Joining the Idaho Matters Doctor Roundtable today 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. Brian Kitamura, Emergency Department doctor at St. Alphonsus in Ontario, Nampa and Boise
Read the full transcript here:
GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. Idaho reported 2,012 total new cases of COVID-19 Tuesday, making this the state's new daily record. And as cases soared, protesters once again disrupted a Central District Health meeting. All this as we are likely one week away from starting to get the COVID-19 vaccine right here in Idaho. So today is our medical expert roundtable. If you have questions for them, email us: firstname.lastname@example.org. Joining us 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. Brian Kitamura, an emergency department doctor who works with Saint Alphonsus in Ontario, Nampa and Boise. Thank you all for joining us today.
ALL: Glad to be here, Gemma. Thanks Gemma.
GAUDETTE: So I want to start with what has ended up making national headlines. This is when a group of protesters gathered outside of the Central District Health meeting last night in Boise. But as that meeting started, board members started to identify themselves:
CDHD TAPE: Commissioner Lachiando here, I'm sorry, I just got a text from my neighbor that there are protesters at my house, so I'm going to step off for just a moment to call the police because my kids are there. Thank you.
Ok, I've also got protesters outside my house as well.
GAUDETTE: That was Dr. Ted Epperly, the last person you heard there, and then just a few minutes later, Dr. David Peterman of Primary Health Medical Group. He was expressing his support for his fellow board members.
CDHD TAPE: In a sense, as a pediatrician, I don't care whether you're a Democrat, Republican, independent, libertarian, we're going to take care of you.
[LACHIANDO] Can I interrupt you for just a moment? My 12 year old son is home by himself right now, and there are protesters banging outside the door. I'm going to go home and make sure he's OK, so I will reconnect with him when I get there.
Ok, Diana, go ahead.
Well, I mean, again, whether I'm a pediatrician or not, I'm a father, and that's just unbelievable.
GAUDETTE: This threw everyone for a loop, I believe, seeing this protesting going to this level when a 12 year old child is, frankly, for no better word, terrorized. There was a Facebook live video of what happened outside of the commissioner's home. Dr. Pate your thoughts on this? Because, frankly, it is shocking.
PATE: Well, it is, and I think we have to have some serious reflection on who we are. It's not just these people who terrorized Diane's child, who were trying to use intimidation, bullying and other tactics, that is so outrageous, but it's also something that we need all of Idaho's leaders to come out and take a strong stance against. That, this is not right. This is not who we are. It so happens that Diane and I were having a vigorous discussion over the weekend as I was debating this issue with her. And we didn't reach agreement. But at the end, we said, when this is all over, let's get together for a beer.
That's how we should handle our differences. We should have vigorous public debate. We should have all sides of all issues heard. But when it comes to impacting people's families, Diane knows what she signed up for when she ran for election. But what she didn't sign up for was for her 12 year old son to be in the throes of this. That is not right. It's not the first time we've seen this. We had a Meridian police officer who had people show up at his home because they were unhappy how he handled a situation with someone who was clearly provoking the police. We've seen this in other instances, and I would like to see all Idaho leaders come out and detest this. And I would like to see the legislature take action this legislative session that removes public officials' private information from the public venues and protects these folks and makes it a crime if they show up their house. It's fine if protesters want to show up at Central District Health. Now, I do have an objection with last week and what we've seen with the legislature where they tried to rush the the doors they tried to force their way in. They break windows, they touch the police officers, which God bless these police officers who know that this very group is very high risk because they're not taking any of our precautions and they're not wearing masks. They're way too close together. And I do find it ironic that those are the same people that are saying that we should trust Idahoans to use their personal responsibility when they gave us a wonderful display of how irresponsible they were and getting too close to the police officers, threatening them.
People should be able to assemble and protest. That's the foundation of America. But we shouldn't force our way into public buildings. We shouldn't put police officers in bad situations, and we should not be going to these people's homes and terrorizing their families.
GAUDETTE: I couldn't agree with you more Dr. Pate. And, you know, we had to have conversations with our children. My boys are the exact same age as Commissioner Lachiando's children. The reason why we had to have conversations last night about this is because my job is in the public eye. I have had things happen where people have said things about journalists, have said things about me, and to have to talk to your children about what to do if people show up at your home, this is not who we should be. And for those people, too, and we will move forward with your questions. But I think this is incredibly important to point out is that many people have said well, they these people at the commissioner's home, at Dr. Epperly's home, they were not trespassing. They were you know, they were on the sidewalk. They never went on to their property. I would just like to point every single person to Idaho code 186409 and disturbing the peace. This is what it reads: 'Every person who maliciously and willfully disturbs the peace or quiet of any neighborhood, family or person by loud or unusual noise or by tumultuous or offensive conduct, or by threatening, traducing, quarreling, challenging to fight or fighting or firing any gun or pistol, or uses any vulgar, profane or indecent language within the presence or hearing of children in a loud and boisterous manner is guilty of a misdemeanor.' That's the law.
PATE: Well, Gemma, the other thing, too, is and obviously we could forgive Commissioner Lachiando if she in the height of that terrible fear and emotions, if she may have details mistaken. But what she indicated was people were ringing her doorbell. That is going to be private property. That's not the public sidewalk or the street. And so if she was correct about that, I think that is even more egregious.
GAUDETTE: And then we have an Idaho Board of Health and Welfare meeting scheduled, I believe, for Friday morning, and this is to vote on administrative rule for crisis standards of care. Can we talk about what that is and how it will affect health care providers and Dr. Pate, I'll have you set it up and then I'd like the other two doctors to chime in.
PATE: Yeah, well, and I think we'll all have plenty to say about this. I mean, this is extremely sobering for those of us that understand what this means. Crisis Standards of care means the conditions under which hospitals are going to have to operate if they get overwhelmed to the point that they are resource-constrained. In other words, if, and this is already happening, we are getting dangerously close to the point of our hospitals getting overwhelmed. And what that means is, in the past, under normal conditions, most of us don't worry that if we have an emergency, if we have a heart attack, if we have a stroke, if we have a bowel obstruction, if we develop sepsis, if we're in a motor vehicle accident, and I could go on and on with all the different kinds of emergencies that we see all the time, even before COVID, what we're used to, we go to the emergency room and we know there's going to be people there who will take care of us and get us the necessary resources, admission to the hospital, surgery specialists, ventilators, ICU care, whatever it is that that we need. Most all of us have never dealt with a situation where we have not been able to get the care we need, even if we couldn't afford it, because hospitals are required to provide us.
What we're talking about with crisis standards of care means that the hospitals are so overrun that now you come in with one of those conditions I mentioned and the hospital's not able to provide those services to you.
Or you may be at a smaller hospital in Idaho. We have a lot of small hospitals in Idaho. And what happens in normal times is when they're not able to care for you, they transfer you. They might -- depending on where you are, they might transfer you to Boise, to the bigger hospitals with more capabilities. But if our Boise hospitals are under crisis standards of care, we can't take people. And then what we would normally do after that is if we can't take people at our bigger Idaho hospitals, we start sending people out of state. But for over a month, Utah has been overwhelmed themselves. They can't take our patients. So we're running out of places that can provide care. And so these crisis standards of care are where we set out the framework that allows our doctors to look at cases and determine if there are two people in the emergency room that need that ICU bed, which one of them will get it. If there are two people in our ICU that need a ventilator and we have one, which one will get it?
And what this means is we'll certainly take care of the other patient and try to make them comfortable. But we're not going to, in some cases, be able to give them the lifesaving treatment that that could save them. And so we are going to have people die because of resource constraints that otherwise wouldn't at all let the other doctors comment.
GAUDETTE: Dr. McGeorge, how are you feeling about this?
MCGEORGE: Yeah, I'm very concerned and I would, just to give you a little bit of background and tell you where we are today, we are not yet at the crisis standard of care. But like Dr. Pate said, that discussion now is the time we have to have those discussions and decisions. We have been operating really for months now under contingency standards of care. And what that means is we even today are not working under the usual way of doing business that a year ago we were doing. So an example of that is is reusing our N-95 masks. We've been doing that at St. Luke's practically back to the beginning of the pandemic. We also have staff working much longer hours or more hours that we wouldn't ordinarily be doing. We have nurses and we have doctors working in clinical areas that is not where they initially trained, but they are leaning in and helping. So all of these things already are adding to our repertoire, but are not things we normally would have been doing. So we are already going down that pathway and in our contingency care.
The other thing I would say is, as I think about this for myself, for my family, for my friends, you know, I think, gosh, if you're going to get COVID, now is not the time to get it. We would have been better off getting it two or three months ago. But we are really you know, if you get COVID and we're in a situation like Dr. Pate said where a choice has to be made on which people can have an intensive care room and an intensive care bed and ventilator, there's a lot of risk for that coming up in the next month or two. So it is just not the time to get COVID. The other thing is it is not the time to have a stroke, but people are going to have strokes. People are going to have heart attacks. And so, again, it is just so important that all of us do everything that is in our control to not get COVID right now so that we can continue to allow the best medical care possible for patients who really need that care.
GAUDETTE: And Dr. Kitamura, do you have any thoughts on on this before we take a break?
KITAMURA: Yeah, no, I mean, I'd just like to echo what Dr. Pate and Dr. McGeorge kind of said already. We talk about crisis standards of care. That's what you see on the national news. But we really are, you know, unfortunately already contingent. Just because things are so busy in the hospital, that may not mean that you don't have a bed. But where you typically have a nurse taking care of three or four patients in a load that they can manage. When we're overwhelmed by those number of patients and have so many nurses and support staff out sick, we just can't get to things as quickly as we would otherwise. And that's not that we're not trying to provide the best care, but you can only get so much when we answer so many call licensee so many patients and in a given amount of time. And we are at that position where we're already stretching the care we're giving you. You don't want to see any doctor on their fourteenth hour of shift, but we'll stay and work because there's patients to see. But obviously it's not going to be ideal. Right? You want someone that's fresh, available, not bogged down in the level of sickness of patients and the pure numbers of it. And we've been there. We're doing it. So it's always a little disheartening to hear people say, oh, well, it's not that bad. The hospitals aren't overrun. The water hasn't come over the dam yet. That that doesn't mean things aren't tight and stressed. We're really already there.
GAUDETTE: And continuing Idaho Matters live with our doctor roundtable. And before the break, we were talking about crisis standards of care and a meeting coming up on Friday at Idaho Health and Welfare. While we were doing a pledge pitch, we just saw that those crisis standards of care were published on the Idaho Health and Welfare website. So feel free to go take a look at that before Friday's meeting. If you have questions.
Dr. Kitamura, you work with St. Alphonsus in Ontario, Nampa and Caldwell. And Sheila wrote in and has this question:
LISTENER: If someone tests negative six days after exposure to a COVID positive person, could they just not have enough viral load to test positive or can they be assured they don't have it?
KITAMURA: It is difficult to know for sure, so I would say, you know, should they feel assured that they don't have it, not quite. There's a lot of differences in what kind of test you use. For example, the rapid test have a lot more stringent requirements. And for when they're accurate and they're only so accurate, you know, we say 80 or 85 percent sensitive for a particular illness. There's a one in four, one in five chance that just didn't catch you that day, whether it was because of viral load or operator error or what have you. The CDC has recently kind of revised our guidelines. And I'm not looking at them right now. But as I recall, I think they've been releasing people from quarantine seven days after exposure, if they had a negative test on day five. But it really depends on a few things. It depends on the test. And when they let that information out, they had a very clear disclaimer to say that, you know, there's going to be some people that are missed by doing this, but we're trying to balance the downsides of keeping people quarantined with the low chances if it's credible. So is it OK to go back to work if you're not sick or this, that and whatever? Perhaps, you know, I couldn't give you a hundred percent assurance if that was the case, [inaudible] you know, that's obviously a little bit more high risk for them, and you can't be 100 percent assured that just based on that negative test, day six, that you're good to go. I mean, the odds are better, of course, but it's not a perfect science.
GAUDETTE: And then Dr. McGeorge, Katie just sent us this. She says,
LISTENER: My son and his wife have recovered from mild cases of COVID-19 their two young children never got sick. Do we assume that they were asymptomatic cases? Also, is it safe to then be around them after they quarantine for two weeks?
MCGEORGE: Well, it's possible that their children had asymptomatic cases, but we certainly know that there are, it's well documented that there are a lot of household members that don't get COVID from the other household members. So just because one person in the household had COVID is not a guarantee that everyone in that household has now had COVID, whether it's symptomatic or asymptomatic. The question of is it safe to be around them after they quarantine for two weeks? So the quarantine is for two weeks after last exposure to someone with COVID. So it would have to go back to I mean, you'd have to look at the duration of the person with COVID and then count back two weeks from when that person's COVID isolation ended. So it's really longer than two weeks from the initial diagnosis of the initial person in that family. A little confusing, I get it. But the answer is it will take a while to assume that they don't have COVID. Now as far as it being safe to be around them. Again, we don't know if the kids had COVID and so we could introduce COVID into that house in a different way. So I just I can't emphasize enough. We are in a very critical period of the disease right now and communities spread. And so as much as we can minimize going in and out of other people's homes for now, that would be the best.
GAUDETTE: Dr. Pate, John literally just sent this question in. He says,
LISTENER: Because there are many anti-vaccine people and lots of young folks who don't wear masks, as a senior citizen, can I get COVID after I get the full dose of the vaccine?
PATE: Well, the technical answer is, yes. It's going to depend. So, for example, the two vaccines that are likely going to get authorized this month, they have about 94-95 percent effectiveness. It's not 100, but it's really, really good. So the first thing is, it certainly makes it much less likely that he could get infected, but it doesn't make it impossible. Another concern why we still want everybody to take precautions is that because we haven't seen all the data yet. And while it does look like these vaccines are extremely effective at helping you prevent get getting the disease COVID, we don't know yet, I think we'll know very, very soon, we'll have that data. But we don't know yet that it doesn't mean you still couldn't get infected and have it in your mouth and nose and that you couldn't pass it on to somebody. We're hopeful that that doesn't happen, but we don't know that that doesn't happen yet.
And and then finally, the other thing is, obviously, we're going to be trying to figure out how long the vaccine lasts. But, you know, certainly it could be while he might be protected for, let's say, the next year, it might be waning off after that, he might need another booster and maybe until then he could get reinfected. So there's just a lot we don't know. It's going to be of huge benefit to him. We certainly want him to get immunized as soon as he can. But it would be too early to assume just because you got the vaccine that everything's great and you can return to normal life.
GAUDETTE: Right, still wearing the mask, still social distancing.
Dr. Kitamora, Karen from Boise wrote this. She says,
LISTENER: We've heard that the Pfizer vaccine needs to be kept super cold temperatures. So how will they go about raising the temperature before injecting it into people? And then how long can the vaccine stay at room or body temperature?
KITAMURA: Yes, two important considerations there, so that's the thing about the Pfizer vaccine is it can't be kept at just regular cold temperatures or room temperature for a significant amount of time before losing effectiveness. So when it's transferred to Idaho to our hospitals, the one's not in use have to stay in that super cold refrigeration. You'll have a small amount that gets moved to kind of a standard and then before you get the vaccine, they'll actually take that vial and that vial is safe at room temperature brought up to room temperature for several hours. But you can't go back and forth and it's not like a gallon of milk. You can't put it back in the fridge and [inaudible]. So once that vial comes out of once it goes from supercold to cold and cold to room temperature, you've kind of progressed down that track. And obviously we don't want to, with such a precious resource, we don't want to be wasting it. So it's those initial steps, that initial part of the supply chain that's really hard to figure out. And then they're very cautious about taking it out as they need it so they don't lose the efficacy.
GAUDETTE: And then Dr. Mark George, another person wrote in asking, is there a plan in the vaccine distribution process to give some kind of card or proof to those who receive the vaccine?
MCGEORGE: Not yet. I think we are going to be keeping track of who has been vaccinated. I mean, there is speculation that down the road venues, possibly countries would ask for documentation that you had the vaccine. We already do this. I mean, there are countries today that you cannot get into without proof of having had yellow fever vaccine, for example. So it would not be surprising if down the pike we do need some proof of vaccination.
GAUDETTE: Matt wants to know,
LISTENER: Any idea of how and when the vaccine will be administered to assisted living and nursing homes and will they be a priority?
PATE: The answer is yes and yes, so they are going to be in the first group, which means perhaps some will get vaccinated later this month, probably mostly next month. Do keep in mind it is a two-shot series. So we start the vaccine and then it will be required to get another vaccine to complete the series. But we should get started either at the end of this month or next month.
GAUDETTE: Dr. McGeorge, Tom has an interesting question, and he says,
LISTENER: On the past on this program, we've heard that there might be different levels of COVID from mild to moderate to severe. So is the actual COVID virus more severe, like a greater viral load or a worse strain of it? Or is it the body's reaction to it that is either mild, moderate or severe?
MCGEORGE: Well, the COVID virus has had mutations all along, some of them very minor mutations. There was one mutation early on that may have affected the transmissibility of the virus, but really, the COVID virus generally has stayed stable in its of in its severity.
What really matters are a lot of factors in the person who gets COVID. One of the factors we think is viral load, and that is where masking even helps the person wearing the mask. There is evidence out there that having a mask on reduces the viral load that comes into your respiratory tract if you are around someone with COVID. So that is one of the factors. Another factor is just general risk factors. So what is your underlying health going into this pandemic? If you already have other medical problems or if you are elderly, that can increase your likelihood of having a more severe episode or experience getting COVID. And then the last is there's really is an unknown factor of why it's more severe in some people. There's speculation that there may be a genetic component as it relates to the immune system in people, but it's really unknown. I mean, we do know that there are people that have nothing else putting them at risk and yet get can get very, very serious cases of COVID and even die from it.
GAUDETTE: Dr. Kitamura, Sheila sent us this question and she says,
LISTENER: Are the tents that are being erected for outdoor dining at restaurants any safer than indoor dining?
KITAMURA: It's really tough to say without kind of knowing some more information. The thing you really got to think about if you're going to be going to make those kind of judgments, I say, first of all, it's probably best just not to dine out with other people you don't know. Right. I think we've been trying to hammer that point home. Beyond that, the things that we try to do is keep people distanced and have good ventilation or air flow. And that all has to do with what Dr. McGeorge is talking about, about viral load or how much of that innocuous you may get initially. So you go outside and it's cold and you see your breath, that's your respiratory droplets going out there. And the more those can kind of linger in the air close to people, the higher concentration of people in the area will be exposed to. So when there's good ventilation that kind of gets distributed and diluted it out real quickly and when the ventilation is bad, it kind of lingers there. So if you're in a circumstance where you're in a tent and there's air not moving through there, you're probably in a worse situation than in an indoor venue where people are socially distant and air's moving. But it really comes down to the circumstances of the exact environment.
GAUDETTE: Dr. McGeorge, Heidi in Boise, asks, she says,
LISTENER: My sister in law works for a major employer in Meridian and she contracted the coronavirus. She was told she has to wait 10 days before returning to work, but has not been told to have a follow up COVID test before returning. Now, the reason she was given as to why was that they do not have to have a negative test before returning is because a COVID positive patient can test positive for up to a month afterward. If you were still testing positive, couldn't you still be spreading the virus as well?
MCGEORGE: Right. You know, the studies have shown that people do not shed virus that is infectious, typically beyond like nine or 10 days. There are exceptions to that. If you have a very compromised immune system, it is possible that you have difficulty fighting that virus and you can continue to shed it longer. What is being picked up on these tests, though, is not infectious or communicable virus. What it is, is just RNA fragments that are still being shed. So these tests, these PCR tests are just incredibly sensitive to picking up those fragments. And we've seen in some patients, even two months out, you can occasionally pick up viral fragments. And in fact, this is one of the reasons the CDC says that if somebody has known diagnosed COVID, there really is not a reason to retest them within the first three months. We think within the first few months they will have immunity. We don't know how long it lasts, but at least for the first few months or so. And there's actually more risk of picking up what I would call a false positive test or the example that this listener says where a month after having COVID, you're still shedding viral particles. But it does not at all mean that you're infectious or acutely ill with COVID.
GAUDETTE: Before we wrap up today, we have got a just litany of emails this hour in regards to what happened last evening in regards to Central District Health. So I want to read some of these emails, and I would love for each of you to give comment or maybe some advice. So Sheila starts off saying,
LISTENER: Please mention the 600 signs and many emails supporting Central District Health. Please don't let the vocal minority have all the publicity.
GAUDETTE: Another emailer says,
LISTENER: How would you recommend people who support the health district in efforts to put in place stronger measures show that support to counter the small minority of people who show up at board members' homes. Counter demonstrating does not seem to be the best way.
GAUDETTE: And Babbette, she is a nurse and she says,
LISTENER: My colleagues risk their lives every day taking care of patients. It is traumatizing to deal with the COVID deniers while tending to those taking their last breath on Earth.
GAUDETTE: Carol says,
LISTENER: We are close to having to ration health care. We do not have a statewide mask mandate. What can individual citizens do? A few hundred protesters should not dictate policy that would protect the health of the citizens of Idaho.
GAUDETTE: And Ellen wraps up saying,
LISTENER: I am angry and it is not OK for Diana Lachiando and her son to be terrorized. It is time these protesters were hauled down to the hospitals and have to work on these COVID wards for a few hours.
GAUDETTE: I don't think that's the answer there, Ellen, but I think we can all understand your frustration.
But Dr. McGeorge, I'll start with you. I mean, you are in the trenches. You see this on a daily basis. What can an average citizen do who wants to show their support? But frankly, is it going to go out to these crowds and do it?
MCGEORGE: I think that this is, boy, this is really hard. I am hoping that last night was a turning point. I am hoping that we start to see tremendous voice and tremendous peer pressure on this small amount of people that are really driving the conversation. I think all of us, we want to continue to emphasize, we will listen to each other. I think we need, again, trusting our medical experts. It is not OK to threaten or to do violence and it is not OK to go to people's homes. Again, the more people that can speak out, call the governor, call your mayor, let the elected people know that we are sick and tired of it and it is not OK. And this is why it's late. It's after the election. But this is why it is really important local elections matter. And here's why.
GAUDETTE: Dr. Kitamura, your thoughts on this?
KITAMURA: Yeah, really the same. And what I've been doing, you know, I don't imagine that going down and counterprotesting is going to change any of those folks' minds. But what we can do is influence our legislators, right? They are there to represent us. So if they know that they're voting contingent is calling them and saying, hey, we've been quiet this long, but we're tired of it. We want more protections or if nothing else, we want people to go about their business and do what we've asked them to do without being harassed. Light a fire under them. Let's let them know that it's not safe for me to go out and counterprotest. I'm not going to do that. But I'm letting you know I'm watching you to lead us. And if you want them to hear your voices, tell your friends, tell your neighbors, tell like-minded individuals, let them know that we support them in their public health efforts and they'll listen. Right. That's what politicians do.
GAUDETTE: Dr. Pate, we have one minute left and I'll let you wrap it up.
PATE: All right, thanks, Gemma. In addition to all those good things, so I spent this weekend debating with three members of Central District Health board. What they told me is they're getting 60 emails an hour from people that are telling them, don't do this. So it's what the other doctor said, we have got to contact them. We got to let them know that they're not the majority. We are. We want them to take these actions and that we've got their back.
Diana Lachiando lost her election, maybe because she supported a mask mandate. We've got to vote the other ones out of office and we need to call on the legislature to change the law to make this not acceptable.
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