Amid confusion about the coronavirus and its impact on Malheur County, the Enterprise turned to experts to help sort out fact from fiction.

Readers submitted more than 100 questions to the Enterprise along a broad range of topics. We sorted them and then sent them on to a range of experts to answer. The Malheur County Health Department, the Oregon Health Authority, Gov. Kate Brown’s office, Saint Alphonsus Health System, St. Luke’s Health System, the Malheur County Sheriff’s Office, the Ontario Police Department and the Nyssa Police Department all participated by responding to the community’s questions.

The responses are presented as they were submitted except for editing for brevity.

– Les Zaitz, editor and publisher

TOPIC: ABOUT COVID

Q. I’d like to know if a person who has COVID but no symptoms is contagious?

A: Yes, we believe that asymptomatic or “pre-symptomatic” (meaning they don’t have symptoms yet but may eventually develop them) people are very likely contagious. Furthermore, we believe this is the cause of the bulk of the current spread in our communities. You would imagine that now we have a relatively good understanding of how COVID-19 impacts people and that those with typical symptoms would stay home and self-isolate. So, why would there be such a rate of rise in cases all across the U.S.? It is not from the symptomatic patients with COVID-19. It is from those without any discernible symptoms who gather in crowds such as bars, parties, and other social situations and do so without staying six feet apart or wearing masks. 

Even places of worship have been cited as locations that lead to numerous infections. COVID-19 is not discerning. The best advice to share – assume everyone has it. That way you treat everyone the same – stay six feet apart, don’t hug or shake hands, and wear a mask any time you are near others who are not typically in your home. This is what other countries are doing so effectively and why they are not seeing the spike in cases the U.S. is seeing.”

 -Dr. Rob Cavagnol, St. Luke’s executive medical director

Q: Do the total number of infections include the 145 cases at Snake River Correctional Institution?

A: The number of infections among adults in custody is reported in our numbers. The staff from SRCI who reside in Malheur County are reported in our numbers. There are a number of Idaho residents employed at the prison. Those numbers would not be counted in Malheur County numbers.

-Sarah Poe, director, Malheur County Health Department

Q. Why if you have an autoimmune disorder or something like diabetes does your chance of getting Covid go up?

A: People ages 60 and up, and people with certain medical conditions, have an increased risk of having severe disease if they get COVID-19. There is no evidence people with these conditions get COVID-19 more often, but if they get it, they are more likely to become seriously ill. The conditions include cancer, chronic kidney disease, COPD (emphysema), immunocompromised state due to solid organ transplant, obesity (BMI>30), serious heart conditions, sickle cell disease, or Type 2 diabetes.

There may also be increased risk of getting seriously ill with COVID-19 if you have an autoimmune disorder AND are taking a medicine to dampen or suppress your immune system. This is because you need your immune system to help fight the virus. Having uncontrolled autoimmune disease is not safe and so NEVER stop your medicine without discussing with your doctor.

Diabetes also increases your risk of severe infection. This may be because diabetes can affect your blood vessels, kidney function, and immune/inflammatory system. Also, many people with Type 2 Diabetes also are obese and have high blood pressure, and some also have underlying heart disease. Obesity, and maybe even hypertension, are associated with more severe COVID-19 disease.

The most important thing to do is to minimize the risk of getting the virus by maintaining 6 feet of distance from others, wearing a mask, and making sure others around you wear one. Also avoid gatherings, particularly indoor gatherings.”

 -Dr. Laura McGeorge, St. Luke’s Health System medical director for primary care

Q: What categorizes a Covid hospitalization? 

A: Any patient hospitalized within the 14 days following a positive COVID-19 test or the 3 days before a positive COVID-19 test is considered a COVID-19 hospitalization, according to the Centers for Disease Control and Prevention definition.

-Dr. Melissa Sutton, public health physician, Oregon Health Authority

Q: I want to know more about the incentives for reporting Covid cases on a county level.

A: At this time, no, we are not receiving dollars for cases. I have heard there is a possibility that if our contact tracing needs are so high, we would be able to invoice for cases, depending on their complexity. For now, all of my programs are down. Funding in public health is down across all of our programs. Overall, this has been a hit to our public health funding.

-Sarah Poe, director, Malheur County Health Department

TOPIC: COVID TESTING

Q: Is Malheur County showing a higher positive rate because of better access to testing sites, a higher percentage per capita of people being tested but not having symptoms vs. having symptoms?

A: We don’t have better access to testing sites. Testing is our greatest deficit in trying to fight this virus with open eyes. That high positive rate is because we are doing insufficient testing. If doing more, you would expect the rate to be under 10%. I would say to people that when making an assessment of risks activities, consider where you live. If the testing rate is down around 2 or 3%, that tells you that public health is identifying cases and this is fairly under control. At 4 or 5%, we’re doing OK and there is sufficient testing. The more you get up toward 10%, you’re not doing enough testing. We are at 16.7%. [UPDATE: 17.3% on Tuesday, July 28]

-Sarah Poe, director, Malheur County Health Department

Q. What is the proven accuracy of the test kits they are doing?

A: St. Luke’s Health System only uses novel coronavirus tests that detect the presence of viral RNA. Viral RNA that is unique to SARS-CoV-2 (the name of the virus that causes COVID-19) can be detected in a patient sample using the principle of nucleic acid hybridization, where a unique single-stranded DNA molecule can hybridize with another single-stranded DNA molecule that is a perfect match. All tests that St. Luke’s uses to diagnose the novel coronavirus have been cleared by the Food and Drug Administration.

St. Luke’s uses 2 different types of nucleic acid amplification based on the principle of hybridization. They are (1) polymerase chain reaction (PCR) and (2) transcription-mediated amplification (TMA). The presence of a tiny amount of virus (20-30 copies of viral RNA per mL of collection fluid) can be detected in nasal swabs or nasopharyngeal swabs using these nucleic acid amplification tests. These tests are highly specific and sensitive. If a person is infected with the coronavirus, the nucleic acid amplification tests have a 98% chance of detecting the presence of virus in a nasal swab. If a person is NOT infected, these molecular amplification tests are virtually 100% accurate in showing the absence of the virus. The caveat is that there is no such thing as a perfect laboratory test. If enough people are tested, a few false negatives and false positives will always occur.

Importantly, St. Luke’s does not use the blood antibody test to diagnose current or past infection with the novel coronavirus. The coronavirus antibody tests were not recommended for clinical use by the Idaho State Governor’s Testing Task Force. There is great individual variation in the antibody response to novel coronavirus infection. While most persons exposed to SARS-CoV-2 generate a good antibody response, it is unclear if these antibodies confer protective immunity and for how long. The newest generation of coronavirus antibody tests that specifically target the viral nucleocapsid protein are quite accurate and can be useful when used as markers to assess if a person or a population of people has been previously infected with the novel coronavirus. Nonetheless, the coronavirus antibody test result should not be used to make clinical decisions or modify individual behaviors.

 -Dr. Matthew Burtelow, executive medical director, St. Luke’s Health System Laboratories

Q. Do these tests actually tell if the virus is active or has the person just already been exposed?

A: Timely and accurate testing for the virus SARS-CoV-2, the cause of COVID-19, allows providers to make real-time decisions when caring for patients. It also helps our health system and other health agencies plan and prepare for potential future outbreaks. Today, there are two main types of testing.

Molecular testing is commonly referred to as Polymerase Chain Reaction (PCR) test. Molecular testing identifies if the virus that causes COVID-19 is present. It does not indicate whether the virus is still infectious at the time of the test, but it’s as close as we can get at this time to knowing whether there is active infection.

This type of test is most effective when symptoms first appear. It may also detect the virus one to two days before symptoms start and for a limited time after symptoms resolve. Testing outside of a very narrow window of time is not reliable. Molecular testing is helpful to diagnos people with COVID-19 and help guide an appropriate isolation, treatment and care plan.

Serologic testing is more commonly known as an antibody test. It detects antibodies present in people who have had the virus and recovered. Antibodies are generated over time as the body responds to or fights off an infection. Production typically starts five to seven days after the initial infection, but may not be detected until days later.

Antibody tests are best used more than 17 days after COVID-19 symptoms began. These tests are not helpful to providers caring for patients in the early stages of COVID-19 because antibodies may not show up. You should not get this test if you have active COVID-19 symptoms such as a fever, cough, shortness of breath, chills, headache, muscle pain, sore throat or recent loss of taste and/or smell.

Development of these types of tests is ongoing and accuracy varies substantially. It’s also not clear yet if there is a correlation between SARS-CoV-2 antibodies and protection from future COVID-19 infection.

At this time, antibody tests are most appropriate to study the disease, track patterns and help determine how much the disease has spread in a community and potentially predict if a second surge of cases may occur. Serologic tests at the individual level may or may not be useful, but the results could help develop new treatments or a vaccine.

-Dr. Jim Souza, St. Luke’s chief medical officer

Q: How can testing help us understand COVID-19 and help manage the spread?

A: While testing in and of itself is not a strategy, it is a critical tactic within a broader adaptive recovery framework. As we get information from different testing modalities, that information can inform decisions in managing COVID-19 and reinstating activities in our communities. 

We continue to learn more about the COVID–19 virus, which means testing will continue to evolve. The pace of innovation already happening in this space is remarkable. Through the advancements, St. Luke’s recommends thoughtful and informed consideration regarding the various testing options available. Testing choices should be made with current information in mind and in coordination with a medical provider.

-Dr. Jim Souza, St. Luke’s chief medical officer

Q: When the number of positive Covid tests are being announced, is that number of people with Covid currently or is that a combination active and antibody testing? 

A: We do not presently include antibody tests in our test reporting. The tests we do count (nucleic acid and antigen) are indicators of an active COVID-19 infection. Antibody tests should not be used to diagnose active COVID-19 infection.

Q. How many tests are false positives? 

A: Nucleic acid and antigen tests rarely produce false positive results. Antibody testing may commonly produce false positive results.

-Dr. Melissa Sutton, public health physician, Oregon Health Authority

Q. Are tests being double counted? A person tests positive, they quarantine, and then he/she was being required to test negative to return to work. 

A: We count people, not tests. When a person gets tested multiple times, each of those tests (positive or negative) is linked to that person’s case. So, in the example you describe, if a person tests positive for COVID-19 and then self-isolates for 10 days, and is without fever or other symptoms for an additional 72 hours, and then is retested as a requirement for returning to work and tests negative, that person’s initial positive test would only be counted once and the negative test would not be counted.

-Dr. Melissa Sutton, public health physician, Oregon Health Authority

Q: Do these tests actually tell if the virus is active or has the person just already been exposed? 

A: The tests currently in use in Oregon are diagnostic tests, which determine whether an individual currently has the virus. Tests that can show if a person was previously infected with the virus is called an antibody test, and at this time, OHA is still reviewing data on antibody tests performed in Oregon, as evidence continues to emerge on whether we can depend on antibody tests as reliable indicators of current or previous infection with COVID-19, or of immunity.

-Dr. Melissa Sutton, public health physician, Oregon Health Authority

TOPIC: COVID DEATHS

 Q. I’m skeptical if Covid was the real cause of death though since we all we have heard the numbers may have been inflated. 

A: Counting deaths from any cause is difficult. We consider COVID-19 deaths to be:

Deaths in which a patient hospitalized for any reason within 14 days of a positive COVID-19 test result dies in the hospital or within the 60 days following discharge.

Deaths in which COVID-19 is listed as a primary or contributing cause of death on a death certificate.

We count COVID-19 deaths this way because the virus can often have effects on an individual’s health that may complicate their recovery from other diseases and conditions, and indirectly contribute to their death.

-Dr. Melissa Sutton, public health physician, Oregon Health Authority

Q: Does someone have to die from Covid directly for it to be counted? 

A: No. 

-Dr. Melissa Sutton, public health physician, Oregon Health Authority

TOPIC: VACCINES

Q: Will we have to live with COVID-19 until there is a vaccine?

A: We do not yet know enough about immunity to COVID-19 to predict how the virus will move through our community going forward. Early results of testing show not enough people have built up immunity, which comes with the production of antibodies, to prevent the spread.

This means until an effective vaccine is developed and deployed and there is significant immunity, our community will likely continue to see spread of the virus. To help protect the most vulnerable and prevent a rapid resurgence of cases, people should continue to practice prevention measures – washing hands frequently, practice social distancing, wearing a mask, and staying home if you are sick.

-Dr. Jim Souza, St. Luke’s chief medical officer

This is the first of two parts in a Covid Q&A published by the Malheur Enterprise.

News tip? Contact the Malheur Enterprise by email at [email protected] or call 541-473-3377.

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