Idaho Matters is back with our panel of Idaho doctors to answer more of your COVID-19 questions. This week, they answer questions about new sterilization protocol, inconsistent reporting and the risk of super-spreader events like protests.
Joining Idaho Matters this week are:
- Dr. David Pate, a member of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s.
- Dr. Jim Souza chief medical officer for St. Luke's Health System.
- Dr. Ryan Heyborne, Chief Medical Officer at Saint Alphonsus Regional Medical Center
Have a question for the panel? Leave us a voicemail with your question and we may use it on next Wednesday’s show. Here’s the number to call: 208-426-3625. Or email us at idahomatters@boisestate.edu.
Read the full transcript here:
GEMMA GAUDETTE: This is Idaho Matters. I'm Gemma Gaudette. We are continuing to answer your questions and, of course, staying up to date on the coronavirus. So today we are joined by a group of medical experts, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce, Dr. Ryan Heyborne, chief medical officer at St. Alphonsus Regional Medical Center, and Dr. Jim Souza, St. Luke's chief medical officer. Thanks, everyone, for joining us today.
ALL: Hi, Gemma. Thank you. Thank you.
GAUDETTE: And if you have COVID-19 question for our doctors, send us an e-mail at idahomatters@boisestate.edu. So, Dr. Pate, let's just get started with where we are right now, we started Stage 3 Saturday of the governor's reopening plan. How would you say we're doing at this point?
DR. DAVID PATE: Well, at the moment, I think we're doing quite well. As far as you would measure that by number of cases, people coming into the emergency rooms, people being admitted to the hospital, though I do have to say I am cautiously watching those numbers every day. I do fear that there's a lot of people, because we have been doing so well that have become a bit complacent about the virus. I'm seeing larger groups than I would feel comfortable with. I'm seeing people not doing as much physical distancing and I'm seeing mixed use of face coverings and face masks. So I do have fears that the number of cases are going to jump in the next couple of weeks. But so far, we're doing very well, and that is to the credit of the majority of Idahoans who have been taking this very seriously and exercising precautions. For everybody else, I would just warn you, this virus is still out there. This is not gone away. We still need to be cautious. The fact that we're not having a lot of cases in Idaho is because of all those measures. So please protect yourself and protect others.
GAUDETTE: Because it definitely feels like there has been a shift, Dr. Pate. And a sense of, you know, all of a sudden, I mean, you're just seeing more people out and about more cars on the roads. It's like the weather got nice and all of a sudden people seem to have forgotten.
PATE: Yes. And I think, you know, the nice weather has contributed to this. Of course, who doesn't want to be outside? And people do long for a return to some sense of of normalcy. And certainly, I think people are safer outside as a rule. But that doesn't mean you can't still transmit this virus outside. And so we do need... If I could just ask all of your listeners, if I could only have two things, then what I would ask for is please do the physical distancing, a minimum of six feet, more is better. And the second is when you are outside, when you are going to be around other people, please wear a face covering or face mask.
GAUDETTE: And Dr. Souza and Dr. Heyborne, we are lucky enough to have both of you on today, you are both the chief medical officers for the two biggest hospital systems in our state. So what are you seeing right now in your hospitals when it comes to COVID-19? I mean, are you seeing more cases, less cases? And then, you know, what's going on, in your hospital itself? Are we doing elective and non-emergency surgeries now? And Dr. Heyborne, why don't I just start with you?
DR. RYAN HEYBORNE: Thank you and I appreciate Dr. Pates comments as well and really recognize the people of Idaho as heroes in this pandemic and making good choices and helping limit the spread in our state. We have been very fortunate in this state compared to others with the rate of infection, those that get critically ill with it and so forth. And so we're seeing the same thing in the hospitals that are occurring in the rest of the state is that our cases are stabilizing, decreasing. We hope that that's a trend that continues. What we're doing right now is we're really focusing on two things. All around patient care. We want to keep our patients safe and we want to make sure our patients get the care they needed. As you mentioned, a lot of procedures have been postponed or delayed. And our patients need to be aware of that. And people that have chronic illnesses need to know that they need to get the care that they require to keep them healthy. And all of the hospitals, all of the health systems are taking precautions with visitors, with limiting visitors that can come to the hospital, with screening and testing patients who are coming in for surgery, with utilizing appropriate protective equipment for both the health care providers and the patients. All of this we're continually monitoring. This is a very dynamic situation, still. We're monitoring, we're adapting on a daily basis.
GAUDETTE: And Dr. Souza, same question for you. How are things looking with with St. Luke's?
DR. JIM SOUZA: Agree, stabilizing. We have 13 in patients across our system today and we've been relatively stable at that level for the past three weeks or so. Our elective surgeries are also coming back with a focus on safety and testing, our elective clinic visits are coming back. And just for interest, I think everybody's experiencing this. We've had a huge surge in telehealth. We've done more than 20,000 virtual visits now since mid-April. At this point in time, more than 15% of all of our visits are virtual visits. Our clinic protocols have all changed, of course, to enhance physical distance, masking, cleaning itself.
GAUDETTE: And speaking of cleaning Dr. Souza, since this all started, St. Luke's right to using something called the Stara Miss Surface Unit to sterilize everything, I mean, you're talking from patient rooms to computers. So, what is this? How does it work.
SOUZA: Yeah, it's a device that was created by the Department of Defense, it actually uses ionized hydrogen peroxide solution of about 8% hydrogen peroxide, and it creates this visual fog that kind of comes out the end of a wand and allows touchless application and disinfection of this decontaminating solution, which, you know, has proven efficacy against a whole bunch of microorganisms, including SARS-CoV-2, which is the agent COVID-19. You know, it probably has particular utility when you're trying to sterilize complex surfaces with, you know, lots of angles and crevices and things like that because it can get into those. There are sites, we're not doing this, but there are places around the country that abuse these devices to recycle their N-95 masks, for example.
GAUDETTE: And Dr. Heyborne, we know that since the pandemic started, your hospital has really been good about trying to make some community connections. And one of the things you've been doing is your Global Gardens distribution site at St. Alphonsus in Boise. And we've noted this before that I mean, employees can use this, but can you talk about how it's helping refugees and folks who work at the hospital?
HEYBORNE: Absolutely, thank you and this is something we're really excited about. Basically, how it works is we have a relationship through Global Gardens with local farmers that are members of the refugee community. And so they're able to garden and farm and provide fresh produce to our colleagues. The way that works is we've set up a distribution point, clearly using appropriate social distancing, masking guidelines and so forth on our campus. But it allows these individuals of our community to provide a very needed service, supports our colleagues. And, you know, there's there's not a need for them to go into public areas for shopping as much. It's really a Win-Win all the way around.
GAUDETTE: Dr. Pate, Brian, a listener asks this: regarding the Crush the Curve antibody testing. How accurate is this test they're using? I have read many accounts that there are so many different tests out there, and many, if not most of them, have not been vetted for accuracy or efficacy.
PATE: Well, yeah, that's a that's a great point. These tests haven't been fully vetted yet. That is the process that one would go through for FDA approval. The FDA has said these tests in certain cases can be used just because of the urgency of the situation. But they haven't been fully vetted or tested. So we do have to rely on the manufacturers' representations. With that said, it appears that the Crush the Curves test is one of the better ones and it is a good test. But I would also point out there's no test that is 100% accurate. And and so I would say three things: The first is that we're not really sure what the significance of a positive antibody test is. In many cases, it will mean that you were previously infected with this virus. But we don't know if that means that you are protected from another infection. We just don't know. We certainly believe it is likely that people do have some degree of immunity, but we just don't know. We don't know if everybody who's infected get some protection, just some people. If you do get protection, we don't know for how long. So we just really don't know a lot about it. The second point is, with any test, even a good test like the Crush the Curve test, if you test people in a population that are very unlikely to have the condition you're testing for -- and typically that means a population that you would expect less than 5% of the population to have the condition, and in Idaho, we believe it's actually less than 2%, then what's going to happen is you are going to get some false positives. In other words, some people will receive a positive antibody test, and yet they didn't really have the infection. The third thing is, you know, if the curiosities just got the best of you and you are determined to get the test, and you're willing to pay that money. That's fine. But when you get a result, don't change your behavior. So even if you're positive, continue to take all the precautions that you otherwise would. And I would generally, unless you know what your employer's going to do with that information, I generally wouldn't provide that information to your employer. Your employer shouldn't be taking different action based on the test either. We just don't know what the test means. I think one day we will. And I do think it's likely that it's going to be very helpful in the future when we really understand it. But we don't today.
GAUDETTE: And Dr. Heyborne, that kind of goes into this next listener question. We keep hearing different information. And so after recovering from COVID-19, are you immune or can you get it a second time?
HEYBORNE: I think we all share the frustrations and the challenges with hearing different things. And as with any disease process, it really takes years to truly understand it. And so we will be continuing to analyze data and modeling and understand this virus for quite some time. It is very fair to say, yes, it offers some immunity. Now, how much? I mean, you think of even a disease where we know that having it imparts a good immunity like chicken pox. You'll still see people occasionally get chicken pox a second time.
GAUDETTE: Yeah, my sister got it twice.
HEYBORNE: It's no fun. That is bad.
GAUDETTE: I mean, she. She did. She got it twice. Yeah.
HEYBORNE: So, you know, hope that those individuals that have had the condition are are immune to it. We know they are to some degree. But we also know they're they're not 100%. And so that exact percentage is something we'll continue to follow. And that is tied to what Dr. Pates said. Not to make the assumption of I've had it or I've got antibodies in them, I'm Superman or Superwoman, all of a sudden that's that's just not the case.
GAUDETTE: That's just such a good point, though, Dr. Heyborne, that, you know, even if you've had it. I mean, we don't know enough yet to know what kind of immunity that gives you.
HEYBORNE: Correct.
GAUDETTE: Dr. Souza: Sue, a listener, has this question. It is a little lengthy, but I do want to read the whole thing to you. She actually sent it to use in an email. She said "my husband, in the last week, has visited a local hardware store and a lighting store. And in both cases, none of the employees were wearing a mask. He was. And at the hardware store, he actually asked an assistant manager why she wasn't wearing a mask. Her reply: My boss says we don't have to. This makes some of us very uncomfortable because of what we've learned, that wearing a mask protects those around you. So what suggestions do you have for one? What do you say in that kind of establishment? And two, how do we increase the number of those who wear masks, especially in businesses serving the public?
SOUZA: Wow, what a great question. You know that first of all, your your listener already made the point of why you wear the mask. You wear the mask to protect the people around you in the event that you are an asymptomatic shedder. And we know that a relatively large number of people don't know that they're infected and shedding this to potentially vulnerable people or people who are not going to have an OK outcome. So we all got to do it together. Second point I'd make is there's some brand new data just this week, a large study commissioned by the World Health Organization. It was a meta analysis. It's not a randomized controlled trial, but demonstrates that wearing a mask reduces transmission rates by around 85%. So it works. Now in terms of advice? What I would suggest is that, you know, you respectfully engage management in a conversation, as this person did. I, frankly, would have tried to find out how to reach your boss. And I'd want to let that person know that that I have choices and that I'm going to be choosing to exercise those. You know, all businesses, including ours in health care, we're realizing that we need to put a new emphasis on safety. And for those who think that their business or their volume is going to come roaring back, that's only true if we really focus on safety. Otherwise, those who are, you know, following the science are concerned they may not be coming back. So I think those productive conversations with our businesses are some of the best ways we can get people to increasingly adhere to the good science based guidelines.
GAUDETTE: Dr. Pate, Steve e-mailed us this question: Could you give us a status update on contact tracing efforts across our various health districts? Do the districts have adequate funding to conduct tracing on all new cases?
PATE: Yes, actually, there's been a significant improvement in our capacity for contact tracing, and that is through these funds. Some increased hiring, but it's also we've had some wonderful volunteer [inaudible] Boise State [inaudible] and people that can be trained to do [inaudible].The state has just acquired some technology that will help with the contact tracing and decrease some of the people. But, yeah, I think the public health districts are very well still able... To keep in mind the [inaudible] It's that Idahoans have been complying with the public health recommendations. And therefore we have a relatively low number of cases because with each one of these cases, there's going to be many people that you have to contact trace. If we let up our guard and we have a huge resurgence, then obviously not only can we overwhelm hospitals, but we can overwhelm the ability to do contact tracing. And in fact, when it gets to a certain point, the contact tracing is no longer particularly effective because it's so spread out there. So we need to keep up what we're doing. And if we do, we are well staffed, well to handle it.
GAUDETTE: And that's a really good point. I mean, we don't have to just keep doing our part as well as citizens. So, Dr. Heyborne: Mary, a listener, has two questions. She says Number one, since cloth masks mostly protect others, not the person wearing it. And we talked about that before. Will an N-95 mask, not necessarily the medical N-95 ever be made available again to those of us that are immune sensitive? And she says Home Depot used to have N-95 mask for things like dust and pollen and etc.. And wouldn't these be better?
HEYBORNE: Yeah. Thank you and I expect, I mean, we can just say with with good confidence, those supplies are going to be replenished and so consumer availability will just continue to increase. We're fortunate, another call out to those that are doing great things in the community is making cloth masks. We've been the recipient of donations of tens of thousands of masks. One thing to remember as well is that there is some protection from wearing a cloth mask, admittedly, not as much as kind of either a medical grade or a tighter type of mass, like even a KN-95 which are available to the public. You know, they can block large droplets. They do discourage you from touching your face. You know, if your face is covered. And so those are the types of things that do provide some benefit, albeit fully, admittedly, primarily prevent the spread to others and don't offer that same level of respiratory protection. So in summary, absolutely. We expect that if supplies continue to catch up with demand, that more and more options will be available to consumers.
GAUDETTE: Dr. Souza. We have a question from a listener. How accurate is the antigen test for the virus? I read where the antibody tests were only about 50% accurate.
SOUZA: Yeah, so that in in that question. Two different types of tests are mentioned antigen and antibody. It sounds like the main question is around the antigen test. Just to remind your listeners, there's kind of three different types of tests, right? There's a PCR test which tests for the viral RNA and it can amplify tiny quantities of RNA and get really high sensitivity. And in terms of the ability to detect. The antibody test is a test for human reaction in terms of making these protein antibodies against the infection. Dr. Pate already made comments on that. The antigen test is actually testing for little proteins on the viral surface. And it's kind of like a rapid strep test. I am only aware that the FDA has given emergency use authorization to one of those, and it has a reported sensitivity of about 80%, which means there are still, I think, that's the company saying that. I think there's some skepticism that it might not be that high, which means that there would be a lot of false negatives. Probably the kind of place where this kind of test would be used as someone maybe being admitted to a hospital very symptomatic with a lot of virus and a large load that you could pick up this protein source.
GAUDETTE: And Dr. Heyborne, we had an anonymous call from a woman in a Magic Valley and she said four workers and a chain department store had tested positive for COVID-19, but they were not reported to the state. So I guess the question is, are all positive tests reported to the state? And who does the reporting?
HEYBORNE: Thank you. Yes. Well, yes. I mean, those positive test results do get reported for various reasons. And so that happens by you know, it happens when we find a positive test. Any hospital or system, hopefully, that is running these tests is making that reporting accordingly. Unless. Dr. Pate or Dr. Souza knows otherwise.
SOUZA: Yeah, no, SARS-CoV-2 is a reportable disease. It wouldn't necessarily be the employer doing the reporting. But, you know, all laboratories do that reporting. Physicians have an obligation to report. But largely, our obligation is sort of handled by the laboratories.
GAUDETTE: So I think that's a good clarification to make. It may not be an employer doing that. You know, they may not have said anything, but if you get a test, it's going to be reported. Dr Pate, Chris sent us this email: I'm confused why the state's new daily case number often does not match with the COVIDtracker.com numbers. Which source has the current numbers? And he gives a couple examples. I'll give you one: on May 28. That said, the state 34+4 probable but COVIDTracker.com said there were 71.
PATE: Yeah, the the COVIDtracker.com is a really good website and has a lot of good information. However, whenever you're dealing with data, you you need to look at two things. One, what is the source of the data? And number two, what are their definitions, their terms? Because sometimes people count a case, whether they have tests or doesn't, other people include cases where somebody just thinks somebody has COVID. But it's not proven. Sometimes it's done by date of onset of symptoms. Other times it's done by the date the lab reported the test. So there can be a lot of differences. When you look at COVID Tracker for the the the really big overall numbers, like our number of deaths and our number of confirmed cases, which means a laboratory test was positive, there's a perfect match. But if you look at some of the day to day things that when was the data [inaudible]. So you can get some confusing variations. I think if you want to follow daily activity, the best site is our state site. The coronavirus.idaho.gov site that will give you the best information.
GAUDETTE: And we have a comment to pass along from Tanya. She wrote in, and I want to read this in its entirety. She said: My father was one of the unfortunate victims of COVID-19, and passed away at St. Luke's in Meridian. I just want to call out the outstanding care that the medical team did for him. Allowing us to connect with him over the phone was such a blessing for our family before he passed. Thank you.
PATE: Well, Gemma, this is David Pate, maybe I can just make a comment. First of all, Tanya, all of our hearts pour out for you. You lost your father. It's wonderful you're recognizing the great care. And let me just mention, as somebody who is now retired and looking at the health care delivery system a different way. Let me just tell you, I am so proud of all of our health care givers, St. Luke's, St. Als, Primary Health, all these [inaudible] that are so brave, who come to work even though they know they may be incurring risk themselves and the great care that they're providing to the people of Idaho. So thank you for your note, Tanya. And please accept our condolences.
GAUDETTE: And truly, you're right. Dr. Pate, thank you to every health care worker. Doesn't matter where you work. It is the effort. And what you are all doing is saving lives. So thank you all very much. Of course, if you have more questions for our panel, please send them to idahomatters@boisestate.edu.
We've been talking with Dr. David Pate, former CEO of St. Luke's Health System and now a current member of that coronavirus task force, Dr. Ryan Heyborne, chief medical officer at St. Alphonsus Regional Medical Center, and Dr. Jim Souza St. Luke's chief medical officer. Thank you all so very much for your time for answering these questions and for keeping us informed and updated.
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