Episode 12: What You Need to Know About COVID-19 with Dr. Alicia Arbaje

HERE ARE JUST A HANDFUL OF THE THINGS THAT WE'LL DISCUSS:

• What can people do to keep themselves safe
• What do people need to know if isolating themselves is a challenge
• What are some of the critical things to know about COVID-19

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Ben Christy:

This is Ben Christy. Today we have a very special podcast. You might even say we’re breaking format to hear from a special guest from John Hopkins about what baby boomers need to know about COVID-19, about the COVID-19 pandemic. So joining us today, we have Dr. Alicia Arbaje. She is the director of transitional care research at John Hopkins. Of course, John Hopkins is really taking the center stage for certainly reporting on the coronavirus and they’re the experts. They’re diving in to make sure that they communicate to Americans with exactly the numbers and what’s going on.

Ben Christy:

Dr. Arbaje specializes in geriatric medicine, and she’s also studied public health and even worked to design healthcare systems. So this is somebody who knows her stuff. So Dr. Arbaje, thank you for speaking with us today via the phone. I know you’re extremely busy, so thanks for taking a moment to give to us.

Alicia Arbaje:

Thank you so much. Thank you for having me.

Ben Christy:

The numbers are staggering. Both in the numbers of cases and in the death toll. John Hopkins actually has a coronavirus dashboard with the latest numbers and many of you guys have already seen on there, seen that. You can find that if you haven’t at coronavirus.jhu.edu. Could you talk a moment about why those numbers are growing so quickly and how much worse you think things are going to get as we go forward?

Alicia Arbaje:

Yeah. The numbers are really staggering. I think one of the reasons we’re seeing the numbers going up is because we now have the availability of more testing kits. The more testing we can do, the more we can find out who really has this condition. Before, when there was less kits available, we didn’t really have as good of an idea as to how many people were already infected. So I think that’s one of the main reasons why the numbers are going up.

Alicia Arbaje:

I think the second reason is because there really are also more infections. It’s not just that we’re identifying them. We haven’t reached the peak of the number of people that we think are going to be infected. So I think we’re looking at another good, I would say, three or more weeks of seeing when we reach this peak. It could be longer. I don’t think it will be shorter because there are still parts of the country that haven’t really started to see a lot of cases yet though. That’s changing day by day.

Alicia Arbaje:

So I like to stay optimistic, but I do like to also stay realistic and think that we’re looking at least several more weeks before we start to see the full number of people that are really dealing with this illness.

Ben Christy:

Well, let’s back up for just a moment. When did you first start paying attention to the coronavirus, to COVID-19? And as someone who specializes in the health of older people, when did this really pop up on your radar specifically?

Alicia Arbaje:

I think like many people, I was starting to hear about this in the winter time, like around December, and becoming very concerned about what was happening in Asia around this and thinking about, personally, whether to start restricting travel and so on and so forth. Then I think it really starts to hit me more around late January, early February, that this was looking to be pretty serious. Especially starting to see what was happening in Italy, which still to this day is mind boggling, what we’re seeing there.

Alicia Arbaje:

That is what concerns me now, as we start to move into seeing the peak starting to occur, or moving towards that peak here in the United States. I was doing a hospital rotation back in the beginning of March. And then it really hit me that we needed to make some major changes in the way we were taking care of patients, both outside in primary care and outpatient care and in the hospital setting. That’s when things really became very clear and we as a health system really started taking major action to try to improve things. I think we were seeing that across the country, as well.

Ben Christy:

What’s given you the most concern during this pandemic? When you think about the health of people that you help, is it the way it’s transmitted? What gives you the most concern about the coronavirus?

Alicia Arbaje:

I think a couple of things. One is sort of on the medical/biological side and the other is on the social side.

Alicia Arbaje:

I think on the biological side, what really concerns me is how transmissible this virus is. It’s much more transmitted miscible than the influenza virus. And I think at first we thought that maybe they were similar. It’s not quite as transmissible as some of the most efficiently transmissible viruses like measles, which is highly, highly contagious. But it’s pretty close in terms of how easily it’s spread. So I think that concerns me. And I think the fact that it has rapidly… Someone who gets infected who’s very vulnerable, they are rapidly declining. So it’s not just like, maybe in a couple of weeks you might get worse. It’s over the matter of days where, people like five days, where people are starting to get hospitalized and shortly thereafter in the intensive care unit. So I think the fact that it’s so virulent, meaning so pathogenic, so likely to create really serious complications and people pretty early on, I think is concerning.

Alicia Arbaje:

Then the other part of the biological side is that for people who are vulnerable and getting serious illness, we don’t know a lot about this yet, but it looks like this virus also create some pretty serious damage to the lungs for people that do survive it. So we are going to need to learn a lot more about the longterm adverse consequences.

Alicia Arbaje:

Then I mentioned the social side. I think the things that concern me most in this aspect is that I think early on a lot of people weren’t taking it very seriously, partly because we didn’t know a lot about it, and partly because I think we were getting conflicting information, I think in the media around… And frankly, from our public health authorities about how serious to take this virus. I think now I think that’s not the case anymore. I hope it’s not. But I think that delay in taking this virus seriously put us as a nation and us just individually, I think, at more risk because we did not ramp up testing as quickly as we had hoped. So, that concerns me.

Alicia Arbaje:

The final thing that concerns me on the social side is that for our most vulnerable people, our older adults, and for others who have social isolation or limited resources, this is a virus that creating social isolation is key, but we don’t have a lot of the safety net. Many communities don’t have the safety nets in place to help deal with providing needed services to these people in isolation. So. Like our older adults, like our homeless population, like people in rural population and rural communities. We need to really test how well we can deliver services to these vulnerable groups. So, that concerns me as well.

Ben Christy:

That’s good. Very informative. Let’s talk about what those vulnerable groups can do to really keep themselves safe.

Alicia Arbaje:

So what I tell anyone, especially those of my patients who are older, and most of my patients are over 65, many are over 80, is that the best defense against this virus or any other infection is to maintain yourself healthy. Healthy aging is your best defense. And what do I mean by that? Remember, our immune system is what really is at the front lines here in dealing with anything that comes our way, and the way to best improve your immune system is to keep yourself healthy through physical activity of any kind. But even if it’s up and down your stairs, now that you can’t easily get out of your house, or walking around your neighborhood, that could be. But exercise is key.

Alicia Arbaje:

I think people really need, this is what I’m advising, really as best they can need to strive for nutritional excellence. I don’t mean just like, well, let’s eat a few more fruits and vegetables. I mean nutritional excellence, which is at least 10 or 12 servings of fruits and vegetables daily, if they can. Right? I know that’s hard. Can be frozen, it can be fresh. But really fruits and vegetables. It’s not just like, Oh, they’re good for you. They’re actually critical for your immune system. Vitamin C and other vitamins that are in micronutrients contained in fruits and vegetables. So really thinking about doubling or tripling your fruit and vegetable intake, and that may not even be enough. So I really want to emphasize the need to increase fruits and vegetables.

Alicia Arbaje:

And then to avoid that debilitate the immune system. So, in particular, foods like eggs and dairy are highly debilitating to the immune system. They are phlegm producing. They’re inflammatory foods. And for people, especially who have chronic illness, these are not foods that provide nutrition in a way that’s beneficial to folks who have chronic illness. So I really encourage people staying away from those foods. I know it’s a hard time right now to get the foods that you may want, but to the extent that people are able to move towards plant based foods and especially fruits and vegetables.

Alicia Arbaje:

I also tell people to maintain their hydration. It turns out that dehydration is one of the top five most common reasons why older adults end up in the hospital, just in general. And then viral illnesses dehydrate you because they cause fever. So maintaining hydration. So just like the fruits and vegetables, drink more than you think you need to drink. And it turns out that fruits and vegetables, especially when consumed in their raw form, really help with hydration cause they contain a lot of water inside of them. So really maintaining your hydration.

Alicia Arbaje:

And then the final thing on staying healthy is… So that was all the biological and the physical part, but then remember, we’ve been talking about the social aspect. To make sure they’re staying connected, folks are staying connected, with their social networks, even if it’s in a distanced way through technology or telephones, because that helps. We know that good social connection enhances our resilience and our immune system. So this isn’t just about feeling good. So, we like that. It literally has a biological benefit.

Ben Christy:

All right, Dr. Arbaje. Let’s talk for a moment a little bit about some of those who still have to go to work. Maybe someone who acts as a caregiver for their grandchildren and maybe they’re a healthcare provider. What are these folks need to know if isolating themselves is more of a challenge?

Alicia Arbaje:

I think a couple of things, one is specific to this pandemic and then the other sort of general good advice. I’ll start with the general.

Alicia Arbaje:

The general good advice for anyone at risk or taking care of someone who’s at risk is to take the moment now to prepare an emergency information kit and contingency plans for if they got sick. What do I mean by that? An emergency information kit are the list of all your health conditions, the medications you take, who your healthcare providers are and, importantly, who your healthcare decision makers are if you’re not able to make decisions because you’re too sick. Also if there are preferred hospitals or skilled nursing facilities where if you needed to go, you could go, to have a list of those as well. So I think it’s really important for people to always have that updated now, even more than ever. That’s kind of the more care coordination side of things because when you don’t have that information in an emergency, more mistakes can take place.

Alicia Arbaje:

Specifically for the individuals now, I say if you have to get out there, or if you’re taking care of somebody who you’re worried about might be at risk, I think that you should consider things that may make a lot of sense, like wearing a certain outfit just for work and changing out before coming home. Or if you’re caring for someone wearing a certain outfit like scrubs or something that’s easily washable and changing out of those clothes before coming home, or as soon as you get home. Then limiting the amount of jewelry that people are wearing that are not essential. Because again, that’s more stuff that you have to clean.

Alicia Arbaje:

If you have longer hair that you can put up, I would put your hair up and cover it if possible. And then wearing glasses instead of contact lenses, because glasses provide a little bit of an extra shield. It’s not a hundred percent, obviously, but it decreases the need to rub your eyes or touch your face and provide somewhat of a barrier.

Alicia Arbaje:

And then keep in your car, if you’re going out, keep in your car either some disinfecting wipes or just some paper towels with in a spray bottle of cleaning solution so that you can wipe down key surfaces of your car on the inside, like the steering wheel, et cetera. And once you get home to kind of just wipe down the area you’ve just walked into. Then if people have access to gloves, to keep those around for when they’re in transit. And then as soon as you get home, shower, change, if you haven’t been able to do that before getting home. Do that before going and seeing people.

Alicia Arbaje:

Now, I just want to be clear that these are recommendations that are sort of general. We don’t really have a lot of clear guidance yet as to what we need to really do specific to this virus, because we don’t have enough information yet about this virus and how long it sits on surfaces. There are some early studies that are showing that the coronavirus can be detectable maybe even up to three hours in the air and definitely on surfaces. Up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. So what does that mean? It means that even if you do all these things I’ve just been saying, that you want to make sure you clean and disinfect common surfaces in your home often.

Ben Christy:

Dr. Arbaje, you’re probably aware of this even more than we are, but there’s certainly a lot of what we’ll call misinformation out there. Let’s speak real quickly. If you could boil it down to just a couple of things, because there’s all sorts of information getting shared on social media. What are a couple of things that are absolutely critical for everybody to know and understand with what’s going on with COVID-19?

Alicia Arbaje:

So the first thing, as I mentioned earlier, take this seriously. Even if you’re pretty healthy and feel like you don’t get sick that often, you could still infect someone else and be carrying the virus. So take it seriously and perform these precautions even if you feel like you’re okay. Other point is this idea about doing like saltwater, gargles, or other kinds of home remedies, I think it’s okay if people want to do those, in addition to the things that we’re already talking about. I don’t want people to think that the home remedies that are out there are cures for this problem. Certainly do them if you think they’ll help, but do not let that be a false sense of security for you. I’m a big promoter of natural and alternative medicine options. But I think until we know more about this virus, we don’t want to limit ourselves to just those options.

Alicia Arbaje:

The third thing I would say is to avoid dangerous self-medication. So I would not take any additional medication that isn’t something you’re already prescribed for. Over the counters are especially dangerous for older people. Things like anti-histamines are already medications we don’t recommend for older adults. Nonsteroidal anti inflammatories, which are our ibuprofens and our Naproxyns, are fine in short term, but I would not use that longterm, nor if you thought you had a viral illness. So those are things I want to make sure are clarified.

Ben Christy:

Thank you, Dr. Arbaje. We certainly appreciate your time and we thank you for what you’re doing. You’re certainly on the front lines there. We appreciate everything that you’re doing to help Americans to get through this. It’s certainly been a pleasure talking to you.

Ben Christy:

So again, if you’re looking for more information, you can go to coronavirus.jhu for John Hopkins University. Again, coronavirus.jhu.edu is where you can find the dashboard on the coronavirus, on COVID-19. A lot of resources on that site, including answers to some frequently asked questions and some of the coronavirus myths that are floating around there. It’s going to break down the myths versus the facts. Again, that website. Coronavirus.jhu.edu.

Ben Christy:

Well, thanks for tuning in and listening to the Beacon Retirement Strategies podcast. Appreciate the good doctor coming on and helping us keep up to speed on what’s most relevant here. Of course we know retirement can be a complex time. There’s a lot of things going on. We hope this helps you get some more information, in this case about COVID-19, but be sure and see our other episodes for retirement topics like RMDs, like social security annuities, risk income planning, more. Until next time, this is Ben Christy signing off. As always, we wish you a happy retirement. Remember that peace of mind in retirement requires a plan.

Ben Christy:

Investment advisory services offered through Beacon Capital Management, LLC. An SEC registered investment advisor. Beacon Capital Management, LLC is neither an affiliate or subsidiary of TD Ameritrade Institutional, Fidelity Investments, Beacon Accounting and Tax Service, or Night Legal.

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