Q&A On COVID-19 With Dr. Justin Green At LAMC

first_imgDr. Justin Green in his office at Los Alamos Medical Center just prior to pandemic. Photo by Carol A. Clark/ladailypost.comBy CAROL A. CLARKLos Alamos Daily [email protected] L. Green MD, PhD, MBA, FACS is a hometown boy who following his 1980 graduation from Los Alamos High School, left town to study, practice medicine and serve in the United States military.After operating a private practice in Rapid City, S.D., and serving as chief of trauma surgery, emergency surgery and critical care at the University of Kansas Medical Center, Dr. Green has moved back to Los Alamos.“There’s nothing like being home,” Dr. Green said. “I love it here … I really missed it … it hasn’t changed much at all.”During his high school years, Dr. Green served as an ER and operating room orderly at Los Alamos Medical Center. There he came to know and admire longtime surgeon Michael Jackson. He explained that it was during that time that he felt the calling to become a surgeon.Now a Board Certified General/Critical Care Surgeon specializing in General/Thoracic Surgery, Surgical Oncology and Critical Care Surgery, Dr. Green joined the Los Alamos Surgical Associates team a few months ago at LAMC. He practices all aspects of acute care surgery with particular interests in trauma surgery and critical care. His research interests include the biochemistry of primary and secondary metabolic processes in critical illness, as well as complex coagulopathies in trauma and critical illness. This week, the Los Alamos Daily Post presented Dr. Green with a series of COVID-19 related questions submitted mostly by readers. He answered the questions with the understanding that the answers are solely his opinion or judgment and may not necessarily reflect the position of LAMC, Life Point Health or any governmental public health agency:Q & APost: How is the COVID-19 pandemic affecting normal hospital operations at LAMC?Dr. Green: LAMC has implemented a rigorous screening process, limited visitors, and provided personal protective equipment (PPE) to staff and patients. Elective surgical cases and routine clinic visits have been severely limited. Training of all staff has increased significantly, and physical isolation barriers have been constructed throughout the facility. Each of these measures, while essential to protecting the health of patients and staff, has had an impact on the hospital operationally and financially.Post: How many people has LAMC tested for COVID-19?Dr. Green: Readers are referred to www.nmhealth.org which will show testing data and results in real time. Post: How many of them have tested positive?Dr. Green: There have been 6 persons in Los Alamos County who have tested positive for COVID-19.Post: Can LAMC test for antibodies? Dr. Green: No. There are reference laboratories in Santa Fe and Albuquerque who are conducting antibody testing. I would caution readers that all antibody tests are not equivalent in terms of usefulness, i.e. sensitivity and specificity. Highly sensitive tests should capture all true positive results, while a highly specific test should exclude all true negative results. Only tests with sensitivity and specificity of greater than 95% should be accepted as providing a useful result. Readers should also be aware that, although preliminary data is encouraging with regard to the virus provoking neutralizing antibodies (antibodies capable of providing humoral immunity), rigorous trials will be required to ensure that neutralizing antibodies are produced, that they are produced in adequate numbers to confer some degree of immunity and that they remain active for a reasonable period of time.Post: How many patients have been treated at LAMC for COVID-19 since the pandemic began (since March)?Dr. Green: LAMC has treated numerous patients with flu-like symptoms, some of whom did have or likely had COVID-19, since March.Post: How many patients at this time are being treated for COVID-19 at LAMC?Dr. Green: There are currently no patients with COVID-19 at LAMC.Post: Have any patients at LAMC died from COVID-19?Dr. Green: There have been no recorded deaths in Los Alamos County due to COVID-19Post: How many beds does LAMC have?Dr. Green: Forty-sevenPost: How many of those beds are already occupied?Dr. Green: Hospital census changes in real time, from day to day. Post: How many ICU beds does LAMC have?Dr. Green: FourPost: How many of those beds are already occupied?Dr. Green: ICU census changes in real time, from day to day. Post: What plan does LAMC have to expand capacity if it becomes necessary?Dr. Green: LAMC has a comprehensive operational plan to expand inpatient capacity to treat patients affected by COVID-19, or by any other large scale medical disaster.Post: What will happen if LAMC gets a sudden surge of patients who need transport to Albuquerque? Dr. Green: Under the direction of the State Department of Health, all hospitals within the state of New Mexico have been assigned to operational regions for the purposes of care and coordination during the COVID-19 pandemic. Decisions regarding transfer and transport of COVID-19 patients are made through a single coordinating office within the Department of Health.Post: What should a member of the community do if they believe they have COVID-19?Dr. Green: Anyone who believes they are suffering from COVID-19 or have had a significant exposure to a person known to have COVID-19 should contact their primary care physician for directions regarding testing, treatment and quarantine requirements. Patients without a primary care physician may call the LAMC Emergency Department (1-505-662-4201) or the hotline at the New Mexico Department of Health (1-855-600-3453). Excellent online resources are also available regarding COVID-19 in New Mexico at the State Department of Health website (nmhealth.org).Post: Why are the COVID-19 positive cases so low in Los Alamos (NMDOH has listed the same 6 cases every day since April 14)?Dr. Green: The incidence of COVID-19 in disparate geographic regions, including Los Alamos County, is a complex and multifactorial paradigm for which many components remain unclear. It is my personal opinion that the willingness of citizens in Los Alamos County to follow the CDC/NIH/Department of Health guidelines for social distancing, wearing of face masks, self-quarantine and enhanced hygiene has significantly contributed to the lack of community spread.Post: Is LAMC allowing elective surgeries again?Dr. Green: In accordance with the direction of the State Department of Health, elective surgeries are now being accomplished at LAMC. Significant restrictions are still in place to optimize patient care and safety.Post: How is the pandemic effecting the OB/GYN Department at LAMC?Dr. Green: The Ob/gyn Department is operating under the same constraints as the rest of the hospital. Post: How many babies have been born at LAMC during the pandemic (since March)?Dr. Green: SevenPost: Does LAMC have adequate PPE?Dr. Green: YesPost: How many ventilators does LAMC have?Dr. Green: FourPost: How many staff members does LAMC have available to care for COVID-19 patients?Dr. Green: All staff, in all occupational specialties, have undergone extensive training that allows them to safely and effectively care for COVID-19 patients. Post: There are conflicting opinions about safety measures to protect against COVID-19 – do you think masks and gloves are important for the public to wear?Dr. Green: There is reasonable evidence that demonstrates the wearing of face masks significantly decreases the transmission of the virus through respiratory droplets. Wearing a face mask not only decreases the risk of a person contracting the virus, it also decreases the risk of an infected person unknowingly transmitting the virus to others. The evidence for wearing gloves is less robust. It certainly does not hurt but frequent and vigorous hand hygiene by a 20-second soap and water wash or an alcohol-based hand sanitizer is quite effective in killing the virus on a person’s hands. Whether a person wears gloves or frequently sanitizes their hands, it is equally important to avoid touching one’s face, as that is a likely portal of infection for the virus.Post: Do you think it is too early to make concrete assertions about COVID-19?Dr. Green: Absolutely. The scientific and medical community has made unprecedented progress in the months since the first COVID-19 infection occurred. That being said, there still remains an enormous amount of work that must be done before a good understanding of the biology and the pathophysiology of the virus is completely understood.Post: Can you recommend any home remedies or supplements that can help people strengthen their immune system to fight the virus?Dr. Green: There are currently no homeopathic/naturopathic remedies or supplements that have been demonstrated to augment the immune system in peer reviewed, randomized/controlled clinical trials. It is clear, however, that patients who are malnourished or unhealthy due to other medical comorbidities fare much worse than otherwise healthy individuals. Maintaining a healthy lifestyle with an adequate intake of vitamins, minerals and foods is essential to improving the body’s physiology and immune response to any disease process.Post: Is it true that sunshine and fresh air help?Dr. Green: To a limited extent. It has been demonstrated in rigorous studies that the COVID-19 virus is killed by a particular spectrum of ultraviolet light (UV-C). Unfortunately, the high energy UV-C wavelength is the smallest component of the total ultraviolet composition of sunlight. It is the wavelength that is most filtered out by the ozone layer in the upper atmosphere. Sunlight will eventually kill the COVID-19 virus on a variety of surfaces, but it is not practical to rely on decontamination of body surfaces by sunlight. Readers should also be strongly discouraged from using UV light sources for decontamination. In order to be effective, the source must produce UV light at the required wavelength and for the required duration of time. Such a device should absolutely not be utilized on the body, as it will cause severe skin damage and potentially blindness.Post: What is the biggest challenge you have encountered on the job during this pandemic?Dr. Green: For me, the greatest challenge was not being able to provide routine medical and surgical care to the community. While it was absolutely necessary to decrease routine care and procedures to safeguard our vulnerable populations and maintain a capacity to care for those afflicted by COVID-19, I very much missed seeing my patients and caring for them day to day.Post: Have you witnessed acts of heroism among staff at LAMC?Dr. Green: Every day, I see acts of selfless dedication and heroism from staff in all disciplines at LAMC.  From the facilities crew who built the isolation system for the ICU to the nurses/doctors and allied health providers who provide daily care to any patient, regardless of whether or not they are infected, every person at LAMC has put the health and safety of the community above their own. The community should be incredibly proud of these fine folks.Post: What does LAMC need from the community?Dr. Green: The administration, medical staff and operational staff of LAMC are grateful to the community for its ongoing support and generous donations of PPE. We are also grateful to the many citizens of Los Alamos who have provided ideas for dealing with the pandemic. At this point, the continued support of the community is our most pressing need. I am also hopeful that the community will continue to acknowledge and follow the public health guidelines to continue social distancing, wearing a face mask in public and practicing meticulous hand hygiene as these are proven and highly effective measures to mitigate the spread of COVID-19 in our community.Post: Is there anything else you would like the community to know?Dr. Green: Despite the misery and death caused by the COVID-19 pandemic, I believe that we are truly fortunate to have the best and the brightest minds in science and medicine working diligently toward an understanding of the virus and ways to mitigate its effect on humans. The contributions of American scientists and physicians, such as those at Los Alamos National Laboratory, cannot be overstated. While an enormous amount of work remains to be done, and we are far from seeing the end of the misery and death worldwide, I think there is significant cause for optimism: We know that simple measures such as social distancing, meticulous hygiene, quarantine/contact tracing and face masks significantly decrease the risk of illness. We are also seeing broad strides in vaccine development and the care of patients stricken with COVID-19. This pandemic, tragic as it has been, has also provided a hard and introspective analysis of how the United States and other countries must increase preparedness, improve public health, improve population health, decrease healthcare disparities and bolster disease awareness. It is my belief that we will, in time, control the COVID-19 pandemic. The challenge going forward will be to take the ‘lessons learned’ from it to heart so that the next organism that jumps from animals to humans – and there will definitely be a ‘next’ – can be met with a robust and effective response to lessen the overall toll of human suffering.About Dr. GreenDr. Green received a bachelor’s degree in microbiology/biochemistry as well as a master’s degree in biochemical toxicology from Texas A&M University in 1984. He also completed a Master of Business Administration at the University of North Dakota in 1987. He completed a combined MD/PhD degree in biochemistry from the University of Kansas in 1994. Dr. Green completed a residency in general surgery at the University of Kansas Medical Center in 1999. He completed a fellowship in Surgical Critical Care at Children’s Mercy Hospital in 2016. He is Board certified by the American Board of Surgery in General Surgery and Surgical Critical Care. He also is a Diplomate of the American Board of Medical Examiners and a Fellow of the American College of Surgeons.Dr. Green can be reached at Los Alamos Surgical Associates, [email protected]last_img read more