'Do Not Get Sick:' Idaho Doctors Explain What Crisis Standards Of Care Means For The State
North Idaho has implemented Crisis Standards of Care and state officials continue to paint a bleak picture. Health experts are urging Idahoans to get vaccinated, wear masks and socially distance — before the Crisis Standards of Care spreads to a statewide measure.
Idaho Matters is joined today by the former CEO of St. Luke’s Health System and current member of the Idaho Coronavirus Task Force Dr. David Pate and St. Luke’s System Medical Director, Primary Care Dr. Laura McGeorge to unpack the current situation.
"Nobody imagined we'd have this much public resistance to controlling a very controllable disease."
Read full transcript below:
Gemma Gaudette: You're listening to Idaho Matters, I'm Gemma Gaudette. North Idaho has implemented crisis standards of health care, and Tuesday state officials continued to paint a bleak picture urging Idahoans to get vaccinated, wear masks and socially distance before the Crisis Standards of Care plan spreads to a statewide measure. And as we do each Wednesday, we are bringing in our medical experts to explain the current situation and to also answer your questions. Joining us today are Dr. David Pate, former CEO of St. Luke's Health System, as well as a current member of the Idaho Coronavirus Task Force. And Dr. Laura McGeorge, St. Luke's System Medical Director, Primary Care. I want to thank both of you for joining us today.
Dr. David Pate: Thank you, Gemma.
Dr. Laura McGeorge: Good afternoon.
Gemma Gaudette: Now, remember, if you have a question, you can send it to us now, email@example.com. And a quick note about tomorrow's program. We are going to be focusing a majority of the show on COVID, kids, and school. We have gotten so many questions, so many concerns about that, so we're bringing in some experts to talk more on that. So if you have a question specific to kids, COVID, and schools. Email us as well and we will try to get those answered tomorrow. With that said, Dr. McGeorge, I'd like to start with you and just get us updated as to what St. Luke's is seeing right now, especially in regards to these crisis standards of care being implemented by the state up in North Idaho. How close are we to that happening here?
Dr. Laura McGeorge: Yeah, Gemma, you know, it's funny, I look back, I think it was just two weeks ago I was talking with you and how much has changed in those two weeks. And you know, again, we are expecting things to continue to deteriorate before they get better. We right now, we are committed to doing...everybody's committed, of course, to doing everything that possibly can be done to avoid getting into full official crisis standards of care. I think if you speak with any health care provider who is working in hospitals, they will tell you that we are not even today able to provide the level of care that we would have been able to have under normal circumstances because people are so stretched. I will give you an example of that just to really illustrate that. I was down in the emergency room yesterday, speaking with one of the emergency room doctors, and we just took a peek at the different emergency rooms on the board and in a one hour period, one of our emergency rooms--which is not typically our busiest in the system, but it's one of our bigger hospitals--in the emergency room, we had 14 patients come into the emergency room in one hour. Now that was when coming into an emergency room where the beds are already full. We already were having patients stay down in the emergency room because we don't have any place yet to transfer them and don't have a bed either upstairs or have a bed across town where we can transfer. So, you know that alone...you can imagine of 12 people coming in, there probably are some in there that need to be seen much, much sooner than later. And that just illustrates what is playing out everywhere, just how taxed the hospitals are and trying to keep up. But even today can't do as well as as they could do under just normal staffing and normal patient volume circumstances.
Gemma Gaudette: And Dr. Pate, health officials yesterday really made an urgent plea to the public to be more careful. And I want to talk a little bit about this because I think sometimes when we have talked about crisis standards of care, people think, well, that just relates to COVID. It really does not. I mean, when you have health officials tell you, wear a seatbelt. Be cautious about riding your bicycle. I mean, really avoid any high risk activities that could lead to an emergency room visit. I mean... this is unprecedented. I mean, this feels almost like a mash unit in a middle of a war.
Dr. David Pate: Well, Gemma, I think that's a good analogy, and you know, and I agree with you. I think a lot of people think this is just for people with COVID and I'm not going to get COVID, so it's all good... until they realize, no, it's not just COVID--it's a limited number of resources, a limited number of beds, a limited number of staff, and that there's a lot of conditions that you might have that are not COVID that you need the hospital and the hospital may or may not be able to take care of it in the way we normally would. May have significant delays. And certainly, we can look to a situation in Texas where a veteran--I think he was around 42 years old-- popped up in a small hospital in Texas with a serious medical surgical condition--not COVID--that needed urgent attention. And that physician worked for seven hours to find a hospital that he could transfer this patient to, that could give them the care that he needed because all the hospitals were filled with COVID patients. By the time they flew him to another hospital, unfortunately, his condition had deteriorated to the point that he could not be saved. Under normal situations, this 42 year old would have survived. He died because of this.
Dr. Laura McGeorge: I would like to add on to that too, I mean, that story that Dr. Pate has given...I have heard that same story in different circumstances, different diagnoses, but we are already seeing where patients come in and under normal circumstances--unrelated to COVID even--unrelated they could come in with an intestinal bleed or come in with marginal oxygen levels that may or may not be related to COVID. And in the old days, we'd just pop them up in the hospital and take care of them. But that is not an option now in many cases. And so we are practicing, we are doing the best we can. But circumstances, I mean, there are definitely people out there that are even suffering today due to the super tight capacity for health care in Idaho.
Gemma Gaudette: But let's be clear, this is not the fault of health care workers on the front lines who have to make these decisions. With that said, Dr. Pate, Lee has a question and it's regards it's in regards to misinformation that is out there, which seems to frankly be the biggest battle you know, we're waging outside of the hospitals. And so his question is--'this there is a lot of talk about getting the vaccine. I don't hear anyone asking for details about why a person who had COVID and tests positive for the antibodies should also get the vaccine. Is natural immunity actually less effective?'
Dr. David Pate: Well, it's a great question, Lee, and the reason it's a great question is we don't exactly know the answer to that question. So let me just say a few things. First of all, I think a lot of people have this impression that you get the vaccine and then in just a few days or so, you have your immune response. That's not really true. The immune system evolves over months. And so what your final immune state will be from the vaccine is some time out. And what early studies showed us was reason to believe that the vaccines produced a much more effective and durable immunity than natural infection. We even had a recent study that showed that people that had previously had COVID who did not get vaccinated were 2.4 Times more likely to get reinfected than those that did not. So we've had a lot of data suggesting that people that have COVID should still get vaccinated because they'll get better protection. There was a even more recent study that seemed to suggest people with natural infection may actually even have better immunity than those that got just vaccinated. The point being, this is evolving. We're learning, we don't have a final reason or final answer. I do believe that people that were previously infected are going to have a fair amount of immunity. The problem, what we don't know is how well is it going to be against this variant and future ones?
Gemma Gaudette: Before we take a break, Dr McGeorge, I want to talk a little bit about kiddos. Tomorrow, I mean, we are going to focus a big chunk of our show on that. However, just yesterday, the American Academy of Pediatrics Pediatrics announced that about two hundred and fifty two thousand cases of COVID 19 were reported just in the past week. So from August 26 to September 2, that figure marks the largest number of weekly confirmed cases in that age group since the pandemic started. St. Luke's has the Children's Hospital. What are... what are you seeing there? But also, I am assuming you have to be making plans for an influx of of kids coming in with COVID. And yes, may not be as serious as we see with adults, but there are kids that need to be hospitalized with this.
Dr. Laura McGeorge: Yes, Gemma, I have seen definitely nationally where there are larger volumes of children with COVID. We don't know if the Delta variant is more likely or more severe in children than prior variants. But just from the sheer number of children that get COVID, there will be, you know, a proportionate number that are going to end up in the hospital. We have not really yet seen that in Idaho. We're, you know, we're ready, we're anticipating it. I hope it never happens, but we certainly do expect to potentially start seeing more hospitalizations of children.
Gemma Gaudette: And Dr. Pate, does that concern you in regards to the fact that as we've seen, school opens in Idaho, it's been a mishmash. I mean, we've seen schools, in fact, who required mask mandates all of last year were able to keep these students in school...and now have done these mandatory but not really mandatory because we're going to allow opt outs. So we're going to have mask optional. I mean... It just seems like a perfect storm.
Dr. David Pate: Well, it does, and that's exactly what we've seen here in Idaho and across the country. We've seen much larger outbreaks than we saw last year. We're seeing more kids at younger ages getting infected. And that's because we changed our behavior and the virus changed its. We now have the Delta variant, which is very different than what we dealt with before. And I think it is disheartening that school boards are not making more of an effort to learn about this if they're going to be charged with these decisions because we've still seen school boards and school leaders saying some things that are just ridiculous and aren't true anymore.
Gemma Gaudette: Doctor McGeorge, Kate has this question, and you may not have the exact number, but she asks 'how many pediatric ICU beds does Idaho have for COVID cases?' She goes on to say 'children should never have to pay the price for political divisions and leadership, and they need to step up and they need to protect our children when it is difficult.' She says 'I am terrified for my grandsons who are seven and under, but for all of our children'. And I would say Dr. McGeorge, many of us feel that way.
Dr. Laura McGeorge: Right...yeah, we have about 13 pediatric intensive care beds in Boise, and my understanding is I think there there is a smaller number on the east side of the state and the hospital there. But that's about it for the state. So maybe at the most 20 in the state, you know, hopefully it won't get to that. We still, of course, you know, some people, some children and adults hospitalized with COVID also are in regular hospital beds and not necessarily in the intensive care unit. I do think as far as our children go, I don't think...anyone wants to see a child suffering at all from something that we could have prevented, and I do think that we have to make a decision as a society...if it's important enough to keep the schools open--which I think everybody thinks it is important, I hope everybody thinks it's important to keep the schools open--they're really, at this point, is only one way to do it. And that is making sure that they are following the public health recommendations in the schools, including requiring masking and then also again, having as many people, you know, essentially today, pretty much every student in junior high and high school is eligible to be vaccinated. And of course, all the teachers are too. And I think we've seen in the state of Idaho and also see nationally teachers who've gotten COVID in the classroom and have died from COVID. So I think we need to step up and keep our kids in school and keep the schools safe.
Gemma Gaudette: Right, I mean, just the other day, there was a report that 18 teachers in the Miami-Dade School district have died from COVID since August 26. With that said, you know, when we think of this idea Dr. Pate of can we find a common ground--and I think Dr. McGeorge makes such a great point about--I think we can all agree that we want our children in school. I mean, you know, we've seen the benefits of when they are in school. We have seen the deficits of when they have had to be remote. Yet there is still an argument that continues about masking being optional. I mean, it has happened in my own children's school and as a parent, it is...I am flabbergasted by it.
Dr. David Pate: Well, Gemma, I share your frustration, and frankly, I'll tell you it all comes down to school board governance. I have watched many, many school boards and they are just not employing very good governance methods. If they would, this would be far less contentious. It would be far less, you know, ups and downs and things all of a sudden turn on a dime. There was so much that could have been done over the last year and a half to make our schools safer and to make changes that could keep our kids in school--in fact, last year, I don't think that the kids had to be in hybrid--except that school boards and school leadership didn't make very good decisions and didn't plan well.
Gemma Gaudette: And Doctor McGeorge, John is a local nurse, and he wants to know if Idaho should designate "COVID hospitals." He said 'it was done for polio, for smallpox, for TB.' He says 'so why are we still exposing every facility and all of our health care staff to COVID? Is it time to house and care for COVID patients in a single facility?'
Dr. Laura McGeorge: Gemma, I would argue that most hospitals in Idaho are COVID hospitals. You know, about two thirds of our patients--more than two thirds--yesterday, 75 % of our patients in the intensive care units across St. Luke's are COVID. So really, it's not that that high proportion on the floors, but it is still a very large number. You know, if you were to move all of those patients out, I'm not sure exactly where you would put them or who would take care of them. I mean, we really have no choice but to take care of any patient that needs help. I mean, that's what we do. I think there is such a shortage of beds that creating separate facilities would not work. The other thing that's different is we have a much better understanding of infection prevention. And we actually do really-- in all of the hospitals and health care settings--really do a very good job in keeping our employees safe from patients and keeping our patients safe from employees. And that is making sure really that we are using appropriate level PPE, as well as making sure our staff know all the how to don and doff the PPE, making sure that they're wearing masks. The area where most health care workers get exposed is actually out in the communities when they let their guard down and less so at work. Although at work, you know it can happen. People tend to let their guard down, like in the break room or having lunch, and particularly in the winter. It's harder for people to be physically separated while they're eating and while their masks off. We do today have visitors--limited amount of visitors--that can come in and that... there are some pros and cons to that, but that too... visitors can bring COVID into the hospital. So we are very diligent about masking at St. Luke's.
"I hope it never happens, but we certainly do expect to potentially start seeing more hospitalizations of children."
Gemma Gaudette: Dr. Pate, we just received an email from a person who works at one of the large health care systems in Idaho. They do not want to be identified, but they say 'on Saturday of this past weekend, Norco ran out of oxygen concentrators to send COVID patients home with. They often go home on high flow oxygen with much higher oxygen needs than you normally see, and those concentrators were all used up by Saturday morning. This is, of course, had implications for being able to get more patients with COVID into the hospital.' Dr. Pate...everything we continue to hear is just alarming.
Dr. David Pate: Well, it is and there is a limit to all of our resources. It's kind of like the old saying 'you don't build the church for Easter Sunday.' Well, we don't build our health care system for an uncontrolled pandemic in which people aren't willing to adopt public health measures to contain it. I mean, nobody imagined that we would have this much public resistance to controlling a very controllable disease. And so we're not prepared for this. There is a limit to all of the resources and we saw this happen in Florida. Those hospitals got down to less than two days supply of hospital. So right now, we're just talking about the challenge with getting oxygen to send patients home. You know what people ought to pray about is that we don't end up with a shortage of oxygen in our hospitals. He saw Kootenai Hospital just put in a much larger oxygen tank, but...there's limits to all of these things. And keep in mind, you know, for example, there's a real shortage on the kinds of masks that we use to try to keep people breathing before and prolong or delay or avoid putting them on a ventilator. We're running low on those, too, but guess what? So is every hospital in the country, so it's hard to find these things.
Gemma Gaudette: Dr. McGeorge, Jamie in Ketchum has this question. She says, 'can we please connect the dots more clearly here? People choosing to not get an available and free COVID vaccine are filling the hospitals and ICU. This result in fewer options for non-COVID illness. Had these people gotten a COVID vaccine, we would not be in this situation. True or false?'
Dr. Laura McGeorge: True. So let me boil it down to numbers here for you. Right now, we have 224 patients in the hospital with COVID across our system. 91% of them are unvaccinated. So if you do the math--let's keep it simple and say 10% were vaccinated--that instead of 224 patients, we would have 22 patients across all of St. Luke's and with COVID. I don't know how that compares to like a bad flu season, but it's very manageable and would not tax our resources at all. So of the 224, we would have 200 less. We're bringing doctors in who do not do inpatient medicine routinely. We're bringing nurses in from the operating rooms who are not used to working in critical care. We are just...all those excess 200 patients...we would be normal operating procedure if we had everyone vaccinated. And I would add to that, you know, at this at this point, it is so important to get vaccinated again because we are not out of the woods. But I will tell you right now do not get sick. Do not put yourself in a situation where you are risking exposure to COVID 19. Do everything you can because again...it's going to be very challenging to get care right now.
Gemma Gaudette: Dr. Pate, do we have any information yet about when the 12 and under age group can potentially be vaccinated? I mean, as a parent ,again, of a child that cannot yet be vaccinated, this is truly what keeps me up at night.
Dr. David Pate: Oh, yeah. No, unfortunately, we don't have any new information. I think still many of us believe that it will be within the next month, two months or certainly before January. But we don't know when. But I think back to your previous point, Gemma, it's all the more reason why some of these school boards have made very irresponsible decisions because we're not saying that kids are going to need masks forever. We're not even saying they're going to need them for the rest of the school year. We're saying we need them now to keep people out of the hospital and to protect these children until they can get vaccinated. And most all of us are expecting it's going to be by the beginning of the year.
Gemma Gaudette: Dr. Pate, Pam just wrote this email to us, and she says,'how would your medical experts respond to the criticism voiced by some that activation of the crisis standards of care has been caused by the vaccination requirements of many medical facilities--meaning medical personnel are resigning rather than receiving the vaccination. I do not believe this, but I would like to hear the answer from the experts.'
Dr. David Pate: Well, your listeners correct, and it's demonstrably false. And so in other words, if you look at the pressures on the hospital ,for beds and staffing, it is not because a number of employees have resigned that we needed to care for these patients. That is not what has happened. What has happened is exactly what Dr. McGeorge has said. It is the failure of people to get vaccinated or if they cannot or they choose not to, then it's their failure to adequately avoid large groups, wear a mask properly--a good quality mask properly. That's what we're dealing with. This is not caused by people resigning because of the vaccine requirement. That's a very small number of people that would not have made a difference in keeping our hospitals going.
Gemma Gaudette: Dr. McGeorge, Ben writes in saying, 'I'm concerned about the ability of the Treefort Festival to enforce the vaccine and testing policy. So do events with vaccine requirements actually pose less risk than those that do not?'
Dr. Laura McGeorge: That's a tough question. My guess is that they are not validating vaccination status that it is the honor system and and so I don't know for sure how they could possibly validate everyone there having been vaccinated. We know that also some people in lieu of vaccination could get a test. That test could be negative two days ago when they got it. And then the COVID just sort of starts the following day--kind of between when they show up for the festival or not. As we always say, outdoors is better than indoors. I just think, in another year and in another life, it might be OK to do it, but if we think about how stressed the health care system is now--I just can't even imagine how these large gatherings are not going to further impact and stress the hospitals. And if you don't do it for the health care workers and for the community, I would say do it for yourself, just protect yourself from getting sick right now. And I personally would not go to a large gathering even if it were outdoors and everyone's masked. It's just such a...such an unsafe time right now.
Gemma Gaudette: So, Dr. Pate, let's take that a little bit further, because we've got Pride Festival. We've also have Art In The Park happening this weekend in Boise. It is Art In The Park, it is outside--but there are booths, people you know, wander around. It can be crowded. I mean, your thoughts on something like that because, you know, over the summer it was safe to go outside and to do these things. But here we are again.
Dr. David Pate: Yeah, here we are. So let's explain this. Anything you do, if you're going to do it, it's going to be better outside. But being outside does not mean you can't get infected. And in fact, I think it was--you know, time is blurred, but I think it was just a few weeks ago--there was a close to 5000 people infected outdoors in England because they were packed shoulder to shoulder and screaming at a concert. That would be as about as high as risk of activity as anything I can think of. So here's the deal. There are two main ways that you can transmit COVID. One, is what we're all familiar with--respiratory droplets. That's the issue where we try to maintain the six feet of space because saliva and secretions coming out of my mouth or nose can travel a short distance and land on you and infect you. That's respiratory droplets. The other is airborne. This is the small aerosols that move in air streams of ventilation systems. That's why we say when you're indoors with people that aren't in your household, you need to wear a mask because even if you're more than six feet away, the virus can travel on these air streams. The benefit of being outdoors is you don't have those air streams created by ventilation systems. The only significant risk outdoors is the respiratory droplet. But that's why we say when you're outdoors, you don't have to wear a mask, if you can maintain distance because you're not going to transmit it to somebody more than six feet away, you're probably not even going to transmit it to somebody three feet away. But if you're standing shoulder to shoulder for a long time, you're yelling, speaking loudly singing...they're going to be at risk, so we need to still distance when we're outside.
Gemma Gaudette: Dr. George, we're getting questions in in regards to the flu shot and COVID. So I'm going to give you two. So, so Dee wants to know if you should get a COVID booster when available and then at the same time, get your flu shot or should you space them apart. Brooke goes on to say, 'what about the research that's coming out, saying a flu shot may offer some protection against COVID? So do we actually need a booster and a flu shot?'
Dr. Laura McGeorge: Well, so first of all, the easy question, yes, you can get them both on the same day. Generally, that's more efficient. Initially when we had COVID vaccines, we didn't have enough experience with them and so the recommendation was on different days. But we do know now that you can get them both the same day. Certainly, it's the most efficient to do it that way. It's unclear, you know...it just depends what that office has available and whether they can do it. But we can get flu shots at pharmacies now. You can get COVID vaccines at pharmacies. So I always just tell people to get it as soon as you can and when it's convenient or most convenient for you to get it. As far as influenza protecting against COVID, I am not aware of any literature stating the influenza vaccine is protective against COVID. I will comment on influenza in general. I think last year we saw hardly any influenza or RSV and again just don't know what this winter is going to bring. Certainly, if there is less masking compared to last year, we should expect to see a lot of influenza this year. So it really is important to be vaccinated against both viruses.
Gemma Gaudette: And really quickly, Dr. McGeorge, for folks that aren't familiar, what is RSV? I am aware my youngest had it as an infant.
Dr. Laura McGeorge: So it's respiratory syncytial virus. In adults and even in older children, it can just cause what feels like a cold, but it can be life threatening in newborns and also in children who have other complex medical conditions.
Gemma Gaudette: Dr. Pate Dannette writes in she says, 'what can you say about the claim that the government refuses to research ivermectin because it could be an inexpensive way to treat COVID?' I must say once again, Dr. Pate we've got to decimate this misinformation that's out there, I mean, we have to let people know the facts.
Dr. David Pate: Yeah, it is frustrating. So first of all, let me just say emphatically that is false. In fact, there's been many investigations into ivermectin and some studies are done--even by the maker of ivermectin--and they have said it is not effective to prevent COVID. It is not effective to treat COVID. The FDA has reviewed the studies and said the same thing. And so, no, it's not a matter that...for some reason we wouldn't want to do studies because it would be cheaper. The other thing that I think everybody could use as a rule of thumb--just when you when you hear these things, just ask yourself, 'does this make sense? Does it make sense that the government wouldn't want a less costly way to prevent this pandemic when the government pays for a lot of the care? Wouldn't you want something less costly?' So we need to be very suspicious of some of these things we hear.
Gemma Gaudette: Dr.Pate, Sistee in Boise writes in saying 'will the COVID vaccine given to a breastfeeding mother interfere with an infant start of required childhood vaccines? And would there be a reaction or lessen the effectiveness of a baby's vaccines? So should a mom get the vaccine a few weeks prior or after the start of a baby's vaccine cycle?'
Dr. David Pate: So the answer to both is no. The mother, if she is not vaccinated yet, you need to get vaccinated like right away because--not only is it going to be helpful to protect your baby--but we need to protect you because that baby's counting on you. So please get vaccinated right away. What we find is that vaccination and vaccination of everyone around that baby is going to be key to keeping your baby healthy. If you are vaccinated and your breastfeeding, I assume, is the question you will give your infant some of the very protective antibodies. So that's a good thing. And we know that that will last for at least six weeks after your vaccination, but that doesn't interfere with other vaccinations for the baby. And one of the key things is there are many other threats to your baby. So we want to make sure that your infant--or if you have older children that have gotten behind--you need to get your children caught up with any vaccinations they're overdue for and get them back on schedule and do not get off schedule. We need to protect these children. Go ahead and get yourself vaccinated and then get your baby vaccinated whenever your baby is due.
Gemma Gaudette: Since we had the question from Ben, in regards to Treefort, we did get a response from Christian with Storyfort. And so I do want to read their response. I think it's important to share their information as well. So Christian says all Treefort and fort attendees must have proof of vaccination or a very recent negative test, or no entry is allowed. All attendees, vendors, staff, artists, volunteers, performers and anyone aged 12 and older will need to have proof of vaccination against COVID 19--physical or digital card accepted. So is a photo of vaccination card from your iPhone. Or you have to have proof of a negative PCR test--hey go on to say the nasal swab one--within the past 48 hours. Just wanted to let folks know what Treefort is saying about what they will be doing in regards to that. With that, said, Dr. McGeorge, Jennifer just wrote in and she wants to know how soon after having COVID should one get a vaccine. She says 'I have six family members who refused to get the vaccine. They all got sick. A couple are now asking this question about when they should get the vaccine.'
Dr. Laura McGeorge: Yes, so you can get the COVID 19 vaccine as soon as you are out of the isolation period from having had COVID. So for most people, that's just 10 days after their symptoms start. You know, typically they have to be getting better and be fever free. But essentially, as soon as you're out of isolation, you can go ahead and get that vaccine.
Gemma Gaudette: And then Dr. Pate, Mary wrote in, she said 'if tested for COVID by a home test versus a drugstore versus a hospital. Are the tests equally sensitive? Are the home tests reported to the health department? And if you are positive and then become negative after 14 days when when you are exposed, could you become positive again?'
Dr. David Pate: So let me try to remember and take this in order...
Gemma Gaudette: Yeah, let's start with the testing. How about the sensitivity of the testing?
Dr. David Pate: Yeah. So if you are getting the test from, say, one of the national pharmacy chains, that's going to be a good test. What I would be worried about is some of the tests that you can order over the internet. Some are good, some are not so good. So but if you go into a big name pharmacy, they're going to generally have the better test. And so, yeah, those tests are generally going to be of pretty good sensitivity. The question more relates to the timing. So for example, if I just got exposed today and I get tested tomorrow, I could very well be coming down with COVID, but my test will be negative. That's too soon. Similarly, you can wait too long, so a lot of it has to do with the timing. Ideal time to test after you've been exposed would be three to five days. The next question was it if you recovered and then you got exposed again, would it be positive? Was that the question?
Gemma Gaudette: Yes.
Dr. David Pate: Yeah, so the answer is generally yes. So realize, though, that not every exposure results and infection so you could have exposures and test negative, but that would just mean you are exposed, but you didn't get infected. But yes, if you get reinfected and you do the test at the proper timing, then yes, it'll be positive again.
Gemma Gaudette: Dr. McGeorge, Lin has this question, she says 'I had COVID and I'm fully inoculated with the Moderna vaccine, so what are my risks for contracting a breakthrough infection? I have begun wearing a mask in stores and inside public spaces again, as I suspect I could be asymptomatic should I contract it again. I have three grandchildren young enough that they are unable to get the vaccine yet, so I do not want to expose them or anyone else, for that matter.'
Dr. Laura McGeorge: Well, I first of all, I'm glad she got both of the first and then the booster for the Moderna vaccine, so that's great. Her likelihood of getting COVID very much depends on how much she is getting exposed to COVID. But she is much, much more protected now having had the vaccine, and the vaccines with the Delta variant are probably around 60% protective for getting any COVID at all. And again, to her point, it would likely be people have't been vaccinated. It's most likely like a head cold kind of symptoms or no symptoms at all. And of course, you know, the problem with no symptoms at all is is we think we're perfectly fine, but we can, of course, spread it to other people.
Gemma Gaudette: And that is why, once again, masking is key, right? As always... some days I feel like a broken record. But Dr. McGeorge, I'm sure you feel like you've broken many records in the last 18 months. I want to thank both of you so very much for coming on the program for for doing what you do. You know, I don't think we could be moving through this without all of your expertise. So thank you to Dr. David Pate, former CEO of St. Luke's Health System, as well as the current member of the Idaho Coronavirus Task Force and Dr. Laura McGeorge, St. Luke's System Medical Director of Primary Care.