On April 17, 2020, South Bronx Talks host Javi Lopez interviewed Dr. Daniel Caplivski, an infectious disease specialist at Mount Sinai Hospital, for the show’s second episode. He is also a Professor and Director of Travel Medicine at the Icahn School of Medicine. Their discussion focused on COVID-19 but also touched on Dr. Caplivski’s own experiences with soccer. Watch the episode in full.
Dr. Daniel Caplivksi: I’m one of the infectious disease specialists working at Mount Sinai Hospital in Manhattan. My role has been mainly to take care of patients who live with HIV and for folks that are traveling abroad and need some help before they go abroad. But since the COVID-19 outbreak has arrived, most of us in infectious disease have focused our efforts on helping treat patients with COVID-19. The other aspect of what I do is teach medical students microbiology and that’s been a lot of fun in terms of what I get to do in teaching. Their efforts have been very helpful as well. A lot of medical students have been helping in the effort against COVID-19.
Javi: Coronavirus outbreak came in. How do doctors, or how do you teach your students how to handle the pressure because they have the pressure of the entire world due to the lockdown? How can you teach them, and how do you handle the pressure yourself?
Dr. Daniel: That’s a great question because there’s so much pressure on everybody in society, but in particular for those of us in the medical field. Just managing the stress of first trying to take care of the patients the best we can, trying to protect ourselves the best we can, and then protect those around us: our families, our friends and everybody else who we come into contact with. I think the first thing that helps is acquiring as much knowledge about coronavirus as possible, so we get to understand the science behind it and that helps us deal with the uncertainty of something new. Some of what helps is having been through several outbreaks in New York City. As a community, I think we’ve all got memories of what it was like when Ebola was a problem, of what it was like when influenza 2009 arrived, swine flu. Even going back to 2002-2003, when the first coronavirus outbreak, SARS, was starting in Asia and then arrived here in New York City as well. So, I think some of the lessons from the past help us with how to handle the pressure of what’s going right now. This is obviously an unprecedented amount of cases in terms of numbers of cases happening all at once. So they think that’s been part of why the lockdowns have been so important, to keep people separate and to decrease the number of cases that happen right now so that our hospitals can catch up and take care of patients who are there now. Then they make space for more people who might get sick in the future. I think the main thing for handling the stress is acquiring as much knowledge as you can about the disease and then number two, making sure that you take time out to do things that you need to do to stay happy and healthy. I like to spend a lot of time with my family and my kids. I feel like that really recharges me a lot.
Javi: Do you think mental strength has something to do with that like patience, meditation?
Dr. Daniel: Yeah, for sure. A mental strength is a core that I thought about a lot in the last few days and since I think it was something I heard first in sort of high school soccer practices; you know when we would talk about the pressure of a game and being able to cope with playing multiple games in a week and how do you prepare for that mentally. For sure it’s coming into play now and everything you mentioned about meditation and trying to find a space to center yourself before you’re about to perform or do something that requires a lot of focus. I think that’s really important.
Javi: Yeah, mental strength is a big important fact. As a soccer player, and even in school, sometimes I just feel anxious. Meditation, for example, calms me down and just taking a moment. What’s going to happen, is going to happen either way.
Dr. Daniel: That’s right, and I think also as you say, being in the moment and taking one day at a time because I feel like sometimes with a long outbreak like this, it can feel overwhelming to think about how many people are sick and how long is this going to go on, but sometimes it helps to just focus on the patient you’re taking care of right then and let your mind focus on something that’s much more concrete and that helps you just perform at your best when you’re under a lot of stress like that.
Javi: The second question is why did you decide to become a doctor?
Dr. Daniel: That’s a great question. I had a long journey, actually because I grew up in a house where we had two doctors. Both of my parents are doctors; my dad was a cardiologist and my mom was a pathologist, so I was always kind of around it. I would go with my dad to the hospital to see patients when I was like 10 years old. He loved to sort of show me where he worked and I loved it too, but I really felt a lot of different callings when I was in high school and college. I ended up majoring in History and Literature because I just really loved learning more about my parents’ culture. I was focusing on the literature of Peru and I’m learning about the history of South America. Medicine seemed a long way off from what I actually wanted to do, until I spent some time in Peru in my senior year of college and I followed around some medical students who were learning about the tropical medicine in the jungles of Peru in Iquitos. They were seeing patients who did not have a lot of access to medical care. It was really impressive to see people my age, 20-21, who are already kind of functioning like doctors and had this really important knowledge that they were able to help the people who had a lot of need. So I think that kind of opened my eyes to the possibilities of going back and then taking pre-medical courses towards my senior year and a few years after I graduated from college; then eventually applying to medical school. I think medicine is such a long haul in terms of studying. You have to figure out your own way of figuring if it’s right for you. I was lucky to have a lot of exposure as a kid to sort of know what it was all about, but I think once I saw other students my age actually performing and doing things that were helpful to other people, that really inspired me to go back and study and want to do that.
Javi: I have a question about that. Learning in the United States from your parents and then going to Peru and also learning there, what was your best experience or learning lesson, from either country, that makes you who you are today.
Dr. Daniel: Wow, I think there were so many experiences that you kind of came together in terms of my career path and who I decided to become. One of the things that first come to mind is when I was a young boy and would be able to follow around my father in the hospital. I was really touched to see him visit the patients and make them smile. I think a lot of them were very scared and they were going through heart surgery or they had blocked heart arteries and my dad was a little bit of a joker and liked to keep things light and I feel like that gave the patients so much peace and calmness. That really sunk in with me. So when I think of the way that I take care of patients or interact with people, I feel like that’s still a big part of me just trying to put people at ease when they’re in a very stressful situation. So yeah, I think that was one of the major experiences growing up as a kid and seeing my father. I think the experiences of Peru that struck me so much were the vast difference in the United States where we have everything, in terms of material goods, we have this incredible wealth that we really often forget to appreciate. Then when you go to a country like Peru and you see people that are really struggling and really going through poverty; they’re still finding ways to be happy, they still find ways to enjoy life but if they had access to some of the resources that we had, it would be like a new world to them. Including some of the medical students I was rotating with, it felt like simple hospital supplies for their patients were not always guaranteed so that was a big eye-opener for me. When I came back to the states, I had a new appreciation of the level of wealth that we have and so many things that we can easily take for granted.
Javi: The technology in Peru is not the same as in the U.S. and that obviously plays a big part. Sometimes we have to think about other doctors that are still trying to help others without modern technology. As a doctor or as a nurse, the most important thing is the patient and how we’re going to cure them and how to make them feel better.
Dr. Daniel: There are wonderful doctors. They find ways of making diagnosis and they find a way to treat patients, even with very limited resources. As a doctor, I later went back to Peru to take a course in tropical medicine and I was just so privileged to learn from the doctors there because they have this amazing experience.
Javi: What will happen after the corona virus is over or is gone? Well it’s not going to be gone. My prediction is that it is going to be just like the flu, where we find a vaccine. Then every time spring comes in or fall comes in you have to get vaccinated. I don’t think it’s going to be over at all. What do you think is going to happen when the whole lockdown/ isolation thing is over and people could go back outside and be normal again.
Dr. Daniel: Yeah, I I think about this a lot because I think we’ve all been trying to navigate and figure out what the world is going to look like when this is all over. Obviously everything’s going to be changed because of the impact this has had on the economy. I think in terms of the virus, this seems to be a virus that when people recover from the vast majority of people probably become immune. That’s helpful because if they make long-term antibodies and they can’t get re-infected again they’re probably not going to be able to spread it. So, we’re hoping that a lot of people will become immune and then it becomes a munch rare event to see somebody with the coronavirus. Influenza, the flu, does subtly change every season and that’s why we have to get this new vaccine every year. Coronavirus has behaved a little bit more stable in terms of the way their genetics are so it may be that let’s say we do get a vaccine in a year or in 18 months, it may be effective, it may be protective and may sort of see the end of that outbreak. I think the risk of new outbreaks is always in the background, because there’s always different versions of these viruses that float around in animals and then every once in a while they make a sort of jump into humans and they are able to be transmitted from one person to the next. I hope it’s a society we learn to invest in the public health infrastructure so that if there are to be future outbreaks from this coronavirus or from other ones, then we’re prepared and we have all the medical equipment and teams that we need for that too.
Javi: From my perspective, personally I feel like there would be more admiration for doctors. You know like how little kids say I want to be an athlete, I want to be a policeman or a firefighter. I feel like when this is all over, youth are going to say ‘I want to be a nurse or doctor’ This is going to be a big part of history. Right now we’re learning about the Spanish flu that happened years ago. Twenty years later, kids are probably going to be learning about this coronavirus. They’re going to be like ‘Wow, all these people did all of that, sacrificing themselves and their families. I want to be a doctor because they’re heros.’ As doctors and as nurses, people are going to begin appreciating them more.
Dr. Daniel: Yeah, I hope so again I think, I myself included, a lot of what I’m doing is through telemedicine we’re able to do a lot of things that involve caring for patients via Facebook and Facetime and different ways of technology. Some of the people that are on the front lines; the ER doctors, the pulmonary doctors, folks that are in primary care and family medicine, that are so much on the front lines; I have so much admiration for what’s going on. I think we’re all pitching in a lot. I share your admiration because I feel like there’s so many nurses, especially the nurses, and the folks that are the transporters, the technologist; there’s so many people in the hospital that are playing this vital role . I think you’re right. It has a big impact on society and a lot of younger people will look at all the different Health Professions because there’s so many within health, and be more attracted to that profession because it makes a big difference.
Javi: Yeah, also you get so many opportunities. For example, my dad has a cousin who studied to be a nurse, but she doesn’t have her Master’s degree because she’s still in college. This opportunity was just made. I know there are some hospitals calling people to help so I feel like they’re going to learn a lot because they’re in the middle of it. There’s more opportunities because now you have a job as a doctor and it’s serious now. I think that’s pretty impressive. It’s sort of like “I don’t have my degree, why do I have to work,” yet they do it because they want to save people.
Dr.Daniel: They want to help and you’re right. There’s so many licensing requirements in the US that I’m hoping they will be flexible about a lot of that because we just need every person we can get to help out.
Javi: Why are masks and gloves so important at this time? Do you think that masks and gloves will still be important after this coronavirus is over because people are still going to have phobia about it or will be scared about things that can happen in the future? Do you think masks and gloves will still play a big role, let’s just say in five years or even a year or two?
Dr.Daniel: Right, well I think the mask and gloves have always been a part of the hospital environment because a lot of times we care for people that have other infections that can be transmitted from one person to the next like tuberculosis or some of the resistant bacteria that we use the gloves for. So they’ve always been a part of the hospital environment. Now, why would they be needed in the wider community? It helps when there’s a big outbreak like this for people to use the mask, in many ways to help protect the people around them. So, certainly there’s some protection that you get from wearing a mask. It’s less likely that you’ll inhale some of those viral particles that might be on, let’s say some droplets. If someone coughs near you and there’s some droplets nearby, and you’re wearing a mask, then you’re going to get some protection yourself. What’s also important is that we’re learning from this virus that some people can actually shed it or transmit it when they’re not having a lot of symptoms or pretty minimal symptoms. If people wear a mask, that makes it less likely for them to spread it to other people and that just decreases the risk, especially to some of the people who are very vulnerable to very bad infection. Older people right now are getting quite sick with this; some people with diabetes or folks that have underlying heart disease. So yeah, the masks and gloves I think right now are very important because we’re sort of in the peak or sort of just past the peak of the most cases and so there’s a lot of community spread. At some point, the curve is going to start to decline and we’re hoping that that’s true, but it may take a few weeks or months till we’re at the point where the public health officials look at the overall numbers and say ‘okay now I think we’re okay to ease off on some of these recommendations.’ But that still can be a few weeks away
Javi: Do you think the heat will help get this virus to go away? It’s Spring and there’s a lot of bacteria around because people are getting used to the weather, so their immune systems are low. Also places where it’s very hot; for example in Venezuela, there’s not a lot of cases and they’re still in lockdown but it’s not like in New York City where we are still going from Winter to Spring. Other countries like Italy are beginning to decrease, of course after the lockdown, but the cases continue to decrease faster now. Do you think the heat plays a crucial part in that?
Dr. Daniel: It’s a good question Javi. I think a lot of scientists are looking for answers on this but we know from the flu virus, from influenza, when it is cold and dry like in the winter time, the viral particles when people cough actually go farther and so there’s definitely some links between temperature and humidity that can lead to more spread of the virus. I think with coronavirus some of that probably applies, but there’s still some concern because there’s other countries like Singapore that are pretty tropical; that did have a fairly sizable outbreak. So some of this is probably related to population density. When there’s a lot of people really close to each other then it’s much easier to see the big numbers that we’re seeing here in New York City. I’m hopeful that to some degree, the temperature and humidity will decrease some of the spread of the coronavirus.
Javi: Places like Mexico, Honduras, and other places in Central America don’t have a big big outbreak, like there is in the US.
Dr.Daniel: Yeah, you’re right. There’s a lot of theories about what’s behind that and I think some of it may be related to temperature and humidity conditions. There may be other factors that we’re still learning about. Certainly, the number of people living close to each other makes a big difference for sure.
Javi: Okay, so if you had one advice to give families, that will help them for life, as a doctor, what would it be?
Dr. Daniel: I would say, make sure you’re sleeping well, eating well, and doing regular exercise.
Javi: I feel like that plays a big role. I’m an athlete, and my mom is very strict with the food that we eat and how she cleans them; sometimes it’s very annoying because it takes longer to eat, but I feel like it plays a big role. There was a point where I didn’t get the cold for 2 or 2 years and a half years; I recently had a cold in September and I think it’s because I’ve been eating healthy and doing exercise. But also, there was a part in September where I started eating McDonalds, I started going out with my friends, and then I got sick. And to me that was suspicious. Many teenagers and kids think that the coronavirus is not a big deal to them because I feel like their metabolism is high and they could burn calories and they go back to being ‘healthy.’
Dr. Daniel: They probably have a stronger immune system, is what we’re thinking about young people not getting a severe disease. There are some exceptions, there are some younger people that are definitely getting admitted to the hospital and needing ventilators. Unfortunately, I think that’s a hard message to deliver. The truth is many young people, if they do get this, are going to have a mild illness, they’ll stay at home and they won’t need a hospital.
Javi: What is considered so much worse than the flu or any other virus that became a pandemic throughout the years.
Dr. Daniel: I would say the first thing is that a lot more people from this infection are requiring a hospital stay. If we look at the overall numbers around 80% of people are fine they can stay home, but then you have around 20% of people that actually have to come to the hospital because they become short of breath, they can’t breathe, and need a lot of oxygen supplementation. Then among those, you have a certain number that actually get so sick they have to be on a ventilator in ICU. If this was an outbreak that involved a couple hundred people I think our hospital system can handle it just fine, but once you start getting into the thousands of people getting sick and needing hospital stays, that’s when we get stretched in terms of our hospital capacity and ventilators. The thing about this virus is that it probably came from bats, so it’s different enough from other coronaviruses that our immune system isn’t used to it. Whenever something new comes along it’s much easier for a lot of people to get sick because most people are going to shed a lot of that virus. We don’t have antibodies. The thing to know is that like the common cold, there are several types of coronavirus that are responsible for those common colds and those are the old fashioned coronavirus that were always in circulation in our human population. This new one started in December in China and it was coming from an animal source so we don’t really have the type of immunity that we do to the normal coronaviruses. That just led to a lot more cases and a lot more severe cases because our immune system wasn’t used to it.
Javi: Do you think that being prepared and not being prepared can be a cause for which one is worse and which one is not? I feel like the US was underestimating the virus and they weren’t taking it very seriously until two NBA players got it and now the whole US shut down. Does the preparation determine which one is worst?
Dr. Daniel: Yes. For your second question, the preparation that we needed for this kind of a pandemic was way beyond what was done. I think a lot of us underestimated how quickly this could move and how many people could get sick all at once. If we used our experience with SARS in 2002 we were thinking well we might see some isolated cases, we may see a few locally transmitted cases, but as long as we’re carefully tracing them and following up, then we should be able to contain this. I think the problem was that there was not enough testing happening so there was a lot of community wide spread that was happening that was not related to travel. I think our main focus was on people who were just traveling with the symptom. We missed out in an opportunity to sort of contain the cases to a smaller number. The preparations involved things like stockpiling lots of ventilators, surgical masks, different types of n95 masks. I think we were behind on that too because the usual pandemic we were worried about was another flu, another Spanish flu like 1918. In our pandemic preparedness kind of fell by the wayside because of different decisions of budgets and things. Unfortunately, that left us behind in April when we were trying to catch up with this outbreak.
Javi: Do kids and teenagers, like myself, need to be worried about this in a long term or short term?
Dr. Daniel: The good news for most kids and teenagers is that even if you get this, it’s very unlikely that you would need to be in the hospital, but there are kids and teenagers out there who are living with asthma or diabetes or other conditions that might make it a little bit of higher risk. On that front, I would still say be cautious. By sticking with these lockdowns, you’re really helping a whole community because then you’re less likely to transmit to your grandmother; or if you were to get sick; it could be a lot more dangerous for your family.
Javi: You talked about what people could do right now to help, just to stay home. Any advice you give people right now so they can help their community, their buildings or the streets?
Dr. Daniel: Yeah, I think sticking with the lockdowns are being very helpful. I think maybe to just give that message because we are seeing in the hospitals the flattening of that curve, meaning instead of the curve going up and up in terms of people coming in or number of people dying, we’re starting to see a bit of a flattening. That’s very helpful for us because that means we can keep up with the number of patients we need to see. So if people can stick with the rules of avoiding crowded spaces and avoid getting within 6ft of people and using the masks/ cloth coverings outside; that’s really helpful to us. In terms of the family, I think it’s hard to be indoors all the time. It’s the same with our families and with young kids; they want to be outdoors, they want to be running around. For soccer players it’s hard to deal with this kind of being indoors. I think taking care of the mental health side of this too, just trying to be in touch with what is it that makes you happy, even if you can’t go outside, even if you can’t run around. Sometimes it’s reading a book, sometimes it’s just finding some time with your family to have a conversation. Just keeping in touch with that because the stress definitely affects everyone in the city. The better we can do at keeping ourselves healthy while we’re waiting for this to be over, that’s a big plus for everybody.
Javi: Mental health is going to play a big part after all of this is over. There’s going to be a lot of cases of depression, maybe people committing suicide, and anxiety. What advice would you give to those people that are very scared to come out, or very scared to share their stories. What’s one piece of advice that you could tell them because I know economically this is going to affect the whole world. How can patients stay positive during this hard time?
Dr. Daniel: That’s an important question, because it’s not just the health impacts of this virus but it’s also the economic impacts. All the people that are losing their jobs, and they’re worried about how they’re going to pay the bills. I think that’s a big part of the stress that’s behind this. I think you’re right in that people need to acknowledge that and as you mentioned, sometimes storytelling is a big part of this. Just being able to tell your story to someone else, sometimes makes you feel a lot better, because you can realize that other people are going through the same stresses. I think in Mount Sinai, what they’re trying to do is sort of ramp up our mental health availability. It’s an aspect that has often taken a second chair to all the other kidney function, the cardiac function, and all the other things. We don’t always focus as much on mental health. I think at least from Sinai there’s going to be a lot of investment and resources for the people that are feeling anxious, or depressed, or may be having some PTSD symptoms from all of this; they’re going to have a place to go to and talk to. I think the last sort of huge crisis that I think of in the city is 9/11. In 2001, there was such a trauma to the city, and a lot of what we needed was just a way to heal from that mentally. I think Sinai has been really great at taking a lead in healing from that, so both on the health side for the people who were exposed to the dust of the World Trade Central but also the trauma of those events. I think you’re right, we need to make an investment and make sure that people have resources so that when they go through all the stress and anxiety of this and they come out of it, they have a place to turn.
Javi: Thank you for the information about the virus. Hopefully you could help somebody. The last few questions are going to be about soccer. The first question is what is your background story as a soccer player? Let’s say you were a soccer player right now, what would you expect from it.
Dr. Daniel: How did it all start? Well it definitely all started with my dad again. He was a kid in Peru, growing up in a neighborhood in Lima. He used to play on the streets with all his friends and a lot of those friends he grew up with went to medical school as well and became doctors. Some of them kept playing even into their adult lives. As a kid, it was so special because our dad would take us to his pickup games and there were a lot of fathers, sons and daughters. It was an amazing mix of people from Peru, Colombia, Haiti and in South Florida we had so many people from South America, Venezuela. It was a wonderful mix of cultures. It was the purity of the game; it was really joy. It was not anything where we were going after a trophy, we were just trying to enjoy the beauty of the game. As we got older, I kept playing through high school and a little bit in college; although I was very interested in music as well. I was a trumpet player. I still play trumpet, and I found it very hard to balance all the time demands of doing both. I do remember we had this amazing experience where my dad took us to the World Cup in 1990, in Italy. For us it was this great family trip. I got two younger brothers, they’re all soccer players, my mom and dad just drove a van around Italy. I got to see all these amazing stadiums.
Javi: Back then Italy used to be a great team.
Dr.Daniel: Yeah they were. That was the Salvatore Schillaci year. It was being in a country where everybody was just crazy about it. I don’t think we had ever experienced the sort of feeling of being in a stadium, where everybody was singing and had that level of excitement and passion.
Javi: I remember last year, I went to the Redbull’s New York City game; it was so loud. I can’t imagine what it would be like if it were Real Madrid, or Barcelona, that would be better. I was looking at those times and thought ‘wow, that’s crazy.’ Then let’s say I actually make it as a player, well hopefully I can make it, it would feel so great. By the way, shout out to my brothers, my teammates. I have Mexican, African, people from South America, people who went through everything, experience wise, I have learned a lot from them. That’s what really makes me a part of a team. I’m the captain of my team, so seeing everybody talking with each other, connecting with each other, is something I won’t take for granted. I love this organization because of how talented and cultured people are. Also because of the help the staff gives us. They don’t only help us, but our family as well. I tell my mom after I play a crazy game, ‘Man, I really have a brother that comes from Ghana, and a brother that comes from Mexico.’ I call them brothers because I literally do anything that I would do with my brother.
Dr. Daniel: Yeah, they become family.
Javi: Yeah. Going back to the culture, I have learned so much by just playing with them. I remember my first practice with them, I learned a new move. I feel like this is a move that everybody uses, but since I learned it from someone in a different culture, it means something to me. I respect the culture aspect a lot. If you would manage one team only, as a owner or as a manager, what team would it be and why?
Dr. Daniel: Wow, is it club or country? It’s got to be a club right?
Javi: I mean if you want a country then that’s fine. The main club things are Cup America, Euro Cup. Well as a club you have more trophies so whatever you want.
Dr. Daniel: That’s true. You know, if I think back to my childhood, the team I grew up supporting doesn’t exist anymore. It was the Fort Lauderdale Strikers. It plays such an important part in my heart because it’s an incredible study. We had on our team Nene Cubillas. Nene was probably the greatest Peruvian soccer player ever. In the 1970’s World Cup, he was a star when they played against Brazil and he was a great player. Cubillas holds this important part in our story and he kind of wound up his career in Fort Lauderdale. He was on that team, there was Gerd Muller, he was the German bomber and he was an amazing player from the 70’s too. All these guys were here in Fort Lauderdale and they would play in this tiny stadium of maybe three or four thousand people. We were in the stands and I feel like if I could go back in time and manage that team I think it would be such a treat.
Javi: I just want to send a big thank you to Dr. Daniel for his time and his service. If you guys have any questions, just leave it down on the comments below. In the description there will be all SBU accounts for you guys to follow. I hope you guys learned something today. See you guys next week.