State Epidemiologists Answer Your Questions As N.H. Sees Rising COVID-19 Cases | New Hampshire Public Radio

State Epidemiologists Answer Your Questions As N.H. Sees Rising COVID-19 Cases

Oct 28, 2020

A mannequin wearing a "masks please" sign and mask outside a store in Littleton.
Credit Dan Tuohy; NHPR

The state is seeing a significant increase in daily new infections reported - the most since mid-May, and the third-most since the pandemic began.

With that rising case load, and the upcoming holidays and cold weather, we talk with our state epidemiologists about how to keep yourself safe while moving indoors, traveling, and building "pandemic pods" with those outside your household. 

Click here to read all of NHPR's coronavirus coverage. 

Air date: Wednesday, October 28, 2020. 


GUESTS:

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

 

This infographic from The Lancet medical journal, lays out the effectiveness of masks, and was referenced during the program.
Credit The Lancet

Produced by Christina Phillips. 

 

 

Transcript:

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

Laura Knoy:
As cold weather arrives and people move indoors, New Hampshire's coronavirus infections are up. Yesterday, the state had one of the highest numbers of new cases reported since the pandemic began at 140. So now some Granite Staters are reconsidering fall traditions, whether it's watching football with friends or trick or treating on Halloween. And many are having hard conversations about the holiday season just around the corner. Because of all this, there's new interest in so-called pandemic pods or bubbles, small groups of friends who agree on certain rules so they can socialize safely inside today on The Exchange were with the state's top public health doctors to look ahead and answer your questions..

Laura Knoy:
Our guests are Dr. Benjamin Chan. He's the state's epidemiologist, along with Dr. Elizabeth Talbot, the deputy epidemiologist and an infectious disease specialist at Dartmouth Hitchcock Medical Center. Welcome to both of you. I know how busy you are, so I really appreciate your time. And Dr. Chan, to you first, what is behind this alarming increase in infections?

Dr. Benjamin Chan:
Yeah, so thank you for having us. It's always a pleasure to be on your show and to engage with your listeners. So, you know, we are seeing increasing community spread community transmission of Covid-19 across the state. And largely that's due to people relaxing their social distancing. You know, we know that this is a virus that we still believe primarily spreads person to person through close contact. That's you know, we define that as being within six feet.

Dr. Benjamin Chan:
And we know that as this pandemic wears on, you know, we're in this for the long haul. But as it wears on, people are relaxing, social distancing, and that is contributing to more and more spread of Covid-19. And so I think it highlights the need for us to continue to be on our guard, be vigilant. There's different, you know, terms being used.

Dr. Benjamin Chan:
But we still very much are in the midst of this pandemic. We don't have a vaccine yet. And until we do the primary way that we have to control the spread of this novel coronavirus is through those community mitigation measures, the social distancing, the cloth face mask use the good hand hygiene and especially avoiding crowds where people are together in closed, confined spaces, potentially in close contact and indoor spaces. Those are the settings where this virus likes to spread very easily, which we see more of obviously, as we move indoors.

Laura Knoy:
And I want to let listeners know we will definitely talk about vaccines a little bit later in the show, but I'll hold off on that for a moment. So, Dr. Talbot, Dr. Chan mentioned, you know, communities spread, people relaxing their vigilance, people moving indoors. Is that what we're seeing now in restaurants, Dr. Talbot? People moving indoors, sitting close together and you can't eat with a mask on.

Dr. Elizabeth Talbot:
Thanks, Laura. It's an opportunity to review, as Dr. Chan said, the three CS, so this virus exploits conditions of close contact, close spaces, crowded conditions, and that can easily be called a minor restaurant. So if you are in those circumstances and you have to take your mask off to eat, this seems like the infamous perfect storm. So indeed, there are studies showing that persons who have Covid-19 often are more likely to report that they have eaten indoors in a restaurant or been in a bar setting. So we know this the evidence is showing us. It's also intuitive and consistent across everything we know about how this virus behaves.

Dr. Elizabeth Talbot:
Some restaurants, Dr. Talbot, have done a good job putting out those big old heaters. Is eating outside that much safer or a little bit safer?

Dr. Elizabeth Talbot:
Much safer.

Dr. Elizabeth Talbot:
So we we watch very closely what happens internationally and in the research arena. And it does look as though being outside is is pretty effective, given the extra airflow, the climactic conditions, often with sunlight, et cetera. So indeed, again, we're talking in closed spaces, close contact, crowded conditions. Those are the things that I am using as my mantra these days. So outdoors is better. So, you know, as we're thinking ahead to holidays, can we be creative? Can we think about outdoor turkey barbecues or...

Dr. Elizabeth Talbot:
Out there in New Hampshire. So we have beautiful outdoors and we need to think about how to creatively engage together outdoors, you know, the Christmas bonfire, that sort of thing. So we're in this together for the long haul. This is a marathon, not a sprint.

Laura Knoy:
Well, about a month ago, I bought one of those giant porch heaters. And I like to say I bought the last one. I think it was available in central or southern New Hampshire because a lot of people, I think, are taking that message to heart. I did want to ask you, Dr. Talbot, you know, I hear both of you saying that largely this rise in infections is people relaxing their guard, people gathering indoors. What about much more widely available testing, though, Dr. Talbot? Is that also why we're seeing a rise in infections?

Dr. Elizabeth Talbot:
So before we take that question on directly, I want to also frame this, that we're not blaming cases, right, in most cases, that when you hear of someone with a disease, that's a tragedy and that's unfortunate and it may not be a fault of their own. Right. So I just want to make sure that we don't blame individuals, but we look for ways to improve the way that we're all behaving. And now with regards to whether increased testing is the cause of our increased numbers,

Dr. Elizabeth Talbot:
I think only to a certain extent where we're using the new tools in the toolkit, the antigen testing, especially to increase our reach and understand the way this virus is moving and especially populations like schools and long term care facilities. So some of the cases where identifying are those that perhaps would not have been tested previously. So there is some role of increased testing.

Dr. Elizabeth Talbot:
But but clearly, as we observe hospitalizations and symptomatic cases, that's not the only answer here.

Laura Knoy:
Let's talk exposure and infection and listeners, by the way, what questions do you have about getting tested and what you're supposed to do if you get a positive result or what you're supposed to do if you get a phone call saying you were at a place where there was a coronavirus case? We'd love your questions this morning.

Laura Knoy:
And Dr. Chan, as you know, lots of headlines about exposure at restaurants. Let's say you were at one of those restaurants on Saturday night. I'm not saying you would eat inside of the restaurant. Dr. Chan probably wouldn't. But let's say I was at a restaurant on Saturday night and I found out on Sunday there was someone there who tested positive. I got a call from a contact tracers saying if you were at restaurant X, you should know somebody there had coronavirus. Should I run out and get tested that day? Should I wait a day or two? What's the chain of events there?

Dr. Benjamin Chan:
Yeah, and actually, Laura, before I jump into that question, I just want to make a brief comment on the last question about, you know, why we're seeing a rise in community transmission. And it's not just due to testing, right? Testing is readily available. People can access testing all throughout the state. We've set a low bar for testing in our colleges and universities and our kids through 12 schools.

Dr. Benjamin Chan:
But what we're also seeing is the number of hospitalizations beginning to rise. We're seeing the number of people dying from Covid-19 beginning to rise again after a lull during the summer.

Dr. Benjamin Chan:
Part of this is because we're seeing more clusters and Covid-19 being reintroduced back into long term care facilities and vulnerable populations. So there's a lot of evidence that on top of that, our contacts investigations are identifying, you know, more and more people coming into close contact with someone with Covid-19. So multiple reasons, multiple data points that point to the fact that communities spread is increasing. It's not just increased testing.

Dr. Benjamin Chan:
And I think that that gets to your your current question, which is what happens when somebody is diagnosed with Covid-19. Everybody diagnosed with Covid-19 gets reported to public health, either by the provider that's doing the testing or the laboratory that runs the tests and submits that report to us electronically and automatically.

Dr. Benjamin Chan:
Now, there may be a little bit of a lag between when somebody is notified by a provider, for example, and when we may get the report, we get all the report. And when that happens, we reach out to the person infected with Covid-19 and ask them where they have been during their infectious period.

Dr. Benjamin Chan:
And that infectious period is not only the period of time after which they tested positive or were symptomatic, but we go back two days, 48 hours before they develop symptoms or before they tested positive, assuming that they could have been spreading Covid-19 even before somebody became symptomatic. And based on that information, we reach out to different locations, different organizations to find out who may have been in close contact again within six feet for at least ten minutes or longer of that person with Covid-19.

Dr. Benjamin Chan:
And so, at a restaurant, we reach out to the restaurants and we try and get information about whether they have collected, you know, information on who was sitting around them, what's the setup of the restaurant where they in close contact. Anybody that is able to be clearly identified as being in close contact to a person with Covid-19, public health will reach out to in contact directly. There are situations and we've seen this recently with with restaurants where we may not be able to identify everybody that might have come into close contact with that person. And then we're left doing a public notification press release to try and get the word out that if someone was at, you know, a certain establishment on a certain day or during a certain time, they should be on the lookout for symptoms and be tested because of potential exposure.

Laura Knoy:
I see. So go ahead, Dr. Talbot. Yeah? You want to jump in?

Dr. Elizabeth Talbot:
I am remembering that you asked when testing is appropriate, once you've been notified that you may have been a contact to a case. And I think that we have a low bar with regards to accessing testing. So certainly if you have any symptoms, but it is appropriate based on typical incubation period, that is the time from exposure to the time that you might become contagious or symptomatic, say five to seven days following that exposure is probably the most high yield time to be tested, even if you have no symptoms.

Laura Knoy:
I see. So don't if you find out you were at a place where there was exposure on Saturday night, don't run out and get tested on Sunday. Dr. Talbot, you need to wait a couple of days.

Dr. Elizabeth Talbot:
Yes, I think that's right, because, again, the incubation of this virus, most exposure on average is four to five days, but can linger out to 14. So just in terms of a way to maximize yield on testing, probably do it five to seven days after that exposure.

Laura Knoy:
Well, let's go to our listeners. Lots of emails coming in and phone calls as well. Kelly's calling from Francis Town. Hi, Kelly. You're on the air. Thanks for calling in today.

Caller:
Thank you for taking my call. I'm 65, I'm retired after 34 years from the post office, says live a career. I have a business called I have a business, the party bus business. And last job I did was March 14th with a bunch of doctors actually from the Catholic Medical Center. I'm wondering, my boss would have 10 to 14 people in a four to eight hour period visiting maybe four to eight different businesses during that time, the enclosed base of the party bus. For the participants would be about eight feet by seven feet, by 15 feet, and I'm in a separate compartment. We each have separate air, separate heat and separate ventilation that doesn't intermingle. When might it be safe for me to go back in business and for my kids, for me and my clients, my family, for me to operate that type of a party bus again?

Laura Knoy:
Sure. And, Kelly, just real quickly, please, what does a party bus do? I have to say I haven't been on one.

Caller:
Well, in December, I'd like to be able to do Christmas light tours, but I think that's going to be about. But basically what it's small, but like You small city busses that would be maybe 25 feet long and. It's like a my bus is like a club on wheels.

Caller:
It's got circles speeding, it's got TVs, it's got different pictures and penants, you know, decorations, it's a party on wheels, it's what it is,

Laura Knoy:
And you maybe go see the Christmas lights or maybe people like to go on the coast or something like that. So there's sort of attractive scenery while you're having a party.

Caller:
Yeah, can I say my name?

Laura Knoy:
Sure.

Caller:
Ok, I was fortunate to come to New Hampshire three years ago after doing this 15 years in Vermont and my name is New Hampshire Party Bus.

Laura Knoy:
Well, Kelly, thank you very much for calling, and I'm sure this is a very difficult time for you and Dr. Talbot. You know, you probably can't assess all the parameters right here on the air. But in general, how does this party bus sound to you?

Dr. Elizabeth Talbot:
So as we've talked, you know, I've certainly felt a lot of compassion that there are definitely industries, businesses. And things that we do as social humans that are no longer safe. And so, as I think about a party bus, it sounds like there's potential for close contact. It's a closed base and there's likely chronic conditions by nature. So this this feels as though it would be dangerous. It might bring us back to the discussion of layers of protection. So, for example, having everyone universally masks doesn't sound like a party to me. But but I think that that's the era we're in, making sure that people can conduct hand hygiene very regularly. Where's your Purell right now? Kind of thing. And then, as you foreshadowed, Laura, there may be opportunity to think about pods or bubbles in a party.

Dr. Elizabeth Talbot:
So if you are being absolutely safe with regards to these issues on social distancing and these strategies and these actions and your friends and family have also contracted with you to do so. And then this is your part, this is your bubble and maybe this is your party bus. But I, as you say, would have to see the circumstances and the way that these layers fall into place in a way to not further propagate this virus. And, you know.

Laura Knoy:
Well, Kelly, thank you for calling. And it is a tough, tough time for people in business like yours, for sure. Here's an email from Bob in Exeter. And Dr. Chan, I'll throw this to you. I have a lot of concern, Bob says, about the time it takes to get tested. Many people are getting tested and don't know for up to four to five days if they are positive or negative for people needing to travel. This will not allow people in New Hampshire to leave as many places require negative covid tests within 48 or 72 hours. What is being done? Bob asks to speed up testing processing times. Go ahead, Dr. Chan, please.

Dr. Benjamin Chan:
Yeah, so, so good. Good question from Bob. And I think there's a couple of answers. One is that, you know, I don't think we can necessarily comment on what other states are requiring. You know, there's different types of tests and different test technologies that are out there.

Dr. Benjamin Chan:
And, you know, I think I think we generally recommend that people look to local public health guidance for where they are traveling to for the most current recommendations.

Dr. Benjamin Chan:
Some states, we are aware, are requiring testing before coming into another state. I will say that as transmission increases across the country, risk of Covid-19 increases across the country. And so we continue to discourage travel, especially on public mass, mass public conveyances. So that that's just a little point to put in there. But regarding the question about testing, you know, the turnaround times for the test have greatly improved from where we were back in the fall, in the summer.

Dr. Benjamin Chan:
And so we periodically are hearing reports of longer turnaround times for testing. But in general tests are being turned around, we believe, and, you know, two, maybe three days. That's where the PCR based test.

Dr. Benjamin Chan:
And for anybody that's symptomatic, you know, having symptoms of Covid-19 and needs to be tested, there are antigen tests that are being rolled out to our different regional processing centers, and those can give results within 15 or 20 minutes of testing.

Dr. Benjamin Chan:
Now, we continue to promote and recommend those primarily for people that have symptoms of Covid-19. So if someone's looking for a screening test because they're going to travel, for example, the better and the appropriate test is the PCR based test. But partly that's going to depend on the requirements for for where somebody is traveling to. And I believe Dr. Talbot wanted to jump in there also on the question.

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

Dr. Elizabeth Talbot:
I've understood that some people really need to travel for work, so there in my role of the travel clinic up at Dartmouth. I've discovered that there's a whole industry that's sprung up to enable people to meet requirements of the airlines and international border crossing when it's mission critical travel. So this is self testing at home for a fee.

Dr. Elizabeth Talbot:
So this is a new strategy for those kinds of regulatory tests that are required. But otherwise, I fully echo Dr. Chan that we worked very hard to bring those testing times down within our state. We're in a pretty good place in that regard. So it's even now available to you to track online on our dashboard. So you can see those turnaround times by accessing our website and then you can choose your own lab, whoever has the lowest number.

Laura Knoy:
All right, let's take another call. And this is Nancy from Wolfeboro. Hi, Nancy. You're on the air. Go ahead, please.

Caller:
Hi, thanks so much. So my daughter and thousands of others are going to be flying back from college for Thanksgiving, what's the best protocol? I have to pick her up at the airport. So therefore, if she's contaminated, I will be. Should we wait five days or three days to get tested? And if after we have the tests, are we considered safe and could we have Thanksgiving if we had that period? And also, lastly, kind of the college students have insurance that doesn't necessarily pay in New Hampshire. Can we? I understand the state is providing free tests. Will they be covered?

Laura Knoy:
Well, Nancy, thank you for calling in because so many people are asking this question. Beth in Concord actually has a similar question that she wrote in. She says, If your friend served on a local school board and she asked you how to handle the weeks between Thanksgiving and the New Year when teachers, staff and family hold gatherings and travel, I might not be completely truthful. How would you advise her? So this is something we need to get into. Both of you. And Dr. Channel, turn to you first. But Dr. Talbot, obviously want to hear from you as well.

Laura Knoy:
Thanksgiving travel. Dr. Chan, the reports out of Canada are not optimistic. They celebrate Thanksgiving about two weeks before we do. And according to reports I was reading yesterday, they have noticed a rising covid cases in Canada due to their Thanksgiving. So go ahead, Dr. Chan.

Dr. Benjamin Chan:
Yeah, no, it's a great question. And we're getting a lot of questions now about travel and how people can or should travel safely over the holidays.

Dr. Benjamin Chan:
So I think a couple of responses. One is that we are looking at our travel guidance and reevaluating in the setting of knowing that there will be increased travel coming up. But the guidance right now continues to be that people that are traveling to or from areas outside of New England need to quarantine for 14 days when they get to the states after after their travel and that quarantine period, that 14 day quarantine period is because that's the timeframe, what we call the incubation period from when somebody can be is exposed to when they can develop symptoms of Covid-19. And so this puts I understand, you know, families, communities and physicians who may have people traveling in from other states outside of New England even flying in.

Dr. Benjamin Chan:
But as you as you mentioned, you know, travel is higher risk. And even with testing, testing does not get somebody out of quarantine in New Hampshire. You know, that that's that's something that other states around us, Vermont in particular, have adopted a policy where, you know, if you get tested on day seven, you can end your quarantine early. New Hampshire has not adopted that approach. And so the recommendation currently is still that anybody traveling from outside of New England needs to quarantine for 14 days. But that's that's something we're looking at to see what other surrounding states are doing and whether whether we can potentially revise our travel and quarantine policies. So I would say stay tuned. But as you mentioned, you travel especially public conveniences. Travel on public conveyances is higher risk and potentially it can lead to exposures and covid, you know, covid being brought into the state as well.

Laura Knoy:
So the quarantine in New Hampshire is you're supposed to do it, Dr. Chan, but there doesn't seem to be any quarantine police. So how effective is that honor system, Dr. Chan?

Dr. Benjamin Chan:
Yeah, you're right. We have not been going out and serving people public health orders to make sure that they're quarantining after travel. There are instances where we will do that, but we haven't done that when when people are supposed to quarantine for travel. So it's on the honor system.

Dr. Benjamin Chan:
But we want to stress the point, though, that even though we leave it up, we believe a lot of these decisions to personal individual responsibility.

Dr. Benjamin Chan:
And I think many people want to do the right thing. The reason for these recommendations is not only to protect the people in the household that might have, you know, others coming into the state, but also the surrounding community. Once Covid-19 is introduced, it can spread rapidly and it can lead to further spread in the community. And so, you know, it's not just the person who's infected that is potentially at risk. It's the close contact in the household. And if they come down with Covid-19, their close contacts in the community, and if somebody works, for example, at a long term care facility, you know, there could be chains of transmission that lead to Covid-19 spreading within our communities.

Laura Knoy:
So should Nancy's daughter not come home? These are the decisions that parents are having to make. It's heartbreaking.

Dr. Elizabeth Talbot:
It's it is heartbreaking. Oh, my you know, we're all individually, personally, professionally impacted as as we've already heard and my you know, my own Thanksgiving will be intimate more than more than usual. We're just going to have a core our own family bubble. And that's that's sad. We are all grieving the normal life of these large and boisterous and happy holidays. I think that every decision we're taking now is his risk and benefit. So we need to talk more about that,

Laura Knoy:
Dr. Chan.

Dr. Benjamin Chan:
Yeah. And I'll just add that, you know, we're not saying that the college student can't come home. Right. We understand that there are important family and social functions that need to occur. We're simply, I think, recommending that people take the appropriate precautions and that that person coming home from out of state, out of New England, that individual is recommended to quarantine, meaning not go out in public places. But that doesn't mean that the person can't, you know, fly home for several weeks in quarantine in a parent or guardians house and have Thanksgiving. But again, we want to stress that those social gatherings are situations that are high risk. And so we continue to recommend that those social gatherings be, you know, a limited number of people preference preferentially outdoors, although that may be difficult. And so if people are indoors trying to, you know, practice social distancing indoors and good hand hygiene and wear face coverings where where possible.

Laura Knoy:
Well, Nancy, thank you for calling, and I would say in terms of this two week quarantine, a lot of colleges are sending students home for Thanksgiving and keeping them studying remotely until, you know, after the new year. So maybe that helps a little bit with some of those quarantine issues. Another call, Molly is calling from Andover. Hi, Molly. You're on The Exchange. Thanks for being with us.

Caller:
Hi there. I have three children and our school is currently in a hybrid mode and a recent school board meeting, they decided to continue a hybrid mode. And I know there's a lot of other schools are considering going remote as cases get higher. I'd like Dr. Chan to please comment on the transmission rate in the schools specifically compared to the community rates. And if schools are practicing the same things in the classrooms with Marsan, why are we continuing to have restaurants and bars open and no math mandate while we're shuttering our schools? As we know, unemployment benefits have been, you know, cut off for a lot of people that additional and families are struggling economically. And it's a huge stress and kids are really suffering right now. So I want to know if it's warranted that some school districts are actually closed.

Laura Knoy:
Yeah. Molly, thank you for calling. And Dr. Chan can't really comment on the economic, you know, the idea of unemployment insurance and so forth because he's a public health doctor.

Laura Knoy:
But to the decisions, Dr. Chan, that school districts are having to make, you know, opening, closing, going hybrid, how are how are you guys helping them make those decisions? What metrics are you advising them to use?

Dr. Benjamin Chan:
Yes. So these decisions about school instructional models is a local school district school board decision. We have been supporting schools to help put out information. We've been holding weekly calls with school partners. And we have put out guidance for schools specifically around this question of how and when school and consider transitioning between instructional models and a school's ability to function is I think there's two different factors that play in.

Dr. Benjamin Chan:
One is what's happening in the broader community, what you know, the community transmission and the other is what's happening at local specific individual schools. And so this guidance tries to define and take into account both factors. But to Molly's question, you know, as a community transmission increases the risk to organizations, businesses, schools and the communities will also increase. And so schools do need to take into account levels of surrounding community transmission. And we've made metrics and data available to schools and to the public on our, you know, interactive, you know, data dashboard.

Dr. Benjamin Chan:
But I think one of the key points here is that we have seen, you know, I don't have an exact number, but probably around 200 students and staff in the last, you know, two or three months that have been associated with K through 12 schools, but very little in school transmission. You know, I think we have a total of about five small clusters that have occurred within K through 12 schools over the last, you know, two or three months. And so even with the the high number of students and staff that are being diagnosed, we have not seen a lot of in school transmission. And I think that I think that speaks to the two things. One is that the layers of protection that schools are implementing is working. And the second is that, you know, school schools can be conducted safely in person, whether that's Fullan person or in hybrid. And so we continue to support schools and trying to make these decisions. But ultimately, the decision on what learning model is used as it comes down to the decisions by the local school district and school board.

Laura Knoy:
All right. Lots more to talk about, but we have to take a very short break.

Laura Knoy:
When we come back, we will get the latest on vaccine development and some new treatments that might be coming down the line. And we'll keep answering your questions, so send them in. We'd love to hear from you. Our e-mail exchange at Nhpr.org. Our phone number, one 800 eight nine two six four seven seven more. The Exchange in just a moment.

Laura Knoy:
This is The Exchange I'm Laura Knoy this hour, New Hampshire's top public health doctors are with us and we're talking about the latest with coronavirus in New Hampshire as cases rise due to community transmission, as people head indoors, what are your questions for Dr. Chan and Dr. Talbot? And we will try to get to as many of your questions as possible, both of you. Dr. Talbot You, first, please. What are you watching with the vaccine trials? Every time we talk, we talk about this. So go ahead, Dr. Talbot.

Dr. Elizabeth Talbot:
I'm watching very closely, Laura, because, yeah, like like many others, I'm just so hopeful that this is what's going to turn our epidemic, our pandemic around and get us back to normal. So I don't I don't know. I don't have that crystal ball.

Dr. Elizabeth Talbot:
But I do know that there are four late stage phase three vaccines that there's much optimism for. And even a fifth that's about to enter into the late stage trials, will need to show a safe and effective vaccine. So I want to convey that we are working so hard to put together an equitable, appropriate distribution plan with the assumption that we will get that safe and effective vaccine in the coming weeks and months. We'll prioritize the the high those who suffer the most through illness and death for this vaccine. And also our frontline health care workers deserve our protection first with this vaccine as it comes to us.

Laura Knoy:
Why, Dr. Talbot, does the timeline seem to keep getting bumped out? At first we thought we'd have vaccines by January. Then it was March. Now I'm hearing June. Can you just explain why that happens?

Dr. Elizabeth Talbot:
I can try. As I understand it, of course, vaccines all have to come through three phases of development. So I've already made reference to phase three, which is conducted in tens of thousands of patients, 30000 in each of these trials.

Dr. Elizabeth Talbot:
Forty four thousand in one of the trials, these are a lot of people and the vaccine companies have to target those who are going to give us the most valuable information, those where the virus is actually circulating, those who are most vulnerable to disease, those that might be vulnerable to side effects from the vaccine, such as those who are pregnant or elderly.

Dr. Elizabeth Talbot:
So to accrue those large numbers of of persons, including those who are in minorities and with comorbidities, just health problems, it takes weeks. That takes months. And then the vaccine will be considered by our scientific and regulatory agency, the Food and Drug Administration. They will look at all the data, which is a monumental task, and make sure also that they have at least two months of safety follow up from the last vaccination. So when you plot this out on a timeline, it is dynamic and it is all in service of a safe and effective vaccine. So we have to be patient as we all want that vaccine to come to us and turn this thing around.

Laura Knoy:
Let's take another call. This is Suzanne in Keene. Hi, Suzanne. You're on the air. Thanks for being with us.

Caller:
Oh, thanks for taking my call. My concern is what I just observed in the community recently. Driving to work, I saw a group of high school students standing very close together, unmasked.

Caller:
A patient of mine recently commented that a customer threw their purse at her when she was asked when the customer that is was asked to put a mask on my.

Caller:
I'm concerned that as physicians I'm a physician and especially physicians in the public health sector, that we're not doing enough to educate the community, that wearing masks is something that we do for each other. And I don't understand why masks haven't been mandated in New Hampshire.

Laura Knoy:
Suzanne, I'm so glad you called. And Dr. Chan, this has come up a lot, especially recently with the debates. Governor Sununu said a mask mandate, he didn't feel it was necessary statewide right now, but he's relying on the advice of your team and that might be coming down the road. So what are the metrics around? What would make you, Dr. Chan, say, you know, I think we need this.

Dr. Benjamin Chan:
Yeah, so it's a good question and one that comes up frequently and this decision on masks is one that unfortunately has become controversial and political, we we continue to recommend, strongly recommend and encourage that everybody who is out in a public setting wear a mask. That mask is intended to protect other people around the person wearing the mask and is one of the ways that we have to control spread of Covid-19. I am aware that the CDC is working on trying to put out further information and further messaging on mass so that we can try and use science and have better engagement on this on this issue. But at the end of the day, this is one of the layers that we continue to look at and discuss and, you know, promote use for everybody to try and prevent and control the spread of Covid-19.

Laura Knoy:
Is there a number Dr. Chan, you know, where hospitalizations reach X level or deaths reach X level, where you say to the governor, you know, I think we really need to do this.

Laura Knoy:
Is it a feel thing or is it a data thing?

Dr. Benjamin Chan:
Yeah, it's a good question, there's not a specific metric or specific number at which, you know, you would would become mandated. You know, certainly we continue to recommend you as one of the layers of protection, but we need to remember and use that in the context of all the other, you know, recommendations, social distancing, avoiding crowds, avoiding, you know, close contact in confined spaces. So so there's not a specific metric, but certainly it's an area of ongoing discussion.

Laura Knoy:
Well, and Suzanne's a doctor asking about mask mandates. Bobby in New Fields wrote in, he's a physician. He says, I am the town health officer. And I am often asked by people, including my patients and people in town, to, quote, produce the evidence that masks and facial coverings are proven to help prevent the spread of Covid-19. Bobby says, other than saying it is intuitive and that any barrier can help. To a degree, I am often at a loss of what to say to help folks embrace mask wearing indoors. Bobby asks, Do you have any suggestions for a good fact based answer to this question that can help folks understand? Bobby, thank you so much. And Dr. Talbot, go ahead.

Dr. Elizabeth Talbot:
I'm very happy to be able to answer this question. There is no controversial data, but is there's no evidence against masks. In fact, all the evidence is coming to us from every setting that the proper mask works. So we have an effective tool that evidence shows us. Studies show us it's not just intuitive. Right. So so I particularly draw in conversations with other clinicians on a a great Lancet review showing the evidence.

Dr. Elizabeth Talbot:
They've summarized it in a way that's very palatable, very understandable. And I pull it out often. And I even have an info graphic, if you will, for posting places. So please do find your talking points to encourage to enable one another to wear a mask. We're seeing that, you know, the arguments and the fights and the conflict over masks is not productive. But I continue to hope and believe that evidence will show people that this is effective. There's no question there's no metric any longer that this is effective. So so, you know, we need to own that and we need to think about the ways that we communicate that effectively to our friends, our neighbors, our patients, et cetera. Whether it's through a mandate, I doubt I think that really this is a grassroots opportunity for us to to talk to one another in credible, believable, trustworthy ways. But this is not a political issue. This is a life or death issue for many people. And I'd like to offer to that as we learn more. One of the things that emerges for me, I was very important for discussion is so-called long covid that as we watch outcomes for persons, clearly most people recover and get better. But there is increasing evidence that this virus continues to show us new terrible tricks and that it can damage hearts and lungs and your energy for four months after infection.

Dr. Elizabeth Talbot:
So this is not only getting over the acute phase, but but really looking down the long road, so long covid as a new entity that we're paying attention to and further invigorate this effort at advocacy around wearing masks. This is evidence based. We can do this together. We have to think of creative ways to encourage one another.

Laura Knoy:
So in terms of Bobby and Suzanne who want that sort of basic argument, Dr. Talbot, you're saying The Lancet, which is a British medical journal, they've done sort of the best job in terms of putting that basic information out there in a fact based easy to understand way?

Dr. Elizabeth Talbot:
That's right. This is the so-called meta analysis or an end of systematic review, looking at the evidence of this virus and similar viruses such as sars-cov-2 one and Muscovy, where where masks can reduce the rate of transmission, mostly in health care settings. But I think that that is a reference to the general public and community.

Laura Knoy:
Ok, and in terms of long hallers long term illness, I have another question for you, Dr. Chan, on that. But I'm going to save it for after a quick break.

Laura Knoy:
Henry from Keene wrote in, so I will throw his question to you, Dr. Chan. He's got questions about what Dr. Talbot just mentioned. You know, people having impacts a long time after their initial diagnosis. We'll keep taking your questions and comments More in a moment.

Laura Knoy:
This is The Exchange I'm Laura Knoy this hour, New Hampshire's top public health doctors are talking about coronavirus and the spread here in the state. Also, people looking again at their holiday traditions this fall and winter. Now, in a moment, we will turn to pandemic pods or bubbles. That's where you can socialize as safely as possible with a small group of people.

Laura Knoy:
But before we do, Dr. I did want to share an email from Henry in Keene who asks about long term illness, long haulers, so to speak. Henry says, I would like to ask Dr. Chan about the lack of public education concerning the long term effects of Covid-19 in patients who have, quote, recovered and yet are suffering from ongoing myocardial inflammation, pulmonary concerns, multiple organ failures, elevated risk of blood clotting and chronic physical and mental fatigue, Henry says to this day. There have been around 30000 studies pertaining to these effects. Yet, aside from the occasional short news story, this is not being talked about, Henry says. Are we putting more young people at risk of chronic diseases by downplaying the side effects? Henry, thank you for writing. Dr. Chan, go ahead.

Dr. Benjamin Chan:
Yeah, it's a great question. And one of the things that we wanted to bring up to your listeners on the call today is that as the pandemic progresses, we're learning more about how Covid-19 presents and the various syndromes that are presents with and also the potential for long term consequences, the long term health conditions from Covid 19.

Dr. Benjamin Chan:
This is not just people that are older or people with chronic medical conditions. There are reports and evidence that even in young, healthy people, Covid-19 can cause long term health complications with health problems. And and you're the last one. I believe Henry highlighted some of them. Right. It's not just issues of chronic fatigue or sometimes what people call, you know, brain fog, difficulty concentrating. But we're hearing reports of chronic lung problems, chronic, you know, cough and difficulty breathing and damage to the lungs, even heart injury, where there's heart muscle inflammation that can lead to long term cardiac problems. And these are these are situations that are being reported, again, not just in older individuals or people with chronic medical conditions, but in young, otherwise healthy people.

Dr. Benjamin Chan:
So it's going to be probably an increasingly recognized problem. And one of the reasons we continue to stress that people take this endemic in this virus seriously. You know, I think a lot of what we've heard the last couple of months are people relaxing restrictions because people may not think it poses a significant health threat to themselves or their children or their teenagers. But we certainly want to push the message out there. It's not just about, you know, community spread. It's not just the fact that somebody can get Covid-19 and spread it to other people in the community, potentially more vulnerable individuals. We there is increasing evidence that Covid-19 can cause long term chronic health conditions even in otherwise young, healthy people.

Laura Knoy:
That's a hard message to convey, Dr. Chan, to young people who in general, my observation has been they're getting the message about not, you know, not wanting to infect their elders, but I don't hear them, Dr. Chan, as concerned about their own possible covid status. You know, they say, hey, I know so-and-so. He got it. He's fine. I would be fine, too. I just don't want to infect mom or grandma.

Dr. Benjamin Chan:
That's right, and I think that's one of that's one of the challenges and something that I think, as your caller points out, we can and need to do probably a better job messaging. It's not just about preventing it from spreading, you know, person to person. That's obviously a core part of what we do. But we also want to protect the individuals, help protect individual people and families from not only the immediate acute implications of Covid-19, but the long term health problems that could arise as well, especially as we are still learning about this virus.

Laura Knoy:
Well, and as both of you know, on the flip side of this whole health concern is the mental health concerns, people being isolated from each other, people being afraid of infection and so forth. And so toward that end, Dr. Talbot, some folks are forming what are called pandemic bubbles or pandemic pods with members outside their family. What makes a pandemic bubble or a pandemic pod work? Well, Dr. Talbot.

Dr. Elizabeth Talbot:
There is a full adherence to the measures that's discussed, so for the pod or bubble to work, everyone needs to stand shoulder to shoulder from six feet away and absolutely limit their exposure and communities and stop attending in person social events in the spirit of the three C's and all. So this will be a opportunity for extraordinary trust and solidarity when you establish a pot or a bubble. So in the current epidemiology, in the way that this virus is rising in our society, this will be increasingly important that there can be no missteps in a safe spot or safe bubble community.

Dr. Elizabeth Talbot:
What's a misstep, Dr. Talbot? Where might this fall short?

Dr. Elizabeth Talbot:
That urge to go out to the restaurant, the inclination to stop at the pub on the way home from work, the I don't need a mask, I'm 18 and I'll do fine. You know, any of those things that we've already talked about semantically that this is 100 percent adherence to avoiding the three CS to the universal mask, wearing the face, covering the use of hand hygiene after you touch commonly touch surfaces in our public arena, such as in grocery store, shopping cart handles and doorknobs and handrails, etc.. So this will require a commitment, you know, not not as far as a contract, but but definitely a kind of social contract that, you know, you know, you need to trust your pod members, your bubble members and do that with with incredible attention because people's lives depend on it.

Laura Knoy:
Yeah. Dr. Chan, I'd like to ask you about this, too. Again, you know, I've been paying a lot of attention to the pandemic itself, but I've also been paying a lot of attention to the psychological impacts. And we don't want a mental health pandemic to accompany this physical health pandemic. So what are your thoughts on pandemic bubbles, Dr. Chan, and how to make them work?

Dr. Benjamin Chan:
Yeah, and let me first say it's not it's not one or the other, right? It's not either you control the the virus or you let it run rampant and let people have their social freedom.

Dr. Benjamin Chan:
Right. There's a way of doing both. And I think that that's where we keep talking about the layers of protection. And it's not any one specific intervention that is going to lead to ultimate control of this virus. It's not just mask use, that's not just social distancing. It's not just cohorting. I think it's when you look at all of those in combination together where we get that the best in the maximal control and also allow people the flexibility to address the emotional social needs that they have for getting together with others in the community and by doing so safely. Right.

Dr. Benjamin Chan:
And so I think these bubbles or these pods are one way that people can balance trying to limit potential spread of Covid-19 in communities while also having the necessary community social interactions, which we all need to address, you know, the emotional mental health issues, fatigue, that we're feeling from from this pandemic. And so it's you know, this would fall under the idea of cohorting, what we call cohorting in schools or in public settings, you know, cohorts as families and social groups essentially as forming these these bubbles and these pods so that if somebody comes down with Covid-19 and if there is a spread that is potentially limited to a smaller number of people. And so it goes back to this idea of avoiding, you know, frequent close contact with multiple people and public crowded conditions. How do you contain that cohort thing or bubbling or having these pods is one way to do that.

Laura Knoy:
Why do you think, Dr. Chan, it's so hard for people to get that message, you know, avoid groups, avoid spending too much time indoors with others. I mean, we hear the message again and again. And yet, you know, it's still it's still going on.

Dr. Benjamin Chan:
I think people were following recommendations much more strictly early on in the pandemic, and I think one of the challenges that we continue to be faced with, especially as the pandemic drags on. Right. We've been in this for at least eight months now since our first case in New Hampshire.

Dr. Benjamin Chan:
You know, eight months of of public message of you need the social distance, you need to avoid crowds and gatherings and wear masks. That eight months is a really, really long time. And I think it's wearing on people and people want to get back to normal. And it's one of the one of the challenges that we're fighting against is, you know, we will not be back to normal for quite a while, for months. But there is a way that people can control or limit spread of Covid-19, but still have those necessary family and social interactions. And that's what we continue to try and message is trying to have people find that find that balance well.

Laura Knoy:
And for many, many people, myself included, physical exercise is another way to reduce the mental stress of all this. And Dr. Talbot, I have two questions about exercise. Lisa says, wondering about playing tennis indoors, a high ceiling, three courts without masks. And Bruce says, is there any evidence of increased transmission at gyms or is an increase expected as more people move their exercise activities inside and doors and windows are closed? And it certainly has been getting cold this week.

Laura Knoy:
So real quickly, Dr. Talbot, can you address the need for exercise? But some people have to do to indoors?

Dr. Elizabeth Talbot:
Yeah, no, I certainly affirm the need for exercise. I hope that some of it can be novel outside. Maybe this is the time for folks to discover snowshoeing or cross-country skiing or whatever else they've been thinking of doing in the outside arena we have here in New Hampshire. But with regards to indoor sports...

Dr. Elizabeth Talbot:
Right, Lisa wants to play tennis as a sport I love as well. I think there are there have to be intentional strategies to make that safe. Clearly, you're more than six feet apart. But can you do that when you change sides on the court? Can you have different color balls for each player so that you're not creating the potential for spread through handling the ball? Can you make sure you use only your racket? And what about going in and out? And how about the lock, the locker room and such? So everything we're doing anymore has to be intentional in this regard. So indeed, the closed spaces of gym where there can be heavy, forceful breathing is a potential place of spread. So the Purell, the washing, the stations wearing a mask, even when you're breathing hard, right. It's all intentional as we weigh the safety of all the activities that we need to engage in to remain physically and emotionally healthy.

Laura Knoy:
Well, Dr. Talbot, you know, we've talked about all these challenges and the frustration that Dr. Chan expressed that we're still stuck with this thing almost eight months. Dr. Talbot, anything positive you can leave us with?

Dr. Elizabeth Talbot:
Oh, yes, thank you for that opportunity.

Dr. Elizabeth Talbot:
I mean, we highlighted that we're we're getting evidence about what does work.

Dr. Elizabeth Talbot:
People are tired of hearing about masks. But I think we need to adjust our, ah, messaging that the evidence is coming to us very consistently. That's at all. We have better diagnostics. So you've heard of the rapid antigen tests that are being deployed strategically in our state. You've heard that there's a very intentional pipeline to to bring us the safe and effective vaccine. We have new treatments.

You've heard of Remdesivir of your I think on this call before. But there are other strategies such as monoclonal antibodies. We know a lot in the clinical arena about safe ways to support people who are sick. And again, there are scientific breakthroughs happening at an unprecedented pace as our society rises to this tremendous challenge. We've been faced with this pandemic.

Laura Knoy:
Well, I really appreciate both of you, you know, helping us keep track of how this is playing out here in New Hampshire. I'm very appreciative of your time, Dr. Chan. Thank you so much for being with us. We appreciate it.. As Dr Benjamin Chan, he's the state's epidemiologist. And Dr. Talbot, a big thank you to you, too. That's Dr. Elizabeth Talbot, deputy epidemiologist and infectious disease specialist at Dartmouth Hitchcock Medical Center. Today's program was produced by exchange producer Christina Phillips. Thanks for listening. This is The Exchange on NHPR.