Idaho Doctors Talk Masks In Schools And Eastern Idaho COVID-19 Hospitalizations

Sep 23, 2020

As the U.S. surpasses 200,000 deaths from COVID-19 with no signs of the pandemic coming to an end, Idaho Matters brings you medical experts to get us up to date on the latest regarding the virus and to answer your coronavirus questions. 

If there's a question you'd like our panel of doctors to answer, send us an email at idahomatters@boisestate.edu.

Today, our panel is: 

  • Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce.
  • Dr. Meghan McInerney, ICU Medical Director at Saint Alphonsus Regional Medical Center.
  • Dr. Joshua Kern is the VP of Medical Affairs for St. Luke’s Magic Valley.

Read the full transcript here: 

GEMMA GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. As the United States surpasses 200,000 deaths from COVID-19, we are continuing to bring in Idaho medical experts to get all of us up to date on the latest regarding this virus and to also answer your questions. If you have one, you can email us right now and hopefully we can get to it during the show today.

Our panel today, Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of Idaho's Coronavirus Task Force, Dr. Meghan McInerney, ICU medical director at St. Alphonsus Regional Medical Center, and Dr. Joshua Kern, the vice president of medical affairs for St. Luke's Magic Valley.

Hi, everybody. First, Dr. McInerney, congratulations on the promotion.

DR. MEGHAN MCINERNEY: Thank you very much.

GAUDETTE: You're absolutely welcome. I want to begin the conversation with the CDC reversing its decision on how the coronavirus spreads. This has made some big headlines because they now say airborne transmission is possible, but it's not the main way it spreads. So, Dr. Pate, what is the main way it spreads? But also, I think it's becoming difficult to to have faith in what's coming out of the CDC for a lot of people, because there is this back and forth.

DR. DAVID PATE: Yeah, Gemma, you know, certainly the federal government keeps giving us reasons to be distrustful with some missteps that the CDC has made, some missteps the FDA has made and of course, a lot of misinformation coming out of the White House. So I certainly get that. 

With that said, we can still have confidence in the vast majority of the CDC guidance. It is reviewed by lots of doctors, lots of medical societies of experts. And when there is something like this that happens, you hear from that medical community. I'm proud that my colleagues speak up and say, hey, something's not right here. So I think you'll know those instances.

To answer your question, the major way that this virus is transmitted as of today is droplet. In other words, the virus coming out of somebodies nose or mouth covered in secretions and expelled in the air through talking, coughing, sneezing, yelling, singing, etc. That is still the major way. And the mask is, well-- first of all, distance is our major protection. And when adequate distance can't be maintained, a mask is the next best protection. However, this whole issue of airborne transmission, which is-- people get confused between the droplets and airborne because they both go in the air, the droplets are bigger and heavier. And these are what are coming out of my mouth right now as I'm talking into my computer and they're landing on my computer, they're landing on my desk. They're landing on the floor around me. Those are the droplets.

At the same time, when we raise our voice, when we yell, when we cough and certain other activities, there are also smaller, much smaller particles that do get carried in air streams. And so that's the biggest difference. The droplet is just going to travel however far my mouth or nose propels. The airborne, the particles are small enough and light enough that they actually get caught on air streams so they can travel further. And typically that's dictated by your air conditioning system and so forth. That's why it's always better to be outside. And we certainly will probably see more airborne transmission as we get to colder weather and move inside. But right now, droplet is the main way.

GAUDETTE: Ok, Dr. McInerney, we mentioned this in a newscast right before the program started. But some developing news coming from two chief medical officers at two Idaho hospitals.

They're warning public health officials that their facilities are really close to being overwhelmed by patients infected with the virus. This is coming from Dr. Daniel Snell with Portneuf Medical Center and Dr. Ken Newhouse of Bingham Memorial Hospital. And in fact, they told these public health officials that the current rate of hospitalizations for COVID is unsustainable. I would like to know, a) your thoughts on that, but also, b) what are we looking like? You know, at St. Alphonsus, is this something that you are now concerned with?

MCINERNEY: So a couple of weeks ago, I would have said, yes, our numbers at St. Alphonsus are lower now than they were three weeks ago. But at one point in the intensive care unit, which, you know, is where I work, we had so many COVID patients. And what I think a lot of people don't understand is that when somebody has COVID related pneumonia and acute respiratory distress syndrome, when it's severe enough to have them land in the ICU, they're there for weeks. And those patients require a lot of intense care, a lot of time, a lot of resources, not just ventilators, but sometimes they need renal replacement therapy because their kidneys start to fail, support for blood pressure and whatnot. And so if you take, you know, for example, one day I came into the ICU and we had 20 patients in our ICU with COVID. So if you take up 20 beds with COVID patients, those beds are kind of stuck or unusable for other patients for multiple weeks. And so in addition to those COVID patients, you have the usual trauma patients, the septic shock patients, the other pneumonia patients that are coming in. And so that's where the big strain on our hospital health care systems come in. And so you can apply the same kind of rationale to what's happening on the main medical wards.

So I can't speak directly for Portneuf and the other hospital, but it sounds like they are experiencing a surge in their health care system where if these numbers keep going up and we know that ebbs and flows with numbers in the community based on, you know, openings of schools, bars and other societal gatherings, that definitely makes sense that certain hospitals at various times are experiencing a crunch. And if the numbers continue to go up, then they just don't have the capacity to take care of their usual patient population that we're always working with a very narrow margin. Right. Like we always rely on our hospital discharging patients so we can make room for new patients, because that's just the nature of medicine, right? People come in constantly. So, yes, I was bummed for their hospital system to read that and unfortunately not surprised because that's what we've been seeing lately at our health care system.

GAUDETTE: And then, Dr. Kern, this goes into this whole idea of we are officially into fall, which means we are heading towards flu season. And I believe just yesterday, area hospitals, including St. Luke's and St. Alphonsus came together and and are urging people to get their flu shot. And in normal years, you know, we hear, like, 'get your flu shot, get your flu shot.' Doctor, it seems to be at a critical level this year for people to get their flu shot.

DR. JOSHUA KERN: Yeah, I agree. I mean, again, both from not wanting to have that virus complicating your coronavirus infection rate. What we really dread is the idea of having somebody be infected with both viruses at the same time. But just from the public health standpoint, and the confusion that's going to surround if we got a big influenza outbreak at the same time that we're dealing with COVID. And as we just discussed, if hospitals are already getting stretched thin and then we have a really bad influenza season, it could get to that critical point where we actually can't provide even routine care to patients. So that's what every time we are looking at this outbreak, what we're looking forward to the future. And whenever somebody in the health system is raising the alarm, that's what we're worried about.

GAUDETTE: And Dr. Kern, best advice on when -- is there kind of a cutoff as to when someone should get their flu shot? And what I mean by that is, even get it if it's the middle of November. But there's kind of a good window in order to to get it? Like my kids have gotten it. I've gotten it. My husband's getting it October 1st.

KERN: Yeah, no reason to wait. We know that the strains of the influenza vaccine, when you get it, you get pretty persistent immune reaction for that even out to a year. So I know that sometimes in the past, people have talked about not wanting to get it too early, worried that it would wane. But more recent data suggest that there's really no reason to wait. You should just go ahead and get it as soon as you can.

GAUDETTE: Dr. Pate, before we take a break, I want to talk about a Senate hearing on COVID-19 that happened this morning with Dr. Fauci because he talked a little bit about some lesser publicized side effects seen among what's being called these COVID-19 long haulers: heart inflammation and cognitive abnormalities. And I know that you've talked about this some before, but this is a bit alarming, I have to say. And anecdotally, I have a friend who is 43 years old, who is a female in otherwise phenomenal shape, and she is a long hauler. She got infected in March. And I tell you what, it is scary to see her not be able to even walk a block.

PATE: Yep, well, this is concerning and we don't understand it, we don't know the magnitude of it, we don't know how long these are going to last, although we have seen some long haulers start to see improvement in their symptoms after four months or so. And there's very few studies on this. But it is alarming, as you said, when you look at these studies, one study showed the average age was in the late 30s. Another one showed it was in the early 40s. There seems to be a slight female predominance. And what is striking is to talk to or hear from a number of these people that, just as you described, were healthy, vibrant, active, exercising young adults. And as you said, some of these people describing they can barely get out of bed. They get winded after climbing one flight of stairs. They can't exercise like they used to. And they have a whole host of symptoms.

So I think the most important thing about this, because we just don't have many answers right now. But I think the most important thing about this is we need to change the narrative. The narrative all too often is there are people that get mild or asymptomatic infections and then there are old people who get really sick, might end up in the hospital and might die. That is not an accurate statement. There is a whole spectrum of people being affected in a very pronounced ways. And while it's certainly true that your risk of dying is higher if you're elderly, it doesn't mean that someone in their 30s or 40s can't have really bad things happen to them even though they survive.

GAUDETTE: And I think that you're so right. Change the narrative, because this could have some long lasting effects. And as you said, Dr. Pate, this just hasn't been around long enough for us to know if these long haulers will eventually get better.

PATE: That's right, that's right, and that's another reason why we also need to stop this kind of the nonsense that's talked about is "let's just let the young people go out there. We'll lock up the old people in their homes. Let's send the young people out there, let's get them infected and let's get to herd immunity." I think that's hugely irresponsible, especially when we are certainly hopeful that there is a vaccine in the not too distant future.

GAUDETTE: Dr. Kern, Linda is asking this question and she would like some help. She said:

LISTENER QUESTION: I'd appreciate some advice on a routine dental cleaning. I'm overdue, but I'm reluctant to see my dentist since it involves being inside a building and up a couple of flights of enclosed stairs. I am 66 years old in good health and the caregiver for my 76 year old husband, who has severe lung disease requiring oxygen 24/7.

GAUDETTE: So Dr. Kern I think she's wondering if she should go to the dentist right now.

KERN: Yeah, that is a very difficult situation to try to decide what the right thing to do is. And I think she's approaching the question the right way in that she's assessing what her own risk is and what the risk of people that are dependent on her are. My bias in her situation would probably be to consider continuing to put it off. I firmly believe in the importance of regular dental cleaning, but when you weigh the risk to benefits in that situation, it may warrant waiting a little bit longer. Obviously focusing on good oral hygiene for herself, brushing teeth, flossing twice a day, etc. But I don't know that that necessarily is the right answer for everybody, because I think, again, the risk of individual dental clinics is probably usually pretty low, given that people should be wearing masks and assessing what the practices are of the dental clinic probably makes sense as well. But given some of the things described there, I might proceed with caution.

GAUDETTE: Dr. McInerney, Mike has this question. He says:. 

LISTENER QUESTION: If I'm in my office at work with two other people and we are all wearing masks and social distancing when they leave, is it safe for me to take off my mask now that we know that the disease can be transported airborne? And should I keep the door open when other people are in my office, even if we were all wearing masks?

MCINERNEY: So I think there's two parts to that question, as Dr. Pate had spoken previously about the difference between droplet and airborne and aerosolization, this is more of a continuum than it is a distinction between the two. I think it's really important to highlight that all viruses probably have some component of aerosolization, but many more than others. Right. So the major way that that coronavirus is transmitted is via droplet. As far as staying in an office, if everyone is masked, when his colleagues leave, I think it would be reasonable to take the mask off. If and this goes to the second part of this question, if there is good ventilation in the office, I can speak personally for my household. I have windows open. I have the fan on. You know, I try to keep good air flow at all times. And if I am in my office or in the hospital with anybody else, I really try not to be in a room with a closed space without good ventilation. Obviously, when I'm seeing patients, I have to close the door for compliance and and privacy issues. But if there's meetings or anything like that, I try to keep the doors open and keep as good of ventilation as possible because masking helps, social distancing helps, washing hands helps, good ventilation helps. And then you put them all together and you're going to decrease the risk even further.

GAUDETTE: Dr. Pate, can we talk about something that I know that you are worried about? And this is the myth of mask breaks in school. Let's explain what it is and then talk about how some schools are doing them incorrectly. And I'll tell you this. My kids are back in school in a hybrid model and on the first day back in middle school, not for the younger kids, in middle school, they were told that, look, we know it's difficult to wear masks if you need to quickly take your mask off and take a break. Raise your hand. Tell me, go out into the hall. If there is no one out in the hall, you can take your mask off, count to 10, put it back on, come back in the classroom, however, you should only do that maybe once a week. So I don't know if that's good or not, Dr. Pate, but we're hearing this like it's OK to give kids mask breaks in schools, but then we're also hearing that entire classes have their masks off.

PATE: Yes. Well, that's a great point, Gemma. And I am hearing some concerning stories from parents right now about this. I actually applaud the way that your school is handling this. The things that are concerning that I'm hearing about are-- there's three things of concern. One is there is a common misunderstanding that the use of face shields can be a substitute for face masks. That is not true to the best of our knowledge today. And face shields really were meant particularly for our health care workers, to protect their eyes and face from droplets and secretions particularly involved when health care workers are performing procedures on patients that are sick that may cause them to cough. So I do understand there are some very limited circumstances where teachers feel like the face shield would be important, but this should should certainly be a rare exception, not the usual. And we have to realize that if you are going to wear a face shield in most circumstances, you should also have a face mask on.

But back to the mask breaks. And I'm certainly sympathetic to the idea that we want to give kids breaks and I certainly encourage that. But there's wrong ways to do it. And one that I've heard is that the teacher just sets out time during the day that they can take their masks off in the classroom. That is a mistake. It is not a matter of there's just a sufficient amount of time out of the day that they need to wear their masks. When they're in the classroom around other kids, they should have their mask on all the time. So it shouldn't be done in the classroom.

The other mistake that I've heard is at one school it being promoted that as long as the kids are just reading, as long as they all face the same direction, they can take their masks off in the room. And again, this would be a mistake. And this gets back to Dr. McInerney's point about the airborne transmission that you do not have to be facing another person to transmit the virus to them. So those are mistakes. 

Our ideal situation, and of course, this is not going to be possible every day around the year. But the ideal thing is give them a break outside, get them outside, let them distance and they can take their masks off. Otherwise, if they're going to take it off inside the school it should be in an area where there's very good ventilation, like Dr. McInerney talked about, where they can really spread out in order to do that, the mask break.

GAUDETTE: Well, and it's interesting, Dr. Pate, because even where my children go, my youngest is in third grade, he's eight years old, they have a recess break outside. They're required to keep their masks on because they're eight years old. And it's difficult sometimes to get eight year olds in the middle of playing to maintain distance.

PATE: Yes, and frankly, I don't know how you would do that. If you can, fantastic, because our best defense is distance. But when you know it -- and as I've said many times, anything you do outside is going to be better than doing the same thing inside. But that doesn't mean there's no risk of transmitting this virus outside. And if you're close enough and for long enough, you can do that. But I think the key is and another kudos to your school when you know that you're going to be outside, but kids are still not going to distance. Yes, they should still wear their masks.

GAUDETTE: Dr. McInerney, Carolyn sent us this email and she says:. 

LISTENER QUESTION: I want to make some repairs inside my house. However, the handyman just told me he has cold like symptoms. He has not been tested. How will I know when it is OK to let him work in my house?

MCINERNEY: I wouldn't want anybody-- I wouldn't recommend that she have the repair person in her home with any symptoms. You know, even if somebody has a cold it's best to try to minimize your exposure to that person. I would also strongly recommend that the repair person be tested not only for her safety, but also for other safeties that he's being exposed to. I always say to people, I really want to try to decrease the stigma around testing. Testing is information. And if we get tested, we have more information about how bad the community spread is and then we can do contact tracing. So members of that repair person's family and who else he has been in contact with would also have valuable information if he knew that he had coronavirus. I recommend that he gets tested. 

And then what we know, CDC guidance says that people can be removed from isolation 10 days from onset of symptoms. So in general, we know that patients are not going to be infectious anymore, 10 days from onset of symptoms and twenty four hours since the last fever. Those numbers get a little bit different if somebody is immune compromised or if they're in the ICU. Somebody has immune compromised, then it's 20 days since the onset of symptoms. And if they're in the intensive care unit, then 20 days since the onset of symptoms. But if the repair person isn't sick enough to need hospitalization, then in general you can say, OK, if your symptoms started on this day, then from an infectiousness perspective, he's safe to come in 10 days later. But I still do think that people should be tested if they have symptoms consistent with coronavirus.

GAUDETTE: I think what you said too is this idea of taking the stigma away from getting tested. That is, if we take anything away, take that nugget of information away because you're right, it's information. And there's nothing wrong with getting the test if if you have potential symptoms.

MCINERNEY: Right. And I'm a really big believer in just being, I call it disclosure, talking about risk tolerance, talking about testing. So I've had to get tested twice myself. No surprise, I'm sure, to people on the on the line because of my field of work. But I try to make very clear to people, if I had plans to have an outdoor socially distanced drink, I would say, you know what? I had to go get tested. So I'm not going to see you. I'm not going to be able to have that interaction until I get my test result back. And I think I try to model that and have those conversations. And just, again, take away the stigma to say this is the reality that we're in. There's no need, there's no good that comes from hiding these things and not being tested.

GAUDETTE: Dr. Pate, we have another question from a listener came through email and says:. 

LISTENER QUESTION: Have any of the doctors heard anything about people getting Legionnaire's disease from wearing masks caused by constantly breathing the air that we are expelling back in?

PATE: Yeah, I'm afraid that would be another mask myth. Certainly one can get Legionnaires disease, we still see that infection, it's not particularly common, thank goodness. But one's not going to get it from yourself, from breathing into a mask and then re-breathing the air. So anybody that's worried about that, you can cross that off your list of things to worry about masks.

MCINERNEY: From a pulmonologist's perspective, so for those who don't know Legionnaires disease, that's a colloquial term for legionellosis, which is caused by Legionella. It's a bacterial infection that causes a really bad pneumonia. People get really sick from it. And so spreading this kind of myth is really misleading. You can't really get any infection from a mask. I mean, we need to make sure to clean our masks and make sure that they maintain good hygiene like you would with your clothes. But like Dr. Pate said, this is just a mask myth, we're not going to get an infection from wearing a mask. Legionella is spread usually through water contamination. There is some evidence that people can get it because they aspirate on their own saliva if it's in their own body already. But a mask is not going to transmit any infection to a person.

GAUDETTE: And I want to make it clear the reason why once in a while we ask these questions when something comes up regarding something that medical experts know not to be true is because these myths are out there. And I think it is our job to make sure that we have you as medical experts coming in and saying, no, these are the facts.

MCINERNEY: I think it's great that you're doing that. So thank you.

GAUDETTE: Yeah, absolutely. Dr. Kern. So I know we talked about flu shots earlier, but we did just get an email in from Mary. And so I want to ask this a little bit because I'm wondering if maybe she tuned in a little bit later. But Mary is wondering the timing of a flu shot for people over the age of 60. She's worried that it won't last as long if you're older. But does that I guess that does that matter?

KERN: No, we have enough evidence that it lasts at least through the influenza season and certainly maybe even almost out to a full year after getting the vaccine, that I think you can just confidently go ahead and get the flu vaccine.

And again, if everyone gets their flu vaccine, the likelihood of getting a bad influenza outbreak in the community goes down even more. And so, again, we get into a point where if everyone gets vaccinated, it actually lowers the risk that you even get exposed to influenza in the first place. Likewise, we think these protections we're taking for COVID may very well protect us from influenza. I mentioned one of the previous episodes I was on I think that some of the data out of the southern hemisphere where they've just sort of finished winter is that the influenza outbreak was pretty mild there because of these same things.

GAUDETTE: So, Dr. Kern, can you elaborate on that a little bit? Because this is something that I think a lot of people are curious about. I am, is that because we're wearing masks and if we continue to do that and social distance, because the flu, as we know, it's like you breathe on somebody or you're around someone, you might get the flu. But if we're taking these precautions, there is this idea that it might possibly go down. At the same time, still get your flu shot.

KERN: Agreed, don't hear anything I'm about to say as a reason not to get a flu shot. I think that's incredibly important. And I'll start answering the question by saying that there are some past studies on influenza that have shown masks as an individual intervention, have not been effective at keeping the influenza from spreading. So that is one of the things that people who are sort of anti mask have been pointing to, to say, see, it doesn't work for influenza. Why would it work for COVID? But we know for sure it's working for COVID. And I think the totality of interventions that we're taking, trying to limit people gathering together, even things like how we manage patients in the waiting room at the doctor's office, we've probably changed for good permanently in most medical practices. So I think there's a lot of things that are going to reduce the likelihood of spreading regular colds, influenza through this winter. But again, we don't know for sure. And the fear is that if we don't take the precautions and people relax on masking, relax on sanitizing their hands, relax on physical distancing, then we'll get influenza outbreak as well.

GAUDETTE: Well, if this is any comfort to our medical experts, when I went to get my flu shot last Friday, I just went to our local pharmacy. Anecdotally, they said to me, they said they've never been so busy with giving out flu shots. So hopefully that's resonating with me.

PATE: That's wonderful news.

GAUDETTE: Yeah. Dr. Kern, we just got this question from Twitter. A woman wrote in saying:. 

LISTENER QUESTION: My niece and her roommates all tested positive for COVID-19 in early summer. They're now negative. Can they still carry and shed the virus?

KERN: The answer to that is somewhat unknown. We know that the CDC guidelines currently sort of give you a pass for three months after having an infection and feel that the risk of infection is approaching zero for at least three months. But we also are getting mounting reports of people getting re-infected. We also don't know what the possibility really of somebody carrying the virus and spreading the virus, which is why we continue to recommend masking, even if you've had the virus already.

GAUDETTE: And then Dr. McInerney, Gene wants to know:

LISTENER QUESTION: Are people on CPAPs for sleep apnea considered at risk. And wouldn't the CPAP itself be a value if trying to stay out of the hospital?

MCINERNEY: So for those listeners who don't know, CPAP is continuous positive airway pressure, it is a mask that blows pressurized air into the airway to extend the airway open in patients who have what's called obstructive sleep apnea. People who have obstructive sleep apnea, by definition have underlying lung disease because of the obstructive sleep apnea itself and because of the secondary complications from chronic low oxygen levels in untreated obstructive sleep apnea. So I say all of that to get around to the answer that, yes, I would say that patients who have underlying obstructive sleep apnea and therefore are using CPAP are potentially at higher risk of severe disease from COVID.

And then to the second part of the listeners question is, would CPAP help patients who have COVID pneumonia from getting seriously ill. And we use CPAP in a different form in the hospital to help some of our patients who have really bad pneumonia, but I don't want to say that and mislead anybody to think that they should just manage on their own with COVID pneumonia at home with their CPAP. If somebody is sick enough to have bad pneumonia, if their oxygen levels are low, if they're struggling with really bad shortness of breath and respiratory symptoms, they absolutely need to be evaluated for admission. So I don't want anyone to think that they should use CPAP at home to treat their COVID pneumonia if they're sick enough to even be thinking that way, they should be evaluated and potentially admitted to the hospital.

GAUDETTE: Dr. Pate, Sheila just wrote in and she says her daughter is a long hauler. And she asks,

LISTENER QUESTION: My daughter was told by her primary doctor that she should not get a flu shot this year. She is recovering from a COVID stroke. Is this good advice?

PATE: Well, I haven't seen any advice come out, official advice advising against the flu vaccine. Sometimes we do recommend against it, particularly some of the live vaccines for certain people. But the flu vaccine is not a live virus. So I don't know of any reason, perhaps Dr. Kern or Dr. MacInerney do. I suspect the physician is just exercising caution because we don't understand what's going on with long haulers yet and whether that long hauler illness might be immune mediated and how that might respond to influenza. So I certainly, in my conversation with a patient, make clear that we don't know that aspect.

But on the other hand, I would also assess that patient's risk of getting influenza because influenza on top of long haulers is just going to be a really miserable experience. So, you know, we might see if Dr. Kern or Dr. McInerney know of anything different, but I haven't seen any recommendation against the flu vaccine in that situation.

GAUDETTE: Dr. Kern or Dr. McInerney, either of you have thoughts on that? 

MCINERNEY: Yeah, I haven't either. And I tend to agree with Dr. Pate. I would be more worried about protecting somebody who already has something like long haulers from getting any other additional illnesses, particularly if that person has any pulmonary complications, getting influenza on top of an already injured lung, parenchyma lung tissue would not be good.

KERN: Yeah, agreed, I haven't heard any specific recommendations related to long haulers. It sounded like there at the end Gemma that you said the COVID stroke. That's a pretty unusual situation. And again, this question puts us in a weird spot because we don't know the full details. But COVID stroke is a pretty major complication and it's hard to understand what other complications might be underlying that recommendation. When in doubt, again, even doing a video visit, a second opinion with another doctor and infectious disease doctor in that complicated situation might make sense.

GAUDETTE: And maybe ultimately that's what it is, right, Dr. Kern, is that it's OK to go get a second opinion, especially in a time like this, right? I mean, be the advocate for your own health or your daughter's health.

KERN: Very unprecedented virus, unprecedented complications, particularly as we've talked about in young people asking more questions to me seems appropriate. And I liked what Dr. McInerney said earlier about just the need to be more transparent and discuss these things, especially because we don't know a lot of the long term issues around this virus.

GAUDETTE: So Barbara emails this question to us. And I want to do a round robin on this.

LISTENER QUESTION: When will the doctors consider the pandemic over? Where do the number of cases need to be, number of hospitalizations, E.R. visits, ICU, etc.?

GAUDETTE: So, Dr. Kern, let's just start with you on that of that.

KERN:  Complicated question. Probably depends on a lot of factors. I think there are benchmarks for the amount of community spread that Harvard has laid out at five cases per 100,000, I believe is the number. And we're like not even close to that. I mean, we're way, way above that to consider our community spread under control. And then again, if and when there is an effective, safe vaccine that gives a good immunity to it, that will obviously be a game changer if they can ramp up and get enough doses. But I think even if we saw over the next four months a vaccine come online, the likelihood of getting widespread vaccine adoption seems low. So I think we're in for it for a while is my sense of it. 

GAUDETTE: Dr. McInerney?

MCINERNEY:  Yes, I agree with what Dr. Kern said, one addition is that when the incidents, meaning the number of new cases, is on the decline or flat, that we just don't see any new infections, we're still going to struggle with patients who are infected. You know, they they have a long haul as we've been using that word a lot. But when the number of new infections continues to decline and potentially flatten, when we have a vaccination, it's going to be a while.

GAUDETTE: And Dr. Pate?

PATE: Yeah, I think both are right and, you know, we don't have a commonly agreed to definition of what constitutes a pandemic, but clearly ongoing community spread of the viral infection across most of the countries of this world does constitute a pandemic. And so it means that we've got to get community spread of the virus down. And as Dr. Kern was mentioning, you know, one indicator of when you have gotten below community spread to just sporadic spread is when you're down at under one case per 100,000 as an average daily new cases. So, as Dr. Kern said, we are way, way far away from that. And it's probably going to be at least a year.

KERN: The case counts in Idaho are on their way back up right now. So we're literally headed in the wrong direction right now, looking out for the Bonneville County.

GAUDETTE: I appreciate that caveat right there, Dr. Kern, that is in critical information for people to have.

Thank you, all three of you, for coming on today. I appreciate your expertise and your willingness to come in here and talk about how we need to be transparent about this and to give people facts.

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