Rekha Murthy, M.D., is vice president of medical affairs and associate chief medical officer at Cedars-Sinai. She oversees patient safety, hospital epidemiology and infection prevention, among other duties. Prior to her current role, Dr. Murthy served for more than two decades as the medical director of the Department of Hospital Epidemiology. As a leading expert in hospital epidemiology, emerging infectious diseases and antimicrobial resistance, she has served leadership roles on state and national committees developing guidelines for infection prevention and control in hospitals.
Despite the considerable demands on her time in the wake of the COVID-19 crisis, Dr. Murthy nonetheless agreed to speak to the Courier about the evolving pandemic, best practices for sheltering at home and the overall outlook for the Los Angeles area.
Beverly Hills Courier: The situation with COVID-19 is changing so rapidly, it’s hard to keep up with all the news. As someone directly overseeing the local response to this pandemic, what can you tell us about how Southern California is faring?
Dr. Rekha Murthy: Based on what’s happened in our community, we’ve certainly seen a continued increase in the number of cases. And it’s important to note that a shift has occurred from the standpoint of public health. We’re no longer taking the approach of what we would consider occasional travel exposure to the virus. We’ve shifted to widespread community transmission. That’s pretty significant and it’s the reason for new measures, such as Safer at Home and social distancing.
What about the lack of testing? Is this still an issue?
There have been a lot of shifts in availability of testing and recommendations are rapidly changing. Also, because of the wide-spread community transmission, the role of testing has changed. It’s mainly now for those already admitted to the hospital and for healthcare workers. Outpatient testing has been reduced, due to issues with availability of supplies and materials needed to perform the tests, including Personal Protective Equipment (PPE).
Aren’t there new, more simplified versions of the test available now?
Most of the tests to date have been swabs collected from the upper airway that have to be collected by someone trained to do that. There are now some home tests that can be helpful in a home care setting, in ERs and Urgent Care. Newer tests coming down the road are looking at immunities and antibodies. Much like we do for other illness, such as measles or chicken pox, these tests can tell us if someone has recently had the infection and if they have antibodies to it.
If someone has developed antibodies to the virus, does that mean they are in the clear?
We don’t know. We can’t yet tell if someone who has had it has long or short-term immunity. The antibody test doesn’t necessarily tell us if someone is protected and for how long. However, it might be used to show how many people, such as healthcare workers on the front lines, have evidence of immunity. That might mean that they maybe are at less of a risk for getting it. We’re evaluating everything at this time.
We all see the dire situation in New York City, with hospitals at the breaking point and resources stretched to the limit. How are hospitals such as Cedars-Sinai adapting to deal with the influx of patients?
We have supplies and equipment for the moment. We’re very carefully monitoring all of our supply chains and are focusing on training and preparation. Many efforts have been put in place, such as the cancellation of elective surgeries and restricted hospital visits. The number of patients coming into the ER has dropped significantly.
The big concern is what is happening in New York, but in California and Los Angeles, we’ve put a number of interventions in place. We’ve also had the benefit of lead time that they didn’t have in New York. We have implemented very strong actions from a public health perspective, encouraging and asking everyone to comply with Safer at Home orders. The sense is that these are the right things to do.
What advice do you have for those who are staying at home, but believe they have developed symptoms?
They should isolate as quickly as possible, ideally in a separate area where they can maintain distance from others. Make sure to constantly wash your hands, cover your cough and wipe down any surfaces that you may have touched. Be careful not to share items like linens and dishes. Do all of that for the period of illness, up to two weeks.
It’s important to remember that most people will have mild symptoms and can be treated with Tylenol, fluids, rest and self-isolation. They should recover as they would with any cold or flu. There is no treatment or vaccine for this virus. So, really the best advice is to self-isolate, do the symptomatic care at home and practice social distancing to reduce the spread to other people and reduce the burden on the health care system.
At what stage should someone seek medical intervention?
If patients aren’t improving at home, if they begin to feel worse or have trouble breathing that is suggestive of pneumonia, then contact the primary care provider. By “trouble breathing,” I mean difficulty breathing performing normal activities that never caused shortness of breath before. For example, if they can’t get from one room to another. The primary care provider may advise them to go to an Urgent Care or Emergency Room if they are really ill. If they are hospitalized, it would be for a pneumonia that’s worsening.
Obviously, it’s hard to predict the exact course this pandemic will take here in Southern California, but can you give us your general sense of where we are headed?
From the standpoint of public health measures, it’s difficult to plan out beyond the next four to six weeks. That’s partly because what we’re experiencing locally is different from what other places have done.
There is no doubt that in the U.S. and in California, all of the data suggest we are on the upswing. The trends of increased numbers are very concerning. We have to prepare for things to get worse before they get better. We are certainly preparing for battle. We’re really ramping up in case the numbers continue to rise. But at the same time, we’re watching to see if the interventions we’ve implemented slow down the pace of new cases. That is the key message here. We have to make sure that we reduce the number of cases occurring. That means social distancing. Keep away from other people as much as possible. Stay away from anyone coughing. Wash your hands, disinfect surfaces, wipe down packages. Pay attention to hygiene. And avoid touching your eyes, nose and face. We need everyone’s help. We need to slow the spread of this illness in the community.
Any other advice you can give to the community at large that is at home, worried and beginning to get stir-crazy?
Be patient. This may be a long battle. Be kind to yourself and to others. One of the positive things is that we’ve seen and heard about so many acts of kindness arising from our current situation. People want to help in so many ways. We have people bringing food to our staff. Members of the community are helping one another. They are developing new social platforms. I do think we are going to experience very tough times, but I believe we are going to get through it.
You’ve spent your entire career in the field of epidemiology. Did you ever think you would experience something like COVID-19?
After 30 years of a career in infectious diseases, I have given many talks about the Spanish Flu. I never imagined I’d be living through this. I think we will all be looking back on this period. COVID-19 will have an impact on many generations to come. But at the same time, we have so much available to us that wasn’t here 100 years ago. The scientific and medical community have made so many amazing advances. It’s inspiring to see how far we have come.