One of the main players in Spokane County’s coronavirus response is Health Officer Bob Lutz. Lutz is the person who usually decides whether public gatherings should be curtailed or schools should be closed. I say usually because, in the case of closing schools, he was pre-empted by the governor. Lutz wasn’t ready to recommend school closures in the county.
Lutz says the challenge with this coronavirus situation has been the messaging to the public.
Bob Lutz: “Because of the fact that is so unique and so different for people. This is changing and disrupting their daily routine, not just today, not just today’s daily routine, but tomorrow’s and the next week and potentially the week after that and I would suggest for weeks on end. People do not know how to respond to that and they respond by reacting, rather than thinking through the situation and having a contingency plan. I think the thing I would really like to encourage people to do and think about is preparedness. So my message is not you need to go out and buy 20 pounds of frozen corn and buy a lot of Purell off the shelf. What you need to do is be practical and how do you prepare for doing things differently.”
Doug: “Do you think a couple of weeks is enough? Or are we looking at a couple of months?”
Bob Lutz: “The evidence shows that we are probably looking at 8-12 weeks. I’m looking at 8, 12, 16 weeks.”
Doug: “Are you a believer that the warm weather is going to inevitably help to alleviate this virus?”
Bob Lutz: “Nothing is inevitable. Because we don’t know enough about this virus, I don’t know. I would like to hope and I think that is what everybody is hoping for, but I think time will tell.”
Doug: “Lots of questions about testing and there aren’t enough tests for this. Can you explain what that is all about?”
Bob Lutz: “You come in to see me and you say, ‘Dr. Lutz, I’ve had a fever for a couple of days. I have this cough. I feel tight in my chest.’ I say, ‘Doug, I’m concerned that you may have any number of respiratory infections. We can test for a lot of the viruses and we can test for flu. We can also test for Covid-19. The difference is that I can do a specimen for respiratory viruses and send it to the hospital laboratory at Sacred Heart and get a response in an hour. I can do a test for flu and I can give you a test result in minutes. In this situation, I do the exact same specimen, but I have to send it away. In Washington state, I can send it to the public health lab. I can send it to the University of Washington. Locally, we have Quest and LabCorp, but their sites where they are processing those specimens are out-of-the-state. So they have to transport them back east, southeast. Turn around time, transportation and then you run the test. It’s a couple of days. So the limiting factor for us and, you’ve read about this, you’ve read at the national level, the challenges. There was a video that went viral. Robert Redfield was questioned by a congressman about making testing available and covering it. The reality is the amount of testing that has been done in this country has been hamstringing us from really identifying and recognizing that this infection has been amongst us for much longer than we thought. So we are playing catch up in many, many ways.”
Doug: “And the problem is there just aren’t enough places to process the samples to be able to tell you whether or not a person has tested positive.”
Bob Lutz: “Exactly. Right now, as I said, is very limited. Many state laboratories are doing the test. Some universities. Some companies are doing the test, but it’s not a ubiquitously found test that can be done simply.”
This time, we ask about more about the virus itself.
Doug: “We’ve all gone through the flu and we’ve had various types of flu. What does a patient who has coronavirus feel when they have the coronavirus?”
Bob Lutz: “Coronavirus exists on a continuum of presentations, anywhere from those who never knew they had it to those who, unfortunately, succumb to it. Most of the individuals, 80-85% of individuals are going to have typical cold-like symptoms, where they may be a low-grade temperature elevation. They typically have the cough. They typically have the shortness of breath and they may even have some upper respiratory tract symptoms, like a runny nose or a sore throat. It’s that other 15-20% that’s really concerning. Those individuals invariably are getting hospitalized because they are sick. There was something I was reading this morning: this is very different in how it’s presenting in those individuals who are really sick. They oftentimes have very elevated temperatures, 104 for five, six, seven, eight, nine, 10 days. Oftentimes in the presentation it doesn’t get bad until they’ve had symptoms for days seven, eight and nine. They’re feeling under the weather. They’re feeling under the weather. They’re really feeling under the weather. They need to go to the hospital yesterday. About a third of that 15-20% are actually requiring ventilator support. It gets that severe. And it can go very, very quickly, especially in those individuals who are elderly and have underlying health conditions. This is presenting very differently than flu. There are certainly some strains of flu that could have significant impact, but we’ve not seen a virus like this, other than SARS, other than MERS, related coronaviruses, but a little bit of a different nuance. This is much more contagious than those. It’s not as virulent. It infects a lot of people, but it doesn’t kill people to the same degree. The numbers aren’t as great as they were with SARS or MERS.”
Doug: “So how much can you take from those particular outbreaks to predict how long or how severe this might be?”
Bob Lutz: “At some level, it’s like comparing different types of apples. They taste the same, but not quite the same. You have, in this case, a very contagious infection. They talk about a concept called viral load. It’s literally how many viral particles are present in your system. This is significantly greater than what we have seen with both SARS and MERS. Your body just has thousands upon thousands of these viral particles that make you incredibly contagious. And by making you incredibly contagious, the virus allows itself to be readily transmitted across the community. It’s not going to kill you, but it’s going to make you sick enough that you’re going to cough and sneeze and share it with somebody else. It’s tricky because it really gets around.”
Dr. Bob Lutz is Spokane County’s Health Officer. You can find these this interview segment and the one we aired last hour at our website at SpokanePublicRadio.org.