Idaho Doctors Blast — And Praise — Health District Leaders
Tuesday, Idaho's Central District Health Department board voted to limit social gatherings to 10 people in Ada County (with several exemptions) and mandated masks in Valley County. That comes after Idaho was put on a White House list of states with high rates of transmission. On the same day, a board member with the Southwest District Health Department spread misinformation about COVID-19 during a public meeting.
Today, Idaho Matters is joined by three doctors working to fight COVID-19 who share their thoughts on these policies and opinions shared by different health district board members.
- Dr. David Pate, a current member of the Idaho Coronavirus Taskforce and the former CEO for St. Luke's Health System.
- Dr. Meghan McInerney, Pulmonology and Critical Care Medicine, Saint Alphonsus Regional Medical Center.
- Dr. Joshua Kern, VP of Medical Affairs for St. Luke’s Magic Valley.
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 firstname.lastname@example.org.
Read the full transcription here:
MELISSA DAVLIN (host): You're listening to Idaho Matters. I'm Melissa Davlin with Idaho Public Television filling in for Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know many of you have questions and concerns. And here at Idaho Matters, we want to answer those questions with facts. And the best way to do that is to bring in Idaho's medical experts. Every Wednesday, we bring in a panel of doctors and other health professionals to get us updated and to answer your questions. If you're a regular listener, think of this as a doctor's version of our Reporter Roundtable. If you have a question for our doctors, send us an email at email@example.com.
Joining us today are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force; Dr. Meghan McInerney, pulmonologist and critical care medicine at St. Alphonsus Regional Medical Center; and Dr. Joshua Kern, the vice president of medical affairs for St. Luke's Magic Valley. Thanks so much, all three of you, for joining us today.
ALL: Thank you, thank you.
DAVLIN: Dr. Pate. I wanted to start with you and get your thoughts on the latest Idaho coronavirus news. Yesterday, of course, Central District Health Board voted to mandate masks in Valley County -- so the McCall area -- and limit social gatherings in Ada County to no more than 10 people. And as of Monday, East Idaho Public Health District now mandates masks in Fremont, Bonneville, Jefferson and Teton counties. And then there is Southwest Public Health District, which covers Canyon County, home of the highest cumulative case rate in the state and one of the highest case rates by rolling seven day average. No mandates, no restrictions there. What are your thoughts?
DR. DAVID PATE: Well, first of all, I want to applaud those public health districts and their boards that are trying to do everything they can to get this spread of this disease under control. With that said, you know, Southwest District Health just remains a very sad reflection of where public health ought to be in 2020. And it's just a failure of leadership. I certainly was disheartened to hear people that are in the position of making public health decisions, who are saying things that are just patently wrong and it's just alarming.
DAVLIN: And Dr. Pate, what are some examples of that? Because we have been following this so closely, you as a health professional, me as a reporter. But for those of our listeners who don't know what was being said at this meeting, that was so factually incorrect.
PATE: Well, one was the recurring theme that we've heard from some people who are not adhering to science. That 'hydroxychloroquine is the answer to COVID' -- it is not. There right now is not evidence to support the use of hydroxychloroquine and it's not an innocuous drug. So it was disheartening to see a public health board member state that.
Another statement was trying to attribute the increase disease and severity of disease that we see in certain minority groups as being due to a lack of vitamin D. There is no doubt that vitamin D is important for everyone, and there are some differences in vitamin D levels. But to attribute their increased severity of disease to vitamin D as if that's going to address all the problems is just not accurate. And then before I think what has bothered me about Southwest District health, I think it was the meeting before this or maybe two, when they decided that their answer was going to be to quote unquote, 'encourage people to wear masks.' Well, that's just kind of a way to take an action without taking any action. That's what we've been doing for months. And it's not working. And their district has some of the highest disease transmission of any district. And at the time when they were saying let's encourage the people to do so, they weren't all wearing masks. And so it's just -- it's poor leadership. It's it's not evidence based. It is an embarrassment to all the hardworking public health experts that work in the Southwest Health District who I'm sure are incredibly frustrated.
DAVLIN: Dr. McInerney, I want to bring you into the conversation, what's the latest from St. Alphonsus? St. Al's of course covers the Treasure Valley. What are you seeing across the valley? And are there differences between Ada and Canyon Counties?
DR. MEGHAN MCINERNEY: Yeah, so first I want to echo what Dr. Pate said, I can't applaud his words enough. You know, it is time to follow evidence-based medicine. It is time to encourage, not only encourage, but mandate that all people wear masks and take steps towards mitigating the transmission of this virus. We know how to stop its spread. The job of the public health professionals is to make sure that that happens and make sure that people take appropriate steps to help that happen. As far as St. Alphonsus is concerned, we, of course, have multiple patients coming in from both Ada County and Canyon County. Our hospital capacity is better than it was from a COVID perspective two weeks ago. However, we are in the middle of trauma season. We are the trauma center. And so we're trying to take care of all of the patients that we would usually be taking care of during this time of year. And on top of that, we're now having to manage COVID patients and patients with COVID related illnesses again, because the community is not doing its part as far as mitigating the spread of this disease. And so we're OK as far as resources, we will continue to take care of all of the patients who come to our doors. But we need the community to step up and change this projection.
DAVLIN: Dr. Kern, your public health district in Twin Falls, South Central public health doesn't require masks as well. Blaine County commissioners put in their own mask mandates, but otherwise there are no restrictions in Magic Valley, which is home to some of the highest rates in the state. So what are you seeing in south central Idaho?
DR. JOSHUA KERN: Yeah, it's a complicated question for us, because we have an outbreak in the prison, which is a disproportionate amount of our cases in the last two weeks. So actually --
DAVLIN: That's Twin Falls County Jail, right?
KERN: That's correct. And so if you exclude those numbers, actually, we've seen a decline of our overall sort of what you would consider community spread. We do see increasing compliance with masking, although it's pretty variable. And, you know, again, the arguments around why not to mandate masking becomes this debate around how you enforce it. Do you put people in jail or are you giving them tickets? And I think in the more rural parts of the state, it becomes less and less palatable. And I've seen that being the main argument for not mandating it. And again, I totally agree with the previous comments that wearing masks, particularly when in public places or having close contact with other people, is the single most important thing we can do to prevent the spread of the virus. But I also see it on the other side where it becomes a difficult thing of what you do with people who continue to not want to wear a mask when you have a mandate in place.
DAVLIN: Both southwest Idaho and south central Idaho have counties with some of the highest percentages of Latino populations, and as we know, Latinos are disproportionately affected by COVID-19 both in Idaho and around the country. Some of the comments, as Dr. Pate alluded to, from Southwest Public Health District's board of directors indicated that those were cultural issues. But we know, rather, that it's more likely to be working conditions at food processing plants and ag facilities. Dr. Pate, can you expand on that a little bit?
PATE: Yeah, Melissa, you're bringing up a really important point, you know, in this country, our approach to health care results in what we call health care disparities, and these are tied to social determinants of health. In other words, what Dr. Kern and what Dr. McInerney and what I formerly did accounted for maybe 10% of the overall health of the population. And which is very humbling because we all work very hard and do a lot. Yet that's not the most important determinant of health. It turns out that things like your access to care, your education, your income, your ability to pay for care, your literacy, your ability to have transportation, your ability to have a healthy diet, all of these things and many more greatly contribute to people's health even before COVID. And I think what we're seeing in minority populations across the country, we're not quite sure the entire explanation for that. And it's probably multifactorial. You brought up an important consideration: Oftentimes, lower income workers are going to work in conditions that put them at higher risk. For example, as we've talked about, the meat packing plants, for example. But there's probably a lot more to this. Minorities often have higher incidence of a lot of these chronic medical illnesses, particularly like hypertension and others that we know put anybody at higher risk for complications from COVID. And in these populations where they may not have high insurance levels, they may not have access to doctors, they may not have access to frequent health screenings. They may have undetected or untreated hypertension, more than more affluent populations. They're going to have worse outcomes. So it really is probably a multitude of factors.
DAVLIN: So as we are all turning our eyes to the approaching school year, I have a question about flu season from Jimmy. 'How bad might flu season be this year? And what are hospitals doing to prepare for it?' And Dr. McInerney, I want to start with you.
MCINERNEY: Sure, so we've been talking a lot at St. Alphonsus about preparing for flu season, and it's hard to know how bad the flu season will be, but we certainly know that it's going to be more complicated in the setting of the current pandemic. And so our hospital is preparing by making sure that our -- what we call our FURI clinics (Fever Upper Respiratory Infection) are prepared to both absorb and evaluate patients with flu or coronavirus concerns. We recognize that it is unrealistic to expect patients to say, I'm more worried about influenza right now. I think that those are my symptoms versus I'm more worried that I might have coronavirus infection. So we are working hard to prepare for that. We also recognize that it's going to require an increase in PPE usage. So it is on the horizon. We are preparing for it. And this, again, highlights why we need to try to get our COVID numbers or coronavirus infection numbers as low as we possibly can because influenza season is going to put a bigger toll on our health care facilities.
DAVLIN: With all the preparations that you've done for COVID-19, is that going to help kind of mitigate some of the impact of influenza this year or is it going to compound and make it worse?
MCINERNEY: I think influenza might compound our current efforts for COVID. We've been doing influenza seasons for a period of time, so feel like we're well versed in how to respond to that. But they're definitely going to have a compounded effect on each other if that answers your question. A lot of our PPE and other interventions that we use to prevent in hospital transmission where we've been doing for influenza and we're doing for COVID. And so it's just kind of at a higher level. It's ramped up more than ever.
KERN: This is Dr. Kern, one thing I'll add to that is just in some of the countries around the world that are dealing with COVID during their winter right now, so towards the end of their winter, we have seen significant reduction in influenza numbers when they have gotten there COVID under control. So South Africa, as an example, has had essentially no influenza season because of the efforts they were taking with COVID, which is an interesting finding because previous studies didn't suggest that a widespread masking seemed to impact influenza. But in this sort of ongoing experiment we're doing with COVID, it did seem to matter for South Africa's influenza numbers.
DAVLIN: Do we know how influenza season has been impacted in countries that already had widespread mask use, and I'm thinking places like China and South Korea and Japan where they've been wearing masks when they're sick for decades now? Dr. Kern, I'll send that question your way.
KERN: Yeah, I mean, historical data seemed to suggest that that widespread mask use did not prevent the spread of influenza, but it raises the question of how those studies were performed or other things. I think it remains to be seen how we do this year in the United States. That said, I think our overall masking adoption is probably lower than many other places in the world related to COVID. So we may not get the same results as other places.
DAVLIN: Speaking of the upcoming school year, Dr. Pate, from a listener who wants to remain anonymous, 'are you concerned about kids and teachers having lasting effects from COVID-19 if they catch it at school? I've heard it may cause heart and kidney damage long term.'
PATE: Yes, I'm very concerned about the long term effects and complications, mostly because we don't understand them yet. Now, I'm not -- that question said, am I concerned about them catching it at school? -- It doesn't matter where they catch the virus. But the point is, again, this gets back to a misconception in the public. In health care and public health, we probably haven't messaged this the best that we could have. We have referred to people that are 'high risk.' And when we do that, we leave the rest of the sentence unsaid. And what it should be is 'high risk for death.' What people have mistakenly interpreted that is, well, if I don't fall into the group of older people or having a lot of chronic medical conditions, then I'm not at high risk. That's not true. We don't know who develops complications, why they develop the complications, how severe these complications are, how to identify people before they get the complications. But your listener is quite correct. The most disturbing recent information is coming in about heart involvement. There are many other organs that we have seen affected by COVID. But the reason this was alarming, although we knew that the kinds of patients that Dr. McInerney treats that are profoundly ill and in our ICUs, we know that quite a few of them have heart involvement from COVID, which can be due to a number of different potential mechanisms. What we didn't realize until recently was people who actually never saw Dr. McInerney, who were never hospitalized, weren't that sick, yet, we found an alarming rate of those individuals with evidence of myocardial dysfunction -- in other words, heart muscle weakness, a condition called myocarditis. Now, we don't know the significance of that. We don't know if that is just going to kind of go away on its own and return. Certainly the potential for viruses to inflame the heart muscle is not a new concept. We've seen that with certain other viruses, but the fact that some of these people had very mild illness and yet now we can detect heart dysfunction -- and it was in up to forty six percent of these people -- is quite concerning. And many people may have just heard that ten college athletes were just identified with this condition and a couple of pro athletes have been, so whereas we think about older people dying, young people can have complications and potentially serious ones, we just don't know yet.
MCINERNEY: This is Dr. McInerney, I would like to dovetail on that, if that's OK, because I totally agree with what Dr. Pete said, is that people have this misconception that it's only older patients who die or even get severely ill. When I was in the ICU two weeks ago, I was walking down the unit and there was a 57 year old, a 50 year old, a 46 year old. And then while we were on, we actually had a young person who came in 38 years old who had mild symptoms a month prior. And to Dr. Pate's point, she had presented as an out of hospital cardiac arrest. So she had these cardiac problems, no medical issues prior to that, but she had a cardiac arrest from COVID. And so it's a very important message that people get that you can get really sick from this regardless of your age.
DAVLIN: And Dr. Kern, the first big outbreak in Idaho was in Blaine County, and it was so overwhelming for the hospital that Magic Valley took some of those patients. Now that were several months out from that, are you seeing some of these long term effects that are still lingering from some of those first patients back in March?
KERN: We have had reports of some of the patients that they're now calling 'long haulers' of kind of persistent fatigue or other symptoms. And again, what underlies all of that or what leads to all of that totally remains a mystery. But to the previous points being made, yeah, there's a lot of concerns about what the effects are in people who do survive the illness. And just kind of adding on to what Dr. McInerney was just saying is that one of the conspiracy theories about this virus is that we're calling everything COVID related to to inflate the numbers or whatever it is. But the reality is that I think we're probably going to see a fair amount of disease that is kind of this in this weird category of being directly caused by COVID, but not actually during the acute infection phase or the respiratory symptom phase. So if anything, I'm concerned about how it will continue to be misperceived by a non scientific audience.
DAVLIN: Briefly, Dr. McInerney, Ingrid wants to know, 'is there an increased risk of infection or even death among smokers of tobacco or pot or vaping?'
MCINERNEY: So as a pulmonologist, I think it's important, and I always say this, when people come to see me as a lung doctor in my pulmonary clinic, you can't talk to a lung doctor without me saying in general smoking -- or we know that smoking cigarettes, smoking pot, vaping, inhaling anything into your lungs -- is bad for your health. So it affects many different organ systems, not just your lungs. We know that smoking increases cardiovascular disease, increases your rates of stroke. So with all of that said, we know that when you look at the CDC, they say very clearly that patients who have COPD, there's some strong evidence that there's increased rates of severe disease from coronavirus infection. And COPD means chronic obstructive pulmonary disease, which is far more common in smokers than non smokers.
There's mixed data about whether smoking itself worsens the severity of disease. And as far as vaping or pot smoking, I don't believe that we have enough direct evidence to say whether those directly increase your rates of severity of illness for COVID disease. But I don't imagine that it helps. So I recommend trying to avoid inhaling anything into your lungs that's not natural, that could be very harmful to the lungs and the rest of the body.
DAVLIN: Dr. Pate, I have a question for you from an anonymous listener, and it's on metrics, my favorite thing to talk about. 'My question,' the listener says, 'is about what measures and data points organizations, businesses and agencies should be considering to deem it safe for workers to return to their workplaces. There are still several organizations that are allowing full time telecommuting from home, but it seems unclear at what point it will be safe enough for the entire workforce to return to work. So what do we look at?'.
PATE: So, yeah, this is a really good question, it's a little bit difficult to answer because it really depends on the specifics of the community that the business is in and where the workers are coming from and the nature of the business. So, you know, some businesses, the nature of what they do are going to be more inherently risky than others. But in general, what I would say is it just as a very simplistic approach, just look at the degree of community spread of this virus in your county or wherever your workers are coming from. And if you want to, you can go to the coronavirus.idaho.gov web page. And I think at the top, I think it's maybe about the third tab over, it says something like cases by county and PHD, and PHD is for Public Health District. And you can click on that and then open it up, look over to the right hand side. I think the very last column, it may be deaths, but the column next to that is the last seven day average of cases. And I think you can look at that number. Those are cases per 100,000. Ideally we'd like to see that number down below 1. We're way, way, way off from that. I think any number that is over 25, I think everyone would agree that's very dangerous. And probably people should not be getting together in significant numbers and certainly not without distancing and masking where you can't distance. But even at lower numbers -- and we have a number of counties that are over the twenty five mark -- even over 10, you certainly have to be concerned. Ideally we'd like to to see that get down, as I said, the best would be less than one. But I think right now we'd settle if we could get down to 5 or less. So that's one number you can look at.
But I think looking at the community spread, because what you're looking at when you're convening people at whatever your business is, is what is the chance that somebody is going to show up to work, whether they work there or their customer or what have you, and what's the chance they're going to be infected? The higher the community spread, the more likely somebody is going to show up who can infect other people. So I think that's a good way to look at it.
DAVLIN: Now, this question on preventing the spread at home from Tyler, I've been curious about this too: 'Dr. Kern, what are you doing as a doctor to help prevent bringing the virus back home to your family? Separate bedrooms or living spaces, masks inside or other approaches?'
KERN: Yeah, I mean, I think the key thing in this kind of goes to what Dr. Pate was just talking about is that since we've implemented essentially universal masking in our hospitals, we have not seen the virus spreading between patients and health care providers to really any significant degree. I'm not saying zero, but it is really negligible. So I personally don't work directly with COVID patients at this point, but I don't think most of our providers who are working directly with COVID patients are doing many special things. Some of them are changing their clothes in the doorway or doing other things to sort of cleanse themselves as they get home. But again, we're not seeing significant spread in our hospital. And therefore, I think the risk is higher of getting it outside of the hospital than it is in the hospital. And that goes along with what Dr. Pate was talking about. The other thing to look at of whether it's safe to return to work is how your processes are set up in your workplace, because we have gotten our processes to the point where we're not spreading the virus, and therefore, you should be looking at those processes in your workplace to.
DAVLIN: Ok, so so let's turn that around then, Dr. McInerney, my dad works in Canyon County and comes face to face with a number of customers every day. And as we were talking about before, the community spread in Canyon County is extremely high. So what should someone like my dad, who works with the public in a community with extremely high community spread, what should they be doing when they come home to avoid giving it to, say, my mom or my niece or nephew?
MCINERNEY: Yeah, so I think it depends on what your dad's job is and whether the people that he is working with are wearing masks and that he's engaging with. I firmly believe that a private company has every right to require masks for its customers before serving its customers. And so that's one piece of recommendation that I would offer. You know, as Dr. Kern had said, I'm somebody who takes care of COVID patients every shift I'm on and I have full confidence in our PPE. I'm less worried about getting infected at work than I am at the grocery store when other people are not protecting themselves. So I would say that if your father feels that he has had a high risk exposure, meaning a prolonged period of time, greater than 15 minutes in close contact without wearing a mask and without social distancing, that he probably should take measures to prevent transmission to those that he interacts with, meaning wearing a mask, social distancing with those people in the home. I don't know if that answers your question, but I think that we all need to demand that people that we're interacting with wear masks. And if we unfortunately can't avoid that and have a close, unprotected, high risk exposure, then we need to protect others around us by quarantining.
DAVLIN: Dr. Pate, Morgan just wrote in with this question about the long term goal: 'is the goal for people to not contract the coronavirus at all or just to delay the community spread to preserve health care capacity?'
PATE: Well, I think it's multi factorial, first of all, obviously, we don't want anybody to get infected that we can prevent and most of this is preventable. And I think the people that make the assertions that we ought to go ahead and get, especially the younger people infected so that we can get to herd immunity is really a dangerous notion and an ill informed notion. So we do want to prevent infections. The other thing that we want to do is knowing that there are going to be infections -- because the virus is out there, it's not going away -- what we want to do is keep those infections, especially away from those that we know are high risk of death. But let's also keep those infections down so that we don't end up spreading it to more and more people. And so that we can keep businesses open and so that people can keep their jobs and so that we don't overwhelm the hospitals and health care providers, and so that, frankly, we avoid some avoidable deaths. And what we're trying to do is buy time for two things: One, I'm very confident that we are going to have some new weapons in our fight against this virus. Right now, Dr. McInerney only has a couple of options that make a big difference. I think in the coming months she'll have more. And then the other thing that we want to do is buy time until we do have a safe and effective vaccine. And so far, that news is encouraging, far from a slam dunk, but it's encouraging. So right now, let's just keep the disease spread so that we can keep people healthy until we can get them vaccinated and that those people that do get sick, we have very good treatments for them.
DAVLIN: Fantastic. Thank you three so much for joining us this week.
We've been speaking with Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, Dr. Meghan McInerney Pulmonology and critical care medicine at St. Alphonsus Regional Medical Center, and Dr. Joshua Kern, the vice president of medical affairs for St. Luke's Magic Valley.
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