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A Public Health Update One Month In To Managing Coronavirus In N.H.

Todd Selig

In a special extended edition of The Exchange, Dr. Benjamin Chan and Dr. Elizabeth Talbot bring us the latest updates and recommendations for navigating the coronavirus pandemic in N.H. 

Read all of NHPR's coronavirus coverage here.

Air date: Monday, March 30, 2020 from 10-11 a.m.

GUESTS:

  • Dr. Benjamin Chan - State epidemiologist for New Hampshire. 
  • Dr. Elizabeth Talbot - Infectious disease specialist at Dartmouth-Hitchcock Medical Center. 

 

Transcript:

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

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy and this is The Exchange.

Laura Knoy:
On the advice of top health officials and many governors, President Trump said yesterday social distancing measures will remain in place until April 30th. Also, as more states see a surge in covered 19 related hospitalizations in New Hampshire, communities spread, continues to grow and the number of confirmed cases is accelerating. In the midst of all this, uncertainty remains over testing symptoms, how the virus progresses and how to stay safe. And so this hour on The Exchange, we have two of New Hampshire's top medical leaders overseeing the pandemic.

Laura Knoy:
Our guests are state epidemiologist Dr. Benjamin Chan and Dr. Chan, thank you very much for being with us. We really appreciate it.

Dr. Chan:
My pleasure. Thank you.

Laura Knoy:
And also with us, infectious disease specialist at Dartmouth-Hitchcock Medical Center and deputy state epidemiologist Dr. Elizabeth Talbot. And Dr. Talbot, a big welcome to you, too.

Dr. Talbot:
Thank you. Thank you very much.

Laura Knoy:
So some of the numbers I just want to put out there and get your thoughts. A third person has died from COVID-19, in New Hampshire, a woman over the age of 60, Rockingham County. Over the weekend, New Hampshire saw the highest jumping confirmed cases so far, 44 new positive tests for COVID-19, which again is the disease caused by the coronavirus. The total number of confirmed cases in New Hampshire is now 258. At least one person under the age of 18 has also been announced. Both of you, Dr. Chan, to you first. How do we how do you want us, the public, to interpret these numbers? Because there's a lot there.

Dr. Chan:
Yeah. Great question. And I think we're all both in New Hampshire and nationally and globally following these numbers very closely. If your listeners remember, it was about four weeks ago that we announced our first case of COVID-19. And now, four weeks into the outbreak in New Hampshire, we're up to over two hundred and fifty cases. And if you look at what's happening in the rest of the country, United States and what's happened in other countries around the globe, you know, we are in and going into and are already in what we call the acceleration phase of the pandemic, where, you know, initially, early on the first week or two, we were seeing slower came out, slower increase in case counts. And I think over the next several weeks, we're going to see increasing numbers day by day in New Hampshire. That's unfortunate, but expected given what we've seen around the country. And so I think we're certainly following these numbers closely and the public is going to hear of increasing numbers over the coming days and week.

Laura Knoy:
Dr. Chan, how are we to look at these numbers, given that so many, many, many people have not been tested? In one sense, the numbers almost seem meaningless because we really don't know how many people have this illness.

Dr. Chan:
Yeah. And I think that that's that's a great question, one that's been certainly a focus of ours and others.

Dr. Chan:
You know, we are we are doing and promoting testing to to the extent possible. We know that overall looking looking around the state, it's not just the New Hampshire public health laboratories anymore that doing testing hospital labs have brought on or all are bringing on COVID-19 testing. We're aware of a number of commercial labs that are doing the testing as well. So if you look at the overall number of tests that are being conducted, the overall number is increasing. And that's that's a good thing.

Dr. Chan:
You know, we recommend providers have, to their ability, based on local potential limitation, for example, in personal protective equipment and testing supplies, swabs. But we recognize that the reality of the situation here and in New Hampshire and the rest of the United States is that there are limitations in some of these supplies. And so we have advised by prioritizing testing of certain individuals who may have the highest risk of spreading COVID-19 to others in our community.

Dr. Chan:
But certainly we are making efforts to try and increase capacity because one of the key important public health things that we do here in New Hampshire is investigate individuals with COVID-19, to try and slow the spread of this virus. This is something that other states and other public health jurisdictions around the country have not been able to do. But we continue to do investigations here in New Hampshire to try and slow the spread of this virus.

Laura Knoy:
And Dr. Talbot, I want to bring you into this, too. You know, about a week ago, the state and federal advice seemed to shift to say, unless you're a front-line worker, you're very sick, you know, don't come in for testing. Is that still the advice that people are getting or what is the advice around testing these days?

Dr. Talbot:
This is simply the reality. There are bottlenecks at every step of the way for a patient to become tested. It's. An incalculable detriment to our response. For sure. Do we want everyone to be able to be tested? Absolutely. This is one of the most important tools in our toolbox when we're fighting outbreaks. But indeed, that's not the reality. So it only makes sense that we prioritize this for those who can especially drive the epidemic, such as in our health care setting or those who would benefit from some of the emerging supportive care and potential experimental treatments that are coming forward. Those vulnerable persons. So you're right, it is still the recommendation that the prioritized persons come forward, because as we get more data, it's increasingly clear that the people who will have the worst disease and potentially die are those who have underlying illnesses, chronic illnesses, and those who are in the older age bracket.

Laura Knoy:
You sound frustrated, Dr. Talbot.

Dr. Talbot:
I'll say I am, yeah. That, of course. I want to say it again. Do we wish that everybody could be tested? Absolutely. We share that frustration and understand that others are frustrated by this. And we just have a hand that's dealt to us and have to deal with it going forward in a way that's credible and open and available to people to understand better. So, yes, that's where we are. I wish we weren't here, but this is where we are.

Laura Knoy:
When you say we've had, Dr. Talbot, a hand that's dealt to us. What do you mean by that?

Dr. Talbot:
Sure. So this is a wily virus. This this virus presents to us some great challenges, such as the fact that it's spread through the droplet route and can even be spread by contaminated surfaces or handshake or the like. That's the challenge for us. It can also be spread in the very earliest stages of infection. That is sometimes even before people fully recognize that they're ill.

Dr. Talbot:
There's been a lot of talk about this, a lot of investigation, and we need more data about it. But I think that the more we take in the experience of jurisdictions and settings that have more advanced epidemics, I think it's clear that people don't always have really obvious disease. And that's another tool in the toolbox that's taken from us in terms of identifying those who are most contagious.

Laura Knoy:
Yeah, go ahead. Dr. Talbot sorry.

Dr. Talbot:
That's it. So you know that it's a short incubation.

Dr. Talbot:
It's sometimes hard to identify those who are most contagious when we want to. And that testing is not readily available. These are some difficult realities we're dealing with.

Laura Knoy:
Dr. Chan, how much has the slow rollout of testing nationally? And again, we've heard about these shortages and the frustration of doctors who need the protective gear, who need the supplies that will help them carry out the tests. How much has this went to call it bottleneck or whatever? How has that affected your ability to do what you're supposed to do, which is track this disease, understand the disease, look at the data and combat the spread of it.

Dr. Chan:
So that we have we have certainly many more of coming in over the last few days and we can expect many more cases over the coming days. And we continue to investigate each and every confirmed case that that comes to us. But certainly that that part of the core public health work that we do to try and slow that slow virus.

Dr. Chan:
But I want to expand on what Dr. Talbot just said: Is that testing is only one one piece of this. It's one tool. And can we continue to test to the best of our ability possible, obviously rely on our health care providers to do that. And protecting our health care providers is critical and utmost importance because they're on the front lines of this. We absolutely want to make sure that they have the resources at their disposal, the personal protective equipment. It's certainly of concern because the providers, they need the personal protective equipment not only to protect themselves while doing testing, but they need these resources to protect themselves when caring for people that may be sick and hospitalized with with COVID-19.

Dr. Chan:
One thing that Dr. Talbot mentioned that I do want to expand on is that one of the challenges here is that we are learning about this virus in real time.

Dr. Chan:
This is a virus that just came to our attention at the end of December, beginning of this year. You know, a few months ago and initially the thought was that this virus is primarily transmitted from people that are symptomatic. And what we've learned over the last couple of weeks, even, you know, a week or two is that there are a large percentage of people that can potentially carry and transmit this virus while they're either asymptomatic or before they develop symptoms. And I'm saying that's because there have been some new studies that have come out over the last week looking at, for example, the Diamond Princess cruise ship out of Japan. Some of the long term care facility outbreaks in Washington state, which where they've gone in due to the outbreak situation and swabbed everybody in the facility or everybody on the ship, those with symptoms and those without symptoms. And what they found is that in both situations, approximately half of all people that tested positive for COVID-19 did not show symptoms at the time of the testing.

Laura Knoy:
Half of all people.

Dr. Chan:
And so this becomes very important because those people are still able to, we believe, transmit the virus. And that factors into some of the changing advice and recommendations and strategies that are being put out there around social distancing and why it's critically important for people to pay attention to the advice coming out of public health in different states around maintaining social distancing, staying home, even if someone is feeling well, even if they're not having symptoms, maintaining social distance of six feet or more from other people, it becomes critically important because we're recognizing now more people than we initially believe are able to carry and potentially transmit this virus.

Laura Knoy:
So, Dr. Chan, you must be pleased with the president's announcement just yesterday that social distancing and other restrictions will stay in effect until the end of the month.

Dr. Chan:
Yes. So I think that brings up an important point that, you know, we we have obviously that it's good news that the at the federal level that the messaging is consistent with what has been put out at the at the local and state level. But I'm sure you're aware and many of our listeners are aware that the governor in New Hampshire put out a stay at home order last week and still maintaining a consistent message between the state and federal level is important. But even if that message were for change at the federal level, it would not necessarily change how we approach that at the state level.

Laura Knoy:
Well, I invite our listeners again to join us. And this hour, it's an opportunity for you to ask questions to two of the state's public health doctors. We've got Dr. Ben Chan with us. He's the state epidemiologist. And Dr. Elizabeth Talbot. She's an infectious disease specialist at Dartmouth-Hitchcock and she's the deputy state epidemiologist.

Laura Knoy:
Dr. Talbot, here's an e-mail from Brian that I want to give you. Brian says, I have heard there is a test coming soon to detect who has had the virus and may be immune to it. Is this true? And what would the protocol be for those who are post virus? Brian, I just read about this yesterday myself, and it is fascinating. Dr. Talbot, what do you know about this?

Dr. Talbot:
You know that this is long awaited. This is I think what Brian's referring to is the serology test that is looking for antibodies that reflect one's body has seen this virus and reacted to it appropriately. So typically this is taking a small sample of blood and looking for those antibodies through some commonly available technologies that's in everybody's hospital clinical laboratories. So it's not ready for primetime in the United States. But I'm very also encouraged by the fact that it may be within weeks to another tool in our toolbox.

Laura Knoy:
So, serology Dr. Talbot I heard that this was used in Africa during the Ebola outbreak. So people who could get this blood test, you know, knew that they were now immune to Ebola so they could go in and take care of people.

Dr. Talbot:
You're exactly right. So that's that is one hope that we would have for the serology test, is that it allows people to know that they are not vulnerable to the infection any longer, or at least in the short term.

Dr. Talbot:
It also has the potential role of identifying people who have those antibodies that may be useful for treating other people. So this could be a treatment tool. And third, it will give us that long awaited information about just how prevalent is this in our community. That is, if we haven't been able to test anybody, everybody with acute illness, we could at least go back and see how many of them were asymptomatic or pre symptomatic or mildly ill with with disease that turn out to be this virus.

Laura Knoy:
Wow. Well, Brian, thank you for the e-mail. And Dr. Chan, what are the public health implications if we could get this serology testing up and running? And, you know, we know that there are certain members of our community who are now immune. What are the public health implications of that?

Dr. Chan:
Yes. So I think the serology, the antibody based blood test, would give us, that Dr. Talbot mentioned, a mechanism to identify people that may have been infected in the past. And so it would give us another tool to be able to assess the level of exposure and infection in our population, especially in people that may have had, As Dr. Talbot mentioned, mild symptoms, mild upper respiratory symptoms and never been tested. And so it becomes important to better understand the spread of the pattern of infection within our state. But it also becomes important because we're talking about health care workers and wanting to protect our health care workers. It is potentially helpful to know health care workers have been exposed that are potentially immune, at least in the short term. And let me just mention that how long someone's protection after exposure and infection with this new virus last? It's still still unknown.

Laura Knoy:
You know, we don't know if it's. Yeah.

Dr. Chan:
Right. Yeah.

Dr. Chan:
We don't we don't we don't believe that someone who is infected with a virus and get better, we don't believe that they can be reinfected, at least in the short term. But whether, you know, for example, a year from now, they could get the virus again? That information is lacking and we'll learn about that as the endemic progresses.

Laura Knoy:
Well, I appreciate that. And as you said earlier, we're learning about this disease day by day. You know, how it evolves and so forth. And toward that end, I did want to share questions with you that we have heard from our listeners over and over again just about the basics of this. People still really just want to understand how this works. Jerry in Holderness sent us an e-mail with a couple questions that we have gotten many times before. So, Jerry, thank you.

Laura Knoy:
Jerry says, How long can the new coronavirus survive as an aerosol droplet form? How long does it stay airborne? And Jerry says, How can the six foot rule possibly be effective if the virus survives and remains aloft for hours? Jerry, thank you. These are the questions a lot of folks haven't. Dr. Talbot, you first. Can you just explain this sort of airborne form of this virus and whether the six foot rule is even effective against that?

Dr. Talbot:
Right. So we're aware that some so-called respiratory viruses are predominantly, mostly transmitted by these large globs, if you will, and they fall pretty readily. So this is studied. Scientists watch the trajectory of these kind of sneeze droplets as they fall and the majority fall within six feet. So then you can't breathe them in. Yeah. So does it mean every single droplet has fallen to the earth by six feet? Maybe. Maybe one escapes to say goodbye. So.

Dr. Talbot:
So it's not an absolute that these viruses haven't read that textbook or those studies.

Dr. Talbot:
Sometimes there can be people who can put smaller droplets in the air that that can suspend. And that's why we're being so careful, especially with those on the frontline, the health care workers. But social distancing is what we have. And I'll tell you, my observation is, is that people are not adapting readily enough to this. You know, I think we're just such social creatures. We're used to showing our concern and our connection to other friends and family, even co-workers, by by being within their sphere, their personal sphere. We just have to stop it, you know, to arm's length. You raise your voice, you know, wave to someone, etc.. We have to change our culture to be better protected from from this virus. That is especially within the six foot range.

Laura Knoy:
And slightly different question for you, Dr. Chan. So again, but towards Jerry's question about how this spreads through the air and so forth. So a lot of us are going for walks because we need to get out. I went for a walk with two friends over the weekend. We tried to stay six feet apart. Sometimes that works. Sometimes it didn't. But nobody Dr. Chan was coughing or sneezing. So I guess my question is, you know, if at some point during that walk we were four feet apart instead of six feet, but no one was making quote unquote, droplets, like, is that okay? I am just. People are just trying to navigate this, including myself.

Dr. Chan:
Yeah. And I think that's that's a great question and a question we're hearing over and over again and I think how easily the virus spreads - So first off, we know that this virus can spread very easily.

Dr. Chan:
But but whether you get exposure to the virus within three feet or six feet or, you know, eight or 10 feet, there's a lot of factors that go into that. Right. I mean, if someone sneezes and, you know, there's projectile rapid rate droplets, you know, certainly spread further than than six feet or someone's in a hospital setting. And they're, you know, doing procedures that aerosolized the respiratory droplets. Certainly the risk is greater. The 6 foot distance is recommended to be general guide and to be protective of people in general.

Dr. Chan:
But certainly if you're, for example, walking with someone and you're downwind of them and they, you know, sneeze and you're 7 feet away, absolutely. There's a possibility there that those rapid great droplets can blow back in your face and land and your eyes, nose or mouth, and you can be exposed. So I think there's some there's some element of, you know, I think common sense here that that that's involved. But even when someone is outside the recommendation built to maintain a distance of at least six feet. Because even if you're talking, maybe you're not sneezing. If you're just talking, there's respiratory droplets that are coming out of your mouth as as as you talk. And so having at least six feet between you is important for trying to maintain a distance and avoid exposure to some of those larger up for a droplet that someone may may be putting forth, so to speak, as they talk. Certainly if they're sneezing or if there's other force behind behind, you know, the respirator droplets.

Laura Knoy:
Wow. All right. Well, Jerry, thank you very much for that e-mail.

Laura Knoy:
And coming up, a lot more of your questions and comments about how New Hampshire is experiencing the coronavirus and just your basic questions about staying safe, about this disease itself, how it's transmitted and so forth. Also coming up, I'll ask both of you about some of the shortages that still exist for our health care providers in terms of personal protective gear. Stay with us. This is The Exchange on New Hampshire Public Radio.

Laura Knoy:
This is The Exchange, I'm Laura Knoy. This hour, two of the state's top public health doctors join us with an update on how the coronavirus is spreading in New Hampshire. Also, we're hearing the latest on testing treatment. The governor stay at home. Order. And we've been hearing from you. With us for the hour, Dr. Ben Chan, the state's epidemiologist, and Dr. Elizabeth Talbott, deputy state epidemiologist and an infectious disease specialist at Dartmouth-Hitchcock Medical Center. And both of you. Last Thursday, we learned that 33 health care workers in New Hampshire had tested positive for COVID-19 Dr. Chan. Has that number changed over the weekend? What can you tell us about how our health care providers are doing?

Dr. Chan:
Yeah. So. So that number has gone up. I don't have the most recent number, but I remember that one of the prior, one of the groups that we're prioritizing testing for, we were asking, you know, facilities and providers to prioritize testing for our our our our health care providers.

Dr. Chan:
And so we can expect that as testing increases, we're going to see an increasing number of health care workers that do test positive and that that can be either from, you know, travel related risk factors that someone has been infected or through through the course of community interaction. Having been exposed to someone with COVID-19, it doesn't necessarily imply that the health care worker contracted that in the health care setting. And certainly as we identify more and more community based transmission, meaning transmission in our communities, everybody is potentially at risk for being exposed to this virus, including health care providers in their communities.

Dr. Chan:
But certainly we we want to make sure our health care providers are protected because exposure in the health care setting is possible. And it's potentially, you know, a higher risk setting for exposure to COVID-19 between a health care provider who is examining a patient or doing sample collection on someone suspected to have COVID-19.

Laura Knoy:
All right. Well, let's take more calls from listeners and emails And both of you, Bonnie is calling from Hollis. Hi, Bonnie. You're on the air. Welcome. Go ahead.

Caller:
Hi there. Thank you for taking my call.

Caller:
Not sure if it is an echo, but I'm hearing it on my cell phone, but I don't have a radio on anyway, so I was just sitting here thinking I have a comment as well, which is, you know, my mom usually goes to a day program for people with Alzheimer's.

Caller:
And right now, she and my sister are totally secluded in their apartment doing the best they can. So that's kind of like a whole population that really hasn't been discussed. But my question is, when listening to discussions and of course, I'm home some listening to a ton of news, I guess is is using coronavirus in COVID-19. Interchangably, because when I'm thinking about this, understand what's being said and when the numbers are being discussed, you can have the coronavirus, but not necessarily the cold with 19, which is what it causes.

Caller:
So do you think that those are being used interchangeably to make it seem like when, you know, thousands of people will be diagnosed with the virus and something sometimes you hear it's being COVID- 19?

Caller:
That's not exactly the distinction?

Laura Knoy:
This is a really important point. And thank you for bringing it up. Dr. Talbot, just clarify.

Dr. Talbot:
Tour in the beginning of all this. You remember we called it the novel coronavirus. And now we have some more detail on that. Wait, with the actual virus that causes this disease covered, 19 is called SARs coronavirus 2 but because everybody remembers the SARS- coronavirus 1 from 2002. Three, that can be a little confusing to talk about the SARS virus. So you write a lot of people are defaulting to calling it the novel, still calling it the novel coronavirus or having the coronavirus. And I think we're intuiting that's what people mean.

Dr. Talbot:
COVID-19, is the disease that SARS-CV-2 two causes, the novel coronavirus causes.

Laura Knoy:
So the virus is coronavirus, the disease it causes is COVID 19. And that's an important distinction.

Dr. Talbot:
Exactly. That's right, Laura.

Laura Knoy:
All right. Well, thank you very much for that comment. I wanted to ask you both about health care workers since we just looked at those numbers and we still hearing harrowing stories of shortages of staff in other states. Shortages of protective gear. We talked about that a little bit earlier. Dr. Chan, what can you tell us about the health care workers who are providing that frontline care in terms of either staff shortages or gear shortages or both?

Dr. Chan:
Yeah, and that's it, that's something that we're certainly paying attention to.

Dr. Chan:
So what's happening in other states as the number of cases in Hampshire increases the potential for increasing an increasing burden on our health care system? It certainly also increases. You know, we want to make sure our health care providers are protected. One of the ways we do that is to make sure that they have adequate supplies of personal protective equipment. And so hospitals have been trying to source for some protective equipment.

Dr. Chan:
The state of New Hampshire has been attempting to find know various components of personal protective equipment like downs and masks and gloves and that sort of thing to protect health care providers. And the federal government has what we call a strategic national stockpile or an ad which includes things like personal protective equipment. And so we've been putting requests out there to the federal government to procure some of the supplies of personal protective equipment and have been bringing them into the state and distributing them. Other states are also in the process of doing that. And so we want to we want to make sure that our health care providers have supplies that are available.

Dr. Chan:
But this is one of the stresses on our system. And so we're we're very aware of, you know, equipment and staffing, the potential for equipment and staffing shortages. I have something that we're we're monitoring very closely going forward. I will say that I think the third on our health care system, the capacity of our hospital care for patients who may be sick and coming down with almost certainly is on the forefront of our minds as we as we respond to the challenging coronavirus.

Laura Knoy:
Well, speaking of protective gear, Maureen in Elkins wrote in, she says, Are the masks that some of us are sewing at home for Dartmouth-Hitchcock actually going to be used? If so, would they be used by secondary personnel in order that the N-95 mask would be freed up for the health care professionals? And Maureen, thank you. And Dr. Talbot, I'll throw that to you.

Dr. Talbot:
Sure. Thanks for that question, Maureen.

Dr. Talbot:
And can I just come back to it in a moment, because I want to follow Dr. Chan as said and maybe just say it as clearly as possible that my my take on the situation, the more stories I hear, the more I talk to the front lines out there. These health care personnel, these staff are heroes. They are working double shifts. They are working out of their usual professional settings because it's necessary to do so. People are coming out of retirement. I mean, I just need that to sing praises for a moment there of some real stories of heroism out there on those frontlines by your own health care workers. And many of you listening are likely such staff. So really big thanks to everyone. And just to say as loudly and clearly as possible that you are a priority for protection.

Dr. Talbot:
As I said, you know that we deal with us every single day. The concern for the shortage of the personal protective equipment and trying so hard to stay out in front of it and coming up with novel ways to preserve that limited supply. There's just this just another reality is that we are absolutely facing shortages as you can't help but see on the news.

Dr. Talbot:
So then to Maureen's question, I think that this is a fascinating evolution that the CDC, our Centers for Disease Control, has even put on line the sort of the pattern for making these masks. And it's not clear how they could be used right now. So, Maureen, you had a good idea that they might be used for people who are looking for a little extra protection if they're not in the frontlines of patient health care. But I know that they're also being considered for use in covering some of the limited specialized respirators so that that that's cloth mask can be washed. Well, the mask below can be protected against any, as we've been talking about, droplets.

Dr. Talbot:
So remains to be seen. But thank you very much for pulling out your sewing machines and needles and doing that because we just don't know where this is heading.

Laura Knoy:
Well, and speaking with the CDC has said the Centers for Disease Control recently said that health care workers could use bandanas if there are no face masks available, admitting that it is far from perfect. One former federal health official told The Washington Post this should be a wakeup call. She said the bottom line is, if you can't protect health care workers and they get sick, the whole system goes down. She said the priority to maintain public health is to protect health care workers. And Dr. Chan, our New Hampshire health care workers, using bandanas. Have we gotten to that point?

Dr. Chan:
No, We have not heard any reports of health care workers needing to go to bandanas. This is part of the preparedness and planning that that happens anytime we're encountering a new infectious disease threat like COVID-19. So there's a lot of talk out there of, you know, making cloth masks and using bandanas. But our healthcare system, our hospitals, my knowledge, are not are not in that position. There is personal protective equipment out there.

Dr. Chan:
As I mentioned, we're trying to obtain more from our own sources. Certainly from the strategic national stockpile and are distributing those to health care providers. But I think we we all need to recognize and understand that this is one of the limitations our health care system is is likely to face in the future, especially as the number of cases increases the number of people that are hospitalized increases. And that's part of the reason I think it's it's imperative to try and conserve the supplies to protect our health care workers. And one of the reasons that, you know, a week or two ago, we started to prioritize testing. One of the reasons for prioritizing testing was to try and serve these supplies of personal protective equipment so that they're available if and when patients are hospitalized and need care in our health care setting so that health care providers can have those supplies available to protect them on the frontline.

Laura Knoy:
Well, Rosemary wrote us an e-mail. She says, How long does coronavirus live on surfaces, for example? My husband is immune compromised and we're waiting two to three days before putting away non-perishable groceries and opening mail. What are the doctors think? I'm so glad you wrote Rosemary. Dr. Talbot, I heard from a friend who lives in France who told me to absolutely wipe everything down that came from the grocery store so that I didn't, as he put it, contaminate my entire refrigerator. So these are questions people have. Can you help us out with this, Dr. Talbot?

Dr. Talbot:
This virus is not adapted or, you know, doesn't intend to live on surfaces. This is not what this evolved to. This virus wants to live in people and it wants to hijack our machinery to make more of itself. But it does survive on surfaces for short amount of time. We know that under experimental conditions, that is carefully controlled humidity and temperature and perfect laboratory conditions that can last for hours or days on surfaces. And that can be scary at first. But I would say that's not our typical environment, right? We clean our environments. We don't have controlled humidity and temperature and exposure to you. Be light such as sunshine. So does it have a role? Yes, I think so.

Dr. Talbot:
I mentioned earlier was the experience on that ill fated Diamond Princess cruise, where we do believe that contaminated handrails and doorknobs and whatnot may have allowed people to inoculate themselves. I guess I just want to say I hope I hope we don't come to live in fear of every piece of mail and everybody we pass in the streets. And I'd like to just, you know, make that statement that we have to also be rational and try to balance the public health risk of this virus and the hypotheticals with the reality that this is driven by ill people in close proximity and in close settings. So I think that Dr. Chan wants to follow on that.

Laura Knoy:
Yeah, go ahead. Yeah.

Dr. Chan:
Quickly add that, you know. That the highest risk of Acquiring this virus from from surfaces are going to be those surfaces that are frequently touched, right. So, I mean, people have to consider, you know, is the jar of peanut butter picked up in a grocery store, for example, a frequently touched surface? Probably not. As opposed to the grocery cart handle or, you know, the doorknob that you have to touch, that, you know, multiple other people came through and then touched before them.

Dr. Chan:
And I think this speaks more to the two things. One is the need to practice good and frequent hand hygiene. Right. So if you're going into the grocery store and touching the grocery cart handle, you should be cleaning your hands right after that, as well as the need to clean and disinfect frequently touch surfaces. Now, that's not necessarily the jar of peanut butter, but that could be something like the card handle that the basket handle the doorknob. So those are the surfaces that need particular attention to cleaning and disinfection, because that's your as your listener implies that there is some evidence that these bite, that this virus, this novel coronavirus that causes COVID-19 can live or certainly hours potentially on on surfaces. The risk is going to be greatest for those frequently touch surfaces, for those surfaces of the services that are frequently touched by it, by other people. I think that that that needs to be the focus.

Dr. Chan:
Goodhand Hygiene, yes. Cleaning frequently touch surfaces.

Laura Knoy:
I'm so glad that that person wrote in because this is a question I think a lot of people have. Again, when my husband got back from the grocery store the other day, I started wiping down all the cartons of milk and then everybody in my family looked at me like I was going overboard. So it sounds like I was. And that said, that's good to hear. I won't take a call. This is Beth calling in. Hi, Beth. Thanks for waiting. You're on the air.

Caller:
Hi, how are you?

Caller:
So my question is, a few weeks ago on a White House press briefing, Dr. Fauci mentioned the role of sunlight and the virus doesn't like sunlight. So can you go into a little bit more detail about what he meant? And are there some practical things that maybe we should be doing, not on a day like today, but on a bright, sunny day, possibly in our homes sending.

Laura Knoy:
Maybe opening windows and so forth best getting fresh air,.

Caller:
Either open windows or My mother used to always hang our linens outside, put pillows outside after someone was sick. That type of thing with sunlight. So I'm when I heard that, I remembered that memory of my mom doing that. So I just didn't know that was practical or kind of similar to what you were just talking about little over.

Laura Knoy:
Okay. Yeah. Thanks a lot, Beth. I really appreciate the call, Dr. Chan. Can you take that one, please?

Dr. Chan:
So I think this speaks to how well this virus survives in the environment. Right. So so we know that these types of viruses usually are susceptible to dying when they dry out, when they're exposed to sunlight. Oftentimes that's the ultraviolet component of sunlight that kills viruses and other germs. And so the the risk of acquiring this virus, we believe. And again, there's not a lot of data or studies around it, but we believe the risk of acquiring this virus, if you're outside, for example, where you know, there are air currents in, you know, ultraviolet sunlight, the risk of acquiring this virus, if you're something like outside as opposed to in an enclosed room is probably less because of these different environmental components. But the risk isn't zero. Right. And so as we talked about earlier, even if you're outside walking with somebody, it's still important to maintain a distance of at least six feet to try and minimize any exposure to another person's respiratory droplets.

Laura Knoy:
Well, Beth, thank you very much for calling in. I really appreciate the point. .

Laura Knoy:
Also coming up on ask both of you about the goals and the the your hopes for the stay at home order that the governor put into place late last week. So all that is in just a minute. Stay with us. This is The Exchange on NHPR.

Laura Knoy:
This is The Exchange, I'm Laura Knoy tomorrow on our show. Another two hour special on the economic impacts of the pandemic that starts tomorrow morning live at 9:00 this hour. Two of the state's top public health doctors are here with the latest on how New Hampshire is experiencing the coronavirus and taking your questions. And Dr. Talbot, Dr. Chan, let's go right back to our listeners. They have so many questions about this. Heather from Grafton is calling in. Hi, Heather. You're on the air. Go ahead.

Caller:
Hi, good morning. I'm a nurse that works at Dartmouth-Hitchcock.

Caller:
And as we're entering the facility, we're being asked if we have a cough or any new symptoms. We're being screened for a fever. I was in direct contact with patients coming in from their community, being newly admitted or being in the in the clinic for treatment. They were also asked the same question. My concern is that I believe the asymptomatic transmission of this virus is a it is quite a concern that a large number of people are being infected that way. And if we're only screening and testing for symptomatic patients and population. Whereas our production.

Laura Knoy:
I see what you're saying. Yeah. So people who don't have symptoms are not getting tested. They're just being, you know, checked for fever and cough and so forth. Dr. Talbot, I hear the worry in her voice. What do you think?

Dr. Talbot:
Thanks, Heather. Yeah. Again, you're on those frontlines. And thanks for the work that you're doing. We come back to this reality that some small proportion of transmission can occur through asymptomatic persons. That's not the majority. That's not who's driving this epidemic. And in our current belief. So I think it's just the best we can do in terms of trying to screen out those who are shedding the most virus into the environment by coughing, by having fever and reflective of having higher viral loads. It's just the best tool we have is to try to at least screen out those symptomatic. But it does speak to the reason that we have closed our long term care facilities to all visitors where they're symptomatic or not.

Dr. Talbot:
So I want to come back to this that the very most vulnerable persons are those with chronic illnesses or or elderly. So in terms of the goals of what we're doing here, it's it's very much to try to protect those who are institutionalized or in those higher age brackets. So you'll see us continue to come back to that population and try to protect them to even asymptomatic persons cannot enter long term care facilities now. And that's our sad reality.

Laura Knoy:
Dr. Talbot, I also heard that, you know, besides fever, cough, fatigue, and as you and Dr. Chan have been saying, you know, some people are asymptomatic. They feel absolutely fine, but they're still carrying the virus. I also heard that some people lose their sense of smell and taste, that that's another possible symptom. Can you address that? Dr. Talbot?

Dr. Talbot:
Yes, you're you're definitely paying attention. This was recognized in the U.K. in their own epidemic and has not been systematically studied.

Dr. Talbot:
But as I'm convinced of it, you know, we've just heard this very often from our cases right here in New Hampshire.

Dr. Talbot:
So there's some very odd behavior here by this virus that does lead to that as maybe a sentinel symptom that people should also pay attention to. Dr. Chan has something to say to you.

Laura Knoy:
Yeah, go ahead, Dr. Chan.

Dr. Chan:
Yeah. I just want to acknowledge that there are a number of very difficult challenges with controlling spread of this virus and that the caller highlighted. One of those is that, you know, we believe it's possible for people to be able to spread this virus when they're not having symptom.

Dr. Chan:
The majority of these people will be pre symptomatic, meaning they will go on to develop symptoms a few days later. But, you know, we we I think we and our health care facilities do the best that we can. We're trying to screen people that might clearly have symptoms and might clearly be transmitting, maybe transmitting the virus. But I think it's also an opportunity to highlight that the symptoms for a COVID 19 can be really very broad. It's not just fever.

Dr. Chan:
In fact, not everybody has a fever and a fever. It does develop in the course of illness that can be delayed for several days after onset of early symptoms. Not everybody has shortness of breath. Not a. Not everybody may even have cough. This virus can present in a variety of ways and early symptoms can include rule like illness, such as feeling just very fatigued and tired, having muscle aches, having chills. You can have upper respiratory symptoms, we believe, like sore throat, possibly runny nose. Certainly cough has been you, I think, in a majority of people. But the symptoms of these can be can be very broad. And as you mentioned, you know, lots of pain and loss, of smell have been reported in other countries and we're seeing that also in some of our patients here in New Hampshire.

Laura Knoy:
We've a couple more minutes to take your questions. Diane is calling in from Durham. Hi, Diane. Go ahead. You're on the air. Welcome.

Caller:
Hi. My husband, who is over 80 and has some underlying chronic conditions, needs to have a blood test for a change in thyroid medications. And we're on the seacoast and we need to go to Exeter. So I'm wondering what we should do. Should we go to the lab? Shall we? Not at when so many health care workers are affected. I'm just kind of bewildered about what the next steps should be.

Laura Knoy:
Oh, I'm really glad that you called, Diane, because a lot of people are you have medical issues that they need addressed. A lot of people are putting off, you know, regular surgery or even regular checkups like mammograms and colonoscopies, you know, procedures that we're told we should have to stay healthy. Can you address her concern? Dr. Talbot?

Dr. Talbot:
I can recognize it's a common one. You know, Diane, I appreciate that. All of these decisions that used to be so simple now have become complicated. And I would absolutely encourage you to talk to your husband's provider to find out how important that lab testing is and.

Laura Knoy:
Maybe if you can get a hold of him or her.

Laura Knoy:
I mean, it's hard to get a hold of people these days.

Dr. Talbot:
Well, sorry to hear that. You know, as a clinician on the front lines, we certainly have ways that we are you know, we're trying to keep the lines of communication open and interact. We're moving a lot toward telemedicine. I know this might be unusual and not the way you expect to connect with your doctors, but. But we have to weigh risk benefit now. And, you know, if your husband, Diane, is getting blood tests every four weeks, maybe maybe you can check with the provider and see if it could be extended. But we're trying to keep health care settings safe, too. So just because we're reporting that our case count is increasing doesn't mean that the Exeter Laboratory is in any way unsafe. Just go in and get what you need done. Your doctor thinks is is important for you to do. And get out quick.

Dr. Talbot:
I think that's quite fine then.

Laura Knoy:
Yeah, actually. Yeah, go ahead. I've a different question for you, Dr. Chan. Actually, what's the public health implication of large numbers of people putting off mammograms? Regular welness checks?

Laura Knoy:
Is this sort of a health crisis that hits us after COVID 19 is gone?

Dr. Chan:
Yeah. That's it, that's a great question, and I think, you know, we we expect things to taper off in regards to this pandemic in the future. So. You know, this is not where we're in a state right now where we're seeing rapidly increasing, rapidly increasing number of cases. But at some point we think that there's going to level off and decline. Whether this virus will be with us, you know, in the long term still remains to be seen. But I think that given the outbreaks of pandemic that we're seeing in the immediate moment, it's advisable that people who don't need. Medical care. You know, if things can be put off to put off those things like mammograms or, you know, we're talking maybe weeks or two, a few months, hopefully. It remains to be seen how this pandemic progresses. As Dr. Talbot mentioned, there's also the option for telehealth. And we want people to be able to connect with their health care providers and have these discussions about whether a procedure or a lab test for a visit might be crucial. And if it is, we want people to be able to go into the health care system and get the more immediate testing that and evaluation that might be needed.

Dr. Chan:
But many of these well, wellness checks, likely people are OK to put off for a number of months.

Dr. Chan:
But certainly that's a decision that needs to be made between a person and their health care provider.

Dr. Chan:
And so if someone is concerned about testing whether it needs to be done right away or the urgency of a visit, they should they should be reaching out to their health care provider to ask those ask those question.

Laura Knoy:
Yeah, go ahead.

Dr. Chan:
I'll also just quickly mentioned that I think you're your previous caller highlighted an important point, which is those that are of an older age, people 60 and older people with multiple medical problems are at increased risk for serious complications that they become infected with this novel coronavirus.

Dr. Chan:
People in that older age group, people with multiple medical problems are at increased risk of needing to be hospitalized if they're infected. And so the recommendation, especially for those individuals, is to avoid public settings as much as possible, stay at home, make sure they have a 30 day supply of medications on hand and have, you know, a couple weeks of groceries so that they can minimize outings and public exposure, because as this virus becomes more common in our communities, that the risk of exposure going out of the house increases. And we want to make sure that our more vulnerable populations are protected. The best extent possible, which highlights the importance of social distancing, saying at least six feet away from other people staying out of public places. That's that's how we prevent this virus from spreading. Given the fact that this virus, what we know about this virus and how easily it can spread person to person.

Laura Knoy:
Well, a listener emails. I have read about three new coronavirus tests, a five to 15 minute test by Abbott, a 45 minute test by a company named C-Fid. I hope I'm pronouncing that right. And a test developed at Dartmouth-Hitchcock. This listener wants to know, are any of these tests readily available throughout New Hampshire? This person says this could be a game changer. Doctor Chan, I'll throw that to you too.

Dr. Chan:
Yes. So if someone is having symptoms of COVID 19 and thinks they might have COVID 19.

Dr. Chan:
The first the first stop should be a call to their health care provider. Right. We at the public health agency public health laboratories are helping to do the testing in our public health laboratories. But as is mentioned, there are multiple other labs that are bringing on testing. But it still requires a health care evaluation and a health care provider to order the tests where that test is actually ultimately done. There are now a variety of locations where testing can be performed, not just at the public health laboratories.

Dr. Chan:
Dartmouth-Hitchcock Medical Center, as was mentioned, has has brought on the testing. Other hospital laboratories are looking at bringing on some of these tests. Like the Stafford gene expert that was mentioned, they have a turnaround time of, I think, 45 minutes or so. So there are other platforms and other laboratories that are bringing on the testing. But the first stop for someone that might be symptomatic is to check in with their health care provider.

Laura Knoy:
Yeah, well, and I imagine if we talked to the both of you next week, this picture could be completely different. When we talk about testing and the number of cases and so forth. A quick e-mail from Carol in New London. If I could just give this to the last moment.

Laura Knoy:
Carol says We get regular updates on a county basis, but I'd like to know if we'll be getting information on Corbould 19 on a town by town basis. Dr. Chan, is that possible? Is that useful?

Dr. Chan:
Yeah. So. So up until now, we have released very general information, county level, high level numbers. We want to and will be releasing more detailed information about demographic, even location, possibly at a town level. This is something we've we've been working on and we weren't able to release some of that information early on when if not for still low due to identifiable information potentially being released at a town level. But as the number of data things, this is our ability to release more information at a more granular or maybe even town level, but to become more desirable.

Laura Knoy:
Ok. Well, Carol, thank you for the e-mail. And I hope that I get a chance to talk to both of you again soon. This has been really helpful for me and for our listeners. Dr. Talbot, thank you very much for your time.That's Dr. Elizabeth Talbot. She's the deputy state epidemiologist and an infectious disease specialist at Dartmouth-Hitchcock Medical Center. Dr. Ben Chan, thank you also. That's Dr. Ben Chan. He's the state's epidemiologist. And this is The Exchange on NHPR.

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