COVID-19 Brief: Thursday, May 28, 2020

May 29, 2020

Credit CDC

Jenny Carroll, Information Officer for the City of Homer, Nurse Lorne Carroll from the Homer Public Health Clinic, and Derotha Ferraro of South Peninsula Hospital discuss the latest from the Homer Unified Command and answer listener questions about the 5 new cases of COVID-19  detected through tests conducted at SPH.

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Thursday CBrief 200528

Kathleen Gustafson, KBBI:
Good morning. You are tuned to KBBI, Homer, AM 890 the time is 9:03 and this is the Thursday regular COVID 19 Brief and Chloe Pleznac is standing by to take your calls at 235-7721 and on the line, Nurse Lorne Carroll from the Alaska Department of Health and Social Services. Good morning Nurse Lorne. 

Nurse Lorne Carroll, Alaska DHSS
Good morning team. You're loud and clear, Kathleen. 

KBBI: Great. And on the line also, Jenny Carroll from the City of Homer. Good morning. 

Jenny Carroll, City of Homer
Good morning, Kathleen 

KBBI: And Derotha Ferraro from South Peninsula Hospital. Are you there, Derotha, this morning? 

Derotha Ferraro, South Peninsula Hospital:
Okay, good morning. 

KBBI: We are underway. So I have a few questions that have been emailed to over the last couple of days. Is there anything pertinent that you feel like, Jenny Carroll from the City of Homer, that you feel like you need to start with, or shall we start with the questions? 

Jenny: Feel free to start with the questions if you'd like. 

KBBI: Well, then let's start with you if you can. I got a question about what the Council did on Tuesday night, writing into ordinance, the right for the City to open and close public spaces and to arrange, put into, I guess, into ordinance and code to arrange for ways for the public to have access to the Council in an emergency or in a situation like this. Can you clarify what was passed at the Council?

Jenny: Sure, sure. Council passed two ordinances the other night. One of them, the first one you mentioned, amends Homer City Code 19, which is about parks, campgrounds, and public spaces. And basically the ordinance that passed adds a section to code that clarifies that the City Manager has the authority to close City owned public use areas, if it's in the best interest of public health, safety and security. The City Manager has had this authority through State statute and the ordinance pretty much just makes it very transparent and it also added a requirement that when a public space is closed, that there is a written finding that it is in the best interest of citizen safety. Right now because of COVID 19,  there are very few public spaces that are closed. I believe it's really just our playground equipment and the parks. But at one point, following State mandate, the City had closed campgrounds and the bathrooms. As we worked our way through that COVID 19 reopening, those all came back online. So other situations in which the City Manager may deem it necessary to close spaces could be like a sewer line break that creates a toxic environment in a public space, or let's say after a heavy rain and an earthquake, that there might be unstable ground or sloughing that would make it necessary for us to close a public space. So this ordinance just clarified that power of the City and requires that there be some kind of written findings that explain why the City Manager would be doing that. 

KBBI: Thank you Jenny Carroll from the City of Homer. Also, I have questions for Derotha Ferraro from South Peninsula Hospital and Nurse Lorne Carroll, because the last positive case that was identified in the Homer area was actually outside of Homer, but in the South Peninsula area. And that case was identified when someone, as an asymptomatic patient, when someone came to get their COVID test before a medical procedure. And so I got questions about asymptomatic patients. I think this one will go first to Nurse Lorne. How much do we know about asymptomatic patients? Does the virus term out? If you never develop symptoms, do you continue to infect people? What are the findings about asymptomatic patients? 

Nurse Lorne: That's a great question. Maybe I'll start with just kind of speaking a little bit to what does that mean?  Asymptomatic, in my mind, it can mean about three main different things. It can actually mean more, but here's kind of the three different things. I'm the asymptomatic command, which means that this is all complex and so trying to even talk about it to a broad audience is a nice challenge, but offers a lot of opportunities too.  So the first category of asymptomatic would be those folks with COVID 19 that never exhibit any signs and symptoms. So that's kind of an easy one.  Secondly, asymptomatic folks will not have signs and symptoms until they do. And that's important because one thing that we know about or that we feel we know from today's perspective is that folks can be infectious up to two days before the onset, or the start of signs and symptoms and that's why contact tracing, the public health nurses, as core folks have been up to two days before the onset of signs and symptoms, and that's how they start to build a list of high priority contacts to that new COVID case. And then thirdly, asymptomatic can also be folks that deny signs and symptoms and they might be denying them because they're not really associating some kind of, what they perceive to be as normal or insignificant signs and symptoms, until something changes. So for example, an individual may get screened for COVID before an elective healthcare procedure or dental procedure and pop up as positive, so they may deny signs and symptoms at that time, but test positive. But when the Public Health Nurse calls them to interview them extensively, which takes about 30 minutes to an hour, when they go down that list of signs and symptoms, that may trigger their memory or make them kind of think about, Oh yeah, I did, now that you ask, I did have a runny nose a few days ago. 

KBBI: And so what do we know about the virus in terms of how it behaves and how it's passed from asymptomatic patients? Is there a term, do people who are positive term out in some way, and then what if they start to show symptoms and develop COVID 19? After they're counted as recovered, are they still passing that virus on to other people? 

Nurse Lorne: That's a great question. Kind of, in a nutshell, from what we understand today is asymptomatic folks can transmit the disease just like folks that are showing signs and symptoms. But one of the key points here is that COVID 19 is a virus, which is an acute disease process. And what I mean by acute is the virus clears completely from the body, for most people, in about 14 days or less. So that's what the whole process of quarantine is based on. So, for example, if you come up from lower 48, if you hunker down in quarantine for 14 days, have no contact with other humans, even if you did have a virus like COVID 19 it would clear the system entirely within that timeframe of 14 days. 

KBBI: Thank you. And I want to ask Derotha Ferraro from South Peninsula Hospital, is there anything that you would like to add to that? Also, can you start us off with the numbers for testing in at South Peninsula Hospital right now?

Derotha: You bet, Kathleen. Okay, so as of this morning,  we have a total of 977 tests completed or test swabs submitted. And of those 934 are negative, 10 and so that's a new number, folks, 10 are positive and 33 are still pending. And I want to comment to the growing number of positives, and that is because we have the drive through testing and people are starting to utilize it more, both because of their symptoms that they might have, but also because of the pre-procedure screenings. So I just wanted to take a second and talk about those pre-procedure screenings. So, for example, at the hospital, anybody who is having any kind of surgical procedure or a pulmonary function test or a stress test or being hospitalized for any reason, whether it's to, you know, deliver a baby or post-surgery or whatever, anybody who's being hospitalized for any reason then has a mandatory COVID 19 test. So that's really just those areas alone, having nothing to do with other providers in the communities that have requirements for testing, that has really doubled the number of daily tests that we're doing at the hospital drive through. 

KBBI: Are all four or five new positive cases identified right now as asymptomatic character carriers, or are any of them showing symptoms of COVID?

Derotha: These particular ones are still being investigated and information still coming together. To the best of my knowledge, these individuals that tested earlier this week were symptomatic. They were not pre-procedure, but the three or four before, that we discussed last week, they were all pre-procedure screening. So, either way, either reason, it's definitely recommended to come get testing because the turnaround time is really improving and the faster that we can know, then the faster Public Health can reach out to people and begin the investigation that Lorne just spoke about, begin the interview and begin contact tracing. So the faster people know, the better. So on that, I would just like to share some really exciting news from the hospital, and that is that we have totally expanded our testing capability. So without a flip chart or a PowerPoint slide, I'll just kind of like put it into four different compartments. One is that we can swab somebody and just send the sample to those State labs. Another is that we can swab them and use our Assay Abbott rapid testing platform that we've had for a month now, but we all have learned is it’s very reliable for positives, but not reliable for negatives so we still send those to the State anyway. But now we have two new ones and the two new platforms, one is called Cepheids, and this equipment was sent by the State of Alaska and it was sent specifically to reach the fisheries industry and the seasonal workers industry, and it was sent out to various locations all around the State that have significant populations like that. So we, right now, we got the equipment earlier this week, the lab is calibrating and validating it with samples, swabs and everything and once the validation is complete,  the State informs us that this platform is very reliable for both negative and positive results. Therefore, we are anxious to get this up and running because it has a less than one hour turnaround. So it is a rapid test and it's reliable, so we're really excited to roll that out. Equally, we have another platform called BioFire and the BioFire platform we've owned for years, and we use that regularly for diagnostic testing for the hospital and local providers. The difference is that the respiratory panel did not detect for COVID 19, now tests for the COVID too. So now they've improved that panel to do testing for COVID 19. And we've now gotten the units for it and we're again doing validation and putting the systems in place and we'll be able to use the BioFire platform, which is also considered rapid testing and turns around within the hour. The difference is just that when you do that, when you're running an entire respiratory panel of like 22 different screenings it's a little excessive if we're just testing for COVID 19, but at least it's another platform. 

KBBI: And that is not, that's not an antibody test. Right? 

Derotha: None of these are. These are all for just COVID. So what this means is that we can offer additional testing. And so what we've done is we've opened up who can test and that is people with symptoms, but also people who are here for summer employment. They're in the fisheries, they're here for two months, they're becoming residents of the community, a summer resident, a longterm visitor, you are welcome to come get tested. And we're also expanding locations. We're going to start doing some popups. So this weekend we planned to do a popup test site out at the Harbor. We hope to set up in the boathouse pavilion one day. And, don't know for sure the exactly dates and times, but hope to do a pop up out there so that any fishing boat, any recreation boat that's got summer employees coming in from out of state and you want to get them tested, you'll be able to know by the end of the day. 

KBBI: Thank you. And quick tested too, it sounds like. 

Derotha: Yep. 

KBBI: So I have a, I have a caller on the line, but also I have an emailed question from Dawn that I think is for Nurse Lorne. I'll get back to you in a minute. This is about the antibody test that's being offered at the medical clinic.  Dawn asks, she says, Dr. Zink, as far as she knows, is not recommending it because the antibody tests can detect and give a false positive if you've had other strains of Coronavirus. Nurse Lorne, is that still the case? Is the State recommending the antibody test or saying it's not reliable or what's the intel on that? 

Nurse Lorne: Yeah. I kind of want to, I feel like drawing a line here between primary care or your private provider and a population focused healthcare. So while those two work together always, it can't function independently,  there's a little bit of a difference.  So Dr. Zink,  the, the chief medical officer for DHSS, her primary goal is to promote the health of all Alaskans. And that's a little bit different than a medical home or primary care physician and other providers where their primary goal is to promote the health of the individual and family. So they sound similar, but they're actually different, the context of the conversation is a little bit different. So, antibody testing, those questions  regarding, is that right for me? That should go to your doctor but yes, in general, the antibody test doesn't really, isn't incredibly helpful in mitigating disease processes today. And can you repeat what the, what the question was? 

KBBI: Is Dr. Zink recommending the antibody test for people or not? Why is that? Yes or no? And here it is: Can it detect a false positive if you have had other strains of Coronavirus? 

Nurse Lorne: Yeah, I think the take home here is,  there are false positives and false negatives with almost every medical test so that makes what's very much not a black and white situation.  There's no test,  or rarely is there a medical test that can have absolute positivity in terms of results. 

KBBI: And so your recommendation is check with your healthcare provider to see what's right for you. 

Nurse Lorne: Yeah. And the antibody test results gives us an idea of what may have happened in the past. It doesn't really give us any information regarding if you have disease processes like COVID 19 today, which is needed information for stopping the spread of COVID 19. 

KBBI: Thank you, Nurse Lorne. Paul Seaton is on the line with a question for healthcare providers. Go ahead, Paul Seaton.  Good morning.  

Paul Seaton: Hey,  I was really interested in,  you know what we can do and what we can do to protect ourselves since we've got, you know, the asymptomatic proportion of positive tests. So the one thing, they've just come out with a brand new study out of three hospitals in the Philippines and they looked at 212 cases in those three hospitals and classified them by vitamin D level as well as the severity of cases. So the people that had above vitamin D level 30, that's when you get your blood test and if it's above 30, then the other group from 21 to 29 and it was below 20 and people should just know that in Alaska, especially in winter, most people are going to be below 20 and the rest of the time between  21 and 29 and so the big findings were that of the 58, approximately, mild cases, 96% of those mild cases, that's having cough and fever, basically the major symptoms, 96% of those people had higher levels of vitamin D and the severe critical patients,  96% of those have been either one of the two lower numbers of vitamin D, those tend to be pretty critical, that you don't want to be below 30. That's not the only study. There's another 20, just came out in April and nutrients and by a number of doctors, and they were, the title was Evidence that Vitamin D Supplementation Could Reduce their Risk of Influenza and COVID 19 Infections and Death. That's a 19 page article in the peer reviewed science journal was talking about that. So anyway, how well are we doing in Alaska?  What tools we're going to be able to use to prevent infections and then the results. 

KBBI: Thank you, Paul Seaton. And I want to turn it over to the panel, to Nurse Lorne and to Derotha from South Peninsula Hospital, specifically about the efficacy of using vitamin D to have better outcomes if you contract the virus,  what is the science that you're seeing? And are there cautions that need to go along with it? And then I'd like to get to the greater question of what are some of the other ways to boost your immune system and work toward better outcomes?

Nurse Lorne: Yeah. Thanks, Kathleen. And maybe I'll go first if you like.  I appreciate Paul's being a champion of vitamin D, that's valid in terms, I believe in terms of like promoting individual and community health. You know, the thing about health is there are a lot of layers or variables that impact health. Even the things that happened intergenerationally impact your health outcomes today. And so, say for example, in my role I don't have the luxury today of the time to be able to take a look at vitamin D because I'm busy doing COVID case investigations and contact tracing. And so that it really highlights that health is complex and it really takes an entire community. And really, what it boils down to in my mind is we're trying to figure out as a broad team or community, what are the things that we can all do to help give every individual the best chance at reaching their potential and there's a lot of variables there, Vitamin D is one of them. When I work with Paul and I enjoy working with Paul, I kind of think what would our community look like if we had champions for every variable that moves community health? 

KBBI: Thank you. Nurse Lorne. Derotha Ferraro from South Peninsula Hospital, Do you have anything to add to that? 

Derotha: Well I personally would recommend everybody go to the hospital website,  and go down on the right hand side there's a section that is kind of FYI, and there's a great video that Dr. Rob Downey, our functional medicine provider, a board certified medical physician, he did a video on kind of how to boost your immunity in times of COVID 19. And it's just a great video. It has tips in it that anybody could learn from regardless of the lifestyle that you are living based on your location or your job or whatever. Just lots of great tips and information. He's a wealth of information and just talks really about the importance of building your immunity for COVID 19 and everything, but definitely for this. 

KBBI: Thank you. Thanks Derotha. Jenny Carroll, I feel like I've given you the short stick today. Is there anything coming up in the City that people need to be aware of? Is there anything on your list today of information to get out to people. 

Jenny: Well, I wanted to circle back to the very first thing we talked about, because there were two questions about ordinances that the Council passed last night, and we only covered one of them. I want to do the other one and the other one is about telephonic participation at meetings. And if I recall right, the question that was emailed to you was about public participation in City Council meetings and I just wanted to clarify that the ordinance that passed Tuesday night at the Council meeting about telephonic participation just made it clear. It didn't really change any of our previous code that allowed for limited telephonic participation in Council meetings and this is participation by Council Members and Mayor is really what this ordinance is about.  There is code that details how that should happen in ideal circumstances. Ideally Council Members and the Mayor meet face to face in Council chambers and the public has direct access to those meetings in person to give testimony. That's the ideal situation however, now that we're in a declared emergency with social distancing and isolation,  Council wanted to make it very clear in code that in a declared emergency, City Council can go to telephonic web based meetings and in the original code, Members were limited to three meetings telephonically. So this just allows for the meetings to go on kind of as they are now under COVID declared emergency. It also provides the Mayor the ability to preside over the meeting telephonically, while it works, and if it didn't work for some connectivity reason, the Mayor would always be able to pass the gavel to the Mayor Pro Tem and have the meeting go on. So that was the meat of the ordinance that passed Tuesday night. But I want to just very quickly, I know we're right up at the end of the half hour, but I wanted to make sure that people know that there are ways to participate still in the City's public meetings. Commissions will be coming on  throughout the summer. Summer's always very limited as far as meeting times because people's lives get busy. But commissions are meeting, City Council is meeting on their regular schedule and people have the opportunity to watch and listen in to those via Zoom, which is a web based video conferencing app. You can always tune in on KBBI and listen. There are opportunities to submit written testimony. You can sign up for telephonic testimony where you could call in and give your comments on the meeting during the meeting, or you can even still attend in person. We have limited space available at Cowles Chambers and people can sign up to give their testimony in person so if you want the specific details of how to do that, we really want to hear public voices at the City Council meetings. So you can go to the City of Homer, Alaska website and go to the City clerks section  and you can also call the City clerk's office to get more information. Their number is 235-3130 or you can email the clerks 

KBBI: and we'll reinforce that because Council Member Rachel Lord made a terrific public service announcement that gives all that information. We've been playing it on KBBI, but I'll make sure before we go to the library story hour that we make sure to reinforce all that information with Rachel's public service announcement. If I can ask for your forbearance for a moment, I have one more question that was emailed in from Laura.  Laura wants to know what is the count of Coronavirus positive patients on the Southern Kenai Peninsula as of today, including Anchor Point, Fritz Creek, Homer, and across the Bay. Nurse Lorne or Derotha, Can either one of you give us that perspective? 

Nurse Lorne: I can take a go at it. Happy to accept any support from the team too. Maybe I'll start with Alaska, as of the last reporting period, which was yesterday at noon,  412 cases so far for COVID 19 in Alaska.  We've had 46 hospitalizations, 10 deaths, and about 88% of that 412 have recovered so far.  Down here on the Peninsula, we have 27 on the Kenai so far. The split up of that is 6 in Kenai, 3 reported cases in Seward, 6 and Soldotna, 3 in Sterling, and then 2 in the category of Kenai Peninsula Borough, Other. So these would be folks,  these 2 in particular are Kenai Peninsula Borough, Other that are on Southern Kenai Peninsula, but they're within a census designated area that's under 1000 folks. And so moving further down the road here, closer to home, 1 in Fritz Creek, which is a new number for Fritz Creek,  2 in Anchor Point and Homer holds steady at 4 and all 4 of those have recovered for Homer. 

KBBI: Thank you, Nurse Lorne. Derotha Ferraro, anything that you would like to add from South Peninsula Hospital's numbers?

Derotha: No.  Just that, to help the caller understand, so the hospital is testing, and so the testing and testing results don't immediately align with the State case results because the State only tallies every day and announces at noon. So you will see then some of the testing information that has turned over at the hospital over the last day or two show up the following day by the State at noon. 

KBBI: Thanks for making that distinction and thanks to everyone, Jenny Carroll from the City of Homer, Derotha Ferraro from South Peninsula Hospital and Public Health Nurse Lorne Carroll for being a part of the COVID 19 Thursday live panel. Thank you all so much for participating.