Tom Kellond Transcript:
Victoria:
Hello listeners. Welcome back to the next episode of Ask a Scientist. We have a very special episode for you today. As everyone probably knows we are in the middle of the COVID-19 pandemic. There’s a lot going on with it, and everyone has a lot of questions. So here with us today to answer some of those questions is Tom Kellond, a retired respiratory therapist from Stanford Hospital. He’s had an amazing career working in the hospital, and he’s going to answer all of your questions about COVID-19, and how patients with COVID-19 are cared for when they go into the hospital.
Tom, thank you so much for joining us today.
Tom Kellond:
Well, thank you. It’s nice to be here.
Victoria:
Is there anything you’d like to add about your career or your background for the listeners?
Tom Kellond:
Well, respiratory therapy was actually my second career, so to speak. I graduated from the University of California at Santa Cruz with a baccalaureate in psychology, thought I was going to be headed in that direction. But I went into a business world, work for a top fortune 500 company, General Electric, which was in the top five at the time, doing employee relations.
And it was after meeting my wife, that I began looking at that and wondering if that’s really what I want to be doing for a career. And the answer came back, no, no. The question was, what other options did I have? So after doing an assessment, it turned out that I had more geekiness than I ever anticipated. And, respiratory therapy seemed to fit that. Because it had physics, chemistry, biology, and it also dealt with interacting with people. And that’s really what I wanted to do was help people.
Victoria:
Oh, that’s awesome. Lots of great science it sounds like in respiratory therapy.
Tom Kellond:
Well, yeah, there’s, I worked with a great group of folks, many of which are still there, and they just celebrated their first anniversary of their brand-new hospital a couple days ago.
Victoria:
Oh, that’s exciting.
Tom Kellond:
It is exciting and it’s great that they had that new facility. They have a lot of the things that they need currently in the pandemic with regard to being able to care for patients that have COVID because those patients require being in an isolation room, and the hospital is almost exclusively a single room.
Victoria:
Oh, wow.
Tom Kellond:
So they’re, they’re able to also adjust the, air pressure within the room, to make it positive or negative. And generally speaking, in cases, when you have somebody with tuberculosis or COVID, or the flu, you put the room in a negative pressure situation. So that’s, that’s how that’s done.
Victoria:
Oh, wow. And then that does the negative pressure make it easier for them to breathe. Is that what that’s for?
Tom Kellond:
No, it’s actually so that, the small droplet particles that contain the COVID virus do not travel outside the room and posed a danger to staff and other people that are walking in the hallways.
Victoria:
Oh, that makes sense. Yeah. Sounds like they got in the new facility, like just in the nick of time.
Tom Kellond:
Well, it’s a technology that was developed, gosh, back in the eighties, when I arrived at Stanford and Dr. Shumway was doing transplant surgery, mainly heart transplant. And those patients, just the opposite would be put into rooms that would be positive pressure, so that any organisms that might be circulating out in the hallway would not be meandering into the room and posing a problem, because the transplant patients are given a drug that suppresses their immune system.
Victoria:
Oh, yeah, that makes sense. So keep things out or keep things in.
Tom Kellond:
Right. But those same rooms and the technology behind it, they were also able to later serve as isolation rooms for people that had infectious diseases that needed negative pressure environment.
Victoria:
Oh, that makes sense. Well with that, I think that segues really nicely into some of our COVID questions. these questions were submitted by fourth graders from Bromwell Elementary in Denver, Colorado, and a few from listeners through emails and social media.
So we’re going to start off with some general questions about COVID-19 and then we’ll get into some more of the specifics about COVID-19 in hospitals.
Tom Kellond:
Okay, I’ll do the best I can.
Victoria:
(Sari – What is COVID -19 really?)
Thank you. This first question comes from Sari. What is COVID-19 really?
Tom Kellond:
Well COVID-19, it’s a novel coronavirus, or a virus for short. And novel just means that it’s a virus that had not previously been identified or known. And so the reason it’s called COVID-19 is because it was discovered in 2019.
Victoria:
(Brody – Can you get COVID from an animal?)
Okay. I think that segues nicely into Brody’s question. Brody wants to know, can you get COVID from an animal?
Tom Kellond:
Well, no is the short answer. But until we learn more about the virus, and how it affects animals, should probably use similar precautions for pets and other animals in facilities as you would other people, just will protect both people and pets from the virus.
Victoria:
Okay, that’s good. So social distancing for pets as well as humans.
Tom Kellond:
Well, if it’s your pet, it’s, you know, it’s in your social bubble, so to speak, it’s like being with your mom or dad or brothers and sisters. If you know, where they are and where they’ve been, it’s easier to track the lines and figure out where the infection, if there ever is an infection, comes from. If the animals never leave your house, it’s really not an issue. So people with house cats or dogs that only go out on a leash, it’s not an issue.
Victoria:
(Wade – How is COVID made or created or grown in the body?)
That’s good. I have a house cat, and he stays inside all the time. So that is good to hear for him.
And that segues nicely into Wade’s question. How is COVID made or created or grown in the body?
Tom Kellond:
Well, the virus can’t exist alone by itself. It actually needs a host in order to reproduce itself. And the way it reproduces itself is through the protein making engine that the human body possesses. So it kind of hijacks that and uses that in order to make more copies of itself.
Victoria:
(Jude – How does it actually kill people?)
Oh man. Yikes. And that can be followed up with Jude’s question. How does it actually kill people?
Tom Kellond:
What I found in looking was it actually seems to stimulate the body’s immune system sometimes overstimulating it. And that’s what causes the high fever that many people experience with it, low blood pressure, and destruction of small cell structures found lungs, kidneys, and liver. The other thing is that when the body’s immune system is activated, there are all kinds of different formed elements that are in the bloodstream that aren’t normally there. Most people are familiar with white blood cells: they’re the ones that go and fight bacterial organisms. They don’t have really enough any effect against a virus, but they are there nonetheless. And that amount of material in the bloodstream poses a problem to organs that had very, very fine circulatory systems. So that amount of, organisms can get clogged in portions of the lung or the liver or the brain, and that poses a problem.
And part of that is the body trying to fight the virus off. But it’s also the body’s reaction in sometimes having an inflammatory response, which closes off airways and really impedes air circulation. So oxygen doesn’t get in, and the CO2 doesn’t get out.
Victoria:
Oh. And that’s why so many people have respiratory problems associated with COVID, right?
Tom Kellond:
Yes, sometimes known to create pneumonias. And in that situation, the general overall picture is you have difficulty breathing. It’s harder to breathe. It’s like somebody came up behind you and put their arms around you and started squeezing you. And then you try and take a deep breath and they squeeze even harder. And then you try and take that deep breath again and it’s even harder to do that. So it’s, it’s resistance in the lung to airflow.
Victoria:
(Addy – Why is COVID so deadly?)
That sounds pretty terrifying. This next question is from Addie. Why is COVID so deadly?
Tom Kellond:
COVID is deadly because it’s so easily passed from one person to another. Also the way the virus interacts with the body’s biological structure is not really something that is easily dealt with, say a common cold or the flu. In that, COVID could go from zero to 60, very rapidly, meaning you could feel fine one day, and the next day you got a raging fever and you’re very short of breath. What I’ve heard is that kind of saps their energy and takes their breath away.
Victoria:
(Paden – In what kind of environment does COVID spread most easily?)
Speaking of COVID spreading, Paden wants to know in what kind of environment does COVID spread most easily.
Tom Kellond:
I saw that question and I thought to myself, Paden, and that’s an excellent question because that really kind of hits to the point of why it is so dangerous right now and why things are happening or recommendations are being made. Because there are a lot of recommendations that are being made and everybody thinks, Oh, this is pretty scary stuff. And it is. Because this is the kind of stuff I used to see fairly often in the hospital, except this isn’t in the hospital, it’s outside the hospital.
And basically, an environment, that doesn’t have good ventilation is a place where COVID can be suspended in those tiny droplets and then that air is breathed in. So the coronavirus is known to stay active, suspended in tiny droplets in the air. And that’s why the social distancing and that’s why the masks are recommended.
And once the virus is breathed in, it gets into your lungs. Because your lungs are the only organ aside from your skin that has direct contact with the atmosphere.
Victoria:
Wow. That’s crazy to think about that your, your lungs are in direct contact with the atmosphere. Cause I think they’re like, they’re inside me. How can they do that? But yeah, when you breathe in that’s, that’s the atmosphere.
Tom Kellond:
It is. And that’s why so many people have problems with allergy. And some people had problems with asthma. People have problems with smoke, which we had a lot of smoke here in California and there in Colorado and many other Western States this year. The air quality was very poor.
Victoria:
Yeah. There was a couple of weeks there where I would go outside and I would just start coughing and sneezing. It was bad.
Tom Kellond:
Well, some of the smoke you could actually see. And so from that standpoint, it’s not like COVID in that. You could actually see what you might be breathing in. You couldn’t actually see the small particles, but you could see that the air wasn’t clear, like it normally is.
Victoria:
(Gavin – Why does COVID go for the lungs?)
Yeah. Speaking of the lungs. We can go on to Gavin’s question. Why does COVID go for the lungs?
Tom Kellond:
Well, in military terms, the lungs are a target of opportunity, and it’s probably the easiest route for COVID to get into the human body and begin reproducing itself. It’s at body temperature, it has a tremendous blood circulation.
Victoria:
(Paden – Is the reason for the loss of taste and smell related to your neurological system?)
Yeah. That makes sense. And then this is another interesting question from Paden. Is the reason for the loss of taste and smell related to your neurological system?
Tom Kellond:
Paden, another good question. And that one is still being studied. The short answer would be yes. Why that is? They are still looking at that. And they usually don’t find that information out until they begin looking at the people who have died from COVID that have complained of those symptoms. Because some of them have had brain scans in the past, and they can scan those brains and see structural changes that might’ve happened, as well as examining the tissue to try and figure out what, how COVID affected the brain.
Victoria:
(Brody – What are your recommendation for staying safe?)
All right now we’ve got some questions about how to avoid getting COVID. And this first question in that category comes from Brody. What are your recommendations for staying safe?
Tom Kellond:
Staying safe.
First thing is taking a deep breath and relax. A lot of people are very, very stressed about that very question.
The simple answer to that is good hand washing, and that means probably more than you’re used to.
Not touching your face, at any time after you’ve touched any surface.
If you’re going to be out, socially, take a mask with you.
And get at least six feet more if you can get it from people, and that’s not only for your protection, it’s also for their protection. So we need to have kind of a mutual respect for one another’s health.
The short answer though is staying in your bubble. If you’re home with your parents, you know where your mom and dad go, or they’re staying home and commuting to work, you know, by computer. And you’re doing your schoolwork online. That’s about as safe as you get. It’s when you start getting friends wanting you to come out and play. And you want to get out and do things. And if you don’t know where your friends have been. You’ll never see COVID coming. It’s completely invisible. So you, if you don’t know where your friends have been, or whether they’ve been in contact with anybody that might have been positive or anything like that, it’s probably a good idea just to try and figure out ways that you can maybe touch base with them, FaceTime or Zoom or something like that, and stay in touch. I have friends that I do that with and it’s been very helpful.
Victoria:
Yeah. I Zoom at least once a week with a group of friends every Monday evening we do in Zoom.
Tom Kellond:
It’s good for mental health. It, you know, we’re social people and we need that interaction.
Victoria:
(Paden – Are certain medications or vitamins protective against COVID?)
Yeah. That makes sense.
This next question comes from Paden. Are certain medications or vitamins protective against COVID?
Tom Kellond:
At this time, there’s a great deal of promise with regard to the information that’s come out, regarding the vaccines from Pfizer and Moderna. I think there’s another pharmaceutical company that has also come out with their vaccines. But as yet, there’s not been any authorization to distribute those vaccines. And we don’t have any real-world data as to how those people react once they received the vaccine.
So, any vitamins or hydroxychloroquine, that’s all just kind of people grasping for straws. It’s not a clinically proven method for dealing with COVID.
So. Best thing is to eat right, get some sleep, try to interact with friends in a way that you don’t come into contact with COVID, and it’s going to be a waiting game. It’s a marathon instead of a sprint.
Victoria:
That’s a good metaphor. I like that.
Tom Kellond:
It’s a very long marathon.
Victoria:
Yeah.
Tom Kellond:
Well, I say that because, every year, there would be a flu season, typical flu season. And there at Stanford, it was always a very high demand for our service, both out on medical floors and in ICU’s. So the workload jumped dramatically and it stayed up. But in this case, COVID hit and that work level jumped up. It has not backed down since March. And so, doctors, nurses, respiratory therapists, occupational therapists, everybody that’s in the hospital that deals with patient care has been like on high alert. And it’s difficult to maintain that focus and alert status and care for patients while watching out for yourself.
The interesting thing that I did learn is because of all the gel that’s being used on hands and the hand washing that’s going on, the infectious disease spread of MRSA and VRE, which are opportunistic, drug resistant organisms, that rate of infection has actually gone down.
Victoria:
Oh, wow.
Tom Kellond:
So that’s a bit of a rainbow on top of the dark cloud of COVID.
Victoria:
Yeah, that’s incredible.
Tom Kellond:
Not all facilities, but I mean, most report because everybody is just being extra vigilant with regard to washing their hands, gelling their hands, using personal protective equipment, which is what PPE stands for whenever they say it on the news. In case folks were wondering what is PPE? Can I get that?
Victoria:
Yeah, that’s good to know. Personal protective equipment.
Tom Kellond:
Yeah. So those are the masks, gowns, gloves, the hats, the booties.
Victoria:
(Mae- Is it possible that COVID only spread to one person but that person wasn’t careful and spread it?)
Yeah. All right. We can move on to our next question. This is from Mae. Is it possible that COVID only spreads to one person, but that person wasn’t careful and spread it?
Tom Kellond:
Well, that’s pretty much the nature of COVID. You never see it. You never know if you’re got it until you have that fever, and shortness of breath and all the other signs and symptoms that go with a COVID infection. But during the, sometimes three to four days before that happens, you can spread the COVID virus to others that you come in contact with. And you may not know that, they might not know that. Well, it’s very stressful and it’s like, you’re always looking over your shoulder, kind of thinking you’re going to see the boogeyman, but you can’t see the boogeyman. It’s just, just know that the boogeyman is there.
Wash your hands, gel, don’t touch your face, and eat a balanced diet, and get plenty of sleep.
Victoria:
(Ella – Should you wash your masks after every time you wear them?)
That’s a good goal for how to live right now. I think this next question is a good follow-up to that. This is a question from Ella. Should you wash your masks after every time you wear them?
Tom Kellond:
If your concern is that high about COVID, sure, go ahead, wash it. The worst thing that can happen is that when the mask will wear out from all the washing that you give it, and you need another mask. But if you feel safer and your mind is at ease, doing that, do that. That’s where you, where the rubber meets the road on that one, because it has to be a good decision for you.
And if it requires bringing your parents into it or friends do so, share that, don’t keep the feelings in on how you’re dealing with COVID and the threat. Because, those feelings, if you don’t discuss them, you don’t talk, or let somebody know about, it’s gonna wear on you. It’s gonna gnaw at you.
Victoria:
(Lauren – Do you recommend people purchase a pulse oximeter for home monitoring? Is it effective/worth spending money on?)
That is good advice.
All right, this is our last question at the how to avoid getting COVID category. This question is from Lauren. Do you recommend people purchase a pulse oximeter for home monitoring? Is it effective and worth spending money on?
Tom Kellond:
If you’re into tech toys, Go for it. If you have the budget, they’re not cheap, but even in the hospital, pulse oximetry is used mainly as a what I would call a trending device, by that I mean, it kind of gives you an idea which way the wind is blowing or the patient’s going. So to speak, if the patient had an oxygen saturation of 96 in the morning and you go in and you find them at 89 and the probe is connected properly. And the patient looks a little bluer than you remember. It’s probably accurate.
But as to whether or not it’s worth the, you know, buying something like that, it gives you a number and it probably gives you, you know, most of them give your heart rate as well. But there is a margin of error, no matter which pulse oximeter you might choose.
Victoria:
Hm. Does COVID specifically affect the blood oxygen? Like would that be something you could recognize or would it not really show up as much of a change?
Tom Kellond:
I think you’re probably more likely to experience the fever and shortness of breath before you would, you know, be by that time, the pulse-ox would just confirm your suspicions that yeah, the, my blood oxygen levels lower than what it normally is. But that said that doesn’t necessarily lock a diagnosis of COVID, because COVID has a lot of general symptoms.
Victoria:
(Andrea – What are the risk factors for ending up in the ICU?)
With that, why don’t we move on to our next section of questions? These are questions about having COVID and being cared for in the hospital or being in the ICU.
And this first question comes from Andrea. What are the risk factors for ending up in the ICU?
Victoria:
Well, risk factors. Generally, if you’ve already got, what would be considered pre-existing conditions, a cardiac history, a diabetic history, a problem with obesity, if you have high blood pressure issues, these are all things, whatever things existed before COVID got introduced to your system, it’s only going to make those things worse. So it will decrease the amount of oxygen to your heart, which is gonna be a problem; which decreases the amount of oxygen to the rest of your body, which is also a problem; which decreases the amount of oxygen to your kidneys, which is still a problem because the kidneys and also the pancreas very important with regard to insulin regulation. So those are the things that really, if you can’t go anywhere without oxygen, and you’re having trouble with your blood pressure, those are like the two main systems that would you be at candidates for ICU.
But that said, because there are so many people that need ICU, I’m sure they’re looking at the severity of those symptoms when they evaluate the patients because not everybody gets an ICU bed.
Victoria:
(Elizabeth –What type of treatment do mild vs. moderate vs. severe typically get?)
Yeah. And that leads in really well to Elisabeth’s question. What type of treatment do mild versus moderate versus severe patients typically get?
Tom Kellond:
The treatment has changed, and it kind of was interesting to read about president Trump’s experience with COVID and the treatment that he received. And one of the things that he got that, is part of the initial regimen to try and decrease the impact of COVID was a steroid, which decreases the body’s inflammatory response. And the reason that’s important is if your airways become inflamed, the airway narrows; and if the airway narrows by half, that increases the air resistance by almost 10-fold.
Victoria:
Wow.
Tom Kellond:
And it also means that chances of getting oxygen or gas exchange down to the small, terminal bronchioles and alveolar air sacs that are surrounded by the capillaries where the oxygen goes into the blood and the CO2 comes out of the blood, and then the oxygenated blood gets pumped back to the heart and then it gets pumped to the body. When the lungs have a problem, every organ system in the body has a problem.
So, steroids oxygen would be like a frontline, treatment for probably the mild to moderate, and the steroid end of things. They might hold off on, they might just go, you know, mild months it might just be oxygen. The next level would be oxygen and steroids. And then the severe one would be oxygen, steroids, some kind of medication to support, blood pressure and heart rhythm. And, if it goes to an issue where the work of breathing is so much that they it’s causing a very, very serious problem, that individual would be intubated and put on ventilator.
Victoria:
Okay.
Tom Kellond:
That’s the, that’s the one way to unload or try to unload, the amount of work that they’re doing, to breathe.
Victoria:
So the ventilator will basically just breathe for them? Is that how it works?
Tom Kellond:
The ventilator supplies oxygen. It can supply, what is called positive and expiratory pressure or PEP, which helps to splint open the swollen airways and allow air flow to get to the terminal bronchioles and alveoli to exchange with the blood a little bit better. And more importantly, it takes away much of the work of breathing which was causing the individuals. they were just, it’s kind of like you’re out running, but you’re not going anywhere: your heart rate goes up; you start to perspire. If you go long enough, your weight starts to drop.
The ventilator is there as a, think of it as the, the net that underneath the trapeze artist at the circus, if they fall, it’s there to keep them from hitting the ground.
Victoria:
Okay. I like that analogy. I like that a lot.
Tom Kellond:
So you don’t want it. Once people hit the ground, it’s really hard. You have to work really, really hard to make up that ground and bring them back to a state. So having that happen is not where you want to go. So you want to try and anticipate things as much as possible and support systems before they become critical.
Victoria:
(Jane – I heard they have you lie on your stomach in the hospital. Why does that help?)
Yeah. That makes sense.
We can move on to this question from Jane. I heard they have you lie on your stomach in the hospital. Why does that help?
Tom Kellond:
Yeah. Jane, that’s called proning. The lungs are such that if you look at the 3d anatomy, what you see, if you were just looking at somebody straight on, is almost like a shell that’s just wrapped around the heart and the aorta and vena cava, which circulate blood throughout the system. So most of the lung tissue is towards your back, and most of the lungs are protected by your rib cage. So when you used to have patients come in that had what we would call acute lung injury, and COVID could be termed an acute lung injury if it begins to cause major inflammation and obstruction of airways.
It’s sometimes easier to ventilate individuals by turning them over on their stomach so that the blood that is circulating through the lung doesn’t pool on the backside and close off those terminal airways and alveoli to sucking up the oxygen that’s needed by the body.
Victoria:
(Amy – How often are people needing to be intubated? I read that they are not intubating as much anymore, that the steroids are keeping people off the respirators longer.)
Oh, that makes sense.
All right, this next question is from Amy. How often are people needing to be intubated? I read that they are not intubating as much anymore, and that the steroids are keeping people off the respirators longer.
Tom Kellond:
Amy, I don’t know the percentages on that one. I know that as a general rule of thumb, intubation is like the last choice that you make in caring for a patient. That’s essentially admitting that things are bad enough that you need to escalate to a full on ICU critical care, “full press” is what I call it situation.
And, The steroids seem to be helping some people and making a big difference in how they respond and recover from COVID. But the percentages, I don’t know what those percentages are.
Victoria:
(Jane – Is there anything other than a respirator that can help you breathe?)
Okay. And Jane has a good follow-up to that. Is there anything other than a respirator that can help you breathe?
Tom Kellond:
There is. When I hear respirator, I think ventilator, but it’s not the only thing that can help people breathe.
Lots of people, more people in the last 10 to 20 years have been diagnosed with what’s called sleep apnea, which basically means that while they’re sleeping, their airway or their trachea falls back because of their everything is so relaxed muscularly, and it obstructs the airway. So for some there’s partial airflow, for some there is absolutely no airflow. And anybody that you hear snoring that gets louder and louder, and then it disappears and, but you still see their chest moving several times, and then all of a sudden, the snoring reappears it’s possible that they have obstructive sleep apnea.
And for those individuals, the device that they call, let’s just call it a Bi-PAP. And by Bi-PAP, I mean, it’s either is providing the positive and expiratory pressure to kind of hold open that airway, or it’s providing that pressure and assisting them whenever they take a breath in, it gives them a small mechanical assist so that they don’t have to do as much work.
And some of the newer machines also allow the addition of adding oxygen to the line, but it’s all done with a big mask that goes on the face. That is where it gets kind of interesting because not everybody can handle that as some people, they never know whether they’re claustrophobic until that mask gets put on their face.
But a Bi-PAP machine is a device that could be used, for what is called non-invasive ventilation. That device is used, I’ve heard it used by a number of ambulance companies for patients with known lung and heart disease. The reason for that is that it allows them to not only give oxygen, but give oxygen under pressure, which really helps to counteract the oxygen deficit that the patient may have experienced by either a cardiac arrest or respiratory arrest.
Victoria:
(Joe – How has the ICU treatment of COVID patients changed from March until now? Is the length of stay in the ICU shorter now in average than in March?)
Oh, that makes sense.
Okay. This next question comes from Joe. How has the ICU treatment of COVID patients changed from March until now? Is the length of stay in the ICU shorter now on average than in March?
Tom Kellond:
I believe the answer to that question is yes. And, but it’s yes for a number of reasons.
From what I understand, the steroid introduction is part of that equation. The other part of that equation is just there are more individuals needing ICU beds. And so, the moment an individual improves enough to be in a non-intensive care or intermediate intensive care environment, they are transferred out.
And so it’s really at this point, because it’s been going on so long, it’s really staff preservation because you get an intensive care and it’s intense. I mean, there’s no way about it. I mean, you’re, it’s, it’s literally, it’s life and death.
Victoria:
Yeah. That sounds scary.
Tom Kellond:
Yeah.
Victoria:
(Sierra – What is the procedure for when a medical staff member enters the room to treat the patients? Do they have to change masks or clothing?)
Yeah. Well, speaking of medical staff that segues nicely into Sierra’s question. What is the procedure for one medical staff member enters the room to treat patients? Do they have to change masks or change clothing?
Tom Kellond:
For patients that are, have known diseases that have are transmitted by droplets. They’re usually in a negative pressure room. That room usually has a room in front of it called the anteroom. So it’s kinda like an airlock on a spaceship. And before you enter the airlock you gel, and then in that room, you put on a gown and gloves and mask minimum, goggles occasionally when, if you were going to be doing a procedure where you might get splashed on, you don’t want anything going in your eye. And that’s the type of level of protective equipment that goes for that. And the mask that you put on for patients that are in that isolation is an N95 mask. And that is, was the highest-level mask that was used when I was working.
Victoria:
Is there a higher one now?
Tom Kellond:
There are devices that are used that are, they look like, you see a lot of individuals with face shields.
Victoria:
Oh yeah.
Tom Kellond:
Okay. So this would be like a helmet that has a snap-on face shield, but it also has a collar that completely goes all the way around your neck. So your head is completely enclosed inside the helmet. And then there is a battery powered fan that has a, high level filter that provides circulating air within that to provide a positive pressure inside the helmet to keep anything that’s outside from being breathed in.
Victoria:
Wow. That’s intense.
Tom Kellond:
Yes, it is. And it’s also, it’s not cheap. And it takes, you know, to get in and out of something like that, it takes a while and you have to be methodical in doing so because you can’t rush the procedure, you have to check out the battery, make sure that the battery is sufficiently charged, you need to make sure that the shield is properly attached to the helmet so that you have a good seal, you need to make sure that there aren’t any rips in the bungee that goes around your neck, you need to make sure that the hose is not kinked or cut in any area, and you need to make sure that the warning lights that are inside the helmet that would alert you to battery status work properly.
Victoria:
Oh, that’s important.
Tom Kellond:
Yeah. So, they provide a fair amount of visibility, but they don’t, for anybody that’s claustrophobic, it can cause a bit of a problem. But from a safety standpoint, they are probably the, you know, the next step up from that is the device that actually has a collar that goes over the shoulders. Wow. And then the, then the helmet goes on and then the filter and the hose and the face plate. And there’s kind of like, you know, getting ready to go for a spacewalk, except it’s not as fun.
Victoria:
Yeah. If I were to put that much gear on, I’d much rather go for a spacewalk then into an ICU room.
Tom Kellond:
Yeah. Yeah.
Victoria:
(Jane – I’ve heard a last resort is an ECMO. What is that? It was on the news today.)
This is a question from Jane. I’ve heard the last resort is in ECMO. What is that? It was on the news today.
Tom Kellond:
Jane. That’s a good question. And I love it when folks use these abbreviations, so they just go, okay, yeah, you just know what an ECMO is?
Well, first time I came in contact with an ECMO was back in the eighties, and it was fairly new and it was. But to answer your question, it is very similar to the device that is used in the operating room when patients undergo open-heart surgery and their heart are stopped so that, doctors can work on the blood vessels that are blocked and repair them with graphs from their veins. But ECMO stands for extracorporeal membrane oxygenation. And what that means is the ventilator is not used during that surgery because lungs would get in the way of the surgeon, seeing the heart. So this device introduces a certain amount and you can vary the amount of oxygen, but it introduces the oxygen into the blood and then circulates it, bypassing the heart, and circulates it through, through the body.
It’s not as efficient as the heart, and early machines used to have problems in that because they were mechanical in nature, as the blood would go through them, sometimes the blood cells would be subject to what would be called mechanical injury, and they would, no longer function properly, so to speak. And they just become debris in the circulatory system. And sometimes that debris was not a problem. Other times, sometimes you had a stroke as a result of the debris or problems with the kidney or problems with the liver.
So the machines have gotten better, but it’s extracorporeal membrane oxygenation, and it’s generally it’s, it used to be termed the last resort, but that is used a lot more in cardiac procedures, or at least it was in my experience.
Victoria:
Why would it be used for COVID patients? Is it just because they’re not able to breathe and circulate the blood?
Tom Kellond:
I would think that it’s used in a situation where the lungs, either so inflamed, and there’s been so much airway and capillary destruction that the lungs are not able to adequately provide the oxygenation that the body needs. As they deal with the virus, they need to support other organ systems. And that’s what the extracorporeal membrane oxygenation is all about, is making sure that as you fight the virus, you don’t have problems with the brain or the heart or kidneys or the liver or any other organ system. Because that’s, you know, that’s gonna delay recovery.
Victoria:
(Eve – Why do some people survive COVID and some people die due to COVID?)
Yeah. That makes sense.
All right. Let’s see. This next question is from Eve. Why do some people survive COVID and some people die due to COVID?
Tom Kellond:
Well, Eve, that goes back to the other problems that they had before COVID, for the most part. And so, if they’re a little overweight, and if they have a heart that has a unusual rhythm, their kidneys are compromised, liver is compromised. COVID in compromising the lungs, it can also compromise other systems in the body. And the question about the, you know, the neurological effects kind of highlights that. And it’s, you know, at this point there’s not, I have not seen a peer review paper that gets into depth on why that is. But a lot of it has to do with lifestyle, like high blood pressure, kidney disease, all that comes into play when COVID strikes.
Victoria:
(Sierra – Is it true that COVID patients die alone?)
Yeah. And then this is, a bit of a sad follow-up question to that from Sierra. Is it true that COVID patients die alone?
Tom Kellond:
If you mean by alone, not in the company of a family member or loved one, sadly that has been true. But that is changing, under certain circumstances. The main thing that needs to be focused on is safety. So that being said, no patient dies alone because there’s usually a doctor and nurse, respiratory therapist, there. Granted it’s not family members. And I have to tell you from being one of those respiratory therapists, many times. It never gets easy. It’s never, ever, ever easy.
Victoria:
Yeah. I can’t even imagine. Oh my gosh.
Tom Kellond:
Well, you know, you, you, you keep going over in your mind, what could we have done differently? What did we miss? And there’s usually, there wasn’t anything, any of us could have done to change what happened.
I think being a doctor has gotta be kind of like, being a baseball player. You gotta figure if you hit the ball three times out of 10, you’re doing really well. Hopefully doctors have a higher batting average. I’m almost certain of it. But the, you know, the analogy is there, but the thing is that they never carry that, the experience of a bad at bat with them into the next game or the next bat. You can’t do that because you can’t care for patients and be any good to them if you don’t.
Victoria:
(Andrea – What are the lasting impacts of COVID, like people experiencing repercussions months and months later?)
Yeah.
This next question is from Andrea. What are the lasting impact of COVID, like people experiencing repercussions months and months later?
Tom Kellond:
Main ones that I’m familiar with are decreased energy level physically. And, along with that, a decrease in what I’ll call, mental alertness or acuity. And to me that tells me that there was some kind of damage to the brain in some shape manner or form, but there was also some damage to other organ systems. That appears to be taking time to recover.
And it’s unknown how much of their original baseline function, they would recover. Cause, you know, it’s still, we’re in the middle of it. You know, we’re looking from the inside out. We’re not looking back at it, and being able to say, well, yeah, we have all this data now ,we can analyze it. You know. But we’re still gathering data, and testing theories, and medications, and therapy regimens. And that goes for recovery as well.
Victoria:
(Addy – Do you like your job?)
Yeah, that makes sense.
All right. Let’s see. Now we can transition a little bit to some questions that the students and the listeners had about you and your career and your experience working in the hospital.
This first question comes from Addy. Do you like your job?
Tom Kellond:
Oh, there are days I don’t. But, on the most part, I would say, yes, very much so.
The thing that I enjoyed the most was when I was able to interact with the individuals and teach them, techniques that they could use once I left. ,any of the therapists that I worked with would go in and they would give a breathing treatment and they would instruct the patient to take a deep breath. I would go in there and give them nebulizer with the medication. And after a while, I’d say, why don’t you take a breath like a yawn, like do that. And they knew what a yawn is, you know what a yawn is, I said breathe that medicine in, I said. And then I’d say, okay, take a yawn, take another one, only hold your breath this time, for about count of three, one, two, three. And when you hold your breath like that, what it does is it pops open those little terminal airways and gets them busy and allows the CO2 to escape, it allows the medicine that they’re breathing in to get down there, to relax those airways, so that it’s easier to breathe. And sometimes with they have congestion, they find it easier to cough and more productive.
So I always tried to leave them with a weapon, you know, armed them, so to speak, with something that they could do to help feel better and get better sooner. So that was probably the most enjoyable part of my job.
Victoria:
(Ella – What are the good things about such a tough job?)
This next question, I think you pretty much answered, but if there’s anything you want to add, this is a question from Ella. What are the good things about such a tough job?
Tom Kellond:
It’s very rare, except nowadays maybe, that anybody would ever, you know, know what a respiratory therapist was or sing their praises. But, with COVID, unfortunately we’re gaining more notoriety. I wish it weren’t that way. But, it’s tough challenges like that, because, and I say that as an individual who was a therapist, but also more than that, I was not the only one, I was a member of a team of therapists. And together we I took on the job that we needed to do every day, and the job changed and we needed to kind of flex with it, and that was tough, sometimes. But having great people that work with you, it makes for a nice job, really nice job. You look around the people that you work with, and you pretty much called everyone your friends.
Victoria:
(Jane – What made you decide to become a respiratory therapist?)
Oh, that’s wonderful.
Okay. This next question is from Jane. What made you decide to become a respiratory therapist?
Tom Kellond:
Well, I met my wife on April 18th, 1980. And just so happens, that also happens to be the anniversary date of the 1906 earthquake, which I didn’t know at the time, but it’s kind of, you know, interesting trivia.
Victoria:
Yeah.
Tom Kellond:
But, at the time I was 26, and Jeri came along and it was like, she’s like beyond what I could have hoped for. And, what I’m doing now for work, I’m not really enjoying it because employee relations or personnel, it’s not personal, it’s all about business and controlling. And I’d been through layoffs and a bunch of other stuff that really, compared to other experiences that I’d had, like working in special education classrooms as an aid, when I was in college or junior college, and then spending three summers working at a camp for Easter Seals up in the Santa Cruz mountains and Redwoods.
Victoria:
Oh, wow.
Tom Kellond:
Yeah, orthopedically, handicapped, and mentally challenged individuals. That experience and working as a team with other, you know, individuals who are counselors, really kind of set the tone. And when I thought back on that, it was kind of like that environment is something that I would really like. But I also kind of liked the, you know, the science and the things and the challenge that the science brought.
So I pretty much figured that being in personnel was not going to be my career. I needed to find something that was going to sustain me. And, after doing a nice little aptitude test, it turned out that respiratory therapy kind of fit the bill. During my coursework for psychology, I was doing lots of courses in geology, and going on field trips and enjoyed the science and study, you know, goes into that end of things.
So this was, this was different. And then, how different, I really wasn’t that clued in on, because when I was a counselor at camp, I’d always kind of shied away from getting my certification for American Heart for resuscitation. And come find out that, Oh, that’s one of the things that you need to do in order to be a respiratory therapist, because you’re going to be part of the cope team. And I was running from this all this time. And then I got into it and then I got, all right. It’s, I understand it now better because had better instructors for one, and when you’re committed to a field of study, it also changes your perspective on that. But also got to do a little computer tinkering. I designed a matrix for pulmonary function that you just enter the variables for your patient, and the spreadsheet that I built would calculate all the predicted according to a journey X.
Victoria:
Oh, that’s cool.
Tom Kellond:
Which a lot of my fellow students found very interesting, and they started lining up. Can you plug my numbers in? I want to know what mine? You know. So it was like, I kept doing things like that, plus on the side, I was also doing photography, not, professionally. And I kept doing photography was a good stress reliever, and I call it my therapy.
Victoria:
It’s always good to have something like that.
Tom Kellond:
But in photography, you know, you’re dealing with physics, and there’s, it’s the physics of light. And you need to figure out how different systems respond to light, and how you can make adjustments to get to the kind of image that you’re looking for.
Victoria:
(Paden – Do doctors feel afraid when they are working with viruses?)
Yeah, well, this next question comes from Paden. This is a question about doctors. Do doctors feel afraid when they are working with viruses?
Tom Kellond:
I think it depends on the virus, when gosh, you’d have to go back in the early two thousands, when SARS came out of China.
Victoria:
Oh, yeah.
Tom Kellond:
And the reports of medical personnel dying from SARS. We’re kind of spooky. But you know, to realize that this information is coming from half a world away, and you’re getting the full readout of what happened. And one of the things that we learned from SARS was, SARS is another coronavirus that adversely affected the lungs, and would by its replication or reproducing itself, it would damage the lung, and cause problems that required mechanical ventilation. At the time, we were using high levels of PEP, or positive expiratory pressure along with high levels of oxygen. But we are also trying to maintain tidal volumes at what would be calculated to be normal if the person were just off the ventilator, breathing on their own. Later found out that in trying to give patients that normal volume of air or oxygen in the air, we were actually causing more damage. It was mechanical damage. And so through various studies, a regimen called lung protective ventilation came out, which basically said that if you can look at your volumes and they kept adjusting it, but the upshot is that we were given patients about half the volume that they normally would get, and proning them, and then steroid.
So a lot of what is going on with COVID was learned, treatment-wise was learned from SARS. But, COVID as they said, it’s a novel, it’s a never seen before, coronavirus. So it’s a different, it’s a virus, yes, but it’s different.
And so is it scary to doctors? I think, the unknown tends to scare anybody.
Victoria:
Yeah.
Tom Kellond:
But we have the advantage, they have the advantage of having that baseline of experience with SARS. Now that said that prior knowledge could also kind of work against you because you kind of make assumptions that COVID is going to behave the same way that SARS did. And we’re seeing different things in COVID.
Whether that makes physicians afraid? I think the main thing that makes them afraid is when the demand for their service and time and care exceeds what they feel is their capacity to meet.
Victoria:
Yeah.
Tom Kellond:
And when they see others, nurses, respiratory therapists similarly stressed because they don’t have the staffing to meet those needs either. It stresses everybody. And that’s the main thing that is going on now, and why there’s such an appeal for people to stay home, limit as much as possible their social interactions and trips out too, only that is, that is absolutely necessary. Because they’ve got more business than they know what to do with. And that’s, that’s what scares, that’s when physicians tend to get scared.
Victoria:
(Sari – Why is it so hard to make a vaccine?)
Yeah. All right. we are nearing the end. So we’ve got just four questions left, and these are all about vaccines. A lot of the students and a lot of the listeners had questions about vaccines, especially since I think we’ve had a couple different vaccines in the news a lot lately.
So let’s see, Sari wants to know why is it so hard to make a vaccine.
Tom Kellond:
Ah, why is it hard to make a vaccine?
Well, first you need to understand the animal that you’re dealing with. And I used. The term animals just kind of euphemistically to refer to the COVID virus. And people go out and study lions and chimpanzees, and they see all kinds of different behavior, but I need to make sure that they observe that behavior in as many different circumstances as possible, so that nothing is left out.
Beyond the observed behavior, you have to get into the biochemistry of the virus itself, and figuring out what its physical structure is like.
And beyond that you go even further into diagnosing or investigating the virus in you get down to the genetic level: you start to look at DNA and RNA.
And you begin to look at other viruses that you have information on, the SARS would be one, H1N1 would be another one. And so you do kind of a comparative analysis. They’re not always helpful because the fact that it’s novel, it’s completely new and unknown, it’s got a property or some properties that it’s behaving differently.
And so then the challenge becomes, okay, what ways do we have to construct a vaccine in such a way that basically we’re either going to fool this into thinking there’s already a lot of the virus there and you don’t need to reproduce, or we’re turn it off and make it inert. The second one is more difficult than the first one, fooling it as is usually the way that most of them that I have known go about accomplishing their task.
But it takes lots of people and lots of hours to break all of that down and make sense of it, and then build a model for something to counter it. So the fact that vaccines appeared to be, you know, ready for distribution so soon, it is pretty amazing, because usually you kind of go almost on a two-year cycle in terms of vaccine development, so that you you’re, you’re kind of thinking two years into the future almost.
Victoria:
(Mae- How close are they to a vaccine?)
Wow. I think that ties in nicely to Mae’s question. How close are they to a vaccine?
Tom Kellond:
Pfizer was the first to announced a vaccine. They initially said that it was shown to be 90% effective. They later changed that to indicate that it’s 95% effective.
Victoria:
Wow.
Tom Kellond:
The question on that one is how many, because there’s a whole, it’s not just coming up with numbers or chemicals.
It’s, doing first, you do your lab tests where you, you know, put it in contact with the virus and see what happens. Then you do a limited controlled test. And then you do a blind study as your third level test. And all along the way, you’re collecting information about how that vaccine A or vaccine B is doing. And, as you do that, if you know, the main thing is that it becomes a numbers game in that.
Let’s go back to baseball, if you were looking for a great hitter for your team and your scout went and observed 10 games, this one individual, and in that 10 games, they had 40 at bats. Well, in 162 game season, a hitter could have over 400 at bats. And so you’re going to predict their performance based on 40 at bats. You need more, you need a larger sample size.
Victoria:
Yeah.
Tom Kellond:
So that’s where the testing part comes in. So you need something on the order of, you know, it’d be better if you had like 200 at bats, you know?
Victoria:
Yeah.
Tom Kellond:
Then you go, all right, we put this vaccine up against the virus 200 times, and this is what’s happened, 95% of the time it wins. So, you know. So the other thing to that is beating the virus is not the only thing.
The first thing before you beat the virus is what all medical workers are about. You don’t harm the patient. So do no harm. So that’s something that you need to evaluate and that’s why you need that higher, that bigger sample size.
Victoria:
Yeah. That makes sense.
Tom Kellond:
Oh, in answer to your question about, the company Pfizer was the first one. Moderna was the second one, there’s a third one I don’t know the name though. But both Pfizer and Moderna claim to have it 95% effective.
Victoria:
Wow.
Tom Kellond:
Moderna main point the advantage is that, its vaccine can be, definitely it’s refrigeration needs are minimal compared to Pfizer’s. Pfizer needs to be something like minus 95 degrees or something like that, in transport and storage, and two doses of the vaccine are required.
Victoria:
(Boddhayan – If Vaccine A is announced to be safe and people are injected with it, and then after months, along comes Vaccine B and it is announced to be more effective than Vaccine A, will people who were already given Vaccine A need to take Vaccine B too? If yes, will there be issues for taking 2 vaccines? What will happen to Vaccine A in this case? Will it be destroyed?)
All right. Let me see we, just two more questions here. From Boddhayan. If Vaccine A is announced to be safe and people are injected with it, and then after months, along comes Vaccine B and it is announced to be more effective than Vaccine A. Will the people who were already given Vaccine A have to take vaccine B also? And if yes, will there be issues for taking two vaccines? What will happen to Vaccine a in this case?
Tom Kellond:
Chances are, you wouldn’t even know about that. If they found one vaccine to be better than another is, unless you found somebody that, you know, knew for a fact that that’s what was going on. To my knowledge, as long as there, this is where the main, the study of the vaccine and its side effects on actual people comes in to play. And I would hope that they would do a sample group just to find out, you know, if there’s going to be any kind of conflict with that. Because you can make all kinds of theoretical assumptions, but until you actually do the test, you don’t know. So, if it turns out that’s benign, it doesn’t have any effect, you know, negative effects whatsoever.
Then I don’t know that they would get rid of vaccine A. I think they’d probably use up as much as they had, because right now I think they’re still short with regard to the number of vaccine that are needed.
So let’s just put it this way, people are going to get vaccinated for the next year and a half, at least. Maybe, you know, maybe going maybe going two years, but who knows? This is just something that, that we live with.
Yeah.
Victoria:
(Johann – Once scientists are capable of coming up with an effective vaccine, and we no longer have to fear coronavirus, how high are the chances of the world getting another coronavirus or zoonotic disease/pandemic/outbreak?)
All right. Let’s see here. This is our very last question. And this question is from Johann. Once scientists are capable of coming up with an effective vaccine, and we no longer have to fear coronavirus, how high are the chances of the world getting another coronavirus or zoonotic disease, pandemic or outbreak?
Tom Kellond:
Think of it this way. Just in this century, we’ve had SARS, we’ve had H1N1, we’ve had MERS, it was not quite the same, but we also had Ebola outbreak, and now we have COVID. So the cycle time for each of those occurrences, the windows seems to be smaller. That would lead me to believe that the likelihood is probably pretty strong, that COVID is not the last coronavirus that we will see.
So, hopefully that the lessons or the knowledge that we’ve gained from studying and dealing with the coronavirus will help with the next. But as I said, you can always count on the next one behaving like the last one, because mutation is the main lifeblood of virus. That’s how they keep one step ahead.
Victoria:
Yikes.
Tom Kellond:
I guess the more interesting question is, what is it about humans that makes them more vulnerable or a focused target for these versus animals?
Victoria:
Oh, yeah. I hadn’t thought about that.
Tom Kellond:
Because animals breathe oxygen and exchange, you know, CO2 just like humans. Granted animal physiology and anatomy are not the same as human physiology and anatomy.
Victoria:
Well, that is all of our questions from the listeners and the students at Bromwell elementary. Thank you so much for talking to us today. This was great and so helpful to understand the pandemic that we’re in.
Tom Kellond:
Oh, well, thank you. Have a nice afternoon.
Victoria:
You too.
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