On Wednesday, Sept. 9, The Dallas Morning News spoke with two medical experts from UT Southwestern Medical Center about the state of the COVID-19 pandemic in North Texas. The conversation, held via conference call, was open to the public. To hear about upcoming calls, support The News by becoming a member.
Excerpts from the conversation, which have been edited for length and clarity, follow.
Anna Kuchment, Dallas Morning News: Thank you to everyone for joining us today.
September marks 6 months since our first positive cases of COVID-19 in North Texas, and we thought this would be a good time to take stock of what we’ve learned about the virus and talk about the road ahead.
We are joined today by Dr. Nancy Rollins, associate dean of clinical research at UT Southwestern Medical Center and Medical Director of Pediatric Radiology at Children’s Health; and Dr. James Cutrell, associate professor of internal medicine in the division of infectious diseases and geographic medicine at UT Southwestern. Thank you both so much for taking the time to talk with us today.
I’d like to start by asking you to talk a little bit about where we are in this pandemic right now in North Texas.
Dr. James Cutrell: So, if we step back a little bit, nationally we’ve seen over 6 million cases since the beginning of the pandemic, and now over 189,000 deaths. If we hone in on Texas, we’ve had about 670,000 cases total, thus far. So, that puts us at No. 2 in the country, and we’ve had about 24,000 cases over the past 14 days. This is based on data from The New York Times' tracker. As we hone in on the North Texas area in Dallas County, we have a total of 74,100 confirmed cases and 948 confirmed deaths. And then when you look at our trend, we really hit our peak in cases in early to mid July. And since then, we’ve seen a gradual trend down in both our number of confirmed cases, as well as hospitalized cases.
When you look at that 74,000 cases we’ve seen in Dallas County, about 7,300 and of those cases have been hospitalized, so about 10 percent. Of that hospitalized group, about three quarters have been under 65. Over half of them have had some other underlying chronic health condition and, strikingly, almost 80 percent of the people who have been hospitalized have been what we would call critical infrastructure workers. So, these are individuals who work in healthcare, transportation, grocery stores, police officers, other groups that had to continue to work throughout the pandemic.
And then when we look at our percent of tests that are positive, we hit our peak again around July 4th, where in that week 31 percent of tests were positive. And since then, again, we’ve seen a downtrend, but we’re still at about 10.8 percent, positive tests for the last week that we have data. So, I think that kind of gives us a little bit of a picture of where we sit right now.
Schools, team sports and heart damage
Earlier this month, Dallas County moved our alert level to orange from red for the first time. What does that mean, and what can and shouldn’t we be doing right now?
Dr. Nancy Rollins: I would caution not to take that change in the alert level to mean that we’re free to go about our usual pre-COVID activities without taking the precautions that we need to, to be safe. Masks should continue to be worn, especially if social distancing cannot be maintained, and people should refrain from putting themselves or their families at risk by congregating in large groups of individuals.
Dr. Cutrell: I would echo everything that Dr. Rollins said and would really just add, I think it’s helpful to understand how those risk assessments work. So, orange designates moderate risk of community transmission, but as the Dallas County website still indicates, practice extreme caution. There’s a task force that was put together at the County level of experts who look at a number of different metrics: Things like our trend over the last 14 days of hospital admissions, deaths due to COVID, availability of testing, a number of different metrics. And if they see a progressive decline in those metrics, then that’s what allows them to move from, say, red, to orange.
In their guidance document, they highlight that it’s really important that people assume personal responsibility and do their own personal self-risk assessment. So, just because we’ve moved from red to orange, if someone is in a high-risk group, or they live with family members who are high risk, it’s really imperative that they do their own kind of personal assessment of what is, and isn’t safe. And then, finally, just I want to echo what Dr. Rollins mentioned, which is that all of the non-pharmaceutical interventions, the so-called NPIs, that we’ve been pushing are still really critical, even though we’ve moved into this orange space. So, you know, a helpful reminder is the three W’s: Wear a mask, wash your hands and watch your distance. It’s really imperative that people continue to do those things.
I have a follow-up question related to school sports: The orange alert-level guidance says that small group non-contact sports like tennis could be considered in groups of two to four people. But to avoid sports like soccer, baseball, basketball, and football, outside of household groups. Yet most schools have restarted sports. So, I was wondering if you could talk a little bit about how high-risk are team sports practiced outdoors, and how should parents decide whether or not to send their kids to sports practice?
Dr. Rollins: I would say the jury’s out on how high risk these activities are. Clearly, the larger the group of kids, the higher the risk. Not wearing a mask increases the risk. And there are also issues related to not just the risk of the individual playing the sports themselves, but the risk of the family members who might be exposed to the kid when they come home from football practice. In terms of there being a lot of conflicting information, I know that that’s confusing for parents, so be intelligent consumers with respect to COVID-related information and consult your healthcare professionals, pediatricians, at the same time. And I would suggest making a decision that’s right for you and your family and what you’re comfortable with.
Dr. Cutrell: Yeah, I would agree with that. I think it’s really a personalized and individualized decision. We certainly have seen examples of large gatherings like choir practices leading to large exposure events. And so that certainly is a concern, although I would say we’re still gathering more data to understand precisely what that risk is. I would also caution people that they may look and see that many of the professional sports leagues have opened up and have started practicing or playing. But many of those leagues are taking extraordinary measures, such as doing very frequent testing of their players, cohorting into groups that are in so-called bubbles, where they’re not interacting with other people.
And so, it’s difficult to extrapolate some of those professional leagues' experiences to what may or may not be the case on a community sports league or community sports level. But, again, I think it comes down to making a personal individualized informed decision for your kids and your family, in conjunction with your healthcare provider as to what’s the right thing to do. And, obviously, that risk will change as the community rates of COVID change throughout the fall and winter.
Dr. Rollins: I would add to that, there was an article that came out recently in which they studied college football players, and there was some concern raised as to whether or not after the kids had recovered from COVID, did they have some lasting injury to their heart muscle? Nobody knows how serious it is, how frequently it occurs. So, clearly, more research is needed around that area, but it is something to be aware of going forward.
And in that study, did they find any injury to the heart muscle?
Dr. Rollins: They did. it’s not quite clear what the incidence was in a relatively small group of football players, somewhere around 15 percent. I don’t know if the peer-reviewed publication has come out yet.
Dr Cutrell: Yeah, I would just add that that definitely is an area of active research, including here at UT Southwestern, to try to help understand what are some of the longterm effects on different organ systems, including the heart, following COVID.
Do either of you have school-aged children and, if you do, what decisions have you made for them around school and sports?
Dr. Cutrell: We have elementary-age children, and currently we haven’t restarted any type of group sports for our family. We’re in the Richardson school district, so we did the virtual school learning for the first three weeks, but we made the decision that, from an educational standpoint, the in-person learning was going to be the best for our two sons. I felt confident that the school district, in consultation with public health, had put in appropriate measures. So, our sons are doing in-person learning as of this week.
Vaccine timelines
Turning to COVID-19 treatments, what have we learned, in the last six months, about how to care for COVID-19 patients?
Dr. Cutrell: I think we’ve learned a lot about the virus and the disease process. We’ve also come to understand that it appears that there are different phases of the illness. So, early on after infection, it seems to be mainly driven by the virus copying itself. Then, as you move into the second week of illness, it appears that patients who get sicker may transition into more of an inflammatory state where their body’s own immune system, in trying to fight the virus, is causing some of the symptoms. We’ve also acquired a lot of really basic, important clinical knowledge and experience from taking care of patients who need to be hospitalized, who need to be on oxygen therapy.
In terms of specific treatments at this point in the pandemic, there’s really two proven treatments. One of those is steroids. A specific one called dexamethazone was shown in a large trial that was performed in the United Kingdom to actually reduce mortality in those who are the sickest with COVID. Since publication of that, most hospitals have been utilizing steroids in the treatment of their patients with COVID, particularly those who are critically ill and those who are in that inflammatory phase that I discussed.
The second medication is an antiviral medicine called remdesivir. That medication, although it hasn’t been shown to reduce mortality, has been shown to shorten the duration of time for symptoms.
Guidelines recommend that that be used or considered in patients who are requiring oxygen, and it seems to be most effective when started early on, in that first week of illness when the virus is still replicating and copying itself.
Those are the two proven treatments that we have. We still have a lot of unanswered questions, and I think, a lot to learn about the disease to help us inform our treatments and our care of these patients.
How noticeable are the effects of these new treatments? In other words, are patients making faster recoveries? Are we able to lower mortality rates?
Dr. Cutrell: Yes, I definitely think that, in line with the clinical studies that we’ve seen, we have seen faster recovery rates or improvements in mortality. But I would say that it’s still been largely incremental. To borrow a phrase from Dr. [Anthony Fauci] to when remdesivir first was announced: This isn’t a home run. So, none of the treatments that we’ve found so far work in every single patient. And that’s why preventing infection is still of paramount importance. But there are treatments that have been proven do provide a meaningful clinical benefit.
Okay, great. There has been a lot of contradictory information about when a vaccine might be available. The CDC has asked states to prepare to distribute a vaccine as early as October or November. How realistic is it that we could have a vaccine this fall?
Dr. Rollins: That’s probably not going to happen. As I’m sure most of your readers or listeners are aware, the nine leading pharmaceutical companies that are bringing the vaccines through development and potentially to market made a collective statement that they will not be compromising the science of developing safe and effective vaccines in order to achieve an earlier date.
The vaccine trials are complicated to run. The data needs to be analyzed. Along the way you need sizable groups of participants who have different states of health and medical conditions. And we’re not going to be there in late October or early November.
In years past, to develop some of the vaccines, like the polio vaccine, took a decade or more in order for the public to have confidence that the vaccines are safe, and I think the government understands that we need to proceed with caution as well as speed.
Realistically, when do you think a vaccine could be widely available?
Dr. Rollins: I’m going to defer to Dr. Fauci on this one. UT Southwestern has been working with a couple of the pharmaceutical companies developing the vaccines. There is no clear release date, from my perspective. So, I’m going to defer to those who know more about this thing on a global level.
Can you talk a little bit about the leading vaccine candidates, the ones that are in late-stage trials now? How do they work, and what is the preliminary data telling us about their safety and efficacy?
Dr. Cutrell: So, there are fully 37 vaccines right now that are in some form of clinical human trials, but many of those – 24, are still in Phase I, which is early development. Fourteen are in Phase II. And there are nine vaccines that are in that Phase III trial stage. And that’s really critical because these are the larger-scale trials that really establish whether or not a vaccine is effective. [The trials are also important for establishing safety], because many of the smaller Phase I and Phase II trials are not large enough for you to be able to detect what could be a safety concern that may show up when we start using this in hundreds of thousands or even millions of patients.
When we look at the landscape, I’ll highlight a few of the different vaccines that are in those phase three trials. Two of the vaccines are what we call adenovirus viral vector vaccines. Basically, what that means is you take a different virus and you take the SARS-CoV-2 [genetic material] and put it inside that virus and then use it to generate an immune response. So, there’s one that’s being sponsored by the University of Oxford and AstraZeneca. And then there’s another one that’s about to launch Phase III trials that’s led by Janssen.
Then, the other large group are what we call RNA vaccines. This takes the genetic material of the virus and, with some special processing, is able to use that to generate a vaccine. The Moderna vaccine, which is also co-sponsored by the NIH, and the Pfizer vaccine are both RNA vaccines.
Now the data that we have so far are from the Phase I and Phase II trials. These basically show that these vaccines are relatively safe in small groups of healthy volunteers and that they generate the types of antibody responses, the types of protective antibodies, that we would want to see in a vaccine, and also that they generate the levels of antibodies that appear to be similar, or even greater in some cases, to what someone who had a natural infection is able to develop.
But we don’t have any data from Phase III studies, again, showing, are these vaccines going to be effective at either preventing people from getting the disease or in possibly lessening the severity of it when they get it. So, it’s really that Phase III data that we’re really looking for as well as that larger-scale safety data.
We have a reader question about vaccines. The question is, “I’ve heard that to be considered successful a vaccine must be at least 50 percent effective, but what does that mean?”
Dr. Rollins: That’s a terrific question. The short-term marker of effectiveness, as Dr. Cutrell mentioned, is whether the participant who receives the vaccine shows an antibody response. There are questions as to how long that antibody response lasts and would the effectiveness of the vaccine also be due to the ability of the body to mount a non-antibody response using what’s referred to as T cells. At this point, the marker of effectiveness is the antibody response, because we are not doing what is referred to as challenge tests, where you intentionally expose subjects to COVID and then see if they become infected.
Dr. Cutrell: I would definitely agree with what Dr. Rollins has said and would just add that, ultimately, a truly effective vaccine would be one that either would prevent the development of disease or [lead to] a more mild disease.
And I think the important thing about vaccine efficacy is that it walks hand in hand with how widely the vaccine is distributed or administered, which is directly correlated with public confidence in the vaccine. If you have a vaccine that’s 90 percent effective, but you have hesitancy or limited uptake, that’s not going to be as effective as a vaccine that’s only 70 percent effective but has a much greater uptake.
When a vaccine does get approved, will that end the pandemic?
Dr. Rollins: No. This gets to what Dr. Cutrell was saying. If only a small portion of the public gets the vaccine, then all those individuals who haven’t gotten it, and who have not yet had the disease itself, are still vulnerable. And so, the pandemic will go on.
Dr. Cutrell: Once the vaccine is approved, that’s really just the starting line for all of the logistics and everything: Distributing and getting the vaccine to the people that need to get it. I think a more realistic expectation is that, once the vaccine is approved and it starts to be distributed, hopefully that will help along with all of the non-pharmaceutical interventions that people are doing. We’d see a gradual decline in cases and a gradual return back to what our new normal is going to look like following COVID.
Do you expect the vaccine, whenever it’s developed, to be an annual injection like the influenza vaccine, or will it be a one-time shot that grants long-term immunity?
Dr. Cutrell: The short answer is we don’t know, because we don’t know how long immunity lasts after natural infection. But based on what we understand from other coronaviruses, it’s most likely that it’ll be somewhere in between those. Very few of our vaccines, measles would be a good example, provide long-term protective lifetime immunity.
On the other hand, the influenza virus is a virus that is constantly changing, or what we call mutating, itself from season to season. That’s one of the reasons why you have to get an annual injection every year, because the strains that are in circulation are changing from year to year. Although we have seen some mutations and some changes in the coronavirus, it hasn’t been at the same level as influenza. And so, we are hopeful that an effective vaccine will last for a longer period of time, but how long that will be is still an unanswered question.
New COVID-19 pills and shots
Let’s turn to talking about other treatments. What other treatments for COVID-19 are in the pipeline right now?
Dr. Rollins: We have research looking into investigational products on the inpatient side, and on the outpatient side. I’m going to defer to Dr. Cutrell on the inpatient side. On the outpatient side, our goal is to decrease the amount of time that patients with COVID shed the virus and are contagious to other individuals and to decrease the severity of the disease and hopefully limit the number of patients who will ultimately end up in the hospital.
To that end, there are several outpatient trials running. One of them is a monoclonal antibody, which in effect gives an individual who’s newly contracted COVID some antibodies before they have an opportunity to make them themselves so they don’t have to wait to mount an antibody response.
It’s an intravenous infusion. It takes about two hours to give the patient, who stays in an outpatient research area for an additional hour and a half. And then they go home. They do some blood draws over a period of four weeks, and they do some nasal swabbing.
There’s also an oral medication that’s called colchicine. This is given to individuals who are at least 40 years of age who have COVID and who have another preexisting medical condition. It’s used as what’s called an immunomodulator. It can prevent that inflammatory stage of COVID that Dr. Cutrell was referring to, which is after the virus itself has been cleared to some extent, but the body kind of goes into a hyper-alert reaction to the infection.
That trial is being run through Montreal Health. UT Southwestern is one of the participating sites, and patients get their medicine and stay at home for that.
The third trial that’s coming online in the next couple days is the use of remdesivir, which Dr. Cutrell referred to earlier. It’s an infusion of the medicine once a day for three days, and the patients go home. But they are followed for a period of time to see if they’re still shedding virus and how they’re doing on an outpatient basis. These industry-sponsored trials are run by the drug companies. The NIH has a number of trials that are also out and new trials coming down the pike, some of which are inpatient and one is going to be outpatient in which they’re looking at combinations of therapy to see if these drugs can be more effective when given together than apart. Dr. Cutrell, how about on the inpatient side?
Dr. Cutrell: Let’s take a step back for a minute. Globally, there are over 2,000 ongoing clinical trials. So, this is an area of active research. And the two main categories are either repurposed drugs – like some of the drugs that Dr. Rollins mentioned that are used for other conditions and are already FDA approved but are being studied to see if they might have a benefit in COVID, and investigational agents. Investigational agents are new medications or agents that have never been approved before, and they target different aspects of the virus or the disease state on the inpatient side.
As was mentioned, we have several studies that are looking at combining the antiviral remdesivir with another agent like interferon, which is an injection of a molecule that helps to fight against viruses.
We also have a trial that’s looking at remesivir in combination with monoclonal antibodies. Again, it’s similar to what was being studied on the outpatient side but now looking at it in patients who are sicker.
There are also trials ongoing looking at different medications that modify the immune system in different ways. We mentioned the steroids earlier, but there are other types of medications that can modulate or affect the immune system. And people are looking at that.
And then there are also clinical trials looking at certain things like anticoagulation, because one of the things we’ve noticed about COVID is that patients seem to be at higher risk for developing blood clots. So, there’s interest in understanding better how we might mitigate that.
And then convalescent plasma is a treatment that has gotten a lot of attention. We have good data to show that it’s safe, but we are still waiting on definitive data to prove its efficacy in what we would call a randomized clinical trial.
And so those are the main categories of treatments that are in the pipeline.
COVID-19 may be starting to spread faster in DFW
Now, looking ahead, I know UT Southwestern has been putting out a forecast that you update regularly about how the pandemic is spreading in the DFW region. What possible pandemic scenarios should we expect this fall?
Dr. Cutrell: Just so that people understand, this data comes both from Dallas County Health and the other surrounding counties about new cases. It looks at hospitalization data. It also looks at available data on things like mobility. So, it tries to integrate a lot of this different data to really define a model that’s fine-tuned. The most recent data suggests that as was already mentioned, the rate of positive tests, the rate of our cases and the rate of hospitalization has been declining, really since the peak in July. What our model is predicting for the next two weeks is that those rates of hospitalization will likely continue to be largely flat or could possibly slightly decline.
One of the important things about the modeling is that things like hospitalizations or deaths lag for about two weeks behind the new cases. So when we’re looking at and analyzing data like new hospitalizations, that’s really reflecting people who were infected two weeks ago or more.
The other thing that the data shows is we are seeing some trends in a metric called the RT, which is a measure of how contagious the virus is out in the community. An RT value above one suggests that the epidemic is likely to increase, whereas an RT level less than one suggests that the epidemic is likely to decrease in a particular community or area.
Our RT value on our modeling throughout most of August was well below one, but what we’ve seen in some of our data is that that number is starting to trend up again. So I think what that highlights is that what’s going to happen in the future is very sensitive to what we all do individually in terms of wearing a mask, practicing social distancing, washing our hands, and doing the other recommended public health measures. When the level of uptake of that in the community has been very high, we’ve seen positive trends in terms of decreasing cases, decreasing hospitalizations. When the uptake of those types of interventions hasn’t been as high, that’s when we’ve seen the numbers of cases rise, like what we saw in late June and July.
The modeling is best at predicting what the next two weeks or so look like. Moving out further than that into the fall, there are a lot of unknown parameters: What are going to be the impact of schools reopening and other things like that. But I really want to emphasize that what the future looks like largely is up to us in our community in terms of how diligent we are in practicing those recommended public health measures. That’s really what will determine what the pandemic looks like in the fall.
COVID-19′s impact on children’s health
Thank you so much. Now we’ll turn to questions from our listeners.
Brian in Dallas wants to know, “Have we seen healthy kids under 12 have adverse reactions requiring hospitalizations in Texas? And do we see disparity between certain age groups in children?”
Dr. Rollins: So, having a pediatrics background, let me answer that one. Kids do get it, however, they get it at a much lower incidence. If you look at the numbers from Children’s Medical Center, which is obviously a big hospital in the area, there have been about 250 cases that have been admitted to the hospital among thousands of kids who have been tested. And the kids tend to stay in the hospital an average of 1.9 days.
And it averages from less than a day to a few kids who have gotten quite ill and have been in the ICU for upwards of three months. The kids who are getting it tend to be kids with preexisting medical conditions, not exclusively, but over 50 percent of them have been kids with preexisting medical conditions. And then there is the rare but worrisome child who gets this inflammatory response to COVID. That can be a week to a month after the child has been exposed. In terms of who is most vulnerable to getting COVID or the complications of COVID, there are similarities with the adult population: High BMI, preexisting medical conditions, delays in seeking medical care for kids who are ill and in fact do need to be seen by a physician.
So, in short, would you say that healthy kids can have adverse reactions but that it’s rare?
It’s very uncommon. It happens, but it’s very uncommon.
Great. Thank you.
Here’s a question about elementary schools: “Has there been any confirmation of spread of coronavirus in elementary school children, from school back to their homes?” And the listener would also like to know about the risks of coronavirus to pregnant women and to newborns and infants.
Dr. Cutrell: There certainly have been cases of coronavirus in schools among different age groups. And there always is that risk that children could spread it to those at home. Now, there was a nice study that came out of Asia that suggested that children under the age of 10 most likely were less prone to spread the coronavirus to others whenever they got infected. However, kids that were in the age range of 10 to 19 appeared to be just as likely as adults, if not a little bit more likely to spread it. So, it does appear that the younger kids, although they’re still at risk of getting it may be a little bit less likely to spread the virus to others. But that doesn’t mean that the risk is zero.
As for pregnant women, they do not appear to be at a higher risk of acquiring the infection. But if they do get infected with COVID, it does appear that their risk of being hospitalized or of requiring ICU care may be higher when compared to non-pregnant women of the same age. There doesn’t appear right now to be an increased risk of death, but the numbers in the studies that have been published so far are still somewhat limited.
And then in terms of risk to newborns and infants, there does appear to be a slightly higher risk if a mother gets infected in her late trimesters of premature birth. Beyond that, we haven’t seen any definitive evidence of birth defects or other things like that related to cases. But this is an area of active research and our OBGYN colleagues and our pediatric colleagues here are actively following that at our hospitals, as well as updating any guidance that may come from research from elsewhere.
Contact tracing in Dallas
Thank you. Ernest in Dallas wants to know: "Was there ever a serious attempt in the D-FW area to contact, trace and isolate people infected with COVID-19? And if not, why not?
Dr. Cutrell: I think it’s a great question and really highlights the importance of contact tracing to controlling the spread of the virus. UT Southwestern, Parkland and many of the hospitals and the community have been working in partnership with the public health authorities to contribute to contact tracing. We’ve also been involved in different ways in outreach to the community to try to do that more effectively.
I think one of the significant challenges at the beginning of the pandemic was the limited availability of testing. And even when testing was available, the fact that oftentimes there may be delays of five days or longer in terms of getting a positive test with this virus. What we find is that if you’re diagnosing, if you’re getting a positive test back a week or two later, you’ve missed your window to effectively do contact tracing and to isolate people who may have become infected before they become contagious and start to spread the virus. Now, as testing availability has become better, as turnaround times are improving for testing, that is really a key component to be able to do effective contact tracing and isolation. But it’s something that our public health authorities and healthcare systems take very seriously. And we still are very actively participating in the contact tracing endeavors.
How quickly is the coronavirus mutating?
We have another question about the virus itself. The listener would like to know, “Has the virus mutated, and do you expect it to do so? And what would that mean if does mutate?”
Dr. Rollins: I would say that the reports of mutation are fairly rare and that, fortunately, the virus does not appear to be mutating rapidly. That’s not to say it won’t happen in the future. But that gets to a question asked earlier as to whether or not the vaccines would be annual or not. And that would depend in large part on the behavior of the virus with respect to its spontaneous genetic mutation.
Dr. Cutrell: I definitely would agree with Dr. Rollins. The virus does not mutate or change at the same rate as what we see with, for example, the influenza virus. And, Importantly, we haven’t seen the virus changing to the point where we would expect that either the medications that are being developed or the vaccines that are being developed in the short term would be rendered ineffective. Now, whether over the course of several years the virus could mutate or change, that remains an open question.
COVID-19′s short- and long-term impacts
Jackie in Dallas would like to know, “Is there research to follow up on potential longterm impacts on individuals who appeared to be asymptomatic at the time they contracted COVID? And is it possible that those with mild or asymptomatic illness could still develop conditions that do not present at the time and yet may be related to having contracted the virus?”
Dr. Rollins: The multi-system inflammatory disorders that we’re seeing in kids that have been reported across the world, the cases are relatively few in number and the kids have had mild disease or may have been asymptomatic. The only way we know that they’ve been exposed is because there have been a parental exposure or antibody tests drawn that show the kid has been exposed. In terms of following up on the potential long-term impact on individuals who got it but were totally asymptomatic, I’m not aware of any trials or studies in that direction.
Dr. Cutrell: Yeah, it’s certainly an area of interest. It’s easy to forget that this actually just started back in January. So, even the people who got the earliest disease are still less than a year out from that. The long-term impact that this has on individuals, both physically but also psychosocially, are going to be important things that we’re going to be studying for decades.
Different research groups here at UT Southwestern are interested in looking at what are the long-term outcomes related to COVID, for example on the cardiovascular system.
I would also highlight the efforts, not so much in terms of research, but just in terms of clinical support, our physical medicine and rehabilitation department here started what’s called the COVID Recovery Program. This is for patients who have recovered from COVID, they’re no longer infectious, but they’re maybe still dealing with a number of different complications related to their disease. This is a multidisciplinary program that includes things like neuropsychiatric testing, sleep assistance, rehabilitation and a number of different facets to really address the fact that many people, even after they’ve recovered from their acute illness, still have ongoing symptoms. One study suggested that as many as 60 percent of people still have one or more symptoms 60 days after the illness. And so, definitely, I think there’s a lot to learn.
Thank you. This listener would like to know why are diabetics at higher risk? If a person has their diabetes under control with medication, are they still at higher risk of worse outcomes?
Dr. Cutrell: I would say that it’s probably not yet known. Diabetics may be similarly at risk to [those with] other risk factors like cardiac disease and hypertension. We certainly know that uncontrolled diabetes can affect the body’s ability to fight off a number of different infections. And diabetes, sometimes if it’s poorly controlled, may affect the body’s overall inflammatory state.
But I would say at this point, most of the research that we have suggesting that diabetics are either at higher risk to get infected or to have serious disease are at the level of observations or associations. We really haven’t figured out yet what are the kinds of scientific mechanisms underlying why certain patients may get a worse disease than others.
Another pitch that I’ll put in is, here at UT Southwestern we’ve started a registry and a biorepository. Any patients at our hospitals who develop COVID, who are interested, we have a mechanism by which we can save, with their consent, obviously, specimens including blood and other types of tissue to allow some of those long-term scientific studies to be performed, to understand why do certain people get more severe disease than others. So, there are a lot of really important, basic, fundamental scientific questions that still remain unanswered.
That answer is a great segue to this next question, which will be the last one that we have time for today. This listener wanted to know, “How can one participate in the post-COVID studies exploring the long-term impact of COVID on various organs?”
Dr. Rollins: Patients who are treated at UT Southwestern can be referred to the COVID long-term clinic. Those who have not been patients at UT Southwestern will need to call and get a referral to that clinic.
Dr. Cutrell: I would encourage people to check out our website where we have listings of ongoing research clinical trials, and those will be constantly updated with new opportunities if people would like to participate in that.
Thank you so much for joining us today. Do you have any closing thoughts before we let you go?
Dr. Rollins: I would say we’re in this for the long haul. We look back on the pre-COVID [days] and say, “We want to go back there.” I don’t know if we will and when we will. So, it’s a paradigm shift that affects literally every aspect of our lives.
Dr. Cutrell: I would just echo that. I’ve been telling people from the beginning that this is a marathon not a sprint. The mindset of not losing heart, not giving up hope but persevering in the things that we know work is really important. I find joy and hope in the fact that we’re in this together as a community. The medical community of Dallas-Fort Worth has really joined together to fight this virus as well as the larger, broader community. And so we just appreciate the fact that we’re in this fight together and that we can get through this as long as we stick together. So, I just want to say that we are privileged and honored here at UT Southwestern to be a part of this community and to contribute in whatever ways that we can.
Thank you so much to both of you, and thanks so much to our listeners and readers for joining us today.
More information
Those interested in outpatient clinical trials can call these numbers:
UT Southwestern Medical Center: 214-648-7494
Baylor Scott & White Health: 888-50-RESEARCH
Baylor Scott & White has information on its clinical studies here.
UT Southwestern lists clinical studies here.
Find the latest news on Coronavirus from The Dallas Morning News here.
/s3.amazonaws.com/arc-authors/dmn/48acf957-65d5-416b-b137-7a67843e41e3.png)