As Idaho Hospital Beds Fill, Doctors Answer COVID-19 Vaccine Questions

Nov 11, 2020

Idaho set records again this week with number of new daily coronavirus cases and hospitalizations. Now, hospitals across the state are turning patients away, as the bed shortage here and in neighboring states is realized. 

Joining Idaho Matters live today to talk about the real danger of our current situation are:

  • Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce.
  • Dr. Laura McGeorge, St. Luke’s Health System Medical Director, Primary and Specialty Care.
  • Dr. Darin Lee, VP of Medical Affairs at Saint Alphonsus Medical Center and an ER doctor in Nampa.

Read the full transcript here:

GAUDETTE: You are listening to Idaho Matters, I'm Gemma Gaudette. Idaho is heading towards 65,000 confirmed cases of COVID-19. Just Tuesday, 16 more deaths were reported. And even with a rollback to phase 3 two weeks ago by Governor Little, it is safe to say our current numbers are going the wrong way. So as we have done for more than six months now, every Wednesday we bring in our medical experts to give you the science based facts about this virus, and they will answer your questions. So if you have a question for our doctors, send us an email right now at idahomatters@boisestate.edu.

 

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. Laura McGeorge, St. Luke's Health System medical director, and Dr. Darin Lee, vice president of Medical Affairs at St. Alphonsus Medical Center and an E.R. doctor in Nampa. Thanks for joining us, everyone.

 

ALL: Thanks, Gemma.

 

GAUDETTE: So I want to start with something that happened at 10:30 this morning. St. Luke's spokesperson Anita Kissée sent out this tweet and I'm going to read it in its entirety. So it says:

 

"Well, friends, I'm so sad to say we have *75* COVID19+ patients in @StLukesHealth Magic Valley hospital this morning. The hospital had to divert *ICU* patients temporarily last night... and say 'no' to the Elko hospital pleading with us to take patients because Utah won't."

 

Dr. Pate. This is not good.

 

PATE: This is alarming and of course, I've known that we were heading to this point for some time now, but I don't think the public understands how alarmed they should be. So, you know, I have run a large referral hospital when there was no capacity to take patients. And let me tell you, it's terrifying. When you're that family with that patient at Elko and you know that your family member needs care and needs it quick and that Elko hospital can't provide it. And the place you would typically send patients can't take the patient because they're overwhelmed. And the place that that hospital would then typically refer out of state is overwhelmed. And Utah hospitals have been telling us for a couple of weeks they can't take our patients anymore. People are going to die. 

 

And if those listening here think, well, that's not a problem because that will be COVID patients and I'm not going to get COVID, they're mistaken because it also affects people that have heart attacks, people that have strokes, people that get car accidents. There could be any number of things. It doesn't just back us up for COVID. It means that hospitals are going to be overwhelmed for whatever you have. And if you have what we call a time-sensitive emergency, heart attacks, strokes, et cetera, where we have to make an intervention in a limited amount of time in order to optimize the outcome you have, but because our hospitals are overwhelmed, we have to fly you to someplace that's hours away, you're not going to have as good an outcome and it's going to be far more costly. So this is a very, very dangerous situation we're in.

 

GAUDETTE: And I think it's fair to note as well, and our Madelyn Beck at Boise State Public Radio is working on a story right now regarding our surrounding neighboring states having to take our patients here in Idaho. Frankly, many of them are angry with Idaho because they have mandates in place. We just expect that our patients should go to these other states. Yet, we can't even take patients from other states. 

 

So, Dr. McGeorge, I want to bring you into the conversation. You are part of St. Luke's. What is this like for doctors, for nurses? You have been working on the front lines of this now for some eight months.

 

MCGEORGE: Yeah, Gemma. People are tired, they are very tired, I think, tired and really, frankly, starting to feel really demoralized. Our nurses, our doctors, our environmental services team, our respiratory therapist, all of these health care workers have been working extra shifts, longer shifts, not taking time off to rest and recuperate. And then when they are going out into the community and seeing people not helping to reduce the spread of this disease, it is really demoralizing. And I think after months and months of this, I'm starting to see a shift where people are feeling really, really down about that. And I think as we start to see the situations like what is going on in Magic Valley, you know, we're going to get close to that and Boise too. Our hospital in Boise is very, very busy. And, you know, I was just today looking -- for what it's worth -- I was looking at the Boise wastewater fecal count of the virus RNA. And it is going straight up and that curve. And I don't want to give people the impression that is something that's contagious or infectious. But it does give us a sense of what RNA is out there in the community. And everything we're looking at, whether it's that, whether it's test rate positivity, everything we're looking at is looking very, very worrisome, going very strongly in the wrong direction. And it is only going to get worse because I think what's happened is people's behavior, choices they're making-- Actually, I think people are tired and some people are choosing not to do things to protect each other. Some people had been but are getting tired. But, boy, now is not the time. We are heading into holidays. We're heading into winter. And we just have to buckle down and get through these next three to four months. And then I think we'll start to see some light at the end of the tunnel.

 

GAUDETTE: And Dr. Lee, let's talk with you. You are part of St. Alphonsus, a doctor in Nampa. Just Tuesday, just yesterday, Canyon County surpassed Bonneville County on the hotspot list. 156 new infections as of Tuesday and last night, Dr. Lee, you were talking with the Nampa School Board about COVID safety. Can you talk a little bit more about this? Because what we're seeing, too, is things like school sports still being played.

 

LEE: Yeah, in the Canyon County area, it's interesting because you have, you talk about people who are getting sick from COVID. But what's actually interesting is that the number of people that don't know they have COVID that we are testing so much more now, we're seeing patients that are there for their, you know, appendicitis or for their heart attack or for something completely unrelated to COVID who are testing positive, which means they've been positive in the community for a period of time. You know, we had this discussion with the school board because, you know, and I certainly don't envy their job because it's a very difficult job to try to walk that line between making sure that students are well taken care of, not only their schooling, but also their health, their food insecurities, lots of things that go into schooling. But there are definitely things that they can do that would be helpful. You know, sports seems to be one of those things where we know that's a hot spot. We've seen those outbreaks. You see them in professional sports. You see them in high school sports or anywhere they're going to play sports. It's just an activity that, by its nature, is very easy to spread the disease. And while those students may not get sick because they don't get as sick as adults do, they live in multigenerational households, especially in the Canyon County area where they're going to have an impact on their family and grandma and grandpa, especially as we move into the holiday season where they may see those relatives, but a lot of them live within the same household.

 

So, you know those things, even though it's not the kids themselves that we're seeing mostly hospitalized, they're having a huge impact on the community if you allow those things to continue. We try really hard to avoid those outside of you know, when you're in the school room, you're not sitting next to people, you're trying to stagger classes, all those sorts of things that help prevent the spread of this disease. But there's definitely some activities there that, again, the school board has tough decisions to make, but that is one that is a known area where they can have an impact.

 

GAUDETTE: I want to talk a little bit more about what is going on in our state. And with all due respect to every official out there who has to be on the front lines making decisions, so all due respect to our governor. With that being said, though, this idea of personal responsibility, let's be clear, it does not seem to be working. In Twin Falls just on Tuesday, the Twin Falls City Council tabled the idea of a mask mandate because there was so much backlash against it. People showing up, basically a super spreader event. I mean, let's be clear, people who want a mask mandate likely did not show up because you're not supposed to be in crowds like that. Post Falls decided not to implement one. Kootenai County rolled its mandate back. And it goes on and on and on. Yet research just came out yesterday saying that masks work, in fact, are more effective than first thought. And they can protect you if you wear one and you protect someone else if you're wearing one.

 

So Dr. Pate with all of that being said, we saw what happened in Utah on Sunday where Governor Herbert, who, yes, he is retiring. So it may, from a political standpoint, be easier to implement an emergency and put a mask mandate in place. But he did that. It took him a couple of weeks after medical experts in Utah said, we're going to be in a triage level. I think it's fair to say that it sounds like Idaho is on the heels of that. Where do we go from here? I mean, this idea of stepping up and making the right choice for your fellow Idahoans doesn't seem to be working.

 

PATE: Yeah, well, Gemma, it's something that I agonize over and regret our state of affairs for a long time. I'm disappointed in people just as a fundamental promise that we don't have that personal responsibility. Today's Veterans Day. I think about the veterans who sacrificed their lives so that we could have freedoms. And then you think about what freedoms they were thinking about. And now we've got people saying, well, I need to have the freedom not to wear a mask. And the fact that these veterans would lay their lives down to protect us, but the people around here, a lot of people won't wear a mask to protect others is-- it's just very hard for me to understand, and I think frankly, and I have been critical of Republican and Democrat alike, but the fact that our president and vice president, the vice president chairing our coronavirus effort for the country have not modeled behaviors, have not reinforced public health points, in fact, have really been quite antagonistic to public health, has created innumerable harm to our country. And then the effect of social media and the the amount of play that false, misleading information and conspiracy gets out there is just incredible and is a terrible barrier.

 

And then for Idaho, the legislature set up our public health system back in 1970. I don't think they were contemplating a pandemic. And so here we are. And I think we're finding that our public health system isn't structured very well for 2020. But we have seven different public health districts doing different things. We have people on public health boards charged with the public health of Idahoans who don't believe in central public health tenets and principles. It's just incredible. Certainly people are entitled to have their beliefs, but that doesn't mean you should be on a public health board and charged with other people's health and the fact that public health boards have not stepped up.

 

And most recently, I've dealt with the issue of sports. Dr. Lee brought up the issue of sports. I think we have to have a serious conversation in Idaho. What's more important? Is it playing sports or is it keeping our kids in person school who want to be? And I'm not sure that we can have our cake and eat it, too. But frankly, when I tried to talk to people about sports and particularly wrestling, I cannot imagine a more dangerous sport in a time of a pandemic than wrestling. And yet what is happening is when I plead with public health boards, they're telling me they're getting pressures from legislators not to do this. And then we've got the threat from our legislators that they're going to take away emergency powers from the governor, which I'm not confident they can do constitutionally. But they're going to try, it sounds like, and they're going to take away authority from our public health boards. We are going to move in exactly the wrong direction. And, you know, maybe when we have a pandemic with a 3% case fatality rate, maybe we're just so insensitive that we're just willing to have a certain number of people die so that we can have our quote-unquote freedoms. But what if that next pandemic -- because there will be a next one -- what if it has a case fatality rate of 30%? I think we're going to really regret that we haven't paid attention to public health and haven't made the investments and we're not supporting and frankly, what's going to happen to all these public health professionals that work in the public health departments that know the right thing to do, that have been encouraging the right thing and their boards won't take action. So it's just unbelievable the leadership failures that we've had in the country and in our public health districts. But the political pressure is so intense. And then, of course, with the loss of reelection by Diana Lachiando, I think that just reinforces if you vote to have masks, then we will vote you out of office. And I have to believe that the majority of Idahoans want the right thing. If that's the case, we are going to have to come out and stand up behind those elected leaders and tell them we want you to do the right thing. And if you do, we've got your backs. And that vocal minority, we're not going to let them vote you out. We will have your backs. But that's not happening.

 

GAUDETTE: This should be about public health, not politics.

 

Before we get to questions, two more things I want to quickly touch base on. And Dr. Lee, maybe you can talk about this. Is as we just talked about in the last segment, how dire the situation is in Idaho, and that is not an exaggeration. On top of what we are seeing with COVID cases surging with hospital capacity, we have now had two deaths due to the flu in Idaho. So this seems like a perfect storm, but not in a good way.

 

LEE: Yeah, it's pretty scary because we know also that if you get COVID and the flu at the same time, which definitely can happen, the mortality rate is also going to be higher. But, you know, there are things that you can do to prevent the flu. We already have a flu vaccine. We really have to be better at getting the flu vaccine and getting it early. So the flu is here now. So we're already behind if we don't have the population vaccinated against the flu. It's really important we don't have a COVID vaccine right now. It's not going to be out for, who knows, a month, two, three, four. But we do have a flu vaccine and you can get the flu vaccine and it will help protect you. You know, vaccines are going to be really important. They're going to be a lot of discussion about this in the future. We know about the flu vaccine and we know that it is effective. It doesn't stop every flu case, but it can stop adding people to the count that come into the hospital. People who get the flu can get very sick as well. We've had that discussion along with COVID, and we know that this time of year, we're starting to see that increase in patients being admitted for flu, patients from nursing homes, patients with comorbidities. So it's this year more than any it's really important that everyone get vaccinated who can get vaccinated.

 

GAUDETTE: And Dr. Lee and Dr. McGeorge, so speaking of the flu and what we were talking about in the last segment, in regards in particular, let's say to the Magic Valley where they couldn't accept any patients yesterday within their ICU. If someone were to come in with the flu and they needed to be hospitalized, is this one of those scenarios -- and maybe, Dr. McGeorge, we can start with you -- where there may not be capacity for someone like that if we continue down the path that we're on.

 

MCGEORGE: Yeah, Gemma and I do want to talk about Magic Vally or Twin Falls again a little bit more here, too, and how that relates. So first of all, I just want to be clear with the numbers. And I think on that tweet this morning, the numbers are always fluid because we have patients that are being tested that we don't know yet if they have COVID. And we have to treat and assume that they have COVID. Also, the situation with Elko is we would, you know, intermittently we are able to take patients. But for the most part, again, we're not. And it's really on an ad hoc basis whether or not we're able to do that. As far as-- So now we have someone who comes in with influenza. I think to a point made earlier today, I think it was by Dr. Pate, whatever the time-sensitive emergency is, whether now it's influenza or it's a heart attack or a stroke or a car accident or whatever it is, there are a bunch of people normally on any given day that need to be hospitalized. In the winter, we know those numbers surge normally because of influenza, In kids, there's RSV and just other things. But now on top of that, we have this huge number of COVID patients. Right now in the Magic Valley, about 25-30% of the patients in house are COVID patients. So if you took those out, we probably would be about normal capacity and would be business as usual and be able to manage. But again, yes, whether it's influenza or anything else, it's going to cause continued crunch on our space.

 

GAUDETTE: So some news came out earlier this week regarding a vaccine with Pfizer saying that they have a vaccine that is 90% effective. Dr. Pate, we are getting, just as we speak, honestly, my screen in front of me continues to get all of these questions, quite a few of them regarding the vaccine. So can we start with that announcement, Dr. Pate, and what Pfizer has has said about it? Because we do know, if I remember correctly, that the earliest, earliest this vaccine would be available would be January. But that is front line workers, general public, potentially June. So can you start there? And then I will kind of give you some of these questions coming in that hopefully we can answer regarding the vaccine.

 

PATE: Sure, so you're right, we got very good news, very encouraging news out of Pfizer about their vaccine and that is a very high effectiveness rate. Very seldom do we have a vaccine that's 100% effective, in fact, for this vaccine, what we were hoping for was 70% effective. So if it turns out that Pfizer is right about the 90%, this will be really, really good news. And we have another vaccine that looks like it's potentially even more effective. So we have lots of good news. Now, I would caution: these vaccines are still in trials. It is still early. We're waiting more results. Things can change. But I don't think Pfizer would risk coming out and making that statement if they weren't pretty sure that was going to hold up, because obviously their stock price will take a huge hit if they're materially off. They do indicate that they're going to apply for an emergency use authorization with the FDA at the end of this month. And so there's going to be a period of time and our federal government knows that there's a lot of mistrust. So I do believe that they are going to review this very carefully and they will have some outside review. But it is possible that first responders, health care workers, some could get their first vaccine -- because this will take two shots -- could get the first one towards the end of this calendar year, wouldn't get their second one, as you said, until probably in January. And then what we're hoping is that a vaccine could get out to others over the spring and be widely available by the summer.

 

The other good news, though, is that it's not just the Pfizer vaccine out there. We have probably four others that are actually pretty close and might be getting the same kind of authorization in the first part of 2021. The reason that that's important is two things. First of all, all these vaccines are a little bit different. We often find that different populations respond differently for vaccines. Sometimes we have to do things differently for the elderly because they don't respond immunologically the same as younger and special populations. So this gives us a lot more choice if we have a lot of vaccines.

 

The other reason it's so important is if we got two, three, four or five vaccines approved, it will help us get more vaccine out quicker because it's going to be hard for any one company to make enough vaccine for the United States, let alone the world. So this is very promising, very encouraging. We need to watch further. But good news. 

 

GAUDETTE: Dr. McGeorge, Kathy and Ingrid from from Boise are thinking about the vaccine. And so the part I want to focus on in their question is the refrigeration aspect of it. We do know that the Fizer vaccine requires specialized storage and shipment practices. So do we know maybe anyone on our panel, if you know this, do we have the refrigeration requirements for that? Because I think it's important to know that the website STAT is reporting that rural hospitals around the country, so not just Idaho, may not have these ultracool freezers and they don't have the ability-- they don't they can't afford it. So can any of you speak on that?

 

MCGEORGE: Gemma, I believe that we have that capacity right now. We certainly are working on making sure we have that capacity. To your point, that is another issue, a logistical issue that's going to be a challenge nationally. I mean, there has to be a supply chain and then the ability to even get those. So we have anticipated this and have known that this is potentially coming and have been working in this direction. I would say this is going to be a huge effort across the area, across the state, across the country to make sure that we outreach to all areas and share resources or do whatever we need to do. This would be great work if the public health department were able to help with this. And I think, again, back to Dr. Pate's point, they're really not prepared for that. So we'll probably have to lean on health systems to help here.

 

GAUDETTE: State epidemiologist Christine Hahn literally just emailed us. Dr. Hahn, thanks for listening to our show, first off. But she says: 

 

 

STATE EPIDEMIOLOGIST DR. CHRISTINE HAHN: "Public health has indeed reached out to and identified hospitals in Idaho that can store our initial doses of vaccine. Later shipments will go right to vaccinating providers."

 

GAUDETTE: So that is from our state epidemiologist in regards to how we will be able to store this vaccine when it becomes available.

 

An interesting question coming in from Bill right now, Dr. Pate. Maybe you can take it. Bill says:

 

LISTENER QUESTION: What can non medically trained people do to relieve the pressure on medically trained people besides taking care of their pets, their children, housework. Are there any jobs -- volunteer or paid -- at clinics or hospitals? Is there a fund that people can contribute to for hospital workers so they can order takeout? Or...?

 

PATE: Well, that's fantastic. I appreciate that. The first thing I think is back to the point that Dr. McGeorge made earlier in the program, you know, we've got a lot of health care workers that have been working solidly on COVID for 9, 10 months now, putting themselves, putting their families at risk, dealing with a lot of people who don't do well. And it is fatiguing to them and it's further exhausting to them when they see people not taking precautions. So one thing I just recently wrote an editorial, and I think as we approach Thanksgiving week, I think we ought to have a day of Thanksgiving for our health care workers. Back in the early months, we were showing up at hospitals. We were clapping at the change of shift. We had police and fire showing up, demonstrating our support for health care workers. I think it's time for us to do that again. And I've called on the governor to consider designating a day of Thanksgiving for our health care workers. So that's one thing. The second thing, you've got great ideas, I think a lot of these hospitals do have funds if you want to contribute to those. I think there's been a lot of times where people have had various restaurants deliver food for health care workers. Health care workers always love to eat. But I think our support, and the biggest thing would be, is if we would show them respect by wearing our masks. I think it would mean a lot.

 

The other thing that will be coming up, I fear, is I think that if something materially doesn't happen, if you look at the direction we're going, unfortunately, even though we've been able to control spread in schools, for the most part, I think our hospitals are going to get in such bad shape that we're just going to have to -- I think the leaders are going to have to do something -- to send everybody to remote. That will be a huge problem for our health care workers in terms of child care. So if you're a friend, family member, neighbor of a health care worker and you want to offer in the event of that to help with caring for their kids while they're working, that would be huge.

 

GAUDETTE: And speaking of kids, I want to go to a question from Amy and Dr. Lee. I'm going to have you chime in on this, because you and I both have school aged kids. So Amy writes in:

 

LISTENER QUESTION: My six-year-old complained of a headache and now has to stay home for 10 days or get a COVID test. It took three phone calls to find someone that doesn't charge $150 to do a test with no symptoms. So how can we make this process easier? He also didn't have a headache. He just wanted to be home that day. So this is frustrating as a parent and as a working mom.

 

GAUDETTE: And I should know just anecdotally, Amy, I don't know if you have insurance or not. We actually had to get our eight-year-old COVID tested. He had a sore throat and that is considered a COVID symptom. I believe a headache is, too. We actually took him to the pediatric urgent care on a Saturday morning right there on Eagle Road. So our insurance did cover that. But Dr. Lee, can you speak-- I mean, I'm talking just as a mom, right? You're the medical expert. So so how do we make this process easier?

 

LEE: Yeah. And I will speak to you as a dad and a medical expert. This is a really hard problem. To answer the first part of the question, you know, headaches, sore throat, cough, the symptoms are so broad that in general, most of them are considered COVID symptoms. They have drive-through tents, I know St. Al's has them. I can't remember what St. Luke's does, but there are those that are sort of the drive up. There may not be tents anymore. I think they're moving them inside because of the colder weather, but those are places you can get tested if you're symptomatic. And the charge is typically there's no charge, especially if you have insurance, insurance is not supposed to be charging. I think there are some rules around that. I don't know all of them, but I think that's one of the keys.

 

A lot of people have some questions about charges on these tests, and they are a little bit different if you look at the charges. But the biggest difference you'll see is that if somebody gets a respiratory panel, so that's a panel that actually tests for about 20 different viruses, that's a fairly expensive test. And we don't use that test very often, but it does have COVID and sometimes that's the only test you have available. They're not using that in general on the drive thru tent areas. So those are just a specific COVID, the antigen test or the PCR. So those are much less expensive. But anyone who has symptoms can get tested. 

 

In regards to kids and symptoms, I think this is one of those really difficult things that you're not going to have a satisfactory answer. If the child is sick and complaining of any kind of symptoms, if they're having a sore throat, even though they don't look that sick, if they're having a mild cough, you know, those kids should stay home. And the only good news is, is that we've already established this at-home learning, remote learning. And so they'll still have the opportunity to participate in most school districts and learning so they don't have to lose that. But you're going to have probably until we get vaccinated multiple times where kids are going to have to be out of school, where they're going to have that 10-day quarantine, where, you know, they still may be sick. And even if they test negative for COVID, they still should stay home. And we know that parents are not always the best -- and I include myself in this -- at wanting their kids to stay home or identifying these symptoms and being as forthright as they could be. But that is going to be one of the things that we ask of parents is that, you know, if your kids are feeling sick, you should identify that and keep them home. Whether or not they get tested or not might depend on what their symptoms are, but they definitely should not be at school.

 

GAUDETTE: And Dr. Lee, I mean, parent to parent here, right? I mean, at the same time, we all know we did it as kids. Right. This 'oh, I have a headache. I have a sore throat.' So you want to stay home? I mean, with where my children go to school, you know, if one kid has a symptom, if you've got two kids they're both staying home, I mean, and then it got to the point with our youngest, because after the sore throat and then he did stay home and we got the negative COVID test, he started then complaining of these horrible body aches. And that's another symptom. And so we're back at the doctor. Very long story short, we ended up getting bloodwork done so that we could rule out. I mean, our pediatrician suggested this just to make sure that he was actually OK. And what we found out is the kiddo grew two and a half inches in the span of six weeks. But this is difficult as parents right now. It is so difficult. But you're right that if we can't rule out like a growing pain or something like that, we have to keep them home.

 

LEE: Now, the interesting thing is, is that if you actually have COVID your quarantine time can be shorter, right? So it's a 10-day quarantine as long as you're getting better and if you don't have COVID, but you've just been exposed, then your quarantine time can be up to 14 days. So it's going to be hard. And that goes not just for kids, but adults who are working, that are not working remotely. And I'm speaking specifically of those coming to, you know, the ones that I work with in the hospital. You know, we have to be really diligent about making sure we're honest and saying that, you know, we're OK to go to work. Because again, with you know, when it comes to parents, if you don't work, a lot of times you don't get paid. And so there's that extra incentive to not sort of identify those symptoms and sort of think about it for a couple of days before you actually realize. But with kids, you know, it is going to be very hard. And I wish I had the right answer because, you know, you have a test that's not 100% sensitive. And so even a child who gets tested in this negative, if they're still sick, still needs to stay home.

 

GAUDETTE: Victor has this question. Dr. Pate, can you take it?

 

LISTENER QUESTION: Does it make sense to have everyone take an antibody test prior to receiving a vaccination? If they already have the antibodies, do they still need the vaccination?

 

PATE: Well, that answer will be forthcoming from these trials because some of these trials are looking at people that were previously infected. We don't have the answer today. However, if I were betting, I would imagine that the indication is going to be even if people had COVID before, they should get vaccinated, because we are certainly under the impression that the immunity that one gets from COVID infection itself, if you get any, is probably not long lived and will probably be better with the vaccine.

 

GAUDETTE: Dr. McGeorge, Annie wants to know: She says,

 

LISTENER QUESTION: I've heard of many different types of tests and I'm wondering if you can speak to the accuracy of each. So she's wondering about the rapid test, that swab deeply inserted into your nose, and the results coming back within minutes, the same type of swab, but results take days, and then the swab that only goes a half an inch in your nose. So the accuracy of those tests.

 

MCGEORGE: Yes, so there really are two main types of tests out there. Well, there are actually three. I mean, the third is the antibody test, which is really not useful at all for detecting an infection now. And it's not even super useful because we don't know that a positive antibody blood test shows that you have immunity from COVID anyway. So it's really not that helpful. That's the COVID blood test.

 

Then there are two main types of other COVID tests. Both of them involve either sampling saliva or sampling in the nose. There's one called the nasal pharyngeal. Some people joke and call it a brain biopsy because the swab is smaller. It goes way up in the nose there. But we do with studies, we know that we can be nearly as good or as good just going midway up the nose. And so a lot of times a lot of places have shifted to doing that. Which, by the way, if we think about taking samples from the nose, that's because that is the biggest, best place to find the COVID virus, which for those people that are wearing masks below their nose, remember that because you're not covering the area that has the virus. The other place we can sample is a saliva test. And that is also done in some areas. And I think that we will start to see that more and more common. So so that's actually how you sample for the virus.

 

But then how do you test once you have the sample? And this is divided really into two types. One is the type you might hear it called an RNA test, molecular test, PCR testing... That is really what's been around since the spring. Whether it gets sent out to a lab or done locally really is more of a supply chain issue. It is not that much of a different test. So the test that I know is being offered at Albertsons, another test that people mail in, or spit saliva and then mail in, all of those for the most part, are that molecular RNA test. That test is super sensitive for picking up pieces of RNA. So it is really the best test. And that's the only test we would use in the hospital for someone with COVID because it's much more sensitive. The downside to the test is if you have COVID, you can still shed RNA fragments even for a month or two after having the virus. These are not infectious, contagious, not living. They're just particles that are detectable but not really clinically meaningful. So that's the downside to those. But for the most part, really an excellent test. 

 

What we're starting to see now and what we have in our urgent cares and I know in some areas the schools have had access to these, assisted living or nursing homes, is this antigen test. And the antigen test is more like people would think of like when you go to the clinic and you have a rapid strep test or a rapid influenza test, tends to miss some cases, particularly very early in the infection that can miss cases. But it's pretty good. And certainly if you have symptoms of COVID and it's positive, then you've got COVID. If you have symptoms that could be COVID and it's negative, well, then the clinician is going to have to make a decision. Do we now send for the more accurate test or do we check for influenza or now what? And so that really takes a little bit of discernment there. This second test could either be run on a little machine in the clinic or there are even some that are just like a little plastic cartridge, like a pregnancy test you'd buy at Walgreen's. They are not commercially available, though. They're really only to be used in health care settings right now. But those are essentially the two types of tests Gemma.

 

GAUDETTE: We have about two minutes left. So, Dr. Lee, if you can answer this question, Jen wants to know if you can talk about the efficacy of COVID testing, I think I Dr. George may have just done that. But Jen she also wants to know the best time after onset of symptoms for a person to be tested.

 

LEE: Yeah, so there's one thing to add to what Dr. George, she did a very good job explaining that is that a lot of it, especially with the PCR, it has to do with the sampling. So if you are not good at sampling, taking the sample, sometimes it's efficacy or its sensitivity will go down. Really, once you start having symptoms, you should test positive. There is we use those to test the antigen and the PCR test just a little bit differently. We typically only use the antigen test in people who are symptomatic, whereas the PCR one, if you use an asymptomatic patient, it's more sensitive. But essentially as soon as you start having symptoms, if you start having shortness of breath, fever, cough, if you have COVID you've already had it for a couple of days. And so you should be able to be tested that time and be fairly sensitive. It may be a little more sensitive as you go on in the illness, but really that's you should be able to test positive if that was the case, if you felt symptoms.

 

GAUDETTE: I want to thank all three of you for coming in today, for your science-based information and facts, as well as the work that you do, especially Dr. Lee. Dr. McGeorge, the work that you do on the front lines of the hospitals every single day. I appreciate all of you. Our guests, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, Dr. Laura McGeorge, St. Luke's Health System medical director, and Dr. Darin Lee, the vice president of medical affairs at St. Alphonsus. Thank you, all three of you.

 

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GAUDETTE: You are listening to Idaho Matters, I'm Gemma Gaudette. Idaho is heading towards 65,000 confirmed cases of COVID-19. Just Tuesday, 16 more deaths were reported. And even with a rollback to phase 3 two weeks ago by Governor Little, it is safe to say our current numbers are going the wrong way. So as we have done for more than six months now, every Wednesday we bring in our medical experts to give you the science based facts about this virus, and they will answer your questions. So if you have a question for our doctors, send us an email right now at idahomatters@boisestate.edu.

 

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. Laura McGeorge, St. Luke's Health System medical director, and Dr. Darin Lee, vice president of Medical Affairs at St. Alphonsus Medical Center and an E.R. doctor in Nampa. Thanks for joining us, everyone.

 

ALL: Thanks, Gemma.

 

GAUDETTE: So I want to start with something that happened at 10:30 this morning. St. Luke's spokesperson Anita Kissée sent out this tweet and I'm going to read it in its entirety. So it says:

 

"Well, friends, I'm so sad to say we have *75* COVID19+ patients in @StLukesHealth Magic Valley hospital this morning. The hospital had to divert *ICU* patients temporarily last night... and say 'no' to the Elko hospital pleading with us to take patients because Utah won't."

 

Dr. Pate. This is not good.

 

PATE: This is alarming and of course, I've known that we were heading to this point for some time now, but I don't think the public understands how alarmed they should be. So, you know, I have run a large referral hospital when there was no capacity to take patients. And let me tell you, it's terrifying. When you're that family with that patient at Elko and you know that your family member needs care and needs it quick and that Elko hospital can't provide it. And the place you would typically send patients can't take the patient because they're overwhelmed. And the place that that hospital would then typically refer out of state is overwhelmed. And Utah hospitals have been telling us for a couple of weeks they can't take our patients anymore. People are going to die. 

 

And if those listening here think, well, that's not a problem because that will be COVID patients and I'm not going to get COVID, they're mistaken because it also affects people that have heart attacks, people that have strokes, people that get car accidents. There could be any number of things. It doesn't just back us up for COVID. It means that hospitals are going to be overwhelmed for whatever you have. And if you have what we call a time-sensitive emergency, heart attacks, strokes, et cetera, where we have to make an intervention in a limited amount of time in order to optimize the outcome you have, but because our hospitals are overwhelmed, we have to fly you to someplace that's hours away, you're not going to have as good an outcome and it's going to be far more costly. So this is a very, very dangerous situation we're in.

 

GAUDETTE: And I think it's fair to note as well, and our Madelyn Beck at Boise State Public Radio is working on a story right now regarding our surrounding neighboring states having to take our patients here in Idaho. Frankly, many of them are angry with Idaho because they have mandates in place. We just expect that our patients should go to these other states. Yet, we can't even take patients from other states. 

 

So, Dr. McGeorge, I want to bring you into the conversation. You are part of St. Luke's. What is this like for doctors, for nurses? You have been working on the front lines of this now for some eight months.

 

MCGEORGE: Yeah, Gemma. People are tired, they are very tired, I think, tired and really, frankly, starting to feel really demoralized. Our nurses, our doctors, our environmental services team, our respiratory therapist, all of these health care workers have been working extra shifts, longer shifts, not taking time off to rest and recuperate. And then when they are going out into the community and seeing people not helping to reduce the spread of this disease, it is really demoralizing. And I think after months and months of this, I'm starting to see a shift where people are feeling really, really down about that. And I think as we start to see the situations like what is going on in Magic Valley, you know, we're going to get close to that and Boise too. Our hospital in Boise is very, very busy. And, you know, I was just today looking -- for what it's worth -- I was looking at the Boise wastewater fecal count of the virus RNA. And it is going straight up and that curve. And I don't want to give people the impression that is something that's contagious or infectious. But it does give us a sense of what RNA is out there in the community. And everything we're looking at, whether it's that, whether it's test rate positivity, everything we're looking at is looking very, very worrisome, going very strongly in the wrong direction. And it is only going to get worse because I think what's happened is people's behavior, choices they're making-- Actually, I think people are tired and some people are choosing not to do things to protect each other. Some people had been but are getting tired. But, boy, now is not the time. We are heading into holidays. We're heading into winter. And we just have to buckle down and get through these next three to four months. And then I think we'll start to see some light at the end of the tunnel.

 

GAUDETTE: And Dr. Lee, let's talk with you. You are part of St. Alphonsus, a doctor in Nampa. Just Tuesday, just yesterday, Canyon County surpassed Bonneville County on the hotspot list. 156 new infections as of Tuesday and last night, Dr. Lee, you were talking with the Nampa School Board about COVID safety. Can you talk a little bit more about this? Because what we're seeing, too, is things like school sports still being played.

 

LEE: Yeah, in the Canyon County area, it's interesting because you have, you talk about people who are getting sick from COVID. But what's actually interesting is that the number of people that don't know they have COVID that we are testing so much more now, we're seeing patients that are there for their, you know, appendicitis or for their heart attack or for something completely unrelated to COVID who are testing positive, which means they've been positive in the community for a period of time. You know, we had this discussion with the school board because, you know, and I certainly don't envy their job because it's a very difficult job to try to walk that line between making sure that students are well taken care of, not only their schooling, but also their health, their food insecurities, lots of things that go into schooling. But there are definitely things that they can do that would be helpful. You know, sports seems to be one of those things where we know that's a hot spot. We've seen those outbreaks. You see them in professional sports. You see them in high school sports or anywhere they're going to play sports. It's just an activity that, by its nature, is very easy to spread the disease. And while those students may not get sick because they don't get as sick as adults do, they live in multigenerational households, especially in the Canyon County area where they're going to have an impact on their family and grandma and grandpa, especially as we move into the holiday season where they may see those relatives, but a lot of them live within the same household.

 

So, you know those things, even though it's not the kids themselves that we're seeing mostly hospitalized, they're having a huge impact on the community if you allow those things to continue. We try really hard to avoid those outside of you know, when you're in the school room, you're not sitting next to people, you're trying to stagger classes, all those sorts of things that help prevent the spread of this disease. But there's definitely some activities there that, again, the school board has tough decisions to make, but that is one that is a known area where they can have an impact.

 

GAUDETTE: I want to talk a little bit more about what is going on in our state. And with all due respect to every official out there who has to be on the front lines making decisions, so all due respect to our governor. With that being said, though, this idea of personal responsibility, let's be clear, it does not seem to be working. In Twin Falls just on Tuesday, the Twin Falls City Council tabled the idea of a mask mandate because there was so much backlash against it. People showing up, basically a super spreader event. I mean, let's be clear, people who want a mask mandate likely did not show up because you're not supposed to be in crowds like that. Post Falls decided not to implement one. Kootenai County rolled its mandate back. And it goes on and on and on. Yet research just came out yesterday saying that masks work, in fact, are more effective than first thought. And they can protect you if you wear one and you protect someone else if you're wearing one.

 

So Dr. Pate with all of that being said, we saw what happened in Utah on Sunday where Governor Herbert, who, yes, he is retiring. So it may, from a political standpoint, be easier to implement an emergency and put a mask mandate in place. But he did that. It took him a couple of weeks after medical experts in Utah said, we're going to be in a triage level. I think it's fair to say that it sounds like Idaho is on the heels of that. Where do we go from here? I mean, this idea of stepping up and making the right choice for your fellow Idahoans doesn't seem to be working.

 

PATE: Yeah, well, Gemma, it's something that I agonize over and regret our state of affairs for a long time. I'm disappointed in people just as a fundamental promise that we don't have that personal responsibility. Today's Veterans Day. I think about the veterans who sacrificed their lives so that we could have freedoms. And then you think about what freedoms they were thinking about. And now we've got people saying, well, I need to have the freedom not to wear a mask. And the fact that these veterans would lay their lives down to protect us, but the people around here, a lot of people won't wear a mask to protect others is-- it's just very hard for me to understand, and I think frankly, and I have been critical of Republican and Democrat alike, but the fact that our president and vice president, the vice president chairing our coronavirus effort for the country have not modeled behaviors, have not reinforced public health points, in fact, have really been quite antagonistic to public health, has created innumerable harm to our country. And then the effect of social media and the the amount of play that false, misleading information and conspiracy gets out there is just incredible and is a terrible barrier.

 

And then for Idaho, the legislature set up our public health system back in 1970. I don't think they were contemplating a pandemic. And so here we are. And I think we're finding that our public health system isn't structured very well for 2020. But we have seven different public health districts doing different things. We have people on public health boards charged with the public health of Idahoans who don't believe in central public health tenets and principles. It's just incredible. Certainly people are entitled to have their beliefs, but that doesn't mean you should be on a public health board and charged with other people's health and the fact that public health boards have not stepped up.

 

And most recently, I've dealt with the issue of sports. Dr. Lee brought up the issue of sports. I think we have to have a serious conversation in Idaho. What's more important? Is it playing sports or is it keeping our kids in person school who want to be? And I'm not sure that we can have our cake and eat it, too. But frankly, when I tried to talk to people about sports and particularly wrestling, I cannot imagine a more dangerous sport in a time of a pandemic than wrestling. And yet what is happening is when I plead with public health boards, they're telling me they're getting pressures from legislators not to do this. And then we've got the threat from our legislators that they're going to take away emergency powers from the governor, which I'm not confident they can do constitutionally. But they're going to try, it sounds like, and they're going to take away authority from our public health boards. We are going to move in exactly the wrong direction. And, you know, maybe when we have a pandemic with a 3% case fatality rate, maybe we're just so insensitive that we're just willing to have a certain number of people die so that we can have our quote-unquote freedoms. But what if that next pandemic -- because there will be a next one -- what if it has a case fatality rate of 30%? I think we're going to really regret that we haven't paid attention to public health and haven't made the investments and we're not supporting and frankly, what's going to happen to all these public health professionals that work in the public health departments that know the right thing to do, that have been encouraging the right thing and their boards won't take action. So it's just unbelievable the leadership failures that we've had in the country and in our public health districts. But the political pressure is so intense. And then, of course, with the loss of reelection by Diana Lachiando, I think that just reinforces if you vote to have masks, then we will vote you out of office. And I have to believe that the majority of Idahoans want the right thing. If that's the case, we are going to have to come out and stand up behind those elected leaders and tell them we want you to do the right thing. And if you do, we've got your backs. And that vocal minority, we're not going to let them vote you out. We will have your backs. But that's not happening.

 

GAUDETTE: This should be about public health, not politics.

 

Before we get to questions, two more things I want to quickly touch base on. And Dr. Lee, maybe you can talk about this. Is as we just talked about in the last segment, how dire the situation is in Idaho, and that is not an exaggeration. On top of what we are seeing with COVID cases surging with hospital capacity, we have now had two deaths due to the flu in Idaho. So this seems like a perfect storm, but not in a good way.

 

LEE: Yeah, it's pretty scary because we know also that if you get COVID and the flu at the same time, which definitely can happen, the mortality rate is also going to be higher. But, you know, there are things that you can do to prevent the flu. We already have a flu vaccine. We really have to be better at getting the flu vaccine and getting it early. So the flu is here now. So we're already behind if we don't have the population vaccinated against the flu. It's really important we don't have a COVID vaccine right now. It's not going to be out for, who knows, a month, two, three, four. But we do have a flu vaccine and you can get the flu vaccine and it will help protect you. You know, vaccines are going to be really important. They're going to be a lot of discussion about this in the future. We know about the flu vaccine and we know that it is effective. It doesn't stop every flu case, but it can stop adding people to the count that come into the hospital. People who get the flu can get very sick as well. We've had that discussion along with COVID, and we know that this time of year, we're starting to see that increase in patients being admitted for flu, patients from nursing homes, patients with comorbidities. So it's this year more than any it's really important that everyone get vaccinated who can get vaccinated.

 

GAUDETTE: And Dr. Lee and Dr. McGeorge, so speaking of the flu and what we were talking about in the last segment, in regards in particular, let's say to the Magic Valley where they couldn't accept any patients yesterday within their ICU. If someone were to come in with the flu and they needed to be hospitalized, is this one of those scenarios -- and maybe, Dr. McGeorge, we can start with you -- where there may not be capacity for someone like that if we continue down the path that we're on.

 

MCGEORGE: Yeah, Gemma and I do want to talk about Magic Vally or Twin Falls again a little bit more here, too, and how that relates. So first of all, I just want to be clear with the numbers. And I think on that tweet this morning, the numbers are always fluid because we have patients that are being tested that we don't know yet if they have COVID. And we have to treat and assume that they have COVID. Also, the situation with Elko is we would, you know, intermittently we are able to take patients. But for the most part, again, we're not. And it's really on an ad hoc basis whether or not we're able to do that. As far as-- So now we have someone who comes in with influenza. I think to a point made earlier today, I think it was by Dr. Pate, whatever the time-sensitive emergency is, whether now it's influenza or it's a heart attack or a stroke or a car accident or whatever it is, there are a bunch of people normally on any given day that need to be hospitalized. In the winter, we know those numbers surge normally because of influenza, In kids, there's RSV and just other things. But now on top of that, we have this huge number of COVID patients. Right now in the Magic Valley, about 25-30% of the patients in house are COVID patients. So if you took those out, we probably would be about normal capacity and would be business as usual and be able to manage. But again, yes, whether it's influenza or anything else, it's going to cause continued crunch on our space.

 

GAUDETTE: So some news came out earlier this week regarding a vaccine with Pfizer saying that they have a vaccine that is 90% effective. Dr. Pate, we are getting, just as we speak, honestly, my screen in front of me continues to get all of these questions, quite a few of them regarding the vaccine. So can we start with that announcement, Dr. Pate, and what Pfizer has has said about it? Because we do know, if I remember correctly, that the earliest, earliest this vaccine would be available would be January. But that is front line workers, general public, potentially June. So can you start there? And then I will kind of give you some of these questions coming in that hopefully we can answer regarding the vaccine.

 

PATE: Sure, so you're right, we got very good news, very encouraging news out of Pfizer about their vaccine and that is a very high effectiveness rate. Very seldom do we have a vaccine that's 100% effective, in fact, for this vaccine, what we were hoping for was 70% effective. So if it turns out that Pfizer is right about the 90%, this will be really, really good news. And we have another vaccine that looks like it's potentially even more effective. So we have lots of good news. Now, I would caution: these vaccines are still in trials. It is still early. We're waiting more results. Things can change. But I don't think Pfizer would risk coming out and making that statement if they weren't pretty sure that was going to hold up, because obviously their stock price will take a huge hit if they're materially off. They do indicate that they're going to apply for an emergency use authorization with the FDA at the end of this month. And so there's going to be a period of time and our federal government knows that there's a lot of mistrust. So I do believe that they are going to review this very carefully and they will have some outside review. But it is possible that first responders, health care workers, some could get their first vaccine -- because this will take two shots -- could get the first one towards the end of this calendar year, wouldn't get their second one, as you said, until probably in January. And then what we're hoping is that a vaccine could get out to others over the spring and be widely available by the summer.

 

The other good news, though, is that it's not just the Pfizer vaccine out there. We have probably four others that are actually pretty close and might be getting the same kind of authorization in the first part of 2021. The reason that that's important is two things. First of all, all these vaccines are a little bit different. We often find that different populations respond differently for vaccines. Sometimes we have to do things differently for the elderly because they don't respond immunologically the same as younger and special populations. So this gives us a lot more choice if we have a lot of vaccines.

 

The other reason it's so important is if we got two, three, four or five vaccines approved, it will help us get more vaccine out quicker because it's going to be hard for any one company to make enough vaccine for the United States, let alone the world. So this is very promising, very encouraging. We need to watch further. But good news. 

 

GAUDETTE: Dr. McGeorge, Kathy and Ingrid from from Boise are thinking about the vaccine. And so the part I want to focus on in their question is the refrigeration aspect of it. We do know that the Fizer vaccine requires specialized storage and shipment practices. So do we know maybe anyone on our panel, if you know this, do we have the refrigeration requirements for that? Because I think it's important to know that the website STAT is reporting that rural hospitals around the country, so not just Idaho, may not have these ultracool freezers and they don't have the ability-- they don't they can't afford it. So can any of you speak on that?

 

MCGEORGE: Gemma, I believe that we have that capacity right now. We certainly are working on making sure we have that capacity. To your point, that is another issue, a logistical issue that's going to be a challenge nationally. I mean, there has to be a supply chain and then the ability to even get those. So we have anticipated this and have known that this is potentially coming and have been working in this direction. I would say this is going to be a huge effort across the area, across the state, across the country to make sure that we outreach to all areas and share resources or do whatever we need to do. This would be great work if the public health department were able to help with this. And I think, again, back to Dr. Pate's point, they're really not prepared for that. So we'll probably have to lean on health systems to help here.

 

GAUDETTE: State epidemiologist Christine Hahn literally just emailed us. Dr. Hahn, thanks for listening to our show, first off. But she says: 

 

 

STATE EPIDEMIOLOGIST DR. CHRISTINE HAHN: "Public health has indeed reached out to and identified hospitals in Idaho that can store our initial doses of vaccine. Later shipments will go right to vaccinating providers."

 

GAUDETTE: So that is from our state epidemiologist in regards to how we will be able to store this vaccine when it becomes available.

 

An interesting question coming in from Bill right now, Dr. Pate. Maybe you can take it. Bill says:

 

LISTENER QUESTION: What can non medically trained people do to relieve the pressure on medically trained people besides taking care of their pets, their children, housework. Are there any jobs -- volunteer or paid -- at clinics or hospitals? Is there a fund that people can contribute to for hospital workers so they can order takeout? Or...?

 

PATE: Well, that's fantastic. I appreciate that. The first thing I think is back to the point that Dr. McGeorge made earlier in the program, you know, we've got a lot of health care workers that have been working solidly on COVID for 9, 10 months now, putting themselves, putting their families at risk, dealing with a lot of people who don't do well. And it is fatiguing to them and it's further exhausting to them when they see people not taking precautions. So one thing I just recently wrote an editorial, and I think as we approach Thanksgiving week, I think we ought to have a day of Thanksgiving for our health care workers. Back in the early months, we were showing up at hospitals. We were clapping at the change of shift. We had police and fire showing up, demonstrating our support for health care workers. I think it's time for us to do that again. And I've called on the governor to consider designating a day of Thanksgiving for our health care workers. So that's one thing. The second thing, you've got great ideas, I think a lot of these hospitals do have funds if you want to contribute to those. I think there's been a lot of times where people have had various restaurants deliver food for health care workers. Health care workers always love to eat. But I think our support, and the biggest thing would be, is if we would show them respect by wearing our masks. I think it would mean a lot.

 

The other thing that will be coming up, I fear, is I think that if something materially doesn't happen, if you look at the direction we're going, unfortunately, even though we've been able to control spread in schools, for the most part, I think our hospitals are going to get in such bad shape that we're just going to have to -- I think the leaders are going to have to do something -- to send everybody to remote. That will be a huge problem for our health care workers in terms of child care. So if you're a friend, family member, neighbor of a health care worker and you want to offer in the event of that to help with caring for their kids while they're working, that would be huge.

 

GAUDETTE: And speaking of kids, I want to go to a question from Amy and Dr. Lee. I'm going to have you chime in on this, because you and I both have school aged kids. So Amy writes in:

 

LISTENER QUESTION: My six-year-old complained of a headache and now has to stay home for 10 days or get a COVID test. It took three phone calls to find someone that doesn't charge $150 to do a test with no symptoms. So how can we make this process easier? He also didn't have a headache. He just wanted to be home that day. So this is frustrating as a parent and as a working mom.

 

GAUDETTE: And I should know just anecdotally, Amy, I don't know if you have insurance or not. We actually had to get our eight-year-old COVID tested. He had a sore throat and that is considered a COVID symptom. I believe a headache is, too. We actually took him to the pediatric urgent care on a Saturday morning right there on Eagle Road. So our insurance did cover that. But Dr. Lee, can you speak-- I mean, I'm talking just as a mom, right? You're the medical expert. So so how do we make this process easier?

 

LEE: Yeah. And I will speak to you as a dad and a medical expert. This is a really hard problem. To answer the first part of the question, you know, headaches, sore throat, cough, the symptoms are so broad that in general, most of them are considered COVID symptoms. They have drive-through tents, I know St. Al's has them. I can't remember what St. Luke's does, but there are those that are sort of the drive up. There may not be tents anymore. I think they're moving them inside because of the colder weather, but those are places you can get tested if you're symptomatic. And the charge is typically there's no charge, especially if you have insurance, insurance is not supposed to be charging. I think there are some rules around that. I don't know all of them, but I think that's one of the keys.

 

A lot of people have some questions about charges on these tests, and they are a little bit different if you look at the charges. But the biggest difference you'll see is that if somebody gets a respiratory panel, so that's a panel that actually tests for about 20 different viruses, that's a fairly expensive test. And we don't use that test very often, but it does have COVID and sometimes that's the only test you have available. They're not using that in general on the drive thru tent areas. So those are just a specific COVID, the antigen test or the PCR. So those are much less expensive. But anyone who has symptoms can get tested. 

 

In regards to kids and symptoms, I think this is one of those really difficult things that you're not going to have a satisfactory answer. If the child is sick and complaining of any kind of symptoms, if they're having a sore throat, even though they don't look that sick, if they're having a mild cough, you know, those kids should stay home. And the only good news is, is that we've already established this at-home learning, remote learning. And so they'll still have the opportunity to participate in most school districts and learning so they don't have to lose that. But you're going to have probably until we get vaccinated multiple times where kids are going to have to be out of school, where they're going to have that 10-day quarantine, where, you know, they still may be sick. And even if they test negative for COVID, they still should stay home. And we know that parents are not always the best -- and I include myself in this -- at wanting their kids to stay home or identifying these symptoms and being as forthright as they could be. But that is going to be one of the things that we ask of parents is that, you know, if your kids are feeling sick, you should identify that and keep them home. Whether or not they get tested or not might depend on what their symptoms are, but they definitely should not be at school.

 

GAUDETTE: And Dr. Lee, I mean, parent to parent here, right? I mean, at the same time, we all know we did it as kids. Right. This 'oh, I have a headache. I have a sore throat.' So you want to stay home? I mean, with where my children go to school, you know, if one kid has a symptom, if you've got two kids they're both staying home, I mean, and then it got to the point with our youngest, because after the sore throat and then he did stay home and we got the negative COVID test, he started then complaining of these horrible body aches. And that's another symptom. And so we're back at the doctor. Very long story short, we ended up getting bloodwork done so that we could rule out. I mean, our pediatrician suggested this just to make sure that he was actually OK. And what we found out is the kiddo grew two and a half inches in the span of six weeks. But this is difficult as parents right now. It is so difficult. But you're right that if we can't rule out like a growing pain or something like that, we have to keep them home.

 

LEE: Now, the interesting thing is, is that if you actually have COVID your quarantine time can be shorter, right? So it's a 10-day quarantine as long as you're getting better and if you don't have COVID, but you've just been exposed, then your quarantine time can be up to 14 days. So it's going to be hard. And that goes not just for kids, but adults who are working, that are not working remotely. And I'm speaking specifically of those coming to, you know, the ones that I work with in the hospital. You know, we have to be really diligent about making sure we're honest and saying that, you know, we're OK to go to work. Because again, with you know, when it comes to parents, if you don't work, a lot of times you don't get paid. And so there's that extra incentive to not sort of identify those symptoms and sort of think about it for a couple of days before you actually realize. But with kids, you know, it is going to be very hard. And I wish I had the right answer because, you know, you have a test that's not 100% sensitive. And so even a child who gets tested in this negative, if they're still sick, still needs to stay home.

 

GAUDETTE: Victor has this question. Dr. Pate, can you take it?

 

LISTENER QUESTION: Does it make sense to have everyone take an antibody test prior to receiving a vaccination? If they already have the antibodies, do they still need the vaccination?

 

PATE: Well, that answer will be forthcoming from these trials because some of these trials are looking at people that were previously infected. We don't have the answer today. However, if I were betting, I would imagine that the indication is going to be even if people had COVID before, they should get vaccinated, because we are certainly under the impression that the immunity that one gets from COVID infection itself, if you get any, is probably not long lived and will probably be better with the vaccine.

 

GAUDETTE: Dr. McGeorge, Annie wants to know: She says,

 

LISTENER QUESTION: I've heard of many different types of tests and I'm wondering if you can speak to the accuracy of each. So she's wondering about the rapid test, that swab deeply inserted into your nose, and the results coming back within minutes, the same type of swab, but results take days, and then the swab that only goes a half an inch in your nose. So the accuracy of those tests.

 

MCGEORGE: Yes, so there really are two main types of tests out there. Well, there are actually three. I mean, the third is the antibody test, which is really not useful at all for detecting an infection now. And it's not even super useful because we don't know that a positive antibody blood test shows that you have immunity from COVID anyway. So it's really not that helpful. That's the COVID blood test.

 

Then there are two main types of other COVID tests. Both of them involve either sampling saliva or sampling in the nose. There's one called the nasal pharyngeal. Some people joke and call it a brain biopsy because the swab is smaller. It goes way up in the nose there. But we do with studies, we know that we can be nearly as good or as good just going midway up the nose. And so a lot of times a lot of places have shifted to doing that. Which, by the way, if we think about taking samples from the nose, that's because that is the biggest, best place to find the COVID virus, which for those people that are wearing masks below their nose, remember that because you're not covering the area that has the virus. The other place we can sample is a saliva test. And that is also done in some areas. And I think that we will start to see that more and more common. So so that's actually how you sample for the virus.

 

But then how do you test once you have the sample? And this is divided really into two types. One is the type you might hear it called an RNA test, molecular test, PCR testing... That is really what's been around since the spring. Whether it gets sent out to a lab or done locally really is more of a supply chain issue. It is not that much of a different test. So the test that I know is being offered at Albertsons, another test that people mail in, or spit saliva and then mail in, all of those for the most part, are that molecular RNA test. That test is super sensitive for picking up pieces of RNA. So it is really the best test. And that's the only test we would use in the hospital for someone with COVID because it's much more sensitive. The downside to the test is if you have COVID, you can still shed RNA fragments even for a month or two after having the virus. These are not infectious, contagious, not living. They're just particles that are detectable but not really clinically meaningful. So that's the downside to those. But for the most part, really an excellent test. 

 

What we're starting to see now and what we have in our urgent cares and I know in some areas the schools have had access to these, assisted living or nursing homes, is this antigen test. And the antigen test is more like people would think of like when you go to the clinic and you have a rapid strep test or a rapid influenza test, tends to miss some cases, particularly very early in the infection that can miss cases. But it's pretty good. And certainly if you have symptoms of COVID and it's positive, then you've got COVID. If you have symptoms that could be COVID and it's negative, well, then the clinician is going to have to make a decision. Do we now send for the more accurate test or do we check for influenza or now what? And so that really takes a little bit of discernment there. This second test could either be run on a little machine in the clinic or there are even some that are just like a little plastic cartridge, like a pregnancy test you'd buy at Walgreen's. They are not commercially available, though. They're really only to be used in health care settings right now. But those are essentially the two types of tests Gemma.

 

GAUDETTE: We have about two minutes left. So, Dr. Lee, if you can answer this question, Jen wants to know if you can talk about the efficacy of COVID testing, I think I Dr. George may have just done that. But Jen she also wants to know the best time after onset of symptoms for a person to be tested.

 

LEE: Yeah, so there's one thing to add to what Dr. George, she did a very good job explaining that is that a lot of it, especially with the PCR, it has to do with the sampling. So if you are not good at sampling, taking the sample, sometimes it's efficacy or its sensitivity will go down. Really, once you start having symptoms, you should test positive. There is we use those to test the antigen and the PCR test just a little bit differently. We typically only use the antigen test in people who are symptomatic, whereas the PCR one, if you use an asymptomatic patient, it's more sensitive. But essentially as soon as you start having symptoms, if you start having shortness of breath, fever, cough, if you have COVID you've already had it for a couple of days. And so you should be able to be tested that time and be fairly sensitive. It may be a little more sensitive as you go on in the illness, but really that's you should be able to test positive if that was the case, if you felt symptoms.

 

GAUDETTE: I want to thank all three of you for coming in today, for your science-based information and facts, as well as the work that you do, especially Dr. Lee. Dr. McGeorge, the work that you do on the front lines of the hospitals every single day. I appreciate all of you. Our guests, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, Dr. Laura McGeorge, St. Luke's Health System medical director, and Dr. Darin Lee, the vice president of medical affairs at St. Alphonsus. Thank you, all three of you.