Lessons Learned from COVID-19

Apr 16, 2020

Dr. Edmond Hooker has seen and done a lot in his 60 years, but he’s never seen anything like COVID-19. The emergency room physician and Xavier professor has relied on his years of medical experience and academic knowledge to make his way through the minefield that is the new landscape of coronavirus patients and their caregivers. Yet he’s highly concerned at how little is known about this disease.

“This is completely uncharted territory, and no one knows when it’s going to get worse,” he said. “Now they’re saying it won’t be quite as bad since people are isolating, but I saw a picture today of a New Jersey hospital and 20 ambulances with their lights on standing by to get into the emergency room. They could not unload their patients. It’s bad elsewhere.”

Hooker is an epidemiologist who has been teaching Xavier students in the Health Services Administration program since 2003. He works a weekly shift in the Emergency Department at University Hospital and also teaches medical students in the University of Cincinnati College of Medicine. 

Since the number of patients coming to the hospital with COVID-19 symptoms began rising over the last three weeks, Hooker has increased his hours both at the hospital and with his students as Xavier transitioned to all-online instruction. Hooker said there’s a lot the experts still don’t know about the novel coronavirus and how it behaves, but there are some key lessons they have learned that he thinks everyone should know.

STAY-AT-HOME WORKS

Social distancing, stay-at-home orders, quarantine, isolation. Whatever we call it, staying away from each other is working. It’s keeping the coronavirus from spreading, he said.

“We are treating COVID patients, admitting them to the hospital and into the ICU, but we have not seen the ramp-up we expected,” Hooker said. “We are ready for the worst but have not seen it yet. It’s a steady stream of patients, but it’s not overwhelming.

“Now the only way to keep it down is to stay home. If we bring everyone out in two weeks, we’ll be like New Jersey. The only reason we’re here looking at a small number is because of the isolation. But I’m worried we’re going to get fatigued staying home. It’s hard for people to be cooped up inside.”

SANITIZING WORKS 

Washing hands, laundering clothes, wiping surfaces, sanitizing everything is also working both at home and in hospitals. As the medical director for a product called the Soteria Bed Barrier used in hospitals to prevent infection from mattresses, Hooker said good sanitation practices everywhere, including at home, can help prevent the spread of COVID-19.

The Bed Barrier is a breathable mattress cover that can be sanitized in a washing machine. Hospitals normally use wipes to clean mattresses between patients, but Hooker said disease can be transmitted if the mattress used by an infected patient is not cleaned properly.

“We actually are trying to provide a better, cleaner surface for COVID-19 patients,” he said. “The barrier goes into the washing machine with bleach before putting it on the next mattress.”

Washing them in hot water and bleach “will kill every virus,” he said. The company that makes the Bed Barrier continues to research its effectiveness in preventing infection.

VACCINES WORK

Hooker said what is happening now with coronavirus is what it was like 80 years ago before there were vaccines for diseases like measles, mumps, rubella, flu and polio.

“What we are seeing right now is a vaccine-less disease,” he said. “This is measles 70 to 80 years ago. You would have an outbreak of measles and people would die. It’s an important lesson that has not been taught for 60 to 80 years. Now the question is will we get a vaccine? Yes but not for probably nine to 12 months, which is ridiculously fast. Normally it takes five to seven years.”

What makes coronavirus especially dangerous is that it is so easily transmitted, and yet there is no way to diagnose it. With measles, you could tell just by looking for the spots on a person. They didn’t need a test. But a person can be infected with COVID-19 for weeks without knowing they have it because they have no or very minor symptoms.

“This is a great example why we need to mandate vaccinations by law and not allow people to have conscientious or religious objections. They put everybody at risk,” Hooker said.

THE VIRUS DOESN’T CARE

One of the mysteries of the coronavirus is how fickle it can be. Some patients sicken and die right away, while others have no symptoms. Older people and those with underlying medical conditions are more susceptible, but medical officials don’t yet understand why some otherwise healthy young people have contracted the virus and died.

“We do know epidemiologically that if you are older you are more likely to die, and if you have conditions like lung and heart diseases, you are more likely to die, and if you are a smoker, you are more likely to get severe COVID-19 infection and die,” Hooker said. “But why the apparently healthy 32-year-old dies, we don’t understand. It is likely a genetic issue or something in the chromosomes that you don’t respond the right way to the disease. We think it also may be the viral load you get.” 

People who practice social distancing and good hygiene are more likely to have less severe disease if they do get it from a small amount of virus on their hands. “But if someone blasts you with a large number of virus particles, you are more likely to die,” Hooker said. “Doctors who intubate are at increased risk of getting severe COVID because they’re getting a huge blast of COVID in the air if they’re not wearing PPE.”

HISTORY REPEATS ITSELF

In his Health Services Administration courses, Hooker teaches about pandemics and diseases and has always used the 1918 flu pandemic as an example. Not anymore.

“I think I’ll switch,” he said. “We will learn a lot of lessons we don’t know yet. It will show that you cannot ignore it and wait until it’s bad. You have to meet it head-on. We could have been way ahead if our government had started doing something in January instead of promising it wouldn’t come. We need to learn you must prepare.” 

One issue is stockpiling supplies like masks, gowns and gloves for health-care workers and ventilators for the sickest patients. He recommends the federal government pay hospitals to store supplies and rotate them so they don’t decay and so the nation is ready when the next pandemic arrives.

“I compare the federal response to (Ohio Gov. Mike) DeWine,” Hooker said. “He said we’re not waiting, and here’s what we should do.” 

ONLINE LEARNING WORKS

Since ramping up to totally online instruction with his graduate and undergraduate Xavier students, Hooker has discovered he’s actually communicating more with them through virtual office hours he set up to ensure he meets with everyone. And though he misses the interaction he has with students during his in-person lectures, he has found that teaching remotely has challenged him to be a better teacher.

“I think my classes will be better because of it,” he said. “We’ll be better at using technology than before. I might give a lecture just on polio or measles, mumps and rubella. It makes you have to be very succinct, and the good professors at Xavier will end up better teachers when we go live again, so it will be a good thing that shook us up a little bit.”

By France Sloat, Office of Marketing and Communications

Read more stories about Xavier on the Front Lines of COVID-19.