On Thursday, March 5, at 9 a.m., The Exchange brings you the latest on the impact of the novel coronavirus that has reached the United States, both across the country and right here in New Hampshire.
We'll talk with a panel of experts - including state health officials - about how to prepare, what to expect, and what (and what not) to worry about.
Click here for the latest coronavirus news from NHPR.
GUESTS:
- Dr. Benjamin Chan - State epidemiologist for New Hampshire.
- Dr. Elizabeth Talbot - Infectious disease specialist at Dartmouth-Hitchcock Medical Center.
- Jason Moon - NHPR's healthcare reporter.
- Stephanie Patrick - Executive Director of the Disability Rights Center.
WATCH THE PROGRAM LIVE: (Video will begin at 8:59 a.m. EST on Thursday)
LISTEN:
Click here for the latest coronavirus news from NHPR.
Transcript:
This transcript is computer-generated, and may contain errors.
Peter Biello:
From New Hampshire Public Radio, I'm Peter Biello in for Laura Knoy, and this is The Exchange. Coronavirus has appeared in New Hampshire and people are nervous. Can the spread of Coronavirus and the disease it causes, COVID-19, be stopped? Who is most vulnerable? And what, if anything, should people be doing now to prepare? Joining us this hour to answer your questions, Dr. Benjamin Chan, state epidemiologist for New Hampshire. Dr. Elizabeth Talbot, an infectious disease specialist at Dartmouth Hitchcock Medical Center. She's also State Dept. epidemiologist. And NHPR health care reporter Jason Moon. Thanks all of you for being here. Really appreciate it. Good morning. Pleasure. Thank you. So let's get a lay of the land first. Dr. Chan, right now, how many people have been diagnosed with coronavirus in New Hampshire and what do we know about how they got the virus?
Benjamin Chan:
Yes. So we have two individuals diagnosed with the new coronavirus in New Hampshire, as I'm sure many people are aware at this point. The first individual was announced on a Monday of this week. That was an adult who had traveled to Italy, returned to New Hampshire, and then several days after their return, presented with symptoms consistent with what we're calling COVID-19, that's coronavirus disease twenty nineteen that initiated a contact investigation to identify people who are close contacts of that individual. That's how this disease is primarily spread. And in the course of our contact investigation, we asked people that were close contacts to self-quarantine themselves and monitor for symptoms. One of those individuals developed symptoms also of COVID-19. And so we tested them and that individual came back on Tuesday testing with a presumptive positive.
Peter Biello:
And can you define close contact for us like we're in a studio together? We're, what, seven feet apart or so? Is that considered close contact?
Benjamin Chan:
So it's important to remember that this is a virus, a new corona virus that is spread very similarly to influenza. It spread primarily from an infected person through respiratory droplets. And so it requires what we call close contact, which involves longer duration contact within six feet of someone who is infected in order to to potentially be exposed to this new virus.
Peter Biello:
We've got a couple of basic questions from listeners about what we know and what we don't know about the virus. Dr. Chan, so feel free to say if you don't know yet about these questions. But I want to go through them. If you're infected with COVID-19, how long do you stay contagious?
Benjamin Chan:
Yeah, that's a great question and something we've been getting a lot of questions about. And I think it's it's still unclear at this point what's happening if and when someone is identified with COVID-19 is that the Centers for Disease Control and Prevention is recommending serial mouth and nose swabs and testing to identify when the virus clears from the respiratory passage. What we've heard preliminarily from the CDC is this could take up to a couple of weeks after someone becomes symptomatic for them to declare their virus. But it's certainly possible that it could occur sooner. We don't have a lot of information on this. And it's one of the active areas of investigation by the CDC and different health departments around the state that are identifying cases.
Peter Biello:
And Dr. Talbot, I wanted to ask you this other question from a listener. If if coronavirus is a viral infection, will antibacterial measures like hand sanitizers? Will that help?
Elizabeth Talbot:
The alcohol based hand sanitizers are excellent for this very fragile virus. So absolutely, if you're listening in your workplace. Look around. Where's your Purell? Where's your product that you're going to be able to clean your hands after you shake someone else's hands? It's a fragile virus and weak. You can use routine cleaning and routine products to try to prevent contamination of our hands where we then inoculate ourselves or infect ourselves by touching our face.
Peter Biello:
Mm hmm. And what someone is also asking about how safe are we from the Coronavirus passed in pool water? Maybe someone is concerned about swimming at the gym and wondering if it could be transmitted through pool water.
Benjamin Chan:
I don't want to start every question with we don't know much about this novel virus, but. But I will speculate that again, what we do know is it's a fragile virus and it is adapted to be in respiratory secretions. That's where it wants to be and stay intact. And as soon as it's out of that, it falls apart pretty quickly. So a pool seems like a very bad environment for a virus like this.
Peter Biello:
So fragile enough to say, like we're concerned about door handles. Right. Surfaces that people touch a lot. So it wouldn't survive long on a door handle, in your view, where we don't know because there's so much we don't know. I don't know. You tell me .
Elizabeth Talbot:
We have some studies of very closely related viruses, the corona viruses that that cause common colds, for example. So so we know that they have a capacity to stay intact in a nest of secretions. So if somebody has contamination on their hands, that it's protected and then, you know, then you touch that doorknob, it can retain some ability to infect somebody through that what we call phone light transmission. Again, important to keep cleaning in a routine way. All those commonly touched surfaces like like desks and keyboards and doorknobs and handrails.
Peter Biello:
Dr. Chan.
Benjamin Chan:
Yeah. So I just want to mention that this is a new coronavirus, right? We just have first heard about this a little over a couple of months ago when the outbreak began in China and has since spread to multiple parts of the world. But Coronaviruses are a large family of different viruses, and so we have experience from dealing with past coronaviruses. And I think it's important to mention to your audience that there are routine circulating coronaviruses that people normally come into contact with every year. There are four different coronaviruses that are estimated to cause up to a quarter. That's about 25 percent of all common colds in adults worldwide. So people in the community may hear about, you know, so-and-so got a coronavirus. We're not talking most of the time about this new coronavirus. Right. There are naturally occurring, commonly occurring coronaviruses that that people can commonly get colds from. We also have experience with a couple other newer emerging coronaviruses, the SARS Coronavirus back in 2002, the MERS Coronavirus back in 2012. These are related but different corona viruses that we have experience responding to in public health.
Peter Biello:
So we're really specifically talking today about COVID-19 coronavirus is a broad category and it's not necessarily a new word. Correct. OK, let's go to the phones and talk to Deb in Alton. Deb, thanks for calling. What's your question?
Caller:
Yes, hi. My question is, when people are told to stay indoors because they've been infected or near someone, isn't there something that we can do? Or is there someone that can make them stay indoors? For instance, this person that was then in New Hampshire that was told to be in quarantine. And then they went out to an event where there were two or three hundred people there. That just does not seem right.
Peter Biello:
Well, Deb, thank you for the call. And just for a little bit of context. So this person was told or advised by his doctor to self-quarantine, not told by the state to self-quarantine. So he wasn't, as far as I understand. Dr. Chan, Dr. Talbot, maybe. Jason, you want to weigh in. Under any legal obligation to stay home, it may have been wise to stay home, but no legal obligation. Right. Jason, you're nodding.
Jason Moon:
That's accurate. As far as I understand. Now, that person is under legal obligation to stay at home. As I understand as well. So there is the state does have legal authority. The commissioner of health in New Hampshire can force people into quarantine in a public health emergency. You know, I'll throw it to Dr. Chan and add a question, if I could. You know, will we begin to use that legal authority on a preemptive basis going forward, given what happened when we just asked this person to to quarantine?
Benjamin Chan:
Yeah. So maybe a quick a quick point on on terminology. I think this has been a point of confusion. We talked about isolation. We talk about quarantine. Isolation is what we do to patients that are symptomatic. So if somebody becomes sick, we isolate them either in the hospital, if they're sick enough to require hospitalization or at home if if they're not. Quarantine is what we do for people that may have been exposed to a disease or a risk of coming down with that disease, but are not yet symptomatic. And so your caller is talking about the situation where our first case of COVID-19, in New Hampshire, was asked to self isolate. There was no legal order served at that point, but the public health agency has public health powers to get people to comply with isolation and quarantine both most of the time when we deal with these situations. Most people voluntarily self isolate or voluntarily self-quarantine and we don't have to go down the legal route, but we certainly have the ability and the option of serving a legal order to get people to comply. And that happened in the case of the first individual. The decision to use a legal isolation or quarantine order is usually done on a case by case basis. But I will say that anybody that we are isolating because of concern for COVID-19 or quarantining, because they've been exposed to someone with COVID-19, is undergoing monitored supervision by our public health nurses to make sure that they are, in fact, complying with isolation and quarantine.
Peter Biello:
Dr. Talbot.
Elizabeth Talbot:
Following that, there was an important announcement yesterday that as the number of cases increase in countries other than China, we have new hotspots where transmission appears to be prevalent in the community, such as Iran, Italy and South Korea. So the announcement yesterday was that people returning from those sites should self quarantine. This is really a new era. And I think we should talk about that together, what that means. But we want that message out. We can't know who came back from Italy a few days ago. This is not something mandatorily reported. But we hope that we are living in a society where we can facilitate that important step for people to to to make sure they can stay at home. For example, from school, from work, and that they're not certainly pressured to to overcome that. So that this we have to think through together how that's going to work. But people returning from Italy, South Korea and Iran should keep themselves at home. And for the 14 days following their last exposure in those settings where there appears to be very widespread transmission.
Peter Biello:
And just to chime in on that, that's really important because that's new, right? Prior to this, prior to yesterday, it was just travelers returning from China, though some schools in the state had asked people returning from Italy. So that was sort of a step above the CDC guidelines. Now it's very much in line with with the guidelines. And just another quick note on that in terms of which countries people should be self isolating after travel to, we just listed a bunch, but the list might change. And so what's more important is not to remember the list of countries we just said were to go to the CDC travel advisory Web site. You can look at the list of Level 3 travel advisory countries because it will be fluid. It might not be those countries we just we just mentioned. If I could, Dr. Chan, do we have the number of people? Who are currently in self-isolation right now in New Hampshire. Do we have a sense of how many people are being monitored?
Benjamin Chan:
I don't I don't have that current number that I can that I can accurately repeat now, but there are certainly a handful of individuals that are either under self-quarantine and then the two individuals with COVID-19, who are obviously under selfies, self-isolation, and they are complying with with that.
Peter Biello:
Dr. Talbot or maybe Dr. Chan, one listener asked if a family member is quarantined at home. Is everyone stuck there as well? Or do they do the family members go somewhere else?
Elizabeth Talbot:
Really, thanks for that question. It's one we're getting very commonly. So no. Contacts to contacts or contacts to people who are on quarantine do do not need to restrict their movement. It's important to to hear that. That is, if there were such a recommendation, it could be somewhat disabling. So we certainly weigh risk benefit collectively. You know, we can't put everyone on quarantine, can we? But but we want to put those that are at the potentially identified highest risk of coming down with disease that might be contagious to others. So no, family members to people who are on quarantine do not need to also self-quarantine.
Benjamin Chan:
And I think it's worth repeating again. I think that, again, this virus is primarily transmitted from an individual who's showing symptoms of disease through close contact. That's respiratory droplets spread. And so someone that may have traveled to Italy, for example, and come back and are not symptomatic or do not pose a risk, we believe, to the public or their family members. And so while we're asking the individual that traveled to self-quarantine, their family members and close contacts certainly do not need to restrict their movement. That would obviously change if the person could potentially change if the person became symptomatic and we initiated testing on the traveler. But someone who is asymptomatic is not considered a risk that the family members of people who are asymptomatic are not considered a risk to the general public.
Peter Biello:
Dr. Talbot, did you want to weigh in?
Absolutely. And it raises an issue that's coming up a lot for those of us who are in the clinical trenches. There are a lot of smart people out there, I'm sure, listening right now and a lot of. Isn't it possible and couldn't it happen that and even we've had the question about the swimming pool. I think collectively we need to put our focus on where we know transmission is most likely and how we can make the greatest impact with limited resources. Right. So we're going to follow the science closely and and continue to reiterate that this epidemic is being driven by symptomatic people. And that's our target. Is it possible you could transmit five minutes before you recognize a symptom? Yes. But is it worth the intense effort and disabling our society by encapsulating that in some of our protocols? No.
Peter Biello:
Let's talk to Meghan in Portsmouth. Meghan, thank you very much for calling. What's on your mind?
Caller:
Oh, hi. I was wondering, I had read online on a semi reliable source I would say that seemingly young children are less or are not getting sick, which is unusual because usually it's like the elderly and the very young that are, you know, most susceptible to these things and that maybe that's because kids are just petri dishes anyway until they have better immune system to these kind of coronaviruses that cause the common cold. I don't know. Is that true?
Peter Biello:
Well, put out to our panel. Thank you very much, Megan. Appreciate the question. Dr. Talbot, you wanted to answer that?
Elizabeth Talbot:
Well, we do appreciate the question. And I think many of us are very relieved that our vulnerable children, usually vulnerable children are not particularly prone to getting serious disease from COVID-19. And we don't fully understand that. So I do have to give that nod. But what's the data that we have out of China is our multiple analysis of tens of thousands of the first cases that that show us that indeed most of the severe cases are in people over 15 years old. We don't know whether there's minimally symptomatic or even asymptomatic disease in that age population. And we won't know that until our testing capabilities are improved to a place where we can see if people have antibodies, as is one way. But right now, our test detects people who have virus in their throat and their nose. And we're only testing people who are symptomatic. So we don't know really what's going on in the youngest population yet.
Peter Biello:
Jason.
Jason Moon:
While we're talking about different demographics of people contracting the virus, what what can we tell listeners about who is most at risk? Who who's who should we be most concerned about protecting from COVID-19?
Elizabeth Talbot:
Really, thank you for that Jason. And that's that's very important for us to understand together, as is again, that data coming out of places that are more mature in their epidemics suggests that the people who are at the highest risk of needing hospital support or even mechanical ventilation or to die from disease are those in the older age bracket. So also those who are with underlying diseases like diabetes, hypertension, cardiovascular disease, it appears that the disease course may be more severe for those.
Peter Biello:
Dr. Chan?
Benjamin Chan:
Yeah, I was also going to add that, you know, as Dr. Talbot mentioned, we're still learning about the full extent of how people present with this with this infection. The the vast majority of people and we've seen this in studies coming out of China. There was an article published in the Journal of the American Medical Association just last month looking at, I think, over 72000 infections in China and more than 80 percent of people presented with more mild illness. But but it is important to remember that this is a new virus and we know it can spread easily person to person and we know can cause serious disease. People can end up in the hospital. People can end up in the intensive care unit. It can cause death. And the populations that are particularly vulnerable are those who are older primarily and people with multiple other medical conditions which make them susceptible to these more serious complications if they become infected.
Peter Biello:
We got a question from Michael by email who asked, what is the lethality rate as compared to the flu?
Benjamin Chan:
Yeah, that's that's a question that we get frequently. And I think it's helpful for people to hear how it compares to other other viruses. Right. So this twenty nineteen new coronavirus is related to some past coronavirus is like SARS in 2002 and MERS in 2012 and it certainly appears to be much less lethal or fatal than some of these past coronaviruses. The percentage of people who died from SARS was about 10 percent of people who got infected with the 2002 SARS coronavirus ended up dying. With the MERS coronavirus, upwards of 30 to 35 percent of people ended up dying after infection. From reports we're getting looking at infections of this new coronavirus coming out of China and worldwide, that that number for this new coronavirus is about 1 to 2 percent make perhaps closer to 2 percent. So significantly less fatal than some of these past coronaviruses that we've seen that we believe jumped from animals to humans, but certainly potentially more fatal or lethal than just regular seasonal flu. The number that's oftentimes quoted for seasonal flu is that about up to zero point one percent of people during a regular flu season who get influenza cCan it can prove it can prove fatal in those individuals. So it spreads more easily than some of these other past coronaviruses like SARS and MERS, but is less fatal. But certainly we're taking it seriously because it's it can be more serious than just a typical seasonal flu.
Peter Biello:
Is it also kind of scarier because we don't have a vaccine yet?
Benjamin Chan:
That's that's a that's a great point and something we should we should, I think, talk more about it. There are differences with even though this spreads very similarly to seasonal flu, we think through infected respiratory droplets, there are differences with how we respond to this, right. With seasonal flu, we have a vaccine that can help prevent illness and need for hospitalization. We have medications that can treat seasonal influenza if someone becomes infected. We don't have those what we call pharmaceutical interventions or pharmaceutical measures to protect against this new or novel coronavirus.
Peter Biello:
I see. OK. And Dr. Talbot, did you wanna say something?
Elizabeth Talbot:
Well, I certainly want to follow. We don't have them yet. You know, so. So I want to be giving people some talking points right. In their own communities to understand that we're on fast tracks for vaccine right now. I think that it's a very reasonable estimate to say it will likely be a year before you can roll up your sleeves kind of thing. But but also tools against this virus include treatments. So there's a whole lot in the pipeline of treatments right now. More than 100 studies of some very well-known drugs being applied to this and then some less well-known drugs that really have a very nice signal for potentially helpful for those who do become ill with disease.
Peter Biello:
We've got to take a quick break, but when we come back, we will talk more about the Coronavirus. We'll talk about testing. We'll talk about travel. What you should think about if you're thinking about traveling. We'll also think about how the Coronavirus is impacting people who have a disability. I'm Peter Biello. This is The Exchange. We'll be right back.
Peter Biello:
Right now, we're talking about the state's response to the Coronavirus, asking for your questions or comments. Dr. Benjamin Charn, state epidemiologist for New Hampshire. Dr. Elizabeth Talbot, infectious disease specialist at Dartmouth-Hitchcock Medical Center. And Jason Moon and NHPR's health care reporter. And I do want to remind our listeners that we are pausing our March Fund drive this hour to bring you this conversation uninterrupted. You can support this type of programming right now by going to NHPR.org. And thank you very much. We want to bring a caller into the conversation. Let's talk to Morgan in Cape Nettick, Maine. Thank you very much. Morgan, what's on your mind?
Caller:
Hi, I'm calling. I'm wondering what your advice is regarding international travel outside of those three hotspots you mentioned previously. Is it irresponsible to continue with travel plans? Should we be considering whether we might be healthy individuals that might be carriers or any advice for Travel International in the next few weeks?
Peter Biello:
International travel, what do you think?
Elizabeth Talbot:
The U.S. Centers for Disease Control and Prevention CDC is giving us very clear language around how to frame decisions about travel to the hotspots, as you call it. So do not travel, you know, sort of. Those are very strong recommendations. It's very clear what that means. That's level three. But everybody will weigh risk benefit differently in that. And if you have to travel, if this really feels as though it's something that has to happen, then we are asking you with with all energy to to comply with the recommendation to quarantine yourself on return. Certainly be in touch with us if the Health Department and if you are ill on return or become in the 14 days that you are keeping yourself away from others who might be vulnerable to disease. It gives me an opportunity to remind you that the Health Department number for such reports is 2 7 1- 4 4 9 6 in the New Hampshire jurisdiction. I think I heard from you, Morgan. You were calling from Maine, so it would be a different number. But I know that Dr. Chan will want to follow up on that.
Peter Biello:
So is the CDC recommendation do not travel anywhere?
Elizabeth Talbot:
Just to those places that are listed very clearly on their travel advisories.
Peter Biello:
Those other countries. The question I think was about international travel.
Elizabeth Talbot:
Sure. So, international travel is not recommended against. But only the hotspots.
Peter Biello:
Only the hotspots. Dr. Chan?
Benjamin Chan:
Yeah. I was going to clarify that point as well, that, you know, as of right now, the recommendations from the Centers for Disease Control and Prevention, who is obviously monitoring the global situation very closely, has travel advisory notices for only a handful of countries. Right. Level three, travel advisory is, you know, avoid all nonessential travel. That's for the countries of China, Iran, South Korea and Italy. There's a Level 2 travel advisory notice, which is, you know, people that are more vulnerable. You know, our elderly population, people with multiple medical conditions should not travel to Level 2 travel advisory countries. Currently, that's only, I believe, Japan. And there's travel 1 advisory countries, which is there's no recommendation against travel, but there is a notice that there has been some limited community transmission. So people should travel with that in mind. Right. So that's a handful of countries for which there is a travel notice. There's a whole many other countries that people could travel to for which there are no travel notices. And I think they got that that gets to the caller's question, which is what should they do about travel to those other countries? And I think it's difficult to come up with a broad or blanket statement around travel, because risk really depends on the individual and their their willingness to potentially travel and take the risk of going to a country where there may be increasing transmission of COVID-19. And so I think that these these decisions really need to be made on an individual case by case basis basis with the knowledge that this is a rapidly changing outbreak. And so if someone goes even to Europe, you know, there are other countries in Europe with, you know, increasing numbers of COVID-19 detected. There is not a recommendation not to travel as to negatives there currently. But the situation is changing so rapidly that new countries could be added to the travel notice list in the coming days and people need to monitor that closely. And that's able to be accessed on the CDC Web site.
Peter Biello:
Dr. Talbot, you wanted to win.
Elizabeth Talbot:
We're in an unusual space for the observation of the disaster of the Western M and the Diamond Princess Cruises. There is travel advice regarding cruises to Asia and I think that that feels obvious, having observed what happened with the Diamond Princess and other cruises that did go to Asia. So so I think that that also should be a reminder. You know, cruises to Asia right now are recommended against.
Peter Biello:
We'll be talking a little bit more about travel in a moment. But I did want to bring in Stephanie Patrick, executive director of the Disability Rights Center. Stephanie, thank you very much for joining us. We really appreciate it.
Stephanie Patrick:
Thank you so much for having me.
Peter Biello:
You work with people who have disabilities, including people who may require home health aides or regular assistance in their daily lives. So what immediate impacts are you seeing either as a result of the Coronavirus or as people prepare for its possible spread?
Stephanie Patrick:
Well, I think that we are we are monitoring the situation, too, we've been in touch with the Department of Health and Human Services too I know is working on it. But, you know, we do we do have specific concerns for people with disabilities. I think that there's a lot of conversations about people with disabilities and others who may have compromised immune systems or other medical conditions and how they're more at risk. The other part of the conversation that I think is not getting as much attention that maybe it needs at the plans for people with disabilities who do require that day to day care. I mean, that would include people with disabilities who are in nursing homes and other facilities and that the major part of the outbreak in Washington state is in a nursing home. And you know how to maintain the care for the people that live there and make sure that the people that are the staff and the other patients are are quarantined when they need to be. And I think it's also really critical for people who get care in their home, who need support and help to toilet, to bathe, to eat. And those are things that you can't just not do for seven or 14 days while you're a regular direct care staff. It's quarantined. So I think it's really critical that as part of this conversation, we're thinking about how to make sure that these these services are maintained. You know, because you just you can't go without.
Peter Biello:
And so what changes are being made for folks who have disabilities are particularly maybe or maybe will say in in long term assisted care facilities, nursing homes. Are there different standards or procedures being put in place right now to to make sure those people are protected?
Stephanie Patrick:
As far as I know I think that they are starting to they're following the regular protocols. I mean, there are already standard protocols because people with disabilities and others are in these kinds of facilities are at risk for flu. They're at risk for cold, they're at risk for a lot of diseases. So they're following those. But I think it's just ramped up and getting more attention to make sure that they all have access to all the sanitizers they need, that everyone's washing their hands properly and that the that administrations of these agencies and these and families and others who are kind of thinking through this are making sure that they do have a plan in place. I mean, you talked on The Exchange many times about the workforce shortage in health. It's a real struggle to make sure that there are people to fill all the jobs here in New Hampshire. And I think that direct care workforce and the home health workforce is really feeling that, too. So there's often not that many people extra to do this work.
Peter Biello:
So what are your long term plans for dealing with the coronavirus fought for in assisting people who may have disabilities?
Stephanie Patrick:
Well, we're continuing to monitor it. We're talking to the state and to other providers as best we can to make sure that they're covered. We know we're reaching out and making sure that the issues impacting people with disabilities really get the attention that they need. The other one that I think is really critical just being mentioned here is making sure that communication for people with disabilities is as available, that people who are deaf, who are blind, people who maybe can read things on the Web site, that you're providing communication in multiple ways. And so we're doing our best to be able to do that and point that out, to be sure that they that everyone, including people with disabilities, can access the information they need.
Peter Biello:
Stephanie Patrick, executive director of the Disability Rights Center. Thank you very much for speaking with me. I really appreciate it.
Stephanie Patrick:
Thank you.
This is The Exchange on NHPR. We're asking you to send us your questions or give us a call if you have questions about coronavirus. It's been top of mind lately in the lead story almost in every newscast here at NHPR, because it is a big deal both for New Hampshire and for the country as a whole. We're talking about travel just a moment ago about international travel. I wanted to ask you maybe, Jason, you know this because you've been looking at the CDC guidelines. What about domestic travel? Are there any concerns about domestic travel, particularly maybe for Washington state, where there have been the most deaths in the country from from COVID-19?
Jason Moon:
To my knowledge and correct me if I'm wrong, CDC is not issuing any domestic travel guidance at this point. You know, that said, I think it's you know, people should could use common sense in terms of whether to visit. You know, certain parts, certain very particular parts of the country that have ongoing community outbreak. But again, that's one of those things that that could maybe potentially change. And that's why it's just important to check the CDC travel advisories before you travel and not you know, what we say here today on air may be out of date a week from now, three days from now, a month from now, fast moving for sure.
Peter Biello:
We get this question from Kathy, who wrote, My niece works in the Amazon Brazil office in Seattle. Since one of her colleagues has tested positive for COVID-19, she is now working from home. She is pregnant and due April twenty ninth. What is her risk of complications if she becomes infected? Dr. Talbot.
Elizabeth Talbot:
There was a report from China looking at only 10 pregnant women and their outcomes. So I think that intuitively, you know, we we know that this is a vulnerable population. Women who are pregnant can sometimes have worse outcomes with infections because of what's happening with their immune system as as they carry a child. So I think that indeed, looking to protect this population, pregnant women in our society makes sense. But I would say we don't really have the data we want in order to make good counsel to those folks. Like what are the chances of a bad outcome for the mother or the child? But sorry to hear you're dealing with that, Kathy.
Peter Biello:
We get this question from Abby in Amherst. Her question is, can you please shed some additional light on the wearing of masks? I do keep hearing that they don't really help. And the only people that should wear them are those that are already symptomatic. I understand why they would certainly not eliminate transmission. But why would the regular wearing of masks not dramatically prevent transmission? Dr. Talbot.
Elizabeth Talbot:
Let me get started. And I know Dr. Chan will want to have us here, too. So a few prefacing comments, right. Thank you very much for this question, Abby. Because it's one that I get regularly and I would love to talk about and come to some talking points together. There's very clear recommendations that asymptomatic persons in routine life should, should not buy, should not wear masks. There's several reasons for that. First, that this is, as Dr. Chan said, a droplet transmitted disease, meaning that it's not moving about in the air in a way that that mask might help you, but rather than the mask may serve to protect you from auto inoculating, if you're in a place of heavy transmission or where you can touch contaminated surfaces.
Peter Biello:
What, you mean auto inoculating?
Elizabeth Talbot:
Exactly. So I was about to start to share that. We use that phrase to mean that we touch our face 100 times an hour. You know, we don't even think of it.
Peter Biello:
Way too often, it seems.
Elizabeth Talbot:
Exactly. So maybe more appropriate would be to tie our hands behind our back. But but indeed, touching a surface and touching our eye, touching our nose, touching our mouth is how we inoculate ourselves. So you can imagine the logic of a mask in places where there is very active community transmission. Is that it prevents that moment. So. So that is a start to a conversation that I hope we can have more deeply right now.
Benjamin Chan:
And I'll just add to that that and reiterate again that wearing of masks is not recommended as a way to prevent infection in the general otherwise healthy public. You know, as Dr. Talbot mentioned, there are multiple ways of introducing this virus into your body. Right. One way is breathing, you know, infected droplets from someone else. Another way is touching a surface that an infected person recently touched and then touching your eyes, mouth, nose that can introduce the virus into your body. And, you know, some people may wonder, well, why is touching your eyes a risk for getting a respiratory virus? Well, you know that the human physiology of this is that you have a duct called the nasal lachrymose duct, which getting a little scientific out here that connects your eyes to the back of your nasal passages. Right. So if you're touching your eyes or someone coughs or sneezes into your eye, that virus can be transmitted from your eyes into your nasal passages. And this is part of the reason that when someone is being evaluated who's symptomatic in the healthcare setting, there's a whole set of personal protective equipment that health care provider is asked to wear to protect themselves. And the health care infrastructure that includes not just a mask, but gloves, gown, good hand hygiene and eye protection. And so, you know, the general public simply wearing a surgical mask has not been shown to be highly effective at, you know, reducing transmission in the community. And it reduces the supply of surgical masks that are necessary for people who are going into the doctor's office and symptomatic, for example. And the supply for the health care setting.
Peter Biello:
So, Jason, I wanted to get you to weigh in a little bit about the shortage of masks. Is there a shortage?
Jason Moon:
Yeah. I mean, we've seen reporting about that on a national level. And certainly there's the kind of compounding issue that there's an increase demand on masks and other, you know, health care items, protective health care gear from folks in the United States or elsewhere. There's also a reduced supply because a lot of these things are manufactured in the countries that are seeing the worst of the outbreak right now. So you're sort of getting it on both ends. So, yeah, I think that is certainly, you know, there's there's what the virus does and there's what our reaction to the virus does and there's negative potential impacts from both of those things. I wonder, too, to the doctors here, what would it be just a easy rule of thumb to say, don't wear a mask until the doctor tells you to. Is that would that be an easy way to to advise the public on this?
Elizabeth Talbot:
I would advise that people who are symptomatic entering a health care setting should wear a mask. So all our facilities are positioning masks early in the course of being in a facility. So. So you don that mask then? Absolutely. So here's a doctor telling you to when to wear a mask, for sure. In the general public, not so good. I'd like to try to reconstruct the conversation of going out and buying mask a masks as a self-protective moment. I don't think it is. I think more self-protective would be to maintain the supply of masks for our health care workers, our ambulance drivers and everyone else so they don't then propagate the infection. So think of it as altruistic to not buy the mask. Right, and self-protective to not buy that mask, because that's what's going to protect society at this juncture.
Benjamin Chan:
And so the question is gonna come up, right. We don't have a vaccine yet for this new coronavirus like we do with influenza. We don't have medications yet to treat someone who is infected with COVID-19. We're saying for the general public who is otherwise healthy, you don't need to wear a mask. How can people protect themselves? And I think this goes back to the advice that's given every year. All times, especially during influenza season, is that the way people protect themselves is that it's the same way we recommend people protect themselves. Every flu season, right? It's important to minimize transmission between people. Right. And we do that through social distancing. So people that are sick should stay home, should not go to school. They should not go to work until they're a febrile that is without fever and feeling better. We advise people avoid close contact with somebody else who's sick. Frequent hand-washing. It's not just breathing in infected respiratory droplets. It's touching, you know, surfaces and touching your eyes and nose and mouth that can that can infect someone with any range of different viruses. And then it's important if someone perhaps has traveled and does come down with symptoms of fever or respiratory illness to call ahead to their provider office to get further evaluation and instruction. And we want to avoid people that may be sick from walking into a health care providers office and potentially exposing other people, whether it's flu or COVID-19. And so we recommend people call ahead.
Peter Biello:
Listeners, we're talking about the Coronavirus today on The Exchange. We're gonna be talking a little bit more about testing what what is involved in testing of the Coronavirus. Anything goes really. This is your chance to get your curiosity satisfied. This is The Exchange on NHPR. I'm Peter Biello. We'll be right back.
Peter Biello:
This is The Exchange on an NHPR, Peter Biello in today. We're talking about the Coronavirus and efforts across the state to respond to cases already here and prepare for what's to come with me in the studio today. Doctor Elizabeth Talbot, infectious disease specialist at Dartmouth-Hitchcock Medical Center. Dr. Ben Chan, state epidemiologist for New Hampshire and NHPR's health care reporter, Jason Moon. And let's go to the phones and talk to Bob in Concord. Bob, thank you very much for calling. What's on your mind?
Caller:
Good morning. Yes, I've been trying to find out for the last week or so exactly what the longevity of this virus is and different kinds of environments, whether humidity matters or not. And in particular, does this virus live longer if it's on a dry surface or does it live longer if it's in it like a tub or a sink? Because now that I mean, people keep saying, well, the viruses over in Italy and all that, the fact is and I'm sure people are well aware of this at this point, I think it's actually in New Hampshire. So just trying to figure out what the smart things are to do with respect to that.
Peter Biello:
So let's put that to the panel. Dr. Chan.
Benjamin Chan:
Yeah. So I think I just want to make the point that we have detected this virus that causes COVID-19's new coronavirus in New Hampshire. There is not evidence of widespread community transmission. Right. The first individual that we announced who tested positive this past Monday traveled to Italy. So it's a travel related case. The second individual was known and identified close contact of our first infection. The first person identified with infection. And so the purpose of our public health investigation is to identify people that are close contacts to these people with identified infection so we can self-quarantine them and try and prevent further transmission in the community.
Peter Biello:
So you're talking about people to people transmission.
Benjamin Chan:
Correct.
Peter Biello:
Bob may be concerned about. Is it going to stay, for example, on a on a wet sink in a public bathroom longer than, say, a dry desk surface that multiple people use just as an example?
Benjamin Chan:
Yeah. Right. So. So from what we. And let me say first that we're still learning about this virus. And one of those areas that we're still learning about is how long this virus can survive on surfaces, for example. But from what we know of our study of past coronaviruses like SARS in 2002 and MERS in 2012 is that these viruses are very susceptible to drying out. Right. So when they dry out, they usually die pretty quickly. So we've gotten questions of, you know, people shipping packages from China. Is that a concern for transmitting the virus? Generally, no. And I think we keep going back to how is this primarily transmitted? It's primarily transmitted through close contact with someone who is infected or touching a surface like a doorknob or a handle of someone who was infected and recently came by and touched that surface. Right. When when someone's respiratory secretions are put on a door handle and it dries out, we don't believe that the virus survives for it for a long period of time. But I don't know if Dr. Talbot has any other thoughts on that.
Elizabeth Talbot:
I think it's a common question, is there going to be a seasonality to this virus, as there is for flu and some of the other cold viruses? Well, we we hope so, because we're, of course, coming into spring, but we don't know that. And there have been models of respiratory viruses that haven't paid any attention to the temperature, the humidity. So. So I think that it's it's as Dr. Chan said. We've said several times, it's not very sexy, but we are looking at the majority ways that this is transmitted person to person. And so hand hygiene, look around now. Where's your Purell? You know, do you have it in your car? Do you have it in your purse? Do you have it on your desk that it's again. I know people glaze over when we say it, but that's the best mileage here. That's where you're going to make the best protection and bang for your buck, if you will.
Peter Biello:
Let's talk a little bit about testing. We get a question from someone who didn't want to use their name. This person says, I'm a hospital nurse in New Hampshire, not Dartmouth-Hitchcock. We have lots of patients who come to the E.R. or admitted to the hospital with flu like symptoms. Should all these patients be tested for coronavirus or only those with probable exposure to Corona or a pertinent travel history? Dr. Talbot, good.
Elizabeth Talbot:
I'll kick it off. And I think we'll have to go back and forth sometimes. So let me make reference to where we are at this stage of the epidemic in the United States, and that's with a heavy emphasis on containment. So identifying those who still have obvious risk factors for disease. But we have made a subtle change that if you have a patient who's been investigated and usual ways for a severe respiratory illness, we will tell test those folks. But right now, there is not widespread testing capacity. We hope for it. But as it is now, we are using common sense and testing those who have risk factors or have unexplained, severe illness that could possibly represent a signal for community transmission. And Ben.
Benjamin Chan:
Yeah. So so what we really would like to see is testing for COVID-19 commercialized. Right. So that health care providers can get the testing through their normal medical routes. Right now, however, testing is only being conducted through public health agencies and at the Centers for Disease Control and Prevention. And so that by nature limits testing. So what we have asked providers is that anybody presenting to the health care setting or calling in to the health care setting who may be complaining of fever or any respiratory illness, be screened, be asked questions about recent travel, specifically to travel to one of these highest risk countries like China, South Korea, Iran, Italy, Japan. And if there's concern for travel or contact with someone with known COVID-19, if there are these identified risk factors and they're having symptoms consistent with COVID-19, which are primarily fever and lower respiratory tract symptoms of cough and shortness of breath, that these individuals, if they're in the health care setting, setting, be roomed appropriately, that providers use appropriate protective equipment when they're seeing them, and then call call to the Division of Public Health Services to talk through whether testing may be warranted or not, because testing is not widespread through normal medical routes. There is a process in place that providers need to go through to identify those who we think are at risk so that we can we can initiate testing.
Peter Biello:
We get this comment from someone. A couple of weeks ago, I bought a few M95 masks at a paint store, not surgical masks. Now that I hear about the shortage in the medical community, I think perhaps that was selfish and I feel guilty about it. So is there a place I can donate them now? I only have about five or six. That's Jamie in Epping wants to donate some masks. God bless you, Jamie.
Elizabeth Talbot:
That's a very altruistic impulse. I think that your five or six are probably not going to turn the tide, but hold on to them should recommendations change. OK. So thank you for that.
Peter Biello:
Certainly. OK. We got this one from Lauren in Guilford who says, I'm an E.R. physician. I appreciate the health alert networks shared by CDC that the state has sent out. But could you please make them a daily routine? The recommendations seem to change daily. And I'm having a hard time keeping up with the recommendations, such as case definition, testing kits, et cetera. Are we advised now to test all pneumonias regardless of exposure history? So a couple questions there. Daily HANs and you know, are we advise now to test all pneumonias?
Benjamin Chan:
That's a great question. We have sent out five health alert network messages to providers over the last month or so. So they seem to be coming at least on a weekly basis. And we have because recommendations and situations changing so rapidly, rapidly, we're trying to push out as much information as quickly as possible to providers. I will I will mention that we are planning on another health alert network message in the next day or so because of these changes. So I think that comment from your physician is well-taken. We recognize the need for more information. And just for your general audience. Health alert network message is the way one of the primary ways that we communicate with our clinician audience, not just physicians, but PAs, nurse practitioners, nurses. So this is a primary way that we push out information and recommendations to physicians. And we recognize that this is changing rapidly and we need to be putting out routine recognition than we are. We are doing that.
Peter Biello:
Lauren also wanted to know, is the State Department of Health and Human Services staffed 24 hours a day since many of us work the night shift, adding she would appreciate more frequent updates so that I have answers for patients 24 hours a day.
Benjamin Chan:
Yes, it is 24 hours a day.
Elizabeth Talbot:
Okay. The other thing that's happening at the Health Department, which I think is very appropriate, is an institution of a daily call. So it's basically a call in with the likes of Dr. Chan and myself and other knowledgeable partners so that you can ask your questions directly. So really, thank you for that question.
Peter Biello:
Ok, so Anna wants to know how many test units are in New Hampshire. Concord State test universities, commercial sites. How many tests are available, do you know?
Benjamin Chan:
You know, that's a that's a great question and it's changing. We have word that the Centers for Disease Control Prevention is going to be pushing out many more test kits, very rapidly increasing the testing capacity. So right now, our public health laboratory is able to do the COVID-19 testing. They can do that from test kits sent to us from the CDC. So the CDC is the one that works to manufacture these, pushes them out to the state and local health departments to do the testing. We are using an old kit, one that was sent to us that we just recently brought on that has some limited capacity with that one kit. We were able to test about 50 or so patients, but we hear that there are more test kits coming in the near future that will rapidly increase our test capacity.
Peter Biello:
Jason Moon.
Jason Moon:
On the issue of testing, we heard yesterday from Dartmouth-Hitchcock that they're trying to develop their own tests. Do we have an update on the status of that? And if Dartmouth-Hitchcock begins to do its own testing, will those numbers be reported through the state? Will we treat them the same as the presumptive positive tests we're getting from public health? Will we have sort of two separate categories? I know it's getting a little complicated because having to wait for CDC confirmation of these. So how will all that work if there's multiple testing agencies in the state?
Elizabeth Talbot:
COVID-19 will be a mandatorily reportable disease in the near future and probably the long future. But that means that these so-called lab developed tests, which we welcome, we invite will feed into our general knowledge of the movement of this disease in our population. And in terms of your question, Jason, timing, I think that'll take several weeks before that can be brought on board, given scrutiny to make sure that this test is done right. You know, so. So this is a national strategy that you'll see coming forward to bring people more testing capacity and in the weeks to come.
Peter Biello:
Earnest wanted to know wrote in by email. Could you have your guests talk about whether symptoms of Coronavirus would feel any different from the normal? Is a feeling it? Can you tell just by what you have that, oh, this might be coronavirus or this is normal flu generally?
Benjamin Chan:
Generally, probably not, right, the the symptoms of COVID-19 are very similar to many other respiratory viruses, including influenza. Right. The primary symptoms are gonna be fever, cough, possibly shortness of breath. Many people may also experience muscle aches, fatigue, feeling generally run down. Upper respiratory tract symptoms like runny nose, sinus congestion, sore throat are certainly quite a bit less common than than those symptoms I just mentioned. And gastrointestinal symptoms like not like nausea, vomiting and diarrhea are are also pretty, pretty rarely reported in the literature.
Peter Biello:
One listener asked, do all New Hampshire hospitals have the proper staff, education and equipment to handle a cluster outbreak? Dr. Chan.
Benjamin Chan:
So any hospital in New Hampshire and many health care providers doctors' offices are able to appropriately assess a patient and evaluate and test. We're working with hospitals to make sure that they are prepared to handle a potential influx of patients. That's one of the critical things we we want to work with hospitals on. But it's important for people to remember that if they're having mild symptoms and no travel history to simply stay home and, you know, until they're feeling better.
Peter Biello:
That's Dr. Benjamin Charn, state epidemiologist for New Hampshire. We've also been speaking with Dr. Elizabeth Talbot, infectious disease specialist at Dartmouth-Hitchcock Medical Center. And NHPR's Jason Moon, health care reporter. Thank you all very much for being on the program today. We really appreciate it.
Benjamin Chan:
Our pleasure. Thank you.
Elizabeth Talbot:
I hope you'll do it again.
Peter Biello:
Well, we've got so many questions about this that the conversation absolutely must continue on Facebook. We'll continue to cover this story because it's a big one. We really appreciate you tuning in today. I'm Peter Biello, in for Laura Knoy. Thank you very much for listening.
