"Things Are Going To Get Worse:" Idaho Doctors Brace For COVID-19 Surge

Oct 21, 2020

Idaho is experiencing the largest spike in new coronavirus cases since our first case was reported in mid-March. But this time, we're headed into colder months where safer outdoor interactions will be less possible, all while flu season is beginning. What could the next few weeks bring, and is the state ready for a surge in hospitals? 

Joining Idaho Matters today to answer listener questions about COVID-19 are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce and Dr. Meghan McInerney, ICU Medical Director at Saint Alphonsus Regional Medical Center. 

Read the full transcript here:

GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. With Tuesday's 821 newly reported cases of COVID-19, Idaho hit a new record for the number of confirmed coronavirus cases in just one day. Now add to that the Idaho Department of Health and Welfare reporting 119 new probable cases on the same day. If you're doing the math, that's 940 cases in just one day, the largest our state has reported in a day since the pandemic started. Joining us today to talk more about this and to answer your questions about the virus are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, and Dr. Meghan McInerney, ICU medical director at St. Alphonsus Regional Medical Center. Thanks for joining us.

 

ALL: Thanks, Gemma. Glad to be here.

 

GAUDETTE: So Dr. Pate, I just want to start with this: What is going on? Those numbers just continue to go up. I mean, we haven't seen a day in I believe the last week or two where the numbers have even leveled off.

 

PATE: Yeah, it Gemma it is very concerning to me, and if you told me what part of the year would you most want to have the spread of this under control, I would tell you, I wish we had it now because things are going to get worse. We're already having confirmed cases of various respiratory viruses. We've got confirmed cases of influenza A and influenza B. This is going to get worse. And we're not at a good place. So, you know what I think is particularly-- if you just look back, so we had our first spike, March and April. Governor put the stay at home order in place. We really brought this down and we got down to a pretty good level, didn't get down to zero, but we got down to a pretty good level. Then in July, August, we had our second spike. And the problem is, while we were coming down off our second spike, we never got to as low a point as the peak of the first spike when we started having our third spike and now we're taking off.

 

So what does that mean? That means that the hospitals still had lots of patients in the hospital from the second spike. And here we are doing a third spike, which will, over the next week or two, add many more patients to the hospital. Why is this happening? I don't totally understand. I do know that we're continuing to have some bad behaviors. We are continuing to have people who are not physically distancing. We're continuing to have people who are not wearing their masks. We are continuing to have people think that it's safe to have a large gathering outside like a wedding or other things when that is not the case, not by itself anyway. And we continue to see people infected in their families. We still are seeing people get infected by having extended family members over or neighborhood gatherings or friends over for barbecues, socials, parties. And then, you know, it's a real question about what is going on with schools. Clearly, colleges and universities are contributing to this. If you look at the age group that's most infected right now it is that college age group. And we're seeing lots of infections in the college group. 

 

Schools: It's been much less clear. What seems to be happening is schools are not as bad as we thought, anticipated would happen. And probably we're not seeing a whole lot in elementary, but we are seeing cases in middle and high school and that kind of fits with a lot of other data from studies we have.

 

GAUDETTE: I want to get back to the school conversation in a moment, Dr. Pate. But Dr. McInerney, I want to bring you into the conversation because the World Health Organization, a recent study that they released, showed that Remdesivir may actually not be as effective as we thought at treating COVID-19. And this is what President Trump was given and touted as being, you know, a cure, quote, for this.

 

MCINERNEY: So first of all, I think it's important that we not use the word cure, I know that that's what the president has used, but that is an inaccurate term for this viral infection. He has recovered from symptoms secondary to SARS-CoV-2 infection. And yes, he did get Remdesivir. And so just on some background on that Remdesivir is what's called an antiviral, which means a medication that acts against viruses; antibiotics, act against bacteria. So it's an antiviral that was initially developed for the use against Ebola. And then there was a study that was released in the New England Journal of Medicine. It was a it was an early release in May and then it was officially just published in early October. But that study showed that five days of Remdesivir treatment for severely ill patients secondary to COVID possibly reduced the length of illness for those patients.

 

And because of that, there had been emergency use authorization by the FDA for Remdesivir to be able to be given to all patients admitted to the hospital with COVID. So if they're sick enough to be admitted with COVID, then they were getting Remdesivir and we were doing that at St. Alphonsus and have been giving Remdesivir five days course for anybody who falls into a certain window of time from infection and then getting admitted for COVID. And so last week the WHO again, it was an early release, but they released a study that had multiple sites around the world and looked at Remdesivir compared to another anti viral named Lopinavir / Ritonavir, and then also compared to hydroxy chloroquine. And the results of that study suggests that there might not be as much of a benefit from Remdesivir as we previously thought.

 

The big caveat, though, is that the study has not yet been peer reviewed and they were using 10 days of Remdesivir instead of the five days. And the reason why that's really important is a lot of people don't realize that in order to get Remdesivir, you need to be in the hospital because it's an IV infusion and the emergency use authorization only allows it for patients in the hospital. The president is in a totally different category, and I feel like we can't consider him normal care because he was getting it at the White House. But in this WHO study, they gave it for 10 days. And so because they were keeping the patients in the hospital so that they can complete the full 10 days, by definition, those patients might have had longer hospital stays. So the initial Remdesivir studies showed that maybe it decreases hospital length of stay. But if you're keeping somebody in the hospital just so that they can get the full 10 days of treatment, then that kind of skews that data. So more to come on what it actually shows, but it just highlights the fact that we are learning so much from new information about this virus. We need to keep following the evidence based medicine. And those of us in the field of medicine are doing our best to follow the evidence based medicine and changing our practices as good evidence becomes available to us. And the other point that I want to make around the Remdesivir study is that what we know, the most important care that we can offer to patients with COVID, whether it's severe disease or not severe disease is really what's called supportive care, making sure that they get appropriate oxygen supplementation and support in the hospital when they need that.

 

GAUDETTE: Speaking of of care and the things that we're learning about this virus, just today, the U.S. surgeon general, Jerome Adams, said that the herd immunity approach to combating COVID could, and this is a quote, "lead to many complications and death." He posted this comment on his official Twitter account today, along with a link to an American Medical Association article entitled What is Herd Immunity? Now, these comments come after the White House really embraced a controversial declaration by a group of scientists calling for an approach that relies on herd immunity. Now, I want to make sure that people understand this. There is this so-called Great Barrington Declaration, OK? And this claims on its website to have been signed by more than 9000 medical and public health scientists around the globe that opposes lockdowns. It argues that authorities should allow the novel coronavirus to spread among young, healthy people while protecting the elderly and the vulnerable. Dr. Fauci has come out and called this concept ridiculous and total nonsense. I'm really curious about both of your takes on this. We've talked a little bit about herd immunity, but Dr. Pate when the surgeon general of the United States comes out and says that this will actually be more devastating. I mean, how do we have people understand that this is not the answer.

 

PATE: Yeah, Gemma, that's important. I totally agree with Dr. Fauci and the surgeon general. You know, the group that signed this declaration, I haven't delved into it a lot, but on researching who some of these so-called experts are. I think it's questionable. And I read their declaration and I stopped about halfway through when there was just so much nonsense in there that it was just paining made to devote any more time or effort to reading it. It is utter nonsense. And so just for your listeners, in case there are one or two people that haven't heard of herd immunity so far, let me just explain.

 

So herd immunity is the concept by which we get a sufficient percentage of the population protected from a infectious threat, either through natural infection, which frankly hasn't happened since going back into the 70s or earlier, or through vaccination and most commonly now through vaccination.

 

But you get a sufficient group immunized so that some high risk individuals-- so as an example, let's say when the COVID vaccine comes out, let's say it's the same as like for influenza where you can't get it if you're less than six months. So a newborn baby is going to be vulnerable. So what we do is we try to get enough people protected that that virus can't officially transmit and get to that baby even though that baby can't be protected himself or herself. So that's the concept. Now, what level of immunity it would require to have to herd immunity for this virus is debatable. I think the majority of consensus is, if it's even possible, is probably at least 60 percent of the population.

 

We are nowhere near that from natural infection. So we're not going to get to that level without a vaccine. But I question the whole premise, because to have herd immunity, you have to have immunity. And we haven't we don't have great evidence that people do have that all people do have immunity once they get infected and that if they do, for how long. So it's really not a viable concept. And as Dr. Fauci said, if we tried that, which would be hugely irresponsible, given that we believe we're going to have safe and effective vaccines next year, if we said let's just get to herd immunity, if it possible, we will kill hundreds of thousands of high risk people in the United States. But if this was something where there was no chance of a vaccine for a decade, yeah, we'd have to have a serious conversation of this. But it's a ridiculous thing to even think about with the prospect of a vaccine coming.

 

GAUDETTE: And to Dr. McInerney, your thoughts on that as well, because I'm curious, too, if people get a bit confused sometimes about the idea of herd immunity, because we do hear it, as Dr. Pate mentioned, when it comes to vaccinations. Right. Is that you look at a school and and kids needing to be vaccinated because maybe there's a kiddo who is immunocompromised and they can't get vaccines. So you need that, quote, herd immunity. That seems to be completely different to me, though, than willy nilly allowing people just to get a virus.

 

MCINERNEY: Yeah, I mean, I think that you just summed it up well, Gemma, and so did Dr. Pate. You know, vaccinating the larger population so that the few who aren't able to get vaccinated using that form of herd immunity is far different than allowing for many people to go out and get sick and basically take the chance that when they get sick, it won't be a severe illness. And I've said before on the show that I have seen multiple young people previously healthy in our ICU, very sick with COVID. So I don't believe that it is worth the risk to our society, to our individual community members to take that approach of just letting everyone go out and get infected because the chances are good that they will probably survive it.

 

GAUDETTE: Before we get to our listener questions and man, we have a lot this week, I want to go back to schools and Dr. Pate in the beginning of our conversation, in the last segment, talking about where we're seeing these cases and a rise in cases, as you mentioned, colleges maybe a little bit in high schools and middle schools. But but yesterday, the Caldwell School District announced that Caldwell high school students and staff are moving back to remote learning through at least November 2nd because a recent outbreak of COVID resulted in more than 14% of the staff at that high school needing to quarantine because there are other positive with COVID or they'd experience significant exposure. And then we've seen the chaos in the West Ada School District, Dr. Pate. Just last week with public testimony, we heard from parents very angry about teachers doing a sickout, which they did on Monday and Tuesday, but then teachers saying we can't even get high school students to wear masks. But yet you want to go back to in person learning. After all of this Dr. Pate you are now tasked with working with the West Ada School District. I'm happy to hear that. Maybe it should have happened sooner.

 

ALL: *laughter*

 

MCINERNEY: I'm sorry to have laughed, it just sounds like that is a big task, right?

 

PATE: It is, Dr. McInerney. And fortunately, I've got some colleagues from St. Luke's, St. Al's and Primary Health to help me, but they all have day jobs. So I will be doing the heavy lift part of this. And you're right. I'm sorry to see where things are. I wish we could have gotten involved early this summer. I think there was much we could do. You know, look, this is tough. Prior to the United States opening schools, there were no countries that had opened schools with as much disease transmission as we've had in our communities that I know of. And so this was an experiment. It's a novel virus. There's still a lot of things we don't understand about how coronavirus operates in children and what role children play in the transmission of COVID. They clearly do play a role. But there's not a lot of clarity. There's some, but not a lot of clarity about the extent of the role they play.

 

And so, look, you know, having professional educators who are experts in education try to manage a pandemic is really an extraordinary thing because most of them don't have expertise in public health, infectious disease, virology, these things. And so, you know, I don't doubt that everybody has tried to do the best they can. What I do wish and what happens when you have strong leadership is you realize where your weaknesses are and you ask for help. I want to commend the West Ada superintendent to bringing me in now. And that's not an easy thing to do because obviously that makes her have a certain amount of vulnerability. And to ask somebody who is as outspoken and as opinionated as I am to review, I mean, that's a pretty positive sign on her part, that she's willing to do it. But, hey, you know, the way that I look at this is there are not a whole lot of right or wrong answers, but there are some that probably are better than others.

 

And I think what we've got to do is we have to figure out what are our objectives, because you've got one group of people saying our objective is we just want kids and schools and we don't care about anything else. Well, then obviously that is going to shape how you approach this. If, on the other hand, you you take it from a physician standpoint, like mine or Dr. McInerney's, we don't want any child to get sick. Well, that's probably not a good approach for schools either. So we have to figure out what are we going to try to achieve? What are the risks and benefits? What risks are we willing to take that we can try to mitigate? And then we have to have conversations. We have to engage people in this process. We have to not attack people because they have positions where a parent, if their kids are in school, they can't work and they might lose their job. Or a teacher who didn't sign up for being exposed to a deadly virus and perhaps taking it home. So we really need to take everybody's positions into consideration and figure out how can we get to the best place. It won't be ideal, but how can we get to the best place and what risks should we take and which risks should we not take? And then for those that are willing to take more risk, what's their option? For people that want to take less risk, what's their option? And I do think we can work through it, but we're in a bad spot. And as you mentioned, Caldwell High School closing down. It's all about what's the disease activity in the communities. And we've got a lot of it. And it's all about how are you managing this in the schools? Dr. McInerney's Hospital, the other hospitals, they've been able to contain this, even though they have a lot of sick people in their hospitals because they have really good procedures. They have really good protections. So we've got to look at schools in much the same way if we're going to have a chance of keeping them pen, we have to put in protections, we have to make sure that those are followed and complied with, and then I think we can get through this.

 

GAUDETTE: I want to get to some listener questions now. Dr. McInerney, Shirley wants to know this. She says: 

 

LISTENER QUESTION: I was advised that the coronavirus is becoming less deadly, as a virus does not want to kill its host, and therefore will mutate to be able to keep its host alive. Hence, our COVID numbers go up, but our deaths do not. Is there any truth to this?

 

MCINERNEY: Yeah, so I think that the question is getting to-- there are a couple of parts to that question. First of all, we do know that most infectious diseases will mutate in order to improve their ability to infect other hosts. And an example of somewhat unsuccessful virus as far as its spread was Ebola. Right. We know that Ebola killed people so quickly, but it wasn't able to spread as well because it killed people so, so rapidly. 

 

So it's just an interesting kind of commentary on this virus from an evolutionary perspective as to how it can cause very mild infections and spread from asymptomatic person to asymptomatic person. So with that said, I don't know that there is good data that supports that this virus is becoming less lethal. I think that the numbers are just different now as far as we have been testing more people, so we have a larger denominator over which we divide the number of people who have died over the number of people who have been tested positive.

 

So, for example, in New York City, at one point early on in a pandemic in the United States, there were mortality rates as high as something like 10 percent. Now, across the board in the United States, we see mortality rates more about 2.7 Percent. But I think that's more reflective of the fact that we're just testing more people. And so we have a larger population data to look at. And but I also think that the listener makes a good point about a virus is very fascinating from an evolutionary perspective. And, you know, all organisms strive to survive. And so this virus is very good at doing that.

 

GAUDETTE: Mm hmm. Dr. McInerney, how much does it play into as well, though, that as doctors and physicians, when this first hit, I mean, there wasn't any real therapeutics. It was kind of just going blind to see how you could potentially help people. And now, you know, almost nine months into this. I mean, there are certain therapeutics, there are certain things that, you know, as health professionals that can make a difference. Does that also play into the fatality rates going down?

 

MCINERNEY: Somewhat, absolutely. The hospitals on the east and west coast, I think part of the reason why their mortality rates were so high is because many health care workers and other people were getting infected because we didn't know how to protect ourselves yet. And so some of it is just, you know, being able to protect ourselves from people who are actively symptomatic and infectious and potentially delivering kind of what is called a larger viral load to those people interacting with them. But you are right, we know more about what kind of supportive measures to do to try to help people survive this disease. But just as we talked about earlier with Remdesivir, I wouldn't say that at this point we have great therapeutics that we know decrease mortality. Steroids might help decrease mortality rate, steroids like dexamethasone. But other than that, most of our care is what's called supportive care.

 

GAUDETTE: Dr. Pate, Buckie sent us this email, says:. 

 

LISTENER QUESTION: I'm diabetic and when I get a cold or a flu, it's very difficult to get my blood sugar level down into the desired range, even with increased insulin dosing and eating very little. Do you have any information about that related to COVID?

 

PATE: Yeah, a little bit. So first of all, this is not an uncommon situation with almost any kind of infection, because what happens is when you have a serious infection, your body produces certain hormones in excess to try to, you know, make the body more stable for this infection. And many of those hormones are antagonistic to insulin. So it's not an uncommon situation when people are sick enough to be in the hospital that are diabetic, that their blood sugars go out of control because of that. With COVID, there's another interesting aspect, because the insulin in your body is produced in an organ called the pancreas, and the pancreas is in your abdomen, your belly, and towards the back, and in the pancreas, the cells that make insulin are called beta cells. And what's very interesting is when you take pancreas tissue and you stain it for the ace 2 receptor, which you'll remember is the site where the SARS-CoV-2 virus binds to get into cells. And so you look at where those ace 2 receptors are, they're in the exact same pattern as the beta cells. And so we think that this virus can attack those cells, which can obviously aggravate diabetes. In fact, there was a report out of England where they saw twice as many children presenting with insulin dependent diabetes, where their pancreas wasn't making insulin at all, and they correlated it to COVID infections. So, yes, it's a problem in all infections and it may be a bigger problem in COVID.

 

MCINERNEY: I love what Dr. Pate said about the pancreatic beta cells. And I also just want to add two points: we've had multiple patients admitted to our intensive care unit and they come in because of what's called diabetic ketoacidosis, which is an acidosis, an increased level of acid production because the cells aren't able to use glucose adequately. And so basically, it's just a really out of control state for diabetics. And so we've had multiple patients present in that state because they're diabetic and we test them for COVID. And that's how we find out they have COVID so that the underlying COVID infection that they didn't realize they had sent their diabetes out of control.

 

And then the other thing I'm going to say is for diabetics, we're also having a hard time with controlling their blood sugars, because as I had just mentioned, part of the treatment for SARS-CoV-2 infection or COVID illness are steroids and steroids also increase the blood sugar. So definitely something that we're watching closely for diabetics and COVID.

 

GAUDETTE: Yeah, absolutely. Thanks for those add ons, Dr. McInerney.

 

So two weeks ago, we had a series of questions about face masks. Well, this week it seems like everybody wants to know about handwashing. So we got several questions from listeners, one from from Laurie. Dr. Pate, she says:

 

LISTENER QUESTION: Dr. Fauci said that it's friction of hand rubbing that kills the germs, not so much the hot water or soap. So she wants to know if that's true.

 

PATE: So I didn't hear Dr. Fauci statement on this, and I wonder if he really said that the friction is what will kill the virus. I doubt that's the case. But friction is important. And the reason is, is because we want to, when we're rubbing our hands together, we want to free up the virus and other debris from our hands. And so friction is the best way to do that. We don't just hold our hands under the faucet and let water run over them or just put a squirt of sanitizer on it and then the air dry. The key is you want to rub your hands together, you want to get in between your fingers, you want to get all over your hands. And so, yes, I do agree about Dr. Fauci's emphasis on friction. That is very important. I don't know that friction is going to kill the virus, though. I think that the killing the virus is the soap or sanitizer, whatever we're using. But the friction is important to loosen it up and get it off of our hands.

 

GAUDETTE: And then Dr. McInerney, another group of folks wrote in and they're asking you to rate what works best for COVID when when it comes to hand washing:

 

LISTENER QUESTION: Is it rubbing your hands quickly is in hot water with with soap or is it hand sanitizer. So which one works best to least out of those three.

 

MCINERNEY: So soap and water, when, like Dr. Pate described rubbing your hands together for 20 seconds, that is going to work the best. When soap and water are not available, hand sanitizer is a great alternative. And again, you need to make sure to cover all surfaces of your hands, right? A lot of times we know in medical school when you're learning how to, quote, scrub in for a surgery, you always learn how to also kind of take your thumb into the opposite hand and swing it around inside the palm of your hand to make sure that you also get the outside of your thumb. So that's an area that a lot of people will miss. But just soap and water is ideal if you've got access to it, if you can do it properly. But I don't want people to not use hand sanitizer because they think it won't work. It does work. And I use hand sanitizer hundreds of times a day when I'm seeing patients, and then I'll make sure to wash my hands with soap intermittently as well, soap and water, particularly before I'm eating, or if there's any evidence of dirt or soil that you can see. Soap and hand sanitizer usually doesn't work for kind of larger particles to get off. But for coronavirus, it works great. Soap and water, if you've got it. But hand sanitizer is amazing as well.

 

GAUDETTE: And my kids complain every single day about how much hand sanitizer they have to use because they have to use it from the moment they enter the classroom, if they leave the classroom and they're like, all we do is use hand sanitizer, I'm like, well, good, that's that's what you're going to do. That's what that's what you got to do.

 

MCINERNEY: Yes, I totally agree.

 

And I like to wash my hands at the end of the day when I come home after using hand sanitizer just to get the film of the hand sanitizer off. But I think that's where we're at. We got to sanitize all the time.

 

GAUDETTE: So then Dr. McInerney, another person wrote in and they said:. 

 

LISTENER QUESTION: Most public places do not have hot or even lukewarm water available no matter how long you run the water for. So how big a part of the equation is the temperature of the water?

 

MCINERNEY: I don't think it's a big deal. I really don't. If you are using soap and water and getting that friction going and, you know, using soap and water for 20 seconds, I think it's fine. Again, I don't want people to worry about these little pieces and allow that to give them like a -- even if it's on a subconscious level -- an excuse to not wash their hands. So if all you've got is cold water, go for it. If you've got access to warm water, then that might work a little bit better. But I don't know if Dr. Pate has seen any head to head studies with warm versus cold water for hand washing, but I haven't actually seen the head to head studies.

 

PATE: No, and Dr. McInerney, I totally agree with you. You know, this virus doesn't like heat more than it doesn't like cold. It'll tolerate cold a lot better. But the temperatures you'd have to get to would make it uncomfortable for you to wash your hands. So I think what Dr. McInerney and I both want you to do is pick a temperature that's comfortable to make sure that you will wash your hands for the 20 seconds, because the temperature is the very least important thing of all the considerations. So I totally agree with her.

 

GAUDETTE: That's really good information to know because I think everyone thinks, well, if there's not hot water, I should just I should just skip washing my hands and his hand sanitizer. But washing your hands, even if it's that lukewarm water, sounds what the two of you are saying is that that's your best bet.

 

MCINERNEY: Yes. 

 

PATE: Absolutely. 

 

GAUDETTE: Ok, so we've got some other questions and one, Dr. McInerney, this one comes from someone who wants to remain anonymous and they say:

 

LISTENER QUESTION: I am scheduled for an outpatient elective surgery for relatively minor reconstructive surgery in a few weeks. And I'm wondering what the post surgery protocol should be. I'm wondering if I will be more vulnerable to the virus and should I basically quarantine until the wound has healed sufficiently?

 

MCINERNEY: So anybody who has had surgery is at risk of, you know, processes like blood clots, other inflammatory processes, wound infections, if there's a surgical wound there and potentially some suppression in your immune system overall. Can I say for sure that there's a study that shows in the post-operative period, patients are more vulnerable to infection with SARS-CoV-2 or coronavirus? No. But I think that given the fact that there's an inflammatory process that has just happened and that we know that getting infected with SARS-CoV-2 or coronavirus causes increased inflammatory markers and what's called a hypercoagulable state, which is increased likelihood of forming clots, I think that the more likely process that could happen after a surgery is that if somebody did get COVID, they might have a more severe disease process from it. So I probably would quarantine. I would be very cautious from getting any sort of exposure in the post-operative period.

 

GAUDETTE: Dr. Pate Mike sent us this question:

 

LISTENER QUESTION: Is it true that Johnson and Johnson is the only vaccine that required that would require one shot while all the others would require two?

 

PATE: Well, so far, based on what we know, a couple of things, first of all, there's 192 vaccines that are under development or in studies. So we simply don't know yet. It is believed that most, if not all, are going to require two shots, but we don't know that for sure. We'll know soon, even in the Johnson and Johnson vaccine, it does look encouraging that perhaps it can only be one shot, but that is even a question that's being tested right now in some subjects that are getting one shot and others that are getting two to see if there's a difference. So I'm not sure we even know what that vaccine yet, but we'll know soon.

 

GAUDETTE: And then Dr. McInerney, Carol sent us this. She wants to know:

 

LISTENER QUESTION: How reliable are the tests that are currently being used?

 

MCINERNEY: So there are multiple different types of tests that can be done and the reliability depends on the type of test being done, and it also depends on what we call pre test probability. So let me start with the type of tests that are being done: so the type of tests that look for active infection, there's what's called polymerase chain reaction, the PCR testing, where they swab your nose and then they look for RNA strains of the virus. All of the PCR tests have a very high sensitivity and specificity up until like the 90th percentile.

 

There's another type of test that does and this is what's truly called the rapid test that looks for an antigen, which is a different kind of protein, not the actual RNA from the virus. That turnaround time is about 15 minutes. And that test result, the sensitivity and specificity for that is a little bit lower, but it's still in the 80s to 90s percentile.

 

The really important factor, though, in all of testing and not just for COVID, but it's something that anybody who's going through medical training learns about, and it's called pretest probability. So the likelihood of a test result being accurate, meaning finding a positive test in somebody also depends on the likelihood that they actually have the disease.

 

So, for example, if I get tested and I've never had any sort of exposure to COVID, I've never had any concern for exposure, I've just been isolating myself in my house and I don't have any symptoms. The likelihood that that test would pick up the virus is going to be a little bit lower. So but if somebody comes in and they've got fever, cough and their spouse had COVID and they've been living with their spouse, then the likelihood that we're going to find COVID on that person, on their test result is going to be much higher. So it's kind of a long winded answer to say that the sensitivity of the testing depends on multiple factors. But I will say that it's pretty good. And I'll say that if somebody is really concerned that they've got the disease, that they've got COVID, if they've got a history of being exposed and they've got a lot of reasons to believe that they have it and they have a negative test, my recommendation is to continue to quarantine and then go back and get retested two or three days later, because another piece of the puzzle is that sometimes we just don't test late enough in the disease. Right. So sometimes people want to go get tested like the day after they were exposed. Well, there isn't going to be enough virus if they are infected in the person's body to be able to detect it. So I think the most important message to send to listeners is that the test is good if done at the right time in the disease process. But if somebody is really worried and they've got symptoms and they've got a history of significant exposure and their test was negative, I recommend that they go back and get tested again in a couple of days.

 

GAUDETTE: And then as we're wrapping up, we've gotten a lot of listeners asking about the holidays and Dr. Pate, I mean, best advice for people who, you know, want to gather with people over Thanksgiving, which is in -- we're looking at a little bit more than a month away.

 

PATE: Yeah, you know, this is a painful question to try to answer because of the emotion around it. We all miss our families and want to get together. It's not going to be a straightforward answer. But let me tell you a few things. Number one, as I mentioned earlier, I'm concerned we haven't seen the worst of this yet. I think that by Thanksgiving we will be in full blown cold and flu season. I think at this rate, with our increasing cases and across the United States, we may have continued very high levels of transmission. So that's going to make it more dangerous.

 

I do think you need to consider the following things. How much risk would this pose to people that are getting together? Obviously, if you're going to get together and it's going to include older people, people with medical conditions and all, you really ought to rethink this. The second thing is you ought to consider what kinds of risks to those people put themselves in. So if the get together includes some college age students, I'd think twice about that.

 

The other thing to consider is how are you going to get there? If you can drive there, that's going to be safer than if you tell me you've got to get on a plane. So there's just a lot of considerations to if you put this in a nutshell, if you can do your holiday virtually, that's going to be the safest. If you are just determined to get together, then let's look at the specifics of your situation that the people that would be involved, make it the fewest possible, avoid settings that would put people at risk for having the virus when they get together. And let's just take precautions.

 

GAUDETTE: I want to thank both of you for your time, for your expertise. I never thought that we would be doing this every Wednesday for as long as we have done this. So I so appreciate what you both are doing professionally, but also coming on this show and really helping us understand this more.

 

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