Dr. Wayne Tuckson:
Hello and welcome to coronavirus at KET forum. I’m Dr. Wayne Tuckson. Since it was first discovered and Wu Han China in December of 2019 coronavirus or COVID-19 has been steadily spreading throughout the world, including the United States and now in Kentucky. Uncertainty about the impact of the virus is disconcerting to say the least, raising concerns about travel and crowds and even causing school closures and event cancellations in some areas.
Over the next hour, we hope to address your questions about this new coronavirus, with the help of state experts who will share the latest information and tell us how Kentucky officials are responding. We want to hear your questions, so please contact us by phone at 1-800-944-4664 or email your questions to ketforum@KET.org. You can also Tweet us @KET or message us on our Facebook page. We have a great team of volunteers from the Lexington-Fayette County Health Department and UK College of Public Health to field all of your questions.
To get us started, we prepared a short overview of the virus, what it is, and how it’s transmitted and most importantly, what you can do to minimize your risk of contracting COVID-19.
You might be surprised to know that coronavirus is not new. Human coronavirus was first identified in the 1960s. There are seven known types of human coronaviruses, which are named for the crown like spikes on their surface. Four types are very widespread and cause mild to moderate respiratory infections like the common cold. Two types are much more dangerous but relatively rare. Severe acute respiratory syndrome, known as SARS, and Middle East respiratory syndrome, known as MERS. The seventh type is a new coronavirus recently discovered in China, often referred to as novel coronavirus. It causes a disease known as COVID-19.
Dr. Tedros Adhanom Ghebreyesus:
This is a unique virus with unique features. This virus is not influenza. We are in unchartered territory.
Dr. Wayne Tuckson:
We are still learning a lot about this virus, but we know that it is spreading quickly throughout the world and can be quite severe, which is why there is legitimate cause for concern. Not panic, but concern. The virus spreads from person to person through droplets released into the air when an infected person coughs or sneezes. Those droplets can land in the mouths or noses of others within a six foot radius. It may also be possible for someone to become infected by touching a surface with the virus on it and then touching their own mouth or nose.
Eight out of ten people that get sick will have mild symptoms. Others, in particular the elderly and immunocompromised, may become very ill and not recover. Symptoms may appear two to 14 days after exposure and include fever, cough, and shortness of breath. If anyone suspects that they may have COVID-19, they should contact their healthcare provider immediately. The virus is diagnosed only through an official testing kit.
There is no specific antiviral treatments or vaccine currently available. That is why prevention is essential. You can reduce your risk substantially through some simple strategies. Avoid close contact with people who are sick. Stay home if you are sick. Wash your hands frequently for 20 seconds at a minimum. Avoid touching your eyes, nose, and mouth. Sneeze or cough into a tissue and discard it immediately, or if necessary, sneeze or cough into your arm. Clean and disinfect often. Do not purchase face mask unless you are ill. They are not effective for prevention and are needed for healthcare settings. In the unlikely event of a quarantine, make sure your home is prepared. Specifically, have a two week supply of water and food and be sure to stock up on your prescription medications and other over-the-counter medicines you count on. Remember that this is a rapidly evolving situation and when in doubt, contact your local health department or visit the CDC website. You can also call the Kentucky COVID-19 hotline at 1-800-722-5725 or visit the official Kentucky COVID-19 website at kycovid19.ky.gov.
Governor Beshear has been holding regular, ongoing press conferences about the spread of the virus in Kentucky. Here as part of his statement from earlier today.
Governor Beshear:
The most important thing that we can take away every single day is that while we are working to be prepared that everybody should remain calm, that we are ready for this, that our local health departments are ready for this, that the state is ready for this, and we will get through this. To every Kentuckian worried out there, yes, we’re going to have to take some steps that disrupt our daily lives, but we are going to get through this. We’re going to get through it together, and when we take a step that there is difficulty in people’s daily lives, understand that it’s to protect our fellow citizens and we’re going to do everything we can to make sure we manage this coronavirus outbreak in a responsible way that protects our citizens.
So this afternoon’s update is today, we tested 20 cases. Again, those aren’t kits or tests because there are multiple tests per individual. Of the 20 cases, 18 were negative and two were positive. Both of the positive cases are from Harrison County. They include a 60 year old male and a 50 year old female. That brings us in total in Kentucky to eight positive cases, five in Harrison County, two in Fayette County, and one in Jefferson County.
Kentuckians, again, should remain calm, and the number one thing you can do is practice good hygiene. Practicing that good hygiene is the best way to prevent you and your family from contracting the coronavirus. It’s also the best thing you can do not to spread it. As Dr. Stack, behind me, has said, 80% of the people who get this are going to show little to no symptoms and so it’s important in your hygiene to make sure that we are not transmitting the coronavirus to others.
Every day we are taking more and more steps to address the coronavirus in Kentucky. We’ve declared a state of emergency, which gives us every tool in state government to address the coronavirus. We activated the emergency management center. We’ve initiated changes to Medicaid to make sure that there is no pre-authorization or costs associated with getting care or testing for the coronavirus. Filed an executive order to waive copays and other costs for most private insurers. It waves those costs for every insurer that we have the power to do so with. We have guidance on our website for everyone and particularly counties with positive cases and I would highly suggest people go to our website.
Dr. Wayne Tuckson:
And now will we begin to unpack and examine all of the issues surrounding this virus. Our phone lines are open for your questions. Joining us tonight to share their expertise and experience are Dr. Steven Stack, commissioner for the Department of Public Health here in Kentucky, Dr. Lori Caloia, who is medical director for Louisville Metro Public Health and Wellness, Dr. Derek Forester, medical director for Infection and Prevention Control at UK HealthCare, and Dr. Harry Burchett, superintendent of Harrison County Schools.
Steve, let me come to you first. We just heard some significant steps that the governor has taken. Why are we doing this for this virus and not just the flu?
Steven Stack, M.D.:
That’s a good question, Wayne. This was a disease that didn’t exist in the human population until some time in late December 2019. It spread quickly, and in China, it appeared to have a higher mortality rate, so more people were dying from it with severe illness. And when you have an unknown disease with a fairly severe impact, that, obviously, instills concern or fear in people. So there’s a very rapid response. And so I’d say that by early January, they’d sequence the whole genome for the virus. They started designing a test to identify it, and they started global containment efforts to try to keep it in a confined area, if possible, in order to minimize the spread while we had time for scientists to understand it better.
As we get to know more information, I think it will be much less fear inspiring because we’ll know more about it, and we’ll have better interventions that we can bring to bear to test for it and also hopefully to treat it or prevent it with the vaccine over time. But for right now, it’s usually the fear of the unknown that makes it harder to respond to it. And so I think that’s why you see people acting very promptly trying to contain it and take steps to mitigate it if it starts to spread.
Dr. Wayne Tuckson:
Lori, are there any other issues, flu versus COVID-19, that would say, “Hey, we need to be really concerned about this one, but maybe we have a handle on the flu.”
Lori Caloia, M.D.:
I think along the same lines as what Dr. Stack said. When we don’t have mechanisms to prevent something, like a vaccine, that also tends to instill fear or panic into people being able to control something. Even if you choose not to partake in that intervention, like a vaccine, you at least have that option, and at this point, I think that’s some of the fear is also related to that lack of ability to do something to prevent this. I think there is something to prevent this. I know the governor said, we’ve got to practice hand hygiene. We’ve got to practice social distancing, and there’s a lot of recommendations that the Kentucky Department for Public Health has on their website. So I would encourage people to go there to learn how they can gain some control in this situation for their own individual selves.
Dr. Wayne Tuckson:
Derek, it seemed initially when the coronavirus was identified, at least COVID-19, it seemed like there was a high mortality rate. What is the difference between this virus or what is it about this virus that seems to be causing such a high mortality rate?
Derek Forster, M.D.:
Well, a lot of that’s not very well understood. So this is a new virus, but it’s very similar to the viruses that cause MERS and SARS, which has been referenced already. And so we’re using a lot of what we know from those viruses and some of the pathology and stuff that we learned in the last couple of decades and how patients responded and how patients were impacted, and we’re extrapolating that, right now, until, like we talked about, until we get more information. And there’s a lot of overlap in what we’re seeing. So the big thing that was causing issues that was recognized in China is people were coming in with what’s called ARDS for acute respiratory distress syndrome. So this is a severe reaction, typically, to infection, that also involves the immune system, the immune system response. And so I think Dr. Stack referenced this, but this is a virus that hasn’t circulated before. Our immune systems haven’t seen it. And so oftentimes in those settings when there’s no precursor or previous, at least, immunity or exposure, you get that type of response sometimes.
Dr. Wayne Tuckson:
It seemed like a lot of the people who were dying were older people. Is it that the virus has a predilection for older patients or is it that there were some other problems going on in these patients who did succumb to the virus?
Derek Forster, M.D.:
It seems like it has to do with more comorbidities in the aging population. And so yeah, certainly age and comorbidities, immunocompromised states seem to be risk factors. We’re learning more and more. That data now that’s coming out of China about risk factors for severe outcomes, potential death. So that appears to be the biggest role, the biggest player, right now.
Dr. Wayne Tuckson:
I think we’ll come back to that in a minute, but, Steve, telling me what kind of numbers are we talking about here in Kentucky?
Steven Stack, M.D.:
Well, here in Kentucky, we have just over 50 patients who’ve been tested, and we have eight positives and 46 negatives. And so those testing numbers sound small, but it’s just the beginning of our ability to understand what’s going on in the state of Kentucky. And so in other areas, in China and in Italy and other countries, the virus began to spread, and it had a wider impact. I’m really happy to say though, and I’m really grateful to the Governor for taking the steps he’s done because he’s taken a lot of steps to try to implement social distancing, but particularly for the most vulnerable population. So we’re talking individuals over 60 and individuals with chronic medical illness like lung, kidney, and heart disease. And so if we take focused effort to try to prevent them from being exposed to the infection, we can hopefully help those people most vulnerable to this disease.
On the other end of this, it appears that children are relatively spared by this, and so you can have a child under 15 who has no symptoms. So for parents and grandparents, your kids appear to be safe from this. So you don’t have to worry about the young ones. At least, it doesn’t appear so. What we have to do is protect those who are a little bit older and have medical problems, and if we do that and we do it thoughtfully, we may be able to help learn from what’s happened in other countries around the world.
Dr. Wayne Tuckson:
Harry, you had one of the first cases here in Kentucky. Now, since you are the superintendent in Harrison County Schools, what was your big concern when you found out that someone in your area had the disease?
Harry Burchett, Ed.D.:
Well, Wayne, it wasn’t necessarily about one or one single individual. We’re blessed with great community partners in Harrison County. And Judge Barnett and Mayor Smith along with a Dr. Crystal Miller from Wedco Health Department really led that effort and they brought together all community partners and we met Saturday morning and we discussed the situation. We discussed the amount of exposure already in that community to the medical community and then the possible amount of exposure into the community by a patient one.
Harry Burchett, Ed.D.:
So for us, in that community, and it’s going to be different for every school district in every part of the United States, but for us, we felt like it was best to consider the safety and wellbeing of our students, staff, and the community, and we had the opportunity to take some time off and practice what we call nontraditional instructional programming. We had that tool in our tool belt and we hadn’t used that this year. So we thought we would give the public health officials, the community a chance to get ahead of this and just let it play out and see where we go. So we knew we had epidemiologist from the state in doing that trace investigative work, and we just want to give them a chance to get that work done and get ahead of this.
Dr. Wayne Tuckson:
Now, I know you are a superintendent in Harrison County and your decision was for that county, but we did have a question about Fayette County. Why haven’t they closed their schools and do you think even other school systems in Jefferson County might have to, since they’ve also had a people affected with the virus?
Harry Burchett, Ed.D.:
Well, obviously, Wayne, every district’s going to have to deal with this on their own. The situation is different in every community. Harrison County, at this point in time, has more cases than any other place in the county, although we’re a County of about 17,000 and some odd people. So it’s unique to us. Every superintendent, every district has to deal with that on their own way.
Dr. Wayne Tuckson:
Lori, let me ask. So we have someone who infected, let’s take for instance there, or even back in Jefferson County where you are, someone’s been infected. How do you determine who gets tested and when do you decide to do that testing?
Lori Caloia, M.D.:
So our epidemiologists, both at the state level and locally, look at each case individually. So if we have a positive case, we go through contact investigations. We determine who those individuals were exposed, determine the risk to those individuals, and recommend testing in symptomatic cases. At this point, there’s many situations where an individual may have an exposure where we would recommend quarantine, which means they stay at home, they don’t go out in the public, because they don’t have symptoms. They might develop symptoms. We don’t know whether they will or not, and so we want to keep them from potentially infecting someone right at the onset of the illness, before they realize that they could be contagious. So in those situations, I think I would encourage people, if you’re contacted by your local health department or by the state health department, please do what we ask you to do. Please be as honest and forthright as possible. We are here to help you, as well as the rest of the community and try to prevent the spread.
Dr. Wayne Tuckson:
So do we test that individual, everybody in that individual’s family or everybody in that individual’s working circle or where do you stop it?
Lori Caloia, M.D.:
Yeah. Each case is, typically, individualized based on the degree, level of exposure. So it’s going to vary from person to person. We obviously test the person who we think has the case to begin with an end up diagnosing them. And then again, it goes back to symptoms for the individual. If they don’t have symptoms, it doesn’t make sense to test them because they’re not a case, yet, until they develop symptoms. And so we certainly practice that quarantine recommendation, but we don’t go from there.
Dr. Wayne Tuckson:
Steve, why don’t we just test everybody? Isn’t that a simple way of doing it? We can solve the issue. You’re not sick. You’re not sick. You’re sick. Go away.
Steven Stack, M.D.:
Well, I’m glad you asked that because I think the public really needs to know this, but not just the public, I think, the healthcare providers and other community leaders. Anytime we use a test in healthcare, the information has to be useful to you. And like Lori has just said, if you test someone with no symptoms, a negative test doesn’t rule out the disease. Because if you’re in the incubation period, which we think could be up to close to two weeks, you could develop symptoms days after you get the negative test. So if we tell you you’re healthy and you’re not, we’ve not done you a good service. And if we tell you your positive, that is helpful. That can help guide treatment.
In an ideal world and hopefully in the weeks and the months to come, we’ll have the test much more widely available. But right now, remember what I said at the beginning, they had to sequence the whole genome, build technology and science by finding particles of the virus to test for, and now, the process in the laboratory is still very human intense. Technicians have to do a lot of steps and it takes multiple hours. In the future, it’ll be much more like when you go see the doctor and you get a rapid strep test or a rapid influenza test, where they can take a sample and either do it just in a small device or put it in a machine and it comes out the other end and the result’s produced, but were weeks or a couple months away from that being up to full scale for everyone to have that.
So for right now, we have to use the test for the patients at the highest risk or the individuals who are at highest risk for spreading to others so we can try to contain the disease as much as possible. So I’d close-
So we can try to contain the disease as much as possible. I’d close by saying I want everyone to know we want to test everyone who needs to have a test. Tests are not being denied people who need to be tested, but we have to use it judiciously because it’s not yet widely available because science and technology takes time in the commercial industry to get up to scale to be able to do this across a country of 330 million people.
Dr. Wayne Tuckson:
Derek, you’re in the hospital.
Derek Forster, M.D.:
Mm-hmm (affirmative).
Dr. Wayne Tuckson:
Steve’s an emergency room doc, but you’re in the hospital, so I feel like I’ve got a cough, some other little fever chills. What do I do? Do I go to the emergency room? Do I go to my doctor or do I just stay home?
Derek Forster, M.D.:
Well, certainly, if you don’t have… I mean, if you’re not having fever in addition to your cough and those type of things, if you’re otherwise well, then we would recommend you not come into healthcare at all, to be quite honest with you. You can contact your provider and get some advice, but you may be more at risk just by overloading healthcare in general right now,
Dr. Wayne Tuckson:
Steve, what are some of the symptoms or things that should drive me to go in to see somebody?
Steven Stack, M.D.:
If you have a high fever, if you have a cough, with difficulty breathing. If you feel you’re lightheaded, or you’re dizzy, or you’re otherwise feeling like you’re getting incapacitated by illness, that might be a reason to go, but the part I’d want to emphasize is what Derek said. If you are well, if you have no symptoms, there is no benefit to you. Now this is the ER doctor coming up. There is no benefit to you seeking medical care because you have no symptoms, and no matter how much medical care you seek, we cannot promise you you will not eventually get sick.
If you are well, you are well. If you are ill, but you would not go to a doctor or a hospital except for the fact that the coronavirus is out there, don’t go to a hospital or a doctor because if you have a small fever, or a cough, or body aches, and you think it’s just like the cold, I’d normally stay home and take Tylenol, stay home and take Tylenol.
If you have questions, call someone on the phone. Don’t go somewhere where you could spread what you have or where you could get what someone else has. But if you are sick, if you truly think you have an emergency, then yes, call your doctor or, if need be, call or go to the hospital. But don’t go to the hospital if you are either well or just have mild illness because you will probably be just fine, and we need to save the capacity for people who are truly ill.
Dr. Wayne Tuckson:
Lori, let me ask you a question, came out of Hopkins County. We know that the virus is spread through person to person contact, I guess through droplets in the air.
Lori Caloia, M.D.:
Mm-hmm (affirmative).
Dr. Wayne Tuckson:
The question is if it is airborne or droplet spread, why don’t we all wear a mask?
Lori Caloia, M.D.:
The biggest reason for someone to wear a mask would be either a healthcare provider who is in very immediate contact with the individuals that they’re caring for. They might be doing a procedure in the hospital where they’re generating that aerosol, and a lot of that material is coming into their face that they would be at high risk.
Or an individual who’s sick, it might be recommended that they wear a mask to prevent them from spreading those germs out from when they cough or sneeze. Those are the key reasons to wear a mask. An individual like you or I walking around in the general street, we don’t need to wear a mask. It’s not really going to protect us from either when either of those situations don’t necessarily apply to us.
Dr. Wayne Tuckson:
Yeah. It seems when we see video of folks in China, or in India, or some other countries, they all wearing a mask. We don’t need to do that?
Lori Caloia, M.D.:
We don’t need to do that. No.
Dr. Wayne Tuckson:
Tell me about other transmission, being on the surfaces and all that, is that a concern for us?
Lori Caloia, M.D.:
I think this has been a common question. I know early on when this first started coming on the news, and we received many questions about I got a package from China, should I be worried about touching the package. Many of those items take a long time to ship. The virus can live on surfaces for up to nine days. However, that really depends on the amount of the virus that’s in what we call the inoculate, so how much of that is on the surface. What’s the temperature, what’s the humidity level?
In most cases with the shipping process, there’s not a concern at all. Obviously if you have someone at home who has COVID-19, and you are caring for them, you want to make sure that you’re cleaning those surfaces in the area that you’re around. You want to try to separate yourself from that individual as much as possible. But in general the surface concern is less of a concern than being around an individual that we know has that infection.
Dr. Wayne Tuckson:
Derek, if I could ask a question, it just came from Judy out of Jefferson County. You talked about older patients who seem to have a worse prognosis what they do have, or had seemed to have had worse prognosis. What about being around people that are older, and if you could also in that, what about going and eating out at restaurants?
Derek Forster, M.D.:
Well, I don’t know that I can answer that question. I mean, I think certainly just being around somebody or being around somebody who’s at risk is not going to put you at risk or put anybody else at more risk. Obviously, this kind of gets back to the point too, if you’re sick yourself, you should stay home, and you shouldn’t be around anybody who might be at risk for anything as far as more dangerous complications. But the restaurant thing, I haven’t changed my practice in in my pattern, if that helps.
Dr. Wayne Tuckson:
Harry, I got one question I want to ask you about is we’ve been seeing reports from various big box stores are sending out notices to us all. I’ve even seen where Southwest Airlines has commented about they’re doing things to step up cleanliness, or doing things in their facilities, to help prevent spread of COVID-19. Are you doing anything in particular over there at your schools?
Harry Burchett, Ed.D.:
We are, we are. I said earlier our first and foremost imperative was safety and wellbeing of our students, staff, and community.
Dr. Wayne Tuckson:
Sure.
Harry Burchett, Ed.D.:
Our second was the continuity of our instructional and nutritional services. We are doing those things right now. We are doing our nontraditional instructional program, and we’re providing free meals to all our students throughout the county, both by pickup and by delivery if necessary. That’s something I really want to praise our staff, Austin Dacey and our food service staff, for doing that.
In addition to that, my facilities director, Robert [Schweisser 00:06:37], he met with his team yesterday morning at 7:30 AM. Custodial staff, maintenance staff, and the principals were all in our central office. They went over the approved list of agents for cleaning for the coronavirus, and we made sure that we had all those in stock. We instructed our folks how to use those, and they were right out into the facilities cleaning the facilities. Our bus drivers and transportation department, cleaning the buses from top to bottom. It’s safe to say, Wayne, that we have the cleanest school district in the state of Kentucky today, right now.
Dr. Wayne Tuckson:
Well, on that same subject then, the big question a lot of people are asking, what about travel? I understand you can get a cruise on an airline ticket pretty cheap right now, but what about travel? Some schools have said we’re going to cancel seniors, or some colleges are asking people not to go on Spring Break. What is the policy that you’re taking right now as far as travel for your school?
Harry Burchett, Ed.D.:
Well this week, right now, we have restricted our extracurricular activities. Those are currently on hold as we work through this week, and we have another community partner meeting this week. We will evaluate the situation and determine what we’re going to do in the future.
Dr. Wayne Tuckson:
Lori, how do we determine? I know you had a trip that was planned.
Lori Caloia, M.D.:
I did.
Dr. Wayne Tuckson:
What kind of decisions were you trying to make about whether or not you were going to take that trip or not?
Lori Caloia, M.D.:
Well, I think there’s a few things. The first thing I do is look at the Center for Disease Control, or CDC’s, website to see what is the current travel restrictions. Obviously the ones that are listed there, especially the level three, would be locations that I certainly would not go, I would not recommend that anyone travel to. The CDC is recommending against travel to those locations, and anyone who returns from those locations should be on self quarantine for 14 days after return.
To me, that means the risk is just too high to take. Recently, there was instruction to limit prolonged airline flights as well as cruises potentially. That was one of the factors in my decision making on choosing to probably postpone my trip for a few months down the road until we know what’s the big picture here across the world.
Obviously a cruise ship is a little bit riskier. We’ve seen a few of those have not gone so well. Being quarantined on a ship for a prolonged period of time can have significant impact on people psychologically, obviously economically, people that want to get home, get back to their families, get back to work eventually. That’s limited that, so considering those things, definitely.
Steve, what are you telling people? Overseas travel or even travel within the United States? Do it, don’t do it, or just follow the CDC guidelines?
Steven Stack, M.D.:
No, I think Lori got it right. I think that you got to be careful with overseas travel now for a couple of reasons. First of all, you better look at the CDC website and find out if it’s a high risk country, and if it’s high risk, I think it’s high risk, and I wouldn’t do it personally. I also, though, think if you get stuck outside the country, there’s a challenge. I mean, one of the things is hopefully that, in the United States we have more resources, hopefully people are going to do better here because we have a really robust healthcare system to care for folks.
I think there’s another thing, getting stuck far away from home if you’re ill. I think domestically it’s a little bit different. You’re still in the United States, and you’re going to probably be able to get home and get good care. But I do think, and the governor’s even said this, if you’re over 60 or you have major medical conditions, you probably ought to think about just staying home for a little while until we figure this out better, because you are at the highest risk. Over 60, major medical problems, stay home for a while until we figure this out better. Because, quite frankly, you’re at the highest risk, and you’re the ones who are most likely if you get sick to have the worst problems with the disease.
Dr. Wayne Tuckson:
Derek, could you answer this question from Eric from Hamilton County. What is the impact of COVID-19 on pregnancy?
Derek Forster, M.D.:
Mm-hmm (affirmative).
Dr. Wayne Tuckson:
And should we be looking at anything special for the individuals who are pregnant?
Derek Forster, M.D.:
Yeah, well, we don’t have all those answers yet. I mean, we’re still learning, but that is certainly an area that is of interest I think to a lot of people in our group too. We were just having those discussions today actually with our group at UK. We don’t have those answers, but certainly if you look at some other infections, they certainly can put folks at risk, and can put the baby at risk. Right now, there’s nothing to really support that, but we are kind of making some of those plans and thinking about that more. I think there’ll be more to come on that. Again, right now what we know, and the data that’s coming out, it doesn’t suggest there’s any increased risk to the mother at this point in time.
Dr. Wayne Tuckson:
What about to the baby? No idea?
Derek Forster, M.D.:
Don’t know.
Dr. Wayne Tuckson:
Well, you’re the big idea person, therefore we’re going to go with the question from, and I apologize, [Sorea 00:31:23] from Muhlenberg County. We always hear that for viral infections we don’t treat them with antibiotics or any other medications. Since this is a viral infection, are there any antivirals, and if not, how are you going to go about treating these patients?
Derek Forster, M.D.:
Well, currently, there’s no antivirals that we’re using to treat. There are some things that are being studied, some medicines that are being studied in different trials, and we may have some of that data coming out soon, but it certainly won’t be any time in the next couple of months probably to really impact the way we provide care right now. Luckily, and we’ve talked about this already, but the majority of people are going to have very mild disease, and as we’re learning more and more, even as we look at the mortality rates that have been reported.
Those are probably pretty big overestimates because there’s a lot of very asymptomatic disease, or mild disease, that just never gets into healthcare or gets diagnosed. We’re learning more and more about that, but most people are going to have very mild illness, and otherwise, it’s supportive care right now if you do have more severe illness, but the majority, again, are going to have mild disease.
Dr. Wayne Tuckson:
Would you kind of define for me what cure means when you’re talking about this, and how do I know, and when do I go back to work or school?
Derek Forster, M.D.:
Are you talking about if you get COVID-19?
Dr. Wayne Tuckson:
If you’ve been diagnosed and you need to get treated, yes.
Derek Forster, M.D.:
Well, I mean, we’re still learning about that too, but right now we would define cure, or I would define cure, as recovery. As you had your illness, you’re over your symptoms, and you feel better or feel close to the way you were before you were ill. Now we’re looking at repeat testing and what what value repeat negative tests have, and there’ll be more to come about that, I think, as we learn more and more. But I would focus on recovery.
Dr. Wayne Tuckson:
Recovery. Okay. Many people are concerned about how this virus will impact the business community. Earlier today we spoke with Ashley Watts, president and CEO of the Kentucky Chamber of Commerce by Skype to get her impressions. Ashley, thank you very much for joining us. I wonder if you could tell me what are some of the concerns that you’re hearing from your members right now?
Ashley Watts:
Well, thank you for having me, and it has been a busy couple of days and really leading into weeks about, with concerns from our membership across Kentucky, just really with the uncertainty and wanting to make sure they’re protecting their employees the best that they can, making sure their workplaces are safe, and also knowing, if they’re supposed to have events, if they should travel.
I would think Governor Beshear for his really reassuring leadership of saying take the precautions, make sure that your employees are safe, check on each other, make sure that you’re doing the social distance things that he has talked about, but also know that the economy has to go on, and business has to continue to operate. I think it’s important to note right now that there are no travel bans right now. Of course some businesses are doing that voluntarily, but business really can continue on as normal.
Besides the public health concern that we are all facing, and the uncertainty of what’s going to happen in the upcoming weeks and months, and worrying about the health of all of our Kentuckions, there is a really big worry about the economy as well, and potentially this coronavirus and the trickle effects of it, leading into a recession. Those are the things that we’re hearing from the business community that are really worrying them.
Dr. Wayne Tuckson:
Well, governor Beshear asked that companies provide paid sick leave for their employees during this period. How feasible is that and how many companies to your knowledge are actually providing that sort of sick leave?
Ashley Watts:
I know that many of our members are providing that sick leave, and I think it is feasible for many employers in Kentucky. Unfortunately, it’s not the reality that every single employer in Kentucky can offer those kinds of benefits that medium and large-size businesses can offer. But we definitely are encouraging businesses to make sure if they have the ability to offer that to their employees, make sure that if their employees are sick, they are staying at home. We all kind of agree that if you’re sick, you need to stay at home, and hopefully employers are being part of that solution, and we’re really encouraging them to try to find whatever resource they can to help their employees through these next coming weeks and months.
Dr. Wayne Tuckson:
You’re at the intersection of health and commerce. How do we keep the economy going without sacrificing the healths of our communities?
Ashley Watts:
It’s a tricky situation right now that I think we’re all trying to find the balance of, of making sure that we’re safe, our employees are safe, our workplaces are safe, but also making sure that business goes on and commerce continues to grow. We had been in a very good economy up until recently, and I think we’ve all seen what has happened with the stock market, and the economy in the travel industry in particular.
We are urging business, along with the travel industry, and really from the guidance of the experts, of the CDC, Public Health Commissioner, and the Governor, to make sure that you are protecting your employees’ health, make sure that your workplace is safe, do take every precaution that you feel like you need to do. But also know that right now there are no travel bans, there are no calls to cancel any type of meetings or large groups, but to really be cautious, and there are certain groups that are affected more than others. We’re really just trying to listen to those experts right now and make sure that we’re making sound expert-based decision.
Dr. Wayne Tuckson:
Let me ask you one last question if I could, how feasible is it for people to work from home? You talk about the big businesses and small businesses. Is that a real deal for us here?
Ashley Watts:
I think it is, and that’s the beauty of technology in the time that we’re working is that I’m right now Skyping you, and I’m not in the studio, so I do think we do have the ability to work from home, and we are encouraging everyone that has that ability, and you feel like that’s the safest precaution for you, to do that. I know at the chamber we have let a couple of employees that might be a little higher risk have the ability to work from home. I think that’s one of the great things technology brings to us is that ability to work from home, and hopefully not have kind of that lag time or that drag time of what would be a normal business day.
Dr. Wayne Tuckson:
Well Ashley, thank you very much for taking time to be with us, and I hope you continue to remain safe. Thank you.
Ashley Watts:
Thank you. You as well. Thank you for having me.
Dr. Wayne Tuckson:
Steve, we got a question from Benny in Anderson County, and the question was why can’t the public be made aware where an infected person works or has been? Are we going to get to the point where, the question is really about transparency, but it really kind of gets into privacy issues and others? Are we going to have to monitor all individuals and see where they’ve been, and done, and who they’ve been in contact with?
Steven Stack, M.D.:
Yeah, so there’s a few things here. First of all, I think the Governor has led with information on this. I think as soon as we have information, and I’ll qualify this, every step of the way, he supported me in insisting that the clinicians have access to the information they need to treat patients, so they get that information right away. But he gets out there right away to make sure people know here’s what we found, you don’t have to be scared. We’re going to get through this and we’re going to work together as a community. One, he has led with information. I think he’s been incredibly transparent to the point of doing two press conferences a day on some days to try to get it out.
Steven Stack, M.D.:
Now as far as the other information, more details, I’d ask you to put yourself in the patient’s perspective. We all value our privacy, and I think we all have a right to privacy, so we also have an obligation, both government and also me as a physician, to help advocate very strongly to lead with information, but to guard the individual’s right to privacy. Now when these patients are finished, when their infection is over, they are fine, you can be around them. They do not have a chronic, ongoing condition. They will be fine and you will be fin. This will be like when you get to the other side of the flu. We don’t shun people when they’re over the influenza virus, and we should not be shunning these people because when they’re recovered, as far as we know, everyone’s going to be just fine, and it’s going to be like having any other viral illness.
Dr. Wayne Tuckson:
Derek, let me ask you, earlier Harry said that his school is now the cleanest place in the world right now. We can all go over there and eat off of the floors.
Derek Forster, M.D.:
Sounds good, yeah.
Dr. Wayne Tuckson:
What are the things businesses need to do to make sure that their facilities are clean, and how can we be sure about it? Any testing, does the Health Department come in and give their little A ratings, B ratings, et cetera?
Derek Forster, M.D.:
No, I mean, it’s really about just increasing frequency and trying to ramp up the amount of disinfection that facilities do and businesses do. What is reassuring is even though this virus can cause severe disease, it’s actually a pretty wimpy virus.
Even though this virus can cause severe disease, it’s actually a pretty wimpy virus in the environment. I mean, it’s very susceptible to your standard disinfectants and so that’s been certainly something that’s been comforting and I want to make that point as well.
Dr. Wayne Tuckson:
Harry, I want to go to you though. The impact in your county, you shut down the school reasonably and… But kids have to eat. There are some kids who are getting their nutritional programs there. Parents have to be concerned because now their children are at home. What has been the ripple effect?
Harry Burchett, Ed.D.:
Well certainly there’s a ripple effect from any decision that you make to shut down the schools. We want our kids in the schools. We want the schools open and we hope to get back to that very soon. I would like to echo Steve’s comments about Governor Beshear. I would say I have never seen a governor lead a crisis like he has in this particular one. Matter of fact, on Saturday he spoke up and said he supported our decision to close the school and I commend him. I want to thank you and the governor for his efforts in leading this situation in Kentucky.
Certainly those ripple effects throughout our community are vast. Today we had a community partner meeting led by the chamber of commerce director, Tommy Jean Clifford. At that meeting was Judge Alex Barnett, Mayor James Smith, our WHEDco director, Doctor Crystal Miller and many many chamber small business owners and they were there to ask those very questions. How do we continue forward and I would encourage this to anybody in Harrison County that is listening here tonight, go out and support those local businesses. There is nothing keeping you from visiting those businesses, conducting business there, eating, dining, buying, purchasing. Go out and support those businesses. They need your help.
Also, our staff is in the school working right now. Our teachers are in their classrooms working, supporting instruction, our custodians, our maintenance folks, our bus drivers, our cooks, our school secretaries. I also would encourage all those folks get out and contribute to the local community right now and help support them in this time of need. We will get through this. [Cynthiana 00:42:24] and Harrison County is showing what a small community can do with a situation like this. We’re on the forefront of this. We’re the first community to deal with this at this level, but I think we’re showing and showing the state and the nation what a small community can do to lead a situation like that.
Dr. Wayne Tuckson:
What about the feeding programs for those kids who were getting lunches or whatever meals at the school? Are they getting them still.
Harry Burchett, Ed.D.:
Absolutely. We have a two a meal sites open right now, Northside Elementary and Harrison County High School. We have it available for drive through and pick up and we also have a call in program where they can on a list for delivery. Anywhere in Harrison County, if a student needs a meal, we have a process to get that to them right now.
Dr. Wayne Tuckson:
Lori, I’m somewhat being somewhat facetious when I asked Derek about do we put up the ratings like we do in restaurants, but do we need something like this for businesses. We turn on the TV, we see people in hazmat suits walking through the streets, spraying down things. I haven’t seen that here in the States. Are we missing something or is that overkill or what’s going on?
Lori Caloia, M.D.:
I think the important thing that we’ve been doing in Jefferson County is communicating with our local organizations, business community and providing those messages. What do you do? How do you keep your locations clean, safe? How do you reduce the risk to your own employees while you remain open? I think that communication is really important.
The Centers for Disease Control, again, has really great resources for businesses, community members. There’s a lot of information out there, almost information overload at times and so trying to help those community partners navigate that and determine how they can reduce the risk for both themselves, their staff and our community.
Dr. Wayne Tuckson:
Could you comment on prescriptions? Ms. [Sweitzer 00:44:11] in Jefferson County wrote in and was asking, “Will insurance companies honor prescriptions, especially for people who want to stock pile them? Say, I’m going on a trip or we’re told to keep our supplies up.
Lori Caloia, M.D.:
Well, I saw today I believe the governor issued an emergency proclamation to allow the pharmacist to refill medications for 30 days, particularly in effective counties. That is a really important measure that gives some flexibility to local pharmacist to help in this crisis. Our healthcare providers are being overloaded with people calling, needing help with symptoms relating to respiratory symptoms. They’re afraid that they might have COVID-19 and so that pharmacy resources out there, they’re ready to help us and by allowing that to happen, that’s going to be a huge help for the rest of the healthcare community.
Dr. Wayne Tuckson:
Steve it seems in other areas, not here, but there seem to be a lack of direction from the top. Can you tell me what it is that you’re doing in your office to coordinate activities regarding this disease?
Steven Stack, M.D.:
Oh, there’s a lot of activity going on. So first of all, and I hope what you see… I hope what you see when the governor brings people in to the press events we do and what you see here is a community, a serious, thoughtful people working together. I would say first of all, the public should get informed, be informed, get credible information from people who are credible sources. We’ve tried to put that all on the website and it’s right up on the screen now. Kycovid19.ky.gov. It’s a credible source of information. If you go there, you’re going to find the current data, the test results for the day for the state. You’re going to find updated information. You’re going to find new guidelines on a daily basis, so be informed.
The other thing is you have to do those hand hygiene and personal hygiene things we’ve talked about. They’re important. They’re important for a lot of reasons. One, it may protect you from COVID-19, but it may also protect you from the flu or other viruses and that’s important because right now you don’t want to have a cough, a cold and a fever because we may not know what it is. So it’s better all the way around and then the third thing is we have to take steps at government and that’s the question you are asking and you will see more of that when we advise things like we have in recent days. That visitation to nursing homes is restricted now because we have to protect the most vulnerable. You’ll find guidance in the days that come about that effect may be other communities, but we’re trying to do it in a time when evidence is uncertain in as evidenced based a manner as we can.
I get to talk with colleagues like Lori and Derek. I talked to a fellow state health official from Alaska on the drive to the studio tonight. We have networks of people doing this around the country and sometimes around the world and I just want you to know, there’s a lot of people hard at work on your behalf.
My final thing would be a big shout out to the local health departments. Also though to the Kentucky Department of Public Health. There are people in there, seven days a week now, 8:00 AM to 6:00 PM a room full of people constantly trying to coordinate activities. If you are a person who didn’t get a test you thought you needed or wanted, if you’re a doctor or a hospital who’s frustrated because we can’t do everything we want yet, I want you to know there is a whole team of people doing everything we humanly can to make sure everybody gets the best resources we have available and so I think state coordination has really been central to this. I know a number of us have said it, but the governor deserves some credit here because in addition to the efforts for this disease, we have expanded Medicaid.
I was on your show a couple of years ago talking about this. People have access to care because they have access to health insurance coverage. That helps people and so people like Derek can provide services for them and know that they’re going to get some support in doing that. I think we’ve done a lot. I hope others feel that as well, but we have more to do and and I’ll be up tomorrow morning at 4:30 or 5:00 back at the office trying to do more.
Dr. Wayne Tuckson:
Well before I go ask what’s going on at the county level, tell me what’s going on at a healthcare system like UK, which obviously has its fingers into a lot of different communities. How are you guys approaching this problem?
Derek Forster, M.D.:
Yeah, well I’ll start by just kind of reiterating a little bit of what Dr. Stack was saying because this has been a community type response and even from our level as well. We have a great relationship with our Fayette County partners for the health department and the state as well. I’ve known the folks there for a long time. I say a long time. As long as I’ve been practicing now and doing the role I’m in. I mean this is the community that is going to help us move along and move forward here as we get further down the road here. I can’t thank everybody enough and those guys enough and girls for all the work that they do.
From our standpoint, I mean is a different situation from a hospital standpoint, a healthcare standpoint because you got [inaudible 00:49:01] clinics, you have the hospital itself, you have a busy ER. These are things that certainly take some planning and certainly take a lot of logistics on a daily basis, much less when you’re talking about COVID-19 stuff.
A lot of what we’ve done has been focused around planning for how we increase capacity, how we be able to provide care and do it safely and keep people from picking up things in the hospital while they’re there. That’s a big worry I think for a lot of people is when you’re coming in sick to the hospital, if you’re not sick when you’re coming in to the hospital or a busy ER, you’re likely to potentially get something. We’re taking those steps now to minimize risk from that standpoint.
It’s certainly a big effort to do all those things and then the other thing I’ll say, which I think is really important is a lot of our time right now, I know a lot of my time, is… You have COVID-19 and then you have the fear and hysteria that goes with COVID-19 and so a lot of our time is really about education, is really about what we know, what is actually the evidence and what’s scientific and let’s get that out there and let’s help people calm down and let’s try to limit the worried wells who are also going to come into care in potentially over run the system as well.
Dr. Wayne Tuckson:
Lori what measures are you taking at the Jefferson County Department of Health and Wellness and also, how do you get the message to people like me, [inaudible 00:50:35] docs who aren’t necessarily paying attention to all the bulletins that are coming out?
Lori Caloia, M.D.:
Yeah, so I think at a local health department level, it’s important for people to know that some of the work that we’re doing, we do every day around the clock, year after year. Things like disease surveillance, education for the community and healthcare providers. Those things are things that we’re continually doing. In situations like this, that activity gets stepped up to a higher level. We initiate something called an incident command system, which is a structure that’s flexible. We can expand that to gain additional resources, particularly within our organization so we might have people that ordinarily don’t do anything related to communicable diseases helping with those sorts of activities and then I’m working with community partners.
I think working with the healthcare systems has been a major factor, having relationships with those healthcare systems within our community is really important and something that helps us to drive that community response. For those healthcare providers that don’t operate within a system, I think that becomes a bigger challenge because often they feel like they’re out there on their own. There are a lot of resources out there for those providers to get the message. The Kentucky Medical Association, in Jefferson County, the Greater Louisville Medical Society has posted many resources. They’ve sent out emails to those who are members of those organizations. Our website, the state’s website, is a great resource and so those are all ways that they can get messages, the most up to date messages about what should you do and then again, we’re in constant communication with our hospital systems, our infection prevention folks, making sure that we’re all on the same page and when there is uncertainty, helping each other to make those right decisions.
Dr. Wayne Tuckson:
Derek, a question came in from Kay about children with cystic fibrosis or asthma. Are they at increased risk for COVID-19, but also when the answering, could you talk about people who are otherwise immunocompromised, the transplant patient, the person who’s on steroid treatment, even the diabetic patients. Could you comment about that please?
Derek Forster, M.D.:
Yeah, I mean I think… Yeah, so the answer I would say is yeah, I think they would be an increased risk and we know that from some of the evidence coming out. Like I said, in the literature it’s being reported, which has been really impressive to see how much evidence and scientific information has come out in such a short period of time and they really ramped up the literature on this to help really the world respond to this, but yeah, I will say certainly what we know of things right now is they would be an increased risk and they have to really pay attention to the recommendations that are coming out from the health departments, from the CDC and take those seriously.
Dr. Wayne Tuckson:
Is that somebody that should come in a little earlier if they feel sick?
Derek Forster, M.D.:
Well, I think it’s a little bit of a tough call there. I think as long as you… I’d get back to the same thing that was said before. If you wouldn’t come in before for that particular reason, you still don’t need to come in now for that particular reason.
Dr. Wayne Tuckson:
Steve, tell me about it. There’s the elbow, there’s the fist punch, but tell me what can we do about prevention? Talk about hand-washing, the non handshake. Tell me about it.
Steven Stack, M.D.:
I’m going to tell you, so we’ve been saying this over and over and everyone I’ve heard on this stage is and everyone I hear around the country saying the same things. Wash your hands for 20 minutes. I said that in another thing the other day. Wash your hands for 20 seconds with soap and water. Sing happy birthday twice or say the ABCs. Wash 20 seconds with soap and water. Use hand sanitizer, alcohol based hand sanitizer if you don’t have that. If you cough or sneeze, ideally cough into a tissue, discard it and then sanitize or cough into your arm or your sleeve if you don’t have a tissue and you also need to… If you are sick or your children are sick, keep them home. That’s why we keep talking and that’s why in government the governor has said and encouraged everybody and ensured that state workers will have paid time off if you are sick or you have a sick child, keep them home so they don’t infect other people.
Then I would say the fourth thing is please follow the advisories we’re giving about not visiting nursing homes when you… We know you have loved ones. We have loved ones too. We know we want to be with family. It’s one of the most important things to all of us, but to keep them safe, the best thing we can do for right now is keep ourselves away from them so they’re not exposed to these things and so when we get through on the other side, we’ll all be grateful when we can kind of be reunited in person, but I think those things are the action step that people can take and some people may tune this out, but don’t tune it out. We tell you that because it works. Those things work and then the last thing would be social distancing.
When people cough or sneeze or when you talk and you just have a little spray of saliva that travels about three feet, so the guidance is six feet which provides a margin of error. This is why you should go to businesses in Harrison County. You should frequent stores and places of business because as long as you have adequate distance between people and use good personal hygiene, you are safe. You can go out and be with others. You just have to practice good hygiene.
Dr. Wayne Tuckson:
Harry, briefly give me your final thoughts.
Harry Burchett, Ed.D.:
My final thoughts are for any rural community plan ahead, get ahead of these things, work with your community partners, have those close relationships so that you don’t have to develop them when you are faced with something like this.
Dr. Wayne Tuckson:
Lori, some final thoughts from you please.
Lori Caloia, M.D.:
I think know that we are all in this together. We are working together as teams in our communities and we are trying to provide the most up to date information as soon as we possibly can. We believe in transparency. It’s really important in public health. We know that the public has to trust us in order to follow our message and so that is the importance of getting that message out there early. So please help us with that. If we haven’t told you something, it’s because we probably don’t know enough to tell you about it intelligently and we’re all working together to try to get the information we need to keep you informed.
Dr. Wayne Tuckson:
Would you repeat that dictum about public health when you don’t know what to do to.
Lori Caloia, M.D.:
There is something in public health called the precautionary principle and that means that we are going to give you the best information we have at the moment. We’re going to be as conservative as we feel we need to be in order to protect you. Our goal in public health is to protect your health and we’re going to do that the best that we know how at this point in time with the information that we have.
Dr. Wayne Tuckson:
Derek, what can you tell us please? The thing you want me to take home with this.
Derek Forster, M.D.:
Well, I will just say we will get through it. I mean I think we’ll be talking about COVID-19 a lot for the next several months, but I think we’ll get through it and we’ll be able to learn and move forward.
Dr. Wayne Tuckson:
Steve, does the state have the resources to get us through this? Is this a positive thing?
Steven Stack, M.D.:
The governor has made ample resources available for us to respond. I think the most important thing everybody can do at home though is stay calm. It is okay to be concerned. It is even okay sometimes to be scared, but it is not okay to panic and you have to stay calm and I think the best way you can do that is be informed and get your news sources from creditable folks and credible sites like the website because information that is accurate goes a long way and we’re working very hard to try to make sure that’s available.
Dr. Wayne Tuckson:
I think that is some very good advice and I think the other thing is like you said, cough into the elbow, maintaining that six foot distance. Thank you all for joining us. We hope that we were able to answer many of your questions. Remember that if you ever have any concerns related to COVID-19, you can call the official Kentucky COVID-19 hotline at 1-800-722-5725 or visit the website, kycvoid19.ky.gov. For all of us here at KET, take good care and be sure you don’t sneeze in [inaudible 00:18:28]. Thank you guys very much.