Warrior Monk Conversations 013: COVID19—The Facts & What You Can Do About It with Dr. Tulika Singh
Updated: Jul 17, 2020
In this episode, I talk to Dr. Tulika Singh and we discuss:
-her work with the Desert AIDS Project (DAP) amidst the COVID19 pandemic
-the reason why COVID19 spread like wildfire
-why social distancing, washing and sanitation of hands, not touching your face, and wearing face masks are important
-maximizing technology to perform routines and still stay safe indoors
-her self-care routines (which you can follow, too!)
-her insights on the early experimental medications for COVID19
Please support Desert AIDS Project—COVID19 Response here: https://www.desertaidsproject.org/support-our-mission/make-a-donation
Dr. Tulika is a Board Certified HIV Specialist and an Infectious Disease and Internal Medicine Physician who has been working in HIV care since 2009. Prior to joining DAP, she worked as a Primary Care and Infectious Disease Specialist at North Ottawa Community Hospital in Grand Haven, Michigan, and as an HIV Specialist at Mercy Health Partners of Muskegon, Michigan.
Read more about the Desert AIDS Project (DAP) here: https://www.desertaidsproject.org
Intro and Outro Music: Hearts on Fire by Immersive Music
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Warrior Monk Conversations 013: COVID19—The Facts & What You Can Do About It with Dr. Tulika Singh
Welcome to Warrior Monk Conversations, a treasure trove of inspirational discussions in personal and professional development.
I am Poonacha Machaiah. Join me on this journey where I have immersive conversations with the most thought-provoking leaders and everyday heroes from our communities to inspire, educate, and empower you to build resilience and reach your highest potential. Join me on this mission to create a positive societal shift to the compassionate transformation of humankind.
Dr. Tulika Singh is a Board Certified HIV Specialist and an Infectious Disease and Internal Medicine Physician who has been working in HIV care since 2009. She is currently the Associate Chief Medical Officer at Desert AIDS Project (DAP). Prior to joining DAP, she worked as a Primary Care and Infectious Disease Specialist at North Ottawa Community Hospital in Grand Haven, Michigan, and as an HIV Specialist at Mercy Health Partners of Muskegon, Michigan.
She received her Medical Degree from Kasturba Medical College in Manipal, India and then served Internal Medicine Residency and Chief Residency at St. Elizabeth Health Center in Ohio. Tulika also completed an Infectious Disease Fellowship at The Medical College of Wisconsin in Milwaukee. In addition, she also holds M.S. in Health Care Administration from the University of New Haven.
Poonacha: Dr. Singh, good evening. It's such a pleasure to have you today, and I always look forward to catching up with you. Thank you for your time.
Dr. Singh: Thank you for having me. How are you doing?
Poonacha: Fantastic. I want to really jump right into it. There are a lot of things to unpack today. As our guest, the Associate Chief Medical Officer and the Director of Research at Desert AIDS Project, I really wanted to, you know---DAP and the CEO David Brinkman, we're good friends. We've always been collaborating personally and also as the Chopra Foundation, and over the last 36 years, DAP has kind of always risen to the occasion when faced with challenges. It did it with the HIV/AIDS epidemic, and now again, I guess with COVID-19, you guys have been very busy. What is it like as the Director of Research, and what are you seeing today?
Dr. Singh: So, at DAP, when we started seeing the pandemic coming in and actually affecting people around us, us!
Dr. Singh: We decided to have a dedicated COVID clinic that we opened up at Desert AIDS Project on the STI walk-in clinic site (2:41). So we converted physically, and for all practical purposes, converted into a COVID-19-dedicated clinic. So where we see symptomatic patients with high risk exposure and travel history, so that we can remove the symptomatic patients from the generally healthier asymptomatic patient population so that the two don't mix and don't transmit the virus as effectively.
We were initially seeing everyone on our new Blue and Green clinic sites, but then we realized that we should separate the healthy from the symptomatic, and we started a dedicated clinic for COVID. So we basically bring the patient in and put a mask on them once they are passing the screening to go into the Covid clinic.
We don't test everyone. It has to be significant symptoms and exposure history pointing towards COVID. We test them. We give them if they need supplementary oxygen or they need any symptomatic treatment that we can do right then and there, kind of like an urgent care. And if they're too sick, then we also call an ambulance and transfer them to inpatient facility hospitals close by if we suspect pneumonia or decreased breathing effort and any higher level of sickness. So this way we separated COVID potential patients from our healthy population and reduce the transmission.
Poonacha: You know, as a trained physician, you have been---I guess, I never thought in my life I would see a pandemic like this. You're an internal medicine specialist, also trained in infectious diseases. What is your take on COVID-19? How is this so different or has this surprised you, you know? What are you seeing and what is your outlook?
Dr. Singh: So, COVID-19 is special because it's a new virus. We have never had such a virus before. It kind of fused and mutated and became a combination virus of two different types. And the reason this is important to know is that we didn't have already existing antibodies to fight this.
For example, as compared to influenza or flu, every year, we have different strains that are active in the environment and community and vaccines available. Some of the vaccine strains do not match with the circulating string, and that's why we end up getting influenza, and people die from it every year. Thousands! Right? But at least we know that most of those strains are already known. They just circulate at different times. So they might not make it to the vaccine.
Because this is such a new novel virus that we don't have antibodies to it. We have not developed vaccines for it. We don't have treatment for it necessarily. That's why it became a pandemic and globally acquired infections everywhere. It would have stayed in one place, and we could have controlled it if we have a vaccine and treatment for it. But because we didn't have any defense mechanism against it, it just spread like wildfire, and it's in our communities now.
Poonacha: So we look at, especially the DAP community in Coachella Valley with HIV/AIDS, LGBTQ, let's see those who are immunocompromised, what are some of the precautions or what is the advice you would like to give to the community at large?
Dr. Singh: So the main advice is very simple three recommendations that we get from CDC and other organizations trying to control the epidemic. One is the social distancing, which I also call as physical distancing, which is stay at home if you're sick, even if you're not sick, only go out for very essential visits to your doctors, maybe pharmacies, grocery stores. Very important places that you can not go, you should just go step out for that, but otherwise stay at home.
The reason this is very important is because there's person-to-person transmission, there's community transmission. So even if you might not have the disease yourself or symptoms of the disease yourself, you could still be a potential carrier or be able to transmit it to other people who are more vulnerable than you and give them a more severe disease.
So the most important thing is social isolation, which is staying at home not going out at all, and social distancing. If you are close to someone, you have to be close to someone, protect yourself and wear a mask, and also do not come within six feet if possible. So that's number one. That's the most important one.
Number two is washing your hands with soap and water for 20 seconds or using alcohol or hand sanitizer over 60% so that you can get rid of the virus.
And third most important is not to touch your face, eyes, mouth, nose to transmit the virus. And that's why wearing a cloth mask when you go out helps too because not only does it prevent someone else from getting the virus from you, but also from you touching your face too often.
Poonacha: You become more aware.
Dr. Singh: But that doesn't mean that you don't still follow the precautions. You still have to do hand washing, not touching your face, and social distancing, as much as possible.
Poonacha: I guess, in California, the governor last night, I guess, issued a mandate that all public places which are open, restaurants, shops, everybody has to wear masks and recommending that people start wearing masks now, right?
Dr. Singh: Yes. Universal masking is a good idea, in my opinion, because, first of all, it prevents us from touching our face too much.
Dr. Singh: We're not aware, but we touch our fa---like I just I just touched my hair right now. (Poonacha laughs)
Poonacha: I find it might be 17 times a minute. It's amazing.
Dr. Singh: Right? Unintentionally, not unknowingly. So that will prevent that. The second thing is, what the cloth mask, fabric mask is letting people still feel safe and be safe, and then leaving the more surgical, more advanced surgical mask, N95 mask for frontline workers like health care workers, so that that doesn't go in shortage.
So we have to remember that masking is not necessarily to prevent ourselves from getting the virus because the virus is so small it can get in the vicinity despite the mask. Well, masks are more for preventing others from getting it from us in case we're silently transmitting. And that can happen if we're singing or we're talking or even breathing.
Dr. Singh: So it just helps reduce the transmission overall. And I approve of the universal masking directed by the Governor Newsom.
Poonacha: And I guess, you know, I'm just wondering whether this should have been done earlier because countries like South Korea have been doing it since day one, and maybe we have been a little bit lax in being proactive.
You know, I was just reflecting on this while you were speaking, in our dear country, India, where both of us are from, you know. How does social distancing work there? Because it just, I just, I'm baffled, right?
When I think about six feet, when there are five people in six feet distance, you know, is there something called herd immunity or is there another, I mean, obviously, the Prime Minister Modi has done an amazing job to literally shut down the country for 21 days, which I thought is almost going be impossible, yet the streets are empty. Apparently, in Bangalore, the peacocks are now roaming the streets, which is kind of fun.
Dr. Singh: Oh, that's beautiful.
Poonacha: It's beautiful.
Dr. Sing: Yeah. So, my mom still lives in India, and she is a very active social person, and it's been extremely hard for people like her. She still works full time, and she works in a university. So, you know, just being away from her students and not attending her every-morning yoga class, which that's how she starts her day, it's been hard, but she's been doing it at home herself. And, you know, she's just a practiced---a very experienced yoga practitioner, so, you know, she can do it herself at home.
Same with us. I mean, we can all do all that at home ourselves. We have apps. We have all sorts of technology at our fingertips that we can all stay safe indoors and not expose ourselves or others to the virus and transmit them to the pandemic (10:54).
Poonacha: So when I think about this, especially from the seniors, right? So I feel a lot of challenges today, I know seniors are more prone, more vulnerable. They don't even have the ability to even go out. I mean, some of them are literally---I live in a complex where a lot of them are older and I just know that they have not even left the house.
So I look at the aftermath of the virus, right? One is the virus, and then after the virus, the economic resilience we would need to get through this adversity. I believe there's going to be a mental health challenge, right? It already is. I was just reading reports today about people living in homes with domestic violence. Are you seeing a mental health uptake with your patients who are coming in at the DAP? Or is it too early these days to talk about it?
Dr. Singh: No, absolutely. I mean, there's a lot of questions that patients have, and there's a lot of confusion out there in the real story about the virus and also the impact of it.
Dr. Singh: So as a business at the Desert AIDS Project, we have definitely taken a huge hit because we did survive on, you know, patient visits and the revenue generated from that. So we have done our best and try to keep our patients safe and not scheduling any non-urgent visits and then postponing their visits, but March and April have been really hard.
So what we have done is, we have tried to keep our patients safe and clinicians safe, and we have ventured into telehealth which is where we can see our patients remotely. We are like this, you and me. I could be seeing you from the safety of my office, and you could be as safe at home, and I could still be able to give you care and send the labs over and, you know, whatever medications you need refilled.
Only thing is that we can't do auscultation with the stethoscope or vitals, but I have let my patients know that, "you know, if you have a blood pressure machine at home, let me know your blood pressure and heart rate in that way." We can also do observation-related exams and---you know, trying to help our patients keep them safe as much as possible.
But definitely, business has gone down. And the excess expenditure that comes from launching a telehealth program. All those things, that we're just hoping that we can keep our patients safe and still stay open and be able to help them for a long time.
Poonacha: A big shout out to all you guys at DAP and David Brinkman as an amazing leader. And actually, one of the reasons I want to do this podcast today with you was, to share the link and also to get people to donate. I know there's an ActiveCampaign right now going on at DAP website, desertaidsproject.org, where people can donate towards keeping the COVID-19 triage clinic up and running.
You guys have been doing amazing work, selfless service, so how do you take care of yourself? What is your self-care routine? You know, you've been burning both ends of the candle, well, how do you---what do you do?
Dr. Singh: I start my day with meditation. I do about 20 minutes of it. After that, I do start to get ready for work and, you know, kind of update on COVID a little bit just to have the latest information, to be able to be helpful and share expertise later on in the day, then I go to work.
I work from 7:45 to about 5:45. I come home and try to, you know, I'll take a shower in just probably everyday. You don't want to bring the virus home. I try to be careful at home too and wash my hands and stuff before I start touching my own home and make it contaminated. And then after the shower, I just try to relax, go outside.
It's a beautiful week. This has been, you know, 77 plus degrees (14:29). We like it because the virus is less effective. So really hoping and praying to the sun god to give us the wonderful sunshine that we're so lucky to have in California. So I spend some time in nature, walk on the---I do grounding a little bit, walk around, I feel like healed that way, and then, you know, just listen to some light music.
I do like to eat before 7PM, so by 7PM, I'm done with my dinner. I'm trying to eat more vegetables and fresh food items as much as we can have until we have to resort to packaged food. Hopefully, we never get there. But there are farmers' markets that are still open, and they're, you know, being very social distancing and protective. I start to eat more vegetables and then try to not watch news at all.
Dr. Singh: I don't watch news at all.
Poonacha: Sure, it's become like a stock picker.
Dr. Singh: Because they're filled with bad news.
Dr. Singh: And just, you know, try to connect with my friends and family via phone or via FaceTime. I've been talking to my mom a little bit more. Usually, we used to connect once a week. I'm connecting with her a little bit more. I realized that connecting with your friends and family is what keeps me grounded and sane, you know, helping friends who have questions, we're not infectious disease trained.
And my neighbors, we tried to do a little silent disco thing. We're all going to be outside our houses and do a little five minutes, so we at least get to see each other and still know we're in each other's lives. Just trying to be a little creative.
Poonacha: That's beautiful.
Dr. Singh: But still maintain physical distancing, and just, you know, helping each other and just helping each other stay strong. It's a few more weeks, and we'll start to see the rainbow behind it. This is a little bit of a tough time, but together, we can do it.
Poonacha: I do believe that human endeavor of resilience will basically transcend any adversity, and I firmly believe that we will come out as a kinder, more compassionate species. Hopefully, if not, we are definitely screwed. You know, if we haven't learned from this, when a virus has brought entire humanity to its knees, never before has something like this happened, then we definitely are a failed human experiment. Hopefully, that doesn't happen.
So when we look at, you know, when I'm looking at some of the things I was just listening to you, do you have any insights on the horizon as far as vaccines, any medication cocktails which are working? Any insights on that right now?
Dr. Singh: Yeah, so a vaccine is in development. We'll have it as early as the early part of next year. We have antiviral experimental therapies which are intravenous remdesivir, which is in clinical trials and production.
Now, if you know anything about clinical trials, it takes a long time to get all the data and make sure it's safe and all that, but all those have been expedited by the FDA and the US government. We have multiple testing now that is coming in the pipeline in the next couple of weeks. We're going to be able to test even asymptomatic people and be able to determine better who needs to do social distancing and social isolation versus who can still be out and about.
So there's a lot of things coming out. There's hydroxychloroquine and azithromycin experimental combination cocktail therapy that has been used in some countries. The data for the prophylaxis with just hydroxychloroquine has failed, so it doesn't really do much in prevention of the disease.
Dr. Singh: But there's some data out there that shows that together, hydroxychloroquine oral plus azithromycin oral, those two medications together can reduce the viral shedding for a little bit and reduce the symptom duration, which could also ultimately reduce the transmission rate and slow down the pandemic; but also, these are still in very early experimental stages and need to have more data, and also they could all have side effects too, especially combined together.
Although hydroxychloroquine, as you know, being from India, has been used as an antimalarial, and pretty safe even in pregnant people, for a long time, but we need just more data because, how does it interact with virus and how can it be used, especially in an immunosuppressed population?
Dr. Singh: So there are so many questions we still have, but there are scientists and researchers all over the world working towards it, and I think we will have some good, good news coming up very shortly and more data, that we can safely prescribe some of these experimental medications.
Poonacha: And I think, when I listen to you, the new super superheroes are the frontline physicians like you all researchers, scientists. You are the new super superheroes. So hopefully, after all this is over, we will redefine comics, right? (both chuckle) And then see who the new superheroes are.
So any thoughts and comments which you would like to share for the world at large? When you look at it as somebody who was trained to be a physician, you probably could say this is probably the most important time in your life, right? To be of service to humanity. How do you feel? From Manipal, studying medicine in those days, and now in Palm Springs.
Dr. Singh: So this stuff is for real. This is real life, and I'm no longer training, and the dreams of 'oh, I can do anything and everything', and it's just like, you know, we do our best. That is my advice. We help everyone, and we stay healthy. We stay safe, we stay calm, and we help everyone. That's my message.
Poonacha: Beautiful. So, Dr. Singh, once again, thank you for your service. I think, with what you were doing and also with Desert AIDS Project with David Brinkman, I'm really grateful, and hopefully, we all can rally around and support DAP and celebrate once this is all over. So thank you again. Thank you for your time.
Dr. Singh: Thank you. Thank you for everything, and thank you for keeping DAP in mind and trying to help us. We need all the help we can.
Poonacha: Thank you. Talk to you soon.
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Warrior Monk Conversations 013: COVID19—The Facts & What You Can Do About It with Dr. Tulika Singh