Social Distancing Seems To Be Working But We're Far From The End, Idaho Doctors Say

Apr 8, 2020

 

We’re back again this week to answer more of your COVID-19 questions. Every Wednesday during at least the month of April, we will bring on a panel of doctors and health professionals to get us updated and to answer your questions. 

Joining Idaho Matters to share their expertise are:

  • Dr. David Pate, part of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s
  • Dr. Jim Souza, Chief Medical Officer for St. Luke’s Health System
  • Dr. Meghan McInerney, a pulmonologist at St. Alphonsus Regional Medical Center

If you have questions for next week’s show, feel free to leave us a voicemail at: 208-426-3625. We might use your message on the show next week. 

 

 

Read the full interview here: 

GEMMA GAUDETTE: This is Idaho Matters. I'm Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know that so many of you have questions and concerns. And here on Idaho Matters, we want to answer those questions with facts. The best way to do that, we believe, is to bring in medical experts from Idaho. So every Wednesday, for at least the next month, we will bring in a panel of doctors and other health professionals to get us updated and to answer your questions. If you're a regular listener, think of this as a doctor's version of our Friday Reporter Roundtable. So joining us today are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force; Dr. Meghan McInerney, a pulmonologist at St. Alphonsus; and Dr. Jim Souza, St. Luke's Chief Medical Officer. Thanks for joining us today.

GAUDETTE: So, I want to get right to it. There are so many rumors out there right now. Dr. Souza, maybe you can answer this. What is the most frustrating [rumor] that you want to squash right now and set the record straight about this virus?

DR. JIM SOUZA: Thank you for that question, Gemma. I think the one I'd want to squish the most is that this is a big to-do about nothing. This is a big deal of some of the folks who who make a statement like that are looking at our hospitals and health care systems and saying, well, 'you're you're not at capacity.' But the reason we're not at capacity is because of the specific actions that we've taken to prepare. By looking to health care systems on the coasts, in Seattle and in New York and others, we see what what could happen if we weren't prepared. So all of our local health care systems, right, have followed the governor's guidance and we've shut down emergent non urgent cases. We've eliminated routine follow up visits. And it's because of those actions that we're doing okay on capacity. So that that would be the thing I'd want to dispel. It is a big deal and we're preparing for it and we're ready. And there's some signs that what we're doing is working.

GAUDETTE: And Dr. Pate, what about this idea -- because we continue to hear this comparing the coronavirus, COVID-19 to the flu, especially when folks talk about death rates and how much higher the flu is. Can we talk a little bit about that to maybe dispel some myths around that?

DR. DAVID PATE: Yeah. There is some limited comparisons of where they're analogous. They both can present with similar symptoms. It can be a little challenging to tell the difference between flu and coronavirus symptoms. And they both are occurring right now at the same time. Influenza, you said, a higher death rate -- that's not actually true. More deaths from influenza because influenza has infected and has a lower death rate, but more people, in fact, deaths with it. But if you look at the number of people infected, more people will die proportionally of coronavirus. So, you know, and a big difference for flu, is that we have a vaccine for that. We do not have a vaccine for coronavirus. And another difference is that we have anti-virals that we know will help lessen the severity of flu. We do not yet have that for coronavirus. Hopefully [inaudible]. I think another very important difference is that most of us have previously been infected with the flu virus. And even though it changes every year, sometimes having been previously infected with the flu helps protect you from subsequent flu viruses. No one in this world was protected or immune to the coronavirus when this started.

GAUDETTE: And that is a huge issue. And Dr. McInerney, I want to bring you into the conversation because you are a pulmonologist with San Alphonsus. What has been the biggest concern for you when watching how COVID-19, works?

DR. MEGHAN MCINERNEY: Right. Thanks, Gemma. So I am a pulmonary doctor and an ICU doctor, so I've been able to see this in the intensive care unit and see how sick patients actually get. And I think that Dr. Pate did a great job of describing some of the key differences between influenza and coronavirus infections. One thing that I would add, though, is that a lot of the coronavirus infections that we're seeing that causes COVID is different from different viral pulmonary infections in that it's more indolent, meaning that the symptoms come on a little bit more slowly, whereas a lot of times when influenza hits, it hits hard and fast. And so people know they're sick right away. Whereas with coronavirus, what we're seeing is that people will have more subtle symptoms. It takes a while for someone to get sick if they're going to get sick. And so they go about their usual days, not realizing that they might be sick with a virus and potentially transmitting it to others. And then it's at about a week or so later, if somebody is gonna get sick enough to need to be admitted to the hospital and need to come to the ICU, that's when they deteriorate. And they and they do so very quickly. In the intensive care unit, we're seeing patients who come in with very low oxygen saturations. They need to be put on a ventilator rapidly and then they end up staying on the ventilator, which is different from other viral pneumonias, for a much longer period of time, on average, up to two weeks.

GAUDETTE: So then, Dr. McInerney, what are the factors that seemed to most influence the outcomes for those COVID-19 patients.

MCINERNEY: Yeah. Well, as best we can tell, the factors that we know that will influence the severity of illness largely have to do with somebodies age. Meaning older people are at higher risk. And we've already been hearing about this a lot in the media. So people greater than 60 years old. And then when people have underlying illnesses, high blood pressure, pulmonary disease, cardiac disease, they just don't have, you know, they just can't tolerate the the insult from the virus like others can. That said, I think that we've also all heard about some of the more rare cases of young, healthier people also getting sick. In general, it's the older patients with multiple, what we call, co-morbidities, multiple underlying medical issues that are at the highest risk of severe disease.

GAUDETTE: And then for both Dr. McInerney and Dr. Souza, one of the best ways that you have seen so far to treat patients who come into the hospital.

SOUZA: Meghan, would you like to go first? Sure.

MCINERNEY: So, you know, one of the struggles with this virus is that we don't have a lot of direct evidence to inform our management. Usually in medicine, I think it's really important to know that, usually in medicine we try to base our management of illnesses off of high level evidence such as randomized controlled trials. So we don't have that yet with this infection. So a lot of what we're doing, we are just collecting, like Dr. Souza said at the beginning, we're learning from our colleagues on the east and west coasts from what may or may not have worked for them, but did the high level evidence is very limited. So with that, we'll say that we know that maybe some people benefit from hydroxyl chloroquine, but those are people who already are sick enough. These are the people who are in the hospital, in the intensive care unit, that there is an indication to try hydroxyl chloroquine in the intensive care unit. If somebody gets sick enough to need a ventilator from something called acute respiratory distress syndrome. We have seen that people do better when they go into what's called a proning protocol, where they lie on their stomach while they're on the ventilator to help get oxygen from the air sacs of the lungs into the blood. And then there's some other treatment options out there. Again, there's not a lot of data for any of them that look at, you know, Anti-IL6, which is a cytokine that causes this kind of big inflammatory surge. Are there some antiretrovirals that have been looked at, but none of them have a lot of data to support their use at this point. Dr. Souza, I don't know if you want to add any to that.

SOUZA: Agree with everything Dr. McInerney just shared. Totally agree. We don't have a specific treatment. What we do have is fantastic pulmonary and critical care physicians in our state that have learned in the past 20 years about the optimal way to manage the sort of most severe manifestation of this disease, which you've already heard is ARDS and the optimal ventilation techniques and whatnot that were described. Also agree with Dr. McInerney that we don't have a clear data on which medications are going to help. The one thing I'd say, Gemma, is the the rate of knowledge acquisition with this infection is breathtaking. It's stunning how quickly we're learning, how quickly we're learning about the disease, how quickly we're learning about operations management and responding to the disease. I mean, what we know today is different than what we knew two weeks ago. What we're gonna know four weeks from now is going to be vastly better than what we know today. So there's there's hope in that. And I've seen a lot of new potential treatments moving forward to be studied. And then there's vigorous interest amongst all of our colleagues to to find a better way to manage.

GAUDETTE: And Dr. Pate, we know that cases have been going down in Idaho for the last few days. And you being on the Idaho Coronavirus Task Force, is that an anomaly? Are we flattening the curve or is it a combination of both?

PATE: It could be both, but we do believe that it's likely we are seeing the early signs of the benefits of our mitigation steps. In other words, the benefit of the social distancing, hand-washing staying at home, not traveling. That seems to be working now. Dr. McInerney, Dr. Souza and I all have been burned before when we've looked at early data and then something changes. So I'm not ready to pronounce that. But I do think we've seen this happen in California. We've seen it happen in Washington. And they're much further along. And these steps really seem to have made a difference. Almost all of the modelers are convinced and believe this makes a difference. And that's also looking at the experience in other countries. So I do think we are starting to see the benefit of it. And certainly it seems to be less than what would have been projected had the governor not taken these very important steps. With that, let me make sure that I don't mislead anybody that's listening to this. It is good news that we might be seeing some flattening of the curve. That is not the same thing as this disease is under the control. And you can now go about your regular business. Far from it. We are pretty much all agreed that if we relax our these general principles of social distancing and hand-washing and all those things -- if we relax that right now, this will go way up again. So it's good news. We're on the right track, but everybody needs to keep this up.

GAUDETTE: Well, and we should know that Governor Little came out yesterday saying that there may be an extension of that stay home where that's supposed to end on April 15th. So with that said, Dr. Pate, before we take a break, I do want to know what would be some of the signs or the trends that health officials will watch for when it comes to knowing that this pandemic is winding down? Because I do, I want people to understand, just as you you just said, this does not mean to run outside and violate the mandates. It is to continue to do what we are doing.

PATE: Right. Because it seems to be working. So what we will look for long term, we're far from that right now, but what we will look for is the first early sign will be are the number of new cases continuing to decline on on a prolonged basis. Every day they're getting less and less new cases. Then we will look to see, are we also seeing that in the hospitalizations? And so are we seeing that the number of people that are requiring admission to the hospital is leveling off and/or decreasing? And then finally, the last measure that we'll see, because it will lag behind is, are the number of deaths decreasing. And so when we see one of these decreasing, particularly the number of new cases, we start to get encouraged. But how we will know is when they're all coming down.

GAUDETTE: On the panel today: Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Dr. Megan McInerney, who is a pulmonologist with St. Alphonsus. And Dr. Jim Souza, St. Luke's Chief Medical Officer. I want to start this next segment or with a listener question. Let's take a listen to this. It is concerning the antibody test.

LISTENER QUETSION: This is Danny Biehl in Eagle. I want to know why we aren't using widespread testing for the antibodies of the virus to tell if people have had it and are better or have had it and have been not symptomatic. It seems we have local testing that can do this. They have no shortage of tests. They need a doctor to approve it. Why can't we just change the protocol and get as many people tested for the antibody of the virus as possible? Thank you.

GAUDETTE: So who would like to take that one on?

SOUZA: Well I can just take an initial crack at it. Thank you, Danny, for that question. At a high level, I mean, this question makes a lot of sense, if we're if we were to approach this in terms of population health screening and testing and wanting to know the disease burden on the population. But there's actually some more information we need, I think we've before we would take that to scale. So for the listeners, you know, the current test is a lateral flow assay. It's sort of the equivalent of maybe a home pregnancy test. And, you know, the first thing that the doctor orders when you bring in a home pregnancy test is a more accurate test. So we are looking for the more accurate ELISA test to come to scale. And we're also looking again, this is along the lines of what we know about this disease is rapidly expanding. We're looking to understand what does it mean if you have a positive IGG? Are you immune? Can you not acquire the infection again? The timing of that, that positivity is another part of that equation. So I think Danny's question is a great one and it's one that literally two to four weeks from now, I think we may have a different answer.

GAUDETTE: And that goes back to exactly what you were all saying about how quickly you are getting information as medical experts. I want to take another listener voice mail. This is a two parter. It's about autoimmune diseases and ACE inhibitors.

LISTENER QUETSION: My name is Felicity Kidry and my question is specifically regarding autoimmune disease and people who did not take immunosuppressants or chemotherapy. Does having an autoimmune disease in itself make you more susceptible? And also, is there any more information with regard to ACE inhibitors and high blood pressure? And those patients seem to be impacted more.

GAUDETTE: Dr. Pate, could you take a shot at that?

PATE: Well, Dr. McInerney might be actually more I certainly can, but I think she may be more expert at this.

GAUDETTE: Doctor, that'd be great.

MCINERNEY: I would say it's a really good question. And I don't know of any specific data addressing autoimmune diseases in those people who are not on immunosuppressant agents. However, as we had talked about before, any underlying medical conditions just increases somebody's risk for getting more severe illness from COVID-19. So, you know, their bodies just don't have the same kind of reserve to fight the viral infection. As far as the ACE inhibitors... Go ahead.

GAUDETTE: I'm going to say, Dr. McInerney, is that even if let's say you have high blood pressure or you have diabetes, but you are controlling it with medication. Are you still at the same type of risk then for someone who may have one of those underlying conditions that goes unchecked?

MCINERNEY: It's a really good question, Gemma and I would say maybe not. Again, we haven't teased out the real specifics of whether somebody has an underlying illness, and it was, you know, under decent control with various medications. But the fact that they still have that underlying illness poses a risk. And that kind of leads into the caller's next question about ACE inhibitors. So some people -- for those who don't know ACE inhibitors as a class of medications, that's used commonly to treat people's high blood pressure called hypertension. So a lot of people in the United States who have high blood pressure or even a certain heart disease will be on an ACE inhibitor or common ACE inhibitor or that a lot of people probably heard of is lisinopril. So one of the questions is, does being on an ACE inhibitor cause somebody to have more severe illness with coronavirus infection? And that comes from the fact that in the lungs there are ACE two receptors in the actual lung tissue. And we know that the coronavirus also works on these receptors. And so there's potentially increase amount of receptors when somebody is also on an ACE inhibitor and therefore increase receptors for the coronavirus to attach to the cells in the lungs. And that is a working hypothesis around some people on ACE inhibitors might have more severe pulmonary illness in the setting of coronavirus infection. I haven't seen and I don't know if any of the other doctors, Souza or Pate, have seen any actual numbers for increase. But again, we have somewhat of a paucity of data for actual numbers. But that is the working hypothesis that people on ACE inhibitors might be at higher risk for severe pulmonary disease.

GAUDETTE: We have another question from a listener named Mack. And here's his question. He says, Much of the state is rural with a sparse population. So how can the virus spread so widely among such a scattered population? Might there be some other as yet undiscovered method of transmission taking place? And maybe Dr. Pate, you could take that.

PATE: Yeah, I do think that having a lower population density like we do here in Idaho works to our benefit because the way this is spread is through contact with others. And so certainly we are not seeing the same kind of problems that you see in big metro areas like New York City and so forth. And hopefully we won't because of we're complying with these measures. Plus, we have this low density. However, we have to keep in mind that people in Idaho do move around the state and a lot of us like to go to some of the more remote areas and that particularly offer outdoor activities and all. And we can take the virus with us. And also, before things got much better under control, we had a lot of people coming into our state for from other areas. And I think that's why we saw such a big outbreak in Blaine County because of people traveling to that area during the ski season. Similarly, we've seen hot spots in most other ski centers across the country, particularly here in the Midwest. So being in a rural area certainly helps, but it doesn't provide assurance that we're still not going to be exposed.

GAUDETTE: Okay. So then this goes to a listener's question, Larry. He wants to know if going hunting away from anyone. And he says, quote, "out in the boondocks" and camping. Is that permissible?

SOUZA: I would... this is Dr. Souza. You know, other mammals can acquire this coronavirus. I don't think that what he'd be hunting for would would probably spread it to him. And I don't think that, you know... I'd agree with what Dr. Pate said. The risk is not adhering to social distancing and being around other people. I do believe, however, that our campgrounds are closed. So I want to make sure he checked on that before he went camping.

GAUDETTE: So this is a question from from a listener, Brandy. And I think a lot of parents are wondering about this because of certain new restrictions that have been put into place in the hospital. So Brandi's asking: She says, I have a 2 year old, a 15 year old and a 20 year old. The two youngest still live at home. If my child ends up in the hospital, will I be allowed to stay with him or her in the hospital room? She wants to know specifically if they were to have COVID-19, but I would ask if there are hospitalized for any other reason as well. So could Dr. Souza and Dr. McInerney, what are your policies at your hospitals for that right now?

SOUZA: Sure. Thank you, Gemma. Yes, we would allow one adult visitor for a minor. Of course we would screen her for him or her for symptoms to make sure that they were safe to come back. But yes, we would allow one adult. 

MCINERNEY: And that's the same at our hospital system. We recognize that that minors need to have advocate there with them, a parent. And I think it's really important to acknowledge to all of the listeners that it's hard for us as physicians and administrators in the health care field to say no to other family members for visitation. Again, this is one of those seemingly extreme measures that we've had to take in order to limit the spread of the virus. But we all have a lot of empathy for those family members who aren't able to visit their loved ones in the hospital. It would be hard for all of us to handle that. And it's hard for us as physicians at the bedside to see our patients alone. It's an unfortunate but necessary intervention that we've had to make.

GAUDETTE: I want to thank all of you for taking some time out of your day today to answer our questions, to answer our listener questions. I think hopefully we are getting information out there that is worthwhile, that makes a difference for folks. So thank you to all three of you for coming in today. We have we have been speaking with Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce. Dr. Megan McInerney, a pulmonologist at St. Alphonsus, and Dr. Jim Souza, St. Luke's Chief Medical Officer. We'll have more Idaho Matters right after this.

As COVID-19 cases spread through the U.S. and Idaho, we’re committed to keeping you updated and informed. You can get updated info on cases, closures and how to stay healthy at any time on our Coronavirus news blog.

 

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