Dr. Ricardo Maldonado

Dr. Ricardo Maldonado, center, infectious disease specialist, observes the doffing and donning of personal protective equipment at EAMC in early March prior to the confirmed outbreak of Covid-19 in the Auburn community

While the number of patients hospitalized with confirmed cases of Covid-19 declined and plateaued at East Alabama Medical Center over the past two weeks, an infectious disease expert at the hospital expects an increase, and possible second peak, in new cases over the coming weeks and urges those in the community to remain vigilant in practicing social distancing, hand hygiene, wearing masks in public and avoiding large public gatherings. 

"People, at some point, get so exhausted that it's easy, at this point when you're catching a little break, to kind of let your guard down. You just can't do that. We know it's going to go back up," said Dr. Ricardo Maldonado, infectious disease specialist at EAMC. 

According to the Alabama Department of Public Health, as of Wednesday morning Lee County has had 522 confirmed cases of Covid-19, with 90 cases coming in the last two weeks. As of Tuesday afternoon, 21 patients with confirmed cases of Covid-19 were hospitalized at EAMC and EAMC-Lanier, down from 42 at the beginning of May.  

Maldonado and other experts have learned a great deal about Covid-19 since the virus broke out in the area in mid-March. At first, Maldonado said the hospital was basically learning about the disease through communication with people on the frontlines in communities where the virus had already taken hold. 

"We had a lot of information back and forth with physicians from Italy, New Orleans, Washington state, and basically we just learned from their experience," he said. "Things changed a lot from that point until now. In two months, we have learned tremendously about this virus. We have learned a lot about its pathophysiology, how the virus works."

Maldonado explained that the virus has essentially three phases. The first phase is all about the virus causing damage, which is manifested by the symptoms. 

"(The second phase), there is a lot of virus and inflammation, and the third phase there is a lot of (hyper-)inflammation that happens to some patients. That's the phase that makes most people very sick, critically ill or kills them," said Maldonado. "We understand that every phase of this illness has an opportunity for treatment. It's a very complicated illness. I think one thing that is fascinating about Covid-19 is the fact that it could be a very long viral illness, very long. And these stages are very marked, very well-defined. You can just tell, even anticipate, who is going to go down quickly, who is going to get critically ill, who is going to eventually go into respiratory failure and go into the ICU, based on certain markers we obtain, blood tests, etc."

If you want to have the best chance to get the best treatment, it's important to be diagnosed early so hospital staff can monitor how the virus affects patients through all three phases, said Maldonado. 

"We understand that when this patient falls into this part of the illness, these are the potential therapies that might help it," he said. "And even though there's nothing proven to be effective yet, there's a lot of excitement about certain medications and others not too much excitement. But every single one of them has a place in time. You don't want to do it too early; you don't want to do it too late. We're still learning about it, but there's a lot of excitement about how to manage these patients. We've learned a lot in the last two months, a lot."

One treatment that has generated a lot of excitement is remdesivir, an antiviral drug manufactured by Gilead Sciences, which donated a large supply of vials to the United States. The supply is limited, though, and distributed to hospitals from state health organizations. EAMC received only four doses two weeks ago. Maldonado said remdesivir is most effective when administered to a patient early and that it is extremely important for people to seek testing and treatment at the first signs of infection. 

"I think when you lose your taste and your smell, that's a very important symptom of Covid-19 infection. Of course, fevers and coughs are also very important. So people need to keep calling the SICK line or calling and talking to their primary physicians because we want to know when those patients get infected so we can once again apply what we know about this infection," he said. "Remdesivir, which is the most promising medication, will probably only work at the beginning of the illness, or most of the benefit will be in the first half of the illness. If you have already developed respiratory failure and there's a lot of inflammation or things like cytokine storms, a lot of trouble with inflammation, the antiviral really has little effect with lowering inflammatory responses in half the population at that time. The cases are extremely complicated to treat."

If you are experiencing symptoms of Covid-19, you can call the EAMC call center at 334-528-SICK from 8 a.m. to 4:30 p.m. Monday through Friday. The call center is closed on Saturdays and Sundays. 

The number of cases in Lee County is expected to rise in the coming weeks as more in the community venture out to take advantage of the loosening of health order restrictions. 

"People have been building frustration about it, and economically it's devastating to the economy of this country, so I understand why we are reopening this, but we have to be very smart," Maldonado said. "Covid is a very serious illness on those who are older, so if the country reopening and I'm an older person or have comorbidities I will not be the first one to go out and try to reopen the country. Maybe it makes more sense to allow the young and healthy to carefully go and try to do that. But once again, we still have to do social distancing.

"I think wearing a mask is very important. You don't have to wear a mask if you walking your dog around the neighborhood. You don't have to. But certainly to go to the store, grocery store or any type of retail store, really, I think I would highly recommend people wearing a mask, including children."

Reopening the country is a calculated risk, and it boils down to an individual decision, said Maldanado, who urged people to go to www.cdc.gov to get the most up-to-date and comprehensive guidance. 

"The more people that are in a crowd, the more chances you're taking," he said. "Are you willing to take those chances? Do you have anybody with comorbidities at home that you want to avoid? Are you OK getting sick and maybe being out of work for a couple weeks or longer? Are you at a risk of losing your job? So maybe you have to be careful."

The Villager will be delving deeper into more issues surrounding the Covid-19 pandemic in the coming weeks and also providing the full Q&A conducted on May 18 with Maldonado in the coming days online at www.auburnvillager.com. 

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