As Idaho Sees Surge In COVID-19 Cases, Doctors Answer Your Questions

Jun 17, 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 the clusters of cases that popped up in the last week, the importance of mask-wearing and what we should expect this fall.

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.
  • Samantha Birch, Infection Prevention Specialist at Saint Alphonsus Regional Medical Center.
  • Dr. Rob Cavagnol, St. Luke’s Executive Medical Director.

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

 

Read the full transcript here:

GEMMA GAUDETTE: You are listening to Idaho Matters, I'm Gemma Gaudette. Idaho is currently in Phase 4 of its reopening for coronavirus. And with that comes some new cases of COVID-19. In fact, there were 74 confirmed cases of the virus on Tuesday, according to the Idaho Health Department. Now, that was the most that's been added in a single day since May 22nd, the second most since April 9th. We are bringing in our medical experts today to talk about where we are in regards to the pandemic and to also answer your questions. If you have a COVID-19 question for our doctors today, send us an e-mail at idahomatters@boisestate.edu and we will hopefully get to your question. Our panel today, Dr. David Pate, a member of the governor's coronavirus task force, as well as former CEO of St. Luke's Health System, Samantha Birch, and infection prevention specialist with St. Alphonsus Regional Medical Center, and Dr. Rob Cavagnol, St. Luke's Executive Medical Director. Welcome to the program, everyone.

ALL: Thanks for having us, Gemma.

GAUDETTE: Dr. Pate, as always, let's start with you. We are in Stage 4, as I mentioned, and we've seen some increases in cases. Can you give us an update as as to where we are, and were you surprised to see this this type of uptick?

DR. DAVID PATE: Well, first of all, I'd say, no, I wasn't surprised. As you increase people's interactions and interaction with more and more people, you do expect to see more transmission of this virus. So I wouldn't say that the increase is surprising. There are quite a few states that are having increases that are associated with really, really worrisome signs, particularly things like the percent of people that they're testing that are testing positive, the number of people coming to their emergency rooms and the number of people being hospitalized. We are -- and I'm knocking on wood as I say this -- we are not experiencing that here in Idaho. So we're not seeing severe cases yet. However, we have to be on the lookout for that. And I think the most concerning thing to me today is the spread that we're seeing related to bars in downtown Boise.

GAUDETTE: So, Dr. Pate, with it being said, you know, Governor Little -- the bars were supposed to open in Stage 4. We talked about this before. I did. I think there was quite a bit of pressure to open those bars in Stage 3. And anecdotally, I have heard that there are some bars that aren't necessarily following the social distance protocol and the guidelines. And I mean, what do we do about that?

PATE: Well, you're exactly right, Gemma. And I think what it takes is a couple of things. One is I would certainly urge Idahoans to not patronize businesses that are not adopting these best practices, not ensuring adequate physically distancing, not having their employees wear face coverings, not requesting or requiring their patrons to wear face masks. Let's not give them our business. That will probably be the most effective and quick way to ensure compliance. Number two, we have got to get the word out to young people -- because most of these new cases are 20 and 30 year olds who I remember that day and feeling immortal and invincible. But they need to have a healthy respect for this virus. 20 and 30 year olds are not in the high risk group. But when we talk about high risk, we mean high risk for death. Not that you can't get something really bad from coronavirus. And the truth is, most 20 and 30 year olds are going to do fine, but not everyone. And we've certainly had cases of 30 year olds getting major strokes. We've got an instance of someone losing a leg for an amputation because of the blood clots. We have had 30 and 40 year olds in ICUs on ventilators. So there needs to be a healthy dose of respect. And even if they won't be concerned for themselves, they need to be concerned about picking up this virus. And then who are they going to pass that along to? Do they visit grandma? Do they live with somebody that is older or has medical problems? So that's a second thing. And then finally, I think the whole business community and the public needs to put pressure on these bars. Everyone that I heard of wanted to re-open the economy. The governor has facilitated that and he's tried to do so in as reasonable in a safe manner as he can. If we've got businesses that are jeopardizing this for everybody else, we ought to all be putting pressure on these bars to say, hey, you need to turn this around right now or you're going to ruin it for the rest of us if you're not even worried about your own business. Now, let me finally conclude with saying I don't want this to be a broad indictment of bars. I do believe we have some very responsible bar owners and bar managers, but those are the ones we need to give our business to, not these.

GAUDETTE: And Samantha, talking about, you know, people being in spaces with other people, right? And in public, one of those people going back to work right now in Stage 4. So what do you suggest? I mean, especially in that communal kind of cube farm type of environment that a lot of people work in. What do people need to be -- I don't want to say worried or concerned about but maybe vigilant about?

SAMANTHA BIRCH: Definitely, the first thing is individually, we need to get healthy and maintain good, healthy habits and by that, I mean, we need to eat better and get exercise. Lose the extra weight that we often carry around. Quit smoking. Just recently, the Journal of American Medical Association published data about hospitalized people in New York City with COVID-19 and those most common comorbidities, that kind of result in more severe disease or things like hypertension, obesity, diabetes, same thing they've seen in China. And really, that's not a surprise. Obesity, diabetes, hypertension are not good for your body. And if your body's not doing so well, it can't fight disease very well. And then collectively, as you know, a group of employees. We just need to be really, really cautious about cough etiquette, cleaning surfaces in our offices, doorknobs, fridge handles, hand hygiene on an individual basis. And then, as we've talked about before, many times, staying home when you're sick, if you don't go to work and cough on your co-workers, you can't spread the virus. So that one is probably hopefully we've all learned recently that it is very important that we don't go to work when we're sick and we will be more cautious about that.

GAUDETTE: But with that being said, Dr. Cavagnol, now as we open up more, there seems to be less concern about the coronavirus in general among people. I mean, the examples of the bars in downtown Boise, right. People gathering, maybe not doing the social distancing. There really seems to be a misperception that because we're opening up, the risk is somehow less. Are you seeing that in your hospital? And and I would think that's fairly dangerous thinking.

DR. ROB CAVAGNOL: I absolutely agree. People need to realize we're going to be living with this until we get an effective vaccine. And so, yes, the economy is opening back up. But that doesn't mean that the risk of the virus is gone. And so I think your other guests have done a great job in outlining some of the important steps that we can take. Probably the most important, easiest thing we can do as as Idahoans is wear a mask when you go to the grocery store, when you go out, when you go to work. And if you can't socially distance at work and be six feet from others, wear a mask. And that's that's probably the most effective thing that you can do as an individual to help prevent this from spreading. But you're right. It's not over.

GAUDETTE: And Samantha. I mean, you're an infection prevention specialist. Have you seen any changes since March, especially here in Idaho, you know, when things were shutting down in how COVID-19 spreads. I mean, it seems that we are learning more over time.

BIRCH: I would say in general, we're kind of learning more about the nuances of spread, but also viruses and bacteria that are spread through contact or droplets really behave in a lot of the same way. I think what we're learning now is how groups of people maybe interact with each other. We're seeing a lot of COVID disease in some of our refugee and Latino communities now. And they weren't the ones that were affected three months ago. So it's just kind of obvious how this disease is spreading. Started with, you know, primarily people who are traveling to places like New York and Washington for work. And now it's a lot more local spread. And we're seeing it in our communities, as we've heard about, you know, meat packing plants in areas where it's spreading locally. So that's I think what we're seeing and learning about now is how it's going to be spreading locally.

GAUDETTE: And Dr. Cavagnol. You know, Samantha mentioned we're seeing it like in meatpacking plants. It's going into our rural communities. It's, you know, our Latino community here in Idaho. And we know research is showing the Latino community, in fact, just nationwide is having, you know, worse outcomes. Right. And they're disproportionately suffering from from COVID-19. How how is Idaho's medical system, you know, addressing this this problem?

CAVAGNOL: Great question. I think some of the actions remain to be seen in addressing the health disparities across our our communities. So that's work to be done. Certainly it's recognized across the United States, certainly and in Idaho that folks with less access to health care do worse. And so that's something that we have to work on, is making sure that people have good access to care. But there's more there's more work to be done there here at St. Luke's. You know, we're very intentional on making sure that everyone is treated equally and have access. And certainly that's a high priority for us.

GAUDETTE: Samantha and Dr. Cavagnol. Maybe both of you can take a shot at this. This is from Curtis. And he says, "Will you please ask Idaho hospitals how many COVID-19 beds are full? The confirmed cases and amount of tests are sketchy at best." That is a quote from Curtis. Samantha, can I start with you? Do you know those numbers with St. Alphonsus?

BIRCH: Certainly, and I would be interested to know what part he's finding sketchy, that we don't have a lot of cases or... But the answer across the St. Alphonsus health system, our numbers of inpatient COVID positive people have really been extremely low the last, I would say a month. And I really think our concern and we are watching very closely, and I'm sure Dr. Cavagnol agrees with this. We have seen a huge increase in the number of outpatient cases that are positive. And it's great that they are able to manage their disease at home. But we also know that those some of those people are going to worsen and they are going to require inpatient care. Right now, we do have the capacity and we really have the numbers very well worked out at what point we need to reopen our COVID wards. When we see the increased need right now, we're more comfortable. But we're probably only a patient or two away from maybe needing to reopen those COVID wards.

GAUDETTE: And Dr. Cavagnol, what about St. Luke's?

CAVAGNOL: Yeah, we're doing really well, I'd say, across the system. And we share the same concern that we're seeing an increase in cases across Idaho. It's not translating to a massive increase in the number of hospitalized patients or ventilated patients, thank goodness. But that's something that we're certainly keeping our finger on the pulse. So I would say across our system where I don't have the numbers for today, but we're probably running in the 20s for hospitalized patients with COVID. But, yes, we are seeing an increase in the number of folks who are testing that are positive. Just one more point where we're testing the patients who are coming in for surgery. These are asymptomatic patients who are planning to have a surgical procedure and were testing all of them as well. And we are picking up a small percentage of asymptomatic patients. And so that's another population that we're monitoring. And, of course, we're deferring those those operations for folks who test positive.

GAUDETTE: And then we have a question from Susan. She says,"My friend and her husband tested positive for coronavirus in April. No clinician. CDC has asked them to be retested to confirm a negative test. My husband is high risk with a post cancer weakened immune system. They've invited us to sit on their patio six feet away for a social distancing dinner. Is this safe? Could we get the virus from them? And she says, thanks for this valuable information." Dr. Cavagnol, could you take a shot at that?

CAVAGNOL: Sure. If I understand correctly, the folks are going to visit had the virus, but they haven't had the virus, am I understanding that correctly?

GAUDETTE: You are. Yes. And then the two people they'd go to visit have had had the virus in April. She's concerned, though, about her husband because he has a post cancer weakened immune system.

CAVAGNOL: Yeah. I don't I don't see value in retesting those other people. The hosts of the party, because they might test positive and not necessarily be infectious. So the best advice I would give in that scenario is if they're concerned. Don't go. That's going to be the safest thing. April was a while ago. And so it's unlikely that they're still infectious. And so if they went and we're careful, didn't have physical contact, like hugging or shaking hands, wore a mask, make sure that they wash their hands. That that would that would probably be the second safest option.

GAUDETTE: Samantha, go ahead.

BIRCH: I was going to say, in general, they will not have somebody retested to confirm a negative status because people are positive for long after they're no longer infectious. So it's kind of pointless to be retesting. But I have seen a few studies at this point that are finding that -- the CDC has a matrix that you can look at. And, you know, eight to 10, maybe even 12 days after someone is recovered, they no longer have viable virus in the respiratory system. And if it's not viable, they couldn't transmit the disease.

GAUDETTE: Can I ask both of you a quick question, and Dr. Pate, join in too. So Dr. Cavagnol and Samantha, both of you said that you could potentially feel better, be better, recovered, but still be positive because you might have some of that virus. Would you still be able, though, to spread that? Because I guess that is a concern. Well, wait a minute. If if it's still in your system, can you can you give it to other people still?

CAVAGNOL: So the short answer is, we don't know exactly how long folks are infectious following contracting the virus. The tests that we use, tests for viral particles. And so it doesn't necessarily mean that you're actively shedding or able to transmit the virus. It means that you've got evidence that you've had the virus in you. And so I think you've seen some cases in the news where they say people were reinfected or they tested positive and then they tested positive again weeks or months later. And it's not that we think that people can get it twice, but it's that they still have some of the viral particles that that end up causing that test to be positive.

GAUDETTE: Ok. That's just really good clarification. Dr. Pate, another question. This is from someone who wanted to remain anonymous. It's fairly lengthy. But let me read it. It says "Hello. I work for an independent dermatologist and three additional staff. I wear a mask all day. I also keep a small fan running on my desk and I wash my hands frequently or use hand sanitizer. Co-workers and doctors don't wear a mask unless the patient wants them to. Many patients wear masks, but few care if the caregivers wear them. Patients are generally six feet from me for checking in and out. Distancing from staff is usually possible, not always. Charts and appointment books or paper. We all handle them. I stayed home from mid-March through early May because I was worried. Eventually, though, I had to go back. So far, no one has contracted the virus that we know of. The doctor's attitude is everyone will be exposed eventually. So we can't shut everything down or ask the staff to wear masks at all times, apparently. I have several underlying conditions, as does my spouse. Am I doing enough to keep myself safe? Any additional recommendations?"

PATE: Well, first of all, I would tell Anonymous that I applaud the efforts that he or she is taking to protect himself or herself, but I would say and I'll just be blunt about it. The doctor's attitude is ridiculous. This is a time when it is incumbent on all of us that care for people to take the medical and scientific information seriously. And so the doctors assertion that everyone will be exposed eventually, so why not do this, is uninformed and irresponsible. First of all, if we look broadly at Idaho, we believe that only about two percent of Idahoans have actually been infected. There certainly is a higher percentage in Blaine county. But but overall in Idaho, about two percent. That is after we've already had this first initial wave that was bad that we'll all remember in March or April. At two percent. We are a long way away from one hundred percent. So his assertion that we're all going to be exposed is just uninformed. The second is, and as a physician, he should be part of the solution. And that is until we have effective treatments, until we have a vaccine, we need to delay as many people getting infected as possible, because if we just all threw caution to the wind and said, let's all go get together for a big group hug and just let's go ahead and get our exposure out of the way, then we would have countless number of people in our hospitals. Our hospitals would be overwhelmed and people will die because they won't have access to care. So that's just irresponsible. The last point I would say is all of us doctors took a pledge when we got our licenses that we would do no harm. And so here you have an employee who is high risk and this doctor is not insuring that person's safety. So that's not good. And then second of all, you know, I don't know about this dermatologists, but I can tell you most dermatologists see an awful lot of patients in one day. How many people are that doctor being exposed to? And it could have been what are these 20 or 30 year olds that went to the bar and is now infectious and doesn't know it? So it's very irresponsible, it's uninformed. If I were that employee, I would tell her, keep up her good efforts. Talk to the physician or office manager or whatever and indicate that this is not good behavior. He's not modeling the guidance from either the state or from the CDC and that he has a responsibility to do that. And if he's not willing to do that and they have a responsibility to protect her and they should allow her to work from home, but they do need to worry about their patients.

GAUDETTE: Dr. Pate: Ingrid has this question. She says, "I would like to know how tracking is going in our state, how and who is doing the tracking? Are people and businesses cooperating with tracking? Thank you."

PATE: Yes, tracking or what we called tracing is going well. The state has beefed up its resources to be able to do tracing. And so in case any of your audience isn't familiar with what that means. That means that if I were to have come down with coronavirus infection and that case reported the state, the state will then ask me who was I in contact with recently? So we're doing this interview remotely. But if we had all been together in your studio, I would have said, OK, I was with Gemma Gaudette. I was with Dr. Cavagnol and I was with Samantha. And then someone from the state, from the Public Health Department, rather, would reach out to Gemma, Dr. Cavagnol and Samantha and would say, hey, you've been exposed. What we'd like you to do is to self isolate because we don't know if you've been infected. And then we would like for you to let us know if you think since the time you were exposed to Dr. Pate. Have you been in contact with other people? And then they would check in with you regularly to see if any of you are developing symptoms. So we do have adequate staff now, although we're still staffing up some more. The other thing that the state has done as June 1st, they implemented a system called Sarah Alert. And what this would do would allow for you, Gemma, to either say you want to interact with the Web, the Internet and email a text message or a phone call, and you would automate it. It automatically be able to update the system about any symptoms. So rather than some physical person having to call you every day, you could put into the system. Now I'm feeling fine or yeah, I've just gotten some cough or or whatever. And the system helps spread our resources so that we can monitor more people. And it will report to us if anybody is getting symptoms and then we can get them tested. So it's going well. As to cooperation, I would say by and large, it's been good. But when you deal with any large group of people, obviously not everybody is going to be the same. There are some people who think this is the government wanting to get into their personal business. That's not the intention at all. There are people that don't want their whereabouts known that that's not what we're trying to do. We're just merely trying to identify people who may have become infected but are not yet symptomatic so that we can just ask them to please stay home. And kind of like Samantha's early comments. The best thing is just stay home and don't take a chance of spreading this until we can ensure that you have not become infected or if you do become infected, that we've got you home and away from everybody else.

GAUDETTE: Well, right. Dr. Pate, I know that some people don't like their bars being named. Right. And they feel they've done everything as an owner. That's understandable, right? Yes.

PATE: Yes.

GAUDETTE: By naming where these people have been. You can then say, well, was I there? No, I wasn't there. But if you were there, then you can say, OK, I now need to stay home for the next 14 days and monitor my symptoms and also maybe tell any one of my family who I've been around or friends that I was with after that. And is that a way I mean, by doing that, we can all control at least this virus a bit better? I would I would think.

PATE: Well, Gemma, you've said it perfectly. So in the example I gave where I become infected, if I was at the bar last night or a couple of bars last night, then it would be important for that word to get out, because chances are I don't know everybody that was at that bar. And I probably only know who I went to the bar with. And so you're exactly right, getting that word out, then let everybody know if you were at the bar last night. And Dr. Pate was there from 10 to 11. If you were there at the bar last night, then it's possible you may have been exposed. So why don't you stay home if you have any symptoms at all, be sure to contact your physician and let him or her know that you may have been exposed and you now have symptoms so that you can get tested.

GAUDETTE: Samantha: Sue had this question. "If COVID-19 is caused by a coronavirus and the common cold can be caused by a coronavirus, but less serious, will COVID-19 act like a cold during the summer and into the fall?"

BIRCH: Good theories. I have a lot of my own theories about what the virus will do. And really theoretically we consume a lot of things about what it may or may might not do, just kind of based on what other coronaviruses do. But really, the answer to that question is we have no idea until we live through a couple of of seasons of respiratory illness. All our theories sound good. But there's just no way to know at this point.

GAUDETTE: So, again, it's still that: wear a mask. Wash your hands, all of those things that we were doing when it was in lockdown. Dr. Cavagnol, Katherine literally just e-mailed us this question, she says, "I'm struggling with whether or not we should send our teenage kids to summer sleep away camp. Seems like most camps are closed around the country. But Idaho is still open."

CAVAGNOL: I would do some more investigation into what the plans are at the camp. And so how seriously are they taking this? Are there precautions to try to limit spread? Are they testing everyone who is going to come? You know, so it's hard to give a generic answer, not knowing what the situation is there. But I think it's thinking about that is smart and not just assuming, oh, they'll be fine, you know, but planning and thinking ahead, sending your kids with hand sanitizer and a mask or multiple masks that they can use if they do go. So I think whoever whoever submitted that question is smart to be planning ahead.

GAUDETTE: And then Glenda just sent us in a question, too, and she would like all of your opinion on it. She says "what are the panelists thoughts about public schools opening in mid-August. Most important factors to consider?" So why don't we do a round robin? Samantha, what are your thoughts on that?

BIRCH: I mean, there's there's there's going to be disease transmission when kids start going back to school, there's no doubt about that. I do think there are ways to medicate those risks. And there will be transmission to family members at home once kids go back to school. And really my concern is for, you know, grandparents who are now exposed because their kids go back to school. But, I mean, do we keep doing school at home for the next two years or do we cut to the chase and start doing our best to mitigate risk in an actual school setting? I don't have a great answer, actually.

GAUDETTE: Dr. Cavagnol, what are your thoughts on that?

CAVAGNOL: So I think the leadership of the schools need to be thinking and planning about this. How are they going to limit the likelihood of spread? So I've seen various models where, you know, it's partial alive in classroom and partial at home or or students go on various days. I do think some of it's going to really depend on where are we at the end of August and that can be so hard to predict today. What what is the disease burden here in Idaho? But there's a tremendous amount of value in thinking and planning. How do -- schools have a fixed area, right. So they can't just spread everything out. They have a limited capacity to do that. And so what other mechanisms can we put in place to make it as safe as possible?

GAUDETTE: And Dr. Pate, your thoughts on on Glenda's question?

PATE: Yeah, it's a great question. I think you're damned if you do and damned if you don't. And what I mean by that is Samantha is exactly right. If we put kids back in school this fall, we're going to have -- most of us believe -- we are going to have an uptick in the coronavirus infection. But we're also going to have all the other respiratory viruses, too. So, you know, we're going to have that. And and Samantha is exactly right. We got to be worried, not for these children, because very few of them will have something serious happen to them as children. But the big risk is that they're going to infect adults who may have a big problem. On the other hand, when you don't have school. We know what happens, and that is either kids go to a daycare or guess he takes care of the kids. A lot of times it's the grandparents who are at highest risk. So it's really a tough situation. I think it gets to what Samantha and Dr. Cavagnol said is we have to understand there's risks. So then the question is, how do you mitigate those? What we've got to be worried about is high risk children, because there are children who would be at risk for serious problems. How do we protect them? For example, blind students, one of the ways that blind students navigate their world is to touch stuff. And so we've got to be very careful there. The other thing we've got to worry about is teachers and many teachers may find themselves in the high risk groups. The other thing is it's not just a matter of school and classrooms, but it's a question about, OK, what other activities are we going to have? Are we not going to do field trips? Are we not going to do athletics? I'm particularly concerned about colleges and universities that have the additional issues of students being put together in dorms, in high density living, which we know that's a recipe for disaster, and then collegiate sports as a whole other issue. So there's just lots and lots of issues.

GAUDETTE: And with that being said, though, I think, Samantha, you made such a great point. I mean, what do we do then? Like, keep kids home for two years and do school? I mean, we could barely get through a quarter. I mean, but in all seriousness. Right. But there's so many domino effects with that in the sense of, like, you cannot restart the economy fully if kids don't get back to school because parents then cannot all go back to work. Right. And then it's exponentially usually put on the mother. I mean, there are so many issues that come up around whether we open schools or not.

PATE: Yeah. And Gemma, that's why I say I think it's a matter of just -- we understand that there are going to be risks then we number two identify what are those risks. And then number three, what are our plans to mitigate those risks? Because I think you're right and I think Samantha mentioned it earlier. I mean, we're going to be dealing with this virus for a long period of time. We can't totally disrupt our lives. We're gonna have to figure out how do we live with it. But that doesn't mean wild abandon. It means figuring out what are the things that we can do to reduce risk. And I'll just conclude by saying for everyone, as you consider your activities, here's what we know. We know that this virus is spread person to person. We know that you are safest when you're home and not out with people. If you have to go out, then you are safest if you are six feet or more apart. And if you can't be six feet or more apart, then you are so much safer and everybody else is much safer if everybody will wear a face covering or mask.

GAUDETTE: And there you go. That is our new normal as we continue to navigate this. I appreciate all of you taking time out of your day to talk with us about this. Still, I mean, here we are, right? Three months, four months. And we've all lost track. It's been a long time, but the questions keep coming. We keep learning. So thank you so much. We have been talking with our medical experts.

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