Idaho Doctors Answer Your Coronavirus Questions

 


We've asked you to submit any questions you have about Coronavirus in Idaho, and you stepped up. With news (and mis-information) coming out every hour, it’s more important than ever that we provide the most up-to-date and accurate information. 

Joining Idaho Matters live in studio are Dr. David Pate, retired CEO of St. Luke’s Health System and a current member of Idaho’s Coronavirus Task Force; Dr. Jim Souza, chief medical officer for St. Lukes Hospital; and Dr. Steven Nemerson, chief clinical officer at St. Alphonsus Hospital. 

 

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.

 

Read the full transcript here:

Gemma Gaudette: You're listening to Idaho Matters. I'm Gemma Gaudette. As COVID-19 cases spread through the United States and Idaho, we want you to know that we are committed to keeping you updated and informed. You can always go to our web site: boisestatePublicRadio.org And we will make sure that we have all of the latest information out there for you. Now, as of 9:45 this morning, Idaho has seven confirmed cases, 353 people have been tested. 76 people are currently being monitored. Now, since there is news coming in fast and furious, there also tends to be misinformation out there. There is also fear. Now because of all of this, we wanted to make sure that we bring in the experts to answer as many of your questions as possible and to also separate fact from fiction. Joining us live in studio are Dr. David Pate, retired CEO of St. Luke's Health System and a member of Idaho's Coronavirus Task Force; Dr. Jim Susa, chief medical officer for St. Luke's; and Dr. Steven Nemerson, chief clinical officer with St. Alphonsus. Welcome, all of you. So, first off, let's start with the the number of cases that we have right now. So, Dr. David, Dr. Pate, you met with the governor's COVID-19 Task Force yesterday, and now that we have seven confirmed cases, what was the most important thing that you talked about so far within these meetings?

Dr. David Pate: Well, we've talked about a lot of things. One is the shortage of testing. That remains a big concern. Second thing is the shortage of medical supplies, particularly when you see the pictures of the health care providers all dressed up in the gown and face shield and all that -- we call that PPE or personal protective equipment -- shortages of that, those two things, and then we spend a lot of time talking about our vulnerable, most vulnerable people that are in confined situations like nursing homes, prisons, psychiatric hospitals, those kinds of things.

Gemma Gaudette: And when we talk about the fact that we now have seven confirmed cases from those new two came in this morning as we said because we were sitting at five and now we've got the seven. Are we at seven and only seven because we just have not tested enough, or is it because knock on wood, we're just lucky?

Dr. David Pate: Well, there's some component of both. So, first of all, I know a lot of people have played this message. We have no idea how bad it is in Idaho because we're not testing. That's not exactly true because basically we do know the percentage of people that are likely to get severely ill and we would know about the severely ill. And we're not seeing large numbers of severely ill. So we know there's not rampant spread of this across Idaho. Is there disease out there that we're not picking up? Assuredly. Because frankly, as a high percentage of people have a very mild illness and some people even asymptomatic. And so no doubt there's more cases of it out there, but these are the people being identified either because they're very sick or because they had identifiable risk factors.

Gemma Gaudette: I want to bring Dr. Souza and Dr. Nemerson into the conversation. Both of you are boots on the ground within your hospital organizations. And as Dr. Pate said, you would know of those severe cases. Talk to me about what you're seeing within your health system right now.

Dr. Jim Souza: Thanks, Gemma. At St. Luke's where we're seeing a lot of rule-out activity. You know, we've got in one of our facilities a dozen or so patients under observation being tested. I think eight in the Magic Valley, four in Boise. But so far, they're  largely continuing to come back negative. So a rule-out COVID, which we've coined 'the rock' is is becoming an increasingly common reason for admission. Fortunately, most of those are returning negative. 

Gemma Gaudette: Dr. Nemerson, what about St. Alphonsus?

Dr. Scott Nemerson: We're seeing very much the same thing. The unknown in that where you have to prioritize testing right now for our patients that are inpatients in the hospital or patients who are at risk for suffering either significant illness should they acquire COVID, or God forbid, mortality means that there's this large number of outpatients that we're seeing that we're not testing currently. And what we are seeing is an increased number of patients coming in with respiratory symptoms to our various centers for evaluation. And as those numbers increase, we all suspect that the incidence in the community, which we call community spread is increasing -- to what degree is difficult to know. And I hesitate to use abstract statistics. If, as I'm sure you have, among other experts, you talk about epidemiology. The numbers are all over the place. And so one patient that's been diagnosed with COVID by a confirmed test represents some number of dozens to maybe even hundreds of people who are in the community who are colonized, meaning they're asymptomatic or who are bona fide infected, having very mild symptoms. And these are the people that we don't want to infect others.

Gemma Gaudette: I want to play a listener a voicemail from Tony.

Listener Question: Yeah, my name is Tony. I live in Boise. My main question is, why are tests not being given out the Coronavirus? I have a friend and his girlfriend who just got back from the Philippines through South Korea flight connections. They were told to self-quarantine here in Boise for 10 days. But my friend started running a low-grade fever and called around, and there is nobody that will test him. And I'm concerned that the numbers in Idaho, of Coronavirus cases just not even being reported.

Gemma Gaudette: So let's talk about that, because we are hearing stories like this and this is where I think we need to separate fact from fiction, as I mentioned in the beginning, are people being turned away from being tested?

Dr. David Pate: Yes. There are some people who are coming in, that are just worried and they want to be tested. We don't have that luxury because we don't have the supplies. And this is multi factorial. There's the laboratory capacity and capability to do testing, which is limited but growing. There is on the provider side the supply of testing materials to get samples to send to the lab. And then there's the third thing is to safely take those samples because you will be exposed when you do that. You have to be in this protective gear and we have shortages in all three categories. And so for right now, until those shortages are addressed, we have to be a lot more selective about who to treat. Now, this would be a very big deal if you had coronavirus and if we only knew that we could give you a treatment that would cure you or prevent you from giving it to somebody else or prevent a bad outcome. But we don't have a treatment right now. So, yes, w would all like more testing to be done. But right now, it has to be prioritized to the highest risk people where it's really going to make a difference to us.

Gemma Gaudette: So when and if or how will we be able to test more people? Is there just a shortage of tests around the country?

Dr. David Pate: Yes. So up until recently, for example, you take South Korea, they were doing more tests in a day than we have done since the outbreak in the United States. We're not doing the testing that volumes that a lot of others are doing. It is increasing, you know, but we've also been given promises that things were getting get better and then they didn't. We were supposed to have about four million more tests last week. That didn't materialize. We are able to do more today than before. And there's some new technology come on. And certainly involving the commercial labs in this has helped increase testing, but that's still not the panacea. And now we've got some new technology that has just been FDA approved that actually would allow us to test more samples at a time. My question is, OK, going back to those three factors. If you can do, for example, these high throughput tests can do 1000 tests in a run. Are we gonna have enough testing supplies to be able to give them a thousand tests to run? And are we gonna have enough PPE that we can protect health care workers to do those? So we just got a lot of pieces in the air.

Gemma Gaudette: So who should be getting tested right now?

Dr. Scott Nemerson: So, Gemma, I think there's a couple of things to comment on that to provide reassurance, right? So someone who has cold like symptoms and isn't able to obtain the tests. That person can receive good, solid medical advice and isolate, or what we call self-quarantine, themselves to keep themselves from infecting their family. And so I think that reassurance is really critically important and good communication between physicians and other providers and the patient and their family is something that we're augmenting. Now, in terms of who should be tested specifically, right now, our priorities are those that are hospitalized with a condition that demonstrates symptoms consistent with coronavirus. And the reason for that is, one, we know in a predictable way how that disease will advance and so we can be prepared within our hospitals to care for that patient. We also need to protect our health care workers so that they aren't exposed to the virus, if that patient's carrying it. So that's a top priority. The second is patients who may not require hospitalization but are at risk if they were to acquire the virus of having an acute deterioration in their clinical condition and possibly ending up in the hospital. And those patients tend to be the elderly and the numbers are all over the place. But for a working number, [inaudible] good for a family member. If you're over 70, you're at a significantly elevated risk. If you're over 60, a slightly elevated risk and below that, relatively, you know, flat in terms of population risk. So so the elderly are at high risk, the immunocompromised are at high risk. And those who have what we call complex medical conditions. So multiple medical conditions that superimpose on one another are also an increased risk. And when in doubt, because we've been encountering this at St. Alphonsus a lot, family members will call and say, I have a loved one who has these different medical conditions. Do I need to be worried if they were to get coronavirus? Ask your doctor.

Gemma Gaudette: And we should note, too, this just came out before we came on the air that St. Luke's is beginning to open up drive-up testing and screening sites today at St. Luke's Wood River Valley and then St. Luke's Meridian hospitals, and that patients can be tested there from 10:00 a.m. to 6 p.m. every day. And then an additional site will be opening in downtown Boise and then more sites might be opening, in Elmore, Fruitland and the Magic Valley. Dr. Souza, why make that decision? And we've seen it. I mean, South Korea as Dr. Pate said, Colorado is doing it. Why make that decision?

Dr. Jim Souza: In part, it's to prevent the deluge that's hitting those emergency departments in those those facilities. We'll be using similar screening criteria as to whether or not a test is actually performed. But, yeah, the volume of patients crowding into ED's with symptoms wanting to be tested is quite large.

Dr. David Pate: And could I just add, I want to reinforce a point that Dr. Souza just made. Even though you're seeing these drive-through testing sites open up and you are. That doesn't mean it's like a drive through restaurant. You go and you order a hamburger, you get a hamburger. You still have to meet the criteria to get tested. So please don't go and get in those lines and go through all that process if you're well, if you haven't had a known exposure, you haven't traveled to a a high risk country, don't go to those.

Gemma Gaudette: Well, I want to talk with before we take a quick break about flattening the curve. We have I mean, this is you know, we have new terminology in this day and age and flattening the curve is one of them. And the reason for that is, if I'm understanding this correctly, is that if we can spread out those cases, then people will have better outcomes because you still have businesses at you, as usual, at St. Alphonsus and St. Luke's. Women are still having babies. People still have cancer treatment. Am I can you go a little bit more in-depth about that, doctors? Because I think it's critical that people understand why this is being implemented.

Dr. Jim Souza: Sure. Yeah, we do run hospitals that are busy all the time and don't have a tremendous amount of surge capacity. And you've heard already that we need to focus on keeping our health care workers healthy as we see more cases that unfortunately are on the severe end of the spectrum require intensive care type of intervention. Very resource intensive care. That combined with a workforce that could be out because they're sick and we do not want our hospitals to be any place where someone would acquire this, right? Those two things combined, and we could be overwhelmed. So we're taking steps, I know St. Alphonsus is taking steps. We're actually collaborating and communicating together on on our strategies to be prepared to decant, if you will the other work that we're doing so that we can handle a surge if it comes here.

Dr. Scott Nemerson: You know, we are collaborating and working in coordination throughout the state and on a normal day our emergency departments throughout this state see thousands of patients. Now, imagine if we had to triple that number of patients who require hospital care. And I'm not talking about high level care. I'm just talking general hospital care to receive breathing treatments, fluids and oral and other types of care, right? If we're trying to see triple the number in a given day, we just don't have the capacity to handle that. And we're surging to make that capacity available. And rest assured, we've been working at this for now several months in preparation. And nevertheless, when you talk about flattening the curve, if instead of tripling or worse, the number of patients that have to be seen in a given day, we could make that a double. Obviously, it gives us more capacity to handle the volume that's coming. And then we're in this for the long haul. There's no question. And it gives us all of the resources that we're going to need to keep coming in and allow us to care for the patients.

Listener Question: My name is Melissa and I live in Boise. My question is in regards to safety for health care workers. I've noticed in news reports from around the world, most of the health care workers are wearing significantly more personal protective equipment. And our own health care workers in the United States are wearing. Are our health care workers in the United States safe?

Gemma Gaudette: We are continuing our conversation with our panel of medical experts, Dr. David Pate, retired CEO of St. Luke's Health System and a member of Idaho's Coronavirus Task Force. Dr. Steven Nemerson, Chief Clinical Officer at St. Alphonsus. And Dr. Jim Souza, chief medical officer for St. Luke's. That was a question from one of our listeners. And I would love for one of you to be able to answer her concerns. 

Dr. Jim Souza: I'll dive in. The safety of our health care workers, our employees is of prime importance to all of us. I know that we're adhering to all of the recommended standards relative to use of personal protective equipment. As Dr. Pate has pointed out, we're we're challenged with that supply chain. And I know everyone's working diligently to try to to stay ahead of that. I think from the, you know, ground zero Wuhan where things started, we know that training on how to perfectly don and doff -- it's take it off, the personal protective equipment -- is very important. And I think everybody around the country, including us, is engaged in bringing that training to our people, drilling and doing that well, as this thing progresses, we also need to be prepared potentially even cohort patients and put like patients together with, you know, clinically excellent teams.

Dr. David Pate: One thing could I add, just to help keep our health care providers healthy. If you're going to go to your doctor's office or the emergency room or an urgent care center, call ahead, tell them that you're worried about this. Because what we don't want you do is come on into the waiting room and spread this around in the small chance that you do have it. So that gives us a chance to be prepared and treat you appropriately.

Dr. Scott Nemerson: Absolutely. And as Dr. Souza's said, the protection of our health care providers is critically important because we are going to need them for the duration of this event. I'd like to note that the things you see on television are there because they create a dramatic picture. So a caregiver who's in a space suit is in that space suit most likely because they're caring for dozens of patients that are infected with Coronavirus, and they're going to be contaminated, frankly, on their surfaces by all of the aggressive therapies that they're delivering. We know that we can gauge or stage the level of protective equipment that providers are using based on the treatments being given and the number of patients to which they're exposed. And so we all follow very strict guidelines from the Centers for Disease Control to protect our caregivers.

Gemma Gaudette: I want to go just quickly through some questions from listeners. So listener question online:

Listener Question: Does having had the flu shot and the pneumonia vaccine helped lessen the impact of COVID-19?

Dr. David Pate: No, not that we know of. 

Listener Question: How many ICU beds do we have an Idaho? Do we know?

Dr. Jim Souza: Well, I can't tell you how many we have in Idaho. We think that, you know, at the present time we've got enough beds, but we're thinking of how can we expand our capacity and actually create beds where maybe they don't exist today.

Listener Question: How many ventilators do we have in Idaho?

Dr. Jim Souza: I also don't know how many ventilators we have. I do know that we've been saving old ventilators for a while. And one of my tasks actually today is to make certain that those are all operational and ready to go.

Dr. Scott Nemerson: And Jim, I think we're fortunately a little bit ahead of the game in Idaho in terms of beds, ventilators. We've been at St. Alphonsus using an incident command structure to address these needs and plan our surge response. So we have the capability of expanding the number of beds significantly. We are already in conversation -- Dr. Pete may be able to touch on this -- about accessing the national stockpile, which includes mechanical ventilators and other things that we're going to need. And we're also being very thoughtful about the fact that it's not just about machines and people, it's about medications and the equipment that's needed to deliver those medications. And so we're preparing stockpiles of that equipment as well to be able to be fitted to the machines and people that need are needed.

Listener Question: Do we know how long the virus is viable on surfaces?

Dr. Jim Souza: We don't. We know, though, it's at least days.

Listener Question: Does refrigeration or freezing kill the virus?

Dr. David Pate: Don't know that yet. One big question is, is this virus temperatures sensitive? Because one thing is really important about that is as we get to the warmer months. Will this disease activity go down like a lot of other cold and flu viruses do? We don't know the answer to that. We're less hopeful that that's going to be the case.

Dr. Scott Nemerson: But I do want to make an important point for people who are at home is what does kill the virus. And the most important thing is good hand-washing. 20 seconds, soap up first. And as my young daughters used to do, count to 20 or say, Twinkle Twinkle Little Star, whatever works. And then alcohol gel at least 70% concentration, which is becoming more scarce. We know that the lines in Costco have consumed those quantities of alcohol gel, but that's one thing. And then I see on the counters in front of us, NPR is doing a phenomenal job disinfecting this place. And we've got Clorox wipes and Lysol wipes sitting right in front of my nose.

Gemma Gaudette: I want to continue asking listener questions. So one listener wants to know: 

Listener Question: Is it possible for my pet to have the virus on its hair after being grown by an infected groomer and then transferring the virus to a human?

Gemma Gaudette: You're kind of all shaking your heads on this one.

Dr. Scott Nemerson: You win the award for the most amusing question of the day.

Gemma Gaudette: Someone has to bring some levity into this, right?

Dr. Scott Nemerson: And what it really comes down to is how is this virus transmitted? How is it shared from one person to another? And it's thought to be most commonly by droplet, meaning somebody who has a virus has it in their respiratory system, their nose, their mouth, their lungs, and they cough or they sneeze. And the droplets that they sneeze out carry the virus. So that then contaminates their hand, which then contaminates what they touch. So in theory, I suppose and I'll take this one for the group. I think if you petted a dog, maybe, maybe it would be more a Chihuahua than my dog, which is a Keeshond, it's very furry. That droplet might be in a less distributed area and somebody could touch that contaminated dog and and conceivably transmitted to their nose and mouth by rubbing their nose and mouth and get the disease. In reality, though, I would say love your dog. I think that's really an important thing. And wash your hands.

Listener Question: Another question from a listener. What should you do if you are living with someone who is high risk?

Dr. Jim Souza: I think you should adhere to the same good practices, really. We're advising everyone, you know, to the degree that you can. Don't don't gather in large crowds. Use good hand hygiene and then particularly in the home. Double down on those things. Wipe off countertops and surfaces and to the greatest extent possible help that person who might be immunocompromised or at higher risk stay at home and you'll be there conduit to the outside world for a while.

Listener Question: There is some information going around through social media about the virus starting in your throat and that it lasts there a couple of days before it goes into your lungs. So everyone is you know, we're seeing this on social media. So gargle, go get go get mouthwash or use vinegar. Fact or fiction. Or do we know?

Dr. Jim Souza: I think we don't know for sure, but I'm largely going to say fiction on on that. You know, there's there'd be little evidence that in between gargles for example, you're not continuing to aerosolize viral particles into the air stream where they're deposited deeper in the bronchial tree.

Dr. David Pate: But all three of us are proponents of good oral hygiene. Yeah. Yeah, I bet you're right. That's probably not going to prevent it.

Gemma Gaudette: And then what about people who are asymptomatic? There was an interview just yesterday with Donovan Mitchell a Utah Jazz player who has tested positive, was tested because he was exposed to someone saying right on national television. I feel fine. I have no symptoms. If someone told me to play a seven game run tonight, I could do it. So we know that's possible, but is that also why we are seeing this idea of this is why we need to not be in large groups right now?

Dr. Scott Nemerson: Absolutely. And this is the thing that I'm most concerned about. We just had what was it, St. Patrick's Day. And I heard the bars were very crowded and the restaurants were doing a wonderful business, not necessarily here.

Gemma Gaudette: And we saw it in Chicago quite a bit.

Dr. Scott Nemerson: Saw it in Chicago. And that was very disappointing to me, because there is a lot of other people who are like Donovan who are out there. They're having good social interchange and then they inadvertently cough in somebody's face. And that's exactly how the virus gets transmitted.

Listener Question: Another listener: I was originally planning to fly to Vermont in July, I canceled that ticket. I'm now wondering about my scheduled trips to the Wood River Valley in April and eastern Oregon in June. In fact, is traveling at all, regardless of the distance at all. A good idea at this point?

Dr. David Pate: You know, to answer that question, I think you have to consider a number of factors. What is the extent of community spread where you would be going? So, for example, there are some places I would definitely cross off your list. I don't think you need to be going to Seattle or New York City right now. If you're just talking about going in Idaho, we have rather low levels of concern. But of course, things that are not entirely clear to us, could this be transmitted on an airplane? So, you know, someone asked me about taking a trip where they were going to drive in the car. Well, that's very low risk, but it depends on where you going. How are you getting there and what are you going to do when you get there, is going to affect your risk.

Gemma Gaudette: And we heard the president in a news conference the other day say, well, some people say this, you know, we could be like this into July, August, September. Is that what we should be preparing for as a society?

Dr. Jim Souza: I think we don't know. And I think that's why you heard the president give that kind of of a range. I don't think we know.

Dr. David Pate: We don't. And, you know, the great news, like you heard Dr. Nemerson talking about, all this, the efforts that we do make to social distancing should help slow down the spread. The converse side is the more we slow it down, we preserve that we're vulnerable and we haven't established immunity. I don't think we're going to see the end of this virus. There are some scenarios where we might, but I don't think we're going to see the end of this until we develop a large amount of immunity. And that's going to mean we get the vaccine and that's going to be next year. So I'm hoping the president is right, but I'm not counting on it.

Gemma Gaudette: We have about two minutes left. I would like to know from each of you the number one piece of information that you would like the general public to know. I'll start with you, Dr. Souza.

Dr. Jim Souza: Social distancing. I think, Gemma, unfortunately, we we only need to look to Italy, Seattle, some of the activity happening on the coasts to know, you know, what could be coming if we don't use the knowledge we have now to act, to take a different course of action? You know, I think the things that are being enacted now and in Seattle, two months after their first case, I'm happy to see us enacting a lot of those things now. And that's good news for Idaho.

Dr. Scott Nemerson: Two things. Wash your hands and don't go to work sick.

Dr. David Pate: One thing that recently I've been spending a lot of time being concerned about is when we self isolate somebody because they have symptoms and we can't be sure that they don't have COVID. We've taken a pretty lax position relative to family members and we let them go out and do stuff. I'm worried if we used to think that the sicker you were, the more likely you were to transmit that. There's some reasons to believe that may not be true. I think we need if somebody is being isolated at home because they might have this and you don't have the testing results yet, everybody at home needs to act like you have it.

Gemma Gaudette: I want to thank all of you for coming in today. Such critical conversations to be having right now and to alleviate some of the fear and talk about the facts. Our panel of experts today: Dr. Jim Souza, who is with St. Luke's; Dr. Steven Nemerson, with St. Alphonsus; and Dr. David Pate on the coronavirus task force for the state of Idaho. I'm Gemma Gaudette. This is Idaho Matters.

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