Idaho Matters is back again this week with our panel of Idaho doctors to answer more of your COVID-19 questions. This week, you asked them about the new Ada County spike and the Central District Health Department's decision to close barsand what this means for hospitals dealing with the increase in cases.
Joining Idaho Matters this week are:
- Dr. David Pate, a member of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s.
- Dr. Steven Nemerson, Chief Clinical Officer for Saint Alphonsus Health System.
- Dr. Bart Hill, St. Luke’s Vice President and Chief Quality Officer.
Have a question for the panel? Leave us a voicemail with your question and we may use it on next Wednesday’s show. Here’s the number to call: 208-426-3625. Or email us at idahomatters@boisestate.edu.
Read the full transcript here:
GEORGE PRENTICE: You're listening to Idaho Matters. I'm George Prentice, in for Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know that many of you have questions and concerns. And today, we want to answer those questions with facts. And the best way to do that is to bring in Idaho medical experts. Every Wednesday, we bring in a panel of doctors and health care professionals to get us updated. If you have a question for our doctors, send us an email at idahomatters@boisestate.edu Joining us today are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Corona Virus Task Force, Dr. Steven Nemersen is chief clinical officer for St. Alphonsus Health System. Dr. Bart Hill, St. Luke's vice president and chief quality officer. Gentlemen, welcome to you all.
ALL: Thank you. Thank you. Thank you. Glad to be here.
PRENTICE: Dr. Pate, we'll start with you. The Central District Health Department has moved Ada County back into Stage 3. What happened? How bad are things?
DR. DAVID PATE: Well, certainly concerning. We're not having the same problems that quite a few states are, where not only are they having increased cases, but they're filling up their hospitals. So fortunately, we're not at that point. But what happened is we have seen a steady increase in cases, not very many, but a few during the stages of reopening of the governor's plan. And that's to be anticipated. But what happened most recently was there was a huge uptick, particularly in first in Boise, and then Ada County, with cases, particularly among young people, that in many instances were connected to bars and exposures at bars, as well as a super spreader event that occurred on a party bus. And so with significantly rising cases, I applaud Central District health that they took the initiative to respond, because you have to realize you're always behind with this virus. When we're seeing this activity, it means is already out there in the community. And you have to also remember that even though this is mostly impacting young people, we are seeing cases in all ages and those young people will go back to work, will visit a parent or grandparent and will expose other people. In fact, the very concerning thing is that probably for every case that we've detected, there may be something on the order of three others out there who are asymptomatic, infected and not having symptoms, but able to transmit this to others. So that was the problem. That was the reason for this response to try to contain that.
PRENTICE: Dr. Nemerson, Dr. Hill I'll ask you the same question. If you could both weigh in on this. Dr. Nemerson, maybe you first. Do you think CDHD [Central District Health Department] made the right decision?
DR. STEVEN NEMERSON: They absolutely did. Dr. Pate's figures are entirely accurate and our experience here at St. Alphonsus throughout all our facilities, we're seeing an uptick in patients coming in with symptoms who are testing positive. We've seen an increase in our admissions and I can talk about that later, like. And our biggest concern is the horse is out of the barn, as Dr. Pate referenced, symptoms don't appear for up to two weeks from the time of exposure. So really what we're experiencing today at this very moment is a reflection of circumstance two weeks ago. And we at St. Alphonsus across all our facilities have seen a trend with each of the phase transitions and increased number of patients coming to attention acquiring care.
PRENTICE: Dr. Hill?
DR. BART HILL: George, I would concur that from a health perspective, this was absolutely the right decision to be made. I think history is going to judge it with other criteria, economics or political. But from a health perspective, this needed to be done and it's not clear if more will need to be done, because as noted by Dr. Nemerson And Dr. Pate, what we're experiencing now really occurred two weeks ago. And what's going to happen to know is occurring as we speak. And what will that look like?
PRENTICE: Dr. Nemerson, what are you saying at St. Al's? Can you put a face to this? What kind of demographics are you experiencing?
NEMERSON: I can. Let me give you some perspective. Two weeks ago, we didn't have a single inpatient in any of our hospitals diagnosed with coronavirus. And now we're in the single-, moving into the double-digits. The patients that are coming to our attention with symptoms and God bless most of them do not require hospitalization. They just require some medical care and ongoing monitoring at home. We're seeing all ages and predominantly as Dr. Pate reference while ago in those 18 to 29 year olds who were frequenting the bars downtown. So that's exactly what we're seeing.
PRENTICE: Dr. Hill, what about St. Lukes?
HILL: Very similar. Prior to June 15th, the number of positives we were seeing each day were single digits. Since that time, we are now more like 25 to 35 positives in the last two days, as high as 60 positive cases. And speaking with some of my colleagues on the front lines, they have said that most of what they're seeing are young people not yet sick enough to need to be hospitalized, but our hospitalizations have gone from single digits to now in the 12-16 range today. And what we're seeing of those being admitted is people -- Yes, there are the older population that are being admitted, but there are almost an equal number of younger people. Several in the 30s, several in their 40s and 50s. And so it's not something that just because you're young, you are completely immune to.
PRENTICE: Dr. Pate, let's talk best case. Worst case when it comes to Ada County. What might it take for Ada County to move back to Stage 4 or to retreat to Stage 2?
PATE: Yeah, so I don't speak on behalf of Central Distric Health, but I am fairly confident I know how they're looking at this and they're going to monitor what is the consequence of this action. And as Dr Nemerson said, you know, whenever you're looking at on current day, it's really reflecting what was happening two weeks ago. So I don't expect them to make a decision for two weeks, but they'll gather data and they will look at it week by week and look at what are the trends. So with this action of going back to Stage 3, do we see a decline in number of cases? I think what is going to be confusing is that I certainly expect, and it sounds like from Dr. Nemerson And Dr. Hill we're already starting to see that, is that we will have an increase in hospitalizations and probably much more than what we're seeing today. That does not mean that the reversal to Stage 3 is not working. It means that this was already taking place. And so we would expect the hospitalizations are probably going to increase with that, we typically see an uptick in emergency room visits. So they'll watch that. They'll be looking at the E.R. visits, hospitalizations and then looking for that, and fully expecting it's probably going to increase. But looking for it to start on the decline. Unfortunately, what follows hospitalizations by a week or two are then deaths. And I pray to God we're not going to have too many deaths. But I would expect to see an uptick in that. So Central District Health will measure all of these parameters. They'll watch it, see how is it trending, and then they'll make decisions whether to loosen the restrictions, continue with the restrictions or restrict more based on what those trends are showing them.
PRENTICE: And Dr. Pate, since that announcement, the statewide numbers, well, we've been adding 100+ new cases each day for a few days now. These are troubling.
PATE: Very troubling. In fact, if you look at the cases that are being reported now, if the confirmed plus the probable turn out to all be confirmed, it looks like we may exceed the spike at the greatest point that we had looking at by date of onset, which is probably the most important. It looks like we may exceed what we experienced back in March. That's very worrisome. Now, I do think it's a bit of a different story in that this is not uniform across the state. In fact, there are some areas of our state that are on the decline. So that's very good. And I think this is why it supports the governor's decision to instead of taking a statewide action based on this, let's target it to the region where this is occurring. But it is certainly very concerning for Ada County particularly. We'll certainly see some spillover to other counties like Canyon County. And I think what the message to your listeners is, for every one of those people that's been identified, there are probably several more out there that are infected and don't know it. So if you want to protect yourself, if you want to help our economy: wear a mask. First of all, stay home when you can. If you're going to be out physically distance and if you can't physically distance wear a mask or a face covering, those are the big things you can do to help.
PRENTICE: Gentlemen, we have plenty of questions, but I need to start with one that I'm certain you're asked often. So let's just have it. Do you support a public health order that would mandate face coverings? Dr. Pate.
PATE: Yes, I very much support it. I understand why we haven't done that yet. But I would very much support it.
PRENTICE: Ok. Gentlemen. Dr. Hill?
HILL: Yeah. This is Dr. Hill. I, too, would support it. I do it personally. I believe in it. And, it's truly effective when everybody does it. And we're not seeing that. I think that's the next step that we have to seriously consider.
PRENTICE: Dr. Nemerson.
NEMERSON: Absolutely. And George, the thing is that the greatest protection that the mass provides is if you're harboring the virus, it prevents you from spreading the virus to someone else. So one of the things we need is community expectation in a compassionate way to encourage those who are around us to wear those masks so we can be fully compliant. But it's critically important as a community, we come together to expect that of one another.
PRENTICE: Dr. Pate, do you think it would be appropriate for such an order to come from a public health entity?
PATE: Oh, I do. I think this is a public health issue. And, you know, the point that Dr. Nemerson made cannot be overemphasized. The reason for wearing masks or face coverings is that because a substantial percentage of people who are infected with this virus are not aware of it. They are engaging in public activities and they are inadvertently exposing other people. We know, as Dr. Hill just said from the research, there are two things that we know that work to slow down and impair the transmission of this virus. Keep your distance. And if you can't keep your distance, wear a mask or face mask. But in order for face masks or face coverings to be effective, we probably need something on the order of 80% of people doing that. We're nowhere close to that. So that would be why this would be an appropriate public health measure to help decrease the transmission of this virus. And to understand the reason that we're trying to decrease the transmission of this virus is that we don't have a cure, a treatment or a vaccine for it. We need to buy time and that helps us buy time. And by buying time, it also helps make sure that until we have those things, we don't overload our hospitals, which is a very real thing happening in some southern states where people may not be able to get the health care they need because the beds are completely getting full.
PRENTICE: And Karen has just sent us a question, Dr. Pate, specifically to what you were just talking about in regards to the importance of wearing a mask or covering. She asks, "what are the lasting effects of people not taking resurgence seriously?"
PATE: Well, lots of potential things. So first of all, even if you're a young person listening to this, I want to to make sure that we're clear about something. When we talk about high risk and the fact that you're not in the high risk, when we're talking about high risk, we mean high risk for death. We do not mean that you are not at risk for some really bad things. And as you heard Dr. Hill say, it's not just old people that are in the hospital and it's not just old people that are on ventilators. And in fact, we've seen 30 and 40 year olds having major strokes, having blood clots, having amputations, all kinds of serious complications, not to mention the costs and loss of work associated with this illness. As far as lasting effects, we don't even know yet. We are starting to see some things because this virus hasn't been around that long. But first of all, the people that have been on ventilators and understand that for this virus, people are on ventilators, if they need a ventilator, typically much longer times than is typical with other conditions that we have to support their ventilation. And with that, they're they're getting drugs for a long period of time, they're on the ventilator for a long time. And we're seeing situations of people developing PTSD, developing false memories that are very disturbing to them. And we're seeing, in some cases, people having a prolonged recovery just in terms of regaining their strength. Some people are remaining short of breath. And we've even seen a few cases of where people have had blood clots even after they got discharged from the hospital. And we still don't know the full ramifications. So we really need to have a healthy respect for this virus, even though the vast majority of people who get infected are going to do fine and not have any serious consequences. We don't know who's going to and who's not. And we need to all be careful.
PRENTICE: Dr. Nemerson. And we have a question from Steve. He says he's been told that a person who might have been exposed on Sunday would not be communicable for three days. Is that true or false?
NEMERSON: Not entirely. And we can't play guessing games around who's going to be infectious and when they're going to be contagious. Generally speaking, there is a window of time that you've acquired the virus, you're harboring it, it's growing inside your body. And the load with which you're going to contaminate other people is going to grow. So at the beginning, when you're first exposed, it's pretty low. And a few days later, it's getting pretty high. But I would not take that chance.
PRENTICE: Ok. Dr. Hill, we have a question in regards to reliability of antibody tests. Can you speak to that?
HILL: Sure. The antibody tests vary in their what's called their sensitivity and specificity. And that's the critical question. When people are getting a test, if the test is not truly, almost 100 percent -- 99.7% sensitive and specific -- we run the risks of having false positives, false negative tests. And that will have ramifications. Potentially employers deciding whether or not someone can come back to work. People believing that they've had the disease. We don't know yet if it imparts immunity and if it does for how long. But they may feel 'I don't have to be concerned because my antibody tests said I had already had the disease.' So they have a use, but they certainly can't tell you if you're acutely infected or whether you're still contagious. That's an inappropriate use of that test. And they're very highly dependent on how accurate they are. So they're not all antibody tests [inaudible] people.
PRENTICE: Dr. Hill: Barbara sent in this very interesting question, talking a bit about playing cards at a senior center. She asks, 'Is it safe to use plastic coated cards and chips to play for several hours with these same items which are cleaned and disinfected? Then after the game is complete, they're clean and disinfected again for next week's play.' But she's basically asking about protection from plastic coated cards and chips.
HILL: It's an interesting answer. You can spread the virus onto surfaces, especially ones that you're touching, because this virus can be active on surfaces such as playing cards for up to several days. And by touching it with your hand, if at some point during the card game, you wet your finger, you rub your eye, you are no transmitting the virus from the inanimate playing card to a surface that it can begin to grow. So it really depends on how comfortable are you with the people that you're playing cards with in terms of their ability to self isolate, to practice good hand hygiene, to not have any active symptoms, to not be exposing themselves to others that may have the disease before they know it. I see it as a fairly high risk, unless you are very comfortable. So a family setting where you've been together isolating and practicing these measures routinely and religiously, that you may be comfortable playing cards with, in a different setting with people who are coming and going and you don't know who or where they who they've been with or where they've been, I would be uncomfortable in that setting.
PRENTICE: Dr. Hill, we have a crash question here from Rory who writes, 'Now that the bars understand the ramifications of not enforcing social distancing. Shouldn't they be allowed to reopen in a few days?
HILL: I don't know that we will understand how serious the situation is in a couple of days. I fully support that it needs to be looked at over a longer period of time, a week at a time, and into a two week period. I believe that the restrictions really need to be in place for several weeks. I think our community saw the opening of restaurants and bars as the problem is resolved. It's no longer a big deal. And personal responsibility really didn't apply when people were not social distancing, not wearing masks and interacting with multiple people. So I'm not comfortable that in a couple of days it should be relaxed. I think we need to see what will happen over the next one to two weeks.
PRENTICE: I want to make sure I heard you right. So you're saying weeks? Several weeks?
HILL: Several weeks. Yes.
PRENTICE: Before we make another decision?
HILL: Yes.
PRENTICE: Dr. Pate, we have a question from Sharon, she writes, 'Since the beginning of COVID, I've looked up for more specific information about where people got the virus, zip codes, grocery and home product stores, fitness clubs without revealing people's identity. Now we know about the bars and Boise State sports, etc.. Are we finally going to get more advice on where to avoid, what places to avoid to protect ourselves?'
PATE: Yeah, I think we know the kinds of situations that are going to create risk, and as we talked about, the only way that this virus can survive and propagate is for people to come into contact. And so the answer here is if it's anything that's going to put you within six feet of other people -- that are not in your immediate family, that live with you and so forth -- if it's going to put you within six feet and all of those people are not going to be wearing masks or face masks, then, you know, whatever that activity is, that's dangerous. With respect to any more specific information about where cases are occurring, there's no reporting obligations for most of these businesses or sites. So I don't think you're going to find it on the Internet. And probably the only way you're going to learn about it is if it does become a problem and the public health departments talk about it like the bars or if they're instances reported in the press. But for right now, as you look at activities, just judge as is just going to put me within six feet of other people who are not going to be protected by face masks.
PRENTICE: Dr Pate, I've got another question for you from Sue, who tells us she's going back to work next week. She says her employer has set up a place for us to get a coronavirus test from a testing company that had the lowest bid. She asks if I test positive, I can't come back to work yet. What if I don't trust that test? If I get a negative test from someone else that I trust, which is the right one?' But I guess the overall question about viability of testing sites.
PATE: Well, yeah. So first of all, I think, and as Dr. Hill already mentioned when he was talking about antibody tests, no matter what test we're talking about, there's no perfect test. And we have to understand the limitations of every test. The major concern with the PCR tests, which is what I think she's talking about, which is a test to see: do you have the virus right now? -- the major problem is not a false positive. The major problem is a false negative, meaning that you really do have the virus, but the test is showing up negative.
So if you test positive, even though it still could be wrong, there's not a great likelihood it's wrong, you should presume that you are infected, stay home, self isolate and make sure that you don't become sick. The other problem that is not directly mentioned by this question, but the question also is what is the company's testing strategy? So in other words, if I test Dr. Nemerson and Dr. Hill today and they're negative. Well, that's wonderful. But all it takes is for Dr. Nmerson or Dr. Hill to go do something tonight and get themselves exposed. And that negative test today does not tell me that they're not going to be infected in a few days. So we just have to be careful and understand what tests mean and what they don't mean. But if you get a positive PCR, assume you are infected.
PRENTICE: Gentlemen, I've just got a couple of minutes left. I'd like each of you to weigh in on this Dr. Nemerson, I'll ask you first, and that is what is your concern as we approach the Fourth of July holiday?
NEMERSON: Well, it's the obvious concern that families will gather with each other, multiple families together to share food and the joy of the holiday. And we absolutely need to not do that this coming Fourth of July, even with social distancing. The fact is that it's a matter of relative risk in keeping together within your in your family and celebrating and not bringing others in is critically important.
And one of the analogies I want to use that I think is a powerful one is if, when we breathe out, we could actually see a cloud of red dust coming out of our lungs with every breath. Then we get an appreciation for the risk. It's not just the keeping six feet away and wearing the mask. It's also that cloud of coronavirus that one could be walking through, particularly in close situations that we need to avoid.
PRENTICE: Dr. Hill?
HILL: I would say my concern would be the tendency to repeat historically we've done, whether it parades, the gatherings for fireworks. And I think we need to be creative and innovative to think of ways to celebrate our independence, but in a unique way that is safe and different than what we've historically done. And that's my concern.
PRENTICE: Dr. Pate, there is the threat of a holiday bump, yes?
PATE: Definitely. And I fully expect that we're going to see it. I agree totally with Dr. Nemerson And Dr. Hill. The additional concern I'll raise is that we know that people across the country are looking for vacation destinations. They know they don't want to travel out of the country because of those risks. So they're looking within the United States for where are the states that are faring the best? Idaho is going to be one of those. And of course, we know it's a beautiful place to visit. So one of the additional concerns, are people going to be coming from very high activity states here to our wonderful resort towns and bring the virus with them?
PRENTICE: He is Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. Also joining us today, Dr. Steven Nemerson, chief clinical officer for St. L's health system, and Dr. Bart Hill at St. Luke's. He's the vice president there and chief quality officer. If you've got COVID-19 questions for our doctors roundtable, we will include them next week as well. We are at idahomatters@boisestate.edu. And we'll ask our doctors next week. Gentlemen, great stuff.
ALL: Thank you so very much. My pleasure.
PRENTICE: You're very welcome. I'm George Prentice and this is Idaho Matters.
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