By Debra Moore
Community members had a unique opportunity to ask the county’s public health director and two doctors questions related to COVID-19 during a live Facebook session March 26.
Plumas County Public Health Director Andrew Woodruff, Dr. Jeff Kepple and Dr. Ross Morgan sat six feet apart around the Plumas District Hospital conference table and for more than an hour shared valuable information. The full session can be viewed on plumasnews.com or by visiting the hospital’s Facebook page or the health department’s website.
Woodruff began the presentation by outlining the county’s plan to contain the virus if and when there is a positive case.
Kepple addressed the natural advantage that the county has over other areas because “we can spread ourselves out.” He compared the situations in Italy and South Korea, where the latter was able to “suppress, shorten and squash” the outbreak.
Morgan applauded the community’s efforts at social distancing and said that norms have changed. “Eye contact is the new handshake; eye contact is the new hug.”
He said he wanted the following adage to be shared: “Friends don’t let friends touch their faces.”
Questions and Answers
- Many people are concerned about sterilized waiting rooms?
- Morgan said that much was being done to keep the areas safe including disinfecting surfaces regularly. Chairs are also spaced and individuals can also wait in their cars.
- Is it possible the virus is already in Plumas County?
- “Yes, it’s possible,” Kepple answered. He added that it might have been here a couple of months ago, and that’s why it’s important that people change their behavior.
- What is the availability of ICU ventilators?
- Morgan said that Plumas District Hospital is a critical access hospital, therefore typically patients needing ICU/ventilator care are transferred. But, the hospital is preparing that level of care onsite in the event it would be best for the patient or if there were no beds available to transfer patients out of area. PDH has six operational ventilators and the physicians are brushing up on their skills.
- What is the difference between shelter in place and stay at home?
- With a shelter in place order, individuals do not leave home for any reason. With a stay at home order, people can leave to go out for food or medical.
- What do I do if I have an out-of-town medical appointment?
- Morgan said that any nonessential travel should be put off and he encouraged trying a telephone appointment. “If you’re forced to travel, make the risk as minimal as possible,” he said, and advised avoiding crowded waiting rooms.
- What is the longevity of the virus? Can it live in the air?
- Kepple said that according to the New England Journal of Medicine, it’s believed it can be on cardboard for 24 hours and steel and plastic for three days. He noted that there were reports it was found on cruise ship surfaces for 17 days, but the virus didn’t appear to be still viable. “The longer you go, the less infectivity,” he said.
Kepple said that it appeared droplets, not surface contamination, is primarily responsible for the virus spread. He noted that a sick patient has a lot of virus and it gets very concentrated at hospitals (where some outbreaks have occurred). But
As for it hanging in the air, Kepple said it’s possible, but in an environment where air is circulating, that doesn’t seem to be an issue.
Morgan added that’s why “social distancing is key.” He also addressed the changes that are being made at the hospital and clinics.
The front entrance to PDH is closed and people enter through the Emergency Room door where a greeter turns away visitors, gives masks to those who need them, and directs others to where they need to go.
Outside the clinic doors, are stands with masks, tissues and hand sanitizers. Patients can wait in their cars or in the waiting rooms, which due to the heavy focus on telemedicine are virtually empty.
- Is there a shortage of PPE (personal protective equipment)? People are sewing face masks, should we encourage that?
- Woodruff said there was an adequate supply of masks. “In times of crisis people have high anxiety and everyone wants to help,” he said. “The masks that we purchase are tested, effective.” He said that when they are homemade, there is no way to know that. He is also worried that if people use them for personal use, it would give them a false sense of security. He said his department is working on ways for people to help during this crisis.
- How do we protect pregnant moms?
- Morgan said that physicians are concerned about their pregnant patients and are keeping them safe during their prenatal visits and in the hospital. As of now the clinic wing at North Fork that serves OB patients is closed to any with respiratory issues, and soon all patients with respiratory problems will be seen at the Quincy building only. “In the hospital, the entire OB wing is a clean wing,” he said.
- There is talk in the community about the virus mutating?
- Kepple said that there is good evidence that it is, but it’s part of the normal life cycle of a virus. “So far it’s not clinically significant,” he said.
- What is the testing availability?
- Kepple said that in an ideal world a lot of testing would be done early on as it was in South Korea. He said in the United States the testing rate has been one for every 750 people, whereas in South Korea it was one for every 150 persons. In Plumas, it has been one for every 500 people, which is better than it is nationally. Testing allows for contact tracing.
“People ask, ‘Why don’t we let it sweep through?’” Kepple said. The theory being that people would survive and develop immunity. But at a 1 percent mortality rate, which is 10 times that of the common flu, millions of people would die.
“If we have the opportunity to test more, it’s a good idea,” Kepple said, even though there are false negatives.
Morgan said that normally there is a test, then treatment. But there is no treatment yet for COVID-19. The testing is done to prevent the spread so the patient can be isolated, contacts traced and tested.
The goal is to prevent the spread.
- What does tracer methodology look like?
- Woodruff said that if there is a positive case, a team would be mobilized immediately to trace everyone that person may have come into contact with, test them and isolate them. Investigation. Isolation. Woodruff said it’s possible to slow the virus down so it sputters to a stop.
- There is a high population in the county of people over 65. Are home visits a possibility?
- Woodruff said that an entire section of the COVID-19 response team is collecting data to provide for seniors and others at risk. He cited the new home delivery of meals as one way they are responding.
- If there is a positive case, what should they do?
- Morgan said that patients are initially treated at home in close contact with their health care provider. If they become sicker they would go to the ER and either be treated at the hospital or transferred depending on circumstances.
- What is the fatality rate?
- It is 10 times more deadly than the flu and twice as infectious.
- If students return to school in April, will it start all over again?
- Woodruff said that a lot of decisions will be made on the number of cases and the rate that they’re increasing. “Nobody can say when it’s going to be over.”
Morgan said that it’s “not going to be all or nothing.” He said that rock concerts and large crowds would be riskier than some other events.
Kepple said that there will be an exit strategy, but it will be important to “not become paranoid about all pathogens.” He reiterated that this virus is different and needs to handled in a strategic, tactical way.
The public is invited to call the public health department at 283-6400 with questions about COVID-19.
COVid roundtable x
The main entrance to Plumas District Hospital is blocked and all patients are directed to the emergency room where they will be intercepted by a greeter. It’s all part of the response to the threat of COVID-19. Photo by Victoria Metcalf