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Boise State Public Radio News is here to keep you current on the news surrounding COVID-19, the disease caused by the novel coronavirus.

Physicians: Severity Of COVID-19 In Idaho Could Have Been Avoided

Family Medicine Residency of Idaho

COVID-19 has been particularly cruel in Idaho, cutting a wide swath across the Gem State. Six months into the pandemic, there have been 30,000-plus cases of coronavirus and the state is inching toward 400 COVID-related fatalities.

And a chilling letter to Governor Brad Little and other public officials, signed by nearly 40 Idaho doctors, is calling for a "system overhaul" in order to face what promises to be a challenging fall and winter. You can read the full letter by clicking here.

Dr. Ryann Milne-Price, a family physician at the Family Medicine Residency of Idaho, penned the letter, which quickly got the attention of a few dozen of her peers. Milne-Price and Dr. Ted Epperly, CEO of the Family Medicine Residency visited with Morning Edition host George Prentice to share their concerns but also share their optimism, if Idaho is prepared to meet the crisis with focus and vigor.

“Look, you don't have to do this forever. If you do this right, once you recover, you might get through this without getting any one of your loved ones sick."

Read the full transcipt below:

GEORGE PRENTICE: It's Morning Edition on Boise State Public Radio News. Good morning. I'm George Prentice. As the state approaches the number of 32,000 Idahoans infected by COVID-19, a growing list of physicians are calling for wholesale changes to the state's prevention policies. We know that because the doctors have sent a letter to Governor Brad Little and other officials and the letter calls for, quoting here, "A multi-scale and interdisciplinary system overhaul." Joining us this morning are Dr. Ted Epperly, president and CEO of the Family Medicine Residency of Idaho, and Dr. Ryann Milne-Price of the Family Medicine Residency. Good morning to you both.

DR. TED EPPERLY: Good morning, George.

DR. RYANN MILNE-PRICE: Good morning.

PRENTICE: Dr. Milne-Price, I'd like to start with you. What prompted this letter?

MILNE-PRICE: I am a third-year family medicine resident here in Boise, Idaho. My colleagues and I worked both in the hospital and in outpatient clinics. We were looking around at each other, realizing things were getting worse and worse, numbers were rising, and I think a lot of us were surprised that we weren't shutting down again and we could tell that we were headed toward a surge, we're looking ahead, and it felt like something needed to be done. We saw how strong the hospitals were. We could foreshadow how bad it was going to be. Tests were taking six days to come back.

Credit Family Medicine Residency of Idaho
Dr. Ryann Milne-Price

It was a time when I was doing a lot of outpatient work in our respiratory clinic, so I had a lot of time talking to patients who had been exposed either at home or at work and then patients who already had COVID and were feeling worse, they were feeling shortness of breath, and so they were coming in and I was sending them to the ER. I was learning about where they were getting COVID, obviously, mostly from the home, but also intermittently from workplaces and this surprised me.

I mean, my patients would tell me how they couldn't stay home from work when they were sick because they didn't have paid sick leave, or in some more rare cases, they were asked to continue coming to work, even though they were known to have COVID, so it just really made me think about how we reopened in Idaho and I realized we needed a lot more education, we needed more support and direction for employers and employees about how to safely navigate the pandemic. It made me think about systems made me think about how in Idaho we had reopened without changing systems universally enough to sustain control on the outbreak.

PRENTICE: Dr. Epperly, we're six months into this pandemic. Can you give us a sense of what you and your colleagues are seeing this week?

EPPERLY: Absolutely, George. Overall, we've seen over 250 positive patients. We've had 15 of our employees get sick, all through community activities. None have been infected by patients in the clinic because we're really taking this very seriously with masking, gowning, gloving, face shields, the whole enchilada.

As you said, George, at the top, we're at 32,000 cases in Idaho now. Worldwide, it's 25.5 million cases with 250,000 cases a day. In Idaho, we're still seeing anywhere from 180 to 220 cases per day, which by the way, ranks us 15th in the United States right now for the number of states and our positivity rate of about 11% in Ada County and our positivity rate in the state as a whole ranks us third highest in the United States, so we're still a hotspot here in Idaho and in particular, the Treasure Valley, which is the hottest of the hot spots in Idaho right now. We are red in the categorization zone, so there is an active ongoing community outbreak here in Idaho and that's what we're seeing overall.

PRENTICE: Dr. Milne-Price, the pandemic… I think what I'm hearing is that the severity of this could have been avoided.

MILNE-PRICE: Yeah, I think so. I think basically in order to reduce transmission, you have to reduce through the viral load in the community because once there's a lot of virus out there, it's exponentially transmitted. If you can first reduce the load in the community and then second build systems that keep it low, you can be very successful actually at controlling an outbreak and we've seen models for that in many, many places.

I think that's an actually the nice thing about coronavirus, if there is anything that's nice about it, is that it's a global pandemic. Quite literally, the entire world is dealing with it and thinking about it and really creative ways and coming up with imaginative solutions and so I think we can pick and choose models that have been successful from around the world and around the United States that we feel like will work for Idahoans and implement them, but I think we need to implement them universally. Public health measures work, but they need to be system-wide change.

PRENTICE: Dr. Epperly, I guess what we're talking about here is a void, right, the lack of strong public health mandates?

EPPERLY: Absolutely, George. Let me put this in some degree of context. I mentioned there are 25.5 million cases in the world. The United States has six million of those cases. We basically have 25% of the world's cases, approximately 25% of the world's death, but we represent 4% of the world's population, so we're 600% higher than the rest of the world when averaged, so when you ask the question about, "Could this have been avoided? Do we have a void in our public health approach?", the answer is clearly yes and if we had responded both earlier and I think more aggressively around the public health measures, around testing, we would see a different approach in the country right now. We are behind the eight ball in regard to the United States's public health response to this outbreak. Anything and everything we can do to move upstream to try to prevent and avoid downstream cases, downstream hospitalization, downstream death is an important thing for us to do both now and going forward.

PRENTICE: Dr. Milne-Price, what has been the response to your letter thus far?

MILNE-PRICE: I have received letters both from Mayor McLean expressing how she has targeted the response…

PRENTICE: Again, you sent this letter to a number of officials, yes?

MILNE-PRICE: Yes, I did, I sent it to Governor Brad Little, multiple mayors, and both of the Canyon County and Ada County Health Departments and I just received a letter in response as well from Southwest District Health, which is the Canyon County Health Department expressing how they're approaching the outbreak.

PRENTICE: Any word from the governor's office?


PRENTICE: Can I assume that the responses you're receiving are, "Well, thanks for the letter," or is there meat on the bone? Do they actually truly respond to the call for a stronger public health mandate?

MILNE-PRICE: I received two letters and I felt like it was really interesting for me to read them. I was hoping to start a conversation and I think it did to a certain degree, but I also think it was more they were just telling me, "This is how we've decided to do this," and I was hoping to open the conversation about how could we do this, how could we use our imagination to control the outbreak so that we could actually live in a safer environment and not have this drag on for months and months and have it affect the economy for months and months, because I think there's actually pretty easy things we can do if we just create the systems to make that happen.

PRENTICE: Well, my last question, it may not be a fair question, but I'm hoping that you both can give me an answer: What is your level of optimism for us doing the right thing?

MILNE-PRICE: I think the thing about COVID is that it's taught us that we need to work together. It's taught us how interdependent we are. We truly need each other and we need to build social trust. When I talk to my patients in the exam room, if you can imagine what this looks like, I'm gowned up, double gloved, I have a mask on, I have a face shield on. Basically, all they can see are my eyes and here they are and they're sick, they're scared, they might be a little bit short of breath, and I'm telling them something that they really don't want to hear. I'm basically telling them, "Until your test result comes back," which depending on how backed up the lab is, might be six days, "You need to pretend you have COVID. You can't go out in public, you can't go to work. You need to look around at your environment and behave as if you could transmit this to other people, the people that you're living with," and you can see them feel just so overwhelmed by that.

But then I also remind them, "Look, you don't have to do this forever. If you do this right, once you recover, you might get through this without getting any one of your loved ones sick." So I think people really need encouragement as well and I recognize that with my patients and so I think that's what I say here today. If we do this right, if we reduce the viral load and then create systems to keep that viral load low, then I think we could really actually get through this much more quickly than if we just let it drag out by having only suggestions or piecemeal approach.

EPPERLY: I believe that one truism about all pandemics, and we've had 20 of them in recorded history, all of them have stopped, so this will stop as well, so I remain optimistic, George, to a successful conclusion to this. I think a couple of things are going to need to happen for us to get there, clearly sooner versus later. One is an effective vaccine will need to be developed, which has at least 50% effectiveness and at least 70% of the population or so needs to receive. We need to get roughly to 70% of the population having some degree of antibody response and cellular immunity response to achieve what's called herd immunity.

Credit Family Medicine Residency of Idaho
Dr. Ted Epperly

I'm not holding my breath that there will be effective treatments, for this coronavirus is very hard to treat. A type of coronavirus is the common cold. We've still not successfully treated that, nor have we successfully vaccinated for it, so it may not be as quick as we would hope in coming, but I do believe that eventually this will stop, either through an effective vaccine or effective herd immunity.

The one other thing I'd like to just comment on is our schools. We have a real problem, I think, in trying to reopen schools too early when Boise, Ada County, the Treasure Valley is in the hot zone. What we're going to see is kids and teachers getting sick and kids and teachers spreading this into the community and so to the point that Dr. Milne-Price was making earlier, we're going to see this continue to recircle and drag on longer if we don't take really effective measures for this.

But eventually, we will get through this. I don't think this will be the new normal forever, but there is no question that if we all take accountability and ownership for what we can do, which is face masking, social distancing appropriately, making sure that we do good hand washing that we clean surfaces that have been contacted, that we're all mindful of our role in helping prevent the spread of this, we'll all get through it a lot faster. We will get through it, but we'll all get through it faster if we work together.

PRENTICE: He is Dr. Ted Epperly, president and CEO of the Family Medicine Residency of Idaho and she is Dr. Ryann Milne-Price of the Family Medicine Residency. Thank you for what you do and thank you so much for sharing your insight this morning.

EPPERLY: Thank you, George.

MILNE-PRICE: You're welcome. Thanks for having us.

Find reporter George Prentice on Twitter @georgepren

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