Thanksgiving is tomorrow, and as Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce urges, it's not too late to cancel your gathering.
Dr. Pate joined Idaho Matters to update us on coronavirus news and answer your listener quetsions.
Have a question you want Dr. Pate to answer? Email us: firstname.lastname@example.org.
Read the full transcript here:
TOM MICHAEL (host, in for Gemma Gaudette): You're listening to Idaho Matters, I'm Tom Michael filling in for Gemma Gaudette. Boise State Public Radio News has been covering the coronavirus pandemic since it began. Your questions keep evolving. Here at Idaho Matters, we do our best to answer your questions with Idaho medical experts every Wednesday for our Doctor Roundtable. So if you have a question during the show, feel free to send us an email. Address it to email@example.com. Well, our roundtable is a bit smaller today on this holiday week, but just as large in stature. Our guest is Dr. David Pate, former CEO of St. Luke's Health System, a current member of the Idaho Coronavirus Task Force. Good to be with you, Dr. Pate.
DR. DAVID PATE: Same here, Tom, thanks for having me.
MICHAEL: We wanted to first talk about a letter circulating by Dr. Jim Souza of St. Luke's, in fact, you addressed this during Leadership Boise last week with Dr. Souza at the meeting. He talks about how their modeling predicts in December our hospital systems will be at the brink. He writes, quote, "The full spectrum of care will not be available to everyone if we are resource-constrained." So even though it may seem obvious to you, explain to us, because bone doctors work on bones, ENTs work on ears. Why would hospitals treating a pandemic surge mean these other types of health services might be denied?
PATE: Yeah, Tom, this is really an important point, and I suspect few Idahoans really understand the gravity of the situation. So what happens is that if a hospital in Idaho gets overwhelmed or doesn't have the ability to take care of a patient, then what we often do is transfer those patients to another hospital in Idaho. And some of the sicker ones, of course, are often transferred here to Boise, either to St. Luke's or St. Alphonsus. And as you indicated, what Dr. Souza said was that St. Luke's own projections, and I don't think those projections even take into account what acceleration there might be by Thanksgiving and by the soon expected influenza epidemic, are showing that sometime in December, St. Luke's hospitals will be overwhelmed. Similarly, St. Alphonsus data shows that in January they'll be overwhelmed. So we have several problems. Number one is patients that need that higher level of care that is offered by St. Luke's and St. Al's in Boise, they may not be able to transfer those patients here. But also we are seeing hospitals throughout the state getting to this point of soon predicted being overwhelmed.
So what we do in that case is we then transfer patients out of state. Obviously, that causes delays in care and adds a lot more expense because usually that means patients have to be sent by helicopter. In this part of the state, we would typically send patients to Utah. But for a month now, Utah hospitals have told us they're overwhelmed and can't take patients from Idaho. And I believe Montana hospitals for the eastern Idaho states are indicating they are at that point or very close to it. And then we have heard from Oregon that it appears that they are headed to the point of being overwhelmed. They're not there yet. And then the University of Washington just indicated they're going to stop doing elective procedures because they're starting to feel the pressure.
So I think what people don't understand is that when we say these hospitals are going to get to the point of being overwhelmed, that doesn't just mean if you have COVID, it doesn't mean that we're not going to have hospital beds or staff or ventilators for patients with COVID. It means we're not going to have that capacity for anyone, whether you are having COVID or whether you're having a heart attack or a stroke or you're in a motor vehicle accident. And so I'm not sure people understand this and I'm not sure people understand the desperation that families feel because I've seen it and I've experienced this. When a family is in an emergency room of a hospital that doesn't have the ability to take care of their loved one and cannot find a hospital that they can transfer the patient to to get the necessary care.
And so while our hospitals are certainly trying not to be alarmists and get people overly concerned, so Dr. Souza was very careful in his wording, as he always is, what the real concern here is that that means that if there are limited beds, limited ventilators and myself and somebody else are in the emergency room and we both have very severe disease and we both need that ICU bed and a ventilator is probably going to go to someone younger than me.
And that means that we are going to see people that won't be able to get that care, we'll try to make them comfortable, but they're not going to get all the care and resources that they ordinarily would. And they very well likely going to not survive.
MICHAEL: Well, thank you for that thorough answer. It's quite a chilling scenario. We did want to get to some of our listener questions, and this is probably based on recent reports that claim immunities might even last for years. Lee and another listener want to know.
LISTENER QUESTION: I've heard conflicting information about if and for how long you may be immune from getting COVID once you have had it. Is there a somewhat standard answer to this?
PATE: Well, I'm afraid there's not, and that's because we still don't know the answer to that question. First of all, there's going to be two different types of immunity. There's going to be the immunity that someone gets from actually having COVID, and then there's going to be the immunity once we have the vaccines, that's from the vaccines. We believe the vaccines will induce a better and a more durable immunity. But we are waiting on that data. The reason that we don't have a clear answer is because of a number of factors. One is we are seeing that not everybody does make antibodies after they've had COVID. And it appears that may be in part related to whether you had a mild infection or even asymptomatic infection or whether you had a severe infection. Those people having severe infections being more likely to have them. But we've also seen studies showing that those antibody levels fade over months. We certainly have seen some recent studies that give a little bit more optimism that perhaps that immunity could last seven months or longer.
But we also have to counterbalance that with the fact that we have seen very well documented cases of reinfection and we have seen people reinfected in as short as 45 days. So my guess is, is that the immunity level that you're going to get from actually having COVID is going to be variable. Some people will probably have better immune response than others. Some may be protected for longer than others. But very few of us believe that just from having the COVID infection, that you're likely to be protected for a matter of a year or more. We think more likely in terms of months. We are waiting for the data from the vaccine trials. It does look more favorable. However, most of us are thinking even with the vaccine, we're probably going to need an annual booster, very similar to the flu shot where we get an annual flu shot.
MICHAEL: We're speaking to Dr. David C. Pate, featuring your questions about the coronavirus pandemic. So speaking of vaccine, Bill sent us this email.
LISTENER QUESTION: It seems they'll be more than one drug for immunization against COVID-19. So how will health officials decide which one to distribute? Will we have a choice? Will there be a standard of qualification for all the vaccine candidates?
PATE: Yes, in a time when we haven't had a whole lot of good news, we have really gotten a lot of good news lately about vaccines.
MICHAEL: That's true!
PATE: Very good news. And, in fact, better than really what my wildest dreams were. So we're seeing so far that not only does it appear that we will have safe vaccines, it appears we're going to have a highly effective-- Now, mind you, we rarely see a vaccine that's 100 percent effective. My hopes were that they would be 70 percent effective, and my wild dream was that they would be 80. We're seeing vaccines with 90, 95 percent effectiveness. This is just fantastic news. And as your listener points out, we're seeing multiple vaccines, which is really good because there is going to be a challenge in producing enough vaccine for everybody, especially since most of these vaccines are going to require two shots. So the more vaccines that we have means, the more people that are manufacturing the vaccine and therefore the greater supply.
So to answer his question, first of all, I do believe the state will be enrolling providers to administer the vaccine. And I think we will be getting all of the different vaccines. Some providers may not choose to get, for example, the Pfizer vaccine because it has some pretty strenuous storage and handling requirements. But I do think throughout Idaho we will have many options. A vaccine, I think people will get to decide which vaccine they would like. It may be that as we get the data in, we'll find out that some vaccines are better suited for certain populations than others. For example, there might be some that are better for the elderly or some better for children. And so you'll be able to make those decisions in concert with your doctors. And while not every provider may have all the vaccines, I think you can, if you decide you want a particular vaccine, you'll be able to look around town to see who has that vaccine and you'll be able to get that vaccine if that's what you'd like.
MICHAEL: So Dr. Pate, this regular listener has a question. And it is this, quote:
LISTENER QUESTION: I recently heard from a guest on an NPR program that part of the reason masks are important in preventing droplets spittle from landing on surfaces that are then touched by people who in turn touch their eyes. Can you talk about transmission through contact with the eye? And a follow up is we are often told to wash our hands. Why not our faces too.
PATE: Yeah, so it's an interesting question. We do believe that the virus can enter the body through the lining of the eye and we have very few documented cases of that. We do have some where that was particularly suspected to be the route. We think most often that would be by virtue of having the virus on your hand and rubbing your eye or in medical settings where people are expelling fluids, particularly when we're doing procedures and where that fluid might get into the health care workers' eyes. That's the reason why we use face shields in hospital settings. So it is a potential entry for the virus. We don't think it is common or widespread, but we just really don't have a lot of evidence about it. So we do think it's very important to wash your hands, particularly before touching your face. We certainly would not discourage people from also washing their faces. But the big thing we think is more often is that the hand introduces into the mouth, nose or eyes rather than it being directly introduced there.
MICHAEL: Well, here's a timely question. Jim just emailed us with this:
LISTENER QUESTION: My daughter's roommate, an ICU nurse at a local hospital, flew to another state to have Thanksgiving with her family in three different households. How can my daughter protect herself when her roommate returns?
PATE: Wow. Well, you know, that is my big worry. We have been giving the caution for this Thanksgiving that we really don't think it's safe for people to travel right now, and especially not by commercial transportation. So we do think that's high risk. And then, of course, in addition, if that person is going to go around and be with three different families, then certainly they're significantly increasing the risk of exposure. So what would ideally happen is when that person returns here, that that person would go and quarantine somewhere separate from the roommate and quarantine for 14 days, because just in the case that the person was exposed and then developed symptoms and by that time, even if they did, we don't think they would any longer be contagious. I'm guessing if this person was not being careful enough to take our advice not to travel and not to be with these other families, that that person is probably not going to be willing to quarantine either. So my advice would be, unfortunately, probably for that roommate, if that roommate can figure out a place where they can go for that period of time to be away from their roommate when they return here, that probably would be the best.
MICHAEL: Dr. Pate, there are recent news reports about some places really hit with a surge, you know, almost throwing up their hands on contact tracing. So D.J. sent us this email.
LISTENER QUESTION: Please ask about contact tracing and if the state is doing anything to increase capacity. As far as your role on the task force, what's the status of contact tracing today?
PATE: Yeah, contact tracing is becoming increasingly difficult for a couple of reasons. First of all, is just the sheer magnitude of cases that are occurring in Idaho. And contact tracing is actually kind of a laborious and time-consuming effort. So it really does put a significant stress on our ability to do contact tracing when we have so many infections.
But the other consequence is when we have this much spread in our community, it actually is pretty difficult on the contact tracing to figure out which of a multitude of possible ways the person was infected was actually the cause of the infection. So it's harder to do and keep up with, but it's also harder to actually figure out the sources of infection when it's this high. What the state is doing is, first of all, the state has adopted some technology that helps us with the latter part of contact tracing, mostly the daily check in with people that are quarantining to determine if they have symptoms. And we can use technology that relieves the demands on that otherwise would be people having to make these calls. So we're using that technology and that is certainly helping.
The other thing that we are doing is the Medical Corps Reserve has been mobilized and they're helping. Additionally, we've had nursing students and medical students volunteering and helping, and we're including some other volunteers. But still, it is very, very difficult, very challenging, even though we have the technology and we are getting more and more volunteers.
MICHAEL: Great, so Todd wants to know if you can put a rumor to rest:
LISTENER QUESTION: Hearing that people telling him that hospitals are inflating the numbers of people who die from COVID because they, quote, get more money if someone dies from COVID and the argument usually goes along something like this. If someone dies from another primary cause, but also has COVID, then they are classified as dying from COVID. Hopefully you can address that. And also specifically, if someone does die from multiple causes, one being COVID, perhaps, how is the official cause of death determined?
PATE: So when a doctor determines the cause of death and reports that on the death certificate, we look at what was it that precipitated the death? So, for example, it could be that, let's say I'm a cancer patient and and let's say I have a terminal cancer and it is projected that I will not survive more than a year. However, if I were to get COVID right now, even though we don't expect that my cancer would kill me for a year if I got COVID right now and I died, then the cause of death would be the COVID. COVID is why I died, even though if I didn't get COVID, I also would die. But I wouldn't die for a year. And if I didn't get COVID and I died in the year, then my cancer would be the cause of death. So I think people that have concerns that COVID is being ascribed to deaths where COVID was not the cause of the death are largely misguided, so that's the first thing.
The second thing is that there is this rumor, unfortunately, perpetuated by our own president that health care providers are exaggerating the number of COVID patients for financial purposes. First of all, let me just point out that would be illegal and subject organizations to huge penalties. And that law has been on the books for a long time. So I certainly doubt that there is much of that going on. Health care providers are very aware of what the extreme consequences for doing something like that would be. And obviously, I don't think the president really had any evidence of that, because if there was evidence of that, he would be having his Justice Department investigate those hospitals and providers. And obviously, it wouldn't be appropriate for the president to be making comments if there was an active investigation. So I think a lot of that was driven by the fact that it certainly would be in the best interests of the president and his reelection for people to believe that these case numbers were inflated. They're not back to the point about what the financial incentive is. It's only relative to Medicare and what Medicare does. Medicare pays hospitals, what we call case rates. In other words, when a Medicare patient comes into the hospital, we typically get a lump payment if it costs more to care for that patient. And it often does. You lose money. If it costs less, you make money. Most hospitals across the country lose money on Medicare patients. And what is the difference about COVID is that the condition that leads to prolonged hospital stays for Medicare COVID patients is respiratory failure.
When Medicare set the case rate for that, they did it based on the usual kinds of respiratory failure, where these Medicare patients may only be in the ICU for a few days on the ventilator. With COVID, we find that these patients are often in the ICU and on the ventilator for a couple of weeks, so every hospital would lose money on COVID patients.
This incremental payment for Medicare patients with COVID was meant to try to help prevent more hospitals from going under. We're at big risk. There's a lot of hospitals that are financially going out of business this year, particularly because of COVID. No hospital that I'm aware of is doing better than they otherwise would have because of COVID. So yes, it is a lifeline to hospitals, but it is not a financial boon to hospitals.
MICHAEL: Well, thank you for addressing that. Dr. Pate, to close, I've just gotten over a bout with COVID, my family's past the quarantine stage and obviously, while I need to be focused on those severe cases, since that's what leads to hospitalization, as you said, we don't always talk about the mild cases. But if I may be allowed, my personal question to you is this what are the long term prospects for bad effects on my heart and on my lungs?
PATE: Well, Tom, you know, I'm sorry that you got COVID, and I certainly hope that you don't end up having long term effects. We have several things that we have to watch for. Certainly, there have been reports that you're alluding to, for example, of myocarditis, which is an inflammation of the heart and which can range from being something you're totally not even aware of to something that, frankly, could kill you.
And we don't know the general population frequency of this. It's mostly been looked at in athletes and particularly young athletes where their hearts were scanned prior to them returning to play. We don't generally do that. So we're not quite sure what the general risk is, but we certainly see cases of that. And so it certainly is a possibility. But we don't know your exact risk of getting that.
In addition, when you talk about the lung, you know, there is a condition that is really concerning to us where the lungs scar. And we certainly have had cases of that. Not many, thank God, but we don't know over time how many will see. In fact, we've seen it bad enough that there are a handful of patients that have had to have lung transplants after COVID. But certainly that seems to be a very low likelihood.
The other long term effect we deal with is the so-called long haul syndrome, which is people that don't have those specific conditions but are young and healthy people who have long lasting and I'm talking months of really severe fatigue. Even though they were young, athletic, active, they may not be able to climb a flight of stairs without being short of breath, without having chest pain. They have a variety of symptoms, including some mental fogginess and so forth. And the estimates on that is 10 to 20 percent of people that had COVID.
So what I would tell you, Tom, certainly just going with statistics, the most likelihood is you'll be perfectly fine. However, there is some percentage, perhaps is this 10 to 20 percent, of instances where you might have a complication or a long lasting effect from COVID. And I pray that won't happen to you.
MICHAEL: Thank you, sir. We've been speaking with Dr. David Pate, a current member of the Idaho Coronavirus Task Force.
Up next, we go behind the scenes to speak with the Boise epidemiologist about her research at the VA Medical Center. I'm Tom Michael and you're with Boise State Public Radio for Idaho Matters.
On today's episode, Dr. Pate first addressed the recent letter from Dr. Jim Souza of St. Luke's that is circulating in the community. If the coronavirus surge were to continue, argued Dr. Souza, there would be dire consequences at Idaho hospitals for even non-COVID patients, writing “the full spectrum of care will not be available to everyone if we are resource-constrained.”
Dr. Pate also addressed listener questions about the length of time that immunities may be in your body after you have recovered from SARS-CoV-2, how the rollout of vaccine options may occur in Idaho and how the state is going about contact tracing. He also put the rumor to rest that hospital profit from treating COVID patients.
A listener named Jim was worried about his daughter after hearing her roommate was flying to another state for Thanksgiving. Another listener asked if the virus entered the body through the eyes. Lastly, Dr. Pate addressed a personal question about the long-term effects of COVID to the heart and lungs, even after a successful recovery.
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