Transcript of Interview with Phil Skiba: Purpose During the Pandemic

This is a transcript of the video interview titled "Phil Skiba: Purpose During the Pandemic."

Phil Skiba  00:00

We just have people living in this alternate reality. And and that's the thing that we can't break through.

Chris Gorski  00:11

Welcome back to Inside Science Conversations. I'm your host, Chris Gorski. I'm a senior editor at Inside Science, which is published by the American Institute of Physics. This is a show about the human side of scientists, what makes them tick? What are they interested in? And how did they get to where they are? If you haven't watched episode one, please do check it out. Phil Skiba told me about his life and career from would be astronaut to triathlete trainer and coach to working with Elliot Kip Shogi on the team that was trying to help him run a two hour marathon. And to get there, he just started with a little bit of math. That's what he said. But also, more recently, he's been working with patients who have, or had, the Coronavirus at the front lines with athletes who come into the clinic saying I can't run as fast as I used to what's going on. And so he's trying to help understand and address that problem. We're talking in December, the Omicron variant is coming through the United States infecting so many people in other countries. And it's coming, you know, it's already here. Right? Yeah. I'm just curious about what your experience in medicine has been, you know, from March or maybe a bit earlier of 2020.

Phil Skiba  01:32

And, you know, yeah, I saw this coming relatively early on. You know, I've always had this interest in infectious disease. You know, when I, when I left my PhD in microbiology, I was working on naturopaths, myiasis, you know, sleeping sickness, Chagas disease, things like that. So I've always had an interest in kind of world health. And when these first when the first news came out of China, that there was this thing, you know, brewing in January. I immediately thought of SARS, you know, and wait and MERS, even, you know, in the 2000s, we were able to stop those relatively easily, even when we had some Ebola coming into the country, we were able to stop that. But it was relatively clear relatively quickly that this was not going to be stopped, there was a political element to this, to try to minimize the risk. And I kind of knew we were in trouble. As things were building in Italy, and my colleagues, they're telling me this, this horror show that they're seeing. I started kind of going to the hospital leadership, into some of my colleagues, guys, like there's something bad coming, and we got to be ready. And people were saying to me, you know, come on, give up and Chicken Little, you know, the sky isn't falling, it's not going be that big a deal. It's a cold, you know, whatever. And then all the deaths started in Europe. And it was like, Okay, this, this is not a cold. And then New York started getting demolished. And then a week later, we were shut down in Chicago. And, you know, from my perspective, I mean, I was a third or fourth generation volunteer firefighter.

Before I went to medical school, that's what I did in my hometown in New York.  The way I was raised was, you know, when something's on fire, you run towards it, not away from it. And so, I volunteered to work at the front line. We opened up these mesh tents behind the hospital. They were trying to keep the hospital from being overrun. And so I spent the first few months of the pandemic, working on the front line, which was scary as hell to see it face to face, and all that's between you and it are a pair of goggles, and this N-95 mask, you know, every now and then, you just, you almost felt like you were kind of standing outside yourself watching it. You know, because, you know, for example, you don't want to contaminate, you know, your house for example, you look at something like Ebola.

But most people get it the way most doctors get it, is when they are taking off their protective equipment, because they end up contaminating themselves somehow. Right, so you got to be super careful when you're taking off your protective gear. So you can't go in the hospital and do that because the hospitals full of COVID. So here I am in the parking lot of my hospital at midnight, you know, stripping down to my underwear, wondering what the guys on the security cameras are thinking as I'm double bagging all my clothes, you know, in garbage bags, and then putting on clean clothes for the drive home. So it was it was a life altering experience to do that.

And once things slowed down by July in Chicago, I was able to kind of come off the front line. And we kind of closed up the tents and stuff and we were able to come to some kind of balance. And so then it became, now this new enterprise, which was what do we do with all these people that got COVID and they're not okay anymore. These people with so-called Long COVID or will be called PASC, you know, the post-acute sequelae of COVID. And this is a lot of athletes, these are people who, you know, I've seen athletes who were, you know, 15 minute, 5k runners, 16 minutes, 5 k runners that couldn't break 30 minutes anymore, because what this virus had done to them. And so my focus very much changed from kind of the acute how do we make these people not die in front of us. To how are we going to try to help people return to their former level of function? And sadly, for some people, that hasn't been possible. And for some, some of them it has, that's really what I'm working on nowadays is, you know, in the physiology lab, probably for every, “healthy athlete” that I test or something. I'm testing three or four people that had COVID, and are now completely deconditioned, and don't know what's wrong with them. And so we try to answer that question from a physiological standpoint, and see, how can we intervene to help those people.

Chris Gorski  05:51

Wow, yeah. Well, what Gosh, and so are some of these people who, you know, they caught it in the initial rush, and then they're still year and a half on there, there's, they're still hurting?

Phil Skiba  06:10

Yeah. You know, because they kind of fall into a few different bins. There are the people who suffered some kind of, for example, heart damage. There are people who suffered some kind of lung damage, which is, which may be the large one of the larger groups. And then there's the people with this kind of post viral fatigue, plus or minus some shortness of breath, plus or minus strange pains that we can't explain. That kind of becomes the largest group. And so and so the question is, you know, how do we how do we intervene to help these people, because usual stuff doesn't work, it appears that a lot of the lung damage that occurs, occurs to sort of the, you know, down in the alveoli, the very smallest air pockets of the lungs, or in the basement membranes that allow the air to equilibrate with the blood and move gas around, so that you can live, you can move oxygen around, for example. And we don't have medications that help that, you know, so a lot of times with these people you're throwing, you know, they come to me after having a bunch of inhalers thrown at them, which are great for things like asthma, but do zero good in the in the face of a post COVID lung disease. And so what we've really had to do is develop this kind of post-COVID training program, essentially. Where we do pulmonary rehab to strengthen their inspiratory muscles and things so that they can breathe better. And start, you know, exercising them so that we can get them to build up a level of fitness so that their day to day life doesn't feel like such a challenge. And so, it's this really strange twist on what I already was doing for elite athletes, you know, which was trying to find a way to help these people gain new function, and just get them back to where they used to be, right, versus taking them from where the average person is and making them fast.

Chris Gorski  08:01

I mean, is this, I guess, how much of this is new, right? In terms of like, these, these methods of trying to troubleshoot these things, and to try to try to assess what's going on,

Phil Skiba  08:14

it's completely it's real challenging, these things didn't exist before, right? This disease didn't exist before. So we're kind of making it up as we go. So again, much like I talked about with athlete training, before, we're having to go back to very first principles, you know. And then build up from that basis, which a lot of doctors are not good at, right? Because doctors are trained in terms of algorithms, I see this on the monitor, this is how we intervene, you have this arrhythmia with your heart, I give you this drug, and so on. Those rules don't always apply when you're dealing with people who have who have, you know, post COVID, this post COVID syndrome. So you're having to kind of go back more to the basics of physiology, okay. This is how long they can tolerate walking at this pace. And this is how long they can tolerate walking at this pace and make that curve and say, okay, now how are we going to try to train you so that you can do this a little bit faster than before. And that may mean just making you able to walk to your mailbox, or go down to the store to get the newspaper? So there is that part of it. Now, some of these things that we're seeing we have seen before, right? We have seen people with viral damage to the heart myocarditis, we do have some ways of working on that, you know. We have seen people who develop Postural Orthostatic Tachycardia Syndrome. These are people who what's called POTS. It's very challenging to treat. These are people who say they change position, they get up out of a chair, or they try to do some exercise and their heart accelerates out of control and the blood pressure drops and they get dizzy and they feel terrible. So we have ways of intervening with things like that. But this large population in the middle, you know, we're making it up as we go. Let's challenge

Chris Gorski  09:51

How much information about these things can be shared and how quickly to get everybody you know, the doctors caught up and learning from what's happen in Seattle or New York or Chicago or …?

Phil Skiba  10:02

Yeah, I've given a few. I've given a few, you know, conference talks on this kind of stuff for, you know, what we're trying to do here, and where were the things that we're seeing and things we're trying to do. But someone has written a sort of first swing at a rehab protocol, that that's come up more than the journals. But again, it's none of this is it's not like we're doing, you know, controlled studies, right? We're saying that, you know, yeah, we tried this, and this seemed to work for this bunch of people, you know, but there's going to need to be in coming years, especially after the Omicron wave, and whatever comes next, and this is a part that people don't get is that, oh, it's mild COVID, or, you know, it's. And this is the way you know, politicians have always justified not taking the measures in a public health sense that are necessary to stop the pandemic. And now, that's going to be impossible. But we are going to have this huge raft of disabled people, millions and millions of people that we're going to have to take care of, you know, in the coming years, and that's going to be a tremendous burden on the health system, that the health system is totally not prepared for. Omicron has not even really hit Chicago yet, like numbers are going up. We're not getting destroyed yet. Two of my main hospitals here in Chicago, we've already stopped outpatient surgeries, we already have people boarding in the ER, because there's nowhere to send them. The health system is already at the limit. You know, 20% of people have quit health care in the last two years. We just don't have the manpower, we don't have the facilities, we don't have the money. So we're in for a bad go of it here. And people are still pretending like things are going to be normal. Like, if you look at England, their numbers are out of control. And that's going to be here in a couple of weeks. And we have not learned from our past mistakes. I hate to be gloom and doom.

Chris Gorski  11:47

No, no, no. I mean, it's yeah, it's been I mean, so you've been off the frontlines since little, you know, a year or last summer. And but taking this other tack, the medical system has just been stretched. And, you know, it feels like, it's really strange, because I can stay here in my cabinet office, and do my work, talking to people and editing stories, right. And I can be isolated, right. But if you're in the medical system, right, or you're in service, or you're driving a bus, or you're doing any number of different things, you can't, you know, it sounds like if you've, if you've lasted so far, the Omicron is going to get you is what it sounds like,

Phil Skiba  12:43

it's totally possible because it appears to be much more transmissible. And we still, you know, cling to this fiction of oh, just wash your hands and disinfect surfaces, you need to clean the air, the virus is airborne, period. Omicron is as infectious as measles. So you need an N95 best to protect yourself, you know, I mean, do paper masks, you know, provide some element of protection or and possibly reduce the amount of virus that you're exposed to, which could make the difference between you living and dying? Yeah, you know, they do. But do they fully protect you? Of course, not. I have been taking, I've been wearing an N 95 masks, I bought three or four cases of them. And I wear them everywhere. When I go to the supermarket, when I get gas when I you know, when I'm in the office, totally, it never comes off. You know, and my people do the same. And that's how we've kept it out of my department is that we've all been super, super cautious. Now we the vaccines aren't particularly effective against Omicron. And so you know, so we're going to need to do some different things. It appears now that after at 90 days post booster, you have about 75% protection against severe disease. Which, okay, so good. But still, you know, a small percentage of a big number is still a really big number. And so you're going to see a lot a lot of people get really sick, because they're not going to get vaccinated. And even if everyone in the country was willing to be vaccinated, we can't do it in time. So in my estimation, the thing to do would be to literally try and strap in a 95 on anyone in this country that's willing to wear one. You know, is that going to happen? No, it's not gonna happen. We don't have the political will. And that's unfortunate. You know, one of my friends is an ID doctor said this, which is a horrible thing to say. But there's an element of truth to it. He was like, the problem is that COVID doesn't kill enough people. You know, this one, we all know somebody who died. But if it killed people, the way Ebola killed people, we would have had a much different reaction to it as a world. I was in there one day when we had intubate somebody, and you know, she was crashing, and we're trying to get a tube into her. We are pouring sedation into this woman. But she's so young and strong. That it's like it was really difficult to sedate her. It's not we're trying to like you're trying to get the tube into someone who's like, basically drowning in their own fluids. Turning blue and thrashing. It was it was I mean, I'm going take that I mean to my grave. And if more people saw that, like, this pandemic response might have been a lot different. Because what I did see was, you know, I come out of the tent one day, like one of my nurses like, Doc, you got to come out here. There's this guy who's crawling through the bushes around the ER, with his cell phone camera, trying to see through the windows. And I look at this guy, I'm like, can I help you? He was like, I'm here to show the truth. But there's no patients in this hospital. And I'm like, there's no one in this waiting room. I said, You're right. They're all on ventilators in the back. He was like, he's like, I bet you there's no patients in that in that tent. Let's say you want to come in? And he says, Well, you're going to give me a mask. I said, I thought you said there were no patients in here. Why do you need a mask? They start screaming and swearing and you know, throwing a tantrum. And so we call the cops, you know,

Chris Gorski  15:57

It's a big, it's a big, it's a lot of problems wrapped together, I guess math, math being one of them. And the concept of how that that's what that's what's been really, really hard to see is the is the is the lack of grasp of, or, right, well, like you're saying to go from, I can protect myself and others. And we need to work together. Right. Like that's been, that's been the hardest part.

Phil Skiba  16:21

Right? I mean, that's kind of the sad part about it is that this is laid bare these kinds of fractures in our society. And part of that is a lack of education, right? Like we've been tearing down the education system and tearing down teachers for decades now. And there's that great graphic that goes around the internet that shows how politicians look at exponential. And so you see the curve rising? And how Oh, now it's exponential, because the curve is really steep. Whereas scientists look at that curve from the beginning and says, Yep, it's exponential here and here, and here, the whole way up that curve. And if you had done something about it, when it was down here, we wouldn't be in the situation that we're in. Right? The answer last summer, when you're when you're getting better numbers is not to take masks off everybody. What did you do, except turn that curve right around and start going in the other direction again? And it took a little while to get rolling, but it got rolling, didn't it? You know, because we're still in the midst of the delta wave. Right. Omicron is just getting here. You know, in a couple weeks, it'll be dominant. But you know, he's just getting here, we're still dealing with Delta.

Chris Gorski  17:27

Well, so what does your long COVID treatment project look like? For the next, I don't know, for the next for how you see it going, you know, as the winter and spring roll on?

Phil Skiba  17:42

Yeah, I think part of the question is going to be if we can, because typically, the way it works is, you know, people get referred in, they see pulmonology, or whomever and they end up coming to see me and I do all this physiological testing on them. The question is going to be whether we need to pause that in light of Omicron, because it'll just be too hazardous to have somebody exercising in a laboratory with a bunch of other people around, you know, we do test everyone before they would need to get PCR tested before they come in. But that has that takes 48 hours. So there's a small window there. In the laboratory, we put special filters on the machines that you know, that are basically a 95. And so they'll catch what these people are, are letting loose, but you have to take off masks to switch things and switch hoses and things like that. So the risk of exposure there. That's always the question is, you know, what risk are you going to take for what benefit and there's no good guidance on this. Because as a world, not just as a country, we haven't done the things that are necessary to make things safe. You need a high level of ventilation, to make sure that you're not spreading COVID around, you need HEPA filtration, we need people with N95 masks and so on. And yet, we still have the World Health Organization, minimizing the effect of airborne transmission. You know, it's absurd on its face. Why are we playing this game? I don't fully understand it.

Chris Gorski  19:08

The level of frustration that you feel with that, does that want to that alter your motivation for being in medicine or training or where you want to put your time and your focus?

Phil Skiba  19:20

Yeah, I mean, that's a great question. I've struggled with that since the beginning of the pandemic. I know all of us have. In fact, right at the beginning. One of the reasons you know, one of my one of my partners in the sports medicine practice, and I stepped up to go to the front line. Was that right at the beginning, many of my colleagues refused. Nope, I'm not getting paid enough to do that. Nope, I didn't sign up for that. Nope, nope, nope. Not doing it. I have kids and not taking a risk, which I mean to that level, I understand and to a level horrifies me, because your Hippocratic Oath did not come with a Get Out of Jail Free card for a pandemic, right, your physician you have a responsibility respond to the world. So that really kind of grossed me out to be honest with you. And that alone was enough to make me want to say, You know what, like, you know, this isn't for me. So there was definitely that thing that I struggled with. And I continue to struggle and struggle with the fact that, you know, my health system can do everything it can to try to protect us give us protective gear, and all that kind of stuff. But the rest of society is not willing to do those things. You know, and so you start feeling like, I understand why so many physicians and so many nurses and respiratory technicians are burning out. It's because I'm here trying to save your life, and you won't do the bare minimum of putting on a mask, or not going out to eat, or whatever it takes to try to slow this down. Why am I risking my life again? You know, because I mean, I have friends, I have three friends that were killed by this. So it's personal for me, you know, and at some point, there is an element of self preservation that kicks into your thinking. And it's like, yeah, I'm doing the right thing. But should I keep doing the right thing? Or do I need to start worrying about myself? Every physician has thought about that in the last two years, and anyone who claims they haven't is lying. And all of us have different answers. I'm still in the game. I know guys who aren't.

Chris Gorski  21:27

Well, when it's part of your identity to help people where do you go with that tension?

Phil Skiba  21:33

Yeah, that's a great question. You know, I spent a lot of time playing my guitars to play my drums. You know, I try to exercise. And I try to remember what got me into it in the first place. You know, like I said, you know, I was a volunteer firefighter. And I remember being a kid, I was probably 17 or 18 years old. And my dad was the chief engineer, you drove the fire truck for 40 years until he retired. But we were watching the truck for a parade or something, I guess. And one of his pays to his town, Dennis to you, when I was a little kid, you would like leave people in the chair to go drive the firetruck to go put up fire, you know, which I thought was always really cool. So we're watching this truck for a parade on one of his patients walked by. And he's like, What are you doing this for? You know, this is dangerous. You know, this guy was from New York City, like they'd paid Fire Department is like, what are you guys doing this for? My father just looked at him. And he goes, you know, if your house was on fire, don't you want someone to come? And he says, Well, yeah. He says, well, then maybe you should think about joining us, we'd be happy to have you. And so I guess I just the way I was raised, which is that, you know, if you can help, you gotta help. Because if for no other reason that when I catch this, I'm gonna want someone to help me. Because if everyone pulls this, you know, it's not my problem, then where do we end up as a society or as a world? We see the way societies become more and more selfish and more and more self centered. And what's that doing us? You know, I mean, as just human beings, what kind of pressure is that on us? And, you know, if you're not willing to be one of the people that tries to be part of the solution, then you don't deserve to complain. So, for me, I guess that's the way I look at it, is that I still got a good look at myself in the mirror. So we keep on keeping on for as long as we can.

Chris Gorski  23:27

Wow, yeah. I mean, well, I'm not sure I can ask you another question that would get a better answer than that. So I let you go. As there anything else you want to say about training or or treating? COVID? Or any, any? Yeah. Well, I mean,

Phil Skiba  23:44

I think what all these problems have in common, is that they're solvable. Right? Um, you just have to have the willingness to do it. And you have to have the willingness to be strictly honest with yourself, right. In terms of your training, in terms of whatever, like, humans, like the nice, new shiny thing, you know, oh, there's this new supplement. Oh, there's this new whatever. That's going to help in some way. You know, when we saw with COVID, you know, I'm gonna take Ivermectin I'm gonna do all this in that, you know, it's like, look, it's like, we know what stops COVID. It's masking and ventilation. And, you know, and to a lesser extent washing your hands and behaving better. Right? We know what works in terms of making you a better athlete, right? You got to train you got to sleep and you got to eat right. And none of those things. None of the things I just mentioned are glamorous, right? It's all just the hard work. So if you're willing to be honest about that, and you're willing to take those steps. You know, you can make huge differences and you're Health. And then right now in the public health of the world. It's just that you got to have the willpower to do it. And, and I guess, maybe as a coach, and as a doctor, that's my most important job is motivating people to do the right thing. That's what brought me to sports medicine really, is that, you know, when I was doing a lot of primary care early in my career, I can't tell you how many times I saw someone with like, you know, bad lung disease, it was like, Yeah, but doc, when do I really have to quit smoking, right? And you're like, Ah, man, right, you didn't hear a word I just said. Versus my sort of dealing with athletes and things. Or where they were injured. And they really wanted to get back to their sport, you know. And sometimes it required a come to Jesus talk. But very often, they're willing to go along with my program, if they thought it was going to get them healthy again, and get them back to training. So I guess the sports medicine, oftentimes you're dealing with, like a self motivated population, which is helpful. And so I guess part of what I try to do is bring that motivation to the widest bunch of people I can, whether it's a little old lady with arthritis in her knees, or it's some, you know, 15 year old kid who's short of breath when he's, you know, kind of sort of this team. And that's it at the end of the day. That's all we can do. Right? And it's you're asking people to change and to try to take them on that journey.

Chris Gorski  26:32

Nice, nice. Well, Phil, this has been fantastic. And really enlightening. Thank you so much for having me, Chris. It was a pleasure. This is just the beginning. We've already have several other great guests lined up. Hope you enjoyed this conversation. If you missed the first round with Phil, check that out too. Please. We hope you'll join us. For more Inside Science conversations. Please like and subscribe and keep an eye out because we're going to have more great chats with really interesting scientists. Hope you like them.