dr. Bello:  What to do with incoming tourists is, of course, the million-dollar question and everyone in Hawaii needs to ask this.  Tourism is the bedrock of our economy and it is failing. But, keeping tourists out of our islands has resulted in having among the lowest prevalence rates in the country.

We need to have access to COVID 19 testing. A single screening test however does not guarantee that tourists are uninfected for the duration of their stay in Hawaii. It is important to open up take into account that there can be false-negative tests for a variety of reasons. As soon as a tourist experiences symptoms, we need to get them tested. If they test positive they need to be quarantined, but Hawaii does not have the resources to enforce quarantine. It depends on the individual’s personal compliance and sense of public health responsibility.

The question is how to achieve the delicate balance of allowing tourists in, managing the behavior of these visitors, and protecting the local population.  The average incubation time is 5-6 days, but we quarantine for 14 because the range of incubation time is 2-14 days.

Question:  We have seen an increase in cases since Memorial Day when people started to socialize more.  What are the most important tips the community needs to know about preventing the spread of Covid-19 at home, and in the workplace?

Dr. Bello:  It is most important to wear a mask and social distance to at least 6 feet or more.  If people could follow these two measures, 100% of the time, many of our problems would be solved.  Unfortunately, people have not done this.  It has worked in communities that follow these guidelines.  In Asian countries, the mask-wearing communities were able to control their rates of infection.  It is not always easy to socially distance in public, at home, or at the workplace.  And Hawaii in particular, where real estate and space are at a premium, it is especially hard to accomplish this.

We live in a state with a lot of multigenerational households and large numbers of people living in small spaces.  Washing hands frequently once after contact with a high touch surface is also important. One doesn’t necessarily need to use antibacterial soap, but it is best to hand wash for at least 20 seconds with physical friction or use an alcohol-based hand sanitizer and rub your hands until the product dries.

Question:  How reliable is Covid-19 testing?

Dr. Bello:  This is an extremely complex question as there are multiple different tests being used when trying to diagnose someone today.

The nasopharyngeal swab tests for the presence of viral genetic material, yet it does not distinguish from a dead or live virus.  This is why the test is most accurate when you have symptoms.  More rapid tests are less sensitive.  How accurate the test is, depends not just on sensitivity, but also depends on the prevalence of the disease, how well the specimen is collected, and how it is handled until it is tested.

It is a huge challenge to make this understood to the general public.  The subtleties of testing are a complex subject matter and the shortages of testing capacity have affected how people test and who are the populations being tested.  Pharmacies have gotten into the business of testing and are allowing patients to self-swab. We have no way of distinguishing if the virus is dead or alive with the current nasopharyngeal testing so the results need to be put into the context of symptoms and exposure. The general public needs to be very careful in testing and interpreting the results.

None of the COVID-19 tests have gone through the usually strict FDA approved testing.  In response to this public health emergency, the FDA has issued an Emergency Use Authorization (EUA) for these tests.

Antibody testing should not be used for diagnosis. Currently, the antibody test cannot be considered as a reliable marker of immunity to the disease. In some early studies, antibodies persisted for 58 days.  We don’t know if having antibodies is protective.  We don’t know how long they last. They cannot be used to ease up on isolation or PPE. Remember this is a 7-month-old disease.

Up to 35-40% of all people with Covid-19 may be asymptomatic and we don’t know how contagious or exactly at what stage they are contagious.

Question:  Once you know you have been exposed to someone who tests positive, what should you do?

Dr. Bello:  Firstly, you need to confirm that they do have Covid-19, and then you should be in self-quarantine for 10-14 days, monitoring yourself for symptoms.  Consult your primary care doctor. If you develop symptoms,  you should also be tested. If you are part of a large exposure or have certain risk factors or have a public-facing job, you should also be tested. At home, you should be in your own room, avoid sharing bathrooms, regularly disinfecting high touch surfaces, wearing a mask, and social distancing to protect others in your household.

Question:  What are your thoughts about opening up the schools?

The major problem we are tackling is that this is a new disease, only 7 months old, and there are no experts, even in the infectious disease arena.  We comb through the CDC guidance documents regularly and even those are sometimes difficult to apply easily.  Recommendations change from week to week and as health professionals, we need to look at multiple sources.

In dealing with Covid-19 we have limited clear scientific information and we need to use large doses of common sense.  Who do we serve? Who are our stakeholders?  The Department of Health has been criticized extensively lately but they too have been dealing with limited resources.  Here in Hawaii, as in the whole country, the disease has been politicized.

Question:   What COVID-19 research opportunities are being conducted in Hawaii?

Dr. Bello:   At the Queen’s Medical Center we are participating in multiple treatment trials.  Most hospitals in Hawaii caring for COVID-19 patients are using the national distribution of the anti-viral drug Remdesivir which is allocated from the state supply. There is widespread participation in the Convalescent plasma treatment coordinated by the Blood Bank of Hawaii donated by the recovered patients which is part of a Mayo-clinic affiliated protocol. There is a study at JABSOM looking at whether a commonly used blood pressure-lowering can prevent severe complications of COVID infection.  We have the approval to start a study in the next few months to look at antibody prevalence in health care workers.

Thank you for sharing your insights, Dr. Bello!

Click link below to download pdf with details how to participate in COVID trials at JABSOM

 Revised Clinical Trial release telmisartan

by Dina Pinos

Dina Pinos is a Canadian-born Greek, former UH graduate student and EastWest Center grantee. Thriving world traveler, seeking to uncover passionate stories to share with and serve the community.