Tough questions answered: Dr. Tarquin Collis, Chief of Infectious Disease with Kaiser Permanente Hawaii, shares his insight on COVID-19

Tarquin Collis, MD, Chief of Infectious Disease with Kaiser Permanente Hawaii, is passionate about sharing his knowledge about COVID-19 with his patients, their families, and others in the community.

Since the beginning of the COVID-19 outbreak in Hawai‘i in March of 2020, Dr. Collis has been heavily involved in caring for patients with COVID-19 at Kaiser Permanente Moanalua Medical Center, as well as consulting on Kaiser Permanente’s outpatient population of COVID-positive members. He also helps direct Kaiser Permanente Hawai‘i’s overall response to the pandemic. Dr. Collis has been active in the community as an educator and has assisted both in clinical research and antiviral drug distribution policy at the state level. The Hawai‘i Department of Health asked him to share his frontline observations in providing care for patients with COVID-19.

Q: What is one of the most common misconceptions about COVID-19, based on your conversations with patients?

Dr. Collis: Well, there are a lot of misconceptions out there. One of the most common ones I run into is that some people still don’t feel the need to

protect themselves with masks or physical distancing because they simply don’t believe that catching the virus will happen to them, or because they think they’re smart enough to avoid it. In many of the patients I’ve cared for—including some incredibly sick individuals who needed hospitalization and intensive care—there’s an initial sense of complete shock that they caught the infection at all, usually because they didn’t knowingly have contact with an individual who was visibly sick or who was known to have COVID-19. In many of these cases, the simple act of wearing a mask might have prevented some very real suffering and tragedy.

What many folks don’t realize is that someone who’s infected can spread the virus for several days BEFORE symptoms develop. From what we know so far, some people—especially children and young adults–can become infected and never develop noticeable symptoms of COVID-19, and yet still spread the virus to others. This is why I tell people that it’s best to assume that anyone whom they see and talk with could be infected by this new coronavirus, even if that person’s feeling totally fine. This is also why, as a social responsibility to others, wearing masks is so crucial—because a mask may keep you from spreading this virus to someone else before you’re even aware that you have it yourself.

It’s not that I think everyone should live in a paranoid or anxious state all the time; it’s simply that, in our new reality–until this pandemic is essentially over (and this will take some time, well after vaccines become available)–it’s a pretty easy infection both to catch and spread if you’re not consistently thoughtful in how you approach masking and your social interactions.

Nothing’s perfect, but masking really does work remarkably well to prevent contracting this virus—I could tell you many stories in which a simple mask pretty obviously helped save the day, and kept a patient or a health care worker safe from infection. None of this is meant to be political, by the way, it’s all simple physics and basic virology. Sometimes the world changes, and we need to change with it.

Q: Data show that the majority of COVID-19 cases in Hawai‘i to date have been 18 to 29 years old, followed by those 30 to 39 years old, but the majority of those hospitalized are age 60 and above. Is there a perception that COVID-19 affects primarily kupuna and that those who are younger are less vulnerable? What message is important for the younger generation to understand?

Dr. Collis: That’s a great pair of questions.

Most infectious diseases, COVID-19 included, affect different age groups differently when they sweep through a community. For many infections, like the flu, it’s three groups in particular who are most at risk for bad outcomes: the very young, the elderly, and those with chronic medical conditions.

With COVID-19, if there’s anything I’m grateful for, it’s that the young (and by this I mean children, teens, and young adults – those under 25 or so) are relatively spared when it comes to suffering from severe COVID-19. Youngsters are not completely immune to being hospitalized or even killed by the virus, mind you—there have been a number of children, high-schoolers, and college-aged individuals who have died from COVID-19 in the U.S., and each one of those deaths is a profound tragedy. But overwhelmingly, this coronavirus does its greatest damage in two main groups: the elderly, and adults with chronic medical conditions (e.g., obesity, diabetes, high blood pressure, asthma, chronic kidney disease, or combinations of these). These are the two groups—the elderly, and those with any of the above medical problems—who are most likely to suffer a severe or lethal case of COVID-19 if they become infected, and almost without exception these are the folks whom we spend so much of our time in the hospital caring for now.

There’s a crucial message buried in all of this for those who are young, which is that even though you yourself might not get very sick from COVID-19—and there’s really no guaranteeing that, by the way—you can definitely spread it to those in your own family or in the community who are not so lucky, and who might suffer tremendously or even die from COVID-19 if they become infected. I’ve cared for many hospitalized grandparents and adults with chronic medical conditions who did everything right in their own lives—limited their social circles, learned how to mask appropriately, washed their hands frequently—but who got infected with the virus because of the carelessness (or plain old bad luck) of a younger family member who lives in the same household. It can be a terrible tragedy, and I’ve seen it tear families apart.

Again, so much of this comes down to our responsibility to others. Even if you’re young and feel invincible—well, you’re really not invincible, and regardless, if you can protect yourself from infection you’re also protecting others (some of whom you may live with and love very much) who are vulnerable to getting very sick and dying from COVID-19. How each of us chooses to live and conduct ourselves over the next year or two—and it really will likely be that long, I think, to put this behind us—well, it’s important to realize that like so much else in life, this stuff is more than about just you, it’s about all of us collectively. And we need to take care of each other.

Q: About a third of the positive cases to date have been Pacific Islanders. The Department of Health is currently collaborating with the Hawaii Public Housing Authority, the City & County of Honolulu, Hawaii National Guard, community health centers, nonprofit organizations and others to conduct outreach, education and testing in public housing properties and low-income neighborhoods. Are there any insights you can share about the Pacific Islander population that would be valuable to help bring down the number of cases among Pacific Islanders?

Dr. Collis: I think many of us who work in big, busy urban hospitals in Hawai‘i that care for folks with COVID-19 have been struck and deeply affected by the extent to which COVID-19 has absolutely wreaked havoc among low-income, Pacific Islander populations—Micronesians and Marshallese in particular, but native Hawaiians also.

This isn’t a surprise when you look at the experience on the mainland, where people of color (African Americans and Latinx, primarily) have borne a grossly disproportionate share of COVID-related illness and death. Although there may turn out to be a genetic predisposition that’s contributing to poorer outcomes in some of these groups, I think this is overwhelmingly about the social determinants of health, and it’s a tale as old as time; the poor have always been especially susceptible to poor health outcomes of many kinds, and that certainly includes infectious diseases.

For a virus like SARS-CoV-2 that likes to spread in close quarters, and which does tremendous damage to those with chronic health conditions and the elderly, a community full of crowded, multi-generational households of folks who often need to work several jobs to make ends meet and who don’t always have the time to address their own health needs—diabetes, high blood pressure, or what have you—well, that’s just the kind of community in which the virus can spread like a deadly wildfire. Here in Hawai‘i, the virus has done just that in many neighborhoods where residents have limited incomes—Kalihi, Waipahu, and many others—and that has taken an especially cruel toll on Pacific Islanders.

I’ve cared for many Micronesian and Marshallese patients with COVID-19 this year, and it’s been a total pleasure to do so despite sometimes difficult language barriers. These are almost always incredibly grateful, polite, uncomplaining, and brave patients, with very strong family and community ties. I’ve learned a lot from them about their culture and families, and it’s been a real privilege to be a part of their care. I’ve also been trying to learn a little Marshallese and Chuukese—I like languages, and boy, these are not easy ones! I’ve got a long way to go.

In terms of what can be done to help these groups in the community, a lot boils down to culturally appropriate education, providing some simple supplies to help prevent the spread of COVID-19 within households, providing access to testing, and helping with temporary housing. There is a desperate need for basic education, translated appropriately into several languages, about how to prevent COVID-19 and when and how to seek help. I think that providing things such as masks and hand sanitizer to households is critically important—many folks in these groups simply can’t afford these or aren’t sure how best to use them. Making testing for COVID easily available is similarly crucial, and the testing strategy has to make sense for working people and big families. Further, providing housing for those who need to isolate or quarantine is a fundamental epidemiologic need when it comes to blocking transmission chains; I’ve seen several families kept out of from harm’s way when an infected family member was provided with a hotel room by the DOH so that they could recover after their hospital stay before going home. I’m so glad there are dedicated advocates and community groups that are hard at work on all of these issues now, in addition to efforts by the DOH and federally qualified health centers. Those community groups are filling a crucial void, as it feels like we were very late to jump on helping these vulnerable populations as a medical and public health community. There’s a ton of catching up to do.

In the longer-term, efforts to improve the general health of low-income communities in Hawai‘i is also extremely important and shouldn’t be forgotten about in the focus on COVID. Making sure that good, thoughtful primary care is easily available for these groups—including vaccinations, diabetes care and prevention, and efforts to help with culturally appropriate dietary education—well, that’s just hugely important, because problems with heart and kidney disease, cancer, and diabetes will persist in these folks long after this pandemic ends if we don’t get this right, and we can’t forget that.

When you’re providing acute medical care for these folks during a pandemic, you feel it in your gut that we need to do more as a society and a medical community to give them a chance at a good life. And that’s more than just about COVID.

Q: Many understand the importance of complying with the restrictions on gatherings and physical distancing, but may feel pressured by family or friends to attend parties. What kind of advice can you offer? Some have said we need more modeling of safe behaviors to prevent the spread of the virus if there is a gathering is being held, can you describe what this would look like?

Dr. Collis: I guess the best advice I can give here is that it always takes a little bit of bravery to do the right thing. But that’s what being an adult is all about!

These are extraordinary times, everyone is learning new behaviors, and simply modeling the right behavior can be very contagious and effective. If you’re polite about how you communicate things—whether that’s declining an invitation to a party you know is risky in terms of spreading coronavirus, or asking someone to put on a mask during conversation, or suggesting to a friend that you eat outdoors together instead of indoors—most people will react the right way. That’s especially true if you explain that you’re doing this not just for yourself, but for your children or your parents or someone else you care about. And they’re much more likely to do the right thing themselves the next time once you show them how it’s done. If ever there were a time to politely model responsible behavior—or to pay it forward if someone opened your eyes about something you hadn’t thought about doing—well, it’s certainly now.

Humans are social creatures, and that’s at the heart of how this virus spreads. It’s this most fundamental aspect of our nature that the virus exploits in order to do its thing; what viruses really want is actually not to make people sick, but simply to multiply and spread, and we humans make this pretty easy if we don’t change our behavior the right way during a pandemic. The key here is to see if we can address those social parts of our being as safely and thoughtfully as we can during this crazy time. All that takes is a little creative thinking about how we can safely nurture that part of being, plus a little bravery to do the right thing.

Kaiser Permanente has produced videos featuring Dr. Collis to address other frequently asked questions about COVID-19. View his one-minute Q&A videos on Antibody Testing and Cleaning Cloth Masks and Flu, Mail, and Beach.

About Dr. Tarquin Collis

Dr. Collis grew up in Kailua and majored in English, studying creative writing and Shakespeare at Cornell University and at Oxford University in England, but ultimately decided to become a physician. He received his medical degree from Cornell University Medical College in New York. He and his wife, also a physician, completed their residencies at the Hospital of the University of Pennsylvania. Dr. Collis then completed a three-year fellowship in infectious disease at the University of Washington, obtaining a master’s degree in epidemiology at UW’s School of Public Health during his fellowship. He joined Kaiser Permanente Hawaii in 2001.