As Idaho Eyes Reopening More, Doctors Wary Of A Recent Rise In COVID-19 Cases

Jun 10, 2020

 

Idaho Matters is back with our panel of Idaho doctors to answer more of your COVID-19 questions. This week, they answer questions about kids and the coronavirus, changes to hospital visitation policies, who's following CDC guidelines, and stage four in the Gov. Brad Little's reopening plan. The governor will announce whether the state will move to stage four on Thursday. 

Joining Idaho Matters this week are: 

  • Dr. David Pate, a member of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s.
  • Dr. Megan McInerney, pulmonary and critical care physician and assistant director of the ICU at St. Alphonsus Regional Medical Center.
  • Dr. Kenny Bramwell, medical director for St. Luke's Children's Hospital.

​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. Or email us at idahomatters@boisestate.edu.

Read the full transcript here:

GEMMA GAUDETTE: It may not seem like it for some people, but we are still in the middle of a pandemic. Many people have questions and concerns and they want answers from medical experts. So that is why we have brought our team of medical experts back on the program to get us updated. Our panel today, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, Dr. Meghan McInerney. She is a pulmonary and critical care physician and assistant director of the ICU at St. Alphonsus Regional Medical Center. And Dr. Kenny Bramwell, he is the medical director for St. Luke's Children's Hospital. Thanks, everyone, for joining us.

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

GAUDETTE: And remember, if you do have a question, listeners, you can e-mail us at idahomatters@boisestate.edu. Dr. Pate, as always, I want to start with you to get an update on where we are on the task force, because we do know Idaho is one of, I believe, about 22 states in the country that's actually seen a rise in COVID-19 cases since we've started reopening.

DR. DAVID PATE: Yeah, Gemma, to some extent, an increase in cases is not terribly unexpected because we are reopening the economy. People are in more contact. And unfortunately, I think all of us have seen examples where people are not following the guidance. The thing that I think differentiates Idaho from the other states that you referenced, that I'm actually more concerned about those other states, is in those states that increase in number of cases has also been accompanied by increases in severe illness with people admitted to hospitals and ICUs. I'm knocking on wood, but we have not seen that in Idaho yet. So we are in a little bit different place. And it could be that more testing has contributed to our increased numbers. I don't think you can say that about a lot of the other states because there's nothing about the amount of testing done that would really signal definitely impact the number of people in hospitals and ICUs. So, yes, concerning and something for us to watch here in Idaho. But I'm not as concerned as I am about many of those other states that are in that 21, 22 states with increasing cases.

GAUDETTE: And Dr. McInerney, over at San Alphonsus, can you talk a little bit about what your visitation policies are right now? You know, things, you know, are kind of fluid because the governor does continue to open things up. So we go into new phases. So what's going on with, St. Al's in that regard?

DR. MEGHAN MCINERNEY: Yes. So as we move toward what we're calling the recovery process, meaning that the hospital is starting to increase the care provided to non-COVID patients, elective surgeries and other procedures being done, we will likely start to loosen our visitor policy. But this is dependent on the numbers that we're seeing. And so, as Dr. Pate had just mentioned, at St. Alphonsus, we are also seeing an increased number of positive COVID test results. And I actually admitted I was on in the ICU two weeks ago and I admitted to patients to the intensive care unit. And we had not previously had anybody in the ICU for the past week. And so I believe that we are seeing a new kind of rise in COVID-positive cases. So because of that, our visitor policy is still pretty strict and that is with the goal of keeping our colleagues, our patients and our community safe. So we still have very limited visitor policy. We do not allow visitors for patients who are on the general medical wards. We do allow a visitor for patients in the intensive care unit, for pediatric patients, for those supporting mother in labor. And then for patients who might be impaired with dementia or other kind of mental illnesses where they would really need a support person to advocate for them. And then at the end of life, patients who are at the end of life transitioning to what we call comfort measures, focusing on making them comfortable at the end of their life, we do allow to visitors. And I've said this before on your show, it is important to acknowledge that those of us in the hospital taking care of these patients, it is hard to take care of patients when we know that they can't have their loved ones with them. And we work very hard to connect with family members, to do Zoom meetings, FaceTime. So we also want to just acknowledge that this is a difficult time. And although our visitation policy continues to be strict, it's in the effort of keeping everybody safe. And I do want to add that those visitors who to come into the hospital are encouraged to wear a mask and they can bring their own mask in or we can provide them with a cloth mask when they arrive at our doors. Again, and that is for the safety of everybody in the hospital and in our community.

GAUDETTE: Dr. McInerney, are you concerned with maybe seeing kind of another wave of COVID since you did admit two patients to the ICU? Did you say last week or two weeks ago?

MCINERNEY: Yeah, last week. So I am concerned. You know, I respect very much that the measures that the Department of Health and Welfare are using to determine whether it is safe to move to phase four of opening. And I'm not aware of all of those measures. Dr. Pate can certainly speak to that more than I can. But I worry, you know, being an ICU doctor who is admitting COVID patients and being part of the COVID response team at St. Alphonsus, I have to admit that I drive around town and I see some of the loosening of, you know, the social interactions and people not wearing masks...

GAUDETTE: Oh, I think we just lost her. So I know Sam, my producer, Sam, my producer will get her back. Are you there now? Dr. McInerney, we dropped you out for a minute. OK. Sam's going to work on it.

Dr. Bramwell, I'm curious then with St. Luke's and how are things looking at St. Luke's since we've kind of seen the loosening going on of the of the stay home orders?

DR. KENNY BRAMWELL: Sure, Gemma. Those those are good questions. We find as we look at our data each day that we have been in a good place for many weeks now or we have a dozen or fewer cases across our system. So across those seven hospitals, we have, you know, ten or twelve or fewer cases each day in our hospitals. And that's remained there for some time, which is one of the reasons that we started to resume elective surgical care last week to the degree that we did. So it's gone well. I think that the community needs to be commended as best as we can for how they have rallied around these recommendations locally and nationally and done a really good job to get us to this point where we're able to start to do normal activity again. And we're doing that quite cautiously. But I would say that it's going well so far.

GAUDETTE: And Dr. Bramwell, what about, you know, we heard about these cases, what's called Multi Symptom Inflammatory Syndrome. That's the illness that's affecting some children. Have we seen any of that in Idaho? It seems to not be in the news much right at this moment.

BRAMWELL: Yeah, it was in the news quite a bit about two weeks ago. Gemma, as I'm sure you saw, children represent about 20 percent of the population in our state and in other states, but they have represented about one percent of the admissions to the hospital nationally for COVID. So although they are roughly one fifth or one out of every five patients is pediatric, as far as just the general census, they're only one out of one hundred patients who need to be admitted to the hospital. Amongst those, one out of one hundred pediatric patients who get admitted to the hospital, there is this very rare but very life-Threatening complication that has had a couple of different names. But I think we have finally settled on the MISC, as you said. There have been, at last count, and I haven't spoken to anybody in the last few days from our sister hospitals elsewhere in other states, but my understanding is there has been one case in Denver, one case in Salt Lake City and one case in Portland. Fortunately, we have not had any cases here in Idaho. I expect that we will, but we have not had any cases of MISC so far.

GAUDETTE: Dr. McInerney, I want to ask you to give us an update on access to-- I'm I'm going to butcher this name. It's going to let you say it. It's a drug that you've  given to some patients at Saint Al's for COVID-19 treatment. How are they? How did they respond to this? Because we've heard about this in as well in the media.

MCINERNEY: Yes. So it's an antiviral called Remdesivir, which is an antiviral, which was actually initially an investigational drug that was found to be somewhat effective against Ebola. And it was never FDA approved for any use that we saw at the end of April that there was a randomized controlled trial conducted by the NIH that showed that the recovery from COVID might be shorter in patients who received Remdesivir. And because of that, Remdesivir was then approved for emergency use authorization by the FDA. And Gilead has released it for some expanded access use. And with that, our Idaho Department of Health and Welfare then got a distribution of this medication and then they gave it to the hospital systems. So Saint Alphonsus got its allocation. And I imagine that St. Luke's also got its allocation. And so I have used it on two patients and I'm glad to see that both of those patients responded well. It's hard to know if they would have responded well anyway, without it. But they were both severely ill and in the intensive care unit and they tolerated it well, and so I think that that was encouraging use for us. As we know, this is somewhat of a data-free or a data-limited zone. It used to be data-free, but now it's data-limited zone as far as treatment approaches for patients with COVID. So we're learning as we go. And it's good that our state has gotten access to this medication and we're able to use it in appropriate patients.

GAUDETTE: All right. Let's get to some listener questions. Bill has three questions and they're all related to cleaning high touch area. So, Dr. McInerney, I'm hoping you can tackle the first ones. So Bill asked: "in general is diluted Clorox or 70% rubbing alcohol more effective?

MCINERNEY: So I think that we can't say whether one is more effective than the other, I would say that they are equally effective. I recommend, when I was kind of reading about this stuff for high touch areas, doorknobs, counters, what not, the CDC has a very useful link with advice on how to clean people's homes and high touch areas in general, dilute Clorox or 70% alcohol should be equal efficacy.

GAUDETTE: And then Dr. McInerney, Bill, goes on to ask: "what is the recommended residence time, so the time between you apply it and then wiping it off?"

MCINERNEY: Right. For that specific combination, whether it's Clorox or 70% alcohol, I would say between one to two minutes. For other cleaning agents, each manufacturer will have recommendations on the back of the label. And so what they recommend in general is that you wet the table and then and then let it dry and then wipe it off.

GAUDETTE: And then Dr. Bramwell, Bill's last question is: "which of those two products are better for cleaning your laptop, your iPad or your iPhone?" He says, "I'm concerned about damaging the devices."

BRAMWELL: Yeah. My advice would be to use, first of all, to have some sort of cover on your electronic device, including a screen cover. And then once you have those materials in place to follow the manufacturer's instructions, again, there are some suggestions on the CDC Web site: Cleaning and disinfecting your home. There's some really good suggestions there. And I think that probably the main thing is to find something that works well in your situation or in your home. And do it regularly. I think we commonly forget to clean our electronics. And I think if we can get them cleaned regularly, that go a long way for us.

GAUDETTE: And Dr. Pate, Susan and Eagle sent us this e-mail. She said: "on Wednesday, after careful research and interviews, I visited the dentist for a cleaning. The dental office advertised on its website that they're following CDC guidelines. I brought a mask and gloves. However, one of the dental staff at the office seemed to disparage the CDC guidelines. The staff person was critical of Dr. Anthony Fauci, an infectious disease specialist, and this staff person seemed to suggest that Dr. Fauci had a hidden agenda. I am very concerned and I am now afraid I may be infected because this medical business does not really believe in the safety guidelines. How can the public trust that businesses are protecting their patients or their customers, if staff members are actively undermining safety guidelines? I trusted this dentist to follow CDC and state recommendations, not question their efficacy. I trusted this business with my life, so to speak. So how can we truly make sure that these businesses stay safe?"

PATE: Yeah, it's very concerning to hear these kind of things and a week or two ago, we had a similar question about a podiatrist office. You know, the general public has a choice as to how informed they want to be and whether they want to engage in the conspiracy theories. But professionals who care for patients, we don't. We have to be guided by the science and the medical evidence. So it's very disturbing to hear that this staff member was not. That doesn't tell me whether the dentist was and hopefully she doesn't represent the dentist. But what it probably represents is in that office, they're not doing a good enough job of education and training. So I think for Susan, I would notify the dentist that this was what she experienced. Hopefully that dentist wouldn't tolerate that. However, if there is kind of a disregard for science, it also makes you wonder what other evidence they may not be following. And of course, the American Dental Association has supported the CDC guidelines. So I would notify the dentist and then I would probably -- it sounds like Susan doesn't have a long established relationship with this dentist -- there's plenty of dentists out there that are being very careful and it might be time for a change.

GAUDETTE: And I think it's fair to say, and this is for all three of you being medical doctors, is that patients have a right to speak up. If they feel uncomfortable, and let's say that that was the medical hygienist. She just said a staff person there, you have every right to either say, wear a mask or to get up and walk out.

MCINERNEY: Absolutely. I absolutely agree and I support, you know, I can't echo what Dr. Pate said enough. It is our job as medical providers to follow the science and to follow the evidence based medicine as best as we can and to protect. Our job is to protect our patients as well as our colleagues. So I think that they should absolutely say something, a customer and a patient and feel strong enough to walk out and know that they've got other options.

GAUDETTE: Dr. Pate, Josh wrote in and I want to ask you this, Dr. Pate, because you are on the task force. He wrote in saying that bars and nightclubs are packed in Boise and other cities and he says they are not trying to stop this sort of COVID-19. He says, I think the governor moved up the opening of the bars too soon. Why would he do something like that?

PATE: Well, you know, I think the governor got a lot of pressure from bars, and I think it became a difficult distinction between restaurants that served alcohol that were allowed to open and bars that served alcohol, but perhaps not a regular dinner fare, why they couldn't open. And so it got to be a very difficult position. I think all of us worry about bars. It is hard to maintain physical distancing in a bar. I think it's harder than in a restaurant. It's also, I mean, I haven't been to bars in a long time...

GAUDETTE: Neither have I!

PATE: ...But when I did previously go, they tended to play loud music, which means you have to speak very loudly, which means you're more likely to transmit the virus if you have it. So I think we've all been worried about bars. Now, with that said, I don't want to paint all bar owners with the same brush. I think there probably are a number of bars that are doing the very best that they can. But, you know, the other thing I think people have to take into consideration is just like we talked about with this dentist -- if you see that any business that you are going to frequent isn't following this guidance, isn't physically distancing, doesn't have their staff wearing face masks. I just wouldn't give them my business. I'd go somewhere else. And so it is a concern. And I'm afraid that we are going to see cases from bars and other situations where people are getting together in too large of groups and too close together.

GAUDETTE: And we should note: I wish I could remember the name of the bar in downtown Boise because it'd be good to give them a shout out, the weekend at bars did open. I believe either it was the owner or the manager, shut the bar down because people were not abiding by the social distancing rules. So it is not all establishments. And I do think that's critical to make that distinction.

We are going to take a quick break and come back with more questions right after this. More Idaho Matters right now, my producer told me in the break. That bar in downtown Boise is named Karma. They were the ones that closed down because of lack of social distancing.

Want to get to a question from Phil, and he wants to know from each doctor. He says, "just wondering, as summer is here. Would you fly on a plane at this time?" And I'm gonna go around. Dr. Bramwell, would you get on a plane right now?

BRAMWELL: Yes, I would say that I would, particularly with what I've been reading about the distancing that they've been doing and with masks on the -- I'm gonna call them patients, but they're not patients! We're hoping that they stay away from being patients! The people on the plane are wearing masks as well as the staff. So I would.

GAUDETTE: Dr. McInerney, what about you?

MCINERNEY: I would not. I think that the risk is still too high. I worry about gatherings of multiple people. Yes. I wouldn't feel ready yet.

GAUDETTE: And Dr. Pate, what about you?

PATE: I would not. In fact, I just gave advice to a friend of mine this morning whose family members are contemplating a trip here, that I would not recommend air travel right now. And it's not totally just the airplane. I do think there are some good things that airlines are doing about their air flow and all. But we've all been on planes at times when the air's not circulating, like when we're first boarding. Additionally, it's the airports and the congregation at gates. All the things that Dr. McInerney said, I'm not going to be flying for some time.

GAUDETTE: And our last question, because we are running out of time today. Listener Michael said that he heard on CNN that the World Health Organization said the spread of the virus by someone not showing symptoms is rare. So if I don't have any symptoms, do I still need to wear a mask? Dr. Bramwell, yeah.

BRAMWELL: That that was a statement made a few days ago that I believe has since been retracted or corrected.

GAUDETTE: I think you're right, Dr. Bramwell. And Dr. McInerney, you would agree that we need to be wearing masks still.

MCINERNEY: Yes, absolutely. And my understanding is that there is a pretty high rate of asymptomatic spread in the 12 to 24 hours before somebody develops symptoms. So I think that it is a time to be very cautious. And we should absolutely continue wearing masks, continue social distancing and continue handwashing and sanitizing.

PATE: Well, I was gonna say: I agree with both that they did retract that statement. I think that doctor was trying to make a very nuanced argument that was lost on everybody. Please continue to wear masks. You can transmit this virus if you're asymptomatic.

GAUDETTE: And that is the bottom line. Thank you. Thank you to all three of you for coming in today. I'm sorry our time ran short. If you have any questions for our doctors, they will, of course, be back next Wednesday. Send us an e-mail idahomatters@boisestate.edu. It is Wednesday. Hope you all have a good rest of your day. We'll see you back here tomorrow. 

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.

 

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