Doctors Concerned As Coronavirus Cases Climb in Idaho

Jul 8, 2020

Idaho Matters is joined weekly by our panel of St. Luke's and St. Alphonsus medical experts to answer more of your COVID-19 questions. Today, they discuss the recent rise in hospitalizations, travel restrictions and staying safe in restaurants.

 


Joining Idaho Matters this week are: 

  • Dr. David Pate, a member of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s.
  • Dr. Ryan Heyborne, Chief Medical Officer for Saint Alphonsus Regional Medical Center.
  • ​Dr. Joshua Kern is the VP of Medical Affairs for St. Luke’s Magic Valley.

 

​Have a question for the panel? Leave us a voicemail with your question and we may use it on next Wednesday’s show. Here’s the number to call: 208-426-3625. Or email us at idahomatters@boisestate.edu.

Read the full transcript here:

GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know many of you have questions, many of you have concerns. And here at Idaho Matters, we want to answer those questions with facts. The best way to do that is to bring in Idaho medical experts. If you are a regular listener and think of this as our doctor version of our Reporter Roundtable. If you have a question for our docs, send us an email: idahomatters@boisestate.edu.

Joining us today. Dr. David Pate, former CEO of St. Luke's Health System and a current member of that EHO coronavirus task force. Dr. Ryan Heyborne, chief medical officer for St. Alphonsus Regional Medical Center, and Dr. Joshua Kern, the vice president of medical affairs for St. Luke's Magic Valley. Welcome to the program, everyone.

ALL: Hi, Gemma. Thank you.

GAUDETTE: Ok, so first question: masks. The Central District Health Board is drafting a masking order right now that they could consider next week, I believe Tuesday for some or all of the central districts. So I'd like all three of you to to weigh in on your thoughts on that. So why don't we just go down the line? So, Dr. Pate, let's start with you.

PATE: As I have been strongly encouraging them to adopt that policy.

GAUDETTE: And Dr. Kern?

KERN: Yeah, I like to point out that the experience we have in our hospitals, is when the patient wears a mask and the provider, the nurse or the doctor wears a mask, we really have almost no transmission, even with known COVID patients who are quite sick and coughing. And so that's sort of my strongest sort of local data that I can point to that says wearing a mask helps prevent spread of the virus.

GAUDETTE: And Dr. Heyborne?

HEYBORNE: Agreed. Thank you, and this has been a recurrent topic on your program, and it's definitely time to do that based on what we're seeing for spread in the county.

GAUDETTE: So St. Alphonsus announced this week that you are now testing based on medical need and severity of symptoms, and I believe at St. Luke's has said no one who is asymptomatic can actually get a test right now, only people who are sick. So we also heard from Central District Health Board meeting that the testing in our state right now is overwhelmed. Dr. Heyborne or Dr. Kern, what do the two of you know about this? Dr. Heyborne, why don't we start with you?

HEYBORNE: Very good. Thank you. Absolutely. You know what, this is a dynamic situation and has been throughout. And when we first started offering testing at some of our tents, supply was limited. We were screening people based on symptoms. Then we started to have inadequate number of tests based on the people that were coming. We were seeing dozens of people come to our testing sites and in the last week that has skyrocketed. I mean, we've had hundreds of people coming in for tests. We've had lines of 100 cars backed up, causing traffic issues and so forth. And we just have not had the testing availability. And we're not unique in this. This is throughout the Treasure Valley. This is throughout the country. And so in order to keep testing return times down and you can imagine if we just create a traffic jam, not only literally, but also with the number of tests that we're trying to send, it's going to take a long time to get those results back. And so based on the availability, based on the need to really try to focus our testing on those people who are going to benefit from it, most -- the patients who are sick, the patients with symptoms -- that's been the the wise decision to be good stewards of those resources. We still encourage people if you think you've had an exposure or you are having symptoms, definitely get checked out. And we're doing that at our screening sites. Other facilities and hospitals are doing that. They can talk you through that process of 'are you somebody who would be of a high likelihood to benefit from a test or not?' And as this as the picture evolves, I mean, we may get to another point where we have adequate supply to test anyone who's interested, but that's the state currently.

GAUDETTE: Dr. Kern, anything you want to add to that?

KERN: Yeah. The only thing I would add is just the additional idea that the limiting factor is somewhat the testing reagents and the ability to to run the tests. But there's also infrastructure needs. Just the literal amount of having to get people in the right place to keep them safe, get the swab done, make sure that their proper name gets on it. It's actually it's much more infrastructure requirement than you would think on the surface. I heard from a friend of mine who lives in Florida where people were waiting in line in hundred plus degree weather for six to seven hours in their cars running out of gas because so many people were needing testing that you just you can't infinitely expand your ability to literally get the swab in people's nose and get it to the lab. And that's part of the gate that prevents us from doing all the testing maybe that everybody would want.

GAUDETTE: So, Dr. Pate, I mean, you are on the coronavirus task force. I mean, for a while there, it seemed like we were heading in the right direction. And it seems, though, I mean, I feel like this is true: We are in a worse situation now than we ever were. I mean, with the exception of Blaine County when they were a hot spot, but, man, I mean, are we heading to where Blaine County was, where New York City was? And I mean, what's going on with the task force in the sense of how do we catch this runaway train, it kind of feels like?

PATE: Well, so you you are right. I am more concerned about this spike than I was the first one. And the reason I am -- and frequently people express they're not concerned because most of the people that are getting infected are younger adults. And people think, well, they're gonna be fine. So this is no big deal. Well, it actually is more concerning to me. And the reason is we know the younger that you are, the more likely you are to be asymptomatic if you get infected. For example, if you're 19 years of age or younger, only 21 percent, about one in five, of those young people will actually have symptoms. So what is scary about this is you and I look at those number of cases reported and everybody fixes on those number of cases and gets concerned because it's about twice what we were seeing before. But I get alarmed because I know that those are mostly just the symptomatic people. And so for every one of those, there's probably 4 to 10 more people out there that are infected, don't know it. They're getting together in these groups -- I just recently heard about a wedding with one hundred and fifty people -- And I guess nobody's heard of this pandemic. And so they are getting together in groups. They are not socially distancing and they're not wearing masks. And it is absolutely no surprise that this virus is just transmitting between people. I heard one expert that I respect referred to this as this is a wildfire and all these people out there because everybody's susceptible it's all the timber that is the fuel for this fire. So until we can get people separated from each other or if they can't be separated, wearing masks, we are not going to stop this. And what we saw back in April after the governor's order, stay at home order, this rapidly declined because we weren't feeding the fire. But we're feeding the fire right now.

GAUDETTE: We certainly are. And it is frustrating. I mean, we know, like, for example, tomorrow, Governor Little will have a news conference at noon. We're going to play it in place of Idaho Matters because he's going to be talking about the pandemic in regards to reopening schools K-12.

And I'm curious, Dr. Heyborne and Dr. Curran, are you frustrated? And I ask that because you've been on the front lines of this. It seems like hospitals were, you know, starting to do okay, like there were less patients. And all of a sudden there's this spike. And as Dr. Pate, said, for some reason, people think that it's this isn't a big deal.

KERN: Yeah, this is Josh Kern again. I'm going to answer that question sort of in a different way by saying I've started to try to picture these people who I see in my social media feed who are out at large events unmasked and possibly and probably spreading the virus. And if I picture myself now, I'm gainfully employed. I'm married, I have good support with my family. And I'm you know, I started the pandemic in a good mental state. If you are a 20 year old or 25 year old and you're single and you've been laid off from your job and you've been on unemployment the last couple of weeks, you know, in this imaginary person, maybe waited tables in their restaurant has been closed and they haven't gotten a job back. I can see how my response to the pandemic and my ability to sort of stay home or stay away from these social events would be very different. And I think it helps give me empathy for the social pressures that are getting people to forget briefly that the pandemic is real. That said, we're now setting significant new record numbers in almost all of our markets, at least in the St. Luke's footprint. And it could quickly get out of hand. And the other thing is that I think people are forgetting is if you look at the CDC Web site or even Arizona's website where they're having a really significant outbreak, about twenty five percent of the people who are admitted are younger, like 18 to 44. So we've got in St. Luke's right now, people, you know, 40 and under who are on ventilators in the ICU. So it is gambling with your own health, not just the health of your parents or grandparents.

GAUDETTE: Dr. Heyborne, would you like to add anything to that? And I have to say, Dr. Kern, that was an incredibly, I think, empathetic way to look at it. And I do appreciate that response.

HEYBORNE: Yeah, absolutely, I mean, seeing how hard this has been on people quarantining and so forth and how long it's going on. You know, I mean, we had hoped for the best, prepared for the worst. And it's unfortunate that we're here talking about more of a worst case scenario right now. We wish we weren't here. We all wish we weren't here, but we are. And so we have to keep working together to try to get out of this situation.

GAUDETTE: We have a question from Missy in Boise. She is hoping that we can clear up confusion over why there is an uptick in cases right now in Idaho. Let's take a listen to her voice mail.

LISTENER QUESTION: I would think that some of that is related to the amount of testing that is being done. And would that not also be bringing down the mortality, trying to really find out like behind the scenes, pulling back the curtain and really looking at the numbers, not just necessarily the fact that, you know, we have this, you know, large amount that's coming in right now. But really the reason behind it.

GAUDETTE: Dr. Pate, you want to take a stab at that?

PATE: Sure. So what we're seeing is a dramatic increase in cases. We're seeing it particularly in younger adults. And, yes, we are identifying some more cases because there is more testing. But that is not the explanation for what we are seeing. And the reason that I know that is that, first of all, even back in March and April, if you were symptomatic or you were sick enough to go in the hospital, you were getting tested. So all of those people are getting tested today as well. And in fact, as you've just heard from Dr. Kern and Dr. Heyborne, we're seeing increased number of people in the hospital. So these are severe cases. We are seeing more. The other thing is you can look at the testing percentage. And when that number -- and that's on that coronavirus.idaho.gov site -- and when that number is above 5%, you know there's a problem and that we're actually seeing more cases. And the reason is concerning when the percentage goes up is that when you just do more testing, which means you're testing more asymptomatic people or people that don't really seem like they have it, you have to test an awful lot of people to come up with a case. So what happens is your percentage actually goes down. So if we were seeing all these cases and that percent went down, I would say, yeah, that's testing. But we're seeing more people in the hospital and we're seeing a higher percentage. So it is actually more people are getting infected.

The other thing, do not pay attention to the death rate right now. It is not true that the mortality rate for this virus has gone down. What happens is when you have these spikes, you don't see deaths for several or more weeks. It can even be four to six weeks after that. So we're not going to see the death numbers climb now. Look again in a month, six weeks, they'll be up.

GAUDETTE: Dr. Heyborne, Michael has a question. He says, 'My family and I are flying in from Tennessee from July 18th through the 22nd. Are there any restrictions or guidelines we have to follow?' And then Cath has the same problem. She says, 'I'm coming to Idaho for a river trip mid mid July. Do I have to quarantine for 14 days?'

HEYBORNE: Yeah. Thank you, and this has been somewhat of a moving target as we've tried to adapt and and implement policy and practice that are going to keep us all as safe as possible. I mean, just looking at the idaho.gov web site and then looking at Visit Idaho COVID-19 travel information. I just want to state what they say is, as is consistent with what we've heard regarding stage three at this time, is that a 14 day self quarantine is encouraged, particularly if you're entering Idaho from an area with substantial community spread or cases higher than Idaho. Now, we're unfortunately in the situation where our own community spread in case rates are quite high at this time. And so while it's not absolutely mandated, it is encouraged, particularly if you're coming from an area with a high level of activity. I do think it's important to note, if I might flesh it out just a little bit more on air travel, we know is a risky behavior related to exposure to coronavirus. There was a chart that I've been using in various venues from the Texas Medical Association that basically ranks risks of exposure from one to 10. And it lists air travel as a seven, which is the same as attending a wedding or something like that. And so we have to remember that travel by air is still a somewhat risky proposition. And regardless of what people decide to do with travel and quarantines, just reiterating the things we know, the things we've talked about from the beginning of masking physical, distancing handwashing, so forth.

GAUDETTE: And Dr. Kern, Valerie has this question. She says, 'I went to the outlet mall yesterday and was told by a clerk at one store that two employees at another store where I had just been shopping were sent home that morning for showing signs of COVID-19. Should I self quarantine? Is there some way I can confirm if I was exposed?'

KERN: To answer this last part first, it's not easy to figure out if you were exposed because of the problem with asymptomatic testing and knowing when to test you to find out. I think it's reasonable to think that you're at risk and really closely monitor symptoms and wear a mask. And that's essentially what we are recommending to people. It depends on how much time had passed. It has a lot to do with the air turnover in the store that you were in. But most likely, if that employee had been there that morning and then like two hours passed, the risk to you would be pretty low.

GAUDETTE: So should she self quarantine for 14 days or what would be your recommendation on something like that? 

KERN: Wearing a mask anywhere you went and assuming that you could get somebody sick for 24 hours before you have symptoms. I mean, that would be my recommendation for, you know -- whether you're fully self quarantining or not, just recognizing that you could be a pre symptomatic spreader of the virus until you get symptoms.

GAUDETTE: And then Dr. Pate, Bonney sent us this question. She says, 'I think I may have had COVID-19 in mid-January. Is there any way to tell if I may have already had it? Am I possibly immune now?'

PATE: Well, it's a great question and my answer is different today, because we have a whole bunch more studies that just came in. It used to be that we thought that if you had COVID that you would develop antibodies and we could tell by the antibody tests that you had. Now, a positive antibody test still wouldn't answer the question 'are you immune?' We simply don't know. However, what has happened is recently there's been three or four studies that have come out looking at people that were infected. And what we have found is that 2-16%, depending on which study you look at, didn't actually develop a positive antibody test. So first of all, you could get an antibody test. If it was positive, that would tell you that very likely you were infected with COVID. On the other hand, if it's negative, we wouldn't know if you didn't form those antibodies like this 2-16%. But additionally, another concerning fact is some studies recently have shown that between 13-40% of people that did develop antibodies, those antibodies declined to essentially undetectable amounts in two to three months. And so since you're talking about January, it's possible you had antibodies and you just don't show them any more. So is it worth you getting an antibody test? I don't think so. It cost you 100 bucks. And even if it's positive, yes, that would tell us, OK, that would satisfy us intellectually to know that, OK, that probably was COVID in mid-January. However, we don't know what that means. We don't know that you're protected. We don't know that you're immune. So I think it's certainly possible. I would tell you that your story is common and of the people in your situation that think they very well might have had COVID back then and got tested. The overwhelming majority did not have COVID. And just remember, there were a lot of other circulating illnesses back then. So I'm not sure we've got a good answer for you.

GAUDETTE: I literally just saw an email come through to my inbox that I want to address. So a listener just wrote in. She says, 'my daughter is expecting a baby in August. What are the chances they will take her baby away due to the coronavirus?' She has done some reading that this is a thing. I am assuming that that is a myth. But can one of you doctors talk to us about this? Because that's got to be a real fear if there were things going around like that. 

HEYBORNE: Just knowing what we're doing in our hospital, which is very similar to what others are doing. I mean, we identify it as a risk for a mother to have COVID and we are testing our expectant mothers. And we've had positives. You know, I mean, that's just gonna happen. You deliver babies and you have patients coming in that may or may not have symptoms. I mean, it's going to happen. And we're certainly not unique in that regard. We do at that time have counseling with the mother about the best way to prevent spread to the baby: mother masking, identifying an alternate caregiver. I mean, there are people that choose to have the father, assuming he's not COVID positive, provide most of the care, bottle feeding, things like that. So those are things that are considered. But as far as, you know, removing the baby from custody or anything like that, nothing like that has happened which I'm aware. But once again, it's just an opportunity to be safe. Try to make good choices for the health of mother and baby.

GAUDETTE: I appreciate you talking about that because, you know, I think there is a difference between physically taking the baby and taking custody away from the mom instead of, you know what, we may have to separate you from the baby while in the hospital or yes, you may have to mask this and that. That's totally different. And we want to make sure the moms and babies are safe in these situations.

So, Dr. Heyborne, I want you to talk a little bit about this, because we just got a question in from Don from Middleton, because you had mentioned, Dr. Heyborne, that the flying on airplanes just a second ago. So Dawn says 'on the Today show this morning, they talked about how often the air in planes turns over. And they mentioned that you were likely more safe flying than in a building with less airflow. This seems contradictory to what your expert said regarding flying. And he goes, these contradictions are frustrating.'

HEYBORNE: Yeah, absolutely, and, you know, like I said, I was using a resource that identified risk, and we have to remember it's not just air flow, you know, it's proximity to individuals, it surfaces and so forth. And we look at, okay, let's look at an area of airflow being outside. You know, we've got good air flow there. It was compared to flying, it's been compared to, for example, being at a wedding where even if outside, there's a risk of transmission. And so really, 100%, ranking risk is difficult. We know if you're in a confined space, as you are in an airplane, that you are more exposed to the virus than if you are in other areas where more social distancing is possible.

GAUDETTE: We've got a voicemail from Diana from Sun Valley. She has a question about safety measures in restaurants.

LISTENER QUESTION: I'm curious to know what the precautions are for people cooking food and restaurants. I have gone past a couple of kitchens and reopened restaurants in Ketchum. One person at a grill with no mask. Another person putting bacon on a platter with no mask and no gloves. Could you discuss what the problems are, if there are any would doing that?

GAUDETTE: Dr. Kern, can you take that one, because you are based in the Magic Valley and I and I know that you've been working in that whole area in the Blaine county and Magic Valley area.

KERN: Yeah, I guess that's an important question. And it really begs the question, you know, should you go to a restaurant where you don't know for sure people are taking full precautions and everyone is wearing masks. I recently saw on social media a joke, something to the effect of an ICU doc, a scientist and epidemiologist walked into a bar. Just kidding, no they didn't, because they know better. 

GAUDETTE: I saw that, too!

KERN: So and I might have gotten it slightly wrong, but the point is relatively valid. I myself have not yet eaten out at a restaurant for these very problems.

GAUDETTE: Yeah, I'm right there with you on that. Hey, Dr. Heyborne, John asks, 'Should Idaho move to using an app for contact tracing? He says Utah is promoting an app to help people know if they have come in contact. Seems like we need this.'

HEYBORNE: Maybe, you know, with any. There are all kinds of technological opportunities out there, and I know these are things that are being discussed at the state level, various ways to monitor. We're getting to a point, however, with the prevalence in the community that where our chances of exposure are going up. And I don't want something like that to provide either a skewed perspective, a false sense of confidence or something like that. And so, unfortunately, with COVID, as we keep recognizing, there are a lot of easy answers. And so, you know, I think that's something that can be explored and discussed, the true benefit of it, to be honest, somewhat somewhat limited.

GAUDETTE: Dr. Pate, Tanya just sent us this question. She says, 'my husband has to travel to Alaska in a few weeks. They are requiring travelers to arrive with a negative COVID-19 test with in the last 72 hours. How can we get him that test when he doesn't have any active symptoms?

PATE: Well, it's going to be challenging. So the first thing I would say is -- I'm assuming this is work related travel, but I would ask the question, does he really need to travel? -- We've just had the conversation about airplanes and how safe they are or are not. And I think Dr. Heyborne gave a great answer. But that's not the whole story because it's not just while you're on the airplane. You know, most of time when I've gotten on an airplane and I haven't since this when you first get on the airplane, the air's not circulating. It's not you know, they have the engine on and it circulating real well. So it's great during the flight. What about before the flight? The other thing is you're lined up at the gate to go into the flight. Are you going to be physically separated there? What about security and and all these other opportunities to come into contact with people? So the first question is, do you really need to travel? Assuming that the question is correct, that he really needs to make this trip, then it can be done. It's just going to be logistically difficult. And there are very few places offering testing of asymptomatic people. Rite Aid is one. But I talked with them this morning and they're backed up several days. And then once you come in and get the test, it may be a number of days until you get the test results. So trying to time this exactly so that it will be within the timeline prescribed by the state of Alaska may be challenging. There is a new option, and I haven't explored it very much because it just became available. But the FDA just granted nine emergency use authorizations for at home testing. And this will have some logistical issues, too. First of all, I'm not sure which of those companies will issue a test, if you're asymptomatic. Most of them you have to go online and take a symptom checker. But if they'll send it to your home, then you just have to take into consideration how long's it take to order the test and get it delivered. And then typically what happens is you do a video visit with them and they supervise your taking the specimen, but then you have to mail the specimen into the lab and then that can take two or three days. So it can be done. The big challenge here is going to be the logistics of getting it within the time window prescribed by the state of Alaska.

GAUDETTE: And I would make the assumption that if numbers do start going down, we'll get to a place where you could test asymptomatic people again. It's just that we can't do that right now.

PATE: Correct, Yeah, it's a demand for testing and realize that a lot of these labs that are doing this testing, especially that were doing the asymptomatics, were out of the state. And so the regional labs. And so with all the activity you have in half of our states of America that are giving tremendous increased number of specimens, these labs are just getting behind.

GAUDETTE: Dr. Heyborne, we had a question come in from Ambria. She asks, 'I have heard different things about the virus being spread by people who have gotten it and are post symptomatic. How many days after you no longer have symptoms should people who have had it wait before they stop their quarantine?'

HEYBORNE: Yeah. Thank you, and I'm just going to follow the CDC on that one. As the situation continues to evolve and we get more information, these recommendations may change. But right now it's three days symptomatic, ten days since the onset of your symptoms. And that is is felt to be a relatively safe way to go about it. Understanding that, as we talked about with antibodies and so forth, you're not necessarily in the clear. And so regardless of your state, practicing our safety measures, as we discussed, remains important.

GAUDETTE: And then, Ryan, just then this question and and Dr. Kern, I'll start with you. But if anyone else wants to jump in, that would be great. Ryan says, 'I've heard a lot of people saying the only way to end this pandemic is going to be a vaccine or letting it run its course. I'm curious what your experts think.'

KERN: Yeah, I mean, the problem with that mentality is not recognizing that we still have 95% of Idahoans to go on spreading the virus. So while there is some truth to it -- it may need to run its course -- keeping it at a slower pace makes more sense. And then there's these long term questions that Dr. Pete was alluding to earlier about whether or not you get long term immunity to it, whether or not you could catch it again next year. There is a lot of question marks around whether once you've had it, you're good for life because we don't actually know the answer to that. Obviously, it's then too short a period of time. So, yeah, my concern is that if you look at what percentage of Idaho has probably seen the virus, it's probably in the neighborhood of five percent, maybe somewhere slightly north of that, but it's certainly not much higher than that.

GAUDETTE: Well, look, from a personal note, I'd rather not take my chances. Right. We are out of time, we still have so many questions to get to. I appreciate all of you taking time, too, to answer this, to also participate every week. I mean, you guys are on the frontlines of this. So thank you for taking time every single week to answer these questions and to get us updated with facts. So appreciate your time. Dr. Ryan Heyborne, chief medical officer for St. Alphonsus Regional Medical Center. Dr. Joshua Kern, the vice president of medical affairs for St. Luke's Magic Valley. And Dr. David Pate, former CEO of St. Luke's and a current member of the Idaho Coronavirus Task Force. Appreciate your time. 

As COVID-19 cases spread through the U.S. and Idaho, we’re committed to keeping you updated and informed. You can get updated info on cases, closures and how to stay healthy at any time on our Coronavirus news blog.

 

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