Idaho Doctors Address Your Vaccine And Faulty Testing Questions

May 20, 2020

 

Idaho Matters is back with our panel of Idaho doctors to answer more of your COVID-19 questions. This week, they cover questions about a rapid coronavirus diagnostic test that has come under scrutiny, Idaho's low testing rate per capita, possible longterm effects of severe cases of the virus, symptoms to watch for in your children and much more. 

Here's who joins Idaho Matters this week: 

  • Dr. David Pate, part of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s.
  • Dr. Meghan McInerney, Pulmonary Critical Care Physician with Saint Alphonsus.
  • Dr. Michaela Schulte, Internist with 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.

 

Read the full transcript here:

GEMMA GAUDETTE (HOST): You're listening to Idaho Matters. I'm Gemma Gaudette. As we continue to cover the coronavirus pandemic, we do know many of you have questions, you have concerns. And here at Idaho Matters, we want to answer those questions. We want to do it with facts. And we found the best way to do that was to bring in medical experts. So every Wednesday, if you've been listening, we bring in a panel of doctors and other health professionals to get us updated and to answer our questions. If you're a regular listener, think of this as kind of like the Friday Reporter Roundtable, but the medical version of it. So joining us today are Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of the Idaho Coronavirus Taskforce, Dr. Michaela Schulte, an internist with St. Luke's, and Dr. Michele McInerney, a pulmonary critical care physician with St. Alphonsus. Thank you all for being here today.

ALL: Thank you. Thank you, Gemma. Thank you.

GAUDETTE: And a quick note right after the show. Today, we're collaborating with the Mountain West News Bureau to continue answering your coronavirus questions with a Facebook live event. So if your questions don't get answered here, head on over to the Boise State Public Radio Facebook page at 1:00 and pose your questions live. Dr. Pate will be one of the panelists on that. So with that, Dr. Pate, can you keep us updated on the very latest with the governor's task force and where we are right now?

DR. DAVID PATE: Well, thanks, Gemma. So, as you know, the governor announced we have moved into Stage 2 of his reopening plan. And so the task force is continuing to monitor our situation, make sure that we don't see an uptick in cases. Make sure that we don't see any other signs that would alarm us that we've opened up too much or too fast. But -- and I'm not going on wood over here -- But so far, so good. And it appears that things are doing relatively well. And of course, that is thanks to Idahoans. It's thanks to all of those people that are taking this seriously, are social distancing, are wearing their face coverings when they're out and about and are trying to minimize travel and washing their hands and all the things that we know that help decrease the transmission of this virus because it's still out there.

GAUDETTE: Well, with that being said, Dr. Pate, according to the Kaiser Family Foundation, Idaho is actually forty ninth when it comes to testing per capita. Apparently, Maine is the only state testing less than us. So how is the governor and the task force, frankly, dealing with this issue of testing?

PATE: Yeah, so and that is a key thing that we're focused on. Testing is very multifactorial. So, for example, when people think of testing, they just a lot of times think about what goes on in a lab, but before a test gets to the lab, someone has to collect that specimen. And that generally means that they need PPE to wear to protect themselves. You need the swabs. You need the viral transport medium. And then you have to get that specimen to the lab. And then the lab needs the reagent to run the tests, plus the capacity to run the tests. So there's a lot of things. And at times over the last couple of months, there had been shortages in one or more of these key ingredients. And this is one of those things that kind of like the old saying, no good deed goes unpunished, Idaho has done so well in controlling the number of our cases that we have been de-prioritized relative to other states for shipments of these critical supplies. And that makes sense to get those supplies to the places that are the hot spots. But Idaho has fallen very low on that list. Now that there is improvement in most places across the country. The supply is being increased. Not only that, but some of the hospitals have now acquired high throughput testing. So, for example, a machine that St. Luke's has gotten and I believe St. Al's and the V.A. may have gotten similar equipment, can now do up to two thousand tests per day. So our capacity is increasing. Plus, we've been notified by the federal government that they are going to start sending us supplies every month now. And so that's going to help. So our situation is getting better. The Governor's Work Group has also created a testing task force that has come out with specific recommendations. And I'm hopeful -- we're reviewing that guidance right now -- I'm hopeful that that may be able to be published this week or next. And we'll have more information on that.

GAUDETTE: And Dr. Schulte, I'd like to bring you into the conversation because I guess according to an NPR report, St. Luke's uses the Abbott Laboratories ID NOW Rapid Test. And the report from NPR was that a Cleveland Clinic study came out showing that there could be a 15% rate of false negatives. So meaning that, you know, there could be people walking around thinking that they don't have COVID-19, maybe they do. So how confident are you that false negatives are not happening at St. Luke's clinics here in our state when folks are getting tested?

DR. MICHAELA SCHULTE: Thank you for that question, Gemma. Yes. Here at St. Luke's, one of the platforms that we are using is the Abbott ID NOW. We actually only run it in our laboratories. We're not running it in our clinics currently. And as I said, it is one of several platforms that we're using this particular one is actually providing us with the results in a few minutes, which can in certain instances be very helpful when we need to make some clinical decisions very quickly that would alter our management. And we are really, truly reserving this particular platform for the use of those patients that are presenting symptomatically where we do feel that if, for example, they would require admission to the hospital or we're trying to decide which route to go next with testing, it would impact that decision. Now, just to be also very clear, as you already said, that there are no concerns that a positive test in this case is indeed a positive coronavirus test. But there has been some concern that patients that had low viral levels might not be caught accurately as already COVID-positive on this platform where other platforms might have already indicated the presence of the disease. So what we are really looking at is still a learning curve of understanding a little bit more where this platform lands. My understanding is that the FDA is currently looking into it and they have received 15 of such reports where this platform was not providing accurately negative test results and those patients were actually positive. And they're also right now asking the manufacturer, Abbott, to review these and do some additional studies. We have run our internal validation or correlation studies where we have after we became aware of this test at the same patients, again on a different platform. And we have not found any discrepancies at this point in time. So I think we can be fairly confident that those negative tests are indeed negative tests. In addition, as physicians, we are very well aware that there's not a single diagnostic test that is 100 percent accurate. So we always take into account the clinical presentation and readily retest. It is just one aspect of information that we take into account as we are making our decisions. So I would like to reassure people that I don't think we're at risk of missing any patients that are presenting due to the use of this platform at this point in time.

GAUDETTE: And Dr. McInerney, I'd like to bring you into the conversation because there are some other studies that have come out that are starting to point to things like kidney, heart, liver, neurological damage. I mean, not to mention just the possibility of long term lung damage in patients that get COVID-19. Have we seen any issues like that in patients here in Idaho who have come through this, who come through and have survived from COVID-19?

DR. MICHELLE MCINERNEY: Thank you, Gemma. So a lot of the reports that are coming out about long term damage to multi-organ systems are in patients who had what's called the cytokine storm effect or marked inflammatory response to the virus where because of the inflammatory response that is trying to kill the virus, there's also kind of secondary damage to organs like the kidneys, the heart, the brain, even sometimes. And that's something that we actually see in other illnesses in critically ill patients. So it's not necessarily unique to coronavirus infection. That said, because of the risk of the cytokine storm, we are seeing that in COVID patients, whether we've seen that directly in patients in Idaho with COVID-19, I don't think that we have enough data yet. I haven't personally seen patients in follow up after their stay in the intensive care unit, but I am sure that patients will have some form of compromise to their lungs and other organ systems if indeed they were ill enough to be on the ventilator for up to three weeks, which is often what we're seeing. And just critically on the intensive care unit. Anybody who is that sick in the ICU is likely to have some form of long term effects.

GAUDETTE: I think that's interesting. Dr. McInerney, what you said about how this does present even in other illnesses that patients have, as you were talking, I thought back to my own dad, and he had, I believe, whooping cough when he was really little. And he used to always say, like, you know, "I got to watch my lungs. I don't want to get pneumonia. I've had it, and I think it came from that." Now, whether it came from that or not, does that kind of go back to what you were saying is that, I mean, sometimes major illnesses affect the entire body, not just maybe where, where we it initially attacks the body.

MCINERNEY: Yes. And then that is one of the important points. The patients who get really sick and need the intensive care unit, which is where I see these patients, they are sick because of the inflammatory response to the illness. And although it's been really bad with COVID and certain patient populations, it is not unique to this infection. And so, yes, sometimes infections, even if they initially start in the lung because of the inflammation that the body is trying to mount in order to fight off the infection, other organ systems are damaged. And, you know, your dad's example is a good one. A lot of people will say they had a severe pulmonary infection when they were younger and their pulmonary reserve or their pulmonary function isn't exactly the same. You know, and that's going to be different for every person. But we can expect to see long term effects for some patients who had COVID, not for all patients, depends on the severity of the illness with their COVID disease.

GAUDETTE: So is this something that people who get COVID or, you know, have a loved one that has it? How concerned should they be about these long term effects, like the likelihood of this happening to them?

MCINERNEY: And that is so hard to answer in a blanket way, because it's going to depend on the patient. And it's going to depend on the patient's other what we call comorbidities. Comorbidities is a medical term that just means other medical problems that they might have. So, you know, we've seen that patients with diabetes have higher rates of severe disease, patients with hypertension, underlying heart disease. And so I think if a loved one is infected with COVID and they've got underlying diseases, it would be reasonable to be concerned. And then if somebody is sick enough to be in the hospital or to be in the intensive care unit, then there would be reason to have concern for the long term effects. But again, we won't know what those are going to be until that plays out.

GAUDETTE: We're going to take a quick break and we'll have more with our medical experts right after this. You're listening to Idaho Matters... 

GAUDETTE: ...More Idaho Matters right now, I'm Gemma Gaudette. And we are continuing our conversation with our medical experts today. Our panel, Dr. David Pate, former CEO of St. Luke's Health System and a current member of Idaho's Coronavirus Taskforce. Dr. Michaela Schulte, an internist with St. Luke's, and Dr. Michele MacInerney, a pulmonary critical care physician with St. Alphonsus. I want to get to some listener questions. And Dr. Schulte, I'm going to have you take this one. It's a listener and they say, "Hello. I am a pharmacist. And my question is, should patients taking proton pump inhibitors unnecessarily stop taking them? Perhaps their stomach acid could help destroy the coronavirus, increasing survival?"

SCHULTE: That's that's a very good question, and I would say that my pharmacy colleague is obviously very well aware how these proton pump inhibitors are very good and important treatment modalities for patients that experience heartburn or have stomach ulcers or other conditions. However, we sometimes also see that patients end up taking them for many years at a time. And like with any medication, we always recommend that we should try to prescribe and take them at the lowest dose and for the shortest period of time if possible. Now we do know about this class of drugs that it is associated with a bacterial infection called called Clostridium Difficile. And it has also been known to sort of alter a little bit of bacteria that we find in people's guts due to the changes in the stomach acid that it reduces. Now, there's really no association that I'm aware of and that I could find in the literature regarding how this would affect viral illnesses, especially those of respiratory origin, such as the coronavirus that we're dealing with. We have to remember that the primary transmission of this virus of the COVID-19 disease causing virus is really by respiratory route as we are either inhaling droplets or getting them onto our mucosal membranes. And they'd like to replicate in cells that are mostly in the respiratory tract. Now, they can also affect the gastrointestinal system and as we just earlier discussed, really have an effect on the entire body. But that is probably then more likely in a secondary spread of the virus after it has already multiplied and had been released from those respiratory tract cells. So at this point in time, you know, first of all, I would always encourage people go and revisit your medications that you're taking periodically with your physician, discuss them, if there are alternatives, changes in dosages or so needed. But there is no indication whatsoever that stopping these classes of drugs right now would be helpful. So please do not do that. However, use maybe the opportunity next time you see your doctor and see, you know, which medications you might be able to stop. And especially the class of the proton pump inhibitors might be one that you could try to wean off or potentially stop taking.

GAUDETTE: And Dr. Pate, another question from a listener is, "what is this new syndrome facing children who have been exposed to COVID-19? And how worried do we need to be as parents?"

PATE: Well, I think as parents, I wouldn't spend a lot of time worrying about this because it is still pretty rare. However, I would want all parents to be aware of it so that if you do see any of these things in your child, you know, to get attention and get it promptly. So this new syndrome is actually only been recognized since last month. So we still don't know very much about it. We do believe that it is a consequence of the COVID infection, but that hasn't been proven. Most of these children will turn up positive, either having the nasal swab or the PCR test that shows that they actively have virus or they'll show up as having antibodies. And this gets back to a point that Dr. McInerney made about why this illness is so complicated, because a large degree of what she's treating is actually the consequence of our bodies fighting this infection. And that may turn out to be the case in this. We're not sure yet. It may also be that this is occurring in children that have some kind of a genetic predisposition to it. We're also not sure of that. But as I said, it's very rare. What we see is children have fever. They get very red eyes. They get red and cracked lips. They get a red and swollen tongue. They may get bumps in their neck that you could see or feel and they may get swelling of their hands or feet, may complain of soreness in their joints, may have redness over their palms and soles. And some of that skin this infected may actually start to peel. And so this is very much similar to a disease that we've known about for a long time. But it's quite rare in the United States called Kawasaki Disease. And that disease typically only affects children that are less than about five years old. But this syndrome is affecting children that are young and older. And in fact, there's been cases up into teenagers of having this syndrome. And it's not just straight-forward Kawasaki's disease, these things that I just mentioned. But in addition, they have a serious risk for developing shock, and that is a low blood pressure, profound weakness and that kind of thing. And so, again, we have a couple hundred cases across the world. So this is not common. But we have had a case in Oregon. We have had a case in Utah. We have not seen it -- and knock on wood again -- here in Idaho that we've recognized, but we very well may see it. And so not something for parents to worry about, but just be aware. And if your child gets sick, no matter what, keep your child home. And then if your child is sick and something seems to be changing and getting worse or new symptoms or new signs or any of these things I've just described, get in touch with your child's doctor and let them know right away and they can determine whether they need to be seen or tested. And also, just God forbid your child should get this very serious situation. You would want your child to be treated at a children's hospital if possible. So know where your children's hospital is. And if you are relatively as close to a children's hospital as another hospital and your child is very sick, that you think needs to be evaluated, but not an emergency where you need 911, then go to a children's hospital to be evaluated.

GAUDETTE: So be aware of what the symptoms are, ultimately. If you're just joining us, we're talking with our medical experts today on Idaho Matters about COVID-19. Dr. Schulte, we have another question from a listener. They say, we just learned the president is saying he is taking hydroxychloroquine. Is this a good treatment for COVID-19?

SCHULTE: So hydroxychloroquine is actually a medication that has been around since the 1930s and is one of those essential medications that the WHO identified as it is a treatment as well as prophylaxis of malaria, as well as another parasitic disease condition that occurs worldwide very frequently called amebiasis. We are also using it here in Idaho and in the United States for certain rheumatologic and auto-immune disorders such as systemic lupus, erythematosus, or rheumatoid arthritis. It has been found early on in the coronavirus outbreak that it inhibits the growth of the virus in a test cell culture. That prompted the investigation of whether or not this might be an appropriate compound to potentially treat or potentially prophylax people against the COVID-19 disease. We have gotten some data in from some preliminary observational studies that are really very mixed. And there is at this point, no data that establishes either the safety or efficacy of this drug. And I think I would like to stress this: We have a long track record with this medication, but it is not without side effects. Many of them are relatively mild, but it has a known interaction with a lot of other medications. It does impact how we metabolize, how we process many medications through the liver, can affect your other medication levels significantly and in people that may or may not have known reduction in that kidney function. It could really accelerate a lot of those side effects. So it should never for any reason be used without medical monitoring. I cannot speak to, you know, the president's decision or what his medical reasoning and rationale might be to take it. I've personally actually taken it as malaria prophylaxis many moons ago when I was working in the South Pacific. And, you know, I experienced some of the side effects that were not so very pleasant. I was very young at the time. I would currently not personally consider taking it, and I would certainly not recommend it based on the data and evidence that we have and the risks that are associated with it.

GAUDETTE: And Dr. McInerney: Moderna, I hope I'm saying that right, is a U.S.-based biotech company. And just earlier this week, they said they are seeing some promising results in a vaccine trial. So the listener wants to know, "is this too good to be true?"

MCINERNEY: We are all hoping for an effective vaccine to come out as soon as possible. I think that it's too early to know whether this vaccine trial has any efficacy or something that can be carried forward into, you know, actual broad use. I am hesitant to be excited about it because as we have heard many times, it takes multiple more months, usually to develop an effective vaccine to viruses. So I am hopeful for it, but I think that it's too early to know. And I don't think that we should at all use this as an opportunity to relax our social distancing measures, to relax wearing masks, to relax handwashing and to relax just being very vigilant and cautious from a transmission perspective, because I think that we're still going to be in this for the long haul.

GAUDETTE: And Dr. Pate, that goes to another listener's question, wanting to know that if they wear a face mask, can they stop social distancing?

PATE: No. So it is important to understand that wearing a face covering is very much recommended. We want people if they go out to wear a facemask. The reason we want you to do that is that there is a significant number of people who have been infected and don't realize it yet and that may be able to transmit this virus. So wearing a face covering is important in case you happen to be one of those people that has been infected and you are actually breathing or coughing or sneezing out virus from your nose and mouth. A lot of it, when it is first coming out of you, is covered with a lot of fluid that makes it big enough that it can be caught by this facemask. And so you will be transmitting less of the virus to people that are around you. So the face mask doesn't protect you, it protects other people. And then the social distancing protects everybody by just keeping us far enough away that we're not passing the virus between us. When you do both. There are some models that suggest we can decrease the transmission of this virus by 80%.

GAUDETTE: Wow. We're going to take a quick break and have more with our medical experts right after this...

GAUDETTE: More with our medical experts here on Idaho Matters, our panel today: Dr. David Pate, former CEO of St. Luke's Health System and a current member of Idaho's Coronavirus Task Force. Dr. Michaela Schulte, an internist with St. Luke's, and Dr. Michelle McInerney of Pulmonary Care physician with St. Alphonsus. So, Dr. Schulte, let's talk about one of the spaces where germs are typically passed around and have largely been been closed since the outbreak started. This is office spaces, work environments. Now, as employers begin to, you know, start making plans about how to protect employees for an eventual return to the office. There's there's a lot of ideas, you know, floating around, putting plastic partitions up to separate desks, maybe creating a staggered schedule for less people being around in the office at one time. Is there are one investment that you would like to see employers consider when they start kind of this reopening of office spaces.

SCHULTE: Yes. Thank you, Gemma. I don't believe that there is one single measure that will be successful in preventing the spread of the virus, similar to what Dr. Pate already explained earlier. So many multiple things need to fall into place to reduce the chance of the virus to spread from one person to the other. But I think we're all learning very gradually and becoming experts in viral transmission as we're learning how it matters that when we cough, we cough into our elbow or shoulder, that we perform great hand hygiene, that we clean surfaces frequently, that we space each other out as the virus doesn't like to travel very long distances. That wearing a mask further reduces that and then really not sharing the same air, meaning sitting in a small room close together for prolonged period of time, for example, is another layer of reducing that spread of infection. All of those things are obviously applicable, as you are already indicating, as we're returning to the office setting. And you know, whether that is spacing out, you know, how we work, that some people remain working from homes on certain days to have certain to have partitions. As I'm thinking about this question, I think the key thing that I can think of is to encourage people to not come to work when they're feeling sick and if possible, to allow them to then not lose hours or pay or have potentially the alternative to work from home, at least if that is applicable in your industry. I understand that that is not always possible. I really think that that will be a key measure and how we can invest in our businesses, that we allow people to have paid sick leave, that we are not encouraging what we in the medical world call presenteeism. And to be perfectly honest, and I think my physician colleagues will agree with us as physicians, we have been often guilty as charged in terms of showing up to work when we were not feeling well, as we often feel, we are carrying the world on our shoulders and want to make sure our patients get to see us if they were scheduled to see us or we don't want to, you know, have colleagues to pick up additional patient loads. Obviously, we're very well aware of disease spreads. We would be wearing masks, doing all of these things that are right. But I think this has been emphasized, and I'm very glad to say that St. Luke's as an organization has really stressed this and reinforced that, that staying home when you're not feeling well is a key part then determining whether you're sick enough that you could potentially still work, but just want to, you know, sort of self isolate for a little while and work from home, if applicable, versus then having paid time off. I think that is one investment that we as a community, you know, would want to try to push for to have more paid sick leave in my opinion. 

GAUDETTE: And Dr. Pate, you know, we have seen different hot spots in our state since our first case in March. I mean, first it was the Wood River Valley. Then we saw the Nez Perce County deal with an outbreak at a nursing home, Twin Falls recently became a focal point. Is there any way to predict where or if there would be another hotspot?

PATE: Well, there will be. I mean, just past experience tells us there will be. But we can't predict with accuracy, though we can certainly anticipate because we know of certain situations that do create a lot of risk. Like we talked about nursing homes. Interestingly, there's also some companies that actually track cell phone signals and they look at before we were isolating. And what our activity was and how far we venture from home. And then they looked at what just happened after the stay at home orders. And they've been able to kind of suggest areas that people don't seem to be staying home like they should. And obviously, those are going to be higher risk. I think we need to be, especially here in Idaho, we need to be very humble that this is a really peculiar virus in so many ways. And so we have to have a healthy degree of respect for it. If there are areas that become lax about their social distancing and start having big gatherings, as we've certainly heard about some areas around the state, you can certainly predict there are going to have an outbreak in the next month or so. On the other hand, you know, the thing that we have noticed from the episode in Washington where a choir got together and one person was pre symptomatic, he was infectious, but not yet sick, and he spread it to 50 of the 60 people there. And then we heard the story in California of someone showing up to church who again, was pre symptomatic and spread it perhaps to 190 people. When you're talking about an event like that, if that happens anywhere in Idaho because our cases are so low, it's going to tremendously spike our numbers. So we just need to be aware that this could happen anywhere, but especially be cautious of people trying to get back together too quickly in two bigger groups.

GAUDETTE: And Dr. McInerney, that goes to a listener question, talking about crowds. They want to know "when will air travel be safe and should we wear facemasks on airplanes?"

MCINERNEY: So to Dr. Pates point earlier, I think that we should definitely continue to wear face coverings in addition to social distancing. I think it is difficult to give a time when air travel will be safe again, but because by definition, traveling by air equals multiple people gathering in one small space, I feel that the risk of air travel still remains high and it's something that I would discourage unless it's absolutely essential travel. Like Dr. Pate had just very well described, all it takes is one person, even if they're pre symptomatic, to potentially transmit the virus onto others sitting around him or her. So I would discourage it for the foreseeable future unless it's essential travel.

GAUDETTE: And Dr. Pate, you know, as the U.S. begins to reopen, it's being reported that at least 17 states are seeing about a 10 percent daily increase in coronavirus cases. Is this expected with a reopening? And again, how concerned should we be with those statistics?

PATE: Well, we do need to be concerned. We need to pay attention. And the reason that we're seeing this is that there was a lot of pressure to reopen the economy for very understandable reasons. And many parts of the country like Idaho were probably ready. We had gotten the disease under reasonably good control. We had a low number of cases. But then there were some other states that I'm sure due to pressure of other states opening, felt that they need to reopen. Yet they were not in the same position as Idaho. In fact, some of those states were continuing to have an increasing number of cases. So opening up the state is the antithesis of what you should do in that situation. So I would say I'm not surprised at all that they're seeing increases. Frankly, I'm just surprised they're not seeing bigger increases and maybe those are coming. I sure hope not. But I don't think we need to be worried about that in Idaho. I think things are looking good. We need to be vigilant. We need to keep up our distancing and not become lax about it. But the hospitals, the physicians, the state, the workgroup we're all monitoring these numbers so that if we do start seeing a significant increase, we can take measures to reverse that quickly.

GAUDETTE: I want to thank all of you for coming in and joining us today. So important to get these questions answered by medical experts, by doctors. You are all seeing this firsthand. So I thank all of you, for taking time today to do this.

ALL: Thank you. You're welcome. Thanks, Gemma.

GAUDETTE: We've been talking with Dr. David Pate. He is the former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Dr. Michaela Shulte, she's an internist with St. Luke's and Dr. Michelle McInerney, a pulmonary critical care physician with St. Alphonsus. 

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