Idaho's COVID-19 Cases Are Surging Again As White House Outbreak Continues

Oct 7, 2020

Idaho's numbers of new daily cases have been on the rise over the past couple of weeks. Idaho doctors warn that, although case numbers never went down to a safe and contained amount, this surge is our third wave. Every Wednesday, Idaho Matters brings on a panel of doctors to answer listener questions about the coronavirus. 

Got a question for our doctors? Tweet or email us: idahomatters@boisestate.edu.

On today's panel: 

  • Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force.
  • Dr. Bart Hill, Chief Quality Officer at St. Luke's with a background in emergency medicine.
  • Dr. Patrice Burgess, Regional Chief Medical Informatics Officer for Saint Alphonsus, a member of the Saint Alphonsus COVID-19 Incident Command team and a member of the Governor's State of Idaho COVID-19 Testing Task Force.

Read the full transcript here:

GEMMA GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know so many of you have questions and concerns and that is why here at Idaho Matters, we continue to bring in Idaho medical experts to answer those questions. In fact, when we look at our case numbers right now, Ada County -- just Ada County -- added 675 new cases of the coronavirus last week, and if it adds 683 this week, we could see Ada County reverting back into the red zone under the criteria established by Boise-based Central District Health.

So joining us today to talk about where we are with the pandemic and also answer your questions, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, Dr. Bart Hill, chief quality officer at St. Luke's. And Dr. Patrice Burgess, regional chief medical informatics officer for St. Alphonsus, who also serves on St. Alphonsus's COVID-19 incident command team. She is also a member of the governor's COVID-19 Testing Task Force. Hi, everybody.

I think a lot of the questions that we got just this morning are surrounding President Trump's diagnosis of COVID-19. So for people who may be living under a rock, and there are some, President Donald Trump revealed late last week that he had tested positive for COVID. He was later taken to Walter Reed National Military Medical Center for treatment. He is now back at the White House. Now, he was put on a cocktail of drugs, including a form of a steroid and an experimental medication. So some of our listeners have questions about the president's diagnosis. So we're going to get right into this. So one listener named Koda wants to know this:

LISTENER QUESTION: The president says he feels better. Is he still contagious? Should he self isolate for 14 days? And should everyone in the country who tests positive get the same medications the president did?

GAUDETTE: So, Dr. Pate, can we just start with you on this about the president saying that he feels better? So does that mean he's still contagious?

DR. DAVID PATE: Well, there's no correlation, so I'm certainly happy that he feels better. That's certainly good news. But we have to assume this early into the infection that he is still contagious and he may or may not be. But certainly many people at this point in their illness still are contagious. And so the most important thing is, as your listener suggested, he should isolate. For people that were symptomatic, we recommend at least 10 days. And I say at least because you should not end the isolation until all the symptoms are gone and you've not had fever for at least 24 hours without any medications that suppress the fever, which certainly the steroids that he's getting would.

GAUDETTE: Hmm. So then the other question Koda had, Dr. Pate, is, should everybody in the country who test positive get the same medications the president did?

PATE: No, and that's because based on and we can only go off what information his White House physician has provided to us, but based on that information, the Remdesivir that he got, generally we only use that for cases of people that have more severe disease and are hospitalized. He did get hospitalized, but they started the Remdesivir before then. And that would not be our standard because we don't have evidence from clinical trials to show that it provides any benefit. The monoclonal antibodies that he received are still investigational. And the only way the president got this is, first of all, he's the president. And second of all, it was a compassionate use exception because the FDA has not even given the monoclonal antibodies the emergency use authorization, which is kind of the lowest level of authorization to use the medication. So if any of us got COVID today, we would not be able to get that drug most likely. The steroids, the dexamethasone that he got, the studies that we've got to date indicate that it really only benefits those patients that have low oxygen levels and are requiring supplemental oxygen or mechanical ventilation.

You know, there's been a lot of question about just what was going on with the president's oxygen levels. We know his oxygen saturation did decrease on a few occasions, but we don't know how low it got. But, you know, typically that drug is reserved for those patients that are requiring oxygen supplementation.

GAUDETTE: Dr. Burgess, Katie has a question as well, and she is curious about:. 

LISTENER QUESTION: What side effects are there for the drugs that are still being administered to President Trump for COVID-19? And could they affect his ability to work and make decisions? And that could be a question for anyone, I guess, who is given this cocktail of drugs.

DR. PATRICE BURGESS: Well, as Dr. Pate mentioned, the Regeneron, the monoclonal antibody none of us have any experience with because it's still investigational and I think relatively few people have received that. So I'm not really at liberty to comment on those side effects, having not had any experience with it. Remdesivir, is pretty well tolerated. Dexamethasone, like any steroid, can cause a few side effects. A lot of people have trouble sleeping, sometimes have a little euphoria where they're feeling a lot of energy and increased appetite. Most people are perfectly capable of continuing to function, but just have to be aware of those side effects and they are short lived.

GAUDETTE: And Dr. Hill, my understanding is that you actually recently recovered from COVID. So can you tell us a little bit about your experience?

DR. BART HILL: Sure. End of August, I traveled and in one of the flights, it was a very full flight and even though everybody was wearing masks, I'm suspicious that that's where I did pick it up because I had no other known exposures to anyone who was positive. Became symptomatic four days later, I thought it was a mild cold because it was a slight cough and a runny nose, no fever, some fatigue. And on day three called, I set up an appointment for testing the next day. Was tested, the following day received my result, which was positive.

And at that point -- and I had been isolating from the first time that I developed some mild symptoms. That's the expectation we have within our organization, it's just really good sense that if you're sick, don't go to work, don't be around other people. And clearly at that point was feeling a lot of fatigue, a mild headache, mild sore throats, did not ever have any shortness of breath. I had the good fortune of a friend who loaned me their pulse oximeter, which is a little device you can put on your finger and monitor your oxygen intake. And that was stable.

So I basically cured myself at home. I took two of the medicines that President Trump has been on. Zinc and vitamin D. Did not take other medications and then follow through. I'm five weeks out and one of the listeners does have a question about persistent symptoms. And I will tell you, it's even with a mild case, it's a real disease. I still have days where I feel quite fatigued, generally will sleep seven hours. I'd love to sleep 10 to 12 hours every night now. And my energy level is not where it historically used to be. Maybe I'm deconditioned, but I'm getting better. But I'm giving myself grace that it is not something like a typical common cold you may have for a few days and a week later it's completely gone and you go back to normal.

GAUDETTE: So, Dr. Hill, I mean, you mentioned that you took two of the same drugs that President Trump did, zinc and vitamin D, but none of the other drugs that he's been given. Is that because your symptoms are what are considered mild?

HILL: It's clearly that. I would not have qualified for them based on how our clinicians are treating patients who have COVID. But also, any time you're taking medications, the patients should be informed to be able to make a decision on the risks and the benefits. And clearly, I have an appreciation for the benefits that medicine like dexamethasone can give. But I have also seen that it can have some significant and serious side effects. And so for me, the risks and benefits, clearly the benefits were not there. The risks were much greater. And as long as the symptoms were mild, I treated it more symptomatically. But clearly, there's very little harm to take zinc and vitamin D and the evidence is suggesting some benefit. So those are two of the meds that I did take.

GAUDETTE: So now that you've had COVID-19 and thank goodness you're in recovery, what advice would you give to folks who are testing positive for COVID?

HILL: The first is at the earliest onset of symptoms, isolate yourself. You can sit and wait for a few days to see if it's just a mild cold or something that completely resolved or get tested, but isolate immediately. The first 24 hours. My first symptom was achy muscles and I been out hiking the day before and I just thought, I'm out of shape. I haven't done this. And it was then that next morning when I developed a cough that I said there's more going on than just aching muscles. So that Sunday there were several individuals that potentially had an exposure for me because I was probably the first day of symptoms highly contagious at that point. Fortunately, they did not contract it, we wore masks. We were outside and social distances. Two individuals. But that's the first advice is definitely isolate yourself, continue to wear the mask because wearing a mask protects others. I do think there's some benefit that the masks may have assisted me in whatever exposure I did get, it wasn't as severe an exposure, maybe not as high a volume of viral particles. And there is some evidence, at least observational, that the amount of virus you get exposed to can be a factor in the seriousness of your disease.

And then you monitor yourself closely. And if I was concerned that just like President Trump at these five to seven, you can have symptoms that kind of persist but are getting better and then you take a sudden turn for the worst around the seventh or eighth day. So that was kind of my window, a concern is would I suddenly have more serious symptoms later during my illness? And then, like Dr. Pate said, I was in isolation about twelve days at home before my symptoms had reached that point of improvement with no fever, 24 hours and then had the opportunity to again come back to work or to be outside, but still wearing a mask. And now, one of my concerns, Gemma, is I may have some immunity, but I doubt that it's long term. And so this idea that I'm safe and protected and don't have to wear masks and don't have to practice hand hygiene, I'm going to continue to do it because it's just not certain how long I may have to have protection. And that's a concern down the road as well.

GAUDETTE: Thank you for being willing to share your story and to give us that information. I mean, not only are you a doctor, but you have gone through this. And so just such critically good information for all of us to be hearing. 

Dr. Burgess and Dr. Hill, a person who wants to remain anonymous, sent us this email on Monday. I want to read the whole email verbatim. So it says,

LISTENER QUESTION: I work at one of the two large hospitals in Boise. The hospital decided within the last week that rooms used by COVID patients no longer need to be deep cleaned by trained cleaning staff, which takes 30 minutes and involves cleaning every surface, including the walls. Now these rooms instead get wiped down by nurses and techs taking just five minutes. Does this place patients at a higher risk of contracting COVID from room surfaces? I am concerned this places vulnerable patients at risk as staff have not received extra training, nor extra time to clean these rooms in a standardized fashion. Then today, that same person emailed us with an update saying a cleaning staff member told me last night they were suddenly allowed to clean COVID rooms again after a week of not being able to. I have not been able to confirm the change. It used to be that every COVID room got a deep clean and now I don't know if they can just be deep cleaned or not.

So we're curious, Dr. Burgess and and Dr. Hill, is this true? I mean, this person says they work at one of the major hospitals in Boise. And does anyone have anything to worry about when it comes to these rooms being cleaned?

HILL: Patrice, I'll let you start.

BURGESS: Sure, yeah, I think at both facilities, we have very strict cleaning precautions and make sure that all the rooms, whether they have a COVID positive patient or not, are cleaned appropriately with all of the surfaces cleaned. And so, you know, I'm not aware of any five minute cleaning that has been described, and every room gets cleaned sufficiently and there should be no cause for concern. As a matter of fact, we're so extra cautious now that the hospitals have screening in place, very limited visitors, all the things that you've been hearing about to keep as clean and and avoid exposures to COVID as possible.

HILL: Gemma, this is Bart. And I appreciate the opportunity you gave at least to investigate that question across St. Luke's. As an organization, we have not made any changes in our cleaning practices, especially for COVID, because it is a contagious disease and other contagious diseases have existed. And those rooms all require a deep clean, which is the minimum 30 minutes. We're actually seeing it takes 45 minutes to do that clean. And then on top of it we put a machine in called the SteraMist that takes hydrogen peroxide and creates ionization, a mist that will land on the surfaces and will kill germs including the virus. So if it's happening, it certainly is not an expectation and nor is it a desire. And I'm not sure why that might have been communicated. So the expectation and what we've been doing since the beginning of the pandemic is deep cleans in all rooms, and emergency rooms, in patient rooms and exam rooms that have COVID positive or suspected possible COVID patient in between patients to keep both the staff and the patient safe. To the listener's question of is there a concern, there is because while the virus is most often contracted by directly being coughed on, sneezed on, those viral particles will also live on surfaces and depending on the surface, they may stay viable for several days. And then it's this act of touching a handrail and then actually touching your eye or touching your lips, rubbing your nose with it, that now you're transferring the virus from an inanimate surface to a part of your mucous membranes where it can begin to replicate and ultimately causing infection.

GAUDETTE: And Dr. Pate, some information coming out of Johns Hopkins University recently saying that of all 50 states, Idaho has the second highest positivity testing rate for COVID. Our positivity rate is 23.22%. This is according to Johns Hopkins data. So that means, if you break it down, for every 100 tests administered, more than 23 of them come back positive. Our state's rate is 4.6 times higher than the World Health Organization's advisory opening positivity rate of 5%. I mean, we're only behind South Dakota in this. But Dr. Pate, you have said that, you know, testing or positivity rate isn't the only way to gauge the spread of COVID you said we need to be looking at case numbers. So can you talk a little bit about that? Because as I mentioned at the beginning of the program today, our case numbers are back on the rise to the point that Ada County could potentially go back into the red zone.

PATE: Yes, so first of all, the Johns Hopkins calculation of the testing positivity rate is different than what we use at the state, and I think it is likely to inflate that number, because if you look at what's on the Johns Hopkins site, that 23% versus what we've got on the state, the 9%, that's a big difference. 

Now, I'm not sure it's a meaningful difference because even if it is 9%, it is way too high. And as you say, I think that certainly when I look at our numbers, I look at two things to gauge what's happening right now, and that is: what are the the new cases? And I like looking at it on a seven day period of time. What is the new cases and the rate of new cases and the testing positivity? Because what should be concerning is when both are high and both are high. And what that tells us is that we have significant community spread, which is not surprising given all the activities that are going on in our communities. So we want to get that testing positivity rate down below 5%. And we need to reverse the trend of these cases and get our coronavirus cases on the decline, especially as we're heading into a time of the year when we're going to have all kinds of other respiratory viruses, including influenza. So I do think it's problematic and we really need people to take action and comply with the infection control measures we've been promoting.

GAUDETTE: Dr. Burgess, Kate just e-mailed us this question. She says,

LISTENER QUESTION: I wonder if in the case of two people with COVID living together and one person has a high viral load and more symptoms than the other, can the contact between the two people increase the viral load of the person who has the lesser infection and symptoms so that their disease potentially becomes worse?

BURGESS: Well, that's an interesting question. I mean, I don't know that I have any direct evidence of that, but common sense would say it would make sense to isolate and not aggravate each other's infections. We know that some people are mildly affected and some people are more significantly affected and people are going to be at different stages along the way. As Dr. Hill pointed out, sometimes you can be improving and then decline. So it would make perfect sense to, even though you both have COVID, to still practice all the isolation precautions and mask wearing, cleaning surfaces as we've discussed so that you don't make each other worse.

HILL: Let me follow up on that, because my own experience was somewhat unique is for the first three days, it wasn't clear that I was symptomatic with COVID and my spouse was tremendously exposed. And yet she ultimately never picked up the disease and had two negative tests and follow up. So there must be factors that also contribute to why some people get it and other people don't, beyond just how much exposure you get.

GAUDETTE: It is fascinating, isn't it? So, Dr. Hill, Maria has a question and she says,

LISTENER QUESTION: I had COVID in early July with a positive test and was quite sick for about six days. I am still dealing with fatigue. And recently my lungs have been hurting more with breathing difficulties. Is this common?

HILL: Unfortunately, Gemma, we're finding out it's much more common than we would like. And I did some research trying to see how often it's occurring. At least 10% of people are experiencing what's called long haulers who are having symptoms long after they are completely recovered from the acute infection. It's affecting both people with mild and severe disease. Some of the more serious symptoms are related to people who were sicker, required hospitalization or intubation. Fatigue and malaise is the most common symptom. Shortness of breath is the second one. Some people are having some serious symptoms of brain fog, cognitive memory concerns. Some will have long term lung damage. Some will have heart damage. 

So this is another example that this is not a simple cold. This is a disease that is indiscriminate or who it decides to harm. And the harm could be both immediate and catastrophic and it can be long term and chronic. So it's unfortunately very legitimate. And I think the best advice I give is to appreciate it isn't something you immediately may recover from, to give yourself grace, to take good care of yourself, eat healthy, exercise to some degree that you are capable of, and be patient, because I think time will help us understand better which of these symptoms will completely resolve, how long it may take and what we can do to assist people who have persistent symptoms.

GAUDETTE: And Dr. Pate, Rick has a question. He says,

LISTENER QUESTION: What are your thoughts on traveling at this time? Are places like Disney World safe?

PATE: Well, you know, it's a tough question because you really need more details to understand what that travel would entail. With respect to Disneyland, I would assume that would mean a plane ride, if this is someone here in Idaho and I certainly am not comfortable with air travel right now. I'm not putting this all on airlines. It's everything associated with that travel. How do you get to the airport? Do you ride in a ride share or a taxi that creates some risk. When you get in the airport, is everybody wearing masks? Does that airport require that? Does it enforce that? When you're going through security, is there a physical distancing? When you get to your gate, is there physical distancing?

And then while airplanes certainly do have some pretty sophisticated and advanced air circulation and filtration mechanisms, I think all of us have had the experience of getting on a plane when it's just boarding and those systems aren't on. And then furthermore, you're going to have some of these airlines, like Dr. Hill mentioned, are still filling the plane with people. And that's going to create risk. It's just hard to distance even if there is good air circulation. And then, of course, there's the issue about somebody taking their mask off to eat or drink. So right now, I just think it's a high risk activity. Disney has taken a lot of good measures, but even they will tell anybody that's coming to their amusement parks that you're assuming the risk. In other words, they can't protect you. They have put measures in to make it safer, but they can't protect you. And then finally, I would just say that given where we are and given that it is certainly my projection that we are on the cusp of a bigger spike than we've ever had and more cases, that just means all the more you have to avoid being around people you don't live with because you're just significantly increasing the chances that you're going to get infected. And then not to mention what I said a minute ago about influenza also that's coming on us. And as bad as COVID is, you sure don't want to get both.

GAUDETTE: Several listeners have had questions about masks, so we gathered them together and here are a few of them. So, Dr. Hill, let's start with you.

LISTENER QUESTION: We have typical blue paper masks, which my partner and I share, I think one or two masks in a car. Is this OK?

HILL: Well, wearing a mask is better than not wearing a mask, however, sharing a mask does increase the risk quite a bit for transmitting between the two of you. So my first suggestion is get your congeries of masks and do your best not to share them. But if it was a choice of sharing or not sharing, I'd rather have someone to wear a mask. 

Then, which are the better masks? And ultimately, there is studies that show that the most effective mask at preventing both you spreading it or from you getting viral particles is what's called the N-95 masks. But it's the one that does not have a valve and they typically have to be fit-tested in order to have the appropriate seal. And we generally use that in the medical field when we are in higher risks situations like caring for COVID patients or tuberculosis patients, we require that you do that n-95 type masks. Generally what most people see health care workers wearing are what we call a procedure mask, and they are effective, not as effective as N-95s. And the studies that have looked at masks have said those procedure masks and even the double cloth masks, the sewn masks that are double cloth cotton are effective at preventing you from spreading particles, but not absolutely perfect. The interesting information from the research is showing that there are masks that are really not very effective and those are the neck gaiters that we pull up over our face, or wearing a neckerchief over our face. Those are the least effective. And then the one piece of advice I'd give to the listeners about how to know if you have a good mask is hold it up to the light. And if you can see late coming through it, it probably isn't a very effective mask. And if it's pretty easy to breathe through it, which is often why people choose the neck gaiters or the handkerchief over their face, that's probably another indication it's not very effective at keeping you from spreading the germs.

GAUDETTE:  Dr. Pate was one other person wants to know:

LISTENER QUESTION: It is said the mask protects others, not yourself. Why?

PATE: So first of all, we know that that's not technically true at this point, it is predominantly to protect others, but we have recent studies that show there is a bonus effect of it probably does benefit the wearer to some degree.

The reason that masks work and are effective are two things. There are three ways, in essence, that this virus gets transmitted. Dr. Hill mentioned one where you touch things. That's probably the least common, as he pointed out. The other two: one is called droplet and the other is called airborne. And so droplet is where masks are most effective and droplets are when I am talking to you right now, there are little droplets of secretions coming out of my mouth. And if I was infected with the virus, those droplets would contain virus. Those droplets are big enough that if I'm wearing a mask while I'm talking to you, that it will catch most of those and block them from getting out in the air where I might infect you. So that's why masks predominantly protect others rather than the wearer. Some recent studies showed that if you are being exposed, that the mask may even block some of the incoming droplets that are coming your way. It's not nearly as effective as blocking the ones that you're expelling, but it could provide some help.

And then the other, the airborne. What the difference is between a droplet and airborne is airborne are really, really tiny little... So think about when you spray hairspray. That's the aerosol and that's what gets airborne, meaning that it can travel in air flows. And that's why being outdoors is safer than being indoors. But we've got recent evidence that suggests that wearing masks will also help decrease the airborne transmission by about 65%. So that's why they help.

GAUDETTE: And then Dr. Burgess, Stephanie asks: 

LISTENER QUESTION: If masks are effective, why can't we visit our family member in the hospital?

BURGESS: Well, we're still just trying to decrease the percentages, so as Dr. Pate said, they're effective and he mentioned a number of 65%, we know nothing is 100% effective. So when you increase the volume of people circulating, you increase the possibility of transmission. So if we can keep that as minimal as we can, then we help everybody avoid being exposed. And I think we're constantly evaluating that and allowing visitors when appropriate and just trying to be as cautious as we can. All of our facilities are screening everyone that comes in, visitors and employees alike with temperature checks and other questions to try to keep the risk minimum because we have vulnerable people in the hospital and we certainly don't want to have them be here with another illness and then get exposed to COVID while they're vulnerable.

GAUDETTE: And then Dr. Hill, Christina asked,

LISTENER QUESTION: The CDC says face shields are not an approved substitution for masks, but the shields are allowed in some schools. Is that more dangerous?

HILL: I think that it does increase your risk because even in health care, we have some very sophisticated head coverings to prevent people from getting COVID or from spreading it. And we have found that if they don't have tight seals down on the shoulders, tucked in to the shirt, it's really not providing the protection that people assume it is. And I think that's what's happening with face shield, is you won't have the droplets necessarily hitting your face. But certainly the airborne particles of Dr. Pate mentioned they're going to come in underneath the mask. So there is a risk to you. And then certainly if you are spreading virus germs before you may know you're sick, it's certainly being aerosolized. Particles are coming out around the face shield and that's where -- if you're going to wear a face shielf, we also expect that you also are wearing a mask.

GAUDETTE: And then final mask question from Paul. Dr. Pate, Paul wants to know:

LISTENER QUESTION: Can I microwave my nonmetal containing facemasks to sterilize it or just throw it in the wash?

PATE: Throw it in the wash. I would not microwave it. We don't have very good data for that. Not to mention the risks of does that accelerate the deterioration of the mask. The washer machine is perfectly good and effective at killing the virus. Just put it in and you don't have to do it by itself. Throw it in with your other clothes, but do wash on the warmest or hottest setting that's appropriate for the clothes that you're washing and your mask should be fine.

GAUDETTE: We have a lot of questions. Apologies if we can't get to your questions today, we will get to them next week. Jake has a question. He wants some travel advice. He says: 

LISTENER QUESTION: I want to know the panel's thoughts about traveling by car to the Oregon coast with my elderly parents. We've been isolating together, always wore masks in public and will be staying at a professionally managed vacation rental in a part of the coast with only 54 COVID cases since March, we're planning on taking a train ride, an outdoor car with on and that visiting a cheese factory and an airplane museum while wearing K-95 masks. Would you say this is an acceptable risk at this time? Dr. Hill, your thoughts on that.

HILL: Oh Gemma, every person's situation is unique and an individualized choice. It sounds like they are taking a number of very appropriate and acceptable precautions, but they are increasing the risks. And I don't really know, in addition, that he's going with his elderly parents. Do they have medical conditions that if they were to get COVID-19, that their mortality would be higher than others? Because that's ultimately what some people have to answer is if my loved one were to get this disease and have significant harm or death, was it worth it? And that's the personal choice people have to make. But I do applaud all the steps that they are taking. I would be a little cautious, though, about going to a cheese factory or being indoors, the more outdoors you can be. Just because they only have 54 cases since March doesn't mean there will be a case there at the time that is where they get exposed. So they have lowered the risk markedly but they certainly can't remove it.

GAUDETTE: And Dr. Burgess, Mark has this question. He says:

LISTENER QUESTION: A lot of people put their fingers in their mouths when they cook, or they serve or dine on food. And contagious individuals will thus place the virus on to commonly touched surfaces. Others who also inadvertently touch those same surfaces could then pick up the virus. So is this a factor Mark wants to know that's being overlooked?

BURGESS: I think he's probably referring to restaurants and we do know that we have seen transmission in restaurants and I know they're doing all of the precautions they can. There has been a video I've seen circulating of a fluorescent substance they put on people's hands and then evaluated everywhere that they had touched. And so salt shakers and different surfaces are certainly a place for transmission. So what he mentions about putting your finger in your mouth as far as food goes, most of our food preparers now are wearing gloves and doing all those precautions. So I think that's probably low risk, but the surfaces are high risk. And so making sure you're washing your hands, that you're not putting your fingers in your mouth, and you're cleaning surfaces certainly that have been touched by others is your best safety measure. And a lot of restaurants are doing takeout now. And as has been discussed, being indoors in those closed spaces is higher risk than being outdoors or having that food either delivered or picked up and eating at your own home.

GAUDETTE: And then Dr. Pate, Steph wants to know:

LISTENER QUESTION: What are your thoughts about the risk from middle school age kids playing indoor sports, specifically basketball?

PATE: Well, you know, I think a couple of things. First of all, the way this virus is spread is typically through close contact. So you want to think about what the sport is in question and do you have to come in close contact in basketball? Well, the answer is yes. Now, the other thing is the amount of time that you come into close contact. And so the players are moving around. So that's a favorable factor. But on the other hand, an unfavorable factor is that when we were talking about those droplets being transmitted, any time you're breathing hard or fast, if you have the virus, you're going to transmit more virus, a further distance. So that is going to be a risk. But you have to consider all the other factors. Does that mean that the team you know, I always sat on the bench. So are people that are on the bench, are they all congregated? Because that's going to be a risk. Are you getting together and huddling with your coach at a time out or the halftime or whatever, then that's going to be a risk and then you're indoors. And so then we have all the airborne transmission issues. So could you get infected playing basketball? Yes. Is it the most dangerous thing you could do? I can think of some more dangerous things, but it's certainly not safe if safe means I'm not going to get COVID.

GAUDETTE: So it's a calculated risk that you have to decide is worth taking or not, it sounds like.

PATE: Yeah, that's right. And I just would ask all of the listeners, as you're taking those risks into factor, and it's like Dr. Hill was saying when he was answering this other question about the family going, you know, you have to consider a whole lot of factors. It's what are people's health? Who are these kids going home to? Are those kids going to be riding in the car with others that they don't live with? Are they going home to an elderly person or somebody with chronic health problems? And then I would add to the mix, we just need to be extra careful during the fall and winter. I truly believe things are going to get a lot worse before they do get better and it will get better. But as we enter into cold and flu season, people need to be extra careful and conservative about their decisions.

GAUDETTE: It's one of those things, too, as we go into this, as all of you have mentioned, with cold and flu season, is that, you know, we're going into the holidays and people haven't seen family members and they want to see family members. But you might need to take some time to maybe have some conversations with family members. You know, I am having one of my brothers and his family come by and I had to have a conversation that was like, we have to wear masks, we're going to be outside, but we have to wear masks. Those are uncomfortable conversations to have. But they are important conversations to be having.

PATE: Absolutely, Gemma, and unfortunately, everybody's going to feel the same way. I've got family that we haven't seen in a couple of years and my wife asked me to try to think of a plan, how they could come and visit us. I just couldn't come up with one because we have several at risk people. But keep in mind, even though you might be making holiday plans right now, we are on the upswing. We are hitting a third spike. And I don't think that spike is going to get better any time soon. In fact, I think this is going to be our worst spike when you add on respiratory illnesses, and guess when that all peaks? Right around the holidays.

GAUDETTE: I want to thank all of you for coming in today and taking time and answering these questions. So appreciate all of your expertise. I hope that it is making a huge difference for people who are listening. 

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