Idaho Is Breaking COVID-19 Records. Here's What Doctors Fighting The Disease Say

Jul 1, 2020

 

Idaho Matters is joined again by our panel of medical experts to answer more of your COVID-19 questions. This week, they discuss Idaho's record-setting spike and what it means, free testing sites and contact tracing.

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 at St. Alphonsus Regional Medical Center.
  • Dr. Michaela Schulte, Vice President of Medical Affairs at St. Luke’s

​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:

 

GEMMA GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. As we continue to follow the coronavirus pandemic, we know it's incredibly important to make sure that you're updated with the facts about what is going on, especially as we are starting to see more and more cases. With that being said, we are once again bringing in a panel of medical experts to get us updated, but to also answer your questions. If you have a question for our panel of doctors today, you can email us right now at idahomatters@boisestate.edu. Joining us today. Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of the Idaho Coronavirus Taskforce, Dr. Ryan Heyborne, Chief Medical Officer with St. Alphonsus. And Dr. Michaela Schulte, Vice President of Medical Affairs at St. Luke's. Thanks, everyone, for joining us today.

ALL: Glad to be with you, Gemma.

GAUDETTE: Dr. Pate, I'd like to start with you. Can you just give us the latest from Governor Little's Coronavirus Taskforce as to where we are? I mean, we did know that last week, stayed in Phase 4, have not moved forward from there.

DR. DAVID PATE: Yeah, that's correct. Of course, as everybody knows, we've been seeing a spike in cases here in Idaho. Much throughout, we're seeing increases much throughout the state, although interestingly, Blaine County is actually continuing to trend down with very few cases. But the big uptick, the spike has particularly been here in Ada County and a lot of this in younger adults and probably at least half of that attributable to infections acquired in bars and nightclubs. So we're very closely watching this to see what's going to be the consequence. You know, the young people do tend to come out better with this infection. But the real concern is, are they in turn going to transmit this virus, perhaps in many cases unknowingly, to older individuals, individuals with chronic medical problems? And are we going to see a big uptick in ED visits and hospitalizations? And we're starting to actually see some increase in hospitalizations, not overwhelming by any stretch of the imagination, but certainly an increase. And we may see more. And then, of course, the ultimate question is, will we end up seeing deaths, more deaths?

GAUDETTE: Right. Dr. Heyborne and Dr. Schulte, I'd love your input on this as well as Dr. Pate's. But, you know, Dr. Pate mentioned how Blaine County is trending down. We also know that one of the things that the city council in Haley, you voted unanimously for last night, was a mask mandate, as well as the city of Moscow up in north Idaho. How important is it to be wearing masks if you cannot socially distance? And Dr. Heyborne, why don't I start with you?

DR. RYAN HEYBORNE: Yeah. Thank you. It's vital and I really appreciate the recognition throughout the governments, various governments as well as throughout society, increasingly so, that masking helps slow the spread of this virus. And not wearing a mask is not only irresponsible for your own health, but also those around you. And so definitely something we're encouraging. You know, people have heard some of the challenges that come with wearing masks or that, you know, what is the true efficacy? Nothing is going to be 100%. But it is very fair to say that they reduce the spread. If you're wearing a mask from Utah others, you might not even realize you have it, as well as you're blocking yourself from large droplets. You're not touching the areas of your face. If you get some virus on your hands or something like that. So we've seen a spike, as Dr. Pate said, it's related to certain areas where we're distancing and masking. We're limited, and it's really time to get back on top of that.

GAUDETTE: Mm hmm. And Dr. Schulte, your thoughts on this?

DR. MICHAELA SCHULTE: Yes, I would like to echo what my colleagues have said here, I absolutely agree that everything that we're learning about this and everything that we knew probably early on about the spread of this disease, it's really pointing towards that masks are a key component of our efforts to reduce the spread. And I really would like to also stress that there is no significant downside of wearing a mask. It is uncomfortable, and I understand that for some people, you know, that might evoke some anxiety or other discomfort. That is, you know, not as easily bearable, but it is really from a health perspective for most people, not at risk beyond some skin irritation or some other things that we are now seeing in the health care setting where we're wearing those masks at all times. So I would strongly encourage everybody to continue to wear masks. This seems to be a key component of this.

GAUDETTE: You know, Dr. Pate, we have a question, or a comment from Deborah. She is a nurse in Boise. And here's what she wrote. She said, with COVID-19 cases rising dramatically here in Ada County, why are mask wearing and physically distancing not being required and enforced? Transmission is happening exponentially. Why are we waiting for ICUs to become full and for more people to die instead of enforcing scientifically-proven preventative measures?

PATE: Well, you know, the there's a medical question and there's a political question, and from a medical standpoint, I think all three of us would very much support a requirement to wear masks or face coverings. And, of course, that would be up to the local mayors. And it would be up to the county commissioners and the public health district and all. But I think all three of us would certainly encourage that. You know, politically, it's just terribly sad that a public health issue has been politicized. And because it's very unfortunate, it's not a political issue as to whether masks work, they work. And so I do sympathize with those that would have to make those rules. It is tough to know how would you enforce it? Who would enforce it? What would be the penalty for it? I think that all of us would just like to calm a call on all of your listeners, good sense and respect for others to please do it. As Dr. Schulte said, you know, there are no significant risks to wearing a mask and you could perhaps save a life. And frankly, by wearing a mask, you're going to keep the economy open. So we would encourage people to do so.

GAUDETTE: Right. And in fact, Goldman Sachs came out with a study that they did saying that if people wear masks -- if we don't wear masks, we could affect 5% of our GDP. Whereas if we do wear masks, we won't see another shutdown. So you're right. Dr. Pete, I mean, it's so unfortunate that unfortunate that this has become a politicized issue because it really is a health issue.

With that being said, I want to make sure we get into our listener questions because, man, we've gotten a lot. So Leslie has two questions. Dr. Heyborne, I'm going to give you her first part of her question. So she says, as health care worker numbers continue to increase in cases. Who are they? Are they dentists? Are they nurses, EMT, doctors, housekeeping? She's just curious if we know.

HEYBORNE: Thank you. I will be brief knowing that there's a lot we want to get to in this program. It's difficult. And we're not tracking any specific information about occupation type and individual who is being diagnosed with COVID just because it is something that's affecting the whole community. And it's impossible to say if a health care worker does contract COVID. Well, was that from work? Was that because they went to the store or went to a nightclub? We know that everyone is at risk. We're all in this together. And what we're doing within our health care systems -- Al's, Luke's, West Valley, everybody -- is really trying to limit exposure to patients, to colleagues, to everyone through good safety protocols.

GAUDETTE: And Dr. Schulte, Leslie's other part of our question was this. Are we really seeing the correct numbers for ICU and hospital admissions?

SCHULTE: Yes, I have no reason to believe that we're not seeing the correct numbers. Certainly speaking for Idaho, I know St. Luke's is tracking the numbers in real time. And we're closely collaborating with our state and local officials to really provide an adequate representation of what our capacity for care is and to allow for planning. And for the second part of the question. It is the truth that, you know, a lot of patients that are requiring admission to the hospital have are sick and are at risk for developing that most severe kind of illness that requires support in the intensive care unit. We've actually observed in the United States in our numbers, at about 19% of those that develop symptoms with COVID do end up requiring an admission to the hospital and approximately 6% of those to end up having the most severe form of the illness.

And one thing I would like to stress in this answer is, while it is certainly the fact that younger adults are less likely to die in the course of this illness, also developing very, very severe courses of illness and even those that are fortunate enough not to require admission to the ICU, if you talk to them afterwards, if you've had the opportunity to speak to somebody that's incredibly poorly, they still have a significant road for recovery, which is even longer for those who end up requiring support with breathing in the ICU or have other organ damage from the virus. And I really want to stress the point that that severe course of illness is present in all ages. We do know, unfortunately, that disproportionately older people are more affected in terms of their risk of dying from it.

GAUDETTE: And Dr. Heyborne, Elizabeth has this question. She says, wondering where one can acquire a free COVID-19 test in Ada County and other parts of the state. I witnessed a young man walk away from getting a test on at an instant care in Nampa because he did not have insurance or money to pay for the test.

HEYBORNE: Yeah. Thank you, and that's unfortunate for that individual as well as the rest of us who, you know, want to make sure we're appropriately identifying patients and making sure they can get treated appropriately. And so, you know, I can speak largely from our health systems perspective, our tent clinics, where we can screen people and perform tests, where appropriate, are up and running still there in Meridian and Nampa at the Garrity Clinic in the Meridian Health Plaza. And we don't turn individuals away at those facilities. Insurance is largely covering these things at 100% or close to it. Uninsured individuals, there are resources through the government with the CARES Act. And currently we are not turning around or balance billing, so to speak, individuals that don't have the ability to pay.

GAUDETTE: It's critical that if you think you need to get tested, you get tested. But I mean, that is an issue if you don't have insurance. So would you, Dr. Heyborne, I mean, would you say, like, have someone, if there are at a clinic like this, talk to the people there. I mean, see what they can do. I mean, the last thing we want is someone walking away who may need a test.

HEYBORNE: Yes, absolutely. There should be information available there. And to clarify, I mean, right now our statement is we are holding any uninsured patients liable for charges associated with the screening for COVID. So definitely talk to the people that are there. Tell them your situation. We're all in this together and want to support one another.

GAUDETTE: Now, Dr. Heyborne or Dr. Schulte, either of you, Katie, literally just sent us this question. She says, We hear that the time in which you can contract COVID-19 after exposure is 2-14 days. Is there a time that is most common to contract the virus? Five days, 12 days? Also, is it even longer than 14 days after contact?

SCHULTE: This is Michaela. I might jump in to take that question. My understanding of the disease illness that there is sort of the 4-5 day period of time where we see similar to other transmissible diseases where patients do develop symptoms. The tricky aspect of that is that you may already be infectious. Those couple of days prior to you developing the symptoms. So that makes this question a little more difficult to answer. It is my understanding, from what I know about the literature, is that beyond 14 days, it is really highly unlikely. And I don't think we have really any evidence to suspect that people would take them longer to develop the disease. So when we ask people to self isolate, the 14 days are really already a fairly conservative measure. Probably it's within 10 days. Most people will have developed symptoms should they have been exposed. And I don't think we have any evidence or reason to believe that beyond 14 days that that would be then a risk.

GAUDETTE: Dr. Heyborne, Todd sent us this question. He says, I have read on the CDC web site that the virus has not been documented to spread through food. If a group of people is sharing food, say, passing around a piece of cake and everyone is taking a bite using their own forks, what are the chances of spreading the virus that way?

HEYBORNE: Yeah. Thank you. And with everything with this virus, I mean, we're continuing to learn about it. It is correct that it's generally not felt to be transmitted directly from saliva into the GI tract, for example, through the mouth. However, it is carried in those those droplets. And the real risk is being close enough to somebody without a mask because you're eating cake to get, you know, droplet transmission into your nose and other other areas where it can take hold. And so, absolutely, sitting in a circle, passing around cake, you know, the likelihood of you being exposed to the virus some way or another if someone in that group has it is not insignificant.

GAUDETTE: Dr. Pate, Ingrid sent us this. She says, What is the status of contact tracing in our area? How are cases responding to follow up?

PATE: So the state has significantly ramped up their contact tracing abilities, both in staff but also using technology, because as you heard Dr. Schulte comment about how long it is from being infected to developing symptoms, we generally have to follow these people who may have been exposed for a couple of weeks and we check daily for their symptoms while we're now using a technology called Sara Alert where it gives people an option. Do you want a person to call you? Do you want to just do this online? And it gives them a very quick way that they can input are they having any symptoms? And we can keep track of that. So our capabilities are certainly increased. 

Now, there is a limit to that. And of course, the best thing we can all do is to minimize the spread of this virus. If we get like some of these other states and of course, you overwhelm your ability to do contact tracing. As far as how people are receiving it, most people are very cooperative, understand what we're trying to achieve. Of course, we all know that there are those Idahoans that are very fiercely protective of their independence, including their information, and they don't want somebody checking on them. Certainly that's the minority. But overall, I would say it right now, we're in pretty good shape.

GAUDETTE: Dr. Heyborne, Tony had this question. Why are test results taking so long?

HEYBORNE: Yeah, and this is a challenge we're all facing. And there are many different platforms we can do testing, we have and every one of our hospitals throughout the valley that I'm aware of, [inaudible] others have testing that we can do internally. We have rapid testing. We have testing that's a little more delayed. We have multiple machines and platforms that can do that. The state has platforms. We're partnered with external labs that can either run them off site in state or send them out of state. And so I say all that, that we're pursuing every option we can to have testing. At the same time, the volume has spiked, you know, working out at some of our tents. We went from seeing at the nadir of this, dozens of patients to seeing hundreds of patients. And so it just becomes a bit of a traffic jam. And in that type of scenario, results get delayed. We're actively working to shorten that, though.

GAUDETTE: And then, Dr. Schulte, Kim has this question. If you were COVID positive, how do you know when you are no longer contagious?

SCHULTE: So that's an excellent question. So generally, we would consider somebody to be no longer contagious if it has been a minimum of 10 days since it first developed symptoms. And in addition to that, it has been at least 72 hours, so about three days, since their fever resolved. And that is obviously without taking fever reducing medications like Tylenol or ibuprofen. And in addition to that, if they had respiratory symptoms like cough or a hard time breathing, that those are also improving. So under those circumstances, we can fairly safely assume that somebody is improving. There are a few people, however, that only have a positive test and very little symptoms. So for the majority of those people, we do assume that the 10 day mark would be relatively safe to assume that they're no longer infectious to others. For those patients that know that they might have a weakened immune system, however, there's a small risk that they could potentially carry the virus for longer. So it always makes sense to check with your health care provider in this setting. However, we do have now some studies that have shown that while somebody might still test positive for the genetic material of the virus, those are those PCR tests that we are referring to many times, those nasal swabs, it has not been demonstrated that a virus can live or is viable beyond that eight or nine day mark after people have developed symptoms. So we're feeling fairly confident that for the vast majority of people, 10 days of illness, when all of the other symptoms are improving, are fairly safe and should no longer spread the virus.

GAUDETTE: Dr. Pate, this e-mail came from someone who wants to stay anonymous, so they write. I was wondering if you could talk about the reliability of antibody tests, particularly how far back they can go to detect whether you had the virus in the past few weeks, a few months. Also, does it detect anything if your antibody count was never high enough?

PATE: Well, that's very interesting questions, especially in light of some recent studies. So, first of all, antibody tests vary greatly. Some are certainly better than others. But it's also important to note that none of these have been independently verified by the FDA yet. So we're kind of relying on their own internal studies as to how good they are. The other thing that I have repeatedly cautioned people in Idaho about is because we have had suspected much lower prevalence than many parts of the country, we are also at great risk of people receiving a false positive test. In other words, a test that says you have antibodies but you really don't.

As to how far back, if you'd asked me this a couple weeks ago, I would have said if you had COVID at any point during this pandemic, the antibody test was likely to show it. Unfortunately, we've had a study come out just in the past week that showed actually  it appears that the antibody response is more short lived than we even suspected. And that after two to three months, there may be a significant decline in your antibody levels. So I certainly think if you have an antibody test now, if you've had it, it will probably confirm that you've had it. If we do it this fall and you actually had COVID back in February, I'm not confident that it will be able to reliably tell you that. So right now, I don't recommend that individuals get an antibody test. We just don't know what to do with it. We don't know what it means. Even if it does mean immunity, we don't know how long it lasts. There's just too many unanswered questions.

GAUDETTE: Well, and you don't know even if you have the antibody test, right, Dr. Pate, that you've actually had COVID-19?

PATE: That's right. There appear to be cases where people have been infected with COVID, and yet they mount a very low antibody response. So the test may not pick it up. That's called a false negative. In other words, you did have COVID with an antibody test will show up negative. And then there's the reverse where you didn't have COVID. But the antibody test could actually suggest you did. And we suspect it's picking up other things like other coronaviruses that are common, like the common cold, other things like that. So it's just not reliable enough. It hasn't been independently verified and we don't really know what it means. So right now, I would just encourage people, save your money.

GAUDETTE: We literally just got this question. And it's from a child care provider who would like to remain anonymous. And they ask, could your guest please address the risk to child care workers and the threat of exposure from very young children who cannot practice social distancing? Is -- this is my own take -- Is this a problem? Because we don't know, do we, know if children could be carriers and not and not get it because we are seeing pediatric cases of this?

PATE: Well, this David Pate. I'll take it. So you're right. We don't understand stand the role that children play in this disease. Children, by and large, are much less likely to get symptomatic. We don't know whether they are much less likely to get infected. It does appear that the younger you are, the more likely you are to be asymptomatic, to not have symptoms. So certainly younger people can be infected and are more likely than not not to have symptoms. So, as Dr. Schulte had mentioned before, one of the things that is so challenging about this virus is the fact that if infected, you can spread the virus for a day or two before you show any symptoms if you're going to develop symptoms. So we really don't know the role of children that they play in this disease. You're quite right, Gemma. We do know that children can get infected because we've seen this disease in children as young as a few months old. But we don't know the just the the extent of that.

I think the scary thing is, is that children can be infected and probably are much less likely to have any signs of it. So we do need to take precautions with children. If you're someone that takes care of children, then obviously age appropriate, whatever you can do to teach them about good handwashing, about not to pick their nose or those kinds of things, cover their sneezes, that kind of stuff, whereas possible. That's good. Frankly, we're also concerned about the reverse, and that is are some of these child care workers doing things where they're getting themselves infected and may be asymptomatic? And could they be transmitting it to children who are then taking it home? We simply just don't know at this point.

GAUDETTE: And one thing, though, that we're doing in our house, frankly, is not taking our kids to a lot of places. Just to try to to to limit their exposure. You know, I have a twelve year old or an eight year old, and we make them wear a mask. But, you know, I don't drag them to the grocery store like I would have before this. So, I mean, I would hope that those things help, too, right. Is limiting their exposure.

PATE: Absolutely. I commend you, Gemma, that's the right approach, I think.

GAUDETTE: For one of our doctors. This just came in to our email and it says, I need to remain anonymous. Where I work, management will not wear masks. How best can I protect myself? Dr. Heyborne, maybe you can take a stab at that.

HEYBORNE: Yeah, I'm glad to. You can best protect yourself by wearing a mask yourself. Like I said, even though it can primarily protect those around you, it also does provide some protection for yourself, maintaining that social distancing. And, you know, it may involve some some tough conversations. I see what you're doing. Here's what I need to do to protect myself. And I hope for your sake that your employer respects that. So masking, social distancing, good hand washing, the same things we should all be doing.

GAUDETTE: And Dr. Schulte, Chris has a question is somewhat rhetorical to this to that last person's question, but says, why doesn't everyone see that the fastest way to get the economy rolling again is to use the only tool we really have: Personal responsibility and looking out for each other? I continue to be amazed at the number of people in enclosed spaces like stores and businesses that don't wear masks and seem heedless of social distancing.

SCHULTE: Yes, well, that would be wonderful if I think we all share the same perspective on this, like we touched on before. And it has been quite interesting to see how quickly the wearing of masks and that awareness of that physical distance has dropped off after, you know, our numbers went down and the reopening took place. And I think it's a really -- it's an understandable desire to return to some sense of normalcy for a lot of people. And that's been also a lot of conflicting information out there and the news outlets, certainly on social media from various authorities. That has not helped people to really probably fully understand how important these issues are. And, you know, in addition, I would say that we -- and when I say we like everybody here in Idaho, this entire state together -- we did a fantastic job in crushing that initial first wave to the point that it probably makes it somewhat difficult for some of our people to understand and realize the true severity of this threat, right, it seems like almost we had cried wolf. So we now have, I think, an opportunity to really lead by example.

And echoing what Dr. Heyborne was just saying, you know, wearing a mask, encouraging others to follow us, you know, appreciate those that are doing the right things and appreciate them for their efforts to assume that responsibility. Like you just said and shared, Gemma, that you're not taking your children everywhere and you're trying to be very mindful. And then for those who are struggling with, you know, accepting these recommendations, we probably need to try to engage in a really earnest conversation, understand where they're coming from. You know, if we become judgmental and jump outright ahead and attacking people, they can't help but become defensive. And I don't think that is constructive. So really thinking about how can we invite people to listen to their perspective and then open up the opportunity that they might be willing to share ours and really have some constructive dialogue around that.

GAUDETTE: And Dr. Pate, this goes into another question that came into our e-mail. There are people who continue to post on various sites, most recently on NPR's Web site, that the virus is a hoax. Others declare they won't wear face masks because it's unpatriotic or, one woman posted it will lower your natural immune system's response to illness. And she's not planning on getting vaccinated either. So what do you tell people who believe these things? Is it worth even responding to? Because I do agree with Dr. Schulte that you can't attack, but this affects all of us.

PATE: Well, it does. And let me take each of those three points in order. You know, the people that believe this is a hoax: I think that my experience is the vast majority, we're not going to convince them otherwise, they're not really open to the facts. However, I would ask them one question, and that is, if you believe this is a hoax, then what you're talking about is an incredibly massive conspiracy, because every single country in the world agrees that this is really happening. Every medical and nursing organization agrees this is a real thing. The CDC does. And frankly, at a time when we can't get Republicans and Democrats to agree about hardly anything, both parties, including President Trump, even agree there is this coronavirus. There's an argument about how serious it is, but everybody acknowledges that it exists. So I think, you know, you just ask people, is that even credible to believe a conspiracy on that scale?

Secondly, about masks being unpatriotic? What I would say is it's exactly the opposite. If you want to be patriotic, wear a mask. And the reason is our country is founded on capitalism and that the backbone of capitalism is small business. Wearing a mask or face covering is how we keep businesses open. We see what happened in the Boise bars and nightclubs when people did not wear face coverings or masks and did not physically justice. It shut those businesses down. Not all of those businesses may recover. And many people lost their jobs. How is that patriotic?

So finally, the last bit about, afraid that the mask or the vaccine is going to lower their natural immunity. That's completely incorrect. So it probably stems from the fact that with children, we have found it's not best for their immune systems if we keep them in a perfectly pristine environment. It's actually OK for them to get around some dust or dirt and other things. But that doesn't mean you expose your children to something that can kill them. I mean, and it shouldn't mean that we do the same for ourselves. So first of all, wearing a mask has no effect on your immunity. The second thing is the vaccine. Vaccines have actually shown to promote immune responses. In fact, there's some other vaccines that appear that even though they're not great for this corona virus, they actually probably do contribute to assisting the immune response. And finally, I would just say, if if you care about other people, wear a mask and get the vaccine when it's available.

GAUDETTE: Well, I'll tell you that it's a lot different to let my kid go and eat dirt in our backyard than to put him in a you know, in a bar or restaurant full of people who aren't social distancing and not wearing masks.

PATE: Right, exactly.

GAUDETTE: It's two different things. I want to thank all three of you for coming in today. I know how busy you all are, especially as we see these rising cases. But thank you for continuing to to support our program. All three of you. And coming in and talking with us and answering our listener questions. They're coming in fast and furious these days. I really appreciate it. We've been talking with Dr. David Pate, Dr. Ryan Heyborne and Dr. Michaela Schulte about where we are in response to COVID-19 here in Idaho. Thank you all so much.

ALL: Thank you. Thank you. Thanks Gemma.

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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