Here & Now

At-Risk Populations

Frederica Freyberg:

The novel coronavirus is especially deadly for older people with underlying conditions. These people are considered high risk. But what does that mean and what should they do? For answers to those questions and more, we turn once again to Dr. Nasia Safdar, the medical director of infection control at UW Hospitals and Clinics, and doctor, thanks very much for being here.

Nasia Safdar:

Thank you.

Frederica Freyberg:

What first is the circumstance at your hospital in terms of ICU beds filled and patients needing respirators and the like?

Nasia Safdar:

At the moment we’re not seeing that. I think what we are seeing is there’s a growing number of cases around us and so it’s inevitable at some point that will happen. But at the moment, that isn’t the case.

Frederica Freyberg:

You are not currently treating anyone with COVID-19?

Nasia Safdar:

That’s correct.

Frederica Freyberg:

With this outbreak though now a public health emergency and moving very quickly, do Wisconsin hospitals have the capacity and equipment to treat very sick patients with this coronavirus?

Nasia Safdar:

I think it depends. I think to the extent that we can prepare, I think most health systems have developed preparedness plans or collecting supplies and making sure we’re coordinating across institutions to share. It may be if this is very severe, we may not be adequately prepared for the worst possible scenario. But for what we think is likely to happen, I can say we feel we are prepared.

Frederica Freyberg:

How does the declaration of an emergency come into play in terms of your preparedness plans?

Nasia Safdar:

Well, I think it allows for better coordination across systems for sharing of supplies, of resources, of potentially staffing if there was a workforce shortage. For all those reasons, it provides flexibility in managing those crucial aspects of care.

Frederica Freyberg:

Do you expect that measures being taken to limit crowds and universities, for example, going to online classes will allow that so-called flattening out of cases to let hospitals like yours manage smaller waves of patients as opposed to having like a surge all at once?

Nasia Safdar:

I think it’s the only measure we have available to us to allow us to do that. So I think it will be effective. The question is people need to enforce it and adhere to it to avoid these mass gatherings and events where a number of people are congregated together.

Frederica Freyberg:

Is that a concern of yours, that people will just take it lightly?

Nasia Safdar:

I think it’s very different from what we’re used to. We think of a respiratory virus as something that we can easily get over and not succumb to and all will be fine. While that’s the case for the majority of the population, there’s a certain segment that isn’t in that boat.

Frederica Freyberg:

As to those at highest risk, older people and those with compromised immune systems, how dangerous is this for them?

Nasia Safdar:

For that group, this virus has the potential to be very deadly. If you look at the complication rate, the severity of illness, the death rates from COVID-19, it’s that population that is likely to bear the brunt of it.

Frederica Freyberg:

The guidance is that those at highest risk over age 60 and with underlying conditions should self-isolate? Is that right?

Nasia Safdar:

They should avoid mass gatherings. They should avoid public places where there’s people congregating together, yes.

Frederica Freyberg:

When we talk about underlying conditions, what are those?

Nasia Safdar:

So those are any chronic condition: chronic lung disease, heart disease, immune compromise, organ transplantation. Something as seemingly simple as diabetes that a large proportion of the population has. Renal disease or kidney damage. Those are all conditions to be concerned with.

Frederica Freyberg:

What percentage of the population does this represent?

Nasia Safdar:

A considerable and growing population. If you think of just age over 60, 60 and older as a group that’s vulnerable, that’s a large proportion of our population.

Frederica Freyberg:

Well, is there anything that this population can do to try to — other than avoiding mass gatherings to try to prevent this?

Nasia Safdar:

I think avoiding sick people, to the extent that they can. Exposure to someone who is ill, even if it’s a mild illness. So this population is generally taking care of, maybe taking care of grandchildren or family members and doing baby-sitting for their loved ones. This is a time when you want to avoid those activities where you might come into contact with somebody with a respiratory illness.

Frederica Freyberg:

What would dangerous symptoms of this coronavirus look like in this at-risk population?

Nasia Safdar:

So there’s two things that can happen. The early symptoms can be pretty attenuated because their immune system is somewhat compromised. They might not get the very high fever, for instance, that other might. They have to be really on the lookout for mild symptoms. And then in the second week of illness, they might be at high risk of getting complications so they have to really look very closely at their symptoms to make sure they are recovering for what might seemingly be a mild condition but may not really be.

Frederica Freyberg:

What should they do if they see they have these kinds of symptoms, even if they seem mild and just like a little cold?

Nasia Safdar:

I think what they should do is call their health care provider. I don’t recommend people come into the health systems because you put yourself at risk for acquiring something if you do that in a case where there was wide spread community spread of COVID-19. So calling ahead and making arrangements to find out if they need to be tested and then to be tested if it’s appropriate.

Frederica Freyberg:

Dr. Nasia Safdar, thanks very much.

Nasia Safdar:

Thank you.