Who gets sick from COVID-19 — and who doesn’t?

In a special mini-episode of Eat Move Think, guest host Dr. Peter Nord interviews infectious disease expert Dr. David Kelvin

An expert in infectious disease, Dr. David Kelvin is a Canada Research Chair at Dalhousie University’s Faculty of Medicine and cross-appointed as a director at the Institute of Infection and Immunity in Shantou, China. He’s just been given a million-dollar grant to develop a medical test designed to predict whether a given person will experience a mild, moderate or severe case of COVID-19. Medcan Chief Medical Officer Dr. Peter Nord spoke to Dr. Kelvin to learn what people can do to minimize their risk of experiencing a severe form of the novel coronavirus.

This transcript has been synthesized and condensed for readability.

PETER NORD
You’ve been doing quite a bit of research and just received a million-dollar grant from the government to help you expedite the search for a method of triaging patients diagnosed with COVID-19. What do you hope to accomplish with this?

DAVID KELVIN
Well, a little bit of background history here. We — I have a research group that also works in China in addition to the group that we have here in Halifax, and we have good friends and colleagues in Wuhan. So early in the epidemic in Wuhan, my colleagues contacted us with some very alarming stories on the number of patients who were going into the emergency room. And one of our colleagues who works in the emergency room sent back some very alarming pictures of a thousand people waiting to get into the emergency room. Now that presents a really big problem for how to partition resources within the hospital.

For example, if you have a thousand patients, you have a limited number of hospital beds, and you have very few ICU beds. And seeing those patients, you have to make rapid decisions on who’s going to be sent back home with a mild illness, who is going to be hospitalized for one of the few remaining hospital beds, and who’s going to be allowed into ICU for treatment who have critical illness. So our idea was very simple: Let’s use biomarkers to try and help the doctors in the ER room make a decision on who should be given those valuable hospital beds or ICU beds.

PETER NORD
And how quickly can that test help?

DAVID KELVIN
Well, right now it’s in the study phases, so it probably takes a couple of days to do the turnaround time. But our goal is to turn it into a point-of-care device that can give us a readout in 20 minutes. So we’re really hoping that in about six months’ time, we can work with point-of-care device manufacturers, and have a product that can aid the doctors in making those valuable decisions.

“We’re pushing hard for a device which you clip on your finger and could give you a readout [for] one of three groups: mild cases, severe and critical.”—Dr. David Kelvin

PETER NORD
That’d be tremendous. You know, we talk about flattening the curve. I know I get asked a lot of questions about, you know, what are we doing on the social distancing? If it’s going to be so prevalent a year from now, why don’t we just sort of get it over with? And of course, the answer is, we don’t have enough healthcare resources to go around, and by slowing down the process, we’re just taking the pressure and smoothing out the pressure on the healthcare system, so that instead of it being a crisis for a couple of months, it’ll be a bit of a slow burn over the next, you know, six to 12 months. So your research would definitely be helpful in that regard. So are you working with device manufacturers?

DAVID KELVIN
Yes. Simply put, we are. So we think that’s a very promising area. But I just wanted to add an important item for this triaging event: While we have lots of resources in Canada and in North America, and even in Europe, we see that we’re very concerned about the burden that a surge of patients are going to have on our hospitals. We also have in our research network, many teams working in resource-poor countries, such as Africa. An example would be the Sudan. And we really think that a point-of-care device, which might be different than the type of point-of-care device here in North America, would be very, very beneficial for aiding how to triage patients in Africa.

PETER NORD
That’s really exciting. And would those be a swab or is it a blood sample or tissue sample? What is — what are you thinking about?

DAVID KELVIN
Yes. The easiest thing that we can see right now is a blood sample for something that would operate in North America for looking at biomarkers from, say, peripheral blood. But we’re also pushing hard for a device which you clip on your finger and could give you a readout, and would help assess who could be partitioned into one of three groups: mild cases, severe and critical.

PETER NORD
You’re part of an international research network, which includes countries such as China, Italy, Spain, Morocco and Sudan. Are you looking for ways to advise on the best options for your prospective country, or develop more of a worldwide mandate by coming together?

DAVID KELVIN
The simple answer is both. On the one hand, we hope to coordinate activities in all of the different sites, and also have communication strategies so that if, say, a therapeutic worked in China, then we could rapidly give the information to other countries. On the other hand, we expect that we’ll probably see differences with different populations. The population in Canada, we’re a relatively rich country, whereas a country once again, like the Sudan, where the financial status for many people is small, there will be many differences not only in ethnicity, but probably in co-diseases. For example, in the Sudan, many people have a burden of parasites. And we think that people who are co-infected with a parasite, their immune system will operate differently than the immune system of people in North America.

PETER NORD
In terms of pandemics, we’ve had SARS, we’ve had bird flu, West Nile, HIV and now COVID-19. How would you compare at a high level the COVID-19 pandemic compared to previous outbreaks?

DAVID KELVIN
Well, the first thing that I think is important to note is that each pandemic is different. Now, for COVID-19, what we see is that the elderly and the elderly with underlying diseases are the highest risk group for fatalities. So that — that doesn’t entirely set it apart from other pandemics, but it certainly focuses our attention on a very specific risk group.

PETER NORD
But is there anything else that can predict if someone’s going to become more sick with COVID-19?

DAVID KELVIN
There’s a lot of speculation that perhaps the dose of infectious virus that you get early on is going to be proportional to your disease status. And that would be things like, how much virus you got when somebody sneezed in your direction, or coughed in your direction. If you’re very close up, then it would be a lot of virus, but if you’re further away, it may be less.

So [based on that,] the three things that I would suggest that people do to try and improve their chances for a mild illness are, number one, try and keep your distance away from other people. Even if you know that they’re not sick, you have to remember that many people have the virus, but they show no symptoms. So try and keep your distance from other people. And number two, stay away from crowded areas. And the third one is, a good healthy lifestyle is vitally important to surviving many of these illnesses. For example, get good exercise. Eat well. A good healthy diet is important. And also some little things like vitamin D, make sure you get sunlight and have a good source of vitamins if you think that your diet is not sufficient.

PETER NORD
Well, that’s really fascinating. Obviously, we’re in the early days of this particular pandemic. It’s hard to believe that it’s only been about 10 weeks that we’ve been really hunkering down and learning. Your work sounds fascinating, and maybe we’ll circle back to you in the next couple of months and see how it’s all going.

DAVID KELVIN
Thank you very much. That would be really great. I’d be more than happy to talk again when we have more data and see what’s happened to the pandemic.

 

Shaun Francis is Medcan’s CEO and chair. Follow him on Twitter @shauncfrancis. Connect with him on LinkedIn. And follow him on Instagram @shauncfrancis. Visit Shaun’s podcast at www.eatmovethinkpodcast.com. The podcast is produced in conjunction with Ghost Bureau.

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