Dr. Carlos Remolina

Pulmonologist Carlos Remolina Dicusses Covid-19 and the Delta Variant

Dr. Carlos Remolina (SASN ’73) has been practicing pulmonology in northern New Jersey for 40 years. In addition to running a private practice in Linden, NJ, he is Division Chief of Pulmonary Diseases at Trinitas Regional Medical Center in Elizabeth, NJ, as well as Medical Director for Care One, a healthcare company that runs long-term acute-care facilities within Trinitas and other hospitals. He's also President of the Medical Staff at Robert Wood Johnson University Hospital in Rahway, NJ.

When Covid-19 hit in March 2020, Remolina’s life went into overdrive, sending him to the frontlines of the pandemic seven days a week at both hospitals while coordinating care with doctors and senior hospital officials across the region. When we spoke with him during the first wave of infections, the surge of patients and uncertainty about the virus and treatment protocols—along with shortage of Personal Protective Equipment (PPE) and testing options—meant that Remolina and his staffs were stretched to the brink.  

Things have calmed considerably since then, but with the Delta variant making inroads and vaccination rates lagging, especially in certain parts of the country, we wanted to check back in with Remolina to get an update on what he’s seeing and how he’s faring.

In the thick of it last spring, you said your combined caseload at Trinitas and Robert Woods Johnson had spiked from 30 patients per day to between 75 and 100 at the peak of the pandemic. What is your caseload now? 
It has come down significantly. I’m now down to 35 patients per day, some with Covid and many without it. Right now we have seven patients at Trinitas with the virus.

Describe the Covid patients you’re seeing now.
We’re seeing a very different presentation than the first and second surges last year. For the most part, patients are younger—mid-40s to mid-60s—and many do not have co-morbidities like the older patients in the earlier waves. Most are still Black and Hispanic, and all are unvaccinated. That’s the common denominator. Most are not as sick as the earlier patients, but we still have two on ventilators.

So, you’re still encountering serious cases?
Yes. One of my patients is a 49-year-old Hispanic male who developed pneumonia  and respiratory failure, and was intubated and spent two months on a ventilator. He said, “It’s the worst mistake I’ve ever made, not getting vaccinated.” We treated him aggressively, and he woke up three days ago. He can communicate but has no lungs—still requires ventilator and 80 percent oxygen. We put in a feeding tube, and he’s awake and responsive, but if he survives, he’ll be sick for years. 

In addition to hardening of the lungs, are you still seeing patients with blood-clotting and kidney issues, which were serious issues in the first two surges?
Yes, patients are still presenting with blood-clotting and renal issues—some are still very ill—but not in the same quantity as before, because our caseload has come down and because of the patients’ age range. 

How have treatment protocols changed: Do you have better tools at your disposal now then you did earlier in the pandemic, whether drugs or other protocols?
Treatment protocols are mostly the same, but some have changed. For patients with early moderate-to-mild symptoms who are not hospitalized, a well-known monoclonal antibody treatment that was used alone is now being used in concert with other medications, since we’ve found this to be more effective. And for hospitalized patients we’re still using steroids [to reduce inflammation] and remdesivir [an antiviral drug that blocks the RNA chain, upsets viral replication and causes the virus to die], but the second course we were using before has been shown to not be effective. So, some things have stayed the same, while others have changed.  

It’s important for people to be aware of what’s going on and encourage their family and friends to get vaccinated.  

Have you seen any breakthrough cases?
Yes, we have seen a few breakthrough cases, but for the most part they’re going home. The vaccines are doing their job.

Do you have a preference of vaccines?
The mRNA [Pfizer and Moderna] definitely work better. We recommend those to our patients. We see more patients getting sick with Covid who got the one-shot Johnson & Johnson version.

What’s your private practice look like now?
I have very few patients with Covid walking into my office now, but we see a number of patients who had Covid, many now with fatigue, shortness of breath and post-nasal drip. CAT scans often show lung damage, and some are experiencing fibromyalgia [a chronic inflammation process that affects the tendons and causes fatigue, memory problems and mood changes]. It’s painful and presents as arthritis, but it’s not.

How safe do you think it is for vaccinated people in New Jersey to be indoors in public places or house parties without a mask right now?
I’m very conservative. People should wear masks. They work and have also reduced cases of strep throat, the flu and other issues. With the Delta wave, people can contract the virus easily. Senator Lindsey Graham just got a breakthrough infection because he probably didn’t wear a mask. There’s no absolute protection. This mutation spreads so fast and easily, so everything should be done to protect yourself and others.

Have you met much vaccination resistance among patients? And when you do, how do you handle it?
Some patients are stubborn, but I try to explain the facts to them. Most listen to what I have to say, but among those who are hesitant I hear, “It’s not FDA-approved.” I tell them the approval is coming. Who cares when it comes, whether it’s in two weeks or two months. Get the vaccine! Then I share my medical and personal experience with those who have fallen ill.

What are some other reasons you’re hearing?
Some female patients want to have a family and are worried the vaccine could harm them. And many patients cite religion reasons. To them I say, “God has given us a miracle. It’s important we use it. In fact, it’s our civic duty to use it to protect yourself, your family and your neighbors.” This country has lost more than 600,000 people. It’s important for people to be aware of what’s going on and encourage their family and friends to get vaccinated.  

Thank you for spending time with us.
My pleasure.