Coronavirus Cases Rise In What Is Called "Idaho's Third Spike"

Sep 30, 2020

Cases of coronavirus are once again on the rise in Idaho. According to Dr. David Pate, during today's panel of Idaho doctors, we are in "Idaho's third spike," following phases of rising infections in March-April and again in July-August.

Fall brings with it a "confluence of epidiemological fatcors," according to Pate, including in-person schooling, more time spent indoors and cold and flu season. The doctors also were alarmed by reports of large gatherings of people not following the guidance to wear masks and practice physical distancing.

In this episode, Idaho Matters presented our panel of medical experts to answer listener's coronavirus questions. The team addressed questions about the length of quarantine, exercise after contracting COVID and the timetable of vaccine readiness. Listeners also asked about Thanksgiving travel, the prospects of global immunity and the number of ICU beds in Idaho.

To ask the doctors a question for a future show, tweet or email 

On today's panel:

  • Dr. David Pate, former CEO of St. Luke's Health System and a current member of Idaho's coronavirus task force.
  • Dr. Frank Johnson, St. Luke's Vice President of Medical Affairs.
  • Dr. Daniel Bridger, Urgent Care Medical Director at Saint Alphonsus Medical Group at the Lake Hazel clinic.


Read the full transcript here: 

GEMMA GAUDETTE: This is Idaho Matters, I'm Gemma Gaudette. As we head into the seventh month, yes, seventh month of this pandemic, here at Idaho Matters, we want to make sure that we're giving you facts and answers from medical experts. So today, our panel of doctors is joining us to update us on where we are with COVID-19 here in Idaho, but to also answer any of your questions. So if you are a regular listener, you know the drill. Get us that email right now. And we will do our best to get that question on the air in the next hour for our medical experts to answer it for you.

Joining us today, Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of the Idaho Coronavirus Task Force; Dr. Frank Johnson, St. Luke's vice president of medical affairs, and Dr. Daniel Bridger, urgent care medical director at St. Alphonsus Medical Group. Hi, everyone.

ALL: Hey, Gemma, hello. Hi, good afternoon.

GAUDETTE: Hey, Dr. Pate, let's just start like we normally do, and where we are this week with Coronavirus here in Idaho.

DR. DAVID PATE: Well, we're not in a good place. We are seeing what appears to me to maybe be Idaho's third spike. You'll remember our first one was in March, April. We had our second one in July, August. We were coming down from that second spike. And I think a lot of people perhaps celebrating a little prematurely, because even at the point that we had come down to, it was still at almost twice the level of where we were in March, April. And then things started going in the wrong direction. And they have now for over a week. So I do fear-- I have been predicting a third spike and I suspect we're in it.

GAUDETTE: And Dr. Pate, like you mentioned, I mean, it's, you know, a lot of this can go back to the Labor Day weekend. But I'm curious, is there any way to see how the reopening of not just schools, but even sports have potentially played into that? Or is there just no data to figure that out?

PATE: Well, there's variable data, some things we have good data for, some things we don't have good data for. But if you just look at this from an epidemiological standpoint, if you just think about how viruses spread, then what you look at is that we have a confluence of bad epidemiological factors. And those are, as you said, we had the Labor Day holiday. Then every week we've got a new school opening with in-person education. And, hey, I want kids back in school. But what we see is there is wide variation in the quality of the schools' operational plans. And we're seeing some schools that are doing pretty darn good and we're seeing some schools that are having big problems. Then we have kids, I call them kids or young adults, but back on college and university campuses. And we are certainly having a lot of cases among those college students. And interestingly, despite the colleges and universities putting in plans to the best of their ability, we're seeing a lot of off campus exposure of those students.

Then you have on top of that that we are continuing to have people not comply with the guidance. We're continuing to have people get into larger than they should gatherings. And we're particularly noticing a lot of spread among extended families and among kind of neighborhood or little social gatherings. And then, you know, we've seen people having some alarmingly large weddings and not realizing the threat there. And then we're going to have colder weather, which is going to bring us more indoors. And then we're getting ready next month, which I guess is tomorrow, we're going to have the next month and certainly into November cold and flu season. And that's upon us. And so we just have all of these things happening together that just don't give this a good prognosis for this fall and probably the good part of the winter.

GAUDETTE: And Dr. Bridger, you work at St. Alphonsus at Lake Hazel Clinic. This is an urgent care clinic. What are you seeing? How is it affecting your clinic?

DR. DANIEL BRIDGER: Yeah, so I'm actually the medical director for all of the St. Alphonsus urgent cares, and that includes currently our drive up testing sites, an hour drive up COVID evaluation site. And we have noticed an increase, especially over the past few weeks in our volumes at not only our urgent care, but as well as our drive up COVID evaluation and testing sites, our numbers for patients being evaluated for COVID and at our respiratory evaluation sites are starting to look like they did in the early summer. So, yeah, we're certainly starting to see some increased numbers and patients that are seeking care for COVID like symptoms. We had a little bit of a lull in the late summer here. But yes, it has been increasing steadily over the past few weeks.

GAUDETTE: And Dr. Johnson, are you seeing similar things happening at St. Luke's?

DR. FRANK JOHNSON: I absolutely I'd agree with both Dr. Bridger and with Dr. Pate. Thankfully, the number of hospitalized patients hasn't taken a dramatic spike. So at least there's some good news to be found within some of those alarming figures. As of as of last night, as of early this morning, 33 patients hospitalized throughout the St. Luke's health system. So if anything, we may be seeing less severe disease as we've learned more about COVID, as we learn more about how to effectively treat it, as we've gotten better with our contact tracing and better with our strategies for reducing additional exposure to more vulnerable populations. So we are seeing that increase, but it's mostly been in outpatients, says Dr. Bridger had noted.

GAUDETTE: And we mentioned this last week, and Dr. Pate, you just mentioned this about going into flu season. So we know that St. Alphonsus and the VA, you're going to be opening up drive up flu clinics. Maybe you've already done that, Dr. Bridger. In some places, St. Luke's will not be doing that. You can still get a flu shot, but not the drive up. Dr. Bridger, I want to start with you. The importance of getting that flu vaccine and why do the drive-up as an option?

BRIDGER: Sure, yeah, I mean, I'll start with the importance of the flu vaccine. I think anything that we can do to decrease the prevalence of the flu in the community this fall and winter is very, very important as we try to go through this winter with the, you know, the full gamut of different respiratory viruses that are out there that we deal with on a normal flu season through the winter. So I think the importance of decreasing the flu prevalence, anything that we can do to do that is as important as ever this year.

St. Alphonsus is offering drive up flu clinics. We've had kind of a concerted effort to do as much as we can in outdoor spaces. We've been doing outdoor testing and outdoor evaluation for COVID and outdoor respiratory evaluations. And we've kind of carried that through this year with our drive up flu shots and just trying to do what we can to if there's anything that we can do to help protect patients and our staff, that's just kind of part of our approach this fall.

GAUDETTE: And before we take a quick break, Dr. Pate, we know, as you mentioned, you know, schools and we're seeing, you know, because it's a mishmash approach, right? District by district, sometimes school by school as to what they're doing. And we know that I believe it was last Friday that Emmitt High School closed to do a deep cleaning because there were students and I believe some staff that tested positive for COVID. And now just earlier this week, the Emmitt school district actually requested additional coronavirus testing because because of this being such an issue.

And I'm curious, is this something that all school districts should potentially be doing is testing for for students and staff?

PATE: Yeah, well, that's a good question, you know, first of all, I don't think we can test our way out of this problem. I think it gets back to there are some important parts of your operating plan to minimize the spread of the virus. And I think what schools would be better advised to do is to talk among themselves and share those schools that seem to be keeping this down to just isolated cases and containing it very effectively versus those schools that are having outbreaks. And let's look at the difference in their plans.

Of course, a big one, and I just really can't believe, as you mentioned in the opening here we are eight months into this and we've got schools that are not requiring everybody to wear masks in the school. Well, it doesn't take a genius to predict that you're going to have outbreaks if you do that.

And we're seeing a lot of other errors being made, for example, that kids could have mask breaks in their classes, that teachers could use face shields just as a substitute to the face mask.

I mean, we're just seeing a lot of stuff that if they would just work with medical professionals or public health experts and let us help them with their plans, we could straighten out a lot of weaknesses in their plans. Then, yes, then we need testing. But let's do the simple things first.

GAUDETTE: So, Dr. Pate, here's also what I have been wondering about is that knock on wood, my children's school, we are four weeks in to five days a week in a hybrid model and there has not been one case. With that being said, in full disclosure, my children go to a small private school. They are able to maintain social distancing. They have done a phenomenal job with the new requirements of the teachers and of the students. And when we look at a district like, let's say, West Ada, the largest in the state, they are bursting at the seams. And there is not necessarily the funding, it can be argued, that they can do what a small private school can do.

So this goes back to it being a discrepancy to the 'haves' and the 'have nots.' Right. If you can afford it, then you can keep your kids safe. And that is just not the way it should be.

PATE: No, and you have a valid point, however, I want to tell you, the things that we are seeing right now are not money issues. There are things that the schools could do. And West Ada is a prime example of some things they could do, wouldn't cost any money. But for some reason, they are not availing themselves of best practices. They are not availing them -- to the best I can tell -- of any expert advice outside of the public health districts. And there's only so much the public health districts can do. I'm talking about they need to engage a physician or public health expert to come look at their plan, do a walk through their schools and help them institute practices that by and large, don't cost a penny that would keep these schools safer, keeps kids in school. But I think this is a real failure here of leadership and governance because they're not seeking out these kinds of things that they could do. Yes, there are other things that if we had more funding, of course, we could put even more protections in place. But if you're not doing the basics, throwing more money at this is not going to fix it. And just kudos to your school, your children's school. Obviously, they have a very good operating plan that is probably more of the key to the success than any money they're investing.

GAUDETTE: You don't see one kid or teacher without a mask on ever at that school.

Dr. Bridger, we got a question in from Ruth. And it's a simple question, but not:

LISTENER QUESTION: What happens if this never goes away?

BRIDGER: You're exactly right. It's that simple question, but it's not. And I don't know that that myself or anybody really has the answer to that question. I'd be interested to hear what Dr. Johnson or Dr. Pate think. But, yeah, truly, there is so much about this virus that is still unknown and what what the future will hold, what vaccines look like, what immunity looks like is is really not clear quite yet. Yeah, I wish I had a better answer for that. I think that things will get better and, you know, therapeutics will improve. Hopefully we get a reliable vaccination that'll help. So I think there's certainly reason to be hopeful. But there are some questions that are still unknown.

GAUDETTE: Mm hmm. Dr. Johnson, do you have anything to add to that?

JOHNSON: My response would be we are going to get on top of this. We're going to get this figured out. We're going to have a solution for this virus. I don't know what that solution is going to look like today, but I've got full confidence that we're going to get on top of it, if it's a vaccine, medication, treatment or whatever we identify. And I trained back in the early 90s during the height of our AIDS epidemic. It was crazy. Our hospitals at that time were 50%, the ones I trained in 50% filled with patients with complications of HIV and AIDS. We thought this was going to be something that would be devastating for decades and within a matter of years, with investment in research, with investment in learning education, we got on top of that. And right now we just don't see the complications of HIV and AIDS anymore. It's been not cured, but solved. So we're going to get on top of this. And it might mean that we have some different structures or strategies in place to help with our public health measures. But we're going to be OK when we get this sorted out.

BRIDGER: And I would agree completely with Dr. Johnson on that, I have confidence that we will get on top of this as well.

GAUDETTE: And Dr. Pate, do you have anything to add to that?

PATE: Yeah, just just so we set expectations right. I don't think there's many experts that believe the coronavirus will go away. Now, with that said, before everybody freaks out, just like Dr. Bridger and Dr. Johnson said, but it'll be very different. In other words, we're going to likely have a good vaccine. We're likely going to develop more therapeutics and it will get to the point that if we do have an effective vaccine and we do get good participation from the public in taking the vaccine, that this will change from being a threat that we're all dealing with every day to being just an occasional nuisance and probably on a far, far less scale than it is now. But I don't think there's too many people that seriously believe that this virus will completely go away, kind of like how we eradicated polio and some of those kinds of things.

GAUDETTE: Dr. Johnson, this question comes from a listener who would like to remain anonymous. But here's the question. And they said:

LISTENER QUESTION: I've heard it's best to hold off on getting the flu shot if you've previously tested positive for COVID. The reason is that there isn't enough data to suggest whether the flu vaccine will exacerbate any dormant COVID viral load in the body. Is there any merit to this? And are we seeing any complications related to this in the medical field?

JOHNSON: Yeah, I'd say we really haven't seen any complications from that at this point. And I would say get your flu shot, if you've had COVID, get your flu shot, if you haven't had COVID, get your flu shot. There may be some value in waiting for 10 days after you've had COVID to get your shot. Mostly that's because you don't want to come in to a doctor's office or to a clinic and get your flu shot when you still might be infectious from COVID. You don't want to spread that to other people. But there really isn't any evidence to suggest that getting a flu shot after you've recovered from COVID is going to make any complications or difficulties for you.

GAUDETTE: And Dr. Penelope asked this question. She said,

LISTENER QUESTION: My friend is living with a person diagnosed with COVID-19, had all the same symptoms. They have quarantined at home since September 20th. How do you know when you are no longer contagious and when is it OK to be around others -- Masked and social distance, of course -- And if you were very physically fit before COVID can, you were approaching exercise such as mountain biking or other usual forms of recreational exercise. How should you approach that?

PATE: So since the person with the question said that the person infected was symptomatic, then basically what we would do is ask them to quarantine for at least 10 days, but longer if necessary. And how you know when it's safe to end the quarantine is when it's been at least 10 days and they've gone at least a full day with no fever, without having to take any Tylenol or anything else to suppress that fever. Now, before anybody gets confused. We have 10 days for the quarantine for people that are symptomatic because we can kind of tell when they got infected. For people that have been exposed, we quarantine for 14 days. So don't let that confuse you. Then the questioner also made a good point. Even once you finish the quarantine, you need to follow all the same recommendations, avoid large gatherings, physically distance, wash your hands, wear a mask when you can't physically distance. So I was pleased to hear the questioner say that. As for exercise, we want to take it a little easy. We want to give the body time to heal. And so what I would say is start off slow. If the person has chest pains, shortness of breath with their exercise, palpitations, or it feels like their heart is skipping beat, then you want to back off and you probably should let your physician know because COVID can cause an inflammation of the heart muscle. So we don't want to push it very fast. But if they're asymptomatic, if they're truly feeling fine, then a very gradual increase in their exercise. But if they're having any of those symptoms cut way back on the exercise, get in touch with your doctor.

GAUDETTE: Dr. Johnson, Robin has this question. She says,

LISTENER QUESTION: Can you tell us how many beds each hospital has, how many ICU beds and how many patients are in those beds?

GAUDETTE: Now, I am assuming you would only potentially know this for the hospital that you work for. 

JOHNSON: There are some good resources out there that have been made available for transparency purposes. St. Luke's has some online resources to identify a number of patients and total number of beds and the number of patients with COVID and total number of patients who are admitted in our system. I think that's helpful information. It doesn't specifically call out how many of those are in an ICU or how many are on a ventilator, but that's useful.

The state of Idaho has a public resource on the web as well that identifies the total statewide number of ventilators available and ICU beds available. That's useful for individuals who are interested in that. So there is some public information out there.

It's not possible today for the public to really drill down and get more specifics about that. We do have on a daily basis updates within St. Luke's, I'm sure Dr. Bridger does within St. Al's as well, on our capacity to care for patients, including things like ventilators, ICU beds, staffing and other factors that impact our ability to care for patients. But much of that is at this point, not publicly available.

GAUDETTE: Dr. Bridger, we got another email in and the emailer wants to know:

LISTENER QUESTION: How long does the virus live on hard or other surfaces?

GAUDETTE: And I think that's an interesting question, because in the very beginning of this, it was like we were all scrubbing everything down. Right. And then it goes to realizing that it's airborne. So I'm assuming we still need to be cleaning down surfaces like we did...?

BRIDGER: Yeah, that's a great question. So we do know that coronaviruses in general can live on surfaces, it varies by surface. The New England Journal of Medicine put out a report, you know, that COVID can potentially live on on some surfaces for up to a couple of days. What is a little more not as clear is how that contributes to spread, you know, how much of the spread is really being caused by the virus living on surfaces. But the good news is that the coronaviruses in general are very susceptible to just regular cleaning techniques. And again, yeah, I mean, I think it's important that we keep our surfaces clean and we do our diligence to make sure we're keeping our spaces clean and doing our best, because it certainly would not hurt in any way to do so.

GAUDETTE: Dr. Pate, can we talk a little bit about the vaccine trials that are going on? Because we've gotten some some questions in regarding who's being tested, who's in these testing groups. And we know it's adults. So so, a, you know, we don't usually, I would assume, test on children when it's a trial, but also if only adults are being tested, does that mean it will still be safe for children to receive the vaccine when it is widely generally available to the public?

PATE: Yeah, that's a great question, Gemma. So we have several vaccines that are in what we call phase three trials. Phase three is kind of the last big trial. It's a large number of patients. And that's where we really get our most helpful information about is this vaccine safe, is it effective and how would we measure that effectiveness? And so those are well underway. And in fact, we are expecting to get some data over the next couple of months from a couple of these vaccine trials that will see how these are going.

But you're quite right. The early trials don't include children. We do adults first. The youngest children that I'm aware of in any of these trials, and there's quite a few trials going on, so I'm not up to date on every one of them. But of the most advanced ones, the youngest is 16 years old. So when we do have a recommendation from the FDA that we do have a safe and effective vaccine, it is likely that that vaccine will be labeled for 16 and over. What will then happen is they will immediately start recruiting children for another trial, which will move a lot faster because they've already done this. But we do the adults first. But those trials in children could get underway later this year or very early next year. So I don't think it'll take too long. But we're going to do adults first.

GAUDETTE: And keeping on the topic of of vaccines, because there is a lot of speculation as to when a vaccine will be available. Now, there is a difference with a vaccine being ready and having gone through trials to a vaccine, being ready for the general population. So with that said, and I'm curious for what each of you think about this, Dr. Bridger, what is your best guesstimate as to when a vaccine could potentially be available for the general public?

BRIDGER: Yeah, you know, there's a lot of speculation on this. I think my general hope and belief would be early-mid 2021 in terms of being generally available to the public, you know, but it's interesting, I don't know that we know for sure, but that would be my hope and thought. But yeah, I'd be interested to hear what the others think as well.

GAUDETTE: Dr. Johnson, what about you?

JOHNSON: I'm aligned with Dr. Bridger on that. And it is just speculation. We don't have any understanding today. So recognizing that sometime early, 2021 would be fantastic. I think that's a pretty optimistic goal, but a hopefully reasonable goal. We of course want to make sure that any vaccine is safe. That would be the first thing. And that's going to take a little bit of time to ensure safety. We have to make sure we have production capabilities to get enough vaccine storage, distribution, administration. There's a lot of different factors that do affect our ability to get that vaccine out to people safely and have an effect. I think 2021 early spring is probably a good hope for time.

GAUDETTE: Dr. Pate, your your thoughts on that? But if I could add on to that too, is even if it's widely available come early spring, so within the next six months, let's say, we need global immunity for this to be truly effective. Correct?

PATE: Wow, that is a fantastic point, Gemma. And one that I have not heard many people bring up that we have to be aware of. What this pandemic should teach us, and I pray to God we learn the lessons from this pandemic, but the first is that whether our political views is just to focus on the United States or not, when it comes to viral threats, we are a world and we are a connected world and we are connected by travel. And it's just very fascinating. If you look at the early outbreak in Wuhan and then you look at -- which Wuhan happens to have the main international travel hub for China, and then you look at where flights go out of Wuhan most commonly, and you can if you just look at where most of the flights go, you see exactly the trail that this virus took in spreading to other countries. And when you consider, not today with our decreased travel, but before COVID, the hundreds of thousands of people traveling every day, if we don't get the world immunized, we are going to continue to have threats unless we completely close down borders and to all and certainly none of us would recommend that. And that wouldn't be prudent. But we've got to get the rest of the world immunized. And the problem back to your question about haves and have nots. There's a lot of countries that are haves like the United States that's already paid hundreds of millions of dollars to ensure that we get vaccine. But there's many developing countries that are going to be at the end of the list. And so it's in all of our interests to get the entire world immunized, which is going to slow down our timetable because of just merely producing that much vaccine. And keep in mind, for many of these vaccines, not all, but many is going to require two shots. So that's going to be double.

GAUDETTE: So this could I mean, yes, good news that there is hopefully a vaccine widely available by spring, but this process of global immunity could take upwards of a year, I would think, to be able to do something like that.

PATE: Yeah, I would think so, and I think it's going to depend on what is the world's commitment to help those countries that are economically disadvantaged to get them vaccinated. So, yeah, I think Dr. Bridger and Dr. Johnson are exactly right. But as Dr. Johnson tried to point out, there are a lot of steps in this process that still have to go very, very well. And we've seen through this that not all the steps our government has taken have gone well. So I am optimistic. I do believe that we're going to get Americans vaccinated by summer or perhaps early fall next year. But even with us Americans, while we can give -- hopefully if it's an effective vaccine -- we can give individuals immune protection for some period of time. It's going to depend on what percentage of Americans are willing to get immunized as to whether we're going to get this virus as far as one of your earlier questions... Well, let's get it down to those levels where we don't have to pay attention to it every day until we have an effective vaccine and the majority of Americans getting that vaccine. 

GAUDETTE: We just got one in from Laura and she wants to know if our experts recommend a return to face to face learning this coming Monday in Ada County. Now, Dr. Johnson, I know that your wife, you have you have college aged kids. Your wife, though, is a teacher. But Dr. Bridger, you have children in elementary school. So I'm curious about your thoughts on returning to face to face learning come Monday.

BRIDGER: Yeah. You know, I think everyone's risk tolerance may be different based on your own personal family situation, you know, potential comorbidities of family members and the health of children. But, you know, in our personal example, you know, I have a child in second grade and a child in kindergarten. And certainly remote learning is challenging for young kids. Kindergarten is challenging to do, you know, on the computer and in second grade as well. So our children have returned to in-person school a few times a week and the other days are at home. And it's been really going pretty well for us. The kids enjoy being back. And, you know, the particular school that we're in is taking the appropriate measures and really doing a good job thus far. But certainly I think I can relate with any parent of children, especially young children, who are trying to navigate through through remote learning. And it is absolutely challenging. So we then we've been happy to have them back in school at least a few days a week.

GAUDETTE: And then Dr. Johnson, with your wife being a teacher in Boise. Is she feeling confident about going back?

JOHNSON: Yeah, I'd say, first of all, we've got some fantastic teachers throughout Idaho dedicated to working really, really hard to make the situation as good as they can for kids. And they are, at some risk, I think having kids back in school, no matter how good that processes we put in place, there's going to be some risk and we are going to see some transmission of COVID with that within in-person learning. The strategies that the school districts are putting in place to try and reduce those risks, as Dr. Pate pointed out, there's a lot of variability. I'm grateful my wife would share the same thing for the steps that have been taken in the Boise school district to try and reduce that risk. It's not perfect, but they're taking some steps to try to do that. Different school districts have had challenges. I would maybe add to what Dr. Pate had said earlier about the resources. Some schools or districts don't have the resources to help put some of those processes in place, those really important processes of making sure that infection prevention principles, basic low cost, low cost infection prevention principles are put in place. I mean, there are some limitations on schools ability to do that. If the teacher student ratio is such that you just can't maintain social distancing, the only way to really address that is hire more teachers, get more space -- that that costs money. So there definitely are some risks.

I would say that in talking with my wife and talking with other teachers, there's definitely concern out there about that risk. There's hope that the structured strategies that have been put in place work. We're going to need to help support those basic infection prevention principles, though. The mask wearing, social distancing, not coming to school sick. We're just going to have to really work hard to support those principles to really reduce that risk and and rely on our parents to help their help their kids, to be good citizens, be good neighbors to their classmates and their teachers so that we can do the best we can to try to make that work with as little risk as possible.

GAUDETTE: And Dr. Pate, I want to quickly talk about travel, because we're getting quite a few questions and fast and furious about about travel in the upcoming holidays. So Alice has this question.

LISTENER QUESTION: She says she and her husband have decided to stay home on Thanksgiving and Christmas by themselves. Lowest risk. They have family members, though, with essential jobs who interact with others and are outside that bubble. So she wants to know what your advice is for people who are kind of walking that gathering tightrope with family members, especially if it cannot be done outdoors when it comes to the upcoming holidays.

PATE: Yeah, you know, this is going to be a big question for us that we're going to have to deal over the next few months as people make their holiday plans and of course, families want to get together for holidays. We're going to have some of these college students and university students coming home for the holidays. So, you know, it's quite concerning. I think that when you think about this and you really have to know a lot more detail than what the listener that's giving us the question is providing. So the first thing is, I think you have to look at what is the rate of disease transmission from where the person is coming from. So in other words, if I was going to have a family member from Texas or Florida come visit me, then I would want to know what's happening with the disease activity there, because that will give me a bit of an indication of how likely they are to potentially be infected. You also have to know what are their behaviors. So even if it was a high risk transmission area like Ada County is, my wife and I and I know you and your husband are very, very careful. So we're going to have lower risk than if perhaps it's a college student coming home from one of those areas.

The other question then is, so how are they traveling? So obviously, it's going to be much safer if people are traveling by car and just themselves versus are they going to an airport and getting on a plane and that kind of thing or going on a bus or whatever. So we'd have to know how they're getting there and what they're going to be doing along the way.

And then, you know, I think that when we get real close to the time of the holiday, it's going to be, again, another look at what's happening to the disease activity and what have we learned about the airborne transmission, because that is going to be the big risk of not being able to be outdoors. Is how big of a risk is the airborne transmission? There was a study just released that is very encouraging about masks not only helping for droplet transmission, which is our dominant one, but that actually it could decrease aerosols, which is what we're worried about with airborne transmission by up to 65%. So certainly if you are going to travel, wear masks, watch your behavior. [Inaudible] another a month or six weeks when we see what happens and I suspect things are going to get worse. 

GAUDETTE: I again want to thank all three of you for your time today and coming here every week, all of these health systems coming here every week. Just appreciate your expertise and the facts.

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