Coronavirus: Schools Closed For Three Weeks, 13 Cases Statewide

Mar 15, 2020

NH Commissioner of Education Frank Edelblut speaks during a press conference Sunday. Gov. Chris Sununu has ordered all K-12 public schools closed for three weeks, directing them to transition to online learning.
Credit Dan Tuohy/NHPR

With 13 confirmed statewide cases of coronavirus, NH officials are taking aggressive steps to try to contain the spread in the Granite State. Gov. Chris Sununu announced Sunday that he is ordering all K-12 public schools to close for at least three weeks and transition to remote learning. On The Exchange Monday,  we'll explore the latest developments and take your questions.

Click here for all of NHPR's coronavirus coverage. 

Air date: Monday, March 16

 

  • Dr. Ben Chan - NH State Epidemiologist 
  • Jason Moon - NHPR Health Care reporter
  • Frank Edelblut - NH Commissioner of Education 
  • Bobbie Bagley - Nashua Director of Public Health and Community Services 
  • Brendan Williams - President/CEO, NH Health Care

 

One of the posters displayed at the coronavirus news conference March 15 about remote learning:

Transcript:

This transcript is computer-generated, and may contain errors. 

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy, and this is The Exchange. New Hampshire's response to the coronavirus continued to unfold over the weekend. On Friday, Governor Chris Sununu declared a state of emergency. On Saturday, the leaders of the House and Senate said the state legislature would be closed while some towns postponed their town and school board meetings. And then on Sunday afternoon, the governor said all schools will be shut down until April 3rd, conduct an online learning instead during that time.

News clip:
Many school districts are already prepared. Others will need a few days to begin. Regardless, every district will have one week to fully transition to this new learning environment. The Department of Education stands ready to assist all schools in bringing these efforts up to speed so that the education of our children in New Hampshire will not be disrupted.

Laura Knoy:
Today on The Exchange, we keep you up to date on all these developments and take your questions. And a note to our listeners, at least for the next few weeks, we're practicing social distancing here at NHPR. So all Exchange guests will be remote, not in studio with me. That includes our guests for the hour today. Dr. Benjamin Chan, the state's epidemiologist for the New Hampshire Department of Health and Human Services, and NHPR's health reporter, Jason Moon, who joins us by Skype. Dr. Chen, welcome. Thank you very much.

Ben Chan:
My pleasure. Thank you.

Laura Knoy:
And Jason Moon, thank you for taking time out. We really appreciate it.

Jason Moon:
Happy to do it.

Laura Knoy:
And with us now for the first few minutes of our show is the state's education commissioner, Frank Edelblut. Commissioner, welcome again, deeply appreciate your time.

Frank Edelblut:
Good morning, Laura. And thank you for having us. And thank you for your flexibility and willingness to try and learn how to do things remotely.

Laura Knoy:
Well, there you go. And how hard a decision was this, Commissioner Edelblut, to tell all the state schools that they had to stop holding in-person classes until April 3rd? What did you have to weigh there in that big decision?

Frank Edelblut:
Well, so obviously this is a very, very serious decision that had to be made. And I will tell you that it is not a decision that rests solely at the Department of Education, but really is weighed by input from the Health and Human Services, because the safety of our students, the safety of our families and our citizens is obviously of utmost importance. What our focus has been on at the Department of Education in this process is making sure that we can continue to engage our students and active and productive learning during this period of time.

Laura Knoy:
As I understand it, Commissioner Edelblut, this only applies to public schools in the state. Is that correct?

Frank Edelblut:
That's correct. It only applies to public schools. Laura, and thank you for clarifying that. So yesterday in the news conference, I may have you may have seemed like I was trying to say that the supplies brought more broadly than that. But what I can say is more broadly, institutions are able to embrace the concepts of remote instruction and remote support. And so we hope that everybody will do that in ways that are productive for their individual communities.

Laura Knoy:
Well, and Governor Charlie Baker ordered all public and private schools to close. So is there something different about New Hampshire? Do you not have that authority, Commissioner Edelblut?

Frank Edelblut:
So that authority, again, coming back to the beginning of this conversation would really rest with the governor and with the Health and Human Services. And I think that what we're doing is we're making decisions that are going to be most beneficial to our public school students. And that's what we've done.

Laura Knoy:
Sure. What about daycare facilities, Commissioner Edelblut? We've gotten a lot of questions about, you know, the younger kids. Are they supposed to remain open or closed down like K-through-12 public schools yet again?

Frank Edelblut:
Probably more of an HHS type of a question. Dr. Chan is online, he may want to weigh in, but in the conversations I have had with the Bureau of Infectious Disease, those tend to be smaller cohorts of students, you know, in children really at that point in time as well. You don't find that they disperse as much throughout our communities, little less mobile because you're kind of tied to that family unit.

Laura Knoy:
Sure.

Frank Edelblut:
And so didn't I guess the assessment is, you know, and maybe that plus some other things that the risk factors are such that that was not warranted at this time.

Laura Knoy:
Sure. And Commissioner Edelblut, I have a lot of questions about online learning. And I'll just ask you a couple this hour, because I know this is all new and things are still rolling out, but perhaps we can talk to you in another couple days as there's more certainty. But just a few questions for you. I'd love your thoughts. How might this remote learning or online learning be carried out for younger kids? Older kids are used to doing assignments online. You know, my kids at Concord High School, they've got you know, they've got their Chromebooks and so forth. But how do you do online learning for a first grader?

Frank Edelblut:
Yeah. So actually, there's a lot of great resources that are out there for first graders. And some of those resources are even deployed in our schools today in terms of the engagement. But I think what you'll find is for those younger students, it's not about creating a whole bunch of computer time for them. In fact, what will happen is the computer may be kind of the kick start or the initiation, whether it's through some video content or some other type of manipulation that the student may do on a computer that will then push them out into their environment that they're in to engage in something. And it may be something where we have the kids are working with pots and pans in their kitchen or they're working with, you know, paper in there on the floor and they're in their kitchen or something like that. So really what happens is it's kind of a hybrid type of an engagement, instructional models that you'll find with those younger ones. I will tell you that in our view, you know, it is important in that case. Say, sixth grade, you are going to have a little bit more oversight in terms of adult supervision for those students in that learning process.

Laura Knoy:
Yes. Can be tough with a lot of parents still having to work. But I know that's you know, that's that's out there. What is the state?

Frank Edelblut:
Can I kind of lean in that just for.

Laura Knoy:
Absolutely.

Frank Edelblut:
And I don't know how far we want to explore that. And it's true. It is going to be difficult.But I can tell you that leading up to this decision, we heard from many, many, many parents who also were concerned about having their kids, kids and children in those learning environments and were concerned about their health and safety. So we have to really respect the decisions of all of the parents and all of the families, because the problem is we don't always know what those circumstances are at home. So you may have a child who is, you know, healthy and able to engage in kind of that school learning environment. But maybe you have someone at home who has a compromised immune system or someone at home who's in, you know, an aged grandparent that lives with that child. And we have to keep them in mind, too. And so parents were making a lot of decisions that were influenced not just by their own children, but by their total family circumstances that they were having to weigh.

Laura Knoy:
Right. What is the state saying, Commissioner Edelblut, about instruction for those children who get special services in school who might really need that teacher or that aid by their side? I know this is a big consideration.

Frank Edelblut:
It is a big consideration. And so we have really a three tiered approach to supporting our students that have IEP in particular. The first is if you know about IEP, each one is really unique, actually individualized, which is why they call an individualized education plan. Some of those individual support services can be provided quite effectively in a remote instructional and support model. And so those will continue to be provided that way. But some of those services and supports that are called out in the IEP simply can't be delivered remotely and they need to be delivered in person. And in those cases, the next tier of support we're looking at is to continue to bring those children into the school environment, to be able to deliver those services. And it might be occupational therapy, physical therapy, speech therapy, something like that that can't be may be conducted remotely. And the risk associated with bringing a small cohort of kids and literally could be one kid, five children, maybe eight children that would be exposed at any point in time really minimizes the risk associated with COVID-19. And so we feel like that would be a good option for us. And then the third tier really of this safety net is that in some cases, given the exigent circumstances that we're dealing with, we may not be in a position to be able to deliver those services, in which case we will focus on compensatory services and really make that up after we get beyond these current situation on the ground.

Laura Knoy:
How feasible Commissioner Edelblut is online learning in those parts of the state where broadband coverage is poor or where kids do not have, you know, computers like they do in Concord.

Frank Edelblut:
Exactly. So online learning is so that's what we don't if you'll notice, we don't talk about we talk about remote instruction and remote support because instruction doesn't have to be online. And so we will have districts that are going to be fully digitized and we will have districts that are going to be more fully analog is the way that I'd like to describe it. And so we've got a lot of tools that we can use to even in an analog type of a instructional model, be able to support those children in that process. And then I think as well, it's important that we consider, particularly in some of those rural districts and some of those districts that maybe are economically not an advantage and don't have, you know, more broadly available digitizer computers is how do we support them. And, you know, whether that's we talked about the IEP, but also relative to some of our food programs to make sure that we're getting stuff out there. And we had a really interesting thing that that happened yesterday is the Rockingham Sheriff's Department reached out and indicated that they would be willing to do food delivery for our food programs to homes. And so I think that what you're gonna find is that more and more across New Hampshire, you know, we are a very tight knit community and folks are gonna come together and support one another throughout this process.

Laura Knoy:
One last question for you, Commissioner Edelblut. And this came in from Tom in Rye. Who says with everyone working to provide social distance and remote learning and work opportunities. Has anyone looked into how much our Internet can handle? Tom says, I fear the network has never been tested as it is as it is about to be in the coming days and weeks and wonder who's responsible for keeping the network up and functioning. Tom, it's a good question. Commissioner Edelblut, any thoughts?

Frank Edelblut:
Yes. So I can tell you that on my call list today is Dianne Martin over at the Public Utilities Commission to make sure that we are doing the right kind of routing to make sure we optimize our infrastructure so that we don't result in that type of slowdown.

Laura Knoy:
Well, and we talked about the impact, obviously, on academics and on families. In addition to that, though, Commissioner, there's an economic impact of this for many school personnel who are hourly workers. They don't have the benefit of a union contract. If you're a kindergarten teacher's assistant and there are no kindergarteners in class, there's really no work for you and you don't get paid. And I wonder what your thoughts are as commissioner for those many school personnel who are not on salary, who are hourly workers and who are going to be out of paychecks for a couple of weeks.

Frank Edelblut:
So I guess that I would just relook at that assumption that there is not work for them and that they would not get paid. What there is, is there's different work, just as the educators are being flexible and there's different work for those educators, those educators are going to need support as well, helping to monitor those students, whether, you know, right now they may be supporting and monitoring those students on, you know, in the classroom environment, but those students are going to need support and monitoring in that online environment as well. So I don't see and I've not heard truthfully, you know, widespread, you know, concerns that we're not going to need these individual educators to help support our kill our children even in this different instructional model.

Laura Knoy:
Okay. Good to hear. And Commissioner Edelblut, I hope we can catch up with you, you know, in another week or so, because I know this is fast moving and changing. We really appreciate your time today.

Frank Edelblut:
Thank you so much.

Laura Knoy:
That's Frank Edelblut. He's New Hampshire's education commissioner. We are updating you on all the latest developments on New Hampshire and the Coronavirus. Lots of changes over the weekend to this rapidly changing story, including the governor's declaration of a state of emergency, the closing of schools until at least April 3rd, as we just heard in some of the many other changes. Joining us remotely for the hour, again, Jason Moon, NHPR's health reporter, and Dr. Benjamin Chan. He's the state epidemiologist. And Dr. Chan, I want to jump right into the testing issue with you. We received a lot of messages from listeners about testing. What's the status of testing right now, Dr. Chan?

Ben Chan:
That's a great question. I think partly the reason for all the questions is there's been a lot of talk nationally about the status of testing in the United States and in New Hampshire. And if you're listeners remember in the early days, you know going back to two and a half months are now considered the early days of this outbreak. Testing was only conducted at the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia.And so there was a limitation in our ability to test for that new or novel coronavirus over the last several weeks. So actually, two, two to three weeks ago, public health laboratories around the country started bringing on this test that was developed by the Centers for Disease Control and Prevention that detect the novel coronavirus. And so our public health laboratories in New Hampshire has been testing for this new coronavirus for the last two, two plus weeks. And in that time, we've tested over 400 individuals across our state for COVID-19. And we're also aware that there are other commercial laboratories or reference laboratories that can also do the testing. So we have, you know, names like QUEST and Lab Core and Nordic. These are all commercial reference laboratories that health care systems are used to sending testing to more specialized testing and that that is actually now available to providers on the front line. And then on top of that, there's also.

Jason Moon:
If I could just jump in there with a quick question on the commercial testing. It seems like those have been available for at least several days now from Quest's Labs, Norkin and others. I have myself been unable to find any providers in New Hampshire that are taking advantage of those tests. And from what I've been told, that there doesn't seem to be any great impetus to begin using those. Would it be your recommendation that hospitals, doctor's offices begin to rely on the commercial tests as a way to, you know, broaden the pool of of of testing capacity and relieve some strain on on the state public health lab?

Ben Chan:
You know, I think that option. I think that option is there and we would certainly encourage providers to use reference laboratories. As you know, our public health laboratory, which provides testing for a whole range of different, you know, infectious diseases, not just COVID-19, also remains available as an option. One of one of the key limiting factors, I think, in provider's ability to test for COVID-19 is not necessarily the testing capacity itself. This has been talked about a lot that we don't have enough part on that. As I've mentioned, the test capacity has expanded in both in New Hampshire and nationwide. One of the limiting factors here actually are provider companies that the providers comfort and ability to collect the necessary samples, which then gets sent to a laboratory for testing. And so that I think that's a whole nother a whole nother topic. But, you know, the reference laboratories are there. We have put out messaging to providers, to our health alert network messages over the last week or so that that option is available. We're aware that some providers are utilizing those services in our public health laboratory remains available as a service to providers to do COVID-19 testing as well. One of the limitations, I think one of the reasons why providers may be sending more samples to our public health laboratory as opposed to some of the national reference laboratories is an issue of turnaround time. So our public health laboratory can turnaround a sample and get results back to a provider within 24 hours of receipt of that sample at our public health lab in Concord. Some of these reference labs have a three or four day turnaround time. And so obviously in this rapidly changing situation, there's a lot of concern and anxiety around this. A lot of people want answers sooner rather than later. So, you know, this health lab provides that service.

Laura Knoy:
Well, Dr. Chan, we did, as I said, get lots and lots of questions about testing from listeners. It was one of the biggest questions that many people had. And I'd like to share one with you from David in Acworth that just came in this morning. David says, I'm a physician working in a critical access hospital in the area. We've heard repeatedly over the past two weeks that there is no evidence of community spread in New Hampshire. Wouldn't the more honest statement be and have been that we don't know? Given that the state lab was restricting testing to the accepted patient populations for testing by CDC guidance, which was itself based on data at least two to three weeks behind the epidemic curve in the U.S.? If this was due to a lack of testing resources, David asks, why has there been no transparency about the true testing capacity at the state lab? The absence of actionable test data available in a timely fashion has been one of the, if not the, largest holes in our response to the pandemic and one that is reflected badly on the public health infrastructure from the federal to state levels. That's just one of many we received about testing. Dr. Chan and I I hear what you just said about, you know, things are ramping up now. But what about David's basic point that, you know, we're a couple we were a couple weeks behind in terms of testing and getting real data, actionable numbers on this crisis. What do you think, Dr. Chan?

Ben Chan:
Yeah. So I think there's there's a lot of things to comment on in that statement. But maybe if I can tick off a couple of key points there. You know, our our response to COVID-19 has necessarily evolved as the pandemic has expanded. Right. So so the risk in New Hampshire a month ago, two months ago, is not the same as the risk in New Hampshire now, given, you know, the increasing case counts in the United States, you know. Right from the beginning, we have taken a more aggressive stance in testing. Right. The listener, a caller is is absolutely right that in the beginning there was a limitation in testing capacity. When we first brought on our tests, we had and we said this before. So this, I think gets to the issue of transparency when we've tried to be transparent throughout this, when we first had the test kid, we had the capacity to test maybe 50 to 100 people.

Laura Knoy:
Wow, that's it.

Ben Chan:
That's it. And so there was a need to be able to prioritize people at our public health lab who based on the global and the local epidemiology, we thought were at highest risk.

Laura Knoy:
Sure.

Ben Chan:
Before that, testing, as I mentioned, was only at the Centers for Disease Control and Prevention. But from the beginning, we have always taken a more aggressive stance to testing. And when the Centers for Disease Control and Prevention was focusing their testing criteria on people who were more sick and potentially hospitalized, we were doing surveillance and asking people to notify us if they had traveled at all and may even have more mild symptoms because we wanted to test them to know if COVID-19, was in New Hampshire. And initially we were sending those tests to the CDC. And then the last couple of weeks we've been testing at the public health laboratory in Concord. And so we have been making every attempt to identify more community transmission in New Hampshire, even amongst people that may be more mildly ill, and so over the last couple of weeks, that's as we've had increasing testing capacity, we've certainly ramped up our testing. Those numbers are on our Web sites so we're posting them for the public to see on a daily basis. The numbers of people that we're testing, we have tested now on our Web site at least about three hundred and eighty people. That was as of yesterday morning. Our lab was testing an additional 90 to 100 people yesterday. So we're well over 400 tests. And I think it is worth noting that we have not yet identified broader or more sustained community transmission. We have 13 identified people in New Hampshire with COVID-19. All of those individuals are either related to travel or are known direct contact of someone diagnosed with COVID-19 right now. Definitely. I think we can expect to see more tests, more testing done in the coming days and weeks. There are likely to be more positive tests at some point. It's likely we're going to see individuals who test positive with no clearly identified risk factors, which is going to obviously raised concern for unidentified community transmission. But that hasn't happened yet despite our increasing and testing.

Laura Knoy:
Sure. And with all these college students coming home from all over the country, there could be more cases. Here's a listener who asked a question, who filled out our survey at NHPR.org. These listeners say our son just came home from the University of Maine with a sore throat, cough, runny nose. He said many were sick at the university and that his friend had been diagnosed with the flu. These listeners say we are 57 and 59 years old and have experienced pneumonia twice. Where can we go to get him tested here in New Hampshire? We have him wearing a mask and latex gloves when walking about the house. Very scary for these folks. So right now, Dr. Chan, sounds like testing is ramped up. Could this young man go to his local doctor's office and get a test so his parents don't have to worry so much?

Ben Chan:
Yes. So I think there's a couple of points in there. One is that, you know, there's there's a lot of other viruses circulating this time of year. Sure. Influenza is circulating where, you know, influenza is still widespread in our area on him. So if this individual came in contact with someone who was sick and certainly if that, you know, know part of a group that where influenza was circulating, there's there's a good chance this person could have influenza or any one of a number of other respiratory viruses. But but many of many of these viruses can be tested for. Anybody that is concerned they may have symptoms of COVID-19 should be we're asking them to call their health care provider. So, you know, not to walk into a provider's office and especially expose other people on a waiting room, but talk to a health care provider about their symptoms, about any risk factors. And then we have put out guidance for health care providers to help them make decisions about who may be appropriate test or not. Right. These decisions are, you know, because of the the increasing number of requests for a test and increasing demand for testing. Our our public health group here, our public health nurses are not able to be in a position of doing clinical assessments on patients and making decisions about testing. And so questions and concerns about COVID-19 and requests for testing need to go through a person's primary care provider. Now, it's certainly possible someone could call their primary care provider talk about it. And the primary care provider may not have the appropriate personal protective equipment, for example, to to be able to do the sampling, in which case we are asking providers to work within their local communities, setting local hospitals to try and try and find a place where the sampling, the sample collection can be obtained in order to do the testing of a provider thinks that's necessary.

Laura Knoy:
Yeah, I understand doctors don't want, you know, people who have mild symptoms walking into the office. I get it. On the other hand, how are we ever going to get accurate numbers, Dr. Chan, if people who have no symptoms, mild or otherwise, are not tested?

Ben Chan:
Yeah. And I think that's the that goes back to one year prior, the listener comments of, you know, we should be doing more testing and we are doing more testing. But, you know, at the same time, I think there's a balance to be had there. Right. I mean, the goal, I don't think, is to necessarily test everybody that has cold symptoms, nor is that, I think, logistically feasible. And from from a health care standpoint, I think a lot of providers and a lot of emergency departments don't want otherwise. Well, individuals with cold symptoms, you know, flooding there, waiting rooms in their emergency departments that it puts it puts a huge strain on our health care system. And so we are trying to support providers to come up with alternate means for testing if providers think a patient needs to be tested and we're working with hospitals and health care agencies to try and develop alternate testing sites. So so this is this is something that's still in process. But I think one of the key messages here is that, you know, if someone it doesn't have clearly identified a risk factors right there, not someone they're not a contact of someone with COVID-19 excuse me, COVID-19 or they haven't traveled domestically or internationally that, you know, they're still likely low risk for COVID-19. Given what we know about the local epidemiology of this of this new virus. And so people with only mild upper respiratory symptoms likely don't need COVID-19 tests and may appropriately be advised by their health care provider to simply stay home, practice social distancing, but don't go out until they're feeling better and symptoms have resolved. Right. That's that's part of the key messaging that we do that providers put out, you know, every year around flu season to prevent transmission of other viruses like influenza.

Laura Knoy:
Okay. Well, coming up.

Jason Moon:
Dr. Chan

Laura Knoy:
Yeah, Jason, you got to take a quick break here. I do apologize. And again, we're practicing our own version of social distancing here on The Exchange. All our guests are going to be remote for the next couple of weeks at least. So once in a while, I will step on each other by accident and that's OK. Coming up after a break, Jason, I'll let you jump in with Dr. Chan for sure. We will be back in just a moment looking at all the impacts around coronavirus that evolved over the weekend. Stay with us. This is The Exchange on New Hampshire Public Radio.

Laura Knoy:
This is The Exchange, I'm Laura Knoy. Today, New Hampshire and the coronavirus were catching up on the many changes over the weekend to this developing story here in the Granite State, including the governor's declaration of a state of emergency, the closing of the legislature temporarily and the closing of all public schools until at least April 3rd. With me for the hour is Jason Moon, NHPR's health reporter. He joins us by Skype. And Dr. Benjamin Chan, the state epidemiologist, is with us on the phone. And Jason Moon. Just before the break, you want to jump in, so go ahead, please.

Jason Moon:
Thank you, Laura. So, Dr. Chan, if you could just clear up who gets the final decision on who gets COVID-19 tests with the state public health lab. What we've heard from a lot of listeners who feel like they have gotten kind of the whiplash when they when they call their primary care provider with symptoms, they want to know if they can get tested. The doctor instructs them to call the state public health lab and in some cases, the state public health lab is then sent them back to the doctor. I think there's just some confusion out there from both patients and providers about who is calling the shots in terms of who gets a test.

Ben Chan:
Yeah, that's it. Thank you, Jason, for asking that question then, I agree with you. There has certainly been confusion out there. And I think part of the reason for that confusion is, is, as I mentioned, you know, early on, there were there were some need to private, some need to prioritize testing for those who were considered most likely or at highest risk of having COVID-19 because of, you know, limitations locally in testing capacity and also based on the epidemiology of the pandemic. So, you know, early on we were asking providers to that testing, you know, to review testing with us, and we were approving or declining testing at our public health lab. That was, you know, even only a couple of weeks ago. And so given the changing situation, as our testing capacity is increased, as we've seen COVID-19 become more prominent and prevalent in the United States over the last couple of weeks, we have been updating our messaging to health care providers. And so this has changed and that this is part of the reason for the confusion. And we're gonna be actually releasing additional guidance to health care providers today, making it very clear that we are no longer going to be the gatekeepers for COVID-19 testing because we've been moving in that direction. Right. Because we have more capacity in our public health laboratory now, because commercial labs are available, because, you know, local hospitals are able to potentially work to bring on this test. And so we are going to be making it much more clear to providers that our our public health nurses on the front lines who are doing the public health investigations of people were diagnosed with COVID-19 do not have the ability or the capacity to serve as the gatekeepers for testing. We are going to be asking when we have been doing this, asking providers to do an assessment on their patients who may be symptomatic as as is normally done with any disease and use the guidance that we've put out to make decisions about whether testing is warranted or not. Versus, you know, as I mentioned before, asking someone, well, sounds like mild cold symptoms, but if you stay home and just monitor your symptoms until you're better. That message as opposed to let let's get you in for testing. And our public health lab is going to be happy to do the testing if a provider wants testing performed in New Hampshire. There are also other commercial labs available that hospitals and health care systems may have relationships with where they can send for COVID-19 testing. But we are trying to we're trying to pull back the restrictions on testing so that it can be more readily available to providers on the front line who are assessing their patients and their concerns.

Laura Knoy:
And Jason and Dr. Chan, let's go back to our listeners. And Bob is on the line in Concord. Hi, Bob. You're on the air. Welcome. Thanks for calling The Exchange today.

Caller:
Good morning. Thank you. My question for Dr. Chan is trying to understand what was the shift in strategy that has taken place where the word now is the focus rather than on containment, dispersing larger groups of people so they don't get together, such as with the schools, restaurants, et cetera. So I'm just trying to understand, is what caused that change in strategy? Was it because of what's going on down in the Boston area and also trying to understand for those of us who are involved with schools and other public gatherings. What's the what's the longer term outlook for the strategy that's now? So we can figure out when we can actually go back to work.

Laura Knoy:
Yes. Bob, I understand everything just seems to be changing minute by minute. Go ahead, Dr. Chan.

Ben Chan:
Yeah, that's a I appreciate that question. And that's actually a huge a huge question, because it gets at the broader picture of how are we trying to control and prevent this new virus from spreading. Right. And, you know, I think there's been a lot of discussion about, you know, to be contained, the virus. Do we mitigate the impact of the virus? And what we've said and continue to say is that it's really not one or the other. Right. I've heard it described as a dial. You know, you can you can crank up the mitigation. You can focus more on, you know, containment. And when we have no cases identified in New Hampshire, or very few cases, our ability to do our public health investigation and work with health care providers to rapidly identify people and test and diagnose people with COVID-19, we have a much greater capacity to do that. And that's in fact what we have done over the last few weeks and where we continue to do as as patients are diagnosed with COVID-19 are our public health nurses and our public health team here to reach out to those individuals to understand who their close contacts may have been, what social settings they may have been in. You know, who. Who is at risk? Who is at the greatest risk for being exposed and coming down with COVID-19 so that we can then reach out to those exposed individuals, maybe get them into self-quarantine if they are high risk, or ask people that may have a low risk of exposure to monitor for symptoms so that we can then rapidly identify and isolate anybody within that exposed group that might come down with symptoms. Right. This is a basic containment strategy and something that we're very good at doing in public health. As the number of cases increases and as there are more people being diagnosed and potentially more community exposures, our ability to fully contain COVID-19 becomes less. Right. There's more chance of community exposure is more chance other people can come down with COVID-19. And so even in the course of, you know, a few weeks, you know, our strategy shifts based on the testing we do, based on the local epidemiology in New Hampshire, but also the epidemiology and surrounding states and surrounding region. And so as we've watched, you know, the number of cases in the United States increase, as we've lost the number of cases in surrounding states like Massachusetts can create as we've seen more cases being diagnosed in our state. And again, most of them have been travel related cases. It becomes more and more difficult to be able to fully contain spread of COVID-19. And so as that happens, we shift our strategy from one focused on purely investigation and containment to one of beginning to think more broadly about how we can, if and when this becomes more widespread or there's more sustained spread, how we can build in social measures to prevent large groups of people from being exposed, as we've seen in in other states and in other situations.

Laura Knoy:
Bob, thank you for calling in this morning. And let's take another one. This is David in Lebanon. Hi, David. You're on the air. Welcome.

Caller:
Hello, this is Dr. David Beaufait. I work at the Family Health Center in Lebanon. We have the limit bottleneck due to the fact that we do not have personal protective equipment, specifically hazmat suits or any substantial number of and 95 masks, we do have a relationship with Quest. We could do labs if we had the capability to do it safely, do the testing. Any recommendations, it's possible that the distribution to small primary care practices might be able to broaden the surveillance considerably if it was safe to do so.

Laura Knoy:
Wow. David, thank you for calling. And let me also thank you and all the other health care providers here in the state. I know it is a very stressful time and you guys are on the front lines of this. So I just want to thank everybody who is working in the health care field. So thank you very much, David. And Dr. Chan, boy, that's frustrating to hear. He says he's got the ability to conduct tests, but he doesn't have the protective gear for the staff.

Ben Chan:
Yeah, and that's that's something where we're actively working with, you know, our local partners on. We understand that this is a challenge. And just to clarify, it doesn't it doesn't require a hazmat suit to sample someone. The recommended personal protective equipment involves a gown, gloves, face face shield and then a mask. Now, I think one of the sticking points here has been, well, what kind of mask do you use? Do you use a plain old surgical mask? You use a higher level special tested respirator. What we sometimes call an end 95 mask. And the Centers for Disease Control Prevention has updated their guidance about what type of mask can can be used. And so in our last health alert network message, we have also updated our guidance to allow providers a little more flexibility in what PPE they use in terms of the PPE, that's personal protective equipment that that providers in a local office might have. So what I would I would instruct providers to take a take a look at that. But we understand that PPE is a limitation. And so we're working to try and increase access to testing through local hospitals and health care facilities. But obviously, hospitals have limited capacity. And so we've also developed a mobile unit where volunteers who are able to do the sampling in the specimen collection that is then sent to a lab for testing. And so that's something that we have some limited capacity around. But we've been working with them to set up in different communities. Our mobile testing unit was in the Upper Valley, you know, a week or so ago. And so that's something we're looking at, trying to expand the services of. So I guess the best I understand that this is a limitation, but they get the best answer I can give right now is to, you know, work with us and work within your local communities to try and get the access to the sampling supplies that are needed.

Laura Knoy:
Jason, I want to ask you about social distancing. Up until about two weeks ago, many of us had never heard that phrase social distancing. Things keep evolving as things keep changing so rapidly. Again, Jason, what is social distancing and how is that definition evolving here in here in New Hampshire?

Jason Moon:
Well, social distancing is one of the main mitigation strategies that we have as a as a society and basically just means not being around other people as much as possible, and particularly in large crowds, particularly when you're close to people, those are the sorts of situations you want to avoid. And that's obviously why we've seen so many cancellations over the last week or so, you know, concerts, schools, town meeting, you know, on down the line to try to avoid those avoid those situations. And so, yeah, it's a it's a feature of the of the new life we're all living in right now. It's why I'm joining you from my bedroom and not in studio with me this morning. And I think we're all going to have to figure out how to how to how to live like this. If I could just tack on a question from from the previous listener to Dr. Chen. Sure. With regard to the hospital preparedness or medical provider preparedness in general, we saw, you know, a note from Dartmouth-Hitchcock over the weekend that they are taking steps to increase their inpatient dead capacity. They're delaying elective procedures, anticipating a, you know, a surge in patients. Dr. Chan, is that something you would advise all hospitals in the state to do to take those kinds of steps to to free up bed space and and prepare for a potentially, you know, a potential big increase in the number of patients in particularly ICU patients?

Laura Knoy:
And Jason, if I could just tack on I'm so glad you asked that, because we've got an e-mail from Debbie in Concord who says, Do you recommend canceling rescheduling until summer all non-essential medical appointments, such as checkups, eye exams, et cetera. I myself have a routine checkup later this week and I'm thinking I'll cancel to save that space for someone who's really sick. So thanks for the question, Jason. Yeah. Dr. Chan, why do you think?

Ben Chan:
And these and these questions I think, get directly at, you know, the mitigation strategies. Right. How do we how do we build social distancing into our community? How do we avoid that as this becomes more widespread? How do we avoid, you know, exposing individuals, particularly those who may be more vulnerable? You know, we haven't made recommendations yet about steps like you've mentioned, but that's something we will certainly be discussing and considering going forward and certainly taking note of as we understand better how this virus is spreading in New Hampshire and, you know, regionally. But that's something we're continually monitoring and discussing and gets right at the heart of the question about what kind of mitigation strategies will be will be rolled out in the future. I think this is really should be viewed as as a process.

Laura Knoy:
Well, yeah, go ahead, Dr. Chan.

Ben Chan:
I want to have one one comment about that. The question about social distancing and I think this is actually a key and important point.

Laura Knoy:
Yeah. How do you define it? Is it twenty five? Is it 50? Is it nothing?

Ben Chan:
Well, I thought the comment the comment that I wanted to make was about how this virus is spread, which gets at this question of, you know, how how easily people may be exposed and contracting the virus. What what we know about this virus is that it can spread by close contact through rest portrayed droplets, very easily close contact. We usually define as, you know, six feet or closer to someone. We don't believe that this is a virus that spread primarily through the air unless there's some medical procedure or the aerosolize of that. But we know that the virus can be spread from the respiratory tract very early in illness, very early when someone is having symptoms and that their early symptoms may not be very severe. Right. So we oftentimes talk about, well, what are the what are the prominent symptoms someone may have? And we talk about fever and cough and shortness of breath. And those have been certainly been some of the prominent symptoms that have been reported in the scientific literature. But what we're finding as we investigate more and understand more and more about this virus is that some of the very early symptoms may be mild and very nondescript. Some people may have, for example, know feeling tired and rundown. Maybe they have a headache, maybe they're having some muscle legs, but are otherwise feeling OK. And it may not be until several days into illness that someone is developing a fever. And so that's the point about social distancing, I think, is that, you know, people need to stay home at the first signs of illness, not not when they have a fever, not when their cough gets worse. But if people start feeling ill in any way. Fatigue, headache muscle ache. Those can be some of the first sign of of any illness. But, you know, illness, and COVID-19 as well. And we know that people can transmit that virus early on when they're only having mild symptoms. And so getting to the question of pills or social distancing, one of the key components of rolling spread of this virus is going to be people recognizing that they're having early symptoms, even if they're mild and staying home from school and work to prevent spreading it to others.

Laura Knoy:
All right. Well, we're gonna take a very quick break. When we come back, a lot more of your questions. So stay on the line. This is The Exchange on New Hampshire Public Radio

Laura Knoy:
This is The Exchange, I'm Laura Knoy. This hour, an update on the Coronavirus response here in New Hampshire and all that changed over the weekend. That includes the governor's declaration of a state of emergency, the temporary closure of the legislature and the closing of all public schools until at least April 3rd. With me for the hour, NHP is Jason Moon, our health reporter who has been all over this story. Also with us, Dr. Benjamin Chan, the state epidemiologist. And both of you, right back to our listeners. Lots of questions from folks. Mary's calling from Northwood. Hi, Mary. Go ahead. You're on The Exchange. Welcome.

Caller:
Hi, Laura. Thanks. Good to talk to you again. After many years, I'm asking this morning why would each one of us do differently today if we understood that one infection today could translate into a thousand recognized infections in under a month the way it has Italy and then a number of other places. How would we act today to prevent one infection so that we don't have a thousand infections in a month? Twenty percent of them requiring hospitalization, five percent or more requiring ventilators.

Laura Knoy:
Yeah. And that that overwhelming scenario that everyone fears and that we have seen elsewhere. Mary, thank you so much. Dr. Chan, you want to jump in on Mary's excellent question.

Ben Chan:
Yeah, I think it's an it is an excellent question. And I guess I think it gets to the heart of that question, gets to, you know, can we prevent ultimate spread of this virus? And I think it's there's concern that, you know, it will spread at some point. But I think the other question is, can we prevent getting to a place like Italy or China where their health care system is overwhelmed? And that's and that's where the mitigation strategies come in. Right. So we are doing is trying to rapidly identify people, isolate them, you know, test them and do a contact investigation like I described to prevent further spread. But ultimately, as we have more and more people being identified with COVID-19, that it becomes more difficult to fully contain the virus. But I think there are steps that we can take and are taking to prevent getting into a situation like Italy. Right. If we did nothing and just let the virus spread naturally, we would see a rapid exponential increase in the number of cases that would rapidly overwhelm our health care system. If we can take mitigation strategies like isolating people, they're symptomatic, social distancing, you know, avoiding, you know, large gatherings that can not necessarily ultimately prevent total spread of the virus, but can stretch out the the the the peak of the outbreak, if you will, to help prevent as many people getting infected and help prevent, you know, serious health complications, you know, help protect the more vulnerable individual and help prevent a huge sudden burden on our health care system. And so I think it's certainly possible that we can prevent a situation like Italy from occurring. I think that's what you're seeing play playing out both in New Hampshire and around around the nation.

Laura Knoy:
Well, in some European countries, Italy, certainly, and now France, Austria, Germany, I was trying to keep up on this over the weekend. The only things that are allowed to be open are pharmacies and grocery stores. That's it. No bars, no restaurants, no theaters, museums. Do you think we'll get to that point here in New Hampshire? Dr. Chan?

Ben Chan:
You know, I think it's hard to say, sure, we have the ability and public health to, you know, cancel mass gatherings and take more expensive measures. But I don't think I don't think we're there yet. And I think we'll be closely monitoring the situation. We'll be working with our health care providers to prepare to make sure that their help prevent them from being overwhelmed. We'll be continuing continuing to do our public health investigations to try and limit the spread. But I think, again, this is gonna be a process and it's not going to where we say in public all that. It's a marathon, not a sprint. And so we'll be closely monitoring the situation and taking the appropriate steps to try and protect the public.

Laura Knoy:
Well, sure. And I understand because, boy, the advice and the situation keeps changing, you know, hour by hour, it seems. Jason, what other sort of social impacts have you been tracking besides the obvious ones, like, you know, the schools, for example, Easter and Passover coming up. There are houses of worship who are having to rethink the way they they might approach this this season.

Jason Moon:
Well, it's I mean, everywhere you look, it's absolutely changing every every aspect of people's daily lives. You know, one of the perhaps most pressing issues for a lot of people is how it's affecting their work and their and their jobs and their livelihoods. You know, I heard from a listener over the weekend who who works at a retail store, had a co-worker come in with a cough and she became concerned, asked the management if they might consider sending that person home. They declined. And ultimately, she decided she wasn't comfortable going into work the next day. And she is going to remain at home for she's not sure how long, but that's not that's she's taking your sick hours. She's not getting paid for it. She's a Part-Time employee. She doesn't you know, she doesn't have another source of income. And then, you know, with regard to her own medical situation, you know, she was, you know, directed when she called to one one the state hotline for the Corona virus response. She was instructed to call her primary care provider. Well, she told me she doesn't have one. She doesn't have insurance. She doesn't have a primary care provider. So I'm you know, I'm thinking of people like that in that situation who don't have a lot of options for all of the wrinkles this is causing in our lives. You know, for for folks in situations like mine where I can work from home, it's it's inconvenient. It's it's a bit of a headache, but ultimately not such a big deal for other folks. This is this is really, really disruptive and could have really long lasting impacts on people's finances. Not to mention their health.

Laura Knoy:
Yeah, we're definitely focusing a little bit more on the health end of it today because there've been so many changes. But we will we have looked at the economic impacts and we will absolutely do so again in terms of people keeping a distance from each other. Here's a listener comment about this again from our survey at NHPR.org, And we encourage listeners to fill it out. This person says, will all grocery stores and other stores tell their associates to stay at least six feet away from shoppers? And will they somehow allow for checkouts that will allow shoppers to stay six feet away from associates? This person also asks about towns or transfer stations. Will attendance be told to stay six feet away from the people bringing their trash and recyclables to the facility? So especially grocery stores. Boy. I was at the grocery store myself over the weekend, Dr. Chan, and I don't think I was six feet away from the person checking me out. I mean, do we need to be that concerned?

Ben Chan:
Yeah, and I think I think there is certainly a lot of concern out there, and part of the reason we're we're taking steps, as you as you've heard about, to try and prevent widespread transmission of this virus in New Hampshire and minimize the impact of it. And I think that the social distancing measures. Based on information and data, we've we've seen and heard about from the Centers for Disease Control Prevention and Health. What we're saying flatten that curve and prevent, you know, a large, large peak in the number of cases in a large strain on our health care system. But we don't want people to be disabled in their everyday life and feel like they can't can't go out. You know, people should remain active, you know, go outside, go for a walk, go for a run. People need to go go to the grocery store. They should go to the grocery store. Certainly if they need food and supplies. But but they should do so with a measure of awareness that COVID-19 is, you know, is now a pandemic and it's spreading globally and in the United States and take some of those extra steps to social distance, you know, frequent hand hygiene, use Purell if they if they have it, good practice, good hand hygiene. You know, those are the social distancing measures that won't go a long way to helping stop the spread of the virus. And certainly if someone is sick, even mild symptoms of illness, they should they should stay home.

Laura Knoy:
Well, here's one last question from our listener survey that he'd love to close with. This person writes, what opportunities are there to volunteer or otherwise support efforts to help those most at risk? Are there organized efforts to help high risk groups safely access supplies or to ensure children at home without access to schools, free and reduced lunches have access to nutritious meals? Jason, do you know anything about that?

Jason Moon:
I have seen some sort of informal listserv is being created around and in different communities, sort of, you know, who can who can do what and who can help out in certain ways. So I think we're seeing a sort of ad hoc of organic sprouting of these types of efforts in different communities. You know, if if this if this carries on for as long as as we fear it might for, you know, a couple of months, several weeks, something like that. You know, there may be a need for something a little bit more formal. But I think right now folks are turning to neighbors, turning to loved ones, to to to be that support network.

Laura Knoy:
Sure. Well, and we will be following up on that aspect of this story as well. It's evolving. It's huge. Jason, thank you very much for helping us out this hour. I know we'll talk again.

Jason Moon:
Thank you.

Laura Knoy:
That's NHPR's Jason Moon. He's our health reporter. And Dr. Chan, very busy time for you. We really appreciate you being generous with your hour.

Ben Chan:
Glad to be on. Thanks so much.

Laura Knoy:
That's Dr. Benjamin Chan. He's the state epidemiologist for the New Hampshire Department of Health and Human Services. Again, Exchange listeners, fill out that survey, it's at NHPR.org, with your questions, concerns and personal stories about this. You're listening to The Exchange on New Hampshire Public Radio.