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UTRGV medical school, Hidalgo County team up with DHR Health to provide trustworthy news, medical expertise on COVID-19 in the Valley

Featured: Carlos Cárdenas, MD, Chairman, Board of Managers, DHR Health, addresses employees and special guests in the lobby of the hospital on Monday, November 11, 2019 as part of the hospital system’s Veterans Day observance.

Photograph Courtesy DHR HEALTH

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UTRGV medical school, Hidalgo County team up with DHR Health to provide trustworthy news, medical expertise on COVID-19 in the Valley

By DAVID A. DÍAZ
[email protected]

The University of Texas Rio Grande Valley School of Medicine, Hidalgo County, and DHR Health have teamed up to provide trustworthy news and medical expertise on the Valley’s COVID-19 developments, which as of Monday, April 6, 2020, included at least 215 individuals in the four-county region who have tested positive for the infectious disease.

Also on Monday, April 6, 2020, Hidalgo County officials emailed to mainstream news media outlets and major social media sites an online link to videos featuring interviews with DHR Health leaders and affiliated physicians, addressing some of the key issues of most importance to the more than 1.4 million residents of the Rio Grande Valley.

“Below is a link to a series of videos with a panel of doctors from DHR Health,” Jaclyn Treviño, Multimedia Coordinator with Hidalgo County Public Affairs, explained in her message to South Texas media, political, business and community leaders, and other individuals. “Feel free to post the videos on your stations and social media. Thank you for your help in getting out this valuable information to our community.”

The videos about the COVID-19 pandemic are available online at:

https://drive.google.com/drive/folders/1OtbxaqJhEDQWk0nQXbsy3yb52ZTsneV6?usp=sharing

Among the questions answered in the DHR Health videos are:

• How can we as a community contain COVID-19?
• What does ‘flattening the curve’ mean?
• What is our healthcare community doing to prepare for COVID-19?
• How does the COVID-19 test work?
• How do I get tested for COVID-19?
• I can’t breathe and have chest pains, should I go to the ER (Emergency Room)?
• How do our geographical location and rural surroundings help in slowing down the spread?
• Why is it a misconception that the virus cannot thrive in a warmer climate?
• Why is staying home the best way to contain the spread of COVID-19?
• Can I use any soap to wash my hands? Or does it have to be anti-bacterial?
• Why is it important to trust your healthcare community?
• What is the effect of COVID-19 on pregnant women?
• Why are the elderly so vulnerable to COVID-19?

Throughout most of the world, COVID-19 – which is an infectious disease caused by a coronavirus – has been rapidly spreading mainly through person-to-person contact. The early symptoms of COVID-19 include:

• Fever
• Cough
• Shortness of breath

The virus can lead to pneumonia, respiratory failure, septic shock, and death. If a person notices these severe symptoms in themself or a loved one, they must get medical attention right away.

https://www.webmd.com/lung/what-is-covid-19#1

In late March 2020, John H. Krouse, MD, PhD, MBA, Dean, UTRGV School of Medicine, and Executive Vice President, Health Affairs, UTRGV, and Carlos Cárdenas, MD, Chairman, Board of Managers, DHR Health, announced that those two entities had partnered in their efforts to help South Texans have access to the knowledge needed to protect themselves from COVID-19.

“As our Rio Grande Valley community is combating the spread of the COVID-19 or coronavirus, the UTRGV School of Medicine, together with DHR Health, would like to provide you and your family with some words of encouragement during these uncertain times,” Krouse said. “The UTRGV School of Medicine has created a COVID-19 resource website where you can find more information on how to combat and help slow down the spread of the virus as well as a hotline to call medical professionals about possible symptoms and COVID-19 testing.”

The hotline is: 1-833-UTRGVM (1-833-887-4863).

The website resource can be found at: utrgv.edu/coronavirus.

Cárdenas said DHR Health also provides information about the virus on its website: dhrhealth.com

“That’s right. We would like to let you know that both DHR Health and the UTRGV School of Medicine are working around the clock to provide the community with the resources needed to be up-to-date with the latest COVID-19 developments and news,” Cárdenas said. ““We understand that these are difficult times for everybody but know that together we will get through this. All of you are part of our team.”

The bond between UTRGV and its School of Medicine with DHR Health features DHR Health serving as the flagship teaching hospital for the medical school. 

Anchored in southwest Edinburg, with a growing presence in neighboring McAllen and Mission, DHR Health encompasses a general acute hospital with the only dedicated women’s hospital South of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 60 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio. DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing South Campus immediately across Owassa Road in northwest McAllen.

The series of videos, which were taken at the Edinburg Conference Center at Renaissance, took place on Thursday, March 18, 2020 – two days before Hidalgo County Judge Richard Cortéz announced on Saturday, March 2o, 2020, that the first case of a COVID-19 infection had been confirmed.

The transcription of those videos follow:

CORONAVIRUS Q&A WITH DHR HEALTH

How can we as a community contain COVID-19?

Robert David Martínez, MD
Chief Medical Officer
DHR Health

The important part is that everybody has a role to play. We at DHR Health, with acute care, we are ready, we have plans, again, those are for the sickest of patients. What I mean everybody has a role, is even though you are hearing that a lot of at the affected patients are in a particularly age group (65 years and older), even though you are 19 years old and not have a high chance of getting this and having a big issue, you may be asymptomatic (having no symptoms) and not even know it. You can be a carrier of the virus and pass it on to other people. When we say everybody needs to stay home, we mean everybody needs to stay home, because they can be a vector without even knowing it, and that’s the real danger. Everybody needs to do their part.

Carlos Cárdenas, MD
Chairman, Board of Managers
DHR Health

Everyone single person is a member of our team. You can help us by staying home, you can help us by looking after your loved ones at home. By staying home, you’re doing what we need to do to contain the virus. It’s truly that simple. It makes you a part of this team to making it possible for our community to do the best it can to protect itself.

What does ‘flattening the curve’ mean?

Armour Forse, MD, PhD
Chief Academic Officer
DHR Health

What we are trying to do in terms of ‘flattening the curve’ is actually trying to contain the number of incidents of active infection that would have to be cared for in the community. By delaying the incidents occurring in the population, instead of having a spike of cases that then could overwhelm the health care system, we would limit the number at any one time, delay it out over weeks to months rather than just weeks. By doing that, we would reduce the chances that we would overwhelm any of our health care facilities or capacity here in the Valley.

Iván Meléndez, MD
Hidalgo County Local Health Authority

‘Flattening the curve” is a term that is used quite frequently in epidemiology. There are different types of curves referred to by people. The most common ‘flattening the curve’ that people are referring to is simply referring to a chart – a mathematical representation that takes into consideration the incidents of the people that are infected in the community. When you first see the initiation of this disease or any type of epidemic or pandemic in any country, you will see an immediate rise in the curve. That goes immediately up, and you look at the slope or the angle or how quickly it goes up. When the curve eventually comes and makes a turn, referring to the number of new cases, instead of going straight up, it begins to flatten out. When someone refers to “flattening the curve”, they are referring to the flattening of the increasing of the incidents of the folks that are infected. You still may have an increasing number, it’s just a rate of which the increase becomes a lot less. Instead of having a curve that looks like a horseshoe, you have a curve that started as a horseshoe, then it started to flatten out. That is a good thing. We want “flattening of the curve”.

What is our healthcare community doing to prepare for COVID-19?

Iván Meléndez, MD

The first thing that we will be doing as a group is, from an epidemiology (the branch of medical science dealing with the transmission and control of disease) perspective, is to determine if this is from an outside source, or from travel, etc., or if it’s something that has been acquired locally. As you know, we all have been focusing on prevention. The experts who are here, they represent multiple specialities, highly-regarded in their fields, have already been for the last several weeks, acutely, and for months, relatively acutely, preparing. There will be a continuation of the preparation that is ongoing, there will be an activation of those plans that each hospital has, whether it be isolation of a certain ICU for this type of patient, whether it be identifying the pausation of elective surgeries, all these things that have been practiced around the country, not reinventing the field. Those have been laid out, those things will be actually activated. The rest of the panel can address what those issues, those preparations specifically, when cases are announced.

How does the COVID-19 test work?

Ricardo García, MD
Infectious Disease

First, you identify the patient who needs to be tested by risk factors, symptoms, type of exposures. Then you proceed with the testing itself. Nowadays, the preferred test is a nasal swab. We send it to the lab – it can be done through the state lab or through the private laboratories. The usual turnaround period varies, usually may be from two up to seven days. During that time, as long as the patient is a possible case of COVID until you rule it out, the patient has to be kept on isolation precautions. Once you have the results, then you can proceed accordingly, as far as isolation. That is using the technology we are using at the present time, but that is expected to get significantly better. We’re getting new testing kits. We should be able to get results in about three and a half hours. It is important to mention that there is no perfect test. If you perform the screening in the early phases of the disease, you may have a negative result. So, if your level of suspicion remains high, then it is recommended to go ahead and repeat the test.

Armour Forse, MD, PhD

If the person is having fevers and respiratory symptoms, there are a number of causes for that. It’s important for them to be screened and evaluated for those other causes as well, as part of our work-up to make sure to make sure those are not the actual causes for that person’s symptoms, at the same time that we then evaluate them for the COVID-19. 

How do I get tested for COVID-19?

Iván Meléndez, MD

The answer to that question, first and foremost, I would notify your primary care physician’s office. I would ask them, “Do you think I need to be tested? If so, do I need to meet you in a specific area? Do I need to come through a specific entrance area?” If that person, that physician, does not have the ability to test, then those physician offices have been educated, guided by the county health department to refer to those patients to our hotline number. Those epidemiologists, which are those experts who study these type of developments, these diseases, they will refer them to the appropriate manner of how to get the test done. That may be that some will have staff who will check them at home, that may be that they are directed to a particular place that it is being done.

From the private perspective every day, there is a limited amount of new kits that are being made available to the physicians in the community. So the physicians in the community, if you are interested in testing, what you would do is call the private corporations – the physicians know who they are – and they will inform you (physicians) how long it takes, and how many kits you will be provided, and give you an educational aspect of it, of who really should be preselected to do it.

So if you are at home, and you say, “I want to get tested. How do I get tested?” call your primary care physician, and if he/she is not able to direct you, there is a Hidalgo County Health Department website, there is a hotline number on it (COVID-19 Hotline: 956/292-7765), and they will go over it with you specifically.

http://www.HidalgoCounty.us/coronavirusupdates

I can’t breath and have chest pains, should I go to the ER (Emergency Room)?

Robert David Martínez, MD

What’s the threshold for coming to a hospital versus your physician’s office? If you’re sick enough to go to the ER, you don’t feel good, you’re having trouble breathing, you have significant chest pain, you’re bleeding – those are reasons for a patient to come to the emergency room. We’ll figure out if you have COVID-19, or whatever it may, be down the road. You’re acutely ill and need to come to an emergency room for evaluation and treatment. If you have a cough and simply want to find out whether that’s what you have (COVID-19) or not, is not a good reason to come to any hospital at this point. The likelihood is you’re not going to get evaluated for that unless everything else is negative, at this point.

We have to be very cognizant of what the resources are. As soon as we have full resources, like everything else, it’s going to happen much more quickly, and without any second-guessing.

Javier Cortinas, MD
Emergency Medicine

If somebody at home feels they really need to have the test, they need to think, “What is going to happen to me if I am positive (have COVID-19) and what is going to happen to me if I am negative?” But most of the time it is going to be the same thing – you are going to have to be quarantined at home. Sometimes, even going to the ER, if you have the chance to be tested, and if it is positive, we’re going to send you back home, too. That’s the main message for people. Even if you get tested, you are going to be sent home, unless you are acutely ill, as Dr. Martínez said. The main management for the population is to self-quarantine.

How does our geographical location and rural surroundings help in slowing down the spread?

Iván Meléndez

We were having a conversation this morning (March 18, 2020) specifically about the geographic uniqueness of this area, the penetration of this disease, and the incidents of it. Your comments, if you please address, dealt with the penetration of rural communities versus urban communities, and the association of our climate based on the climate of New York or Washington state, because we both felt, to a certain extent, we are at a greater advantage as opposed to a greater disadvantage in reference to the testing through a drive-through.

Ricardo García, MD

I can try to elaborate a little bit more. We have to understand the main mechanism of how we transfer the virus. It is through the droplets of saliva that which expel when we cough or sneeze. Those micro-droplets of saliva, they don’t go too far. They may go up to a distance of six feet. In general, big cities that are more crowded, lots of people in a relatively small space, are at higher risk to get it. It’s easer to transfer the virus that way. But if we are in a rural area, where the density of people per mile is relatively small, then the rates of transmission are lower. It doesn’t mean it cannot happen, but it is at a lower risk. That’s an important factor, and maybe that is why we are seeing some geographic variations, we are seeing that it is easier for this (COVID-19) outbreak to get more easily established in other places, in big cities, whereas in the rural areas, the spreading has been slower.

Why is it a misconception that the virus cannot thrive in warmer climate?

Ricardo F. García, MD

The virus will exist in warmer climates. It is not that the heat will kill it. They way you congregate during the different seasons of the year. During summer, you tend to meet people outdoors, where the spreading of the virus is more difficult. You tend to keep your distance. In wintertime, you have lots of people indoors, in places that don’t necessarily have good air circulation, small space, lots of people, ideal conditions for transmission of the virus. That’s probably the main reasons we are seeing these seasonal variations, because of the way people congregate.

Why is staying home the best way to contain the spread of COVID-19?

Robert David Martínez, MD

Even if I didn’t have a (COVID-19) test, we can essentially do ourselves a lot of good, and really minimize the chance of spread if everybody stayed home for 14 days. It wouldn’t be perfect, but we would do a heck of a lot of good without a test ever being done, just because of the natural life cycle of the disease. Those simple measures will take care of most of the problems.

That being said, even if you did test positive, it is more for our information, make sure you don’t spread (the virus). Looking at the (statistics) in China, which is the best we know right now, we’re talking about an 80 to 85 percent walking-sick. Most of those people get over it, some don’t even know they every have it. At 85 percent, those are pretty good odds. Those who get sick, very ill, requiring acute care to an emergency room, they will have free lanes to come into the hospital and not have to wait for days. That’s what we want to do, is to not overwhelm the system. Those who need it with acute care should be able to get it. We’re prepared for that. Just heeding the warning that you are hearing at all levels: stay at home. The test isn’t really that important. If you are planning on milling around, the test becomes more important because you need to know if you are spreading the disease.

Armour Forse, MD, PhD

To build on that, the only proven way to control this is containment. It’s the only thing that has been shown to be effective in terms of this virus. That means stay home.

Can I use any soap to wash my hands? Or does it have to be anti-bacterial?

Ricardo F. García, MD

There has been a lot of misunderstanding about hand washing. The recommendation is 20 seconds washing your hands with water and soap. You don’t have to use anti-septic soap. Any regular soap is enough to deactivate the virus. That is an important clarification I wanted to make.

Why is it important to trust your healthcare community?

Robert David Martínez, MD

Trust your healthcare provider and your county in what they’re doing. We are going to lay out some plans and adapt. The good news is this is a recoverable disease, it’s preventable if we do it together, but everybody plays a role. Realize what every different entity, what their role is, and what they can and cannot do for you.

The hospitals are prepared. They’ve been prepared for months, years, I’ll say. That’s not the difficult part. The difficult part is the misinformation and folks assuming something else, and not listening to what’s going on here. It’s really important for people to listen, ask questions, and remain educated about what’s going on in the Rio Grande Valley. You can always look at news and what’s going on in different communities, but remember, as some of these gentlemen mentioned to you, there are variances to the way things are done, and the way that recommendations are made, based on what we have available to us and what we don’t. 

The hope is at the state level and the federal level, I am anticipating some of those things changing, us getting more of those resources. But we don’t have to wait for those resources. We need to start mobilizing different things, which we have done, and we can do a lot of good for ourselves by just heeding information from county officials, that you hear from health care professionals and the hospital folks. They have your best interests at heart, there’s no doubt. Many of us grew up here, we know a lot of folks, we know what we’re doing. But everybody has to play their part in order for us to get out of this as soon as possible.

What is the effect of COVID-19 on pregnant women?

Efraim Vela, MD
OB/GYM

At this point, it’s just basically repeating what we’ve said before – the hand washing, the social isolation, using good sense, and avoiding crowded places at crowded times. If you have to go to shops and to stores, find those times that are less traveled, less crowded. Continue with you prenatal visits, and again observing the recommendations we have laid out at the hospital for visitation and for hours of visitation.

Ricardo F. García, MD

There is a limited experience, a relatively small number of pregnant female who have been infected by COVID-19. But based on that experience, mostly coming from other countries, there is no documentation that the virus is transmitted from the mother to the baby. That’s an important point to keep in mind, as far as the pregnant patient. Pregnancy is related to some degree of Immunosuppression. Your immune system kinds of gets weak during the pregnancy. That may be a factor that may predispose pregnant females to be particularly careful, monitor symptoms closely, and if they develop any of the symptoms – fewer, cough, or of course, shortness of breath – during the pregnancy, notify immediately the treating physician.

Why are the elderly so vulnerable to COVID-19?

Carlos García Cantú
General Surgery

The prognosis is worse for the elderly, and for that reason, containment and self-quarantine is very important for that population. For the most part, it will be of much help if the elderly remain in self-quarantine, because this speeding is not for them very easy, and not to go to places where there a a lot of people.

UTRGV CENTER FOR VECTOR-BORNE DISEASE SHIFTS WORK TO COVID-19 SCREENINGS, TESTING

The UTRGV Center for Vector-Borne Diseaseis playing a key role in the Valley’s response to the COVID-19 pandemic.

The center – which normally focuses on viruses like Zika that are transmitted through insect or other arthropod bites – now is helping with COVID-19 testing, which the UTRGV School of Medicine’s clinical practice, UT Health RGV, started March 30 withtesting sites in Brownsville and Edinburg.

“This was not something we expected to do,” said Dr. John Thomas, UTRGV Assistant Professor of Biology and a founding member of the UTRGV Center for Vector-Borne Disease.

“The medical school called me a couple weeks ago and asked if I could help them prepare samples for shipment to an external diagnostic lab, so they could get tested for coronavirus,” he said. “And that request somehow turned into, ‘Well, could you do the testing?’”

The Center for Vector-Borne Disease has an Applied Biosystems 7500 Fast Dx, a diagnostic machine that detects the Zika virus and other viral agents. The machine requires specialized training, and the center owns the only one south of San Antonio, Thomas said.

“We just made a few changes to our protocols and started doing COVID-19 testing,” he said.

Thomas set up teams to work on the two parts involved in the screenings – extracting the RNA and running the Applied Biosystems 7500 Fast Dx.

“The first part is actually extracting the coronavirus genetic material from the swab after it’s been placed in somebody’s nose,” Thomas said. “It’s a very complex process.”

He has seven highly trained graduate students working on that process.

“My graduate students, because we do so much work with Zika and dengue and other viruses… they’ve had a lot of practice already. They’ve already learned these skills from doing their graduate projects,” he said.

After verifying the purity and amount of RNA extracted, that team hands off the sample to the people running the Applied Biosystems 7500 Fast Dx.

Juan García, a UTRGV graduate student from Edinburg majoring in biochemistry and molecular biology, is one of the people trained to use the machine. He manages the lab, and Thomas credits García for directing the student teams.

“This is a once-in-a-lifetime opportunity to directly contribute to one of the most significant events in our lifetime affecting populations throughout the globe,” he said.

García said the work is especially important since most of the students working in the lab are from the Rio Grande Valley.

“This allows Dr. Thomas’ lab to truly give back to the community during this time of concern and uncertainty,” he said.

Thomas said the switch to COVID-19 screening was a lot of work but potentially critical to the community.

“The sooner we can identify somebody as being positive for COVID-19, the faster we can intervene and lessen their opportunity to be able to infect other people,” Thomas said.

“We want to make sure our community is going to be safe and protected,” he said. “I don’t think anyone else but UTRGV and the UTRGV School of Medicine could have been in a position to come in and set up the system so quickly, and make it work for the Valley.”

The lab has been certified as a clinical lab (CLIA) through an emergency waiver approved by the state’s Health and Human Services Commission. 

In the first week of testing, Thomas’ lab and UT Health RGV tested 338 people for COVID-19 across the two drive-thru sites, one in Edinburg and one in Brownsville.

People who feel they need to be tested for COVID-19 at UT Health RGV must first complete a mandatory phone screening by calling 1-833-UTRGVMD. UT Health RGV now offers the option to complete a form online to request a COVID-19 phone screening.

To learn more about the UTRGV Center for Vector-Borne Disease visit utrgv.edu/cvbd.

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María Elena Hernández contributed to this article. For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).

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