A NEW YORK CITY E.R. DOCTOR WITH CORONAVIRUS!
(Z-61054V) CM1010 COACH MIKE PODCAST: DR. DARA KASS
MIKE BAYER: Welcome to the “Coach Mike” podcast. I have a special guest today who is uh, an emergency room doctor. Her name is Dara Kass and she’s a mother of three, lives in New York, uh was working in the emergency room and has come up positive for COVID-19. I thought there was no one better to have a discussion with than someone who understands medically what’s going on that happens to be a parent and also came up positive themself. So uh a lot thrown at her and really curious how she’s doing with everything, so welcome to the podcast Dara.
DR. DARA KASS: Thanks for having me Mike.
MIKE: So tell us a little bit about you and (STAMMER) and what your life kind of looked like leading up to testing positive?
DR. KASS: Okay so a couple of things, um so I’m an emergency medicine doctor by training. I’ve been an E.R. doctor for longer than I want to admit I guess based on my current hair color, but probably close to 20 years, um and I was actually working part-time in the E.R. before this. I do a lot of work on gender advocacy and I travel a lot and I have three kids and so I was working a few shifts a month. Um you know about three weeks ago, four weeks ago we all started pivoting, uh knowing that this was about to hit our healthcare system pretty hard and that watching what was happening in China and then in Italy, we really saw that there was about to be an escalation in America especially as it hits emergency departments. So I-- like a lot of my colleagues, started looking around at my life and figured out how I needed to reframe my life and the more complicating factor for me is that I have a twelve year old, a ten year old and an eight year old. But my eight year old when he was two years old had a liver transplant and so he’s immune compromised. And so although this virus-- everyone likes to talk about how the kids are vectors and that they’re not sick and they don’t get affected. You know there’s no good data on how transplant kids deal with this, um and knowing that the data from China and Italy told us that the healthcare workers were getting infected at a much higher rate than anyone else. I actually moved my kids out of my house, um, before I actually was exposed and so they’ve been living with my parents for about a week and a half. And so um I-- so that goes back to once we moved them out, uh I’d been seeing patients on my computer, telemedicine to help really decompress a lot of the patients that were nervous about this. Uh patients that were having a cough or maybe a fever, but didn’t really meet criteria to be tested anywhere and then I went-- went to my first in-person shift in the E.R. uh and wound up taking care of a bunch of patients that most likely had it, a lot of whom we didn’t test either, uh and the-- the next day literally. So by Monday I started having symptoms myself and then I got tested. By Wednesday night I did a tele-medicne appointment for myself to uh talk to a doctor about my symptoms and by Thursday I was tested and had the results.
MIKE: And so you-- you went back Saturday/ Sunday and you felt the symptoms within 24 hours?
DR. KASS: It seems that way. I mean it’s a little impressive actually. (LAUGHS) I don’t know what else to call it, uh but I started having symptoms on Monday and you know I wasn’t even sure. I was worried they were sympathy pains actually, that I was like basically like a non-pregnant husband. I was seeing so many patients that had these symptoms that I was starting to feel the cough and started feeling the muscle pains and I actually was-- felt a little guilty about getting tested. Um…
MIKE: And what was-- what was the first symptom you feel like was happening, but then your brain was like, “Nah maybe I’m overreacting” or?
DR. KASS: So I uh-- so Monday morning I had (UNINTELLIGIBLE) I had woken up after working like five days of telemedicine and then two days in the E.R., moving my kids out of my house just like processing all of this anxiety, um and I woke up and I couldn’t walk and I was like…
DR. KASS: ...wow. I am manifesting this like real-- this process in a very real way. You know my legs are so tired and I can’t walk and I don’t know what’s going on, so I’m just gonna like, use a foam roller and I’m gonna do a yoga video and I’m just gonna try to like, feel better ‘cause I have to…
MIKE: Work it out
DR. KASS: ...see patients later. Right and like, I was like damn I’m out of shape, you know. And um-- and I just-- I got progressively worse and then I all of a sudden I had a cough. And I was like, okay muscle aches and fatigue and a cough.
MIKE: And what kind of cough was it?
DR. KASS: It’s a dry cough, so I can-- if I talk long enough you’ll hear it, but it’s like a (COUGHS) cough um...
DR. KASS: That is if I take a deep enough breath it-- it totally triggers the cough. Um and that cough was persistent and I was-- I started seeing patients even on telemedicine with the cough and they were complaining of a cough. And I’m like, you mean like this? And they were like, “Yeah like that.” And I’m like, we probably (STAMMER) probably both have it.
MIKE: Did you move to telemedicine recently or has that just always been a part of your practice?
DR. KASS: Yeah I’ve-- I’ve done a lot of telemedicine. I actually-- I’ve done it for years…
MIKE: Mm hm.
DR. KASS: ...in lots of different ways, uh and I think it’s a great innovation that helps patients where they are. Uh it’s a great way to help people not have to go to the doctor. It’s good for the system. We see patients all the time when they’re at work…
DR. KASS: ...and they just have a-- like a question. So I had been doing a lot of it beforehand and it just became super useful in this moment.
MIKE: You know uh, we uh started doing telehealth at uh-- I own a treatment center, so um it’s been interesting because a lot of the clients, you know they struggle already with depression, isolation and anxiety and then we’re having to provide treatment without ever seeing them in person now, which we’re having to get really creative with solutions for people when they're in their own homes.
DR. KASS: Right.
MIKE: Um and what would you say in terms of telemedicine is the big difference? What-- what’s kind of the, the benefit or the challenge with doing telemedicine?
DR. KASS: So I Think telemedicine requires a certain-- I, I have a pretty large personality. It’s both a benefit and a risk of what I do, or whatever, um and I think that in a lot of ways that’s really good for telemedicine because you can make somebody feel safe and comforted without actually being in the same room with them.
DR. KASS: So a lot of times patients will call and their medical need isn’t as much as their like, psychosocial need to feel like they’re not crazy or that their symptoms are real or that they should or shouldn’t take a medication. And if you can kind of assuage that fear quickly or answer the question they have about the health system or give them the prescription that they were almost afraid to ask for, but they didn’t, you know, ‘cause they wanted not to bother you. If you can do that in a moment it, it like solves a huge problem that would’ve otherwise been in the system because a lot of times people don’t know-- even know where to go for their like…
DR. KASS: ...healthcare issue. And so when you put it in their fingertips and then you can make them feel comfortable through a computer, uh it’s really very helpful.
MIKE: Now you’ve seen an increase in people, uh, contacting you specifically for COVID-19?
DR. KASS: Oh yeah. I mean there are, um hundreds fold increase in telemedicine visits across-- especially New York City, uh and that’s good, right. So one of the things that was really important when this was-- when this was ramping up and one of the things that I was really vocal with on social, was that telemedicine as a resource would be the big, like, decompression agent for people otherwise going afraid to the emergency department.
DR. KASS: Like, we knew based on the data out of China and Italy that we couldn’t have all these relatively well people coming to the E.R. asking for casts, checking on their symptoms and most of that can be done (STAMMER) via-- you know with a video visit/. And so by keeping that portal open and making it available to people, it’s the reason that the administration supplemented the payments for that and that it’s at the state level. In New York they made those video visits free, um and it has to do with the idea that that’s what we want people seeking care in the first level so we know who to send over to the E.R.
MIKE: You’re a doctor and so where do you go in order to get the most accurate information about COVID-19?
DR. KASS: So I go to (STAMMER) ironically this is a-- I go to my trusted Twitter sources, which is not the same thing as going to Twitter (LAUGHTER)...
DR. KASS: ...and I think that’s really important. So I have-- and I use that because it’s the fastest news feed that I have that gets current information out there. Articles that are being processed through China (UNINTELLIGIBLE) other national sources. Um I don’t get my info-- I actually-- I don’t get my information from federal press conference right now, but I do get a lot of my information form our state level press conferences as well, um because I find that that’s local or information that I need to manage the patients that are gonna call me in New York. There is a desperate need for answers to questions that people have and we don’t have a lot of those answers and unfortunately, there are people with very large platforms, including the president, who enjoy solutions. And sometimes those solutions when you put them out without the (STAMMER) the respect for the downstream effects, can be even more dangerous, um in their inner (UNINTELLIGIBLE). So one other really important thing is, how does immunity work, right? So I have the virus right now.
DR. KASS: When am I considered immune?
MIKE: Mm hm.
DR. KASS: Why? Because I need to go back out and take care of more patients, right? And we’re building this (UNINTELLIGIBLE)…
MIKE: And your kids. And-- and you have kids.
DR. KASS: I need to get them back in my house. If I’m immune, right? Maybe they could come home…
DR. KASS: ...because then I’m not a risk to give it to them again. Right? Because I’ve already gotten through that phase. That would be amazing. I can’t-- I don’t have that answer and the people that are supposed to be giving me those answers aren’t giving me those answers right now. Because unfortunately, again and as we look at the landscape of um, the way decisions are being made at different layers of leadership. The-- one of the first things we-- principles we know is that our federal leadership right now does not like bad news, right? They don’t wanna publicize things that make them look bad. Now...
MIKE: Mm hm.
DR. KASS: ...that doesn’t mean that they are-- we’re looking at information that’s their fault. Right? But knowing how many people who are infected in America is scary.
MIKE: Mm hm.
DR. KASS: And so we spent a lot of time not testing people, which doesn’t mean the infections weren’t there, it just meant we didn’t get ahead of them.
MIKE: How many guess-- what’s your-- what’s your guess on how many people are actually infected?
DR. KASS: I mean, I have no idea. I really don’t. What I know is that easily, easily ten to one or twenty to one of the tests that we’re doing versus the test that I could be doing.
MIKE: I’m wondering even in general when somebody has, I don’t know, the flu or uh any, any sort of medical condition, what are the odds (STAMMER) of cases that people say-- you know that they go in and get tested versus people that just get well at home in general? Like what is…
DR. KASS: We don’t know. Like, the amount of emotional anxiety people are holding on to, not knowing if they’re gonna get it and if they get it how sick they’re gonna get.
MIKE: Mm hm.
DR. KASS: If we could then have an entire population of people that think they had it go to a lab, find out that they’re immune and then be part of the workforce, the helper workforce, the immune workforce. The people that can go out then…
DR. KASS: ...and deliver food to elderly people, that could make sure that young people are staying in their homes that could walk around our parks and say, “Hey you guys really need to stay six feet apart.” Regular old, you know, community helpers, right, who know that they’re immune. There are so many ways that could be useful in a society that’s trying to survive through what is a really unknown and scary time.
MIKE: And, and through this all, like what’s your greatest fear, um in the position you’re in?
DR. KASS: We’re gonna-- we’re about to have a healthcare workforce that has to make choices about who lives and who dies before the person is dying. And that is a really, really scary thing. Um because we know from Italy and from China that without the appropriate federal leadership and forethought, once you hit a critical mass of sick people, the choice isn’t yours anymore.
DR. KASS: And every trajectory we’re seeing in um-- on all the studies show that New York City is about to be one of those places and in the next couple of weeks. And that’s really scary, um and sad.
MIKE: And what do you think the solution is?
DR. KASS: I think that we’re doing what we can right now, um as far as-- uh you know first of all supporting each other is critically important. Right? So the healthcare workforce supporting each other, the regular people out there you know going out at eight o’clock and saying, “thank you” to doctors and nurses is also gonna be really important. Um, realizing that we’re all human and that the kind of experience of being a doctor or a nurse or a healthcare worker at this time is going to be challenging, but leaning into that and knowing that we need each other and knowing that we have to talk about experiences. In New York we have an extraordinary governor who’s doing an extraordinary job and um, is able to mobilize locally and at the state level. But the missing piece right now is federal leadership. Um and I say that (UNINTELLIGIBLE)...
MIKE: Um, so when you talk about “federal leadership” and that’s what’s really needed right now, what-- what you’re talking about is the messaging and the um, kind of collective of, “we’re all in this together” or what is-- what is kind of the messaging that you think needs to shift?
DR. KASS: It’s not just messaging, it’s action actually. So the two things that I’d really like to see I think that are-- it is um, honesty, acknowledgement that this is scary.
MIKE: Mm hm.
DR. KASS: Realizing that we are all hitting something unprecedented. None of us are expecting a magic fix, right? In a lot of ways the humility that this is overwhelming and that we’re in this together, would be fully refreshing. But there’s a lot of kind of like it’s this glossing over that somehow it’s gonna be-- it’s not that bad. Right?
DR. KASS: Most people are going to be okay. Like, how do you-- when you’re on the ground and seeing people who can’t breathe, die? But somebody from a podium is saying, “But don’t worry it’s not that bad. We’ve done a great job.” It-- this is not political. This is-- this is very personal. You feel like there’s a disconnect between what you’re seeing in front of you and the choices you have to make and what somebody is saying you’re supposed to be seeing. You’re supposed to be seeing most people do fine. You’re supposed to be realizing that everyone’s having a, you know (STAMMER) is taking care of you. We’re supposed to be seeing that there’s magical tests everywhere that everyone’s getting the equipment they need, but that’s not what we’re seeing. Everyday nine out of ten people that need a test, I’m telling “no”. Everyday I’m reusing a mask that I’m holding in my bedroom because I don’t know if I’m gonna get one when I go to work. So these are the issues that don’t match, right? So the messaging that we need right now is the humility and the honesty that this is a really tough time.
DR. KASS: And tha, that’s not (STAMMER) that’s bad news, but it’s real to that-- ‘cause that creates a level of trauma for the providers on the ground that don’t (STAMMER) like they feel like left out, so that’s first of all. The second thing we need is actual organization, right is resources? Like (UNINTELLIGIBLE) that the immunity-- like we need a CDC website that has exactly the resources we need for easy to answer questions.
DR. KASS: I need to know that there’s a centralized processing for all of the protective equipment that the states need so that it’s not the hunger games. It’s not New York versus…
MIKE: Mm hm.
DR. KASS: ...California versus Illinois fighting for masks. I-- that’s not gonna help anybody. And so there’s a level of um, competition that historically has been allowed between states, that in this moment needs to not happen because we’re all Americans. And it shouldn’t matter if you get sick in New York, California whether or not your doctor gets a mask.
MIKE: And, and why do you think that isn’t the message?
DR. KASS: Because I don’t think they like bad news and this is bad news.
MIKE: I want to ask you to parent, uh three kids, what is the messaging you’d give to your eight year old? Um and because I think a lot of parents are pretty confused around, in general, what to say to their kids right now.
DR. KASS: Um right. So it’s funny when I found out that I was positive, which I think has all these connotations of HIV from when I grew up as a doctor. And so I, I think that whenever we talk about people being positive, um I’m okay to lean into the idea of the terminology. But it reminds me of the stigma that happened um when HIV and AIDS were coming out and one of the things I think is really important about every person who becomes-- who finds out that they’ve, you know, contracted, you know, COVID which is really a respiratory virus to come out publicly about it. It’s the idea that to destigmatize this concept of anybody’s kind of status in any medical condition being um, somehow a burden on who they are. You know what I mean?
MIKE: Mm hm.
DR. KASA: Um so uh, with my kids as soon as I found out that I, you know, was positive I called them and I said, “Don’t I make coronavirus look good?” And they were like, “You do.” And I was like, “See I told you guys I needed to get you guys out of the house ‘cause I knew I was gonna get it. I knew I was gonna be fine, but you know this is-- this is what corona looks like.” You know?
MIKE: Mm hm.
DR. KASS: And um, the reason why I-- my friends were like, “Did you tell them?” And I was like, “Of course they did-- I did.” ‘cause in my family we don’t hide things. Um, we talk about truths.
MIKE: Mm hm.
DR. KASS: Um, but I think that the other part of it is like, they’re gonna see a lot of stories out there about lots of different people doing well. And again, they’re gonna know somebody who’s, you know, parent, grandparent is gonna pass away from this.
DR. KASS: Um, this is gonna be a defining moment of their life just like the war was in the 40’s, you know for those kids who grew up as, you know, kind of World War II kids. Um that was probably the last time in American history that a national crisis defined a generation in that way. Um, I am really honest with my kids. They’re not gonna hear about the bad things that I see in the hospital because that is a unique experience that I’m gonna have. But I probably won’t tell my husband about a lot of it either. I will just tell my friends...
DR. KASS: ...who are in it with me. Um there’s a cohort of, of doctors who are all positive, um who talk about their symptoms every morning just to make sure that we all are breathing still, you know, um and we’re worried about each other because we know the, the progression over the days and we wanna make sure you get to day seven, day eight, day nine, day then and then you’re better. (COUGHS) Um that was my cough for effect, um…
MIKE: So someone who does come up positive in order to have the best outcome in terms of recovery, what are you seeing with the other doctors is the best protocol besides just, stay home and sleep?
DR. KASS: Uh there isn’t I mean we’re still working on those medications and they’re seeing if they’re useful. Uh, the most important thing is you rest and to let your body recover. It’s the reason why I am at home right now and trying to minimize as much as I can, the stuff that I’m doing. Um, but that’s the best. That’s it. It’s like any virus. The goal is to become symptom free for three days and if they-- they say if you’re symptom free for three days, you can get back to work. So that’s kind of the metric we’re using for now.
MIKE: They say if you’re symptom free for three days, you can go back to work?
DR. KASS: Mm hm.
MIKE: Even if you’ve tested positive?
DR. KASS: Oh yeah.
MIKE: No kidding. So someone tests pos-- ‘cause I spoke to someone last week and the requirement for him was 14 days where he wasn’t allowed to leave the house.
DR. KASS: That is the screening protocol if you don’t test somebody. So the 14 days is supposed to be from testing to (STAMMER) to make sure you don’t develop symptoms. Ones who develop symptoms and you’re presumed positive, then a new clock can start to say that you’re three days symptom free. Does that make sense?
MIKE: Yeah. I mean he came up positive and then uh…
DR. KASS: And he was told 14 days from the positive status?
MIKE: He was told 14 days and he was in this basement for a week.
DR. KASS: Mm hm.
MIKE: And he was actually feeling a lot better until he started on some new medication for malaria, he said, and then his-- his stomach’s been really bothering him.
DR. KASS: That’s probably-- that’s actually probably the virus. So there’s a really significant, uh, GI component that people have with this virus, both nausea and diarrhea unfortunately, um and so that’s probably not related to the medication for malaria, it’s probably just his viral syndrome as it is. Um, but either way.
MIKE: And it’s been for him-- I mean it’s been over ten days.
DR. KASS: Yeah. I have friends that are on 14-- the 14th day of symptoms right now. I mean it really is hitting lots of people lots of different ways. What I will say is for me, um you know this idea that you wake up and you say-- I literally open my eyes and I’m saying, “I can breathe today.” And I’d stop and that’s a gift.
MIKE: Mm hm.
DR. KASS: And that is how I am telling everybody that finds out that they have this, that should be their routine every morning. Cause if you can wake up and say, “I can breathe today” and then you watch your symptoms through the day. It’s the days you can’t breathe that you need to seek care, um and those are the patients we need to take care of. The other symptoms, the muscle aches, the fatigue, even the diarrhea, like that’s all stuff we can manage at home. None of those people need to be coming to the hospital, not even for the fever. The only people that need to go to the hospital are the ones that can’t breathe.
MIKE: Those are the only people that need to come to the hospital (UNINTELLIGIBLE)?
DR. KASS: The only people. And we need to keep as many of those people out of the hospital as possible. Again, it’s not because we don’t think that in a regular world they might’ve needed something in the hospital, but it’s b because the closer we keep the numbers down, the more beds we keep open, it doesn’t get us to that tipping point by which we start to see people die.
MIKE: So, so let's say ten people come, uh to the hospital who are concerned about having COVID-19. Out of those ten, roughly, how many actually can’t breathe or having trouble breathing?
DR. KASS: Like one in ten.
MIKE: One in ten actually.
DR. KASS: It’s like (UNINTELLIGIBLE/ OVERLAPPING DIALOGUE)
MIKE: It’s the other nine in ten that are coming to the hospital that actually don’t really need to be in the hospital?
DR. KASS: Right. Probably. Yeah and again it’s not-- problem is right now is figuring out who that looks like, but at the same time um you know we don’t want people not to come if they’re scared. Like we really do want people to seek care if they are um, in trouble, but remember that that’s what telemedicine is for.
MIKE: So uh, how can somebody who’s listening do telemedicine with your group?
DR. KASS: So the reality is, is that um in any-- every hospital system-- so I work at um, NYP which is New York Presbeterian, um, and so you can go to the app of NYP, download it from the app store and click a virtual visit. NYU has one as well, Mount Sinai has one as well. Uh there are uh regular…
MIKE: Are those for New York residents or anyone in the country?
DR. KASS: So actually it depends on the license of your doctor-- of a doctor on call. So I have licenses in four states, so I can see somebody in New York, New Jersey, Connecticut or Pennsylvania.
MIKE: Mm hm.
DR. KASS: So when they say who they are and where they live, it’ll give them an option of the doctors available if there are, um, options of doctors that are available with a license in your stage.
MIKE: So it sounds like the best solution for anyone listening is to maybe look at the hospitals in their area...
DR. KASS: Right.
MIKE: ...see what’s available in terms of the telehealth. Most of these websites supply those it seems now?
DR. KASS: Yeah. So Google actually should work well here, so you could probably put in, “telehealth visit” into your Google, like, browser and it should select for your local telehealth opportunities. So because that’s the beauty of the Google algorithm. So uh it should put in “telehealth visit”...
MIKE: Mm hm.
DR. KASS: ..and then the hospitals that serve your local area probably will come up top and then there’s a couple of national programs like uh, “Doctors on Demand” or uh “Teladoc” that might serve everywhere that you are.
DR. KASS: Um, but that’s how I would do it and I would say if anyone’s concerned about their symptoms or has another problem, right. The other issue we’re seeing right now is um, making sure that people have regular problems, so a rash or a urinary tract infection, or a sinus pain or something else can have somewhere to care because we’re really encouraging them not to go to the hospital.
MIKE: What are your socials so that if someone wants to continue hearing your point of view or seeing the latest research? I imagine you’ll (STAMMER) retweet something…
DR. KASS: Yeah.
MIKE: ...that comes out. What is your, uh, social media handles so people can follow you?
DR. KASS: So uh the best way is on Twitter which is just @darakass.
DR. KASS: Um, that is D-A-R-A-K-A-S-S, just one word. Uh that is probably the most useful way to follow the things that I think are important about this moment. Um (STAMMER) the other social handles are-- like Instagram is the same, but I’m not-- I don’t use that as much for medical information because it’s not-- it’s just not the portal that I think is important on that-- in that way. Um, and then Facebook not-- again, not for, like that kind of stuff.
MIKE: Yeah so Twitter-- so what (STAMMER)...
DR. KASS: So I would say Twitter (UNINTELLIGIBLE) are the most important.
MIKE: So someone would wanna follow-- that’s D-A-R-A-K-A-S-S. Uh Dara’s gonna continue to Tweet out over time as-- as you have different solutions or different things…
DR. KASS: Yeah.
MIKE: ...that people can follow you with um so that-- because I think that’s part of the issue right now is, you don’t know who to follow, you don’t know who to talk to and being that you’re a medical doctor and you also have COVID-19. I can't think of someone better to help provide information to the general public.
DR. KASS: And I-- and you’ll see through our Twitter feeds like my feed, you’ll see me retweet people that I trust.
DR. KASS: So other doctors, other emergency medicine doctors, other resources for um, who to listen to on, on medications or uh, you know, the diagnostics. Where are they testing locally? One of the biggest questions that people ask me is, “Where do I get tested?”
MIKE: Mm hm.
DR. KASS: And the answer actually changes every single day. Um the other thing I will say is that if we keep following our-- our state leaders, so our governors. Right? That’s probably the other best resource right now for people in their own environment.
DR. KASS: Not every governor is acting in the way that we want them to, right. We had governors of certain states Tweeting that they were at restaurants with their family after certain states had put lockdowns in place. So I can’t say that everyone’s behaving perfectly, but I can say that um, for the most part you know people are really coming around and those are the local leaders that you can depend on to give you a sense of what’s happening in your community and that, um, really important.
MIKE: Well Dara, thank you so much for doing this with me and providing this information. Um super helpful, uh I’m gonna go follow you on Twitter now.
DR. KASS: Lucky me. I (STAMMER) I’ll follow you back.
MIKE: Okay cool. And so if you guys have any questions, um uh make sure to, uh, follow us on Twitter and talk about the episode and also just really appreciate you taking the time in your very busy schedule, uh with having kids and having so many people probably reaching out to you. I really appreciate you taking this time, so.
DR. KASS: Thanks for having me Mike. I really had a good time.
MIKE (VO): Hey guys thanks for listening to Coach Mike Podcast. I have an ask for you and what I’m asking is that you click to subscribe and also I would greatly appreciate it. You could also rate this podcast. Look forward to delivering you more content that helps you be your best self. Stay safe, Stay informed, stay inspired and I will talk to you very soon.
(END OF PODCAST)