Tuesday, October 20, 2020
Doc Says Start Worrying About Your Hospitals Now
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Miles Fink-Debray has been leading fitness workouts outside his Ketchum Sweatshop during the pandemic.
   
Friday, October 16, 2020
 

STORY AND PHOTO BY KAREN BOSSICK

As a member of the state’s Coronavirus Task Force, Dr. David Pate is getting pelted with questions about whether it’s safe to go over the river and through the woods to grandmother’s house for Thanksgiving. He’s also repeatedly asked what he believes is the riskiest sport to engage in during the COVID pandemic.

He answered both and more this week during a virtual question-and-answer hosted by The Idaho Statesman.

Pate, the recently retired CEO of St. Luke’s Health Systems, said that most Idaho schools have been successful at keeping coronavirus to a minimum in the classroom. It’s the activities outside the classroom that have been more challenging when it comes to keeping students safe.

“I’m having a panic attack because I heard the Boise School District is ready to start wrestling next week. If you asked me what the most dangerous sport activity is in terms of COVID, I would say wrestling,” he said.

Even with safer sports, you need to look at the details surrounding it, he said. And that’s where many school operational plans have come up short.

Swimming, for instance, is inherently safe because the swimmer swims in his or her lane.

“But, when that swimmer is not swimming, congregated on the side of pool with other unmasked swimmers, cheering on teammates, that’s dangerous,” he added. “Are kids going to be carpooling? Riding buses? Riding buses has turned out to be a problem in some parts of Idaho.”

HOW MUCH DO SCHOOLS CONTRIBUTE TO COMMUNITY SPREAD?

Pate said that schools opened in other countries with dramatically less disease transmission than what we have in our communities.

“You have to know that, if there is very high disease transmission, which is the case in many areas of Idaho, the statistical likelihood of teachers and students showing up at school infected goes up,” he said.

That said, Pate said he has seen conflicting information about whether schools contribute to community spread.

“I think, yes, but not all schools equally. It does not appear elementary schools are a big contributor to spread. It does appear that somewhere 13 and above you get into an area where they contribute to spread.”

Colleges and universities pose the highest transmission areas, he added.

WHAT SCHOOL BOARDS NEED TO DO:

Those who have outlined good plans and have stuck to them are doing well, said Pate.

“One thing we’ve learned: It’s not just enough to encourage facemasks. You have to wear them to be effective,” Pate said.

The biggest problem with schools is a lack of transparency and communication that builds mistrust. School boards need to say: Here’s where we’re seeing cases. Here’s where we’re not. They need to explain how they arrived at a decision.

START WORRYING ABOUT OUR HOSPITALS

Idaho saw a lot of hospitalizations during the second COVID spike in July and August and now it’s seeing rising hospitalization rates in the third spike—right as flu season starts. Part of the problem is weddings of 100 or 150 people and other large gatherings, Pate said.

“If you haven’t worried about hospitals, you should start now,” he said.

Health care workers get sick, too, meaning that even if a hospital has available beds it may not have enough staff to utilize them. And transferring a patient to another hospital adds additional risk.

“And, don’t forget: It’s not just COVID. People are still having heart attacks and strokes,” he added.

The single best thing anyone can do to help their local hospital is get their flu shot, Pate said.

“Also, we’ve got to get the spread down. Where we need to do this most is in these smaller gatherings where people have a false sense of security. People think: My family and friends wouldn’t be infected. But that’s where we’re seeing the most of our cases now. We’ve got to stop this.”

SHOULD THERE BE A STATEWIDE MASK MANDATE?

It took Idaho four months to hit 200 COVID-19-related deaths. It took just two more months to top 500. The state rates sixth in the rate of new cases and is the third highest in test positivity, according to the White House Coronavirus Task Force.

A statewide mandate is complicated, Pate said. He said he was greatly disappointed that the governor, who took “very strong steps” at the beginning of the pandemic with a statewide emergency declaration and stay-at-home order, is now being berated by the legislature.

“Now they’re talking about coming back in January and stripping some of the governor’s policies. They think he’s overreached, and this is disappointing and alarming,” he said.

Pate said “encouraging” masks can’t be presumed to be effective: “If I encourage my kids to be home by 11 p.m., you can imagine what time they’d be coming in.”

But, he said, a mandate is not helpful if people are not willing to follow it, noting that some sheriff’s departments have said they won’t enforce a mandate.

Pate said he is certain the governor will do what he needs to “if we get to a situation where we have no choice and it becomes absolutely critical…A lot of what we’re asking the governor to do is because the local authorities have failed us. We need to hold our mayors, city council members and others accountable.

“The people who complain to me the most about staying home and wearing masks are the very ones complaining now that we don’t have our kids in school, we don’t have sports,” he added. “You can’t have your cake and eat it, too.”

WHEN DO WE PULL BACK TO STAGE THREE OF IDAHO’S REOPENING PLAN?

The Coronavirus Task Force is not focused on that right now, although it might have to eventually, Pate said. He added that he is particularly worried about November and December when people get the itch to travel and visit family.

“We have to stop looking to the government to tell us to do the right thing. We need to appreciate we’re in a bad spot. We’ve said ever since March, April, May that the coronavirus would come back in fall, and it did. What we were incorrect about was that we thought our rate would go a lot lower in summer.

“We’re in for a rough ride now. The first spike was less than half of what we saw in July and August. The number of cases came down drastically after the first spike, after people stayed home. They never came down after the second spike. So, I think the third spike will be lots higher.”

IS THERE A SAFE WAY TO GATHER OVER THE HOLIDAYS?

“There is going to be risk any time you get together with people you don’t live with. You need to consider what kinds of risk the people you get together with put themselves in,” Pate said.

For instance, Pate said, he and his wife have rarely left their home since the pandemic started, putting them in a low-risk category. “But, if your gathering includes a 21-year-old who’s been going to parties, that’s high risk.”

If holiday plans involve travel, ask: Where are they coming from and how are they going to get here? Are they coming from a high-risk area?

Everyone could quarantine for two weeks. But then you have to ask how strictly that quarantine will be, noting that the words, “We’re being careful,” means different things to different people, Pate said. “Do they think they’re quarantining if they’re staying home other than going to school? Other than going to the store? You have to know those people.”

And, the moment someone steps on a plane, he added, they negate all the benefits from quarantining.

HOW ABOUT DINING IN AS COLD SETTLES IN?

Pate said he has not been to a single dine-in restaurant since COVID because of the risk of air-borne transmission of the virus. Sitting outside, physically distanced, is pretty safe.  And masks block a lot of the droplet transmissions between three and six feet.

The problem inside is the airborne transmission. If you sprayed deodorant or hairspray aerosols, you would see that they travel in airstreams moving to the air return duct, Pate said.

“That’s why we tell teachers not to have their desk underneath the air return,” he said. “And studies have shown that people at one table have infected people at a third table because they’re under the air return.”

A recent study showed masks can decrease inhalation of aerosols 65 percent. But masks can’t help when we take them off to eat, said Pate.

CONFUSING DATA

Pate said that in the early days of the pandemic Idaho ranked near the bottom given the number of tests it performed. That’s because many national counts were including PCR and antibody tests, whereas Idaho was only counting PCR tests. Once national counts started counting only PCR tests, Idaho climbed to the middle of the testing pack.

When looking at data, it’s best to look at the state data, he said, as national data collectors might manipulate the daily data or use it in different ways. That’s what happened this past week when Johns Hopkins included Idaho lab reports that report only positive cases, making it seem like Idaho’s positivity test rate was over-the-top.

The state includes those reports in its daily count of new cases but not in its positivity calculations.

LOSING HEALTH CARE DURING A PANDEMIC

Pate said he is frightened that the Supreme Court could kill the Affordable Care Act right in the middle of the pandemic, as 20 million people would lose their insurance and millions more would not be covered for long-term problems they incur as a result of having COVID.

As people lose insurance, hospitals, which are already teetering on the brink because of COVID, will have to absorb more losses “and some may be pushed over the brink, forced to close,” he said. “If they’re going to strike the ACA down, we need to know what they’re going to do, instead. The President keeps alluding to a new plan but we haven’t seen it.”

LEADERSHIP MATTERS

Pate said he had been planning for pandemics for 15-20 years.

“There were so many things we assumed would happen that haven’t happened. We thought there’d be a national stockpile to support us. We thought people would rally and say, ‘Tell us what to do and we’ll do it.’ That has not been the case at all,” he said.

“I do think leadership matters, and the fact that this president has been the most anti-science, anti-facts leader in history has greatly undermined our efforts and turned what should have been a rallying of our country to one of political discord.”

 

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