After A Deadly August, Idaho Doctors Answer Your COVID-19 Questions

Sep 2, 2020

In the last couple of weeks Idaho has seen a downward trend in new coronavirus cases, but August is barely in the rearview and was the state's deadliest month so far. At the same time, the Lewiston Tribune is reporting a spike in cases on the Nez Perce Reservation as K-12 schools reopen in various forms across the state, and universities try to keep campuses safe. Ahead of the Labor Day weekend doctors caution against letting down our guard against the disease.

Today on Idaho Matters, three doctors join to answer your questions about COVID-19 and how to stay safe during this time. Our panel is: 

  • Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce. (Read his recent blog post on "long haulers" here.
  • Dr. Andrew Southard, St. Alphonsus Emergency Medical Director.
  • Dr. Frank Johnson, St. Luke's Vice President of Medical Affairs.

Read the full transcript here: 

FRANKIE BARNHILL (host, in for Gemma Gaudette): You're listening to Idaho Matters, I'm Frankie Barnhill, filling in for Gemma Gaudette. As we continue to cover the coronavirus pandemic. We know many of you have questions and concerns and here at Idaho Matters, we want to answer those questions with facts. And the best way to do that is to bring in Idaho medical experts. Every Wednesday, we've been bringing in a panel of doctors and other health professionals to get us updated and to answer your questions. If you're a regular listener, think of this as the doctor's version of our Friday Reporter Roundtable. And if you have a question for our doctors, send us an email: idahomatters@boisestate.edu. If we don't get to it this week, we will try to get to it next week.

Joining us today are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. He's joined by Dr. Andrew Southard of St. Alphonsus, Emergency Medical Director, and Dr. Frank Johnson, St. Luke's vice president of Medical Affairs. Thanks you all for joining us.

ALL: Thank you. Thank you.

BARNHILL: Hi. I want to start just with a few quick stats and headlines around the coronavirus before we get into some questions, just to kind of keep our minds, you know, focused on what's going on right now. In the last couple of weeks, we have been seeing a downward trend in new cases. But we also just got out of August, which was our deadliest month so far in Idaho. The states reporting a total of 368 deaths. About half of those are connected to long term health care facilities. And, of course, K-12 schools are reopening in various forms across the state. Universities are trying to keep campuses safe. And I should note, the Lewiston Tribune is also reporting a spike in cases on the Nez Perce reservation, and that's spreading from young folks at nearby Washington State University. And since our last conversation with doctors last week, the Idaho legislature passed a law that gives schools and businesses protection from lawsuits connected to folks contracting COVID-19. So a lot of news.

I want to dig in right now, though, with Dr. Pate. The governor is holding a press conference tomorrow. He will announce whether or not the state will move out of stage four of his reopening plan. This, of course, won't be the first time the governor has held a press conference on stage four. The state has had to extend their two week timeframe for stage four, five different times. And that's because each time before the state didn't meet the criteria and remained in the stage. So, Dr. Pate, can you give us any insight on what you think might happen tomorrow?

DR. DAVID PATE: You know, Frankie, I'm really not quite sure what the governor is going to decide. On the positive hand, as you mentioned, our cases have been declining. But let's put that in perspective. Even though our cases are declining, our cases are still more than what we had at the peak of our first spike when we went to the stay at home order. So, yes, we're seeing good news, but I don't think anyone should get overly celebratory about this. Of course I'm encouraged. But then I would say at the same time, even if the governor does take us to the next step, I'm very concerned that things are going to change significantly in the next two to four weeks because we're changing the environment. And that is that we have a number of schools that are beginning to open for in-person classes. And personally, I think we are going to see a very dramatic increase in cases. So while on one hand, I'm sure he'll have pressure to advance us to the next stage, because things the numbers are looking better. On the other hand, I think this is going to be short lived and I think it's going to be very frustrating for people if the governor then needs to pull us back.

BARNHILL: Right. So do you think if we were to move out of stage four, that would be premature? Is that what I'm hearing?

PATE: Well, you know, I think what the governor will do, you know, based on his conduct the entire time of this, is he'll base it on the numbers and he'll look at the numbers. He'll look at the advice from experts. And I have no doubt that he'll make the right decision. What I'm just saying is, if we didn't have schools opening, I would say that's perfect. I'm totally on board. But given the fact that we are opening so many schools and then we've seen some really kind of crazy things that just defy science, for example, a school district deciding, well, they shouldn't have in-person classes, but they will have all their sports. I mean, that just makes no medical sense. And so I just think we're set up for a recipe that we're going to see a big surge in cases before long coming out of our public schools, coming out of our colleges and universities. And one only needs to look at other schools across the country that are ahead of us. And this is exactly what's happening. And it's already what's happening at Idaho schools that have already opened. So I just really don't think that we're going to be that much different.

BARNHILL: Right, Dr. Southard, so that I want to turn to you into the question about testing. We've heard about continued delays in testing, especially during the recent spike this summer in cases, you know, up to two weeks in some cases folks were waiting for their diagnostic test. What is the state of testing now? And kind of in the near future, you know, who can get a diagnostic test and how long does it take in the St. Al's system?

DR. ANDREW SOUTHARD: Sure, so I agree, about three or four weeks ago, we were seeing a significant delay in a lot of our testing mediums that we were sending to outpatient labs. It was taking up to, as you said, up to two weeks. Fortunately, as the number of people getting tested decreased and I think probably some ramp up of the labs that has actually come down, we're seeing a pretty good turnaround time now for just routine outpatient PCR testing of about two to three days. Sometimes it can go up to five, but that's currently where we're at. So that has actually helped us quite a bit. And then you combine that with most of the hospital systems. Now we're doing some of their own in-house testing. And for our purposes, that can be done in a couple of different machines we have and we get results back usually within an hour or sometimes overnight, depending on what the purpose of the test is. So we've seen those come online in the last month, month and a half, very strong. And that has changed a lot of what we can do from our perspective. Now, those tests that I'm talking about, the retroactive ones are more limited. And so we have to use them fairly cautiously for certain populations or it was going to make an immediate decision. So we're not giving them out, like you said to everyone. But that's kind of the current state. And I think the real hope is kind of coming down the pipe, we're seeing some more of these fairly rapid tests that are these 15 minute or 45 minute tests coming out that we hope to have a lot of availability to use. I think Albertson's just put out that there that they're going to they're going to do the saliva testing for people. So testing is increasing. Now, how that's going to play out in the general public is a little bit harder to say. We do test for very specific reasons and medicine based on pretest probability and how much we think you have a disease. You know, a lot of these are being used differently now for asymptomatic patients or for return to work purposes, which has some other consequences and downstream effects on test utilization. So I think that's pretty much a summary where we're at right now saying. 

BARNHILL: OK, and thank you for that. And Dr. Johnson, what about at St. Luke's. Talk to me about prioritization of who gets, the test turnaround time for results? Is it similar to what Dr. Southard said?

DR. FRANK JOHNSON: Yeah, thanks for asking that. We're about the same as where they're at at St. Al's. Most places are. Right now, we characterize test as really two categories. One would be what I would call reactive testing, which is someone presents they're sick. You wonder why they're sick. You do a test, and you do a COVID test to see if it could be COVID that's causing them to be sick. And then there's proactive testing, testing someone before either getting a medical procedure, maybe going into school, going off to college or for work related issues. They're not having symptoms, but they want some proactive testing to be used by our health departments or by their employer, by their school, to do some epidemiologic work and take steps to reduce the spread of infection. Currently within St. Luke's, we've got plenty of capacity for those reactive tests. When someone is sick and we get a great turnaround, we still are sending out some of those tests, about 500 tests a month, go to outside labs that we partnered with that give us a good turn around. By the end of this month, we'll have all of our testing in-house and we'll have 24 hour turnaround on all of those reactive tests. Our capacity for proactive testing will also be increasing by the end of the month. We still won't be at the point where we have enough testing capacity either within St. Luke's, nor do I think within the state for broader proactive testing for epidemiological purposes. Still got about a twenty four hour turnaround is what we're seeing now with some rapid testing that allows for really a 15, 30 minute turnaround in cases that really warrant that.

BARNHILL: Ok, and what's the accuracy of those rapid tests? We heard earlier in the summer and late spring, I suppose, about concerns about some of those rapid test kits? What's the status on that?

JOHNSON: Yeah, at least the platforms that we're using here at St. Luke's have we've got more experience now than we did earlier in the summer. We've got some more understanding and knowledge of that. And I'd say we can believe the results of those tests. Now, we're confident in that. We've been following up with our laboratory directors and with our infectious disease doctors, and they're finding that the accuracy is running right around 99% accurate on even the rapid tests, which is fantastic.

BARNHILL: Right. Dr. Southard, you talked about and Dr. Johnson spoke about this for a second as well, about asymptomatic patients. And so right now, asymptomatic patients, it's difficult to get a test. But if someone, you know, has been in contact with someone who has coronavirus, but they are not exhibiting symptoms themselves, then they're not able to get a test. What should they do? A reminder for folks about how to handle that situation right now?

SOUTHARD: Sure, well, if you don't have any symptoms, you need a test for work or to go on to travel, I think there are a couple of options. I think Albertson's has that, and I believe Crush the Curve will still test people based on just wanting to get a test. The question of how to use that information for the individual is a little bit more interesting from a medical standpoint. If you are truly asymptomatic, the only thing that that result is going to tell you is did you have a virus that was shedding at the time we did the test. And it doesn't mean that you're not going to get sick or that you were exposed. And so I, I just caution people to use that wisely. There are some good reasons to do it epidemiologically, but on an individual basis, I think sometimes we can get lulled into a false sense of security with a negative test. You really have to consider what that means in your given situation. And for example, we know if you had like a really high exposure and you get sick the medium ontime is about seven days. So if you go out and get tested on day two or three or one and it's negative, that just means you don't have it then, it doesn't mean you're not going to develop it. And so you just have to be careful how you're interpreting that data. And that's my only, I guess, word of caution to people who are potentially getting these tests on their own without involvement of a clinician is really understanding how to use that in their given situation versus an epidemiological situation.

BARNHILL: Sure. And Dr. Pate, has there been conversation recently with the Coronavirus Taskforce when it comes to asymptomatic testing in Idaho? Is there a desire to be able to give asymptomatic tests to more people, or is that not the focus?

PATE: Yes, for right now, the focus is just expanding our testing capability and capacity because certainly we're at no point where we could even entertain testing everybody that's asymptomatic. In fact, Dr. Berk's just came out with a recommendation about the testing that she recommended for colleges and universities across the country. And I mean, that would be a tremendous increase in testing over the capacity that we have right now and is really unrealistic. So, you know, the initial focus is let's increase the testing capacity, particularly for those higher tier risk groups. And so that work is underway and the state is working at seven different places of the state to implement high throughput testing where you could do hundreds, if not a thousand tests on a machine in a day and get rapid tests. Where we would like to go in the future, but we're not anywhere close yet, is really to get to that situation where we have truly rapid tests. And what I'm talking about rapid tests is like a home pregnancy test or a strep test that you would get in the doctor's office where you can get that test result in 10 or 15 minutes. That doesn't have to be done in a high complexity lab and is very inexpensive. If we could get to that kind of a testing situation, it would allow us to test people frequently and often and get and get this really under control. But we're not anywhere close to that yet.

BARNHILL: OK, we have a question from Julie and Dr. Pate, I'd love if you could take this one. She says, I'm a teacher in the Treasure Valley and my boss is saying that we will be fine in the halls with the students as long as we wear masks, since we are not standing next to them longer than 15 minutes. Is that correct?

PATE: Well, first of all, the 15 minute guideline is a guideline we use to try to figure out who are we going to do contact tracing of, it does not mean that you can't possibly get infected from someone in less than 15 minutes. We don't know how long it takes, but one has to imagine that if you and I were in close proximity and I was infected and I was coughing in your face, it would only take minutes for you to get infected. So I don't think we should hang on that 15 minutes -- that we have to put the line somewhere to identify when we're going to do contact tracing. But that's not meant to suggest you cannot get infected unless you're around someone for 15 minutes. The other thing is when you talk about schools and I just went to a school this morning to do a walk through through the school with the principal and teachers and talk to them about things. The risks are many fold. It's not just the hallways. And so they have to think about everything, the children coming in the door, the children congregating outside the school, whether the children are wearing masks -- there are some schools that still don't understand that if children are not wearing masks, that they're in for a recipe for disaster. I think that's what Payette Schools just learned. And now they're implementing a mask mandate. So, you know, there's many, many things they need to take into consideration.

BARNHILL: Right? It's not just one factor. It's many, many, many. Dr. Southard, this question from John. I'd love if you could take it. He says, we have adult children that live in other states -- it doesn't mention which states -- they would like to come home to Idaho for a week or so. My wife and I are over 65 and high risk. Can they get a COVID test here before we interact with them so that we all know if they are carriers or asymptomatic? And we've already talked a little bit about testing, but could you address that particular question? And maybe if you know what other suggestion you would have for John if they can't get tests?

SOUTHARD: Sure, I think that's a pretty common issue a lot of people are facing right now. I mean, personally, we're facing that with our parents as well. And, you know, the best thing I guess I could say is if you can get a quick test before you come, you'll probably get a little bit more accurate information -- I guess not accurate, but you'll get it. You'll get a better time response just if you come here, it's going to take a while to get it and get the results back. And so if you can get it before you leave, that might be helpful. The other thing to consider is what you do before you come. And so if his adult children can isolate fairly well and for 7-10 days, whatever the case may be that they can do seven days is a pretty good amount of time. If they're still asymptomatic and they come at that point, if they have a COVID test or not, that shows that they're negative, that's a pretty good indicator that they're not currently infectious. It's not perfect, but pretty low risk. And assuming they're doing the other things like hand washing and wearing face coverings, et cetera, while they travel, I think that's a way to approach it in a risk mitigation strategy that I would feel comfortable with. So, you know, doing that is probably the best thing you can do.

BARNHILL: Yeah. And risk mitigation, those are the two words that are really key with a lot of this, I guess. Dr. Johnson, I'd love if you could take this on kind of that it's connected to John's question. Labor Day weekend is upon us. And we know that after Memorial Day and then after the Fourth of July, we did see spikes come a couple of weeks after following that. What do you think? You know, have we learned our lesson about gathering around holidays? What do you think folks should think about before participating in gatherings this weekend?

JOHNSON: Well, I would hope that we've learned our lesson, I know that we have in many places. As reflected by some of the decreases that we're seeing in our COVID incidents. But as you point out, these holidays, like Labor Day, we tend to see spikes in cases two or three weeks after that because of the increased gathering. I hope that people will remember and will work hard to take care of their neighbors and look out for one another by wearing masks. That is the best thing that we can do. And it really works. It's such a simple step we can take to help care for and look out for our neighbors just by taking that simple step of putting a mask on. So hopefully we've learned that lesson and we'll be doing that to a greater extent. Keeping some distance, being thoughtful about how many individuals you're going to be gathering with over a Labor Day will be important, being thoughtful about the activities that those you're gathering with have partaken within the in the preceding 10 to 14 days. If you've got someone who's been on a couple of trips to different places in the country, that might be worth taking some extra precautions with that person, keeping them a little bit more separate, making sure that they're not in close proximity with a bunch of other people, if someone is having symptoms, being thoughtful about that and really asking people to monitor their own symptoms and not come, not partake in a gathering if they're feeling sick in order to help avoid spread. Situations that have tended to increase the risk of spread or close gatherings, often with alcohol involved or inhibitions dropped. And we tend to forget some things that we should be doing in the setting of alcohol. So being cautious and thoughtful around those situations where there's going to be that risk, I hope we've learned our lesson and I hope we won't see that spike. I think we've made some progress in the last couple of months. But we'll keep our fingers crossed.

BARNHILL: Right. And Dr. Johnson, if you could take this as well. We've had several questions about schools reopening. And we heard from Julie in the Treasure Valley, a teacher here. Let's go to eastern Idaho where there's some folks, including Carl, who asked 'my sister in law teachers in eastern Idaho in a school where masks are not required, no other teachers and most students don't wear them. Most people are treating school like normal. My sister in law cares for elderly parents. Any suggestions to keep them all safe?'

JOHNSON: That's a tough one. In areas where there is a large gathering of people where people are not wearing masks, where there's not that social distancing, there will be spread. There will be people in those groups who do get COVID. And and that is going to happen. I can't specifically speak to the risk of that individual and her circumstances, but she can mitigate those risks, as we've talked about here, by wearing a mask herself, being really thoughtful around her own handwashing, being really thoughtful around the distance and separation that she is keeping from from her students and colleagues, really requiring the maintenance people and the people at her school to keep a clean environment as much as possible. And then when she is at home and caring for her, her elderly parents trying to keep your keep your mask on, have your parents keep their masks on, be vigilant about hand washing. There may be some value for identifying separate areas of the house where the parents are and where individuals who are out in the community are staying for the most part and limit the interactions to specific places within the house, if that's possible. That's just not always possible. But it is a real risk. And I know that we have seen in the west end of the Treasure Valley outbreaks in families where there has been multigenerational families living in the same home, which we've seen, that that's one of the reasons we've seen higher numbers in the west end of the valley.

BARNHILL: Right. Dr. Southard. You had mentioned earlier about the Albertson's tests that are now available. Someone asked how accurate is the saliva test that Albertsons is now offering? Can you comment on that?

SOUTHARD: Yeah, so they're reporting about a 99 percent sensitivity and specificity. I don't think it's probably going to be that high. They're authorized under the emergency use acts for the FDA. And most times that's kind of starting to get the test back. We start to see that it's probably not quite that good is my suspicion, but it's pretty good at that level. So we'll see. I think the interview I saw with the Dr. Cole from the lab, he was thinking might be more than 90 percent. And I do think one of the issues where we will see is the collection. That's can be a big deal. You got to realize that when you collect a test, if you're doing it from a home kit, it's just a little different than if you're having the nurse or medical professional do it now. Obviously, it can be done and has been done other things. I think that this is the the way of the future. But we will know more about this test, I guess, as the months go on and the numbers come back. But it looks, at least at this point, to be a decent test. So.

BARNHILL: Right. And on the testing questions, again, one more. This one is from someone who wants to remain anonymous. How and where do you get a free test in Boise and the Magic Valley if you have no insurance. And this person says they're asymptomatic. You just want one because you may have been exposed to someone who does have COVID. I've heard anecdotally that Rite Aid and Cole Diagnostics do free tests. I've heard directly from Crush the Curve clinic at Saltzer in Nampa of a no charge test. But one has to have health insurance and then can be billed that health insurance. So again, someone doesn't have insurance and is asymptomatic. Where can they get a free test? Is that is that possible?

JOHNSON: Frank Johnson speaking, I'm not aware of of any locations where that can be done, I would say that within St. Luke's, someone even with insurance who would come to their clinic or their doctor and say, I'm asymptomatic. I'd like to be tested. Currently, we're not offering testing for that indication. They would have to have symptoms, be sick or have an upcoming medical procedure to warrant testing. So with or without insurance at St. Luke's, that individual really wouldn't be able to get a test.

SOUTHARD: And Frankie, this is Dr. Southard, I agree with Dr. Johnson, I'm not aware of that situation. And again, in response to your question, I think it brings up the point that if you're asymptomatic and you just want to know if you've been exposed to to COVID, that is probably not going to work in that situation anyway. So it may not be worth spending your money on that individual test.

BARNHILL: Ok, what would you suggest for this person? They can't get a test, but what should they do if they're concerned that they might have been exposed as far as isolating all of those different advice pieces? What would be good?

SOUTHARD: Sure, yeah. It goes back to the same sort of risk mitigation if they are in close contact with family members trying to decrease that. Basically what we would consider a person under investigation or waiting to see if they develop symptoms. Seven to 10 days out, you should have developed symptoms that are going to develop them. So if they're not having them there in that time -- and just using the good hand hygiene, mask, even at home, if you feel like you've been significantly exposed, would be an appropriate step that would be pretty high yield to not spread the infection, even if you had it.

BARNHILL: Ok, and Dr. Pate, I have a question about data and how it's how it's collected and how it's thought through on the state level when it comes to things like how many ICU patients or even the case numbers and which county they're attributed to yesterday. Last night, Ada County Commissioner Diana Lachiando at a Central District Health Board meeting, Raise this question about, you know, if folks who don't live in Ada County but are being treated in Ada County and, you know, perhaps are being hospitalized and perhaps even die in Ada County, those numbers are attributed to Ada County, even if that person is not a resident. Is that right?

PATE: That's not my understanding. The cases are attributed to where the person lives and, you know, in Frankie, understand there's challenges doing this either way, you know, so, for example, if you look in Idaho, if you live in Idaho and you get severely ill, you can't be treated in all parts of the state. So you may very well have to travel to Ada County or another one of the big counties to be treated. And so you don't necessarily want all those cases attributed to Ada County because it makes it look like the disease spread in Ada County is worse than it is. And so typically we would count a case based on what's the county of residence. Now, on the flip side, it makes it a little challenging for us. For example, college students. There, when you attribute their infections to their home state, then they don't get counted in Idaho numbers, even though they may be living here for, you know, nine months of the year or something like that. And in fact, that does represent a burden on our current systems and -- 

BARNHILL: I think we might have lost Dr. Pate, we'll try to get him reconnected here in just a minute. But while we're doing that, let's see. Dr. Johnson, I wonder if you could address this question from Jen, this news out of Florida this week that they severed ties with Quest Diagnostics due to a backlog of COVID-19 tests, and those tests went unreported for months. Is there any evidence or any indication that that occurred in Idaho as well? Do you know that? Or Dr. Southard?

JOHNSON: I can speak to that, at least with our St. Luke's experience, we did have a relationship with Quest Diagnostics that they were using some of our or, performing some of our tests that we didn't have the internal capacity to perform earlier this summer. They were doing that. We were seeing some delays. We did have 12 to 14 day delay. That was fairly common with Quest earlier this summer. We have severed our ties with Quest. We're not using them for send out labs anymore. And so there is no further backlog with St. Luke's of pending tests.

BARNHILL: Ok, and Dr. Southard, is that the same with St. Al's?

SOUTHARD: That is. Yeah, exactly the same situation.

BARNHILL: Ok. And one more question from Jen. Maybe Dr. Southard, if you want to take this one. Are there indicators such as decreased hospitalizations that would coincide with the decrease in cases that have been reported in the last couple of weeks?

SOUTHARD: Yeah, this is actually a fun question for me to answer from the emergency standpoint, because, you know, about a month ago we were seeing a ton of patients through emergency departments and it really had picked up. And then we noticed about about two weeks later, the hospitalizations had increased, which we would anticipate because we're noticing a lot of people get diagnosed. And then of that group, a subgroup gets sicker by the week in and then they make it to the hospital and then eventually ICU. So we saw that trend kind of waterfall effect. We saw a bunch. They started becoming more and more in the inpatient units, more and more in the ICU. And that happened up until, I would say about last week at St. Al's. We had quite a few in the ICU. It was a pretty significant disease factor for our hospital system. And over the last probably seven days, we've noticed that the ICU is now kind of clearing out again and we still have a fair number of inpatients requiring treatment. But actually, anecdotally, in the emergency department in the last week to two weeks, we've stopped seeing as many COVID illness related visits. And a lot of them are actually to people who have been tested positive and have been known to be positive rather than coming in for the first time for their symptoms. So, you know, data kind of follows a little bit behind what we're actually seeing on the front line. But anecdotally, it does seem to match at this point from my experience.

BARNHILL: Ok, and I believe we have Dr. Pate back with us. I just wanted to let you finish your thought, Dr. Pate. We were talking about specifically around Ada County numbers and numbers in other counties as well. But Ada County, where potentially college students who don't reside in Idaho year round but are here nine months out of the year, where if their cases were to be attributed, how would that be counted, I guess? Did you have any other thoughts on the question of attribution and specifically ICU patients that comes with reporting and how that contributes to decision making for officials?

PATE: Yeah, sorry about that, Frankie, and if anybody out there knows of a great Internet service that won't disconnect me, please let me know offline.

So the issue is what we really want to do is try to understand the disease activity of a community. And given that ICU patients can only be treated in significant amounts in very few places around our state, you wouldn't want to count all of those cases for that particular community because it would give you a false sense and it would under represent the cases from other counties. So typically we count cases based on the county of residence, and that's how that works out pretty well, as opposed to where they're treated. The problem, the flip side, where it becomes a little bit of an issue is college students, because as you said, even though they might be living here in Idaho for seven, eight, nine months out of the year, they're case is typically going to [inaudible] if it's not Idaho rather than Idaho. So especially when we're seeing significant outbreaks in colleges and universities across the country. If we were to have one here, it could certainly under-represent the stress on our local health care system where they would end up. So that is the downside. To give us a better idea of what's happening there, so we don't miss that based on reporting those students to their home states rather than Idaho, I think that the state is working on preparing a separate report that would count all the students regardless of where they lived, if they were sick here in Idaho.

BARNHILL: Ok, thank you for clarifying that. Dr. Southard, I wonder if you could take this one. This came in from Twitter. Can you explain how COVID can cause other health problems that ultimately lead to death? And then part two of that question is explain how this would be a death related to COVID, in essence.

SOUTHARD: So I think most people think of it as a respiratory disease, which it is for for most people. However, it also is an inflammatory disease process where the blood vessels and your blood clotting can all be off. And so a lot of times what people actually do die from is related to the heart and cardiomyopathy. And so it's an inflammatory state that can affect your heart and its output. And we've seen that pretty dramatically, especially in the ICU patients, something called your ejection fraction can go way down, [inaudible] to pump blood. And so while the coronavirus may not be actually attacking the heart, the inflammatory condition is. Additionally, it creates a thermogenic state, which means your blood is more tendency to clot. And so that's why we're seeing more stroke related illnesses with this. And the thought process is something about the viral particles is making your your body want to clot more and then you get blood clots in the vessel that's small and you can have a stroke. And so those are just some examples of some of the body systems that it's affecting and how it can lead to death and how it could be related to the coronavirus, although the virus itself isn't exactly attacking that area of the body.

BARNHILL: Ok, thank you for clarifying that. And Dr. Johnson, this question from Laura on Twitter. I wonder if you could reflect on this. She says, I work in a hospital and find the messaging and protocols to be very clear, despite the obvious political climate. Why is it so hard for this messaging to be clear on the community level?

JOHNSON: Well, first, thanks for the work you're doing in the hospital, Laura. That's fantastic. We've got some great people and all across the state who are taking care of sick people at this real crisis. So thank you for that. And I'm grateful that the messaging at your facility, your hospital has been so clear.

Why is it hard to get that same messaging out to our community? I wish I could answer that, because then we could perhaps help address that. I'll share my own personal messaging around wearing masks and the importance of that. And it really comes down to that's who we are as Idahoans. We look out for our neighbor. We care for our neighbors, regardless of your political stripe or your opinions, I believe that we are unified in our desire to look out for our neighbors. Wearing a mask is the way that we demonstrate that during a pandemic like the COVID pandemic, wearing a mask does reflect our desire to help our neighbors and look out for our neighbors. So for those who are taking that step and are wearing masks, I want to say thank you for that. Thanks for looking out for your neighbors and demonstrating your Idaho values. For those who are skeptical about wearing a mask, I would ask that you please consider wearing a mask anyway, because even if you don't believe it helps you, it does help your neighbors. And really, that's who we are. I think we're all united in a desire to get kids back in school safely, to get people back to work safely, to help make sure our vulnerable neighbors are safe and healthy. And we should be united around wearing masks because that's how we demonstrate those values. That's as good as I can share that message in a way that hopefully is clear and concise. I hope that we'll continue to come around that message in the coming weeks and months.

BARNHILL: Ok, and I want to do a quick follow up to that question we had a while ago from an anonymous listener who was wondering about how they could get a test if they're asymptomatic and don't have insurance and can't afford to pay for it. Someone wrote in on Twitter saying that a Rite Aid test is available for some folks, apparently you need to be 18, have a Gmail account. They never ask for insurance, only your I.D. It was self-administered in a nasal test in the drive thru and that there are four locations doing it, including in McCall. So I have not verified that myself. But someone on Twitter is listening and wrote that in. So might want to check into that.

Dr. Pate, we have this question from Judy and Frank, another great question about reporting and data. Why can't we get new COVID cases by zip code or city so we can more accurately gauge community spread?

PATE: It's a great question. Unfortunately, I'm not sure the premise is correct. I don't think that would help you more accurately assess community spread, because from the standpoint of this virus, if you look at too small of a geographic area, like a town, a city, a zip code, you're not going to get the true reflection, especially here in Idaho. It's not unusual for us to work and live in different zip codes or different counties even. And from the standpoint of how this virus behaves, it doesn't respect zip codes and town city limits. So it really doesn't make sense to look at this at too small of an area. That's exactly the mistake that one of the school districts did, is they tried even though their county was in red, they looked at their zip code and it was yellow. So they justified opening and unfortunately, they had many outbreaks. So I think it actually would be more misleading than helpful.

BARNHILL: Ok, thanks for that clarity. And we just have a couple of minutes left. And Dr. Pate, I'd like to ask you to wrap us up with this question. I know you wrote a blog post about this recently, this question from Twitter. What do we know about long term effects of COVID and what studies are being done about this? What do we know about that in the next minute or so that we have Dr. Pate.

PATE: Ok, I'll try to be quick. First of all, we don't know a lot, we are only starting to get the information. What we do know is that it seems to affect a lot more people than we ever imagined and for a lot longer than we imagined. We have people reporting pretty significant disability at even six months now. And so we don't know who gets these long term effects or why. We have some guesses. But it is quite clear that, first of all, this is affecting younger people. Of the limited studies that have been done. We're seeing the average age be in the upper 30s or low 40s, and it does seem to have a predominance in women. Some of this resembles something that we've seen in other conditions called chronic fatigue syndrome. But there's many, many manifestations and we have only yet begun to understand.

BARNHILL: Ok, thanks, Dr. Pate. I'll link to that post that blog post you wrote in our website. So we've been speaking with Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Dr. Andrew Southard, St. Alphonsus emergency medical director, and Dr. Frank Johnson with St. Luke's. He's the vice president of medical affairs there. Thanks to all of you for spending time with us. We really appreciate it.

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