UF Health infectious diseases expert talks COVID-19

Since participating in multiple clinical trials and the treatment of more than 150 COVID-19 patients at UF Shands Hospital, local infectious disease expert Dr. Kartik Cherabuddi says local response teams have come a long way in understanding the virus and how to fend it off.

Dr. Cherabuddi is an associate professor of medicine for UF’s College of Medicine and the Division of Infectious Diseases and Global Medicine with a background in treating Zika and Ebola viruses.

Mainstreet Daily News checked in with Dr. Cherabuddi to find out how the local hospital system was handling COVID-19 patients and to get advice on staying healthy during a pandemic.

Q: What cases are you seeing coming in and how are they treated?

A: From our first cases we initially saw older individuals with severe presentations and cases that came into the hospital relatively late because it’s an unknown virus. From those initial cases, it started progressing to seeing nursing home patients come in.

These groups came in really sick and took a long time to recover. They would take about 20-25 days to recover and then trying to get them better and safe enough to return back to the nursing home was a challenge.

And then, we slowly evolved into seeing patients of all ages. Most people that were younger had other risk factors. They had diabetes, they were obese, they had hypertension, kidney issues. They had other things that put them at risk. They were younger, older, people who were very sick to be out in the ICU, some very sick on ventilators. We also took care of some transplant patients.

As time went on, our number of admissions started to go down. And numbers stabilized until they started going back up in the last two weeks.

Now, we are starting to see younger age groups and more in the 40s and 50s, and a few patients in 60s and 70s, not as much in 80s an 90s.

There are higher admissions that have been discharged relatively quicker. We are starting to see people improve and get back home than we saw earlier on.

These changes of people getting better we believe are due to a number of things but mostly because they are coming in earlier.

Q: What have you learned about COVID-19 treatments?

A: We were already proning patients in late March if they needed it, we are doing that consistently. On the floors and in the ICU we have teams that know how to manage these patients well. We have learned small things as we have gone along.

How to interact with patients, how to get families involved. When to do lab tests, at what time of day, when should we get admitting services. It’s been a lot of learning through experience, what literature we see and what other places are using as best practices.

Treatments evolve the same as most institutions in the country have. 

Q: What research trials has UF participated in?

A: We’ve had clinical trials set up here pretty early and have been able to benefit from those.

UF Heath worked with the National Institute of Health (NIH) right from the start. Patients included in the trials received Remdesivir and another drug over the last two months. That was very helpful. Also looking at immune modulating drugs (which bring the ratio of the different immune cells back into balance in order to enable the immune system to function correctly.) and other anti-hypertension drugs. 

There are three trials that make the treatments available by enrolling patients to evaluate the drugs.

Remdesivir will be available commercially soon but patients at UF Health have been able to benefit from it through trials all along.

Sarilumab (is an antibody against the interleukin-6 receptor developed the drug for the treatment of rheumatoid arthritis.)

We are looking at Losartan, and how the common medicine used to combat high blood pressure blood helps.

Q: What is your role in reopening UF?

A: My role is to advise the hospital and UF on activities and spread and when to allow different phases of opening up and how different activities can be done in the best possible way such as teaching classes.

Experts through UF Health are advising UF on these matters. It’s a two-way communication. The infectious disease expertise is here and the expertise for running the university is with them. And you need both. 

What is the status of a vaccine?

A: Some trials are entering phase three in China and the Oxford trial. UF is expecting to obtain a trial soon. 

Q: What is the mutation rate of COVID-19?

A: Mutations happen because they are replicating and infecting so many people. This is one of the slower replicating viruses. It doesn’t change as much over time. We are trying to include more than one region in researching mutation. All vaccine manufacturers  are cognizant of this.

The virus is sequenced by scientists and compared to virus samples from other regions. 

Genomic experts study the sequence of the virus while phylogenomic methods are used to read and compare the sequence over time and see what region of the world a virus is from and then compare it to the local virus sequence.

Eventually, the vaccine will be rolled out across the country. Some of these timelines are difficult to predict and the rollout effort will be coordinated through the NIH and other agencies.

A strength that UF has is modeling the effect of vaccines, learning their applications and studying the effects. The experience comes from previous experience involving the Zika and Ebola vaccines. 

Q: How are emergency patients treated before a COVID-19 test can be administered?

In an emergency we won’t wait on the result (to do surgery or treatment). Everyone wears the appropriate PPE and gives medical treatment while waiting for the test results to come back. 

Q: When is COVID-19 most contagious?

A: We know that two days prior to showing symptoms, you have a high amount of virus and that decreases over time.

Most studies show that you are not infectious by day 10 after your initial symptoms given that your symptoms have gotten better.

Your highest day of shedding the virus is two days before you show symptoms and the early days when you do show symptoms.

The problem with asymptomatic carriers is we don’t know when they got infected. We only know a point in time when they were tested, so it’s hard to guess.

Q: What are common ways an outbreak happens?

A: Indoors is worse than outdoors. Outbreaks happen when a certain number of people congregate. As the number increases, the risk that one of them being infected increases. At least 1 in 100 people will have it but also in a group of 20 it is best to assume that at least one person will have it.

The higher number of people you have, the higher the chance that someone at the event is going to have it. 

Also, when you have a heterogeneous group there, people from different areas, the risk of spread increases.

If it’s the same group of people you have been with, it is lower risk than inviting people from different areas to attend.

You don’t know how safe they have been or what kind of practices they have and you meet together.

The bigger the group, the more indoors, the more closed nature it is, and if it involves shouting, singing, laughing activities where you could project more virus…and if it involves eating and drinking because you can’t keep your masks on.

July Fourth was really a concern. 

Advice: Keep congregations minimal, outdoors, use distance and face coverings.

Are case surge plans in place?

A: If we get a high number of people coming in we have plans on how to manage on any given day including after July Fourth.

We’ve had plans in place for a surge capacity for quite sometime now and the same applies for this weekend. If we do get a number of people coming in we can accommodate them.

Q: What are hospitalization trends currently at UF Health

A: We have seen a slight increase but not compared to Miami-Dade or other epicenter areas.

We get transfers from South Georgia, and northern Florida regions. These are longstanding relationships established prior to COVID-19.

Q: What are the lengths of hospital stay?

A: We’ve had some who have stayed a month and walked out well. We’ve had people who initially come in with mild symptoms, they return home and some come back with increased symptoms.

We’ve had more than 150 COVID-19 patients admitted into the UF Health system before the July Fourth weekend.

We’ve had kids and babies positive. Most kids do well. 

Q: Should essential workers get tested regularly?

A: Doctors get testing only if they have had exposure or symptoms. We know if you use PPE well, it doesn’t spread easily. Health care personnel generally have lower rates than the rest of the population.

For essential workers who have a coworker test positive, if you were both wearing masks the whole time, the level of exposure should be low so keep an eye on possible symptoms.

If you we’re masked and spent a lot of time in close quarters, watch more closely and get a test.

Q: How can a person prepare to strengthen their fight against COVID-19

A: There’s certain things you should do to keep your risk down.

Get enough sleep, stay physically and mentally healthy. Whether it’s stretching, improving your breathing, getting your medical conditions under control. If you are diabetic you want to get your sugar levels at a good level.

If you can get to be at the healthiest version of yourself, that is the best investment you can make.

Try to keep this going longer (not contracting the virus and staying healthy) than it will take to get a vaccine out. We’re already finding that hospitals are managing COVID-19 better, we already have some therapies. The longer you can stretch this out (using mitigating measures to fend off the virus)  the better fighting chance you will have because there will be additional therapies or vaccines.

Follow the right PPE, mask practices, distancing, but staying socially connected with people you know through phone video or in your social bubble or physically outdoors.

In summary: Stay socially connected, stay physically distanced while wearing a mask where you can’t maintain distance, being the healthiest version that you can be. Those three things together. 

About Dr. Cherabuddi:

Dr. Kartik Cherabuddi provides clinical care to patients with complex infectious diseases; patients living with HIV; and internal medicine patients. He serves as a specialist for antibiotic resistant pathogen infections. He is the Director of Antimicrobial Stewardship Program at UFHealth. He also serves as the Associate Hospital Epidemiologist providing leadership for infection control issues.

Dr. Cherabuddi has been recognized as a Master Clinician and inducted into the Master Clinician Society at UF. He is an award winning educator recognized as an Exemplary Clinician through the college of medicine and in multiple years for excellence in teaching through the department of medicine (DOM). He enjoys teaching medical students, PA students, pharmacists, residents and ID fellows. He has been recognized as the DOM Attending of the year by the residents. He serves as the Associate Program Director for the ID Fellowship program.

Dr. Cherabuddi conducts research through clinical trials for novel antimicrobial compounds that enable transition to patient care. He also conducts research looking at Antibiotic resistance and genetic sequencing of microorganisms. He collaborates with researchers at the UF Emerging Pathogen Institute on (re)emerging viral infections including Zika, Chikungunya and Keystone viruses.

Dr. Cherabuddi also serves on international infectious diseases committees to develop enhanced training in Antibiotic Stewardship.