200424-ne-doc-edit

>>BOB ZALTSBERG: This is Noon Edition on WFIU. I'm Bob Zaltsberg from WFIU WTIU news. We are doing a show remotely today to avoid the risk of spreading infection from COVID 19 or the corona virus. I'm hosting with Sara Wittmeyer the WFIU WTIU news director. This week we're talking with recent IU School of Medicine graduates and an IU Health doctor about what it's like to work in health care during COVID 19. Joining us on the program today or David Vega, recent IU School of Medicine graduate. He will work at the Rotabush V.A. Medical Center in Indianapolis. Roshni Dhoot is a recent IU School of Medicine graduate. He has not yet been assigned a facility. And Jim Laughlin is an M.D. who works with IU Health Bloomington Hospital. You can join us on the program by sending your questions to news at Indiana Public Media dot org. You can also follow us on Twitter at noon edition. So thank you all for joining us today. We're talking about the coronavirus and covered 19 for about the sixth straight week. I think it's what's on everybody's mind. And I wanted to start today with Dr. Jim Laughlin from IU Health Bloomington Hospital. How has this changed your life. How are your days going during this pandemic? 

>>JIM LAUGHLIN: Well it's turned our daily workflow pretty much upside down. I'm a pediatrician by train. And I'm also the chief practice officer for Southern Indiana Physician Group which is our regional physician group for IU health. And since this has started we've had to dramatically change our workflow and workforce within our group to increase capacity and change our capacity at the hospital to accommodate covid with our intensive care physicians, our hospitals and our emergency room. As you probably are aware and people are aware in the region, we've gone to almost 100 percent virtual visits in our offices. So many of our office staff have had to be redeployed to do other work and work from home so that we can protect our workers and our patients in our region. So it's been dramatically different. 

>>BOB ZALTSBERG: I want to talk with our our two medical students who have just graduated. And they're gonna be starting in the practice earlier than they thought. So let's start with Roshni Dhoot about where do you think you're gonna go? And you know what about starting early like this? 

>>ROSHNI DHOOT: Hi, Bob. Thanks for having me. So as a medical student now graduate my experience is it's pretty - like a lot of abrupt changes. In the middle of March we got suddenly pulled from our rotations in the same way that Dr. Laughlin was talking about to minimize our exposure, to minimize our exposing doctors and other health care staff. Then a few weeks later we were given the opportunity to graduate early to help provide extra support with the response. At that time about a third of our class opted to do so. And then we graduated as of a week ago, became M.Ds and then just a few days ago I became aware that not too many of us are actually needed which is reassuring that in Indiana at least the additional support is not required at least at this time. So now in the meantime, I think most of us who aren't working or who are just waiting for placement are getting ready and thinking about what our residency will look like, which will be the next phase of our training for residency. Depending on what specialty we've chosen will look very different for everyone. People who are going into internal medicine fields, emergency medicine fields, they will be directly working with covid 19 patients whereas people who have chosen specialties that may not be providing direct care may see the next phase of their training start remotely or develop very differently like Dr. Laughlin was alluding to. 

>>BOB ZALTSBERG: Let me ask before I go on to David Vega. I want to ask you first. I mean what - how prepared were you for something like this. That is you know had you - had this part of your medical school training, how surprised were you when this corona virus actually started hitting people in the United States? 

>>ROSHNI DHOOT: That's an interesting question. We certainly heard about coronavirus. We learned about it in our microbiology class. The novel coronavirus, of course, is not something that anyone was prepared for. No one knew exactly what this particular viral strain looked like and what its symptoms were. And we don't even know exactly what it will look like going forward and what the manifestations might be for people who are recovering or what the complications might be in the future. So I don't think that we were prepared for this particular strain. But certainly we're prepared to take care of patients. We're prepared to take care of the complications of a virus. That you know - that means managing patients who have respiratory problems, talking to families, providing support in whatever capacity is necessary. Those things of course every clinician is prepared to do regardless of what the disease process actually is. 

>>BOB ZALTSBERG: All right. Thank you Doctor. Dr. David Vega, could you talk about your experience because you actually had the virus correct? 

>>DAVID VEGA: Yes correct. Thank you for having me on the show. So again like Doctor Dhoot was saying. It was very interesting learned a bit about the virus. It was very interesting because in the beginning they had pulled all of us from rotations and wanted us have as minimal its exposure as possible. And I think really just regulations changed you know day by day week by week and seeing that they saw a need for us in the work fields. I was motivated to help out especially since - like you said I did end up having covid back in early March. Thankfully I'm now recovered. But it does give me you know just based off you know the minialogical principles that we know so far confers some sort of immunity to the virus. So it made me feel a little less anxious about entering a field right now where we might be exposed to obviously potential covid 19 patients. So right now I just finished my first shift on Wednesday. We'll be working for the next few weeks as well. So we'll see where that leads us. 

>>BOB ZALTSBERG: So be the experience of going so quickly from medical school and before you - before you knew it into a clinical rotation, was that you know - how difficult was that to do, to sort of change your mindset? 

>>DAVID VEGA: It all happened very quickly. And it's interesting because at the end of fourth year, starting intern year, there's - you know you go from being a medical students and being a doctor and nothing really changes in terms of your knowledge base. It's really just a period of time. And everyone says internship is the hardest year because you're learning how to incorporate all these scientific principles learned by medical school and incorporating that into being a practicing physician. So there's always that bit of a learning curve. I think for me it just happens to be a lot sooner than later. Instead of having a month or two month break before starting residency, it was just more of an opportunity that arose and just decided to step up to the challenge and being able to help out where needed. 

>>BOB ZALTSBERG: So I want to ask all three of you - I'll start with Dr. Laughlin. But from your view on the ground, the big discussion it seems like these days is Indiana ready or is any place ready to reopen for business? From where you stand from your perspective, is Indiana ready to start reopening for business? Dr. Laughlin? 

>>JIM LAUGHLIN: Well that's a loaded question. I would have been interested in hearing what our new graduates would say. But I think I think we can be ready with proper preparation in abiding by different principles of social distancing and hygiene and being careful in how we do it. We've in our field we've said life is not going to be the same ever again. And a lot of the things that will have to change are probably for the good. But I do think in that we can open up safely if everybody agrees to kind of follow some basic ground rules. Our organization as a health care organization is also in the early preparatory stages of trying to gradually reopen because we do know that we're going to have to provide surgical care for patients and procedures for patients and see patients not only virtually but in person. So we have to do it. But we're going to have to do it differently so we can - so everybody can be safe, particularly until we can develop treatments and hopefully a vaccine that will provide some protection and more herd immunity for the virus. 

>>BOB ZALTSBERG: Well let's ask the recent medical school graduates. Dr. Dhoot? 

>>ROSHNI DHOOT: Sure. Yeah. I think it's important to know why we're not open right now. And I think it's sometimes hard to get into that data. But there are models that public health experts are using. And I think because the United States was a later country to get hit, some of those models are based on other countries that are faced with the same challenges, with the same virus that we can use that data to make our own recommendations for when we should open up like - the IHME based at the University of Washington, even Dr. Carroll who's the Indiana University School of Medicine Public health expert is making recommendations. And when we understand where those - or why we have those recommendations that makes it easier but then also understanding why people want to reopen, what those concerns are and addressing those. So I think the biggest concern, of course, is the economy and how people are struggling. And we understand that when people are hurting financially that hurts them with their health, as well. And as physicians, we care about our patient's health. And if - I think the biggest concern we have is if we open too soon they will continue to struggle financially because we'll have to shut down again, and we'll continue to have these waves of opening up and shutting down. And I think, like Dr. Laughlin said, until we have heard immunity or we are closer to having a vaccine, we need to be very cautious with how we proceed in reopening but still respecting all of those concerns that people have. 

>>BOB ZALTSBERG: And let's go to Dr. Vega, as well. And Dr. Vega, you're in Indianapolis. You're practicing in Indianapolis. And Dr. Dhoot is there as well. And there've been protests at the governor's mansion about this. So how do feel about - there's a lot of passion about this issue, I guess. So if you can give us your best thoughts about it, that would be appreciated. 

>>DAVID VEGA: Definitely. And I think as Dr. Laughlin and Dr. Dhoot both alluded to it's difficult because it's a double-edged sword. If we start reopening business too soon, you know, we'll have a second wave. We'll have a lot more coronavirus cases, and that's inevitable. However, you know, if we keep just staying at home, continue with this self-quarantine, then the economy is at a compromise. So really it's - for me, it has to go to, you know, what are we waiting for right now. It doesn't seem like a vaccine is coming anytime in the near future. I know there are people that are working on it, but there's nothing promising as of right now. So we do need to start opening, reopening business slowly and gradually. And what we have to do is we have to have screening efforts. For example, every time anyone goes into the VA and other screens in terms of their symptoms, anyone that has fever, chills, cough, you know, any sore throat, diarrhea, et cetera. And if they, you know, screening any of those questions, they - you know, they have a further screening and can get a COVID as well. So some sort of measure where there is at least some screening going on to reduce that risk of exposure would be very beneficial to at least reduce the number of people that would be exposed and contributing to that potential surge we would have if we start reopening business. 

>>JIM LAUGHLIN: Today, on Noon Edition, we're talking about the recent COVID-19 related events in Indiana. We're also talking with people who are working in medicine during this time. If you have questions for us, you can participate by tweeting us @NoonEdition or you can send comments, emails to us at news@publicmedia.org. Dr. Laughlin, seems like every week we still continue to have questions about testing. How is testing going with IU Health? And, you know, people send us questions all the time about, you know, what do they do if they want to be tested? 

>>JIM LAUGHLIN: Well, testing has been one of the big frustrations as far as you're aware of throughout the United States for various reasons. Right now, we're able to test our hospitalized patients, health care workers and first responders and outpatients where having the tests would make a big difference. Those are have been the priorities to start with because of limited supply. But as we've been able to expand the capability for testing, it's now expanded to, for instance, as we reopen, as we plan on reopening all of our patients getting surgery will be tested preoperatively for their protection and staff's protection. Our OB patients delivering in the hospital will be tested. Many independent labs are opening testing sites. So the ability for the general population to have testing done will be tremendously increased. The issue is that many of these tests are not extremely accurate, and we're going to have a lot - need to have a lot more experience in research to decide which tests are the best test. Do we test for antibodies after the illness, you know? David mentioned, you know, he's had the COVID virus. So how long do the antibodies protect him before they - we can (unintelligible) protective for him? So there are a lot of unanswered questions that we have regarding testing, which is I think why IU Health has been cautious in their testing procedure because they want to use it judiciously and hopefully not put people at risk with inaccurate results. 

>>BOB ZALTSBERG: Now... 

>>JIM LAUGHLIN: It's really important as we try and reopen the economy that we have some testing means that's reliable. 

>>BOB ZALTSBERG: David Vega, as, you know, Dr. Laughlin just mentioned that you not only are a physician but you have the disease. We haven't had anybody who's recovered from the disease on the program yet. So can you talk a little bit about what it was like? 

>>DAVID VEGA: Absolutely. I think one of the most frustrating parts about having and experiencing the virus is the duration of symptoms. So for me, I remember experiencing fever, chills, fatigue, muscle and body aches for about a week, a week and a half. So in the beginning, it almost felt like a flu but worse. Like, the worst flu you've ever had. But it just wouldn't go away. I think that was the the scariest part about the virus. And for me, personally it took about a week to get my results back. So in that interim, I was just kind of wrapping my head around all the things that it could have been. So I found out that it was COVID-19. So other than that thankfully the symptoms, you know, dissipated. But I think just that titration sometimes is probably the scariest part for many. 

>>ROSHNI DHOOT: If I could add, Dr. Vega actually had contracted the virus well before any - there was really much going on in Indiana. It was at the beginning of March. And so he kind of had it and recovered before Indiana really had any stay at home measures put in place or really was experiencing any problems with COVID-19. So really got hit with it quite early in the process. 

>>BOB ZALTSBERG: And that's one of the issues, too, isn't it, Dr. Dhoot, is a lot of people walking around with it, they're asymptomatic and could be, you know, be walking around with the virus. And then eventually maybe they will show some symptom. 

>>ROSHNI DHOOT: Yeah, absolutely. I think there was a study released just this morning that they did a sample in New York where 21% of people have antibodies to it and they never had any symptoms. Now, of course, like Dr. Laughlin was alluding to, we don't know the sensitivity and specificity of these tests. We - you know, we - there's a lot we don't know, but, of course, if someone had - wasn't asymptomatic carrier pass it on someone else felt symptoms. Like, it's very hard without contact tracing and a lot of public health resources to be able to calm the spread of the disease. 

>>JIM LAUGHLIN: I might add that along those lines it was originally thought that you weren't contagious if you were asymptomatic, but all the data coming out now shows that asymptomatic infection rate may be up to 25% of people that get it. In my - being a pediatrician, my hunch is that a large vector of that spread is probably in our young people and kids. COVID virus of other strains is probably one of the more common causes of just common colds in kids. So the question I ask myself all the time is, what aren't kids not getting really sick with this and it's primarily a disease of adults? And it's entirely possible that they have some immunity from other COVID viruses that they spread through daycares and schools over the years that's protected them in some way. But the fact that you have 20 - could have 25% of asymptomatic people that are there can spread this virus is really pretty scary. 

>>BOB ZALTSBERG: So before I toss out to Sara because I know she's got questions, just to clarify. So if you do get a test and you're asymptomatic, it will still show up, correct? 

>>JIM LAUGHLIN: If the test is accurate. Some tests have been only shown to be 20 to 25% sensitive and specific. 

>>BOB ZALTSBERG: I see. OK, Sara... 

>>JIM LAUGHLIN: The one that IU Health does is closer to 75 to 80%, so it's more reliable but still not 100%. 

>>SARA WITTMEYER: David, I just want to go back to something you said earlier about we need to start gradually reopening the economy. So something I know we've been talking a lot about in the Newsroom is just, like, what are you looking for in order to say now is the time to start doing this. I guess - like, what kind of criteria should we be meeting in order to start reopening. 

>>DAVID VEGA: That's a great question. Definitely I think we'll take coordination with our state officials and just public health representatives to really find, you know, that sweet spot. It does have to be a gradual process. It is hard to say what exact measures you are looking for. I know we already started flattening the curve and, you know, we're starting to see numbers go down. But, you know, I think is the worry something is that, for example, I'm working the emergency department. We're seeing less patients than we usually do. And, you know, are these patients that usually come in with heart attacks with strokes or, you know, are we really just having less or are they just staying home because they're scared to go out? So I think it's affecting health care in many ways that we have to address. I think we just have to start gradually but have some sort of measures to reduce the risk, you know, having some screening protocols and having some sort of accessibility to testing in case any, you know, patients or any people business workers, you know, screen positive to those tests. 

>>BOB ZALTSBERG: All right. You're listening to Noon Edition. And as we talk with some medical providers about COVID-19, we have a recent medical IU School of Medicine graduates Dr. David Vega and Dr. Roshni Dhoot. And we also have Jim Laughlin, an M.D. with the IU Health Bloomington Hospital. You can follow us on Twitter @NoonEdition and send us questions that way. You can also send us questions to news at indianapublicmedia.org. Because we are doing this remotely, we can't take any questions by phone today. Sara. Oh, sorry, Sara,. I thought you had another question. So we have gotten questions. We did get a question from one of our listeners about the need to wear masks and that, you know, they've read different, I guess, news reports about how effective the masks are and what you should wear them for. Could somebody answer that, one of you doctors? 

>>ROSHNI DHOOT: Yeah, I can start. So the CDC guidelines are currently that everyone should wear some type of protective covering over their face when going out in public. This doesn't replace the need for social distancing or staying at home whenever possible. It should be a cloth covering, if possible, to allow the Morse, the surgical N95 masks to be in the health care system. The cloth coverings are not as effective as the surgical masks to the N95s, but they are they are significantly more effective than nothing. And they become even more effective when everyone is wearing them. As far as the direct percentages, I think, I've seen numbers somewhere in the 70s. I don't think people are exactly aware, but they, of course, become more effective if they're cotton, if they're double layered, if you're wearing them as a tight fit around your both nose and mouth. Make sure it's tight fitted around your face. And also make sure you're removing it without touching the mask itself. Remove it from behind the ears. Wash with soap and water after every use and allow to dry with sunlight. So all of those are measures you can take to make that the use of the cloth mask more effective for you. 

>>JIM LAUGHLIN: I might add also. I view health as pretty strict criteria in what instances different masks should be worn. So the N95 is the most effective at filtering and prevention of the viral spread. Surgical masks are somewhere between 50 and 70% with studies with COVID, other COVID viruses, viral strains. Plot masks are probably somewhere between 30 and 50%. But if you have two people wearing a mask instead of just one, you know, a little bit more protection. The other question is, can these masks be re-sterilized and reused? I think for the... 

>>SARA WITTMEYER: From Jack in Bloomington just wanting to know you all's perceptions about news coverage and what the news has gotten right what it's gotten wrong and what has been sensationalized. So who wants to jump in first on that? 

>>JIM LAUGHLIN: Well, I'll jump in and start, and I'll let my recent medical school graduates chime in. Obviously, not too much news is presented anymore in an objective format. So much dust gets sensationalized. But unfortunately, this has been a pretty sensational event for us. It's something that, you know, I've been health care for 40 years counting my student time and had never seen anything like this. So it's definitely different than anything we've ever experienced before. And we feel like the public news media can be very much of an asset for us in helping us promote. Health care habits that will help us get through this. But not all the information is accurate as you know. And it's often difficult for the average citizen to sort that out. 

>>ROSHNI DHOOT: I think an additional challenge is also that it's evolving, the situation is evolving so quickly and everything changes so quickly, too. And that is hard to deal with in any situation when information is continually changing and people are unable to make plans and move forward with their lives. And I think playing on those, fears it has been a real challenge, I think, for people tune in to broadcasts and chat and news media that plays to those fears. 

>>JIM LAUGHLIN: The CDC, I think, has done a good job at trying to give daily updates that are as accurate as they can be regarding the status and in terms of the where we are with the epidemic and what medicines are effective and what is the recent epidemiological evidence of doing things to protect ourselves. The Indiana State Board of Health has a daily update, which is a really good update on their website that kind of gives us this status of the epidemic, as well. And we have daily calls throughout our system with IU Health where we are continually updated with the situation with IU Health. And we're trying very hard to push that out to the public so that we can be a trusted source of information. 

>>DAVID VEGA: To add on, it's definitely - to complicate it another layer, I think is being in the year to 2020 and having the presidential elections this year complicate the mix a bit more in terms of just presenting information in a non-unbiased fashion. I think there's, like Dr. Laughlin said, going to the numbers, the numbers aren't going to lie and seeing the addresses from the people the representatives themselves as was going to reliable sources. I know Snopes is pretty reliable in terms of just seeing, you know, the same things that are actual factual, not things kind of debunking any myths that are out there. And it's very hard. And it can be confusing for everyone out there. But just continuing to focus on the statistics, you know, see what the CDC has to offer and, you know, fact-checking, you know, making sure it's not just coming from one media source. 

>>BOB ZALTSBERG: So I just have to thank you all for those answers. That was a tough question. And I would just say, you know, as a veteran of the media for over 40 years myself that, you know, we've never faced anything like this either. And so, you know, it's a disease that I think all of you can verify. If you get a flu like disease like this and then within 10 days or two weeks you could be dead, that's just something that people have never been writing about before and trying to trying to vet all the information in the days of social media and all the information that's flying around is not an easy task. I will tell our show Noon Edition because, Dr. Laughlin, we've had IU Health experts on here every time we've done a show and you guys have been more than open to joining us to try to help support out all these issues. And I really do appreciate that. And I know the rest of folks the do, too. 

>>JIM LAUGHLIN: I'm going to add, you know, as a kudos to the media, they have come - they have shown the human part of this very well in many cases. When you look at some of the some of the special stories they've done, families that have been affected by this, health care families and workers that have that have been on the forefront. And the stories have been touching. And I think it's a real credit to our - to the people in our country that they can they can rally together for a common cause. And it's really brought out a side of us that then I think often our politicians aren't able to enjoy expressing. And you've captured that in many instances. 

>>BOB ZALTSBERG: Dr. Dhoot, you had said earlier you indicated that you could say a little bit more about reopening the economy and some of the things that you would be looking for. I mean, that's another - it's one of those hot potato issues that's become very political. But from a physician standpoint... 

>>ROSHNI DHOOT: Yeah. 

>>BOB ZALTSBERG: What are you looking for? 

>>ROSHNI DHOOT: Sure. I'll refer to, actually, Dr. Aaron Carroll. So he's a professor at the University or the Indiana University School of Medicine. He published an article in The New York Times just a week or two ago. And so these are just four measures that he's looking for objectively. So one of them is that - and it's a state by state approach because we're not going to open the whole country at once. It's going to be state by state. And I think even some states are adopting regional approaches, as we've heard about. One of the measures is that there must be a sustained reduction in cases for at least 14 days. In Indiana, I think that's projected to be mid-May. The state is able to conduct monitoring of confirmed cases in contacts, so that would be a large force of contact tracing. The state needs to be able to test everyone who has symptoms, so that would be much more expanded testing beyond hospitalized patients or patients who are severely ill, health care workers, etc. And then the last one would be that the hospital should not be overwhelmed. They should be able to treat safely all patients requiring hospitalization as well as provide health care to all other patients would be requiring it, which - as Dr. Laughlin alluded to, we've put a lot of other health care procedures and patients on hold right now. Those are the four measures that he recommended. Yes, please. Question. 

>>BOB ZALTSBERG: Yeah, I just want to ask all of you to - you can follow up first, and then the others can join in. And it seems as if the - a lot of the dire predictions about health care being the health care facilities being overwhelmed at least in Indiana have not come to pass. Are we doing well with the number, with the supply of PPEs and ventilators and all of those things? And I think you said earlier that many not - not as many hospitals needed medical students to join their staffs at this point in any way either so. 

>>JIM LAUGHLIN: I think Indiana is in a fairly good position. If you look at Indiana, Ohio, Kentucky, Illinois, Michigan, even though Michigan and Illinois have been hit harder, we've been pretty consistent about shutting things down, which I think has really helped flatten that curve. In terms of supplies and capability, we get a daily report, which matches IU Health and statewide capabilities. And like today, IU health resources show that we have enough PPE or protective equipment on hand for the next two to six months. We have an adequate supply of drug therapy, even though the drugs that we're using are not proven yet. Our bed utilization for ICU beds is about 58% capacity. Our not ICU beds is 40% capacity, and ventilator use is only about 34%. So we have a significant capacity and we're prepared for surges and we're prepared for a bigger surge than we got. Thank goodness it wasn't as bad as some of the other states and metropolitan areas, but we're in good - good area of preparation for that. 

>>BOB ZALTSBERG: All right, we have three medical professionals with us on the program today. You're listening to Noon Edition on WFIU. If you want to call us with your question or you have a comment, please do so. You can't call us, but you can send it to us @NoonEdition on Twitter or you can send it by email to news@indianapublicmedia.org. So we've gotten lots of different questions and Sara, I think you're sort of monitoring those. What have we had come in today? 

>>SARA WITTMEYER: Can you - I'm wondering maybe this is for Dr. Laughlin if you can talk about what this might look like this winter with it being flu season, as well. And then do we have to worry about COVID-19 on top of that? 

>>JIM LAUGHLIN: Well, that's the thing that everybody's worried about right now is what happens when if we reopen and we're confronted with the normal seasonal flu that goes around every year. And we're anticipating that we will have some more surges of the COVID virus until we have active vaccine or treatment for that (unintelligible) immunity. So it does mean that we're going to have - if we open and how we open, we'll have to be different than life was before and be safe and protect our citizens and health care providers. 

>>BOB ZALTSBERG: We seem to go over this question, but I think research is continuing to go on. So I'll ask you what's the latest research on changes in temperature, whether the heat could affect this virus or whether, you know, very cold weather could affect the virus. Is there any research that shows (inaudible). Dr. Laughlin. 

>>JIM LAUGHLIN: It's kind of a wimpy virus. People call it a wimpy virus even though it's deadly. It's very heat sensitive. And so the question is whether summer will kill it. Temperature of 158 to 60 degrees will kill it. But we're not going to get that hot this summer, hopefully even with global warming. But we do expect that this summer will bring some relief. Although if you look at the outbreak worldwide, it's not - it doesn't seem to be too specific. So not sure if heat is going to be as much of a factor in terms of controlling the virus as some of our other measures are going to be. 

>>BOB ZALTSBERG: All right. I know we had a question - we've had several questions out of a couple of hot spots in Indiana. And could one or all of you talk about, you know, why a certain rural community might have a really high incidence of COVID-19 while others seem to be pretty much free of the virus? Is it just a matter of, you know, one or two people got there it just spread there? 

>>JIM LAUGHLIN: There are a few things that we do know and, you know, obviously nursing homes are potentially a hotspot and have been in South Central Indiana. We've had a few outbreaks in nursing homes, and it's very difficult to keep that from spreading because it is in a very vulnerable population. So they have a high mortality rate that affects them. There have been some groups that have not chosen to practice social isolation as we've been asked to do. Often those can be church groups or other community groups that have not been real good about that. And so even though that the incidence is less in the rural communities, there are little hotspots. And I think part of it is because we just can't predict who's got the virus ahead of time... 

>>BOB ZALTSBERG: There's so much we don't know, right? 

>>JIM LAUGHLIN: Right. 

>>SARA WITTMEYER: Speaking of rural areas, we did get a question about the Amish community and if we have heard anything about the virus's impact in those areas. Do any of you have any information on that? 

>>JIM LAUGHLIN: The (unintelligible) Area in Orange County in the Amish - is where a lot of our Amish are concentrated in. There have been cases there and some deaths in Orange County. But by and large, it's been a slow - low percentage of the statewide numbers. 

>>BOB ZALTSBERG: Dr. Vega, here's a question that has come in during the last week that I'm sure that you can answer. It says are hospital workers tested again before returning to work after having the COVID virus? 

>>DAVID VEGA: It's a good question. Not necessarily. So - like Dr. Dhoot alluded to earlier, I was actually infected early March and was recovered by March 23rd - 24th - around then. So just because of the big increment of time - it's now been almost a month since I've experienced any symptoms - I was not retested. 

>>BOB ZALTSBERG: OK. Do you think that - is that - I think that the questioner followed up with, if not, why not? Is that - is it just that, you know, you probably build up the antibodies or what? 

>>DAVID VEGA: Right, yeah. I've been involved in a lot of different studies, you know, especially a lot of studies, you know, looking at plasma donations and things like that look to see, you know, antibody titers and things like that. And actually this was very interesting. One of the studies I was a part of, it showed that I was three times fold the normal immune response in terms of an antibody response, showing good immunity, you know, towards the virus. In terms of regulations, I'm not exactly sure why. I remember once I was starting to feel OK again, I asked my health care provider about a retest and was told no at the time because of availability of testing and was just told, you know, by my provider that as long as I'm asymptomatic for an interim of time, I should be OK to continue - to continue on. 

>>BOB ZALTSBERG: So just to clarify again - we've done some - quite a bit on testing in the last week or so, but you do have to have a doctor's request - doctor's orders to be able to get a test in Indiana, is that correct? 

>>DAVID VEGA: Yes. 

>>BOB ZALTSBERG: OK. All right. Thank you. Short answer is good enough for me. So for both of you students - and I guess I'll start with Dr. Dhoot - 1/3 of your class decided to go ahead and graduate early and start work - make yourself available to start working. The other 2/3 didn't. Have you had discussions with various people about, you know, their - the reasoning for going ahead and graduating early? And the reasoning for perhaps not graduating early and staying in medical school? 

>>ROSHNI DHOOT: Oh, sure, yeah. So I think everyone who graduated early - well, I'll go - I'll talk a little bit about the process. So our clinical rotations - the last day was actually March 21, so we finished a little bit earlier than most medical schools do as a part of our normal curriculum. And then we have a month of transitions to residency in April from April 1st to April 30th. So that was basically expedited until April 10th for those of us who wanted to graduate early so that we could graduate on April 15th. On April 30th, everyone will be done and then everyone who didn't graduate early will graduate on May 15th. So most everyone is done with clinical rotations, and then it was just a matter of if we could expedite that month - if you could finish your work by April 10th, then you could graduate early. So logistically, it was quite simple to do that - to finish the work earlier - and people who wanted to make themselves available - the number one reason was that I am at the stage of my training where I'm a month away from doing this anyway and I am available and I went to medical school to be able to help people and of course I would. It was a non-decision. For people who decided not to graduate early. it was - the reasons I heard were - one of my classmates had a baby due the first week of April, so that was a logistical reason. Someone else is - was closing on a house at the end of April. Other people had already moved back home and so were not actually physically present in Indiana anymore. So also logistics but were still willing to help if their situation had been different. 

>>BOB ZALTSBERG: So - yeah, go ahead, Dr. Vega, you can answer that and then I have a follow up, so... 

>>DAVID VEGA: Sure. Yeah. Just one other point as well. I think some of my classmates - you know, speaking to them about their decision, some of them live at home with family or live with significant others so of course, jumping into the workforce now, there's always that chance of exposure. So just to kind of limit that potential exposure and spreading it to their significant others or family members, especially parents or any other elderly family members, was another big concern for them. So I think, like Dr. Dhoot said, it's multifactorial. However, there's - I don't think you can go wrong either way. 

>>BOB ZALTSBERG: So for both of you, how's this experience maybe changed your mindset or reinforced your mindset about being a physician? 

>>ROSHNI DHOOT: (Laughter). That's an interesting question. I don't have any regrets, certainly. Going from being a medical student to being a physician I think I've become more aware of being part of the physician community. And I say that just not wanting to get too much into it but we've heard about physicians being fired for speaking out against unsafe working environments and things like that. It's made me more aware of those issues. I think that would be the only acute change about going through this process at this time. 

>>BOB ZALTSBERG: All right. Dr. Vega? 

>>DAVID VEGA: Yeah. I think for me personally - and I'm going to be starting my residency in emergency medicine - so definitely right up my alley. I think for me it confirms my calling even more. Like Dr. Duke said you know we go into medicine because we want to help people. We really want to see an improvement in someone's health care. And in emergency medicine specifically the reason why I fell in love with that field is because no matter what regardless of whether a patient can financially afford a treatment or life-saving measure you know we're there for them. And we're there to take care of their life you know whether it's resuscitation or treat whatever complaint that they come into the E.D. for. And that wasn't really a big draw for me. So seeing that there's a big need for that I was definitely inclined to jump in. And if anything just confirms that - that you know this is the calling. This is something I'm passionate about. 

>>BOB ZALTSBERG: Where will each of you go next and how will this change - perhaps change your professional transition overall? 

>>DAVID VEGA: So I guess I can start. I will be starting emergency medicine residency at the University of Miami Jackson Memorial Hospital in south Florida. So for us we typically start orientation in June. We are still - they're still having conversations about whether or not this orientation will occur in person or if it'll be online via Zoom. But what my residency program has done to make sure that we are adequately prepared going into residency is they've released a set of pretty much an online curriculum for us to do in the eight weeks leading up to residency. So just different resources for us to review as emergency medicine physicians - things that we should know going in. And normally we would kind of have more in-person orientation things like that. But just because there's so much in the air about whether or not this will occur in person or over Zoom they just want us to be more prepared than usual. So at least my residency program is starting us early and we're having weekly sessions with our program director and assistant program director to discuss these topics to just really prepare us. 

>>BOB ZALTSBERG: All right. Dr. Dhoot? 

>>ROSHNI DHOOT: Yeah. So I'll be heading to Duke University in North Carolina to start a neurology residency in June. Our orientation also may be remote. My first year will actually be in internal medicine so treating patients that are admitted or in the ICU. I think it's - the differences are twofold. One that we'll be spending more time treating patients that have COVID-19 and less time in specialties like cardiology or gastroenterology. We'll be spending more time actually on the general medicine floors but then actually less time in the hospital because they don't - health care providers in general - they're having less people at a time on a team or in the hospital just to reduce exposure. So it'll be a little bit of a change in what previous classes have experienced. It'll be my normal experience but it'll be different from what I was expecting. 

>>BOB ZALTSBERG: All right. In about the last 15 seconds that we have Dr. Laughlin, could you just tell our listeners what you hope that they'll do in the next - you know the next week or so until we open up? 

>>JIM LAUGHLIN: Well I would ask that our listeners do what we've been probably preaching all along. And that is that we want you to protect yourselves first - and so practicing frequent handwashing staying at home if you're sick practicing good off etiquette - not touching your face - wearing a mask if you are out. And that also protects other people as well. And... 

>>BOB ZALTSBERG: All right. That's good. Thank you for that. We are out of time. I want to thank - that was Dr. Jim Laughlin from IU Health Bloomington Hospital. I want to also thank that Dr. Roshni Dhoot who is a recent IU School of Medicine graduate and David Vega - Dr. David Vega who's a recent IU School of Medicine graduate. For my co-host Sara Wittmeyer and producers Bente Bouthier and John Bailey and Matt Stonecipher, engineer Mike Paskash, I'm Bob Zaltsberg. Thanks for listening to Noon Edition. 

>>UNIDENTIFIED PERSON: Noon Edition is a production of WFIU public radio. A podcast of this program is available at wfiu.org. Production support for Noon Edition comes from Smithville - fiber internet streaming TV Home security and automation in southern Indiana. More information at smithville.com. And from the Bloomington health foundation partnering with local organizations and citizens to invest - these health needs. Bloomington health foundation - improving health and well-being takes a community. More at bloomhf.org.