Idaho Doctors Weigh Risks That Come With Governor's Plan To Reopen Idaho

Apr 29, 2020

 

We’re back again this week with our panel of Idaho doctors to answer more of your COVID-19 questions. As the state prepares to begin reopening on Friday, Idaho Matters is here to help get your questions answered. 

Joining Idaho Matters this week to share their expertise are:

  • Dr. David Pate, part of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s.
  • Dr. Samantha Birch, Infection Prevention Specialist at Saint Alphonsus Regional Medical Center.
  • Dr. Rob Cavagnol, St. Luke’s Executive Medical Director. 

Have a question for the panel? Leave us a voicemail with your question and we may use it on next Wednesday’s show. Here’s the number to call: 208-426-3625.

Read the full interview here:

GEMMA GAUDETTE: You're listening to Idaho Matters. I'm Gemma Gaudette. As we continue to cover the kind of virus pandemic, we know so many of you have questions. You have concerns. And here at Idaho Matters, we want to answer those questions with facts. We believe the best way to do that is to bring in medical experts here in Idaho. Every Wednesday, we've been bringing in a panel of doctors and other medical experts to get us updated and to answer your questions. If you're a regular listener, kind of think about this as our Wednesday version of our reporter roundtable, except with medical experts. So, joining us today are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Samantha Birch, she is an infection prevention specialist at San Alphonsus Regional Medical Center, And Dr. Rob Cavagnol, St. Luke's executive medical director. Thanks, everyone, for being here today.

ALL: Thanks, Gemma. Hi, Gemma.

GAUDETTE: Dr. Pate, I want to start with you. Give us an update on where we are with the coronavirus task force. Any latest information?

DR. DAVID PATE: Well, thanks, Gemma. You know, it's amazing to think of how much has transpired. Our first case here in Idaho on March 13th, and we've already gone through our first peak and we've learned a lot. We've learned a lot about the virus. And we also learned that social distancing and our other infection prevention techniques work. And I'm so proud of Idahoans because of Idahoans compliance with the governor's orders, we're now in a place where he has the option of deciding whether we do further re-opening of the Idaho economy. So I think the focus of the work group is going to be probably on three things: monitoring, anticipating and preparing. By monitoring, I mean, as we do take any steps, as the governor allows for any reopening, we've got to monitor new cases. We've got to monitor E.R. activity at our hospital capacity. When I say anticipating, I think that we need to be thinking about when is our next peak going to come? Is it going to be better or worse than what we've already experienced? Part of that, we'll be updating our modeling. Part of it, will be observing what happens to other countries as they're reopening, what happens in other states, because all 50 states are taking a little bit different approach, some more aggressive than others. So we'll be watching that. And I think the third thing that will be really interesting is to observe what happens in the southern hemisphere because they are getting ready for their flu season. And I think a lot of us have questions about what to expect this fall and winter as we move back into our next flu season. So all of those things we'll be looking at. And then finally preparing. And by that, I mean making sure that we have sufficient testing capacity and capabilities, contact tracing, hospital capacity and supplies.

GAUDETTE: So we are officially starting the reopening, kind of soft reopening on Friday, May 1st. Now, it's a four phase reopening. And I am curious to know, what do we all need to do in order for this plan to work? I mean, should we be wearing face masks in places like the workplace, you know, going to the grocery store, going, you know, out in public, basically? And I and I'd like each of you to answer that question. So, Samantha, can I just start with you and then let's kind of go down the line.

SAMANTHA BIRCH: Yeah. In my opinion, the probably the most important thing that people do as we start to venture out again is to stay home when we're sick. I think that's really hard to do. But if the people who are acutely ill would not leave and unless it's necessary, we could definitely reduce spread outside of our homes.

GAUDETTE: Dr. Cavagnol?

DR. ROB CAVAGNOL: Yeah, thanks so much. You know, I think we have to recognize that we're not back to normal. And this is going to go on for months. We have to continue to physically distance from other people. I think wearing masks is critical, handwashing, avoiding large crowds. All those things that we've been doing that Dr. Pate highlighted that have resulted in getting to where we are now. We have to continue to do all those things. This is kind of our new normal and we're gonna be in this situation for a long time. The other thing I'd like to add on the Dr. Pates comments is that we have to be nimble. And what I mean by that is that if we start to see spikes in cases or we start to see that hospitals are getting filled up, we have to be able to turn things back off. And I think that's you know, the governor and other folks in leadership are put in a tough spot because they have to make hard decisions and they may very well come back to us and say, hey, we have to go back to closing things down in the communities need to get behind that, because that's that's really what resulted in getting us to the point that we're at.

GAUDETTE: And Dr. Pate?

DR. PATE: Yeah, I think Samantha and Dr. Cavagnol are exactly correct. This doesn't mean wild abandonment and that we're going back to normal. This means we got to keep doing all those things, like Samantha said. Big thing is, if you're sick, stay home. And so we need to really look at schools and businesses that make it hard for people to do that because, you know, this would not be the time to say, well, you've got to go to the doctor and have a doctor's note or excuse or something. No. For right now, if you're sick, just please stay home, you know, and we should continue to work from home if we can. And and no big meetings. We should be doing teleconferencing. We've still got to do the social distancing. Like Dr. Cavagnol said, good handwashing cover our coughs and our sneezes, disinfect surfaces. It's still also a time to minimize our travel. Realize that every place of this country is at a different spot. And while we are in a pretty good spot here in Idaho, that is not true of all places. And so we still need to minimize that travel. And I think we also need to continue to make sure that our elderly and our most vulnerable understand that really probably with this at least in these early stages of reopening. Nothing changes for them. They've got to take extra precaution and protect themselves.

GAUDETTE: And Samantha, I'm curious. I mean, you're an infection prevention specialist. What do you think that we have learned so far? And also what can we do as regular people to maybe prevent the spread? Right. It doesn't seem like we're going to stop this until there's, you know, possibly a vaccine, but maybe it goes back to what we've just talked about. But are there other things that long term while we're going through this, we should be doing?

BIRCH: I think one thing we've learned here is that we've been reminded that pandemics are going to happen. Just in my lifetime. You know, I remember MERS and SARS and H1N1 and 2008 and 2009. I think that we are technologically and medically advanced and we should be able to solve these problems. But this is a good reminder that even though we think that we can, you know, get through this with no deaths or it's not going to be a big deal, these things happen and they happen on a regular basis. And we probably should do a better job of being prepared and start early with prevention. And you're right, the things we have mentioned already this morning, you know, washing hands, especially good respiratory hygiene is probably really important. And kind of one thing that would help health care systems is more supplies, not something that, you know, the the general population has much to do with. But we all are in some areas scrambling for more masks or gowns. And we think we have enough because we feel like we have so many. But when everyone all of a sudden is a person under investigation, we use up our supplies really quickly.

GAUDETTE: Go ahead, Dr. Pate.

DR. PATE: Well, I just wanted to add on to what Samantha's saying and just say amen. Samantha, made a really, really important point that I just want to emphasize, and that is if you're just listening to cable TV, you might think that there was no way anybody could have foreseen this or or thought this would happen when, in fact, health care providers and experts in this field have been planning for this for decades and knowing that pandemics were coming. And like Samantha said, this isn't our first pandemic. I think the really important thing for all of us when we get to that point is there are lessons for all of us to learn. There's lessons for the CDC to learn. There's lessons for the federal government to learn. The state those are providers. And we have to learn those lessons because, as Samantha said, this will not be our last pandemic.

GAUDETTE: And it goes back to also I think the point, Samantha, that you brought up -- and Dr. Cavagnol and Dr. Pate, you both reiterated this -- is if you are sick, stay home. That is just culturally not acceptable within our country. And that, we have to flip a switch on.

BIRCH: Right. I agree.

GAUDETTE: I am guilty of: hey, if my kid has has a cough, you know, you're going to school, you don't have a fever. I mean, even as parents, we have to switch on that right now.

DR. CAVAGNOL: Gemma, this is Rob Cavagnol, so I'd say too. You know I'm new to Idaho and I'm learning there's this grit about Idahoans. It's kind of almost like a badge of honor that I'm not calling in sick. You know, I don't feel that bad. I don't need to go to the emergency room. And people need to realize that it's not a sign of weakness is actually being smart because you're not exposing your co-workers and other people to the illness. And that's what we saw, you know, early on, is that, you know, it was being passed very quickly from person to person because of that interpersonal contact. And people weren't staying home when they were ill or or also they were obviously asymptomatic patients passing the virus on. But it's just it's against that, you know, ingrained Idaho, get it done-type culture. And so people just need to realize  they're doing other folks a favor by staying home.

GAUDETTE: We need to take a quick break. When we come back, we have got listener questions that we want to get to. This is Idaho Matters. More of our conversation with our medical experts today as they get ready to answer your questions about the coronavirus. Our panel, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, Samantha Birch, infection prevention specialist at St. Alphonsus Regional Medical Center, and Dr. Rob Cavagnol, St. Luke's executive medical director. Our first question comes from our listener, Joanne. She called in worried about going back to work safely. Let's take a listen.

LISTENER QUESTION: Hi, my name is Joanne and I live in Napa and I currently work for a company in Boise that works exclusively in the center as well as residential habilitation. The center has closed down since that order from Governor Little, but now they are wanting to reopen on the 4th of May. And I'm curious if that feels safe. I'm 63 years old. There's a population in the center of about 50 to 55 participants and around 25 staff. And so I don't know it because it's an essential business, but they feel they can open it within the CDC guidelines. I'm a little bit worried for my own personal health and feel like I need to stay out longer. I just would like to have an opinion of the doctor. Thank you. 

GAUDETTE: Dr. Pate, can you take that one?

DR. PATE: Sure. Well, Joanne, you're right to be concerned. We need to be cautious and and especially for those. You're the same age that I am and I certainly would be cautious, even though I'm not, you know, technically at much risk as some of the people that are older than me. And you didn't mentioned whether you have underlying health conditions that might put you at at more risk. I think that the key is that you need to talk with your employer. I think employers also want to keep their employees safe. And if you and they may not be thinking about every job that every employee does for their company. So, you know, talk with the people in your business, in the health department or the H.R. department about special concerns that you have, especially if there are things where you think you can't avoid being in close proximity to others. That would be a special concern. Think about ways that you can still do your job, but do it differently where you can be on a conference call instead of in a meeting where you can't and not have to interact as closely with others. But if you think you can't avoid being in contact with a lot of other people, I would certainly talk to your employer about the additional steps that could be taken to protect you.

GAUDETTE: And then we have listener Judy, and she had this question: since the last stage of reopening Idaho still includes 10 to 50 people with social distancing, what constraints will churches need to keep after May 1st to be saved? Because churches come Friday, as long as they follow, certain guidelines are allowed to reopen.

BIRCH: I just actually read on the governor's website the directions directly to houses of worship for opening. And they're pretty specific about what people need to be doing and keeping six feet between people or between families and not shaking hands and not, you know, having direct contact, you know, hugging and things like that. And if and when Church congregations get back together, I think they should be very cautious about those things. I know it's hard to to think about maybe going to a church congregation where you are excited to see people. But we should probably be very careful about the close contact with our congregation members.

GAUDETTE: And then we have another listener question about daycares in pre-K. Those are allowed to open in phase one. But we know that it's not easy to impress upon little kids that they need to wash their hands for 20 seconds, for example. In your professional opinions, what specific measures need to be in place for those to open? And do you think that they can operate safely right now?

BIRCH: I would imagine some of the things that a daycare could do is pretty rigorous screening of the kids. And if, you know, anybody has a temperature or any kind of symptoms, then they probably shouldn't be there for the day. And then just regular, daily, you know, handwashing, which I know three year olds, some three year olds I know really enjoy washing their hands. And so just making that a habit, getting in the habit with those groups of taking care of their own health through, you know, hand washing and paying attention to runny noses and things like that.

GAUDETTE: And Dr. Pate, I'm curious to what you have to say about this, because, I mean, there are parents that are going to have to go back to work and you can't go back to work if you have little ones that don't have any care.

DR. PATE: Yeah, it is a concern, and I think Samantha's advice is very good. In addition, I would suggest that daycares look at what options they have to decrease the number of children that are in contact with each other and maybe keep that kind of a stable group rather than continuing to mix children. I think Samantha's point of screening is very important. And we've got to emphasize to mothers like you, Gemma, that want to send your kids to just school with a cough or something, you know, we can't do that right now. I think the other thing is, just like you said, Gemma, is that this is a great opportunity for us to teach our kids about proper hygiene and how to minimize the risk that we're going to make somebody else sick.

GAUDETTE: Absolutely. And I'm curious, too. Do any of you think that when schools maybe go back in session in the fall. Are we going to see requirements like facemasks for kids? I mean, there's 20 kids, a lot of times, 25 kids in classrooms.

DR. CAVAGNOL: That's a really interesting question. I think a lot of it is going to be based on where we are at that time. You know, this is such a dynamic situation. I don't think any of the three of us could tell you where we think we'll be in the fall. But I think we do have to start thinking differently. And that is, you know, frequent handwashing. You were talking about the daycare situation earlier. And, you know, my biggest recommendation to those parents picking up their kids from daycare is bring some hand sanitizer or some wipes or something to wipe down your kid's hands and face after you pick them up. Because if they have anything from that from that daycare, you don't want to bring it home and transfer that to other people. But regarding the question about schools in the fall. Yeah. Maybe we'll see a mix of some online classes and some live classes. Maybe the classrooms be more spread out. But I think our teachers and our our leaders, our educational leaders are going to have to start thinking about those types of things so that when the fall rolls around, we'll be prepared just in case we still have a significant disease burden in our community.

GAUDETTE: So Kathy called in wanting to know if there is a list of coronavirus cases by city like Boise. Here she is.

LISTENER QUESTION: Yes. My question is, is there a count of COVID cases in Boise? I know there is for Ada County and the state of Idaho, but I have read somewhere Boise had zero, which would be surprising since Ada County has so many. I'd love to get that answered. Thank you.

GAUDETTE: Dr. Pate. I think a week or two ago, someone asked a similar question and about city by city.

DR. PATE: Yes, you're right, Gemma. And to my knowledge, that reporting does not exist publicly that I've seen. First of all, I can assure you there have been cases in Boise. But second, I think it's it's difficult and it's a bit artificial, just like your previous caller who lives, I think she said she lived in Nampa, but she works in Boise. So these distinctions about what city you're in are a little artificial when people often live in one place and work in another. As far as our risk and so forth. So we do tend to take this approach of reporting by counties and public health districts and and the statewide rather than by individual cities.

GAUDETTE: And then Rob in Boise called in and he is not very confident about the safety of our coronavirus vaccine if the process is as rushed. We want to give you a quick note on this one. We had to filter out the traffic noise does question. So he's going to sound a little bit tinny.

LISTENER QUESTION: I actually have very little confidence in our current administration and probably even less than the FDA. If they do come out with a vaccine, it seems to me like the entire process is rushed. What level of confidence we have that any vaccine, they create for the coronavirus is going to be a.

GAUDETTE: Dr. Cavagnol, can you take that one to begin us?

DR. CAVAGNOL: Sure, sure. So, you know, I think it's a balance, right? So the way out of this is is getting an effective vaccine. And so there's certainly a desire to get that up and and functional as soon as possible. But I can tell you, in the process of developing a vaccine, what they start off with is safety and they start testing it in a small number of patients. And the first thing they're looking for is, is it causing any harm? And then they increase the number of people exposed to the vaccine and then later on. Is it is it effective? Is it generating an antibody response that's actually going to reduce the likelihood of contracting the virus? And so safety is is the number one concern. And that's what they start off evaluating. And I'll just add, you know, vaccines have probably been one of the most effective things that we've implemented on a public health standpoint that have saved lives. And so, you know, vaccines typically take years and years to develop. And I know that there's a ton of companies that are ramping up their testing and evaluation of these. But I think safety is going to be the top of everyone's minds.

GAUDETTE: And while we're in that process of figuring out the vaccine, because we know it could take upwards of 18 months or so. Can someone explain -- because we've learned all these new terms. Right. Social distancing, PPE. There's another one coming out. And this is contact tracing -- can can one of you you explain what that is and and why it could be helpful.

BIRCH: I could do that. The health departments do contact tracing for many different diseases. TB is one of those and they are doing it here with COVID-19. And when someone has a positive COVID test, they contact that patient and they do an investigation to see who else they had contact with at work, school, various places like that. And if they feel there was enough interaction between this index patient and the others, they recommend testing for those other people just as a way to try and stop the spread and get the people who potentially had significant contact tested or, you know, or treated before they can spread it on.

GAUDETTE: So then with that, you could then potentially say, all right, this individual tested positive. They were around these groups of people. We need everyone to to quarantine while we wait for test results. I mean, is that kind of how it how it would how it works? I think a lot people trying to wrap their brain around how that in, you know, is effective.

BIRCH: Yeah. I'm actually not sure exactly what the local health departments are doing right now, if they are recommending quarantine until the test results come back or if they're saying if you're not symptomatic, you don't need to quarantine. I don't know the specifics right now, but that's the general idea, is the people who had had had exposure know that they need to watch out for illness.

DR. CAVAGNOL: Contact tracing is a partner with testing in isolation. So you trace contacts of who's been infected, you test them and you isolate the people who test positive. And so all those things need to be taken together. Testing by itself is not a strategy. Contact tracing by itself is not a strategy. But you need to do all of those things in order to limit the spread.

GAUDETTE: We're going to come back with more of our medical experts roundtable right after this. Our conversation with our medical experts today. Our panel, Dr. David Pate, former CEO of St. Luke's Health System and a current member of Idaho's Coronavirus Task Force, Samantha Birch, infection prevention specialist at St. Alphonsus Regional Medical Center, and Dr. Rob Cavagnol, St. Luke's executive medical director. Listener Michael asks this question. He says, I sneeze down and away from people. Is that worse than sneezing into my elbow when it comes to infecting others?

BIRCH: If you're sneezing because you're ill. I think the preference would be to contain any of those droplets in a tissue or something that can be disposed of and then doing hand hygiene. If you're sneezing because you have allergies, maybe not a big deal that you're just sneezing down and away. But then we'll reiterate the the fact that if you're ill, then you probably shouldn't be around people where you're sneezing on them.

GAUDETTE: Mm hmm. And then a follow up to that, what is the latest on how far coronavirus droplets can spread? Well, we were at six feet at one point. Is that do we know if that's still the the consensus?

BIRCH: The last time I looked at the CDC guidance for infection prevention, it was still six feet. 

DR. PATE: Oh, sorry -- I was just going to add just for clarity. First of all, if you're anywhere around Michael, six feet is not enough. So, but the important thing to remember is that six feet is a minimum. It is a good rule of thumb. There's nothing magical about it. But if you're around people who are coughing or sneezing, you want to get way further away from that. Six feet is going to be a good general rule of thumb. But that doesn't mean there's no possibility you could be infected by somebody else.

GAUDETTE: Well, listen, my eight year old came in and told me the other day, he goes, Mommy, did you know that a sneeze can travel 13 feet? I'm not sure where he got that from, but I'm going to go with it. [Laughs] So another listener had this question: "When I wear a face mask at work or at a grocery store. Am I helping myself or my helping the people around me from getting the coronavirus?"

DR. CAVAGNOL: Both. I'd say the mask helps to prevent people from touching their face. And it also helps in case you're an asymptomatic carrier, you have very mild symptoms. You don't realize you're infectious. So it helps from you spreading infected droplets to other people. So both.

GAUDETTE: And then that listener had a follow up question. So do homemade masks work?

DR. CAVAGNOL: It in that respect, I would say yes, because homemade masks help you to stop touching your face and contain the droplets as well.

GAUDETTE: So if you're just joining us right now, we are just two days away from things reopening just a little bit here in Idaho. And I want to go back. We talked about this a little bit in the first segment, but I want to go back to this. What will we see that's different come Friday? And Dr. Pate, you're on the task force. I mean. Well, because when you read it, it doesn't seem like there is a lot changing from tomorrow to Friday.

DR. PATE: Yeah, I don't think it will be dramatic and it shouldn't be dramatic. Probably the biggest change we're going to see is this weekend related to churches and houses of worship that we've already discussed. Otherwise, this shouldn't be a lot of difference between how you conduct yourself today to how you conduct yourself then. We'll certainly be continuing to monitor things. I think the governor was very wise to say, you know, the timelines put in his reopening plan are just kind of illustrative, he's not saying definitively we're going to advance from one stage to the next based on those timelines. I am sure that we're going to be watching things and we may be some of those opening plans may evolve. But looking at it in 14 day increments, I think is a good way to look at it and see if we see anything that concerns us that we need to take a different track. We'll be continuing to watch the number of new cases, we'll be watching E.R. visits and activity to see if that becomes a problem. So we're going to continue to monitor this. But over all, there shouldn't be a tremendous change from today to Friday.

GAUDETTE: Dr. Cavagnol, all I mean, you know, being the executive medical director at St. Luke's, for you being on the frontlines, what would you want to see that would make you comfortable going into that phase to come May 16th. And on the flipside of that, what would make you hesitate to wanting to move forward?

DR. CAVAGNOL: I'd say a lot of it will depend on the community's behavior. And so if you see people who are making good decisions and wearing masks at grocery stores and maintaining their distance, that's a good sign. If people think this is behind us and we're out of the woods and everything's fine, we're back to normal. That's going to be a problem. And there is a lag in in when we start to see spikes in cases and when we're actually having problems. And so, to Dr. Pate's point, we have to really keep our finger on the pulse and be monitoring how many people show up in the E.R., how many cases do we have? Because that can really, as we saw, you know, earlier, that things really spiked up quickly and folks in the community might not know a lot of people who are infected or they might not really notice that it's a big deal. But health systems can quickly become overwhelmed. You know, our ICUs were getting close to capacity there, a couple weeks ago, and that's when we really start to get concerned that we're not going to have the capacity to care for people.

GAUDETTE: And with that, you know, everybody's getting antsy, right? I mean, I don't think there's one person that's, you know, at a point where it's like, I want I want to stay like this indefinitely. But the best advice, you know, for people right now, I mean, what what would you say? I mean, because I think, you know, it's spring fever, right? It's beautiful out. It's supposed to be almost 90 degrees today, but we still need some type of vigilance. I mean, that just seems to be the proper course to be taking.

DR. CAVAGNOL: Yeah, I'd say get outside. Do something fun. Go hike, go bike, go do whatever you like to do. Don't do it in a group of 20, you know, be smart. Stay away from people. You can run the trails or you can ride your bike or do whatever you want. Go to the park, but do it with people that you live with in your house. And when you come home, wash your hands. I think those are some solid recommendations.

GAUDETTE: One last question before I let the panel go. Well, even though come Friday we're in that phase one, it still says no. No public gatherings or even private gatherings. So there were a lot of people that have been able to see their loved ones. Right. Is this the time to reunite or do we need to wait until that that phase two.

DR. PATE: Yeah. Gemma. This is David Pate. I think the concern is that this virus can be transmitted from someone who feels perfectly well and and we've especially been able to see that the virus can be present and can transmit, especially in the one to three days before someone becomes sick. That's our challenge. If if this if you've got this virus and immediately you got seriously ill, we wouldn't have a problem because nobody is going to go out and be around others if they're that sick. But the problem for us, the challenge for us is this ability to transmit this infection without knowing that you are creating a risk for others. And that is why Dr. Cavagnol makes it very good point that, you know, those face coverings, those are because we could be carrying that virus and transmitting it to other people and not knowing it. So those face coverings will help prevent that. This is not the time. I know everybody's anxious. And I'll tell you what, as a grandpa, nobody's more anxious than I am to get around those kids and give him a big hug and everything. But we're not there yet.

GAUDETTE: Good advice. I want to thank all of you for taking time out of your schedules to be on this program, and just give us the facts and the information that we need moving forward through this. We've been talking with David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Samantha Birch, infection prevention specialist at St. Alphonsus. And Dr. Rob Cavagnol, St. Luke's executive medical director. Thank you to all of you.

ALL: Thank you. Thanks. Thanks, Gemma. 

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