Cardiologist, Dr. Alison Bailey, of Kentucky and Tennessee responds

This interview took place on March 28, 2020.

Splitting her time between her home in Chattanooga, Tennessee and her work in Frankfurt, Kentucky, Dr. Alison Bailey is faced with helping her cardiology patients stay protected from and informed about the coronavirus. In this interview, Sally Hendrick and Dr. Bailey discuss the differences between the responses of the citizens and governments of both Tennessee and Kentucky as well as how the healthcare system is pivoting to the needs of patients during this time.

Guest bio:

Alison Bailey, MD is a cardiologist in Chattanooga, TN.  She is very involved in public health and focuses on both the prevention and treatment of cardiovascular disease.  She is the Governor of the Tennessee Chapter of the American College of Cardiology.

Read from March 27: 800,000 Physicians Pen Letter Asking Trump Not to Lift Social Distancing Guidelines Too Early

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Transcript:

Sally Hendrick (00:00):

Hi Allison. My name is Sally Hendrick. How are you doing?

Dr. Alison Bailey (01:14):

I'm doing great. Sally, how are you?

Sally Hendrick (01:16):

Good. Good. Thank you so much for meeting with me today. I am excited to talk to you about what's going on because you're in Tennessee. I'm in Tennessee and I'm speaking with people from all over the world about what's happening with the COVID-19 coronavirus pandemic response. The thing is here and we've got something we have to deal with and potentially manage and it's spreading all around. And I wanted to ask you a little bit about, you know, what are you doing? Like what kind of doctor are you and what do you do?

Dr. Alison Bailey (01:53):

Yeah, no, that's great question Sally. And I'm glad you're doing this. So I'm a cardiologist which means I take care of people who have heart disease and we know that patients with heart disease seem to be having a higher risk of having a bad outcome if they get this virus. So I actually specialize in heart failure, but I see all sorts of different patients now. I live in Chattanooga, Tennessee, but I'm actually working in Kentucky right now. And so it's been pretty eye opening to me to see the difference between the two communities as well as just sort of as the,uthe response of the leaders in both,States,uhas been different.

Sally Hendrick (02:32):

Yes. And I noticed that the other day there was a press conference from the Kentucky governor talking about what was going on in Kentucky versus what was happening in Tennessee. So it's very interesting perspective that you have both of that. So thank you. I'm glad that, that I know that. Are you working at all in Chattanooga right now? Well,

Dr. Alison Bailey (02:54):

I am not working in Chattanooga right now. I am working in a, in Kentucky doing cardiology both in inpatient and outpatient. And I can kind of explain to you what we've done there, if you have any interest in how it's affected our daily practice.

Sally Hendrick (03:07):

Yeah, definitely would like to know what's going on with that.

Dr. Alison Bailey (03:11):

Yeah, no. So so I work at a hospital and starting last week we moved to tele-medicine for the majority of the patients. So in the past you could do tele-medicine, but there was some pretty strict legislation about that. And so CMS and Medicare last week loosened that up and so it was able, you can actually do it over zoom over Facebook messenger, me over FaceTime. And in the past you couldn't use any of those methods to do a virtual visit. It had to be a HIPAA compliant software, but we know it's the right thing for our patients, especially for these routine followups. You know, if you have heart disease or heart failure, you need your routine follow up. I mean that's what helps keeps you out of the hospital. But write law office and get around people, you can't be socially distant. So we started doing that last week and by this past week I would say we were at 95% telemedicine visits where you still kept the office open. So if someone was really ill they would, we felt they would be at lower risk coming into our office and going to the ER where all of the patients with COVID are going. But the overwhelming majority of our visits have been via just like this, the video or for our patients that don't have video. We've been doing phone visits because we feel like that's safer for our patients. Otherwise.

Sally Hendrick (04:30):

Now if they have symptoms of the COVID-19 are you then telling them on the phone what they need to do to make sure they isolate themselves?

Dr. Alison Bailey (04:41):

Yes, we, you know, the, I found that a lot of our visits we've talked about COVID as much as their chronic coronary artery disease or their heart failure. And we have, you know, from, from my perspective, based on everything I've read and what the CDC has recommended if you have fever, chills, myalgias the same sorts of things, muscle aches and pains that you would get with the flu, you should basically probably assume that's COVID. And you know, the people who really get into trouble, about 80% of people will have a mild illness that don't need to be in the hospital, not, you know, 15% will be more ill and about 5% will require critical care services. Things like I see using ventilators. And all of that seems to be associated with chest pain complaints and shortness of breath. So I've been telling people, as long as you don't have shortness of breath or chest pain, I think you're okay at home if you have some way to monitor your oxygen level and a lot of our patients do because, because there's so much virtual technology now, as long as your oxygen levels are staying, you know, within a normal range I would say, you know, above 92% it's probably okay to be

Sally Hendrick (05:48):

Now. Do you know how long, if they are potentially holding this virus, how long is it before it passes that they can step out of this self quarantine situation?

Dr. Alison Bailey (06:00):

Well I think it's still, we don't really know is what I would tell you is that is the true answer. If you look for healthcare workers, you know, most places were saying seven days from the onset of symptoms, you know, after the symptoms have gotten better before you would come back around and then you would need to wear a face mask. It probably depends on where you go. I would say as long as you can stay away from other people, the better. There's been some data that people can shed the virus asymptomatically or without symptoms for up to 30 days after an infection. Wow. Yeah. And you know, I think we think the median is probably a week or so, but you know, we don't really, we don't really know. We're learning more about this every single day.

Sally Hendrick (06:41):

Okay. So in other words, the people that are not showing those symptoms, and I've heard this, I've heard super shedders yes. Is that what it is and the super shedders are passing this around potentially for, you know, longer periods of time or for at least not knowing that they're passing it around. Maybe they don't even have any symptoms ever. Is that possible as well?

Dr. Alison Bailey (07:07):

That's possible. You know, I mean, it's, it's a sort of springtime in the South here, so something, most of us have a little bit of allergies or a sniffly nose, you know, everything's blooming out, especially as warm as it is right now. And so it's hard to know. Some people have a very mild illness, you know, when you go back and look at antibodies, I didn't really even know they were sick. And so that's what it's part of. What makes this social distancing so important because most people will be spreading the virus before they ever have a symptom. And so, you know, you may think you feel fine, but you're out there and you know, at a party like the bike, some of these, as I was driving through college campus, I saw some, a lot of you know, groups of 10 or 15 people out, relaxing college kids was probably not a good idea. Okay,

Sally Hendrick (07:53):

I understand. And of course we've heard a lot in the news about the spring breakers that were in Florida over the last couple of weeks and so forth. Now as far as the, you work, you're working in Kentucky, but you're from Chattanooga, so are you living in Chattanooga right now and going to Kentucky for your practice?

Dr. Alison Bailey (08:12):

I am. I am. You know, I'd been in Kentucky for three weeks and last week came back for a weekend and sort of the same thing now and I'll be gone for a couple of weeks. You know, right now there aren't travel restrictions. You know, I'm anticipating that if things get worse, that may happen and I may end up having, you know, having to stay in, in Kentucky. The governor of Kentucky had actually made a statement yesterday advising Kentucky is not to visit Tennessee. And how I saw that, I think it was yesterday, was one day this week because there weren't the same sort of movements containment I think that they've seen in Kentucky. Right.

Sally Hendrick (08:49):

So what are you seeing personally, like from a personal standpoint when you are at versus when you're in Kentucky? Do you see a big difference there?

Dr. Alison Bailey (08:59):

Yes. So I drove the set for two weeks. I've driven from, from Kentucky a Frankfurt, Kentucky to Chattanooga and it's all been interstate and it's been pretty dead. I mean, the city is, there's not very many people there, you know, restaurants were closed last week or, or dining rooms. The week before last, and so [inaudible] in Kentucky and Kentucky and salons and gyms and all that were closed last week as well. And so when you're driving around during the day, there's just not very many cars, you know, almost a lot of people with everyone. But non-essential and workers have been moved to telework if possible. And so there's just not very much traffic. You know, I'll go out and take a walk every evening and there's very few people out moving around. And then when I came back to Chattanooga, when I was, I was driving back to Chattanooga between, I would say Knoxville and Chattanooga, it seems like a normal amount of traffic to me. I mean, it's no different than what it normally was. And when I'm on the interstate coming from Kentucky, there's, there's really not that many, not that much traffic. It's that very palpable difference. But what about

Dr. Alison Bailey (10:06):

Streets in Chattanooga as far as people moving around?

Dr. Alison Bailey (10:10):

Yeah, so you know, I honestly, I was over on the sheller fork red shot of town last week, which is one of the busier sides. And I couldn't tell much of a difference. I mean, it was pretty busy. It was the middle of the afternoon, it was about two 30 and there was a lot of traffic and a lot of people going around, you know, moving around hood. I, you know, I can't tell, I mean there's people out walking around, but everybody seems to be, you know, trying to stay away from each other. I haven't seen large groups of people, so, you know, I think, I think it's probably in neighborhoods. It seems like people's doing a better job.

Sally Hendrick (10:44):

So, and all of this, I know that, you know, we're not in a situation here in Tennessee or in Kentucky yet where it's, you know, like it is in New York or Italy or whatever, which are really scary stories coming out of there. So what is your biggest fear about this? Of what could be happening in the next two or three weeks?

Dr. Alison Bailey (11:05):

Yeah. You know, so I have a lot of friends in New York. Chicago is also hard hit right now as well as Seattle and California. And then of course, Louisiana's, you know, new Orleans and then Atlanta is getting hit pretty hard right now as well. And so, you know, what, what, what it seems is all of those places are such taught living structures that it's hard to be socially, it's been much harder to be socially distanced. And that's when the virus spreads so rapidly when people are in close proximity. You know, so what I hope doesn't happen is that we see in, in more rural areas or areas that aren't quite as urban as those places that we take for granted and it isn't going to happen here and that we have over-prepared and then people become very lax. And then we start seeing rapid spread.

Dr. Alison Bailey (11:56):

You know, the, the, if you look at modeling, I'm not an epidemiologist, but if you look at epidemiologic modeling, the peak is not supposed to happen until probably early may. And that's still, you know, weeks of time for us to continue this social distancing. And so our hope is that we have over-prepared and it never comes, that tsunami of patients coming in to overwhelm the healthcare system never comes. And when we can say, Oh my gosh, we ever prepared, that would be the best case scenario. But what I fear is people are going to become lacks of being in the house and staying away and you know, they aren't going to see as many sick people as we thought early on. Like not every place is going to be New York. Not every place is going to be a new Orleans and then people become lax again and we don't do what we should because the problem is, you know, we're, we're already short on these personal protective equipment and that's going to take a while to replete that population.

Dr. Alison Bailey (12:49):

And you know, you go through a lot of those with each of these patients and not just in a normal setting in a hospital.

Sally Hendrick (12:55):

How many would you go through in a day? Like let's say you had, how many patients do you normally have anyway in a day?

Dr. Alison Bailey (13:02):

Um it probably depends on where you're at. If you're in an ICU or if you're on the floor, but if you're, you know, if you're safe, you're in a typical 10 bed ICU, which is, you know, a smaller side of an ICU and each patient has, you know, a concern for COVID. So the problem is multifold right now we can send the test, but in most places the test is taking five to seven days to come back. So even the people that you suspect you have to, you have to pretend that they're positive and use all of that aggressive personal protective equipment instead of for patients who are positive, requires the most equipment.

Dr. Alison Bailey (13:36):

And you really, you know, want to be careful because it lives on surfaces for up to 72 hours. And so you want to be careful and everybody wears a gown, gloves. And in 95 respirator, which is the special one that filters out the microns, especially if you're doing anything that is has aerosolized or you know sputum or anything coming out in goggles or a face shield and probably a hair net if you want to be the site, you know, something over your hair if you want to be the safest. But if you think about every single time you go into a patient room, you have to do that and then coming out, you have to take all of that off and try not to touch yourself with everything and then dispose of it for each patient. For each patient, you have to change every time you go from right.

Dr. Alison Bailey (14:23):

And you know,

Sally Hendrick (14:26):

Oh my gosh, cause nurses are going through it how many times a day?

Dr. Alison Bailey (14:30):

Multiple, multiple. And then if you have a patient that's having breathing difficulties, you have more members of the care team. So what, you know, what every hospital is trying to do is to simplify care as much as possible. So if I know I need labs checked, try to get the labs checked just once a day or put everything together so that when the nurse goes in there to do bottle signs and you know, give medicines, they can do the lab draws and everything with just one set of equipment. But you know, it's really thinking about things like that. And it is a, you know, it is a big ordeal, especially when you know, someone's COVID positive to make sure you don't touch yourself with any of the materials you're taking off.

Sally Hendrick (15:07):

Right. Well and then what I would think about too would they, you know, you're coming in as the doctor and the nurses are coming in, the respiratory therapists are coming in and, and all of the people and imagine being the patient and seeing all of that, that's got to be an incredibly difficult emotional experience for the patient.

Dr. Alison Bailey (15:35):

Absolutely. You know, and, and hospitals aren't allowing visitors right now, so the patients are by themselves, you know, we're trying to do, you know, CMS has also allow for virtual consults. So I can do a consult over a phone to stay personal protective equipment. Right. Unless there's some reason I need to go physically go in the room and touch the patient, which would cardiology. Sometimes there is sometimes when we do need to, sometimes we do need to listen. But you know, we're really trying to minimize the number of people who go in the room because it's a potential exposure every time.

Sally Hendrick (16:06):

So knowing all of these things that you guys are having to change as far as the care and, and you know, multitasking and putting more things within one visit to the room do you think that that's going to potentially change the way that healthcare is looked at later on? That maybe some efficiencies would come out of this? Like you think that there's like a hopeful thing that could come out of all of this?

Dr. Alison Bailey (16:33):

I think so. You know, hopefully one of the things that I think, you know, I've been using tele-medicine for years but there's so many restrictions on it from a regulatory standpoint. We haven't had wide adoption of tele-medicine, but hopefully, you know, just tele-medicine services can expand. When you're in a state like Tennessee where we have a large rural population that frequently travels long distances to come see us for sub specialty care.

Dr. Alison Bailey (16:58):

Especially I'm a subspecialist or cardiologists, there tends to be primary care doctors in most communities, but there's not always cardiology. You know, I'll have patients that'll come an hour or two to see me for a checkup. Hopefully we can expand and do more of that over the phone. And then even providing services to rural hospitals. You know, that's one of the challenges with a lot of these small hospitals are critical access hospitals. They don't have sub specialists subspecialists because the, it's not very large and you don't have enough patients to see. But hopefully we can expand into that. And then, you know, hopefully we also understand the importance of the being prepared and having a nationwide disaster system. You know, I think this is, has shown that we really do not have a great way to handle a national emergency in a unified way from our medical systems.

Sally Hendrick (17:45):

That's true. And then all of this, you know, running around to try to find the right equipment and so on and so forth to equally share where it's needed or equitably share where it's needed so that you don't have stockpiles sitting in New York if you need it in Memphis or Louisiana or whatever and that, and people don't know where everything is. If there was some sort of national data bank or something like that where you had all of that information keyed in, then that would be an opportunity I would think to improve on our entire healthcare system.

Dr. Alison Bailey (18:23):

No, I agree. You know, while if you look at the numbers that are expected, we probably have this shortage of all of these things just overall, but there's huge, huge gaps. You know, like right now we don't need any ventilators in New York has a huge shortage of ventilator. So if we had a very well coordinated system, we would ship all of our ventilators to New York. And then as things, as we got more ventilators, we would replace them in these other and other places. We don't have anything like that. And you know, with the technology we had today that, I mean it would require setting up a system, but it would be a, it's a possibility.

Sally Hendrick (18:57):

Okay. Well, thank you so much for talking with me today. Is there anything at all that you want to share in addition to what we already talked about that that we could share with our viewers and our listeners?

Dr. Alison Bailey (19:09):

Yeah. You know, I think while it's hard to be socially distant as the right thing, you know, hopefully we'll all realize that, that we don't need all the things that we thought we did it right and get, you know, and hopefully we'll get to enjoy some time with our family and, you know, be outside and do some of the other things that we kind of forget about. The other thing I would say is, you know, I've been stilloverwhelmed by the kindness and support of other people. It's still really nice, you know, being in the hospital, even when people are really afraid and scared, you still see lots of tiny, tiny acts of kindness all day long. And I think it's important to remember that, you know, especially in these times when we're all fearful and we don't know what the future looks like. So remember, we're all people and let's try to treat each other with kindness.

Sally Hendrick (19:54):

I agree. Thank you so much. Thank you so much. I really enjoyed talking with you today.

Dr. Alison Bailey (20:00):

Yes, me too. Thank you. And I hope this turns out well.

Sally Hendrick (20:04):

All right. Thank you.