As cases of the coronavirus rise across our state and hospital beds fill, we know many of you have questions: how exactly does it spread? What is safe, and what isn't? To get answers for you, each week we've been bringing in Idaho medical experts to answer your COVID-19 related questions.
Joining Idaho Matters today to answer your coronavirus questions are Dr. David Pate, retired CEO of St. Luke's Health System and a current member of Idaho's Coronavirus Taskforce; Dr. Steven Nemerson, Chief Clinical Officer for St. Alphonsus Health System; and Dr. Bart Hill with St. Luke's.
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:
GEMMA GAUDETTE (host): You're listening to Idaho Matters. I'm Gemma Gaudette. A new federal report released Sunday sent a warning to 21 states that are in a red zone and need to take aggressive steps to slow the spread of the coronavirus. Idaho is one of those states. So today, as we've been doing every Wednesday for months now, we are bringing in Idaho medical experts to give us the facts on this virus and how it's impacting our state.
Joining us live today, Dr. David Pate, retired CEO of St. Luke's Health System and a current member of Idaho's Coronavirus Taskforce; Dr. Steven Nemerson, chief clinical officer for St. Alphonsus Health System, and Dr. Bart Hill with St. Luke's. Welcome, everyone.
ALL: Thank you. Hi, Gemma.
GAUDETTE: And if you have a question for our doctors, you can send us an email right now at IdahoMatters@BoiseState.edu.
All right, Dr. Pate, I want to start with you, since you are on the Idaho Coronavirus Task Force. Any word on on where we are potentially in more mask mandates? And I ask this because, you know, as we're all quite aware, the science is showing that masks work if people use them. However, we kind of have a patchwork of solutions here in our state right now.
DR. DAVID PATE: We do, Gemma, and you're quite right, that the evidence is certainly overwhelming, that it helps, and in fact, that's even been our experience here in Idaho. We are seeing areas like Boise that was a early adopter of a mask mandate that we're seeing some definite improvements. And I think we're also seeing improvements from a number of other areas that have implemented them, as well as many businesses have now required them. So I think those things are helping. Idaho has a public health system that I hope after this the legislature will reevaluate because it was established in 1970. And it seems after going through this pandemic that it has not served us well. We've seen some real strong leadership from some public health districts. And then as you referred to, for example, Southwest District Health was disappointing both that they encouraged people to wear masks while the board members in large part were not, as well as the fact that we've been encouraging people to wear masks for months now. It's not working. And, you know, as I told someone the other day, I suspect that if Idaho only encouraged us to pay our taxes but didn't require it, Southwest District health budget wouldn't be quite what it is today.
GAUDETTE: So with that being said, Dr. Pate, you know, I believe it was last week, Governor Little said that he will not -- he doesn't have any plans of putting a mass mandate in place because there are some counties that don't have the virus. But we should note that there are only two counties in the state that do not have a case. So where is the task force on this?
PATE: We have been discussing this issue and certainly the governor is looking at and re-evaluating the situation constantly. I think what the governor said is that he didn't have plans to do so at this time, but he wasn't ruling out that he wouldn't take action. I think, you know, appropriately, he's deferring to the public -- the structure that our legislature set up, that we have public health districts. And I think he is looking to those public health districts, and then, of course, mayors and city councils and county commissioners all have authority to do these things. And I think he's looking for local leaders to lead, especially because, as you point out, there is a lot of difference around the state as to of a few counties that really are not having problems and a number of counties that are having a significant spread. So, you know, I think if the governor needs to step in, he will. And I think that will be further evidence that our public health system doesn't work. And, of course, you know my criticisms about having people on public health boards that don't even believe in basic public health principles.
GAUDETTE: Some of them don't believe in basic science.
I want to bring Dr. Nemerson and Dr. Hill into the conversation, because according to a report by NPR that was released today, Idaho saw 3,228 confirmed cases of COVID this past week, and about two thirds of those were in the greater Boise area, so in the Treasure Valley, we know Canyon County, their numbers continue to go up. And more than 200 people statewide were hospitalized with confirmed cases of COVID just over this past weekend. And then we saw our first fatality of someone in their 30s in Idaho. Almost 20% of our COVID deaths over the course of this pandemic happened last week. And we do know the two ICU units within the St. Luke's health system filled up last week and then they had to move patients into the main facility in Boise. So according to this NPR report, ICUs in Idaho are running at about 130% of normal capacity. Dr Nemerson and Dr. Hill, you are on the front lines of this. This cannot be sustainable. And Dr. Nemerson, can you can you talk to us first about what you're seeing at St. Alphonsus? I mean, these numbers just seem to, they continue to go up. They're not going down.
DR. STEVEN NEMERSON: Yes, Gemma, they're definitely not going down, and to Dr. Pates point earlier, we're seeing some subtle hints that things are not growing at the same rapid rate in Ada County that they had, but they're still continuing to grow and things are still continuing to spread in all of our communities throughout Idaho. In terms of San Alphonsus's experience, we are caught between a rock and a hard place in that rock is that we have patients that still come to us with heart attacks, strokes, that require cancer surgery, other kinds of invasive procedures. And we need to accommodate those things. We cannot continue to put those off. We learned a very hard lesson at the beginning of this pandemic when we delayed everything but emergent care for four months and people had complications because of that. And we are not going to do that again. And so we have to accommodate that need. And at the same time, this growing COVID surge that we're experiencing now, and this is what puts our ICUs and our regular hospital beds at very, very high occupancy. That having been said, we do still have capacity because as the COVID numbers continue to rise, we're going to make the tough decisions about which procedures need to be delayed. And I've said this before in other forums, the great tragedy of what's going on here in Idaho is we have the opportunity to make these interventions, cover our faces, stay apart, not get together in social gatherings, wash our hands. And if we do that, we can get this thing to settle down. If we don't do that, then what we're already experiencing at St. Alphonsus, which is a small number of patients, have to have their cancer tumors removed after a few days delay and having to have other things like orthopedic surgery delayed for a period of several days, if not more than a week. So they continue to be debilitated on that basis. We will have to extend those timelines further, and I don't want to do that.
GAUDETTE: And Dr. Hill, what about what's going on with St. Luke's? I mean, as I mentioned, I believe it was in Nampa at some point last week where the ICU beds were filled and you had to move people to the main facility in Boise. This just cannot be a sustainable model. But I want to make it very clear this is no fault of the medical systems.
DR. BART HILL: You're absolutely right. And I echo Dr. Nemerson's comments. Our facility in Nampa has been full, but rather than extend and push them beyond their capacity, we're fortunate as a health system with other facilities nearby that we can leverage the resources of multiple facilities. So transferring from Nampa to Boise is not ideal, but it is certainly an option for patients when their capacity is reached. We're running about 20 to 30% higher ICU in the recent few weeks as compared to a year ago. So again, we're operating in a range that we can manage, but it is definitely higher than what we've experienced historically. And the trend is concerning because it is being taken up by people who have COVID. And in addition to the patients who need the acute care, the strokes, the heart attacks, people with severe injuries. And like Dr. Nemerson said, we too have started to scale back some of these procedures that can be, we hope, safely delayed. But that's always a bit of a gamble with delayed care. It isn't an elective case that is completely optional. And if you never get it done, it's not an issue. These are people who have medical conditions that would benefit from surgery, but we're asking them to hold off until we're more comfortable that we have the capacity to manage them.
GAUDETTE: And Dr. Pate, in the introduction, I mentioned a new federal report, that federal report that came out Sunday placing Idaho in a red zone along with 20 other states. Now, this report was shared with state officials by the White House Coronavirus Task Force. And in that report, it said that each of these states has had more than 100 new cases per 100,000 people in the past week. And it goes on to say, if aggressive measures are not taken, this could get really bad. What are your thoughts on this? I mean, you've got to be concerned.
PATE: Well, I am, Gemma, I'm very concerned, and again, I certainly am disappointed in some of the public health boards, although I will commend Central District Health, Panhandle Health, there are certainly examples of these public health boards making the tough and right decisions. But, you know, I think that reality being what it is, we cannot just say that we're going to abdicate all of our personal responsibilities. We know what the answer is. Would it be better if these public health officials took action? Of course. But, you know, we're not seeing it. So it's now on us.
And what I would tell your listeners is, regardless of whether you think this is a hoax, regardless of whether you think you're young and you're invincible and you don't have something to worry about, whatever that is, put that aside for a second and let's just deal with where we are. And as Drs. Nemerson and Hill have mentioned, we have rising cases, we have rising hospitalizations. And as you alluded to, Gemma, we're starting to see the rise in deaths, which I've been talking about. Those are coming. And we are hearing from our hospital leaders that there is a risk that they could get overwhelmed if we don't do something. And on top of that, we're opening schools in weeks.
So what I would I would tell listeners is that if you care about our economy, if you care about keeping businesses open, and unless you are looking forward to homeschooling your child while you try to work, we all need to take this seriously. Let's do what we can. And that means if you're going to be out, physically distance and if you cannot keep that distance, wear a mask.
GAUDETTE: Dr. Nemerson, I have the first question for you. This is from Mac from from Parma. And he said recently I was talking with with a hotel owner in Donnelly. He said shortly after Winter Carnival in McCall, his entire staff, as well as the entire staff of some restaurants in McCall, became ill with the most severe case of flu ever experienced. Can we be certain that the coronavirus was not already being spread in Idaho back in January and February?
NEMERSON: Mac, we absolutely can be certain it wasn't here back in January or February, and it sounds like you just had the worst flu of your life, which happens every year. The reality is here in Idaho, we had our first illness reported back at the very beginning of March. The earliest estimation that the disease entered our state was around February 23rd.
GAUDETTE: And Dr. Hill with St. Luke's, Elaine has this question: Should we send kids back to school with masks? And how much does good air circulation in inside spaces help keep the virus away? And I should note that Central District Health yesterday said that if you are within the Central District Health, you will be required to wear masks in schools.
HILL: Gemma, I certainly would concur with sending your kids back to school with masks and really working with them to keep them on all the time that they are not able to be socially distant. I think being in an enclosed space, in a room that was never designed to have really effective air circulation puts people at risk and masks should be continued to be worn in those environments. I'll use the example of the choir in Washington where one teenager carried the disease, sixty eight, I believe students practice for two hours in this classroom and over 50 of them became positive. That's what can happen in a room that is not designed to circulate the air and even our operating rooms where we recirculate the room air every three minutes. We will wait 20 minutes or more before we will change our protective equipment because it takes that long to remove the virus out of the air, even circulating it every three minutes. In classrooms and conference rooms, they are not built to circulate air that that quickly.
GAUDETTE: So, Dr. Hill, that's why it's critical for not just students, but faculty and staff, I mean, for everyone who is in a school building to be wearing masks?
HILL: Yep, at all times. I mean, the exceptions are when you're at lunch break. And even then, that's where we're seeing even in our own organization, we can be very effective at wearing masks in the hallways with our patients in the nursing areas. Then we go to break room at lunch and we sit together and we take our masks off. That's where we run potential risks of spreading the disease.
GAUDETTE: Dr. Pate, Ingrid asked this question. She says, we have a family reunion planned next week. How can we spend time together safely? We are driving to north Idaho to a remote place, but some are driving from Arizona and New Mexico. No one has tested positive or has symptoms. Is it safe if we use masks and careful cleaning? What else should we do?
PATE: Well, if by safety you mean that there's not a chance that somebody could get this infection, they no. There are always risks when we get together in groups of people that we don't live with. Now, I need more facts than what you presented because I don't know how many people you're talking about in total. And I don't know about age distributions and whether anybody might be in the high at-risk group. But a couple of observations. First of all, you are going to present the greatest risk just from looking at the three states of people that are coming together. The other two states you mentioned have their spread under much better control than Idaho has. But the key point to you is you mentioned that no one has tested positive or has symptoms. That's certainly good news. But it may be that as much as half of our cases are transmitted by people that are infected and have no idea that they're infected. So that doesn't give me reassurance that somebody couldn't bring the virus with them to this gathering. And certainly the younger that people are, the more chance that they are going to be asymptomatic yet able to transmit this virus. So what I would tell you is that if you're going to get together, hopefully it's not a real large group. Hopefully you're not bringing people who are at high risk into this gathering and make sure that you do everything you can to keep people physically distanced. And that can be a real challenge. So if that's not going to be possible, have everybody wear masks and do not assume that just because people feel well that they are not presenting a risk of spreading the virus.
GAUDETTE: Dr. Nemerson, this next person wanted to remain anonymous, but they say I work all over town during the course of the day, I see hundreds of out-of-state plates on vehicles every day. I believe many of the new cases are generated from people who are coming here from places which have high incidence of COVID, true or false?
NEMERSON: False, Gemma. The fact is that our prevalence here in Idaho and particularly in Ada and Canyon Counties is somewhere between 500 and 1000 cases per 100,000 population. I think in your presentation earlier, you mentioned that the number of less than 100 is considered moderate or low prevalence. So we're way up there. We're keeping pace with Arizona, Texas and California. So the prevalence in our community is huge. As a result, the spread from one person to another is much more likely to be from somebody here in Idaho giving it to somebody else than it is somebody from out of state. Now, it is true that people could be coming in from high prevalence areas and there is a higher risk of them bringing it in as well. But looking at the big picture, you're much more likely to get it from somebody walking down the street, not wearing a mask and spending time chatting with them than you are getting it from somebody from out of town who you don't know you're going to keep at a distance.
GAUDETTE: And Dr. Hill, Tina has this question: How are you preparing to keep track accurately of hospitalizations and available ICU beds, needed PPE equipment for hospitals to keep staff safe, et cetera?
HILL: Tina is hitting the nail on the head. This is a complex question because there are so many variables you have to keep track of and you never know which one could become your limiting resource. Ever since February, when this was starting to hit in Seattle, we begin preparing for processes that we could count. How many of the N-95 masks, how many procedure masks, how many ventilators do we have, how many ICU beds, what's our staffing today? We report that every single day. We report that locally, that then gets reported up to what we call our hubs and then from the hubs to a Central Command so that we have visibility. We've created through technology, the ability to report this information internally at a moment to moment basis. But even still, you sometimes get surprises: The suppliers are suddenly cut short and the supplies you were anticipating are not going to be coming in. And you have to start making adjustments of how do we accommodate with the change that we were not expecting but now confronted with.
GAUDETTE: Dr. Nemerson, a question from Linda. Kind of interesting. She says, I have a friend who works in the OR. They were exposed to a fellow health care worker in the OR who tested positive. She was told that since they both had masks, it was considered a non exposure and there was no issue of quarantine. And she continued to work. How do the different health care facilities handle this sort of thing?
NEMERSON: That's a great question and there's a couple of things that your audience needs to know. First of all, within a health care facility, we use a high degree of personal protective equipment in an operating room, we wear surgical masks and those masks are even better than cloth masks at containing infectious material that we may be breathing out and also filtering stuff that may be coming in. So when you've got two people, one of whom ultimately tests positive and another one who works with that individual, the risk of transmission through the mask of the first and then through the second mask of the uninfected second person is very low. We call that a low risk exposure. And then within our health system, for every kind of exposure, we have very strict guidelines that we've developed around the category of risk, and then what needs to happen. So specific to Linda's question, the risk would be considered very low and therefore it would be acceptable for the uninfected or not symptomatic individual to be able to work as long as they continue to wear the protective masks that we supply and they maintain the standards that we mandate for contact with patients. And we also have a very strict monitoring process for those individuals with frequent temperature checks and symptom monitoring to ensure that if they were to suggest that they have COVID symptoms, they'd be immediately exited from the facility. That's all part of our keep patients and colleagues safe package.
GAUDETTE: Dr. Hill, Emily from Boise wrote in and she says she's 35 and she's healthy, except she has what's called Factor V Leiden, which means her blood over-clots. So she wants to know how serious is this as an underlying health condition when it comes to COVID? And do we know enough yet to even answer this question?
HILL: Emily, I will tell you that I have family members in the same boat as you. They also have the Factor V Leiden risk factor for clots, some of them had clots. And some of those family members have had coronavirus. At this point, we don't know. There is just not enough information, not a large enough sample of people who have subsequently had clots from Coronavirus to be -- and they also have Factor V Leiden -- to really understand how much of an additional, if any, risk that condition is as it relates to the clotting problems that we see with coronavirus. So I'm as curious and as eager to know the information as you are, Emily.
GAUDETTE: Dr. Pate, another person wrote in saying, what will the coronavirus vaccine be like? Will it be like the flu vaccine where we get a different one every fall and it's only somewhat effective at prevention and somewhat effective at easing symptoms? I keep hearing that the virus will mutate so the vaccine will not be a silver bullet.
PATE: So at this point, we don't know the answers to most of those questions, but we will soon. The studies are underway, the clinical trials. And first of all, understand that this really is amazing to all of us that have been practicing for a while. The number of different types of vaccines being tried out right now is really staggering. And I find it exciting because even though we might find some don't work as well, we're more likely to find some that do work better. We only have some very preliminary reported information. And it's encouraging for two of the vaccines that are currently in the phase three, which is the final trial. That trial will help to answer that question about how effective is the protection. Most of us are not expecting that it's going to be 100 percent effective. But as Dr. Fauci said, even if it was 60% effective, that would be a big win. And I am certainly encouraged that it might be more effective than that. We'll know the answer soon. The other good news is that so far, these two vaccines that are in the phase three trials, when they were in the earlier trials, we didn't see anything alarming in terms of safety. There certainly are some local effects of redness, sore arms, that kind of thing, but nothing scary.
Our best guess is that these vaccines, to be fully effective, are probably going to require two shots, perhaps a month apart. Again, that will become more clear with these trials. But to get to the root of your question, we don't expect they'll be 100 percent effective, but we do expect they will be very helpful. And the frequency at which you're going to have to get them, it's not going to be like some vaccines that you just get once in your life. You probably are going to have to get this at periods of time. We don't know what that period of time is. It certainly could be yearly, it might be longer. And then, of course, the mutation issue that you bring up is something we always have to be concerned about. This virus is mutating. The good news is with as much spread as we've seen of this virus and even though we've picked up a lot of mutations, most of them are pretty inconsequential and we don't think are going to impact the effectiveness of the vaccine. But we'll continue to monitor that. That certainly could happen over time. But on the other hand, one of the best ways to prevent the virus from mutating is keep it from spreading. So if we can take our personal actions and then have a vaccine that will help decrease the spread, we will decrease the chance that it is going to mutate.
GAUDETTE: And Dr. Nemerson, another person wrote in asking, where are we with treatments? What treatments are doctors using locally and how to local doctors learn about how doctors and other places are treating COVID?
NEMERSON: Gemma, I'll take the last part of that question first. In terms of sharing knowledge, St. Alphonsus health system as part of both a regional and national collaborative for sharing information and and making sure that we're engaged in best practice. As you'd imagine, therapy and recommendations change very frequently, in fact, in some cases daily. And so we're on top of this constantly. And people should be confident that the care that they're going to receive at St. Alphonsus is going to be truly state of the art, and state of the art, meaning literally, if something changes tomorrow, that's the care they're going to receive when they come in tomorrow. Regarding the treatments that are available here within our system, everything that's available nationally is available here locally. I'm sure that listeners have heard about Remdesivir, the antiviral medication. We've got that in stock. Convalescent plasma infusion, which is taking the antibodies from somebody who's had COVID harvesting them and then having them available to infuse in somebody who gets COVID. We can do that. It's generally reserved for the truly critically ill patient. Dexamethasone. Another thing that's clearly been shown to have benefit, that's an anti-immune medication or steroid. We've got that. And then immune neuromodulation therapy is the other class of medications that are showing promise and they're tailored to individuals. So it's a form of using specific medications that are targeted to the complications that patients are having with COVID. And the thing about COVID that we learned is that no two patients have the same manifestations. And where the virus attacks your body, if you get really sick from this virus, can be vastly different from one person to another. So all our doctors are constantly evaluating through blood testing, imaging, clinical signs and symptoms. What's being affected and what do we need to do to affect that part of the body, that organ system, to help it to recover?
GAUDETTE: Before I let the three of you go, I want to talk about something that took off over social media yesterday. And it was a video that was taken down by social media outlets and this was put out by Breitbart News and it was titled, quote, "America's frontline doctor staging a press conference." Doctor, you were very active on on Twitter yesterday and this morning regarding this. I want to bring it up because I think it's critically important that we talk about science and we talk about facts when it comes to this pandemic. Can you talk a little bit about why this, even though these are doctors, the information they were giving was not scientifically accurate.
PATE: Well, Gemma, it was horrifying to me, I have a great deal of respect and pride for our profession. Doctors Nemerson and Hill represent the vast majority of physicians who are very knowledgeable, very committed to science, very committed to making sure that we know what is in our patients' best interests. Unfortunately, the concept that a physician would put out some very unaccepted, unsupported information is is quite concerning because people are vulnerable, because most people don't have a lot of medical knowledge. And so a lot of people do give credibility to physicians. And I think in 99.9% of the time, they're justified in doing so. In this case, this Dr. Emanuel in Houston -- and I didn't know her when I was there, I knew quite a few doctors, but I did not know her. The things she said in various forms were so outrageous that frankly, I am concerned if she may have a mental health problem. It's certainly more worrisome if she knows this is wrong and is putting this out. And I was very discouraged by the number of other physicians that joined her out there for this press conference.
But let me get to the point. So the people I was dealing with were outraged that her videos, her comments were deleted from Facebook and some other venues. Let me say, first of all, I applaud Facebook for doing that and others. The information she was just putting out there was frankly dangerous and more so when it comes from a doctor. And what I told these people is, she has an avenue to get her message out. She indicates she has cured hundreds of patients, I guess it was with hydroxychloroquine. Well, the avenue to do that is to submit her data to a medical journal for peer review and review by the medical community. And then if there is something there, then, of course, let's get it published and let's get it out to the medical community. The way that we disseminate -- you were asking Dr. Nemerson just a little bit ago about how do we make sure our doctors are always keeping up with the latest developments -- the way we do that is through medical journals that are peer reviewed. It's not through YouTube. And so I am hopeful that the Texas state board will take action against her license. I hope the Harris County Medical Society will discipline her. And frankly, we need more doctors to speak up. Doctors are hesitant to criticize our colleagues, but when it comes to potentially harming people, I have always spoke up and I hope others will join me.
GAUDETTE: I want to thank all three of you for coming in today. We are in a critical place when it comes to this pandemic. So I thank you for your expertise, for your time, for telling us the facts. Thank you to our medical experts, Dr. David Pate, Dr. Steven Nemerson and Dr. Bart Hill. We will, of course, have our medical experts back next week. If you have questions, email us: idahomatters@boisestate.edu.
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