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Transcript of JoCo on the Go podcast 11/10/2020

Theresa Freed 0:00

Community COVID-19 spread breaks records and Kansas City metro hospitals are feeling the strain. On this episode, hear from Johnson County public health officials on the latest data and what this means for you and your family and how you can help.

Announcer 0:14

Whether you live in or just love Johnson County, Kansas JoCo on the Go has everything Johnson County. Here's what's happening and what's coming up in the community you call home.

Theresa Freed 0:28

Thanks for joining us for JoCo on the Go, I'm your host Theresa Freed, a Johnson County resident and employee of Johnson County government. Johnson County, along with the rest of the state and the nation are seeing new cases of COVID every day, but the rate of infection is beginning to be alarming. To get the very latest on the situation along with the impacts and solutions, we have with us some of the best experts in Johnson County, Dr. Areola, director of Johnson County Health and Environment Dr. LeMaster, local health officer for Johnson County, Dr. Jacobsen, Johnson County EMS system medical director and Elizabeth Holzschuh, director of epidemiology for DHE. Thank you all for being here today.

Dr. Sanmi Areola 1:06

Thank you for having us.

Theresa Freed 1:09

All right. Well, just last week, there was a call with chief medical officers to discuss the concerning increase of COVID-19 cases in the region. Can you all talk about the message from that call, and just what are we seeing as far as data is concerned?

Dr. Ryan Jacobsen 1:23

Several weeks ago, we had a reason to believe that the hospitals were having more challenges with their capacity, the ability to care for a patient, in the hospital, with staff with nursing, respiratory therapy, physicians, etc. And we noticed that trend line was going in the wrong direction. And so we had been reaching out to hospitals, public health officials, local government elected officials to kind of clarify the difference between the data we were seeing on the dashboard that shows that we had many available hospital beds, many available ICU beds, and it looked like we had thousands of open beds. And when we really started digging into that data, it turned out that wasn't the picture that the boots on the ground were getting. So it really kind of came to a head two weeks ago when an outside hospital tried to transfer in a patient to the Kansas City region who had COVID and needed ICU care. And there were no hospitals that agreed to take that patient because they were full. And that really did not jive with the dashboard that we were seeing showing hundreds of open ICU beds. So over the last couple of weeks after that kind of critical point hit, realizing we couldn't transfer in a patient from a rural hospital because we had no ICU capacity, suddenly, really starting to shift the conversation that now how can we marry the data that we're seeing longitudinally since July with the HHS protect data that are on the regional dashboards with what's really happening. And that's what we've been focusing on these last couple of weeks is trying to get the hospitals, the elected officials, public health officials to really get on the same page about what the real, true capacity issues that are going on in the Kansas City region.

Theresa Freed 3:08

All right now, Elizabeth, do you want to talk a little bit about what the community spread looks like right now,

Elizabeth Holzschuh 3:13

Our community, to put it briefly, is on fire. And this is not just unique to Johnson County, or even the Kansas City metro region, we're seeing this really throughout the country right now. And our numbers have really increased dramatically over the last several weeks, we're looking at about a three, three and a half fold increase, likely by the end of this week in the number of cases we receive daily. And that has tremendous impacts across the board, not only when we think about the public health department's ability to respond to this kind of these increasing case counts. So for each one of these individuals best public health practice is to call every single one, let them know that they're positive, although they should already know that make sure that they're staying home for 10 days until they're no longer infectious no longer no longer have the ability to spread the virus. And then also identifying who they were in contact with while they were infectious who they could have already spread the virus to. So we can then reach out to them and have them stay home for 14 days to prevent them from also spreading it in our community. Unfortunately, with these kinds of cases, we just don't have the ability in our public health department or really any public health department, I think throughout the region, to keep up with these kinds of numbers, which has a really dramatic effect. If you think about the fact that our tried and true public health intervention for COVID is tracking and tracing these individuals, if we don't have that capacity, that means people who have been exposed or who are infected could be wandering around our community going to events being in schools, and this has the potential to continue to increase our spread throughout our community, making our numbers much worse. And again, it's not just the number of cases we've seen our present positives increase dramatically. We are very much in a period of what we call exponential growth where the cases are doubling every period of time. Just because transmission is so rampant in our community.

Theresa Freed 5:03

And, you know, we have some people who might just say, so what? So what if we have all these cases out in the community? It's, it's like the flu, you get the flu, and it's over. And it's no big deal. So why is that not true?

Dr. Joseph Lemaster 5:15

The real concern that we need to address is misperceptions on on people's part, that just getting this virus and becoming infected is not going to have any impact on their health or the health of those that they love. If you look back over the last, over our total case counts over the whole period of time, the right now the highest number of cases is happening in in people who are in the 20 to 29 year old group and overall hospitalizations. 50% of hospitalizations have been in people who are under the age of 70. I think everyone thinks of this as being a problem with people who are older. And that's where most of the deaths are happening. But we're seeing with this sort of increased case numbers and and mark this, most of the recent rise in cases is not happening among our our people living in nursing homes, and other sorts of protected living environments. It's mostly coming from out in the community. And so we anticipate that now in a couple of weeks from now, with the things that we've talked about in terms of the hospitalizations that we're going to see a rapid increase in the number of people who are needing hospitalization coming up into the sort of Thanksgiving time now with colder weather people are indoors more this may have had part of an effect on what people were doing. And and so the concern is that with the the capacity issues that we're now identifying in the hospital, I in a hospital context, that we may not have the ability not just to care for COVID patients, but for other medical emergencies that people have going into the holidays. This is a real issue, not just for those people that get COVID and need to be hospitalized for COVID. But for anyone who's going to need hospitalization and emergency or ICU care going into the holidays.

Theresa Freed 7:11

And just touching on that briefly to Dr. Jacobsen, if you can address does this also put a strain not just on the hospitals, but also our EMS system in general?

Dr. Ryan Jacobsen 7:20

Yeah, it absolutely does. So yesterday, on November 8, we had, I believe, about 94 transports for 911 EMS calls in Johnson County alone, and 22 of those, the impression was COVID. That's all about a quarter of our patients that were 911 transports yesterday, according to our dashboard had an impression by the paramedic that this could be COVID, which is a much higher number than just a week earlier, we were at four a day, five a day. So we've had an increase in what paramedics believe are COVID in the community. And that trend line is definitely going up. And it could impact the availability of EMS, as we've also noted that fire and EMS stations are being hit with COVID and having to quarantine and things of that nature. So there's definitely downstream impacts to emergency services in the county.

Theresa Freed 8:07

All right, and Dr. LeMaster talked about this about kind of the age range where we're seeing most of this, I do want to talk to you about our schools because I know that's a big concern. We're getting ready to go into the holidays and important decisions are being made relative to the the incidence rate and positivity rate within the community. So Dr. Areola, can you talk a little bit about what it means that we just moved into the red zone? What impact does that have?

Dr. Sanmi Areola 8:34

Thank you. I'm happy to address that. I think the numbers are rising in a way that is that is concerning to us as public health professionals. The good thing is we have been working with our schools for several months through the process. And our schools have done a pretty good job of getting ready and doing, in my opinion, the best that they can to quickly identify cases by working with us isolating and quarantining as necessary. Again, it is easier to do those things when transmission of the virus in the community is slower. And the higher the level of transmission, the higher the risk of introductions into our school buildings. And the higher the risk of spread within the school buildings. And the the exponential increase that we have seen in the past couple of weeks is very concerning. It's gone up so much that we're not just in the red zone. We're, we're deep in the red zone. With that, again, part of what we've been communicating with our schools as well as community leaders is comes really enhanced, pretty significant risk and so the schools make decisions, we make recommendations to them, our capacity is pretty overwhelmed. Last week, we were getting 216 new cases a day. Even though we have devoted a lot of resources to our schools, we have an epidemiologist that is linked. So each of those school districts, we are pushing about 20 part-time staff into the districts, where a lot of the metrics that we look at include our capacity, it includes the capacity of the school districts to work with us to contain the spread of the virus. Now, even in normal times, our school nurses are very, very busy. Sometimes you have a nurse taking care of hundreds of students. So now when you add the having to deal with COVID having to work with us to identify cases and their contacts, you can imagine what what they're working working with. So So our messaging remains the same, we're pretty proud of what our schools have done. But we also know that there's just so much that you can do when you have this kind of spread in the community. And so we continue to tell our schools, the risk is much higher now than at any time prior to now, in this response, while we continue to be optimistic that schools will keep doing the right things, it is also good to be realistic. And the reality right now, the spread is very high. And the again, as you go from the continuum of remote learning to hybrid to in-person learning, your risk increases. And so as we have this high spread in the community, it's very important for schools to be on high alert, monitor the spread, and be ready to take the steps that are necessary to make sure that they protect not just the students, but the teachers and staff. And we hear a lot from our teachers, they're worried. There's a lot of fear in that narrative. And they're also part of the community. they're exposed to people with a virus. Some of them have been in isolation, some of them in quarantine. And those are factors that we have to take into consideration. Now here's one thing that's kind of worrisome in the communities, this concept of people wanting to achieve what they call natural herd immunity, having people go around and deliberately testing that, we can't, we don't have a lot of evidence to show who is doing that. I know it's a lot, but we do know that that's been publicly presented by different people. And part of what we have to contend with is this really a lot of misinformation that is out there. So part a part of that message to the community is, the way to get the right information is to get it from the public health source to get it from the Department of Health and Environment from the from KDHE, from CDC, Centers for Disease Control and Prevention, not the information that's out there like masks don't work, this is only impacting people that are old, so the rest of us can just go around and party and infect, that's why we're where we are. And to reverse this course we have to intentionally and deliberately follow the recommendations of public health, which is avoiding crowds, maintaining physical distancing, wearing masks, they seem pretty easy. But they do work, where we don't do those things. We lose control of the virus.

Theresa Freed 13:47

All right. And of course, we're coming up on the very busy holiday season. And some people will want to just continue with these holidays and gatherings. Like there's no virus and why is that not a good idea this year?

Dr. Joseph Lemaster 14:04

Well, Theresa, I think that of any year this is the year where we need to be the most careful as we than we ever have been. We know that when people are inside, and they're close, and they're not with people that they've been living with all the time, that the risk increases. When people wear masks, that helps. It definitely decreases the amount of time that the amount of exposure that they have. But when you're indoors for a party, be that a celebration of some event that's happened or for Thanksgiving or for Christmas or for any other sorts of events. People generally want to eat together and they take the masks off, and then they they'll their their risk goes up during that period of time. The other thing that we're seeing around around the county are other gatherings of people where some of the people in the room are not wearing masks. Sometimes saying, well, we're not in a public setting, therefore we don't have to do it. But the virus doesn't care whether there's a whether you're following the absolute letter of the law or not. If you're close to other people, for an extended period of time, you're going to get exposed. And we've seen lots of situations where people were, we're not following those, the directions that are there with respect to wearing the masks, in numerous places. So this is the time to be the most careful when we've got the numbers where they are right now. We need to be even more careful than we have been because the risk is higher.

Theresa Freed 15:41

And Elizabeth, I know that you're you're deep into this work of contract contact tracing, and where are we seeing these cases come out of?

Elizabeth Holzschuh 15:50

This really speaks to why it's so important that everybody be hyper-vigilant this holiday season, a lot of the spread we're seeing is not from schools, it's not from workplaces. It's really from these social gatherings, football, watch parties, right? We all love watching the Chiefs, everybody comes together at somebody's home, and they're eating and drinking and hollering at the TV. These are prime opportunities for COVID to spread. And we're seeing it in places like that. Halloween parties, we saw some spread and fake homecoming parties in high school students. Weddings have certainly been a place where we've seen a lot of cases. And the problem is a couple of pieces. One is we know people can spread this disease before they're showing symptoms. And so a lot of individuals will show up at these events and think I feel fine, the people I'm with feel fine. So there's no risk, they take that mask off, and they think that they're safe. But the reality is, is people can spread it, even if they're not showing symptoms. And so it causes individuals to become sick in those spaces. And then they go home to their families or to their other social circles and spread it within those. And so that's really how we see this spread across these different groups and communities.

Theresa Freed 16:57

All right, so we've definitely talked about the places you should probably avoid right now. But the one place I want to talk about that we should get to is our our health care system if you have checkups that are due, and also childhood vaccinations, you know, parents are concerned when they when they go take their child to a clinic that they might get COVID. So what kinds of reassurances or safeguards are in place for individuals and families to know that going to the doctor's office is still a safe place?

Dr. Joseph Lemaster 17:31

Well, one of the things that I think that we can say pretty, pretty clearly is that in all of the places that you go to get individual care, protective personal equipment, PPE is being worn still, there are good safeguards in place to make sure that people who are in those spaces are wearing masks that includes both the staff and the patients. We've been doing this sort of level of of personal protection, both for patients and healthcare staff the whole time that this has been going on. And as as Dr. Stites in his daily show at KU Medical Center says we're not seeing transmission within the hospital setting, within the clinic settings. Because people know how to keep safe in that situation from because they're using the protective equipment and and wearing masks and washing their hands carefully. That being said, the most important thing that we can say to anybody is get your flu vaccination this year. Children need to be vaccinated for the the other sorts of diseases that they're at risk for. These things should not be put off and and it really is not unsafe to go to the doctor to get those sorts of things done. Yeah, and I'll piggyback on what Dr. LeMaster said about there's some prevailing theories out there, we are seeing some higher acuity patients overall, in the emergency departments that are requiring admission for non COVID related issues. We think there are many people back in March and April, May that neglected to go to the hospital or to the ER or to their doctor for their regular health care and or exacerbations of their underlying diseases like heart failure, diabetes, hypertension. And what's happened now is we're seeing the end result of folks refusing to go to hospital out of fear during the initial lockdown. So we want to make sure people absolutely go to the hospital, call 911 if they need it for an emergency and absolutely go to your doctor for regular health maintenance. And if you have chest pain, if you have signs and symptoms of a stroke, if your disease process is uncontrolled, please seek care in the hospital and we saw that that was not occurring when people were fearful initially, so we want to make sure people go to the doctor until the ER is when they when they actually need to.

Theresa Freed 19:51

Alright, that's some great advice. Next, I want to talk about vaccinations related to COVID. We've seen that there are a lot of trials happening right now. We actually got some promising news this week about about one trial and the effectiveness of vaccines. So can we talk a little bit about what a vaccination rollout might look like here in Johnson County,

Dr. Sanmi Areola 20:15

There's been, obviously efforts at the national, state and local levels. And that includes our staff here in Johnson County, working on when the vaccine is here to ensure that it's distributed quickly, it's one thing to, to have the vaccine, but we get the full advantage of the vaccine when we get it out to people that we can get a significant percentage of our population vaccinated. And yes, the news about vaccine is pretty encouraging. And that's a good thing. But again, our staff's been working very hard with KDHE staff, with local institutions.KU Med and others, our long term care facilities on just getting the vaccine as quickly as possible, I think it's going to be phased it will take a while for all vaccines to be here, I don't think we expect the first shipment to be enough for all of our residents. So we're going to work through, who gets it first, who gets it next. We want to make sure that our most vulnerable populations are protected. And look at our numbers we are seen underlying conditions that are associated with the most severe outcomes. We are seeing impacts on minority populations, Our essential workers all of those factors that will take into consideration but as has been working very hard and putting up the processes in place. One thing that I do want to emphasize is even prior to COVID-19, public health does practice all of this processes. We've practiced how to distribute these things. So people have to be assured that we are ready. As soon as we get this, we're going to be pushing that out to the community. Because again, we do know that when we have the blessing, we get it to our community that is going to be very helpful in that effort towards this. And one of the questions that I've had quite often is people thinking that once the vaccine is here, it's kind of a be all, cure all kind of thing. I think we absolutely have to continue to take all of these basic steps, some of these we're doing anyway, I think we should be doing them anywhere, whether it's with COVID or not, I think washing your hands at all times. Elbow greeting, maintaining physical distance, and all of those things are things that would be nice for us to get used to as a community that's going to help us deal with COVID. And other things that may come after that. But we'll all be pretty excited when we have the vaccine here, and we will begin to distribute that. We are ready to do that in Johnson County.

Theresa Freed 23:11

I think there are concerns, you know, just about the the speed at which this vaccine or these vaccines have been developed. People are worried that if they take the vaccine, there will be adverse effects. So can you talk a little bit, Dr. LeMaster, about what the the safety protocols are that are in place to help prevent any of the concerns there.

Dr. Joseph Lemaster 23:31

Right, thank you. So, first off, it's important to realize that all of the vaccines that are in preparation right now are going through a very detailed protocol to test them. So they start out with safety trials, at the beginning with a smaller number of people to see if there are side effects. That's the most important first thing that happens. After we are pretty sure that we're not seeing common side effects in those people, much larger vaccine trials, which are what are happening now what we call the phase three trials take place in those we are also measuring vaccine efficacy, that is what percentage of people will be protected when they have the vaccine from subsequent infection. But we also are continuing to monitor for less common side effects. That may be ones that are of significant health impact to people that would receive the vaccines. There have been a couple of cases that have been reported during these trials which needed to be investigated more closely to see if they were vaccine-related. In the end, this was all cleared and the vaccine trials continued the data safety monitoring boards that oversee these trials have allowed them to continue to go forward. So we're continuing to feel that the risk of severe side effects In these vaccines is now at this point, I think what we call pretty close to infinitesimal. They won't be approved by the Federal Drug Administration or CDC or any of the other bodies that allow these sorts of vaccines to be administered, and we won't administer them until they have been authorized for administration, you're probably aware that there's the emergency use authorizations come out first, and then full federal approval afterwards. So it is possible with one of the emergency authorizations for us to start distributing those, and we would anticipate with the first of these, and we might see that even by the first of the year. So it's an encouraging time and fear that there's going to be a large number of people that have negative side effects of this really should be laid to rest. We're not seeing that coming out of these trials. And those vaccines will not be released, if there's any evidence that that would be the case.

Theresa Freed 25:56

All right. That's some great information. Just final question, anything else that we need to touch on that the public should know about the efforts here in Johnson County related to the pandemic.

Dr. Sanmi Areola 26:10

I know that we have been doing during this for 8, 9, 10 months, and there is fatigue, there is also clearly us taking certain situations for for granted, for example, we are with friends and families and we don't think those present risk for us locally, as well as nationally, based on data from Centers for Disease Control and Prevention, a large number of infections and transmission also do occur in settings where in the homes, and so the virus doesn't speak, you can see it and doesn't smell so you don't know what who is infected and get you infected. So protect yourself at all times. We are closer now to vaccine than at any point anytime during this response. And, and so wearing masks and doing all of the basic stuff that we we do need to continue to do. We can we cannot afford to let the virus get out of hand. We also hear argument that it impacts only the older people, which is not true. But even if it does, we do have the responsibility to protect our more vulnerable population. And so out of respect and responsibility, your sense of responsibility to the community, we ask that you continue to work with us. We're closer to solutions now than we were at any point in time. And we again, acknowledge disruptions to our normal way of life. We acknowledge not just the physical health impacts, but also the mental and emotional impact. But one thing that we cannot do is give up trying and let let the virus run wild. The cost will be too high for us to pay. And so we are very appreciative of your continuing support for those public health measures.

Theresa Freed 28:17

All right, that's some great information. I want to thank you all for being here today. I know you're all busy with addressing the pandemic and you provide some very helpful information to the public. To get much more on COVID-19 and Johnson County including the latest data and safety precautions. Go to joco gov.org/coronavirus. Thanks for listening. You just

Announcer 28:39

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