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What is the single most important question about COVID-19 you think needs to be answered? Submit it for a special Idaho Matters Doctors Roundtable in English and Spanish.

Idaho Doctors Celebrate Vaccine News, Brace For Holiday COVID-19 Surge

Taimy Alvarez
AP Photo
In this file photo dated Wednesday, Sept. 2, 2020, University of Miami Miller School of Medicine lab technician processes blood samples from volunteers taking part in testing the Moderna COVID-19 vaccine.";

Joining Idaho Matters to fill us in on the latest coronavirus news and to answer your COVID-19 questions are:

  • Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce
  • Dr. Michaela Schulte, St. Luke’s Vice President of Medical Affairs for the Western Treasure Valley
  • Dr. Meghan McInerney, ICU Medical Director at Saint Alphonsus Regional Medical Center

Have a question you want the doctors to answer? Email us: idahomatters@boisestate.edu.

Read the full transcript here:

GEMMA GAUDETTE: You're listening to Idaho Matters, I'm Gemma Gaudette. Another 31 people are dead in our state due to the coronavirus. At the same time, Idaho is experiencing its highest levels of hospitalizations and ICU usage during the pandemic. So today, our medical experts are joining us once again to update us with the facts and to also answer your questions. So if you have one, send us an email at idahomatters@boisestate.edu. Joining us today, Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of the Idaho Coronavirus Task Force. Dr. Michaela Schulte, St. Luke's vice president of Medical Affairs for the Western Treasure Valley. And Dr. Meghan McInerney, the ICU medical director at St. Alphonsus Regional Medical Center. Thanks for joining us.

ALL: Thank you, Gemma. Thank you.

GAUDETTE: So I do want to talk about ICU beds, but first I'd like to start, Dr. Pate, with what happened last evening with Central District Health. They held a meeting last night, and to just update people, at their last meeting, they put an advisory in place, a public health advisory. And Dr. Pate, we now know that this could become an order very quickly. And Dr. Ted Epperly spoke at that meeting. And I want to quote him because he says, "We have an absolute imminent crisis right now. If we do not do this, we will lose the hospitals. Hear me when I say that, we will lose the hospitals."

If Dr. Pate could comment on that.

DR. DAVID PATE: So over the course of yesterday, I had conversations with a number of folks from Central District Health, including Dr. Epperly, to just express how serious the situation is, that this is truly extraordinary, that I don't think the people of Idaho really understand what the implications are if we continue on this course, and understandably so, because most people in Idaho have never experienced anything like this before. And I certainly had been vocal in my criticism of Central District Health for last week, believing that issuing a strong advisory or however they phrased it was somehow at the end of November now going to change behaviors. And I indicated that their intent expressed at the last meeting to wait until we got to crisis standards of care. And then at that time they might issue an order. I explained to a number of people that by the time you put that order in, it will take weeks for the cases to drop. And that means the hospitals will have to operate for weeks at that level. And that means people are going to have delays in care, which may worsen outcomes. And it's going to mean many more people will die that wouldn't otherwise have died.

And I just wanted to impress upon everyone that while the hospitals are certainly doing extraordinary and hanging on, there are cracks and we're seeing them in a number of places and I wanted to emphasize that when we go from, OK, we're kind of handling things to, when now we're overwhelmed can be a matter of hours or days. We are not going to have a lot of notice, and so I stress that now is the time to act.

GAUDETTE: And we should note that they are taking this up again on Friday evening. And this advisory would turn into an order and it really would significantly limit what people can do.

But with that said, let's talk about where we are in hospital capacity because yesterday we know that St. Luke's held a media call to say that all of the ICU beds in its Treasure Valley hospitals were full on Monday night. So as we know, there is a concern, a real concern over this. So, Dr. McInerney, can you talk-- you are the ICU medical director at St. Alphonsus Regional Medical Center. Can you talk about where you are at Saint Alphonsus and what is that tipping point?

DR. MEGHAN MCINERNEY: Right. So Gemma, we are always walking a thin line right now with ICU bed capacity, and then even if we have room for an actual physical bed, because our staffing supply and the number of people that we've got available is also limited. That is oftentimes what is the actual tipping point of where we're able to say, yes, we can continue to take ICU patients. We currently have capacity for more patients to come in, either with COVID or without, because we are the trauma center, we are absolutely able to continue to take trauma patients. And a lot of those patients do end up in the intensive care unit. But it's tight right now. And, you know, sometimes we'll have moments where we don't have any ICU bed capacity and we have to keep patients down in the emergency department. And then we are able to shift some patients around and move some patients who don't need ICU bed care or ICU care the next day we can move them out to the medical ward. So it's a moving target all of the time. And I think that it's important for everybody to understand that even in non-COVID times, that's always a moving target. Right? Sometimes our ICU beds fill up in the time of heavy trauma season, but right now it's more of a constant stress. And as I've said before on this program, because patients who are critically ill from COVID require so much intensive care, so much time and so many resources, once they land in the ICU, they often stay for a long period of time. So that's also one of the reasons why our bed capacity is so challenging, because those ICU beds are taken up for a long time.

GAUDETTE: And Dr. Schulte, if you could join the conversation, as I mentioned, with St. Luke's being full Monday night, I mean, I'm assuming it's the same with St. Luke's where it's at that moving target. Right. So maybe today you may not be full, but you've already reached capacity once.

DR. MICHAELA SCHULTE: Yes, that is, I can only reiterate what my colleague just shared for St. Luke's as well. We are exactly in the same situation and to a degree, you know, we're used to being creative. And just as we'll share, you know, trying to really optimize the care, you know, along the line as much as we can. But we did have to open up an overflow area for our ICU capacity last night. This morning, again, we were able to free up some beds and we are, you know, able to safely care for patients right now. But the margin is incredibly thin and really not at a level where any one of us feels comfortable that we can continue to provide the care, as usual, to all patients that are coming. As we're looking ahead and are preparing that we are probably just in the early stages of a tidal wave that might still follow. So I can assure you that in all the health systems across our state, like in any other region of this country, there are a lot of people losing sleep over how we will be able to continue to staff and safely care for all of these patients.

GAUDETTE: And can we talk about you know-- we know that at least at St. Luke's through Christmas, all elective surgeries have been canceled. This is the second time this has happened. Let's clarify what that really means, because I think that when we say elective surgery, people think, you know, like plastic surgery, something like that. Yes, that's in that category. However, these are things like hip replacements, people who have cancer, who need certain surgeries. These are surgeries that maybe you can move them off a little bit. Correct, Dr. Schulte? When you talk about that?

SCHULTE: Yes, absolutely. And you're right. So what we had decided at St. Luke's is to cancel those cases that we say can safely be put off for at least about 90 days and those that would require an overnight stay in the hospital. Those are the ones that we have basically canceled or are not scheduling right now. But you're absolutely right. You know, something that is OK to do in 90 days right now, you know, because it might not incredibly negatively impact your life is still an incredible burden. Unfortunately, as we're moving through this crisis, we will have to start considering pulling other levers, you know, along the lines of surgeries that are, you know, not necessarily being put off for this long and really moving down the list of only providing really these emergent and very urgent cases which we really will try to work incredibly hard to avoid.

GAUDETTE: Before we move into our listener questions -- and we have a lot. Dr. McInerney and Dr. Schulte I want to know how you and your staff are doing, because you talk about the health system being overwhelmed. And, yes, we talked about ICU beds and those getting full. But part of this is what is happening with our medical professionals: our doctors, our nurses, our respiratory therapists. You know, you are working around the clock. So, Dr. McInerney, if I can start with you, how are you and your staff doing?

MCINERNEY: Thank you for asking. I'm tired. I'm tired and I'm frustrated at times and, you know, hopeful, though, also that we can try to turn this thing around, but a lot of our staff are feeling the same way. There's certainly some underlying, you know, senses of burnout and fatigue. But then when we're at the bedside and when we're together as a team, you know, we're still, I think, tighter than we've ever been because we're all going through this together and realizing, you know, sometimes in this time we've really noticed that we have to look to each other so much more than we ever realize, because unfortunately, we haven't felt like our community is all coming together in the same way that we had initially hoped, you know, as far as wearing masks and kind of taking and doing their part to try to limit the spread of this virus. So I'll say that as exhausted as we all are, because many of us are working extra shifts, longer hours. I think that we are all closer as a team and that will always help to benefit patient care.

GAUDETTE: And Dr. Schulte, how about you and your team?

SCHULTE: Yes, a very similar picture, I think Dr. McInerney really described it very well. On one hand, sort of that esprit de corps is as strong, people are working together, people are helping each other. People are reaching out. And any kind word from anyone is really greatly appreciated. And we are able to support each other really well. But it doesn't, you know, take away from the fact how tired and exhausted people are. We've asked them to take time away from their families during the holidays at a much greater rate. Those that have unfortunately contracted the virus in the community are feeling incredibly bad that they can't be there to help support their colleagues. We're asking people to juggle a lot at home. Many of our nurses, you know, also have children at home right now that may not be able to go to school. People are juggling the same demands that, you know, everybody is facing in these times in addition to what they're facing at work. And then sometimes that great discrepancy where, you know, on occasion we feel that we are very much confronted and criticized for, you know, experiencing the reality that we are experiencing and not having a shared belief in what is important to do right now. So very emotional times. Many of these emotions are good and positive. And I think we're trying very hard to focus on that and to maintain our ability to really focus on the patients, do what we do best, which is provide compassionate care and excellent care to our patients.

GAUDETTE: Well, I do want you to know there are people out in the community who do care. And Dr. Pate, I mean, you've seen this-- I mean, you've talked about this a lot, this idea of where our front line workers in the hospitals were revered at the beginning of this pandemic. And now here we are with them feeling like they're not supported from the community.

PATE: Yes, well, this is something that I've been very worried about at the very beginning of the pandemic, of course, we saw the people lining up at shift change, banging pots, cheering, clapping. We saw law enforcement showing up and fire trucks and so forth in a show of support. But then over time, you know, this has it just really deteriorated in terms of the behaviors of the community in general. And I think what is so discouraging to many of these people, you've got Dr. McInerney, you've got Dr. Schulte and countless others who are working extra hard, who are going into the hospital and dealing with these patients, who a lot of them are there because they wouldn't follow our guidance and they wouldn't wear masks. And now Dr. McInerney has to look at their faces. And I can tell you, it's been a while since I was in the ICU. I still remember that look on somebody's face when they are needing to be intubated. The fear... And add on top of that, that Dr. McInerney and the nurses and others have to service that patient's family often because the family can't be there. And so it's even a more emotional burden for our providers because we're trying to fill that role as well. But then for Dr. McInerney or any of our other providers to get done working 12, 14, 16 hours in the hospital, dealing with this back to back and then drive home past a place where people are congregated in large numbers, not wearing masks, listening to people assert that this is a hoax, that this is no worse than the flu. It really undermines what these health care providers are doing. Because when you don't acknowledge this, when you don't take precautions, we get the kind of transmission that we're having now. When you have the kind of transmission you have now, that means a lot more people end up in the hospital. When a lot more people end up in the hospital, Dr. McInerney, the staff, Dr. Schulte, everybody, they have to get exposed to this. And they're worried about their own families. They don't want to take the virus home to their families. And certainly none of them begrudge taking care of patients who are in need. What is frustrating is when more people are putting themselves in harm's way than necessary, when they're already so overworked, they're already so resource-constrained. It really is disrespectful of what our health care workers are doing. And that's why I wrote some op-ed pieces. I made a suggestion to the governor's office that for Thanksgiving, let's do this again. Let's show up and thank our health care professionals and show them that we do support them. We do appreciate what they're doing because they really need to hear that.

GAUDETTE: I agree. Let's get into some listener questions. Dr. Schulte, Jean wants to know:

LISTENER QUESTION: If we know yet with the vaccine where we will be able to get vaccinated once it's available, since doctor's offices won't be able to provide the necessary freezing for the Pfizer vaccine. Also, once we're vaccinated, will we no longer be carriers?

SCHULTE: Now, that's an excellent question, and I can understand that that's on everybody's mind right now. So fortunately, there's been a lot of planning going into how we will be distributing the vaccine. And these plans are already in place, although we're still waiting for the vaccine to be shipped and then to be delivered. There will be once we're able to open up those phases, there will be clear instructions where people can sign up to receive the vaccine. As you might have heard, that these vaccines are not optimized for easy use, as you were just referring to. But we will have the phases of care outlined with health care workers and those that are vulnerable, receiving the vaccine first and then gradually working through that everyone in the community can get the vaccine.

Now, how long will we be immune for? Can we still carry the disease? That's a great question. We don't entirely know yet. What we do know is very encouraging data that the vaccine will prevent development of severe COVID and really seems to be promising also to actually prevent development of symptoms altogether. Whether or not it can prevent the spread entirely, meaning that I might still carry the virus, although I don't develop any symptoms, but I might still be at risk of spreading it, that we yet have to learn and we don't know yet with certainty. Likewise, we're not yet sure how long that immunity will last. We know that these initial vaccines that we're looking at will require two shots about three or four weeks apart, and that we do think that by the end, after a week or two after that second shot, we do believe people will have some protective immunity. But no vaccine is 100%. So we will learn a little bit more as time goes by and more people will be vaccinated, but it's definitely been encouraging to see what's coming through.

GAUDETTE: And then Dr. Pate, another listener wants to know:

LISTENER QUESTION: If you get a vaccine, would a person getting a COVID test afterwards show positive for the virus, even though it's just the vaccine?

PATE: Well, it depends on the test, because we have a number of different kinds of tests, but if you're talking about like the rapid test, the antigen tests, no, those will not turn positive. If you're talking about the PCR test, the most common one where we're sticking things up your nose and sending that off to the labs, no, that will not come back positive either. But if you have an antibody test, then, yes, that will turn up being positive.

GAUDETTE: Dr. McInerney, Patrick is asking about ICU doctors, he says:

LISTENER QUESTION: We are a state of about 1.8 million people, do we know how many actual critical care doctors we have in our state?

MCINERNEY: So I don't know the numbers for this year, and I know that we currently have added at least multiple-- we've added four ICU physicians to our team this year. But as of 2019, Idaho had around 30 ICU physicians throughout the state. So not a lot. Yeah. So to become a critical care physician, it requires a lot of years of training. Right. And so, you know, it requires going through medical school and then residency and then two, at least, to four years of fellowship training, depending on whether you do research. So, you know, there are just fewer ICU physicians available throughout the country in general. And so.

GAUDETTE: Well, and we should be clear on that, Dr. McInerney, that that's part of it. Right. Is this-- when we talk about fatigue and we talk about medical staff being infected. Right. You can't just all of a sudden make new critical care doctors and just make new nurses and respiratory therapists. It's not-- you can't just go find them.

MCINERNEY: That's correct. And one of the things that is so different about this surge than earlier in the pandemic is that when New York City and California and Washington were experiencing their big surges, physicians and nurses flew into those places from all over the country to help. And now we can't do that because every single state is struggling.

And so I literally get, on average, five texts or emails a day from different facilities around the country asking if I can come and help for a short period of time to do what's called locums ICU care or, you know, to help out with a surge. And so, you know, obviously, my answer is I can't I'm trying to deal with my own patient population. And I'm not saying that I get those because it's just me. I think that every ICU physician probably gets the same number of inquiries to come and help, but we just don't have enough people to offer the support that's really needed all over the place.

GAUDETTE: Dr. Pate, Mike is a regular listener to Idaho Matters, and this is what he wants to know. He says,

LISTENER QUESTION: As a healthy 77 year old waiting for up to three vaccinations to be fielded, would you suggest waiting for several months after health care workers and senior home residents are inoculated for more data to be gathered that might determine if one of the three choices is more effective for older patients?

PATE: Well, Mike, that's a really good question, because it shows that you understand that with some vaccines, older individuals often don't respond as well as younger. But in this case, no, I would not recommend that you wait. And the reason is that the two vaccines that are first in line, the Moderna and the Pfizer vaccine, did look at whether these were equally effective in older individuals. And in fact, we got wonderful news that they are 94 percent effective across all ages. Now, that excludes, they didn't do young children, but across all ages, race, ethnicity and gender. And in the Pfizer trial, 41 percent of the subjects they had were aged 56 to 85. So I think they're sufficiently good evidence. I mean, we want to see the data, but if it's what they're saying, there's sufficiently good evidence. And given that this is such a high risk and that your age would place you in a high risk group, I would encourage you to take the vaccine as soon as it's your turn.

GAUDETTE: Dr. Schulte, Alana from Nampa has this question. She said,

LISTENER QUESTION: My husband recently contracted a mild case of COVID. He tested positive for it. We isolated it in separate parts of the house. We wore masks. She did all the cooking. They cleaned common contact surfaces like doorknobs, light switches. So far, I've not contracted the disease. Can you tell me when it is safe for us to return to normal household status? I've heard mixed things from three days after his symptoms are gone to ten days from the onset to 21 days after the symptoms end. And I'm concerned and I would rather air on the side of caution.

SCHULTE: Yeah, I can absolutely understand that and thank you for being so cautious and careful, I always love to hear that when people ask these good questions and it can be confusing. Well, it depends a little bit on the immune status of the person. Meaning if they're taking some medications that for some reason modulate their immune system because they're undergoing treatment for an autoimmune disease or cancer. For the majority of people that are encountering a mild illness, it is really the recommendation to wait about 10 days from the onset of symptoms as long as the symptoms are overall improving. And the exception there's the return of taste and smell can be, you know, very various among people and linger on. But more symptoms like shortness of breath, cough, you know, other symptoms that they might be experiencing and that the person is no longer experiencing fever without taking any fever reducing medications. So I think 10 days from his symptom onset unless he has some specific immune issues should be safe. That is what the data is showing us. And if she has any further additional question, I would recommend to double check with a physician.

GAUDETTE: Dr. McInerney, Karen has a question. It's pretty long, so I'm going to try to summarize it for you:

LISTENER QUESTION: They would like to have two to four guests over at a time. They have a sun room, no heat, but a fireplace. But it has windows that they can open. They have sofas that are eight feet apart. They have purchased a high quality air purifier with a HEPA filter. So they want to know if running the air purifier will help keep everyone safe. If someone asks once in a while to close the windows, she says any feedback on how we might make our plans safer is welcome.

MCINERNEY: So I recognize that it is really challenging in this time when we feel like we're socially isolated and can't have the gatherings at home that we would usually have. And I very much appreciate that she is working hard to try to minimize the risk. We've always said that outside is better than inside, distance is better than no distance and masking absolutely is better.

However, given our current community spread, I would actually recommend against having people over. And I know that people don't like to hear that. But even if you have what you think is a small social bubble, you don't know for sure what each person in that bubble has been doing, who they've come in contact with. So my recommendation is to hold off on having dinner guests over right now. You know, there is some light at the end of the tunnel with the vaccinations coming in. I understand that everybody is struggling right at this point in the pandemic. But err on the side of caution, I cannot tell you how many patients I see in the ICU who think that, you know, their friends or their friends, friends or their kids friends were being safe, but they still got the virus from them. So my first recommendation would be to not have dinner guests over for a while until you're vaccinated and until we've gotten through this. But if you insist on having dinner guests over, then outside is better than inside wearing masks when you are even if you're outside and even if your distance will mitigate the risk even further.

GAUDETTE: Dr. Pate, Lara has a question. She says,

LISTENER QUESTION: I know several families or roommate situations or couples where only one person is tested and the rest of the group who is symptomatic do not get tested. Are they counted in the probable column or are they untracked? And then she would also like you to speak to the number of people who are sick with COVID symptoms, yet don't get tested because they do not want to have to quarantine or miss work or school. She says I'm hearing this a lot in the community.

PATE: Yeah, so I hear that as well. So on the first point, whether those family members get counted depends on if there is contact tracing occurring relating to the index person in the family with the positive test. If there is and we have largely been doing that in the past, it right now is getting quite difficult because of the volume of infections. So certainly some of them may not be counted. But if we are doing the contact tracing, we identify the index case and then we identify that there are people in the family who are symptomatic and in close contact with the index case, but they don't get tested, but they have symptoms compatible with COVID. Then we will list them as probables.

Then as to the second question, you know, the problem is by the very nature of the question, we don't know, because what the question is, is about people not getting tested. We find out through testing. So if people don't get tested, then, no, we're generally not going to be aware of their cases. As to how prevalent that practice may be. You know, certainly we only have ideas from what we're hearing. I talked to the school nurses to get their sense. Some school nurses tell me they really don't think that's a huge number because it appears that the parents are being very cooperative. I have talked to another school nurse who said that certainly not the majority people, but she also certainly believes that is happening. So but I want to come around to a takeaway point from this question, and that is, please do not let the good be the enemy of perfect. In other words, if you are looking at our Idaho data and you are thinking, well, I'm sure some cases aren't being reported or they're not finding about this, that's all true. However, whether we are really, really bad or really, really, really bad makes a little difference. Please don't dismiss this data even if it's underreporting. Please recognize we have very high levels of disease activity and we all need to be taking this very seriously.

GAUDETTE: Dr. McInerney, Katie wants to know,

LISTENER QUESTION: Are there any statistics on what percentage of positive cases end up being hospitalized and what percentage of the hospitalized cases end up dying?

MCINERNEY: Right. So as far as the percentage of cases that are hospitalized, it's very low, it's in the single digits and to Dr. Pate's point, I think it's always important to recognize that we actually don't even know the true numbers of infections out there because of exactly what Dr. Pate just spoke to. I think that sometimes not everybody who is in contact with people and even get symptoms get tested. The mortality rates at the beginning of the pandemic were in the 20 percent range, 20 to 25 percent mortality for hospitalized patients. And now we're seeing that it's lower, it's at about 10 percent. And that's pretty good. It's very encouraging. It's still a very high mortality rate, you know, compared to other viral infections that we see. And it's a reflection of all of the science that's been collected on this virus and the new kind of approaches that we have to taking care of patients who are admitted to the hospital. So we have improved as far as mortality rates for hospitalized patients.

GAUDETTE: But I want to be clear on this, though, Dr. McInerney, is that, yes, those numbers have gone down. That is incredible. But there is a difference between mortality rate and quality of life, because we know that the research is showing that there are long haulers, that there are people who their life expectancy will be less because they contracted COVID and they may have heart issues, they may have lung issues. And these are lifelong issues that they will not be who they were before they got sick.

MCINERNEY: I agree, absolutely. And we still don't know, right? We don't know yet because we haven't been in this disease process long enough to know long term outcomes. Right. So I'll give another example. And critical care medicine, acute respiratory distress syndrome, which is something that people can get from severe COVID pneumonia, but non COVID related acute respiratory distress syndrome. We weren't able to say what the long term outcomes were for, you know, five or 10 years because it took people going out and finding those people five years later who had ARDS to see what their pulmonary function was, to see how their quality of life is. And so a lot of people forget this, that we are still in the very beginning stages as far as like thinking about big picture for long term effects of this disease.

You know, I have the great fortune of not only taking care of patients in the ICU with COVID, but I get to also see them in pulmonary clinic. And so in follow up in pulmonary clinic, I've taken care of multiple of my COVID patients and some of them have taken six months to get off of oxygen and they're still short of breath. They are not the same, a lot of them. So it's a very good point, Gemma.

GAUDETTE: Dr. Pate. Nancy just wrote in and she says,

LISTENER QUESTION: Even with getting a vaccine, I am assuming we will still need to wear masks for some time?

PATE: Yes, for a period of time. What we've got to do is it's not just individuals getting vaccinated, we've got to get to the infamous herd immunity levels and we don't know exactly what those are. Mathematical models project that it's somewhere around 60 percent. It ranges from, you know, 50 to 80 percent of people that we need vaccinated. You know, so what we want to do is get as many Idahoans vaccinated as possible. Once we get more and more people vaccinated, we'll see the numbers of cases coming down. And that's how we'll be able to tell when we're getting to the point where it could be safe to not have to exercise all of the restrictions that we have today. We're not going to get rid of coronavirus. So we're still going to have some cautions, but it's not going to be anywhere near like what we're doing today.

GAUDETTE: Dr. McInerney Del wrote in today and he says,

LISTENER QUESTION: I often see people wearing masks while driving or walking alone. Is this necessary?

GAUDETTE: I want to put a caveat in there. I've gotten to the point, though, where if I'm running errands, sometimes it's just easier to leave my mask on in the car.

MCINERNEY: Yes, it's funny, I see the same thing and chuckled to myself. It's not necessary, is the short answer, but I completely understand why I think wearing masks more frequently than not is better. And we've also spoken on this show before. Sometimes when my kids get into the car, they say, oh, you just forget to take their masks off. And I'm like, OK, buddy, you can take it off. So. So, yeah, it's not necessary, but I understand why it happens. It's better to have that kind of habit than to forget it when you go out.

GAUDETTE: Oh, 100 percent. I absolutely agree with you on that.

Dr. Schulte. Patrick is wondering,

LISTENER QUESTION: Can doctors just walk off the job in a situation like this?

SCHULTE: Well, first of all, I don't think we are at any risk for that, I thank you for Dr. Pate Dr. McInerney myself and many of my colleagues speak at this forum. We remain incredibly dedicated to this and so are our fellow clinicians. I think there's been a long debate whether or not physicians can go on strike. And we all agree that from our moral obligation, moral and ethical obligations to our patients, we would never do so without assuring care for patients. And to abandon a patient would be unthinkable, I think, for any one of us who is a frontline health care provider. So when you do see physicians or nurses go on strike, those are pretty much the extra hours that they might be spending to demonstrate an important aspect that they want to draw attention to. So I don't think that we are, you know, at any risk for that. But we're as we said, we're tired, we're exhausted. People feel a great degree of moral injury at times. You know, we do appreciate that most of the people are supportive and are trying to do what is right. And we will be here to take care of everyone, no matter what walk of life or what their belief around this disease is and what they present with. But, you know, it is something that that is taking a toll right now.

GAUDETTE: At Dr. Pate, Ben in Boise asked this question. He said and he said and he does say that, you know, we've talked about this on the program before, how sometimes things can go from being a public health issue to a political issue. And he says,

LISTENER QUESTION: I'm interested to know your thoughts about what scientists have to do to reach these people that are susceptible to disinformation and how do scientists and medical experts overcome these barriers of reaching this population in order to better align our pandemic response to evidence based practices.

GAUDETTE: I mean, is there a way Dr. Pate?

PATE: Well, it's a fascinating question, one I've been thinking a lot about and Dr. Jen Schneider over at BSU has actually interviewed me for a paper that she's writing on this subject to look at how do you communicate during a public health crisis where there is so much misinformation. So, you know, I think that for the physicians and the scientists, you know, one of the things that we have to do is we have to be clear at the onset that we do expect to learn more about something and our guidance might change. There are still people that are saying, well, I don't believe anything, because Dr. Fauci told us back in March not to wear masks. Well, you know, we got to get over that and realize that when there's a novel virus, we are going to learn things that we didn't know before. And we don't want scientists and doctors to not tell us what their best thinking is, even if it's subject to change. But we need to be more clear about it. I think we've faced a lot of really unique aspects. We've got social media, and right now it is so easy to perpetuate myths, conspiracy theories and false information. And we've never had a president who undermined our own public health response. So I think it's quite multifactorial, but I do think we have a lot to learn. And one last thing I'll say, I was talking to a New York Times reporter about this very subject. And I think one of the things is we need to look at education and how do we teach our children how do you find reliable sources of information? How do you know what you can trust? Because there are ways and it can be taught well.

GAUDETTE: And let's just remember this idea of, you know, certain things changing when it comes to recommendations. We used to tell people to put babies on their tummies. Well, we know that the back is best, right? We know that now. Scientists learn more. We know better. So we do better. Thank you, all of you, for what you do.

ALL: Thank you, Gemma.

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Samantha Wright is a news reporter and producer for Idaho Matters.