Idaho Doctors Warn Of Increases In Coronavirus Cases And Deaths In April

Apr 1, 2020

 

As we continue to cover the coronavirus pandemic, we know many of you have questions and concerns about how to stay healthy and how to protect your community. The best way to answer those questions with facts is to bring on Idaho’s medical experts. 

Starting today, and every Wednesday for at least the next month, we will bring on a panel of doctors and health professionals to get us updated and to answer your questions. (Regular listeners: think of this as a doctor’s version of a Reporter Roundtable!). 

 

Today’s panel includes Dr. David Pate, former CEO of St. Luke’s and a current member of the Idaho Coronavirus Task Force; Dr. Darin Lee, vice president of medical affairs for St. Alphonsus Medical Center in Nampa; and Dr. Kenny Bramwell, administrator for St. Luke’s Children’s Hospital. 

 

If you have questions for next week’s show, feel free to leave us a voicemail at: 208-426-3625. We might use your message on the show. 

 

Read the full interview here:

GEMMA GAUDETTE: This is Idaho Matters. I'm Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know so many of you have questions and concerns. And here on Idaho Matters, we are committed to getting those answers for you and getting those answered with facts. We believe the best way to do that is to bring in medical experts. So starting today and every Wednesday for at least the next month, we will bring in a panel of doctors and other health professionals to get us updated and to answer questions. If you're a regular listener, think of this as a doctor's version of our Reporter Roundtable. So joining us live today, Dr. David Pate, a former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Dr. Darrin Lee, he is Vice President of Medical Affairs for St. Alphonsus Medical Center in Nampa, and Dr. Kenny Bramwell, administrator for St. Luke's Children's Hospital. Welcome to the program. So I want to start with a question that we seem to be getting a lot. And that is why are the COVID-19 cases in Idaho going up and going up so quickly? Who would like to tackle that one first?

DR. DAVID PATE: Well, I could take that one. This is David Pate. So this is what has been expected. The number of cases are going up in Idaho and the severity of cases are going up. And this is not just due to more testing. I've heard a number of people say, well, of course, we have more cases because we're doing more testing. We still are doing a very small amount of testing, relatively speaking. Yes, it's more than before, but it's still a small number. What really gives me the best insight is not looking necessarily just at those number of reported cases, but looking at what's happening in our hospitals with people being admitted to the hospital, be people being put in the ICUs, people being put on ventilators and deaths. And you can tell that that number is worse. We're certainly on that upswing. Most people have seen these graphs that the president has shown and others have shown of kind of a bell curve. We are definitely on that curve that is going up. And that's true of the entire United States, more in some areas than others. But the number of cases is ramping up in every state. And another indication that, you know, that the number of cases is truly going up is, just take into consideration that overnight we had about twenty three percent of all the deaths that have occurred in the United States occurred. So we're definitely on that upswing.

GAUDETTE: Dr. Lee, let's talk about what's going on in Canyon County and what you are seeing there on the frontlines in your emergency room. Have you seen more people coming in, let's say, just in the last week than you saw before? I believe Canyon County didn't even have their first reported case until about a week ago or so.

DR. DARRIN LEE: Yeah, I would say that is correct. We have had a drop off in just total ER volume. If you look across the board, both in King County and an Ada County, but we are starting to see more patients coming in that are probably going to be COVID positive. And I say 'probably' because right now the testing is still lacking to the point where we can't get rapid turnaround of those tests. So a lot of patients who are coming then are being seen, they have symptoms that are consistent with COVID-19. But we won't necessarily know that result if they're admitted. We made a note in a few days that they're not admitted and tested. We may not know it for over a week. And so we can't really say right now how many of those are going to be positive. But just based on the symptoms, it's likely there's an uptick that we're starting to see.

GAUDETTE: And Dr. Pate, I want to bring you back in the conversation, because it's something that you said about the severity of cases that we are now seeing. Is that, was not expected because we because we hear, we heard so much about these cases being, you know, so many people having not severe symptoms.

PATE: Right. We do know that the overwhelming majority of people that get infected will have relatively mild illness that can just be managed at home. And, you know, we don't know exactly what that number is, but it's it seems like it's in excess of 80 percent of people who are getting infected can certainly just manage their symptoms at home and they're relatively mild. However, we've known from watching what has happened in other countries that conversely, somewhere less than 20 percent number seems to be settling maybe closer to around 17, 18 percent of people will have more severe illness. And that and the more severe illness is typically shortness of breath and pretty profound shortness of breath to the point that oftentimes they can't really take care of themselves at home and they may need supplemental oxygen in the hospital or in a fraction of those cases may actually be so severe that we have to put them on a ventilator for support of their lungs. But we did know this was coming and probably just a point to make: I think everybody has heard that you that the deaths are more likely to occur in the elderly and those with underlying medical conditions. And that's certainly true. I think what people have missed is that you can be younger and still have this severe illness to where you have to come in the hospital and perhaps even have to be put on the ventilator. And we have cases of those in Idaho and we have seen those across the country, in other countries. So I do want to just point out for people who are not elderly listening, who think maybe they don't need to pay much attention to this. But while you're not likely to die, those that are in your 30s, 40s, 50s, you're still at risk for getting this severe illness.

GAUDETTE: And Dr. Bramwell, I want to have you join the conversation, because you are the the administrator at St. Luke's Children's Hospital. And as Dr. Pate said, even as this hasn't even reached our country yet, there was so much talk about, well, it seems that the kids are not affected by this yet we now know that, yes, they are in the minority for certain. But we've seen minors come down with COVID-19. I believe we know there's a there's even been a handful of deaths of some teenagers. So what do parents need to be doing when it comes to how we're interacting with our with our kids and things like that? Because we don't want anyone to get this. But, you know, I mean, especially, you know, if this is affecting children.

DR. KENNY BRAMWELL: Gemma, there are a lot of questions hidden in there and I'll get to them in order. So what we know is that if we look at the experience of other countries, which is how we knew two months ago that this was coming and that we really needed to brace for this and change everything that we had been doing. We know that the mortality rate, the number of deaths in children less than age 10 is exceptionally small. That's the good news. The bad news is that many children at less than age 10, and teenagers as well can get this disease and maybe they won't have symptoms of the disease and maybe they won't need to be hospitalized, but the other real concern is that they can spread the disease to other people. This means you if I have a grandson, so I talk about that all the time, like Dr. Pate does as well, I think. What you need to do is distance yourself from your grandchildren, not because you don't love them, but because there's a likelihood that they could share this disease with you. The good news is that the children don't get it, as I mentioned, but somewhat more complicated news is that many of them will get the disease, have a mild go around with the disease, not need to be hospitalized, but they can continue to spread. So one of your other questions is what can we do with our kids? And really what we want to do is keep them away from other people. We want to keep everybody at home who can potentially stay at home, should be at home. We want to become somewhat obsessive about cleaning things and we want to distance ourselves from other people, if you have to go outdoors or you want to go out of doors to get a walk and restore some sanity to your day, I think that's a great thing. But you need to be aware of how close you get to other people. The term is social distancing, which it's not my favorite term because it sounds like you're not supposed to talk to people or be friendly with people. I wish the term had been 'physical separation' or something along those lines, but horses out of the barn on that.

GAUDETTE: Yeah, we can't change it now, right? So for Dr. Bramwell and Dr. Lee, where are you when it comes to PPE, another term that those of us who we're not in the medical industry didn't know before this: personal protective equipment, because there is you know, there is so much talk of shortages around the country. Where are we standing in Idaho?

LEE: I can go ahead and start, this is Dr. Lee. From the standpoint of all of Idaho, that might be difficult to say. I can say from the Saint Alphonsus system and the systems that I've worked with, then we are doing okay with PPE. One of the concerns with PPE is mostly that you don't know where you're going to need it in the future, what that peak is going to look like. You want to be very conservative at this point when we have less cases. And so a lot of the use of PPE is meant to conserve it so that if we're three weeks down the road and we really have a lot of sick patients, we're going to need more aggressive PPE for some of those sicker patients that we have to do procedures on that we still have it. We're still getting supplies and the hospitals still have supplies, but we're trying to conserve it in anticipation.

BRAMWELL: I would echo what Darrin said, Gemma, I think at St. Luke's I can speak for what I see there and what we talk about every day. We are doing OK with with a reference to the PPE that we need. The challenge is that much like the groceries that you have at home, you always have a few days or maybe a few weeks on hand. You don't necessarily have months or years of supplies on hand. And so the concern with PPE locally is not that, 'oh my gosh, we are out of PPE.' But 'what can we do to conserve what we have? What can we do to get ready for the onslaught of new patients in the next few months? And how do we protect our staff who are on the frontlines and and dealing with these patients who are infectious?' So I'm happy to say that we're getting lots of responses from the community. There's a project that I'm aware of. I was talking with some leaders yesterday where we are trying to repurpose local manufacturing and volunteer efforts. People dropped off N95 masks, bless their hearts. Over the weekend, both to my office and to my house. People were starting to drop off masks that they've made at home. And, you know, it's wonderful to see the community rallying around the health care teams. But I would say to answer your question, we are doing OK and we are doing everything we can to shore things up for the future.

GAUDETTE: Dr. Pate, you are on the the governor's coronavirus Task Force. And we have a statewide stay home mandate until April 15th. President Trump extended the social distancing recommendations just the other day through April 30th. Why... I have a couple of quick questions: What what are we'd be likely to see in the month of April? Because we've heard that these next two weeks across the country are critical. And would you put Idaho in that spectrum?

PATE: Yeah, I think that yes, the next two weeks are critical, but I think it's actually going to be longer than that. What people are doing is they're looking at the various models that are being created. The president showed one such model in his press conference, I think it was yesterday. And I'm sure people have seen multiple of these models online and they typically show a, what we would call a, bell curve. And then people are looking to where's that bell? The top point at that bell, where's it going to peak? And that's where they're coming up with the two weeks. For Idaho, I think we're going to be more like three weeks. And, you know, the good news is it Idaho was like the next to last state to have a documented case. And I think our rural nature of our state is helping us. The less population density, the less being a travel destination, etc. A lot of things are helping us that are going to make the impact to Idaho a little bit less. But nevertheless, we are going to see this continuing surge of of cases and severe cases. Right now, a lot of those models project for Idaho that it'll be somewhere between perhaps April 21st and 25th. But I should tell you that there are many assumptions that go into these models. And if you change one assumption a little bit, it can make a drastic difference in that model. And there's certainly just a lot of things that we're just making a best guess. So we don't really know. I think the important points are for people in Idaho to prepare themselves that things are going to get worse. They are going to get a lot worse in the month of April. We are going to have many more people hospitalized. We are going to have many more deaths. We've been fortunate so far that compared to many, we've had fewer deaths, but we're going to have many more deaths and we have to be prepared for that. What does that mean? Well, I think it means that everybody needs to take this very seriously. And those that are the naysayers, we can't listen to that. That is not reality. And for young people, you're going to make the difference. We're really relying on you. I know nobody likes to be cooped up, but it's more important now than ever. And we've got to protect people from coming into contact with others who might be infected. That would make this even worse. Everybody has heard by now the phrase flatten the curve. And what we're talking about there is there's there's no doubt. I think, as Dr. Bramwell said, this this horse is out of the barn. There's no doubt we're going to see an increase in cases, more hospitalizations, more people on ventilators, more deaths. The question is, what can we do to decrease that peak and spread this out so that even though Dr. Lee and Dr. Bramwell said that St. Luke's and St. Al's And our other hospitals are doing OK for the moment, we could easily be overwhelmed if people don't adhere to these guidelines and stay home and distance ourselves and wash our hands and so forth. So that's what we're talking about. Things are definitely going to get worse in April. It's still going to be rough in May, I'm quite sure. And then what other. The other the last thing I would say is for all of you that are looking at these curves and you see this one bell curve, understand unfortunately, that's just the first wave. There will be more.

GAUDETTE: This next segment: We've got some listener questions that I would love to get answered. So the first one comes from Katy McConnell. And she says the state and public health districts so far have reported confirmed COVID cases and deaths. Is there any agency reporting hospitalizations?

PATE: So this is David Pate, I'll take that. So, yes, we are starting to report hospitalizations both to the federal government and to the state government. Some people may be surprised that those aren't metrics that would routinely be reported, but they aren't. So with the enactment of the CARES Act last week, there is now a requirement on hospitals to report that to the federal government. So they will start having that data soon. And then the hospitals are reporting that currently to the state that is going to roll up to the Office of Emergency Management, and they will be measuring the number of hospitalizations as well as a lot of other data. And they're looking at that right now to determine what data will be made public and what won't. But that is going to be tallied from across the state.

GAUDETTE: And then Erica Griffin asked, does the governor stay at home order mean I can't go outside for a walk around my neighborhood exercising proper social distancing? I would love for one of you to answer this. We get this question a lot.

BRAMWELL: So I'll take that one. This is Kenny Bramwell. I don't think that that is what is intended by the stay at home order. What we're trying to do is, in essence, decrease the exposure that you have to other humans. And if you are staying away from other people while you walk. I think it's great. It happens to be what my family's doing at home is that they go for a walk every day. I was out mountain biking on Saturday. I will say that the group of 10 guys school were leapfrogging me and stopping and kind of joke around with each other. That was not social distancing when they stop in a group of ten and they're hooting and hollering. But for the most part, if you can get outside and you can get some activity, you're gonna be better off and you'll get it a little, a lot of benefit out of it for the movement. And and I think your risk of exposure is really small, particularly if you're distancing as we've talked about.

LEE: I just want to see if I could add into that. I think the one thing to remember are really the ways that this viruses is obtained or transmitted and it's mostly through droplet. And so it's going to be important to number one, you know, always wash your hands or use and sanitizer if you're touching any surfaces or outside of your home and clean frequently in your home. And the second one is to not touch your face. So the most common transmission for this disease is hand to face, hand to mouth, hand to nose, hand to eye. And so if we can learn to stop touching our face, that will stop a lot of the transmission. The social distancing is for those small amount that are potentially if you're in close contact with somebody and getting direct droplets from them. But we know that if you're at least a six feet away, you're not going to get them. We also know if those contacts are very limited in short spans, you're not going to get it that way. But the most common way is really through hand touching your face. And that is one of the benefits of wearing a face mask. It's not really to it's going to protect you that much from the droplet, although the CDC may be changing what they recommend on that, but really it's to remind you not to touch your face and you can reduce the transmission that way.

GAUDETTE: And then a question from listener Katie John, she says, What does the 21 day stay at home water in Idaho mean for blood banks like the Red Cross?

PATE: So this David Pate. The blood bank, is an essential service. So it is open and I would just like to make a plea to everybody listening to this. You know, one of the things that can be very tough about this stay at home order and so forth is that we can kind of feel like victims. Look what coronavirus is doing to us all. What's really exciting is to see how people are using this as an opportunity to make themselves, you know, very helpful. And and that can help you with your mental health. Dr. Bramwell already mentioned people making cloth masks for health care workers. Another thing you can do is if you are not ill, if you are healthy, please go donate blood and understand that, yes, we have a pandemic we're dealing with right now, but there are still people delivering babies who have significant bleeding. There are still people that get in car accidents that we need blood. There's still pink cancer patients who need transfusions. Please donate if you can.

GAUDETTE: And then we have a question from a listener, Cooper, and he says, I heard an interview with a St. Luke's doctor from Wood River on Boise State Public Radio who mentioned that, quote, We know now up to about 50 percent of people with COVID do not have symptoms. He says the doctor also went on to say, we know that it takes about 17 days after symptoms start before you start seeing people needing to be admitted to the ICU or having fatalities. And it's really probably about three weeks from the time people contract it. What Cooper wants to know is, are those statements accurate?

BRAMWELL: This is Kenny, I'll answer part of that. There was an announcement from the CDC today that I got on one of my feeds, as well as on one of my emergency medicine feeds that the CDC announced today that up to twenty five percent of patients -- that's their highest estimate -- may not have symptoms. That's that's the most reliable thing that I've seen was from the CDC today. As far as the other comments from Dr. Torres, I happen to know him and like him. He's a good man and a good doctor. He probably has as much local experience as anybody because the epicenter, at least initially, was in Wood River. And he works in that emergency department up there and has quite a bit of insight from the number of cases that they saw up there in the last few weeks.

LEE: And I might add one more thing, this is Darrin Lee. I think there is a difference between how the population health look at that and then the individual look at that. And we know that from a population health, it takes a couple of weeks from when you first start seeing them do it, where you start seeing the sicker patients who are the older ones with co-morbidities. And then some time later, usually the the younger ones. But that's not in an individual. You know that, of course, the illness is usually shorter than that to where, you know, it can have an incubation period up to 14 days. But usually the incubation period is a few days and then you start getting sick. And then about day seven to ten is when you could potentially get sicker and require hospitalization. But that's very dependent on the individual.

GAUDETTE: And then listener Michael Russell asks, counties reported with positive cases do not always list the cities or the towns that are affected. I would like to know how we find out what cities and towns have positive cases. And so, I guess, is there a way to find that out? Because I know, let's say for Ada County, they say, you know, X amount of people have it in Ada County. They don't say Boise or Meridian or Kuna or Star.

PATE: This is David Pate. So there may be someone tracking that information that's actually less helpful than you would think. And and the problem is that we have so much movement from one county to another and -- sorry, from one city to another. In fact, even from county to county, but cities. So, for example, even if you were to look at Blaine County, which Dr. Bramwell mentioned was a big hot spot, even if you tried to look at, well, how many of those cases were in Ketchum? How many were in Hailey? How many in Sun Valley? Wouldn't really help us that much because people move around a lot. You have people that do provide essential services in Sun Valley, for example. And a lot of those people don't actually live in Sun Valley. So it's just not as helpful as you would think. But there may be somebody collecting that data.

GAUDETTE: And before I let the three of you go, and  first, I so appreciate you taking time out of all of your busy schedules right now to be answering our questions. Dr. Pate, before we came into this segment, you said, you know, we need to prepare ourselves that this isn't the end, even when we start to be on that downward curve. Does that mean that we are going to need to prepare ourselves to continue, you know, living the way we're living right now or if we do everything we are doing? Yes, we will continue to live with this and hopefully there will be a vaccine at some point. But is this something we just have to all mentally prepare ourselves for? Or will life start to open up again and then we may see this again in the fall?

PATE: Yeah, I think the latter part of what you said. Gemma, you know, there's a lot of variables and we're not quite sure what is going to happen when we get to the summer months. There are reasons to be optimistic and hopeful that the transmission of this virus is going to decrease. And so if we are effective at flattening this first curve, I do think there will come a time in the next couple or several months that we may be able to loosen up the restrictions. I still don't think we're going to be going to big crowds, but we may not be as tightened down as we are. The other thing that could be a big game changer that is not ready now, but may be ready in that timeframe is we may be able to actually measure who is immune, who got that COVID and now is immune and could be the frontline workers that come back and that we don't need to worry about as much. So I do think we'll get to a point where we'll be able to loosen this up. My fear is that, will we take this seriously again the next time we need to do this, which probably would be the fall or winter? And then, you know, as you mentioned about the vaccine, that's a year to a year and a half away if everything goes well and there's a lot of variables there. And then it depends on how quickly we're able to manufacture, distribute and administer the vaccine to get levels up to where we need it, to where it'll provide communities for protection. But we will not be living the rest of our lives like this. And we may get some reprieve in just a couple or several months.

GAUDETTE: I want to thank all three of you for taking time and talking to us today about this. We've been talking with Dr. David Pate, former CEO of St. Luke's Health System and current member of the Idaho Coronavirus Task Force. Dr. Darrin Lee, vice president of medical affairs for St. Alphonsus Medical Center in Nampa. And Dr. Kenny Bramwell, administrator. We will keep having these conversations every Wednesday. So if you have questions, e-mail us at IdahoMatters@BoiseStatePublicRadio.edu Or send us a voicemail at 208-426-3625. Thank you, all three of you for the facts and for helping us understand this. So appreciate it. 

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.

 

Idaho Matters is working on a story about how families are dealing with school closures during the coronavirus outbreak. Parents: What do your days look like now? Are you creating structure, or are you letting your kids have an extended spring break? Kids: What do you like about being at home, and what do you miss about school and being with your friends? Using your smartphone, please send us a voice memo with your family. Tell us about your daily routine, or about what your’e doing to stay distracted or learning. Send the voice memo to idahomatters@boisestate.edu. We might use your message in an upcoming show.

 

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