While Idaho has reported a week of relatively consistant new daily case numbers, that number is still in the hundreds each day. Today, a panel of Idaho medical experts join Idaho Matters to talk about this and other trends, and to answer your listener questions about COVID-19.
Today's panel is:
- Dr. David Pate, former CEO of St. Luke's Health Systema and a current member of the Idaho Coronavirus Taskforce.
- Samantha Birch, Infection Prevention Specialist at St. Alphonsus Regional Medical Center.
Read the full transcript here:
GEMMA GAUDETTE (host): You're listening to Idaho Matters, I'm Gemma Gaudette. We are six months into the coronavirus pandemic and here at Idaho Matters, we are committed to bringing you the facts about this virus. And the best way to do that in our mind is to bring in medical experts to answer your questions. So if you have a question for our medical experts today, send us an email right now at email@example.com. We will be talking with them for the next hour, so get those questions in. Joining us today, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, and Samantha Birch, infection prevention specialist at St. Alphonsus. Thanks, both of you, for joining us today.
ALL: Thanks. Good to be with you, Gemma.
GAUDETTE: So I would like to start the conversation today with some things that President Trump said last night during a town hall in Pennsylvania, and he said the virus and I am going to do a quote: He was being -- George Stephanopoulos, the chief anchor at ABC News, was the person moderating this. So this is a direct quote, the president says with the virus, 'it will probably go away now a lot faster because of the vaccine. It would go away without the vaccine, George, but it's going to go away a lot faster with the vaccine.' Stephanopoulos replied, 'It will go away without the vaccine?' Trump replied, 'Sure, over a period of time. Sure. With time, it goes away.'.
I wanted to bring this up because there is, I think, fair enough to say some misinformation in that. Dr. Pate, can you respond to that in this idea that even without a vaccine, this will go away?
DR. DAVID PATE: Well, it's very, very unlikely. This coronavirus does mutate, as all RNA viruses do. However, even in all of this time, we've not seen any significant mutation. Certainly, it is not impossible for it to mutate and do so in a way that it might, quote, unquote, go away. But the ordinary experience is when the virus is spreading and spreading effectively, as it has been all this time, the mutations typically only get worse, not better. So I think it's a very farfetched notion to think that this will go away. It's not impossible, but I don't know of any expert that is expecting that or thinks it is likely.
GAUDETTE: And Samantha, with your work with infectious diseases, you know, what are your thoughts on this idea that it could go away? I mean, the flu hasn't gone away. You know, we get our flu shots every year.
DR. SAMANTHA BIRCH: And I agree with Dr. Pate, I just don't feel it's going to go away with or without a vaccine, and you're right about the flu virus. There's lots of evidence that the virus that caused the 1918 flu pandemic about one hundred years ago is what -- the viruses we have now that circulate are a direct descendant of that 1918 virus. And the coronaviruses in general, there are a handful, I think maybe five different coronaviruses that are human coronaviruses, and they circulate every year during respiratory illness season. And that's been going on for years and years and years now. So I do feel that it's not going to go away. And it will I mean, it's spread across the world to the point where it's likely going to be a presence, at least during respiratory illness season, which is generally the winter season for many, many years with a vaccine that would probably get better. But same thing as flu and flu vaccine. Even though millions of us get vaccinated for flu every year, we certainly still have flu illnesses and deaths every single year.
GAUDETTE: And Samantha, so once we do have a vaccine and if people choose to get it or not, in your opinion, with what we're seeing with the trials, do you think it will be a one and done or will it be similar to a flu shot where, you know what, you get your coronavirus shot when you get your flu shot?
BIRCH: I wish I had an answer for that. And maybe Dr. Pate has a different thought than I do. But, you know, we're just barely starting phase three trials for these vaccines. So we really don't have any good evidence about their efficacy or really any of that information, whether or not the -- and we don't know yet whether the virus is going to mutate and evolve on a yearly basis like the flu does, or if it's not. So, although we could speculate about a lot of that, I don't think anyone knows any of those answers.
GAUDETTE: The other thing that I wanted to talk about was two Idaho children within the South Central Public Health District, just, I believe yesterday or two days ago this came out, that they have confirmed cases of the multi-system inflammatory syndrome that MISC which is associated with COVID-19. We know that there was another case earlier. Both children were hospitalized. This is according to a news release from South Central Public District Health within the St. Luke's Health System. This came out of the Twin Falls area. Dr. Pate, we do know that this is rare, but it happens. Is this something that you have been concerned with, with schools reopening, or is this just something that we knew would eventually we'd see more cases in Idaho?
PATE: Yeah, you know, as you point out, it's rare, but I've been worried about it and I've been worried about it because, number one, we can't predict which children will get this. We don't know why some children get this and others don't. And secondly, we don't know what the long term effects of it are. These children do get very, very ill and do require hospital and often intensive care support. But they also do seem to make significant improvements as well. And we do have some treatments for this, but we don't know yet what the long term effects of this are.
And secondly, as you mentioned, when we have started seeing the cases that we've seen in kids, it has largely been at a time when schools were closed. And for the most part, we believe children had fewer interactions because of that. So one does have to worry, I think, as we do restart schools, as we do increase the numbers that students have, are we going to see an increase in infections, spread and even these complications? And I do think certainly we're seeing an increase in infections. So the question is going to be, are we going to see more significant complications? And I pray not, but I don't think we know yet.
GAUDETTE: And that goes into my next question, which last week right here on the doctor roundtable, we talked about our COVID numbers trending down in the state. However, data is showing that our seven day case average has risen. But Dr. Pate, we're still not two weeks out from Labor Day. So it's like a roller coaster ride that we are on...
PATE: Well, I think it is and for a number of factors. And in fact, I think right now we have the most number of changing factors that we've had since the stay at home order.
So as you mentioned, we just had a holiday and we haven't seen the full effect of that. We have schools reopening and we have not yet seen the full effect of that, but we are seeing increasing cases around the country at schools. And then I think colleges and universities really are significant enough difference from K-12 school that we need to consider them in a separate bucket. And then we have a approaching cold and flu season. And the other thing is, with these declines that we're seeing, that results in two bad things. One, people getting complacent and thinking, OK, things are going well and I can go out and I don't have to take all the precautions. But the other thing is, is that we start decreasing the restrictions. And with that, we give more opportunities for people to get infected.
And we still continue to see here in Idaho, but also around the country, that a lot of the exposures that we're currently dealing with are happening from too many people getting together. And whether it's extended family that you don't live with or whether it's neighbors or neighborhoods getting together, we're seeing more and more infections from those kinds of of activities. And we just have to keep our guard up. And it is hard because people are tired of this. People don't like taking all these precautions. And I get that. I don't enjoy it either. But it is what we have to do or we will pay the price.
GAUDETTE: Samantha, are you surprised as we see, like, these dips in numbers and then we see them go up? I mean, is this kind of how infectious diseases work sometimes?
BIRCH: I think that's how they work all the time. It's interesting to watch it and watch our data change because it's pretty obvious when you look at it, what our lifestyle, I guess, is a good term to describe it, how that affects disease transmission, because it really does when you start to look at, you know, holidays and school openings. And just there's so many things that really affect disease transmission. Until you look closely at it, you would never know that that's affecting it.
GAUDETTE: Samantha: listener Judy. She is a nurse. And here's her question. She says,
LISTENER QUESTION: I'm wondering about how contact tracing is being done in Idaho. Who is doing it? What do you think is the value of it? And how does it work to best curb the spread of the COVID-19 virus?
BIRCH: So the public health districts in Idaho perform contact tracing. Contact tracing is kind of a basic public health function that's happened for lots of years and it's routinely used for contacting people who may have been exposed to a disease, commonly something like tuberculosis or a sexually transmitted infection. Now, COVID. And someone who was diagnosed with something like COVID is contacted and public health reaches out to them and asks them which other individuals they have had close contact with.
Those exposed people are contacted and they are just told that they have been exposed to the disease and they need to take some precautions. One of those things is 14 days of self quarantining. Watch for your symptoms if you get ill and those kind of things.
It works really well when our community collaborates with our public health districts, if we're able to share that information with public health, they can contact those people and we can kind of stop viral spread before it gets beyond two degrees of people. We are really meticulous and I have experience doing contact tracing for TB and HIV, and we are very meticulous about protecting the identity of people who are diagnosed with these diseases. We would never share personal information. So when the public and our public health officials work together to contact those exposed individuals, we can do a really good job of keeping the virus from spreading and stopping spread before it gets too big.
GAUDETTE: I appreciate, Samantha, you saying that the contact tracing is something that is used regularly in public health. You mentioned HIV. You mentioned STDs, tuberculosis. So, you know, there hasn't been a lot of talk about contact tracing being something that's used a lot. So hopefully that can put it in a better perspective as well, you know, and how it's been used in the past.
BIRCH: Yes, it's it's very common. We've been doing it at a very accelerated pace in the past few months. But it's been it's been going on for years and years. And those contact tracers that we've been hearing about a lot recently, that has always been a job at health departments. People have been contact tracing for various diseases for a long, long time.
GAUDETTE: Dr. Pate, Rick sent this question in. And the reason why I'm going to ask it is that I think we need to put some fallacies to bed. So here is the question. So, Rick asks:.
LISTENER QUESTION: I have heard several times, hospitals are putting on the death certificates that a death is COVID-19 related, even though the person never tested positive for the virus. Why?
PATE: So I suspect that this emerged from another false narrative that actually was being perpetuated by one of our state legislators who was making, as far as I can tell, baseless, because we've asked them to come forward with his evidence, claims that hospitals were somehow putting on their billing, that more patients had COVID than what they had because there would be some financial benefit. Well, that's a federal crime. So that's a pretty serious allegation to make. And certainly we have asked for him to give the evidence of that. And to my knowledge, he hasn't given any evidence of that. And I think that's an effort to try to send a message that somehow the magnitude of cases of COVID that we have are exaggerated by fraud or or some other method.
With respect to death certificates, death certificates are not filled out by hospitals or filled out by doctors. And if we're talking about hospitals, patients that get admitted to the hospital where there's a concern about COVID, they're all getting tested. I mean, there's not been an issue where a patient has been sick enough that we needed hospitalize them, that we haven't been able to get them tested. Now, I can certainly strain my brain and think of a scenario or two where it might be appropriate to code someone on a death certificate as having probable COVID without the test. But that should be a very distinctly unusual event. So my guess is that this is an offshoot of that other falsehood and that there's probably little basis for this claim either.
Leslie had a question and maybe Samantha, you can take it or Dr. Pate, either of you. But she says:
LISTENER QUESTION: I'm curious because I'm not seeing any reports of COVID-19 in the West Asia School District. Are they not required to disclose that information?
GAUDETTE: I will put in that the Boise's School District, even though they are fully online right now, they are reporting any confirmed cases among students or staff. They've been doing this since August 17th. And as of yesterday, they have had 11 in the Boise School District, 11 confirmed cases. Now, we know that these haven't happened in school because the Boise School District is not physically in school, but they are reporting these. So getting back to Leslie's question, A) Do school districts, are they required to disclose this information? And Samantha, I'm assuming they would do this to the health districts?
BIRCH: I actually -- so, I'm not aware that a school district is required to report that. The actual the health care provider, so the doctor, the lab that does the test is required to report the positive result. So unless I'm just not aware of it, I don't think a school district has to share that information. They certainly wouldn't report it to the health district because the health district already knows about it. They would get that, I mean, they're kind of the first people that get the information after the hospital or doctor gets the positive lab results. The next place that goes is to the health department.
GAUDETTE: So the health district may be the ones actually informing the school district.
BIRCH: And that might be possible. Yeah.
GAUDETTE: Dr. Pate, you know I've been searching for this and I have not been able to come up with a definitive answer.
PATE: Yeah. So Samantha's right. The school districts are not obligated to report. And I think a lot of the school districts and the colleges and universities, a lot of them have made a commitment to report, but they're not required to. Samantha's correct. The way that reporting occurs is that the laboratories who actually conduct the test and then have a positive test are mandated to report to the state and then the state notifies the respective public health districts. And then, as Samantha was talking about earlier, with respect to contact tracing, then the public health district would reach out to the infected person and try to establish who the contacts were. So I think, you know, West Ada may just be behind right now. I think yesterday was their first day of school. They may not have their website adjusted for this yet. I'm not sure. I mean, it would be extremely surprising for them not to have cases by the end of this week. I suspect they've already got cases today as large of a school district it is.
The the other thing I think on this subject is that it may be less of an issue in the lower grades, but in the higher grades and particularly colleges and universities, there is some concern that some students are not reporting their infections to the schools. Could be because they don't want to be excluded from sports for that period of time that would interfere with their participation or other activity. Of course, that would be a very dangerous thing. But there is some concern that that may be happening is that there might be some underreporting.
GAUDETTE: Samantha, Susan just emailed us these two questions:
LISTENER QUESTION: Number one, are there individuals who simply aren't receptive to the COVID virus? I don't mean they are asymptomatic after exposure while harboring it in their body. What I mean is, can they continue to accurately test negative after adequate exposure?
GAUDETTE: So let's start with that first question.
BIRCH: So a person who's exposed simply does not get ill. Not that they're asymptomatic, but they they just don't ever get it. I mean, sure, there might be people who just do not get ill. I -- really that is something that would probably need some, you know, in laboratory research done. But I don't know if there's any way until we get human studies where we expose people to a quantified amount of virus and see if they react to it, we have an answer for that right now.
GAUDETTE: And then Susan's other question, but also we also got the basically the same question in from from Jan. So, Dr. Pate, maybe you can take this.
LISTENER QUESTION: Can one of the doctors please speak to the recent information moving around about potential immunity in people who have received MMR vaccination, specifically those who received them in the early 1970s when that vaccine became available? And then they say, do you know anything about this?
PATE: So there was some hope that the MMR, which is a vaccine that we get to prevent mumps, measles and German measles or rubella, there was some hope that the MMR induced an immune response that would be similar enough to what we think is needed for the coronavirus, that it might offer some protection. And it doesn't seem that that has panned out. So I certainly would not suggest to anybody that has received an MMR and that's probably the vast majority of everybody listening to this, that you would be in any way protected from becoming infected. There is still some hope that maybe you would have milder illness, but we don't have anything convincing. It's more theory at this time.
And I think related to the other question, it's not a matter of there are people out there that just cannot be infected, but rather it's a matter of how symptomatic they're going to get. And we don't completely understand why some people don't get symptomatic and other people get very, very ill or even die. And there's probably a multitude of issues. But what we have seen that's been a pleasant surprise is it appears that one form of your immune response called a cellular immune response. So this is not your antibodies, this is another type of way that your body fights off infections, that it does appear that people who have perhaps not too long ago had one of these other coronaviruses that Samantha mentioned that we've have every year that cause the common cold they've been circulating for decades. There is some evidence that some of those people, the immune response that's generated to fight that coronavirus may actually help. It doesn't prevent you from getting infected, but it helps minimize the illness you get from this COVID infection. And it may explain why, especially in younger kids, we're tending to find much more asymptomatic infections because they're getting exposed to these viruses all the time. Very little of this is proven at this point. So you shouldn't hang your hat on it. But there's certainly a lot more evidence to suggest that prior coronavirus infection might protect you than there is that the MMR will protect you.
GAUDETTE: Well, that makes sense when you also think about just within your own family. Right. And I know in our family, like if one of my kids get sick, the next one's going to get sick and it's only a matter of time until I get something. But I swear, my husband is, like, immune from it all of the time. But I'm also the one who's -- I'm hugging them and kissing them and they're climbing on me and all of that. So I mean, that kind of goes back to this idea of somebody -- doesn't mean my husband doesn't necessarily carry whatever virus it might be. Maybe it's just not showing itself the way it would maybe in me.
BIRCH: Yes, and, you know, it helps to look at it as a maybe a spectrum of immune response, some people are going to be exposed to the virus and their immune system is going to, you know, one day kill that virus and move on while other people are extremely ill. And if you you know, there are people along that whole spectrum. And if you think someone's, you know, an asymptomatic infection doesn't mean they weren't exposed to the virus and their immune system didn't react to that. It just means their symptoms were so minor that it was not noticeable.
GAUDETTE: Dr. Pate, Amanda just sent this question in. And I would like your take on this. She says,
LISTENER QUESTION: What research is being done or what is known about recurrence of symptoms within an individual? Is it possible the virus, quote, hides in the body until the immune system is weakened? Kind of like the herpes virus. Are there reports of such things?
GAUDETTE: And I'm wondering, Dr. Pate, to add on to this, if that has anything to do with what we're seeing in long haulers where they, you know, all of these symptoms are coming up or they may have gotten better. And then they get a heart issue or a lung issue or something like that that we're seeing.
PATE: Yeah, it's a very good question. So the first thing is at this point in time and I just want to clarify that this is all a matter of active investigation. We don't know all the answers yet. So we may have more or different information before too long. But right now, we have no evidence that the virus itself persists in anybody for months or years, and certainly not the way that she's referencing about how the chicken pox virus stays with you and can later reemerge decades later. We don't have any evidence of something like that. And that certainly would not be characteristic of this virus, family, the coronaviruses.
However, it does appear that even though people do clear this virus and don't have the virus live and replicating within their bodies, they can have long term effects. Early on, we talked about these children, Jemma, you asked me about the children with MISC. So far, the cases I've looked at, we've not identified the presence of the virus at that time. We think this is mostly the immune response that has gone haywire from that initial infection rather than them currently being infected. Same thing in the long haulers. We don't have any evidence that the virus is persisting for months in those individuals, but rather we're contemplating that either the virus has caused some kind of direct injury that we're seeing these long term effects from, or it's a similar thing where the body's immune response to the virus is causing these persistent symptoms or complications to occur.
GAUDETTE: So we just got a question in from Nicole. It's fairly lengthy, but I do want to read it in its entirety. Nicole says:.
LISTENER QUESTION: I recently went to my hairdresser in Eagle and was terribly upset to find that out of six hairdressers, mine was the only one wearing a mask. None of the customers were wearing masks. When I asked my hairdresser why no one was wearing a mask, she replied they were just asking customers if they wanted their hairdresser to wear a mask. I replied there was a mask mandate in Ada County. Her thought was that the Eagle mayor was not enforcing this. I followed up with a call to Eagle City Hall. They said they were following CDC guidelines, but that the masks mandate was a recommendation only, not an enforceable law. Can you please clarify what the mask mandate means for businesses? And as a consumer, how can we be protected knowing that people are spending 30 minutes or up to two hours here for services is terrifying when we think of this being an airborne virus.
GAUDETTE: Who would like to take that on and clarify if this is just a recommendation?
PATE: Well, it does depend on what jurisdiction you're talking about, because, for example, where the city of Boise did have an enforceable mask mandate, they've now terminated theirs and then Central District Health had an enforceable mask mandate. Then you take another area like Southwest District Health, which has Canyon County in it, and there is just a recommendation. So, you know, unfortunately, it's a patchwork across Idaho, towns or cities have mask mandates. Some health districts have mask mandates, others have mask recommendations and others don't have any position at all. And then even if it is a mandate, then the question is, OK, you're required to follow it. And just like there's a speeding limit, you're required to following the the the speed limit. But we all know we see speeders. And so whether they get cited or not depends on what the level of law enforcement is. And are they doing, you know, radar patrols and those kinds of things? Well, same thing with this. And unfortunately, we've had some areas of Idaho where the law enforcement has said we're just not going to enforce this. So in some areas it has teeth and other areas it doesn't. You know, my position about businesses, I do understand this puts them in a difficult position. I think that if enough of us are concerned about them not having their employees and their customers in masks, then the response is for us not to give them our patronage, those of us that are concerned about it. And if there's enough of us, then they'll realize that it's going to hurt their business not to require it. On the other hand, if enough people continue to give them their business, then they may not feel compelled to enforce this themselves.
GAUDETTE: Right. And we should note for Nicole who asked this question, Nicole. Eagle, as as Dr. Pate said is within Central District health. And yes, it's a mandate. It's not a recommendation in the city of Eagle.
Samantha, a question for you in regards to the vaccine. You know, a lot of people have said, I'm not going to get it when it comes out. There's no way you can have a good vaccine in this short amount of time. Can you maybe clarify some misnomers around that in regards to the fact that normally when vaccine trials are going on and they do take many years, not every resource is thrown at them financially, as it has been for a vaccine for COVID.
BIRCH: Yeah, and that part is true, the resources that have been going into the COVID vaccine are vast. There are many organizations and pharmaceutical companies that are trying really hard to get an effective vaccine. And I have thought through this also because I've heard of people saying they they wouldn't trust the vaccine. But my kind of personal feeling is that, you know, in general, vaccines these days are made very similarly. They are fairly -- well, I shouldn't use the word fairly. They are extremely safe, the ingredients that actually go into a vaccine. Right now, it's hard to say whether or not they are going to be extremely effective in preventing or COVID illness, but there's no way to know that until, you know, we've been able to give enough people the vaccine and see how well it actually does to prevent the illness. But whether or not it's going to be safe, I really don't think vaccines these days are unsafe. They're made from kind of the same ingredients. There's really nothing about a new vaccine that would scare me. We'll see how effective it is at actually preventing illness. But actually getting the the the vaccine injected into my arm, I have have no concerns about something that's not going to be safe.
GAUDETTE: And speaking of vaccines, Dr. Pate, Tom has a fairly unique question. He says, I recently received the Novavax vaccine as part of a double blind phase two COVID study. There is an 80% chance I received the real vaccine, 20% chance I received a placebo. If I had actually received the real vaccine, would I test positive for COVID antibodies? In addition, assuming I did test positive, what I be able to donate plasma to be used in convalescent plasma treatment.
PATE: So this is a good question. So, Tom, first of all, thank you for enrolling as a study participant. The vaccine that Tom is referring to is a really interesting one. This is really unprecedented. We have over 100 vaccines being studied right now. As Samantha alluded to, there's a lot of financial interest because these companies can sell these vaccines to the whole world and most other vaccines have a much more narrow population. So we're actually benefiting from a lot of aligned incentives here, plus some very good moves by the federal government to encourage the development of these vaccines.
And included in this is we are seeing some brand new technologies being used that we've never used for vaccines before, which, if successful, actually are easier to be made, such as the messenger RNA vaccines that we're testing. And one of those is very far along.
Now, the vaccine there Tom's talking about is actually it uses a virus, another virus, that is weakened and then causes the body to make this protein that the coronavirus has and then react against it. And so far, it looks very promising. Now, if Tom just signed up in August -- well, if he just signed up, I think they just started given the first immunizations in August. So my guess is Tom has only had one shot. This is a two shot series. It's possible he's had his second one. But my point being to Tom is it does take time to mount the antibody response. So generally, you need that second shot to get your maximal vaccine response. So you may not have it yet. But, yes, if you actually got the vaccine and not the placebo and if your body is responding to it, then you'll be making antibodies. And it's very likely they would be picked up on an antibody test there. There are lots of different antibody tests and some are better than others. But in general, yes, it would be expected that those would be picked up.
The other thing about it is if this is a double blind study, you shouldn't do that because part of the double blind means that the patient's not supposed to know if you're getting it so they can get a better assessment of your symptoms. So I urge you not to get the antibody test just to see. Wait until they tell you. And then the the the final thing would be I did check with the Red Cross. I contacted the CEO for Idaho and Montana. She's dealing with wildfires right now. And she didn't know the answer to whether you could donate. But I do have a message in to their medical director. And if you want to follow me on Twitter, once I get that answer, I'll tweet it for you. But I think you will be able to donate.
GAUDETTE: Such good information. Thank you both for taking the whole hour with us today. I just appreciate your perspective. Also giving us the facts on this. Our guests today on our medical panel, Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of the Idaho Coronavirus Task Force, and Samantha Birch, infection prevention specialist with St. Alphonsus. Thank you both so much. Appreciate your time, as always.
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