In this No Spin Live 1 on 1, experts discuss strategiesand data to support getting back to work during the coronavirus / COVID-19 crisis.  Dr Tom Wiener of Houston, Texas, is interviewed by Dr. William P. Adams Jr. of Dallas, Tx.  Dr. Wiener succinctly answers a number of important questions regarding the evolution of the COVID – 19 science and data, as well as the premise for getting back to work.

What exactly is a pandemic?

Dr. Wiener explains that a pandemic is specifically defined as a “new” virus that crosses between countries.  The interesting distinction that he makes is that the seasonal flu would be classified as a pandemic every year; However, it is not new and therefore does not get classified as a pandemic.

Is COVID – 19 more dangerous than Influenza?

This is an important question and one that the media and social media has largely handled poorly.  Initially months ago, it was very concerning that the COVID – 19 virus was much worse than influenza, but the science and data have not shown that to be the case.  At the time of this program there is been significant evolution in the data and it continues to evolve in a more favorable way.  Dr. Wiener states that much of the data on influenza is actually more severe than COVID – 19; however, it is not covered in a similar fashion by media and social media sources.  Nevertheless, the perception is that COVID is more severe. Dr. Wiener quotes statistics on hospitalizations and deaths globally and in the United States, both of which show the seasonal flu to be worse.

The other important point that Dr. Wiener makes is on the use of hospital resources.  Much of the strategies with that was originally developed by many countries to “flatten the curve” was based on modeling that has turned out to be untrue by orders of magnitude.  Currently only Italy has outpaced their healthcare system, and there are some important logical reasons of why this occurred.  Even the United States hotspot of New York City did not outpace their healthcare system.  Dr. Wiener makes the argument for that reason it is now time to start thinking about reopening businesses in getting back to work.

Getting back to Work and Surgery

The expert discusses important points about getting back to work in the United States and across the world as well as specifics on surgical cases.

Dr. Wiener provides his current thoughts and algorithm for operative cases.  These include:

1. For big semi-elective cases that carry higher risks, longer surgical times and more potential for complications. He recommends:
   1. initially testing for IgG antibody. If the patient is positive, which represents exposure and immunity proceed with surgery.
   2. If the IgG test is negative then test the patient for the antigen or the virus. If this is negative then proceed with surgery
   3. If the antigen test is positive, obviously wait let the patient recover before proceeding with surgery
   4. also, he discusses continuing typical preoperative medical screening for typical signs and symptoms of infection, including fever, cough, runny nose, loss of smell, diarrhea, exposure to known COVID – 19 patients.
   5. At the time of surgery a temperature is also taken as part of the screening process
2. For elective cases Dr. Wiener makes the point that we don’t routinely test for the seasonal flu.  Thus, he contends that routine testing for elective surgery is not indicated.  Rather, proper pre-surgical screening, as detailed above would be recommended.  He makes the point that there may be certain cases or potential historical items that may lead to pre-operatively testing elective surgery patients.

Finally, Dr. Wiener acknowledges that once a vaccine is available which may be as early as 3 to 4 months from now that all this will be a moot point, and we will not need to do anything more than our typical current process for pre-screening surgical patients.