The Thursday COVID-19 Brief: June 18, 2020

Jun 18, 2020

Credit CDC

Homer's COVID-19  Incident Command Team takes listener questions.  Jenny Carroll from the City of Homer and  DHSS Nurse Lorne Carroll talk about what causes a  false positive and if differences in level of  exposure to  COVID-19  affect the severity of patients' response to the virus.

South Peninsula Hospital Spokesperson Derotha Ferraro talks about the six cases of COVID-19 among workers at SPH that were confirmed by The Homer News this week.
 


Kathleen Gustafson, KBBI:

This is KBBI Homer AM 890. The time is 9:03 AM. I'm Kathleen Gustafson with the Thursday live COVID-19 Brief. On the line Nurse Lorne Carroll from Homer Public Health Center.

Nurse Lorne Carroll, Alaska DHSS, Homer Public Health Center:
Good morning, Kathleen. You're loud and clear.

KBBI: Good morning to you. And Derotha Ferraro from South Peninsula Hospital. Are you there?

Derotha Ferraro, Spokesperson, South Peninsula Hospital:
I'm here, Kathleen. Good morning.

KBBI: Great. And Jenny Carroll from the City of Homer. Good morning.

Jenny Carroll, Communications Officer, City of Homer:
Good morning, everyone. How do you hear me?

KBBI: I hear you just fine. Thanks. So Derotha Ferraro from South Peninsula Hospital. You are the star today, but I want to start with you because the Homer News, I got an email from you last night, talking about the Homer News story about 6 South Peninsula Hospital’s employees who have tested positive and is that over the course of the last three weeks? Is that right?

Derotha: Yeah, that's been three weeks of really rigorous testing in this community, not just the community of Hospital employees, but the community of the Southern Peninsula.

KBBI: Well, I'd like to focus on the hospital employees right now, if we can.

Derotha: Sure.

KBBI: So, how many, can you talk about the difference between workers who are showing symptoms or are they asymptomatic positives? How were they tested? Was it because they were in contact, direct contact with someone who was showing symptoms of COVID?

Derotha: Well,  each of the 6 are a unique case and situation just the way they are unique at the community level as well. Some were for medical pre-screening, medical procedure pre-screening, a known positive contact, known exposure with a positive contact, just so many different reasons why they are. So let's just kind of start from the top. So we have 6 employees, since late May, it's actually three weeks today, and of those 6, that represents just over 1% of our 480 employees and these 6 employees work in five different departments and none of these employees reported close contact with patients or residents. I think that's the most important piece of information here is that none of these cases had close contact with patients or residents and some people might scratch their head and say what? Well remember we have 24 departments in eight different buildings and locations and we have 50 of us working from home and some of us are full time, some of us are part time, some are casual, meaning they just come in on an as needed basis, so they might only be here once in a week or something. So it's not just, when they say hospital employees, it's a little misleading because it's the employees of the overall organization. One of them did work some in longterm care and that was actually the first positive employee that we had and when we discovered that we followed the CDC and Alaska epidemiology instructions and we immediately informed all staff and residents, and then we tested 100% of the residents and 100% of the longterm care staff and the first round of that was all negative. And just in the last, really, the last three days, we've been finishing up the second round of testing of everybody. So I'm really relieved to know that none of the residents were infected with that particular situation and the other five…..

KBBI: Derotha, I want to stop just a minute,  because can we make the leap there that none of those people were, those people were all infected by community transmission?

Derotha: The leap, I don't know about leap, what you can take away is that none of these 6 were occupational exposure. So none of these 6 ended up getting COVID-19 because of providing care or interacting with a patient with COVID-19.  They may have had some, you know, some workplace exposure, but that might've been with coworkers but not from occupational exposure. That's correct, which is really, considering the fact that we have treated COVID-19 patients here both in the ER and hospitalized, I think that really speaks to the great measures that are being taken in wearing PPE and using infection prevention strategies with the patient.

KBBI: Well, I stopped you though, so, if you want to keep going on talking about the health workers, I'm sorry I interrupted you, but I needed to make that clear for myself at least.

Derotha: Yeah. So the one thing, Kathleen, I also wanted to address was the difference between being out sick with COVID and being a part of our really strict return to work guidelines for potential of COVID. So, we've adopted these really extreme measures that if you, because they're the measures we want the community to adopt, and if you have a sore throat, you are not to come to work. If you have a runny nose, if you have any one of those COVID like symptoms, you're not to come to work. And not only are you not to come to work, you need to have 2 consecutive negative tests. So a person might be out due to COVID mitigation strategies, but they're not really out sick with COVID.

KBBI: But that's not these people, these 6 people have COVID. Are you making a distinction between people who've tested positive and people showing symptoms like they're sick and the people who are just testing positive or not?

Derotha: I'm making a distinction to information that I shared that was recorded Monday evening and possibly shared Tuesday on the radio, which was, wow hospital, I hear you have a lot of people out sick and we don't, and didn't have a lot of people out sick, but we do have a significant number out as a form of a COVID prevention strategy.

KBBI: Yeah, you definitely said that on Monday, definitely said that a lot of the people who were out, it was a result of people who might've been exposed, but I would like to talk, press this one more step further. How are you addressing, you had a meeting with your staff, with hospital staff?

Derotha: Yeah, we do weekly meetings, so we do morning briefings on email, and then we do weekly zoom meetings and everybody's invited. So we inform all staff anytime there's a COVID positive employee, we let all the employees know because we want to learn from each other. If the reason one of us is positive was a preventable, something preventable that we could do within our organization, we want to learn from that. So the minute that, like from the first positive we had that was a known positive of one of our employees up until now, it's announced in our morning briefing and then again, discussed at our weekly employee forum. We don't discuss the detail of who or exactly what department, but we do learn from the contact tracing and the investigation because these cases are handled the same exact way as a community case and investigation immediate, first immediate isolation, then an investigation begins and contact tracing begins, and public health is quite involved in it. We do handle internal activity, but public health handles the community side and also crosses over and has certainly been known to call an employee and say, Hey, you are named in, as a potential close contact of a known positive. So I mean, the employees are kind of getting hit from both angles there when it's an internal investigation. But yes, to the question, yes, we share the general information with staff immediately. KBBI: Nurse Lorne, I think I hear you putting your mic up.  Well, before I move on to Nurse Lorne, Derotha, can you tell me, I received a question: How many people are hospitalized for COVID-19 at South Peninsula Hospital right now, then why doesn’t SPH release hospitalization numbers? But I see on the State website, Nurse Lorne, that there are hospitalizations listed for the Kenai Peninsula, just not for which hospital they're in. How many people are hospitalized itself at South Peninsula Hospital, do you put that information out? Derotha: We don't put that like on a daily basis or anything like that, because I really don't want anybody to feel that their identity might be compromised by seeking care here. I will tell you that we saw a slight increase and we are seeing a slight increase of individuals seeking medical care and advice due to COVID-19 symptoms. So the phone, the ER and hospitalizations are active. At the moment we have adequate staffing and supplies to provide care within our normal operation so we have not activated any of the newer different sites as a result of this.

KBBI: Okay. Derotha, I'm sorry to stop you. I just want to let people know if you have any questions you can call 235-7721, Chloe is standing by to take your questions, but I do need to, I want to move on to a question that is for Lorne, it's actually for everybody, I'm going to ask you to weigh in. But the next question that came in was via email: Latitude 59 is closed till Tuesday, June 23rd, they say, their staff is going through its 14 day quarantine for all of them due to possible exposure to the virus. If an employee at a restaurant tests positive, what are the suggested and required actions for that business?

Nurse Lorne: Yeah, that's a good question, this is Lorne, one of the public health nurses. The interesting thing about that, and in my mind as a local public health nurse is, we and community partners and the clients handle that very much like all other cases of COVID infection. So just kind of like unpacking what that looks and feels like is, somebody pops up positive for COVID, either because of a routine test or their provider says that they should go get a test and then the provider or the laboratory notifies the section of epidemiology and that's in line with Alaska State Statute in terms of reportable conditions. That information along with any known contact information is communicated to the local public health nurse. That's especially true for during daytime hours and then at nighttime and weekends, there's a kind of after hours crew of public health nurses and short term non-permanent registered nurses that take on those duties and the duties I'm referring to are index case investigations and contact tracing. So in the scope of like restaurants, it's much like any other case, is that the public health nurse or the registered nurse that calls to do the initial index case investigation looks to rebuild the story of what happened in terms of how did transmission happen and how might transmission continue from that point and look at ways of mitigating that or stopping transmission. So that person on the phone would look to make a master list of contacts. These would be folks that, like in a restaurant setting and outside of a restaurant, who's been within six feet of that person who's known to have had COVID and also for 10 minutes or longer. And there's some other variables there too that can encourage transmission of COVID from one human to another. Those are things like coughing or sneezing. So that master list is made and those folks are suggested to quarantine in the absence of signs and symptoms for 14 days. And that's because of the virus is an acute disease process and it's going to be pretty much done within 10 days so having those folks quarantine for 14 days means that the virus will complete its disease process and can't be transmitted to others.

KBBI: Thank you, Nurse Lorne Carroll from the Homer Public Health Center. I guess hats off to the restaurants that keep their reservation lists and make seating charts, that must be immensely helpful. 

Nurse Lorne: Yeah, I think another point here is that, you know, in terms of like, I think the question embedded here might be: is going to a restaurant increasing my risk of getting COVID? It's been my experience, probably not, but another thing is when you go to Save U More or say like Safeway or another store, and you walk down that aisle with the cleaning products, you'll probably notice that there's a high demand for cleaning products right now. And I think that's a sign and symptom of all of our community partners really doing their best to clean all surfaces and decrease transmission at COVID. So I think all businesses are doing a pretty amazing job with that, keeping us safe. So thank you.

KBBI: Thank you. Jenny Carroll, from the City of Homer,  you can talk a little bit about State advisories to restaurants opening up under Phase 3 and 4 of the State's plan?

Jenny: Sure. The best is to follow the public health nurses’ recommendation should a case come into or be identified in a restaurant worker. But in general, if restaurants are looking for guidance on how to be as preventative as possible, they're in the Reopen Alaska Responsibly Plan. Attachment F is one that advises restaurants on how to operate safely and I wanted to point out that it's good to note that all the State Mandates under Phases 3 and 4 of the Reopen plan were changed to Advisories. And so the advice to restaurants is that if you have an employee that's displaying symptoms, any symptoms of COVID-19 whether, you know they have it or not, they should not report to work, they should monitor their symptoms and they should get a test if they think they may have COVID-19.  Also employers are asked to ask their employees not to return back to work,  within 72 hours of exhibiting a fever, so if you have a fever you should not come into work, you should let that fever be out of your system for 72 hours and out of your system means not with any kind of aspirin or any fever reducing medicines. The CDC also gives guidelines to restaurants about cleaning their facility after there is a suspected COVID-19 case.  So businesses can go onto the State website https://covid19.alaska.gov/  to look at that and make sure that they have precautions in place to keep their employees and their patrons safe and keep your business open and operating.

KBBI: Thanks, Jenny Carroll, from the City, I'm going to come right back to you, but I want to go to Lorne Carroll, Public Health Nurse for a minute and ask about, I'm getting phone messages from people, one of the questions I'm getting is about workers not wearing masks and I'm wondering if,  I'll go back to this to Jenny from the City about, because the question is, be ready Jenny, why can't the City just mandate that people wear masks? But Nurse Lorne, can you talk about the benefits of wearing a mask and why this is something a business might institute as policy since there is no mandate for it?

Nurse Lorne: Yeah, sure thing. That's a really good question in terms of transmitting COVID to others. Kind of some of the things that we think we know is that COVID is transmitted by respiratory droplets so that would be whenever someone is singing or even talking,  but then also from coughing and sneezing.  So a couple of things here is that we know that most respiratory droplets they’re, in terms of COVID, they're very heavy and so they drop out of the air, most of them within a four foot radius of the individual and then additional droplets, of course it depends on the environment,  go beyond that four foot radius. So the idea there is kind of two major components is that if you keep those respiratory droplets to yourself then there's decreased chance that you may be transmitting COVID to others and then secondly is there's kind of no real way of knowing at any particular point, no good way of knowing at any particular point, if you have COVID or not, so you could be asymptomatic.  So for example, when I'm working here, with my colleagues at the Public Health Center,  we're essential service and we really have to have access to all this technology to do our work so that means we're in close proximity, but we try to keep to our offices, wear masks and maintain at least six feet from others.

KBBI: Thanks Nurse Lorne. Jenny Carroll, can you answer that question? The question was why can't the City mandate that people wear masks in businesses? And, but the question really is can the City mandate that? Did they give themselves the ability to do that at the City Council meeting, when they were giving themselves the ability to close parks and things?

Jenny: No, they did not. And as I understand it, and I have to admit to everyone out there, I don't understand all the legalities on and the reasons behind it, so bear with me, but as I understand it, under the City's current emergency declaration and the Council resolution that formally adopted that declaration,  the City did not grant itself the power to implement and enforce stricter mandates. That is my understanding. I believe Council would have to pass an ordinance granting that authority under what kind of circumstances, similar to the park closure, public space closure authority, and it would also have to pass legal review that that’s something that is within, rightly within the powers of the City. And I'm sorry, I don't, I’m not up on all that legal, but that is my understanding.

KBBI: Well, I appreciate you addressing the question. What about, has the library set a date for opening or are they still on a wait and see basis? I know they're still, they're still letting people in by reservation to sign up, to come in and use computers and printers and things, right?

Jenny: Correct. They had a hope to open up a little bit more on a little bit wider basis to allow people to come in to the library, keeping the numbers down so that physical distancing could happen, but allow people to browse materials that they would like to check out, but with the rise in case numbers, the City is taking, the library In particular is taking a very cautious approach to protect their workers and protect patrons. So they are postponing that until further notice, but that patrons can still make reservations to utilize the wifi service within the building and the computers. They also are doing the book delivery out, you can check out your book and have a no touch delivery service out in the parking lot. You can still return books to the book drop. The bookmobile is in the parking lot. So I would encourage everybody to go to the public library website https://www.cityofhomer-ak.gov/library  on the City website and there's a lot of online resources and programs, the summer reading program for people to be able to access library services and ask your questions there. So right now we're just going slow and trying to be as protective as we can against this rise in case numbers on the Southern Kenai Peninsula. We understand the library is an important service for many people in the community so where we're working to try to provide more touchless and better service as we move forward in this new climate of COVID-19.

KBBI: Thanks, Jenny. I know we didn't really get to it today, but you and I are gonna organize a little bit of information gathering and dispersal for CARES funding from the State and what might be coming with the City. So we will,  I'll get with you after this is over and we can start getting that information together for people. I do have a question to kathleen@kbbi.org. It's for Derotha. How many workers at South Peninsula Hospital are under quarantine right now due to exposure to the 6 people who tested positive?

Derotha: I don't know that exact number.  Yeah, I would have to get back with you on that. 

KBBI: Do you have a general, do you have an inexact number, an estimate?

Derotha: No, I don't.

KBBI: Okay. And the people who are under quarantine right now, did you say were now in the 14th day today? 

Derotha: So remember these 6 cases have been spread over time. They all just didn't happen this week, last week, or on May 28th, so that these 6, they are 6 unique cases that have happened since the pandemic started. So I don't want to get very specific on an individual's isolation period or first test or second test, yeah, because there are 6 unique cases.

KBBI: Well, I mean, the people who are being, aren't there people quarantining because they work in the same place as the people who tested positive? I'm not talking about the people who tested positive.

Derotha: Okay. And so, so what is the question again?

KBBI: The question is how many of them are there, that are not able to work right now because they worked in the office with the people who tested positive?

Derotha: Right. I wish, I would have to reach out to our infection prevention nurse. So remember, that's all part of contact tracing and part of a little bit of employee privacy. So for like, for me to know why Lorne's not at work today, I don't know why Lorne’s not at work today, right. So I would need, and Lorne’s at work, obviously he's on the phone, but, I would need to reach out to our employee health nurse and just get a good number there. I really don't know at this moment.

KBBI: I’ll check back with you on that. I do have a question come in from Kurt. Kurt says: I was tested as COVID-19 positive. I will be off my quarantine tomorrow. Under the 10 days from symptom onset and three-day symptom free, I would like to retest at the hospital to be sure I'm negative. Does the hospital have enough tests available to do this? And is it recommended? And then, so that's for Derotha: Does the hospital have enough tests for someone to, after their quarantine, retest to be sure they're negative? And then Nurse Lorne, he says also: I assume I will not be contagious. What is Nurse Lorne's take on this?

Nurse Lorne: Those are a lot of great questions. I can, my gut tells me that  a very good move would for that individual Kurt, I think it was, Kurt, if you reach out to your primary care provider, they'll be able to answer some questions and one of the reasons why I'm recommending that is to make sure you get the best information for your situation but also your provider, he or she will be able to take into consideration all other variables in your particular scenario to make sure you get the best information possible.

KBBI: And Derotha, wouldn't the fact that a person tested COVID-19 positive, make them eligible for a retest or do they need a referral for that?

Derotha: I think the same thing. I think that this person should call the COVID nurse at 235-0235, and ask to talk to the COVID nurse because there can always be different things, given an individual situation. So I don't want to answer over the phone or over the radio to the person. I think they should just call the COVID nurse.

KBBI: Okay. And remember if you don't have a healthcare provider, I think Nurse Lorne says that SVT Health Center is the place to call, is that correct?

Nurse Lorne: That's right. The SVT Health and Wellness Clinic they’re our federally qualified health center for this area, which means they get federal funds to serve people that don't have good access. They're at,  226-2228 that’s SVT Health and Wellness, pretty amazing people over there, 226-2228

KBBI: Okay. Thank you. And I have,  if you don't mind, I have one more question and then I'll call for the final comments, thank you for going, we're a minute over now.  Laurie says: it does not appear that people in Homer, except for seniors are wearing masks in public and practicing physical distancing. The number of positive cases, hospitalizations, and the epidemic curve for Homer and the lower Kenai Peninsula is at their highest point and seem to be climbing. Is the City of Homer working with the Governor to reinstitute any Mandates to bring those numbers down. Jenny Carroll?

Jenny: Yes. I can answer that.  Certainly, City leadership had a call with the State,  who are very supportive of Homer’s efforts to educate the public about best measures to prevent COVID and bring that to light. We met with Commissioner Crum and Commissioner Crum pointed to the fact that measures that the State can take in the event of increased numbers is like what we worked with with the Tustumena. So the Tustumena had an outbreak of positive cases, that ship was docked and the Public Health investigations and tracing went out from there before anything else happened with passengers or crew on that ship. So the State was able to step in and suspend operations of the ferry, they're able to step in and suspend some, like fish processing operations that may be experiencing an outbreak. So participating in spot closures like that is one thing that Commissioner Crum pointed to on that call. 

KBBI: And the Tustumena is still, I just spoke to someone whose family is on board that ship, still under quarantine.

Jenny: Correct. That is right.

KBBI: I need to move on to another question. I think this one is for Nurse Lorne. Is there data on how many positive cases are asymptomatic? Is there any information showing the correlation of immunocompromised people who've tested positive, being more likely to be symptomatic?

Nurse Lorne: You know, there may be, and I'll give you the two options here and be happy to follow up. You can get ahold of us at 235-8857. But also if you go to the State's website https://covid19.alaska.gov/ under the Alaska Coronavirus Response Hub. You'll see an area there to click on for access to the raw data. And as you scroll down there,  you'll find several,  I think there's about 92 different data sets and one of them speaks, I believe to, I think there was a question about immunosuppression. You might find an answer in there.

KBBI: And the last question I have here is that it's my understanding this, it's reading from the question: It was my understanding that there are no false positives, however, a resident at the Friendship Terrace, Homer Senior Citizens Inc.,  is being reported now as a false positive, because they tested positive once and now has tested negative twice, just a couple of days later. Nurse Lorne, can you talk about how the false positives happen?

Nurse Lorne: Sure thing.  The take home here is that all tests for COVID there's none of them that have 100% specificity and sensitivity. So what that means is there's always a chance of a false negative and a false positive, even though that chance is pretty small, that does happen, especially when you're considering like,     a data set of like 45 or 50,000 tests. So that's important to consider. And I think thinking through this highlights the importance of a medical provider's role in assessing an individual and determining what the diagnosis is.  So a test result is only one piece of the puzzle. The other pieces of the puzzle are assessing what risk factors that individual has for COVID. One thing we know about COVID tests is their specificity and sensitivity are higher in pools of individuals being tested that have risk factors for COVID and then the sensitivity and specificity falls off a little bit for folks that don't have specific risk factors for COVID-19 like being within 6 feet and 10 minutes of someone known to have had COVID.

KBBI: And Nurse Lorne, does whether or not a person is symptomatic or asymptomatic or how sick they get, does how sick you get have any correlation between how much of the virus one is exposed to?

Nurse Lorne: Yeah, that's a very good question. And it's complex because there are several variables that contribute to answering the question of is transmission possible or not. One of them might be is how sick that person is and if they're coughing or singing, so the suggestion there would be that there could be more virus expelled and respiratory droplets and more respiratory droplets in the environment. And then one other would be it's the environment in which the respiratory droplets exist. So kind of an example here is if I'm riding in a taxi cab from Homer to Anchorage and the windows are up and I'm riding with someone who has COVID and they’re coughing, that's a different scenario and has more risk than if I'm riding in a taxi cab in the same scenario, but with the windows down. And then third, another variable of, it's highly complex, but another variable is the susceptibility of the person being exposed.

KBBI: That was my question. If you have a lung condition or some such thing.

Nurse Lorne: Yeah. Yeah. That's right. Or any other chronic condition that could increase the susceptibility of the people around those with COVID. Yeah, that's a very good question. Thank you.

KBBI: Well, thank you too. Go ahead, Jenny Carroll

Jenny: I just wanted to follow up on that first question about false positives and,  I don't pretend to be a health practitioner at all, but in this COVID work that I've been doing now for a few months,  I do listen in to the epidemiologists from the State and that question comes up a lot in communities about false positives. And in addition to what Lorne had to say,  I would like people to keep in mind that the test is a point in time. And if you are, you may test positive once and then several days or a few days later, test again and have it come out negative. The negative test does not necessarily mean the positive test was false. It's more of a look at the viral load in your body. So, if you were at the tail end of your COVID infection, the viral load may have diminished to the point where your subsequent test is negative. So there's different reasons why a person might test positive at one time and then later negative. In fact, you know, that's one of the ways that people can confirm that they,  you know, are no longer having that viral load in their body. So I just wanted to add on an extra answer to that question about false positives.

KBBI: I appreciate it. Jenny Carroll, from the City. Is there any information that you need to get out to the public today for the City of Homer?

Jenny: No, I think we've done a long, long haul today. Thank you. I appreciate it.

KBBI: I appreciate you staying 10 minutes later. Thank you, Jenny Carroll, from the City of Homer. Nurse Lorne Carroll, is there anything on your list today that you feel like needs to get out?

Nurse Lorne: Yeah. Yeah. I was kind of thinking this morning if we kind of step back and look at all COVID cases to date, reported up until yesterday at noon, we're at 696 cases. So we're at about 700 cases statewide and then considering Southern Kenai Peninsula, like our home, from Ninilchik south and across the Bay, we're at 72. So one of the things I've been thinking about this week is even though that Southern Kenai Peninsula only represents 2% of our State's population,  we have 10% of the cases based upon residency or the address of the person that tests positive for COVID. So I think like, this week would be a great time to reevaluate with your friends and family and maybe ask the question and talk about it, like, what are the things that we can do, in our circles,   in order to decrease the chance of transmission of COVID from one person to the next? Otherwise just want to say thanks to all the partners that have been right there with us, and we'll be right there with you too. Thanks.

KBBI: Thanks Nurse Lorne Carroll from the Homer Public Health Center and the Alaska Department of Health and Social Services. Derotha, I started with you so let's finish with you. What is on your list today? Is there anything to talk about testing?

Derotha: Well three things. Actually, I want to follow up with Lorne on testing and the numbers in general. So the Hospital has done 3,225 tests out of the 4,300 and odd change on the Peninsula. So, I mean, we've tested 75% of all the tests on the Peninsula. So I say like, good job SPH and related folks and also good job to the service area for coming out and getting tested because that's half the battle. So thank you for doing that. I want to remind everybody that a little bit of the uptick in our numbers, we think may have come from Memorial Day gatherings and this weekend is Solstice and I just want to like ask people to reconsider their traditional Solstice gatherings and, if not reconsider having them at least reconsider what they look like and just make sure they're conducted in a safe manner for all involved. And I also just want to remind listeners that we have a lot of infection prevention strategies in place here at the hospital and all the other buildings. So, I apologize I'm hoarse this morning, I guess. So, I just want to remind folks, it starts at the door when somebody tries to come in one of the buildings it's, you have to answer a series of questions. Do you have these symptoms? Do you have a fever? Have you recently traveled? Do you live with somebody who has recently traveled or has tested positive or has public health ever contacted? I mean, the list is really long and it starts at the door and it continues during your entire experience with a variety of, using PPE and enhanced cleaning and disinfecting strategies and I just want to really let people know that employees up here are going above and beyond to maintain a safe experience, not only at the hospital, but at the clinics and any of the buildings.

KBBI: Well, thanks for that. I think I was listening to someone in the community say yesterday, that so much of the beginnings, the first few months of this was, it was like a sprint, we're all gathering PPEs and we're getting disinfected and we're making a plan to work from home. And that this is now, but this isn't a sprint, this is a marathon and we have to start viewing it that way now.

Derotha: That's a good way to look at it. And, how can we, how in a marathon, can you maintain that kind of pace, that normal pace to get all of your normal stuff done, but in a safe way, that's going to allow you to finish. So, if anybody in the community has an interaction at the hospital that they want to share their experience or give me a suggestion or give us a suggestion, give me a call at 399-6212. I'm always happy to hear suggestions because we're all learning as we go through this.

KBBI: Thanks so much Derotha Ferraro from South Peninsula Hospital, Nurse Lorne Carroll from the Homer Public Health Center and Jenny Carroll from the City of Homer. We'll check in soon. Thanks so much.

Everyone: Thank you, Kathleen. Thank you.

KBBI: This has been the COVID 19 Thursday brief I'm Kathleen Gustafson.