Interview with Doctor Anne Zink MD. FACEP on Dec. 8th, 2020

Well, guys, we have arrived at that anticipated moment where I have a distinct honor and welcome Doctor Anne Zinc to this week's show. Doctor Zinc is the Chief Medical Officer for the State of Alaska and an expert on the impact that the Covid 19 has had on the State of Alaska's population.

A fellow of the American College of Emergency Physicians, she has a very strong background in emergency medicine, serving for over 20 years as both the emergency medicine physician for 11 years at MatSu Emergency department, and then if that wasn't enough, she then served another 11 as the medical director, for the MatSu Emergency Medical physicians Corp. Thank you so much for taking time out of your crazy busy schedule to provide my listeners with some answers they can use.

Great. Thanks. So much for having me, Mark. Thanks for the group tuning in. It wasn't quite that many years as medical director, but it has been an honor to serve in Alaska. So great to be here.

Well, outstanding. And I know, on a personal note, Doctor Zink I want to sincerely thank you for doing such a great job with your team at keeping the citizens of Alaska safe and informed at hopefully mitigating the effects of this pandemic. Hopefully, you've had an opportunity to review the questions I sent over. And with that, I'd like to get right after it. Are you ready?

I'm ready. Let's go for it.

Outstanding. Well, we've all heard that wearing a mask is the best way to prevent the spread of COVID to others. Why exactly is this and how does a mask help?

I really appreciate that question. I think it's really important to think about the way that masks works. We talk a lot about this virus, and it's a very small particle, but the particle lived on droplets, and it's transmitted on droplets. For the most part, droplets are much bigger, Um, and so a mask is an important way to catch those droplets that tend to carry the virus that allow it to spread from one person to another, COVID 19 is caused by a virus called SARS CoV two that can easily spread prior to someone being symptomatic. So when you don't even know that you're ill and just with talking and then particularly with singing or shouting, those droplets come out of your mouth, spread into the air and last longer, and can spread to other people. And a mask is essential, uh, like a net to catch them catches those droplets.

The follow-up question then is comparing this infection to the 1918 influence. The spread. What is it about the masks that make them more protective now than, say, in 1918?

Yeah, so great question. Uh, we know that a well-fit, cloth face mask that multiple layers and layers and tightly woven works much better than, say, a gauze face covering. During 1918, there was a lot of gauze face cover that we used. Not as much tightly. woven. We've learned a lot about droplets and viruses since that time. Uh, and the more that we can catch those droplets, uh, the better off we are. There's also differences between the virus that causes COVID as well as influence a spread more when people are that influence us. More days of that, uh, we also see it has a much longer incubation period. And this is a big difference between, the 1918 pandemic and the pandemic that we're having right now. You know, very short incubation, period. So people knew they were sick. They felt very ill, and they quickly got sick. Here. You can have the disease for a while and be infectious, be spreading it to others. And many people are asymptomatic. Very mildly symptomatic, uh, and can spread it to others, and when people get sicker from covid, they actually don't spread as much as they do earlier. So there are some differences between the influenza virus and SARS CoV two, which causes covid.

Oh, alright. So essentially, what I just heard for clarification purposes, folks are more opt to spread these pre-showing symptoms, than they are once they are actually visibly ill if you will.

Yeah, that's one of the real challenges you really peak at how much you spread right at the very, very beginning of your symptoms. You're most contagious. Two days prior to symptoms right in your symptoms. Stop your symptoms. Start Excuse me. And then the following two days. But as one gets sicker, you actually spread less of the virus. And that's very different than some other viruses. Even SARS CoV one, the virus that causes SARS, spread more the sicker someone gets. As an individual, you feel fine. You feel like I'm fine. There's no way I have COVID and I'm trying to interact with others. Yet you can be highly infectious, uh, and unfortunately, the spreading it to other people. And that's one of the major challenges influence spread of this virus.

Got it? That's good information right there. Throughout the world, we've heard that many people have recovered from the infection. What are some, and I say details, but I mean, obviously, without violating any HIPPA or anything, what are some of the factors that separate those who go from all the way through their whole interaction with COVID without ever showing symptoms to those whom we hear about are, you know, using the breathing machines? They're really, really sick. Where are the factors? That kinda I mean, have we identified anything that separates those two classes?

Yeah, it's a fantastic question. It's a million-dollar question in so many ways because you're exactly right. Some people can have no symptoms. Most people have very mild symptoms. Most people do very, very well, but some people get very sick, and some people get sick initially, and some people get sick later in their disease course. And as you mentioned, some people really need a lot of respiratory support or support of other organs and end up in the hospital in the ICU and unfortunately, passing away. We don't fully understand why some people get sicker than others. I was actually just reviewing an article last night, with identical twins who both got COVID at the same time and had very different outcomes, which I thought was really fascinating. Yeah, and trying to understand why two identical twins would have a different response. We do know from our population standpoint, the older someone is the more underlying health conditions they have, particularly obesity the higher they are being at risk for being hospitalized or, unfortunately, passing away. But it's not dichotomous like one or the other. It's not that if you're 80, you're gonna die. And if you're 20 you're gonna live. We see eighty-year-olds all the time who get it and do very, very well. And unfortunately, we see 20-year-olds get quite sick, and need hospitalization. So when you look at a whole population of older and more underlying medical conditions, the worst people, men actually do worse than women. However, when you're looking at an individual to understand how they're gonna respond, there's a lot of variabilities that we're still trying to understand. A lot has to do is, we think the body's ability to respond to their immune system. Your ability to clot, and so some people look at heart attacks or blood clots afterward or strokes. And we also think there's probably a degree of dose dependency. So how much virus we were exposed to? Likely place to a degree. A role in how sick you get. And we also think that that's part of our masks working. Not only do they catch those droplets, but they are also reducing the amount of virus that you're getting. Helping it to be that you're more likely to be asymptomatic or mild symptomatic if you get the disease.

I can see why you guys are staying up all night. Yeah, talk about pin the tail on the donkey in a hurricane. My goodness. Okay. From our perspective and I mean our as in the kind of separating us from the medical community. Common sense tells us, you know, you guys have been telling us and I'm just shot here. You guys have been telling us for a while the wear a mask, social distance, wash our hands, do the things that we normally do when? Normally during flu season, but now we're doing essentially all the time. That should kind of as long as we follow those guidelines, we should be okay. I'm guessing? I mean, there is no rhyme or reason to who's getting sicker, who gets sick and gets better. Who gets sick and gets worse? It sounds like a crazy zoo that I am very thankful that you are driving. Guys, we've heard from Doctor Zink some great information, some good news, and just kind of the awareness again of deploying a little common sense following the mandates, following the instructions that were being provided. It's not an attack and freedom. And so that it is a preservation of life.

Doctor Zink, I need to take a real quick minute for a couple of commercials, but when we return, I want to continue to talk a little bit about a little bit more. As I mentioned before we started, talking about comparing influenza and, COVID and other things that are gonna come out near just kind of talking about those. In a general sense and so kind of applying some of the logic that we are learning here, through COVID to some of those other scenarios. We're gonna take a real quick break. And when we come back, we'll get back after it again with Doctor Zink and it's more answers and, hopefully, get you guys, knowledgeable in what we got going on here. We'll be right back after this message.

Alright, you guys. Hey, we are back speaking with Doctor Anne Zink, the State of Alaska's Chief Medical Officer about common sense preparation for protecting our breathing. Uh, it's important, particularly following a natural disaster. Local emergency. We've been talking with Doctor Zink more about the COVID, as that's her major fight here in the state. Just talking about that hopefully can kind of give us some ideas about some other airborne particulates. It's that we've got to be conscious of when we're preparing. So when we left, Doctor Zink has just covered some of the factors that separated, If you will, or identified maybe the survivors from the victims when it comes in this case, the COVID but certainly any particulate. Because, you know, when we talk about viruses, we can compare them to smoke inhalation. We can compare them to gasses, in the environment. So anything that's kinda gonna be hazardous. That's what we're kind of protecting against here. So Doctor Zink from what you understand other than just surviving it, is there any way other than what you guys prescribed? The handwashing, the masks, the social distancing that can better set us up for beating this thing back or avoiding it altogether? You know, something like vitamins or supplements or healthy eating or whatever?

Yeah, that's a great question. Absolutely. I think about it in a couple of different chunks. So I think about what you can do as an individual to take care of your health.  We know that the healthier someone is, the less likely they are gonna become really sick, require hospitalization or die. So that includes, making sure that your weight under control. A friend of mine, recently lost 100 pounds since the pandemic started because he thought it's such a huge risk factor and he took control over that. We know that if your vitamin d deficient, you do worse, and that you're more likely to be hospitalized associated with covid 19. You wanna make sure that you're not Vitamin D deficient people who have high blood pressure underlying lung disease, Uh, making sure that those are well controlled. A really great time, to make sure that your underlying health we also know that people's mental health and physical health go hand in hand, and it's been a long pandemic. And it's really important for people, to stay connected and, do what makes sense for them, to keep track and to care for both our mental and physical health. And then there is trying to make sure that you don't get the virus. And so, as you mentioned washing your hands, wearing your mask, keeping your distance, I like to think about a little bit like you know, my kids going outside and it's negative 20. I wouldn't tell them to just put the gloves on, just put their mask on, and also tell them to put a jacket on, hat on, and their snow pants on. When we got a lot of covid is going along, we need a lot of layers to be able to keep it at bay. And so, it's not just one or the other. It's, the more we have more we need to layer up, and the more we need to kind of, use multiple tools, to be able to minimize. So that's masking and distancing and washing your hands. Other things to consider. We know that COVID spreads, particularly in indoor places when you cannot mask and, and so any time you're an indoor place and you need to be masked and distance and then also continue to look at anything else that can be done, such as air ventilation and circulation. There's a lot of good resources now on how to increase your circulation and cleaning up the air to make sure that's a safe place. Remember other places that may seem safe, but maybe at risk. So carpooling in a car with other people, you know, with the windows open and having that closed we see again and again is when people let their guard down. With those that are closest to, you know, I know Bob, my friend, And he's fine. He doesn't feel sick at all. I'm gonna have him over for dinner, or he's just gonna come in and help me fix a few things in my house. Quickly. And then he's gonna close indoor space potential without a mask without distancing, and that's how we see it spreading again and again throughout the time. Unless as you mentioned the mask also, then helps to minimize how sick you are. There are a couple of treatment options later. That kinda can help minimize how sick people get. But like anything on prevention is the best tool. I wouldn't tell you to go hit a tree with your car just because your car has airbags and seat belts. So I still telling people to avoid the virus, and that's your best bet.

Outstanding. Yeah, that's exactly right. Yeah. No point in testing. If they just keep it on the road and you'll be fine. Well, worst-case scenario. Alright, we get infected with the virus. Is there anything from a natural source that we can use to destroy the virus?

Yeah, so a really good question, you know, there are many things that naturally destroyed the virus without but before it gets into your body, so it's actually a very fragile virus. It's destroyed really easily by it's destroyed by soap with water. It's destroyed by high temperatures. It's not destroyed by cold temperatures, which is a bummer for Alaska. Actually, stabilize by the cold temperature. 

Wow, that it is a bummer.

Probably see more of it is, we're all headed indoors, and these colder temperatures lipid outside of it is stabilized by cold. And so that you wanna think about, you know, the things that you can do to kind of minimize your closure as we talked about before. Once it's inside of you, you wanna do everything you can to keep your immune system strong, and so that's interesting. That's drinking plenty of fluids. The only thing I would add is you wanna make sure your oxygen level stays adequate. You wanna say at least higher than 90%. But I really suggest higher than 92%. And sometimes people will become what we call happy hypoxic won't realize their oxygen level is dropping low and they won't feel short of breath until it's low enough that it's starting to cause damage to their heart, their kidneys to other organs. So people get cold. But I always encourage them. If you have little measurements to their finger to make sure that their oxygen level isn't dropping too low so that they know to go and get help if it's getting below 90% that we become concerned about that many people we see have a headache, vomiting. It can cause diarrhea, into making sure you keep up, you know, electrolytes,  keep making sure that you're protecting and taking care of your immune system during that time. Really? Keep it up with those fluids can be super important. It can cause clots. And so particularly people are at higher risk for, there are starting to be recommendations on treatment and to kind of prevent clots moving forward. This is not something you want to take beforehand because you don't want people to bleed. But there are certain people who are at risk. And then there are now what we call antibodies manufactured antibodies that can be used early on, in the disease course for those who are higher risk, that may help antiviral medication. And the biggest thing that we've seen is later in the disease course some people's immune system overreacts, and a very,  it's probably more a medication that touches many different things in your body. Called can It can help later in the course. But it's not something you want to take early, and it's really only showing to be beneficial for those requiring hospitalization. So we're learning a lot more about treatment, and there are more treatment options across the board. But just really taking care of your immune system to make sure option level drops are critical things for the general public.

Wow. Wow. Okay, alright. Well, sounds like some of that. I mean, correct me if I'm wrong, but some of that what we would normally kinda deploy for, like, influenza every year about this time of year. As a matter of fact, we're kind of looking at eating right, making sure everything's healthy. Everything's up and going, and you know, we've talked about before where had some, making sure we were keeping up on the vitamin d. Keeping up this time is keeping up on oxygen. And so,  awesome. That completely makes sense to me. It really does to the point about Airborne's safety. Now, we've kind of talked about having it how we're gonna get through this. But realistically, from a prevention perspective now it's cold out. It's there. And we've always said 6 ft, is our social distance is, But I'm in my backyard, my neighbors in their backyard. And the only thing separating us is a wooden fence. Should we increase the distance, Particularly if we've got some kind of breeze going, I guess, is what I'm I'm saying here. I mean, does this thing move around like that? And what about like, in the wilderness or something where you don't really have any kind of somebody could be right on the other side tree line. So is there a distance from an outdoor perspective that maybe is larger than the six?

Yeah, it's a really great question. And in general, outdoor space just has so much more air mixing, um that even if the wind's going one direction or the other, there's just a lot more than that virus to kind of break apart and to spread apart and to not move on one person to the other. So in general, outdoors is much safer than indoors. Um, the sixth one is really where when you look at these models where the drop was kinda hit the ground most consistently within 6 ft of someone. And that's why that barrier is there. And when we if you're in an indoor space for a prolonged period of time, you can easily spread the virus non 6 ft to anyone kind of help from that room. Indoor spaces. And clearly, you can imagine a scenario outside where maybe you were downwind to someone and 2 ft away, close by and be getting nailed, uh, right there by the respiratory droplets. So they're shouting. They're singing, uh, really close to you. Those are we? We have seen a couple of events where we believe there were outdoor settings. Um, but it is much less likely, much less comment to have outdoor-related, um, spreading events. They tend to be more like weddings that took place outside where people are sitting next to each other for a prolonged period of time outdoors and maybe, you know, foot or 2 ft away, or even three or 4 ft away. Um, but sitting there for a long period of time. So in general, I'm just, you know, continue, recommend. I know when I'm outside people outside my household and I'm running or biking. Um, and people are really exerting themselves. I tried to increase that. I try to spread it out, you know, 20 ft or so. You know, great science behind, uh, that we do see some model that shows some spread, you know, really, up to anywhere from 15 to 30 ft. And so, if you're really exerting breathing hard, just increase that space a bit more. Particularly when you're outside

Outstanding. So it limits my outdoor caroling this year. Okay, I'm good with it.

Just stick with your household family because

I can't carry a tune in a bucket. So I'm saying um, so understanding that this is really part of the natural world. There's not really anything we can do about the wild transmission of the virus except to prevent it from entering our body. Really? The infections begin life as a respiratory issue, but we've heard too many times on the news. And this may be misreporting, which is why I'm asking the question. But then once it's in the body, it spreads to other systems. Question mark. And we heard that underlying symptoms seem to catapult this virus essentially into the next level where it becomes life-threatening. Can you speak to that? I mean, what does that?

Yeah. No, absolutely. So it enters our system. They are the respiratory system, our nose or mouth. It can enter from the eyes as well. Um, but it can affect almost every organ in the body so it can affect your nervous system. Uh, we see people can have some confusion. Chronic fatigue. We see people the sense of taste and smell. It can affect your kidneys. It can affect the reason for the sufficiency. Uh, we also see, as I mentioned previously, quite a few clots and so numerous people who have a heart attack or a blood clot, either in their lungs or the brain, as a kind of recovering from Covid because they become what we call hyper platform. Usually, um, we also see people's immune systems kind of overreacting in all age groups, but particularly in a few cases, we do see in kids uh, the most common. It happened a couple of weeks after infection, where they can have a new response with their body. Sort of overreacts to the virus as a whole, but it is. It's much broader than just a respiratory virus, that is for sure. Um, reducing it in multiple organs and it can affect multiple organs short term.

Wow. Wow, that is certainly, uh, concerning, uh, given the knowledge. And again, it's all Wikipedia knowledge, unfortunately, which is where what I'm trying to do is kind of stem the Wikipedia knowledge and actually get real knowledge. So I thank you so much for all that information that you've given. I know that I speak for many of my listeners when I say how helpful it has been to have you kinda guide this, um, and guide our populations in the attempt to flatten the curve of the pandemic here, particularly in Alaska. Speaking for myself, I know I remain hopeful that our friends and neighbors understand the power and just the overall necessity of wearing a mask. Enforcing those social distances is particularly during these times, and hopefully, soon we can get back to normal and a real normal, not the new normal that I keep hearing about. Um, thank you so much for your time today. The show, um, coming out on the 16th. So, uh, hopefully, it can provide guidance as we get into this next holiday season where everybody's gonna is gathered around the table or Christmas tree. And, um can you think of, I mean, other than arm entre social distance mask?

Can you think of anything else that might help our listeners as they ready for this Christmas and New Year's holidays?

Yeah, I appreciate those things that you mentioned are really important. Um, a couple of the things that I would say if you're really gonna get together with people outside your household, uh, consider quarantining for a bit of time beforehand, and getting tested at the end of that somewhere between 7 to 14 days to really not mixing with anyone else. And they're getting tested prior to getting together and then get tested again afterward to make sure that you didn't pick it up and asymptomatically spread it to others. So these are tools, all of this public. All things are really tools of power. You, uh, to keep yourself safe to keep your loved one safe. And then the other thing that we haven't really talked about this vaccine, uh, we are full-fledged planning and all the details of vaccines right now. And while they will not be generally available to the entire public right away, they were gonna start available in limited quantities That will help to preserve our hospital capacity, protect those terminals vulnerable. And I think that is a real game-changer in this pandemic. I see a great light at the end of the tunnel right now, and it's gonna be a rough few months. Um, but we're getting to a much better place. Uh, and so I know for, uh, you know, my holiday season this year will be connecting to people virtually um, But, man, I'm planning to really, uh, get together with people I miss. I miss my parents. I miss my friends, hugs, and, uh, this summer, uh, next fall is gonna I think gonna be a very different place, Uh, for all of us in this country. And so I just I want people to know how much hope there is. And then if we're fatalistic about this, we do have control the spreads and are impacted and encourage people to really use these tools to keep their friends and family safe, particularly when we're so close, uh, to a really good, uh, prevented tool coming up around the corner. 

Outstanding. Yes. And I am. I have been watching the news with bated breath as well. Um, as as I've seen the, uh, multiple, um, vaccines can coming to fruition, and I'm just flabbergasted. And I use that word only because in 1918, uh, influence as they developed that vaccine, the amount of time as they develop that vaccine working, I'm sure as diligently as the doctors did this time. But how much faster? The vaccine for covid, uh, came to fruition and was able to be a little bit more flexible in that, um they looked at a whole bunch of different parts to make it happen if I'm not mistaken, and please correct me if I'm wrong, but, um, where this vaccine is going to be, as you mentioned, a real game-changer in the the the quest to crush covet.

Alright, completely. 100% agree. No steps were skipped, Um, that we went to all the normal processes. Uh, it looks to be both a safe and applied vaccine. The two things that we wanted to be, um it's just that there were a lot of people, a lot of time, a lot of money, and a lot of previous science on vaccine technology that was built upon to be able to build these vaccines. Um, from my seat in this, it kind of feels like I'm watching a man landing on the moon. It's amazing to watch the technology and what we have learned about this virus. Uh, when really we had a scientific community that has been collaborating and putting a lot of effort into this, uh, to make sure that we have the tools and resources for people to keep themselves healthy and safe. And so it's pretty exciting to see how far we've come and to think about how it happened in a short time frame yet not skipping the steps, just doing them in working collaboratively together. It's pretty amazing.

Outstanding. Well, thank you so much for all your information and for taking the time. Because I know you're crazy busy. I see you on the news two and three times a day, so I know you're crazy busy, so I really appreciate it. The time that you've taken with us today. Ladies and gentleman, Doctor Anne Zinc. Thank you so much. Have a great day and stay safe, Doc.

Thanks. You too. I appreciate you taking the time. And, uh, thanks for listeners. Uh, we all have a role to play in this. But, man, each individual asking really has the power to slow the spread. So thanks for all you're doing and stay safe. Be well and we'll talk soon. Thanks.

Posted on: December 16, 2020, by :

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