Dr Teresa Frankovich Talks COVID Pool Testing, Mendocino vs Humboldt Information Releases, and More

Humboldt County’s Public Health Officer Dr. Teresa Frankovich has been answering questions since the stay-at-home orders were instituted on a two question per media outlet roughly twice per week basis. The Emergency Operations Center takes the questions, and staff reads them on camera for their response. The resulting video, called a Media Availability, is then provided to news outlets at the end of the day.

Here are some of the main points covered in the July 20 Media Availability session with a summary of answers from Dr. Frankovich:

Staff:  Dr. Frankovich, before we get started can you talk about pool testing that we’ve been hearing so much lately?

Dr. Teresa Frankovich: 

Sure. So, here at Public Health we’ve been talking about pool testing since gosh I think as far back as probably March or April when the first reports of this started to come out.  These were research-based reports, because it did not have any FDA approval per se at that time, and was really a theoretical thing to try.  So, the idea of pool testing is that you basically take- in a population that isn’t expected to have a whole lot of COVID, so it’s good for surveillance kind of testing- you basically collect samples on everyone and you take about five people’s samples and you combine them and you run it.  And if it’s negative you’re good and you know everyone in that group is negative. If it’s positive, you have to go back and 

retest each individual sample to verify who the positive was, or which were the positives if there’s more than one. So, it really can save workload if you have no positives. 

If you get positives, it makes your workload heavier. And so again, it’s really a potentially very good tool for doing surveillance on large populations and so people may be seeing in the media now some of the like large commercial labs looking at this as an option, who are set up obviously to run thousands of specimens, and so that may be possible. We’ve looked at it and we continue to look at internally for when that might work but what we’re what we see is right now because we have the fastest turnaround time, we are specifically funneling samples into our laboratory that are more likely to be positive. People who have symptoms and people who are contacts of cases people in high-risk settings to some extent, and so right away we’re expecting to have some positives quite often in the batches we run and so you know it may have less utility for us right now.  As our capacity changes internally and we maybe have some capacity to do some more basic surveillance testing, it may be useful for us. So we’ll always keep evaluating it, but right now in-house, probably doesn’t have the utility we’d like commercially may be very helpful. 

7 mins 30 secs in:

Media Question:   There has been an increasing disbelief of the physical impacts of the COVID virus.  What could you tell us pertaining to the recovery cases that have always been touched on lightly?  Is there follow-up and further monitoring?

Answer by Dr. Frankovich:  

Well, again, you know we well again, you know, we have talked about this a bit.  You know with Public Health, we are very involved on the front end of these cases in terms of identifying isolating quarantine.  We monitor symptoms while people are in isolation so that we know when they’re ready to come out, but we are not charged with or able right now to do long-term follow-up on the people who are released from isolation. Their clinicians are able to see them for that, there are large research studies looking at that, and what is persistent. 

I can certainly say that some of our individuals still have some respiratory symptoms when they complete their 10 days of isolation, but they’re markedly improved- they’re not running fevers that type of thing.  We have had some individuals who have had a persistent loss of taste or smell for a more extended period of time, and but you know, we all also have individuals who had very little in the way of symptoms at all, so there’s really no big change in what they do long term. 

 

4 mins in:   

Media Question: We know that the recovery rate exceeds the complicated rates, and we also understand that the virus is highly contagious, do you think the hype of the media is scaring residents more than necessary?  Why or why not?

Answer by Dr. Frankovich:

Sure, and you know, I think it’s a fair question. We obviously know that a large percent of the population appears to get the virus, many have few symptoms. The problem we have is that we know that the more virus is circulating, the more we start to see it in younger and healthier populations, and the more likely it then becomes for the next step to be people who are more vulnerable, are in one of the higher risk groups to become ill and therefore to see some of the more serious consequences of the virus.  So again, if you are in the under-18 age group, a lot of people your age have to get ill before we start seeing some of the less frequent complications in your age group. If a lot of our cases are people in the sixty to eighty year age range, we’re going to see those complications a lot quicker along this road. And so what we’re seeing play out in areas across the country with a lot of activity is we’re seeing the initial rise in cases led by young healthy individuals who may not be very ill. As the virus continues to circulate we see increasing hospitalizations because large numbers of those folks are sick and we’re starting to see high-risk populations get sick, and then the ICU rates start to go up in addition to hospitalizations, and then deaths follow.  So I don’t think so- I think it’s unreasonable for people to be concerned.  I think most people will, likely do okay, but we are learning more about this virus every day. And we’re certainly seeing in people for instance who are hospitalized there may be some long-term consequences for the infection, but this virus is so new we don’t even know what long-term means right now.

5 mins 55 sec in:   

Media Question: The governor is expected to talk today about the option for hair salons and barbers to work outside. What needs to be done for that to be permitted in Humboldt County, which is not currently on the state watch list? 

Answer by Dr. Frankovich: 

Well, I think you know, any opportunity we have for businesses to operate in a manner that is safer and where they otherwise would not be able to be open is great. And I’ll be very interested to hear what suggestions the state has about sort of, what permitting and other things can be done to allow these things to happen in these environments. The author of the question is correct, right now we’re not on the state monitoring list, and so these businesses are able to operate fully. But certainly, if I were those entities I would be watching what comes out of this in terms of developments and keeping that in mind, so that if we do have some difficulties down the road here and get on the list, they may be able to transition more easily to that model.

6 mins in: 

Media Question: How has the local testing strategy — and Public Health’s direction to local providers — changed in recent weeks given issues with the OptumServe site and supply chain problems?

Answer by Dr. Frankovich:

So, you know, we’re communicating on an ongoing basis with our hospitals, with our outpatient health care providers, with our residential care facilities, to try and work through the challenges that we have with testing right now. And so we actually will be, we’re revising our prioritization schedule and getting that out shortly to providers, but what we’ve been communicating is obviously, we are trying to prioritize in our own lab testing- symptomatic individuals context of cases where there’s a higher likelihood of a positive and some priority populations internally. At the same time, we’re working very hard within our Emergency Operations Center and with partners, identifying other testing strategies beyond Optum for our area, and we’ll keep people posted, as those develop.

8 mins in:

Media Question: Has Humboldt County had any luck in finding other partners to help in testing as delays at local sites continue? 

Answer by Dr. Frankovich: 

Well what this is going to entail for us, is we really need to establish, you know, either an entity similar to Optum that does sort of start to finish collection, to getting the specimen run and reported out, or we need to build those pieces separately. So that means that we set up collection as a county here, that we identify a billing entity to be able to work through that piece of it for insurance billing, that we identify a commercial lab that has a better turnaround time and a good supply of reagents in the near future, as far as we can tell.

And of course, that’s an ever-changing game, so we are looking at both things- the opportunities that are out there for sort of start-to-finish entity to replace Optum and if needed, and the other possibility of building our own- and we’re really sort of advancing down both those paths right now to cover all our bases. As well as working on increasing our internal capacity in our lab, as possible.

9 mins 10 sec in:   

Media Question:  Locally, what percent of COVID positive cases are confirmed in non-county residents, especially in Southern Humboldt?

Answer by Dr. Frankovich: 

Well, it’s an interesting question because what happens is obviously -you know, a small minority of our of our cases tested locally are non-residents- those cases we actually don’t report out of our lab as positive they get reported out of their county of residence, and that’s for consistency. If we have a Humboldt County resident who tests positive elsewhere, you know then they get reported in Humboldt County data, it’s just the way that the record-keeping goes. And so when we don’t track these specifically in a separate category. So it’s hard for me to give an exact number without going through all of our previous cases, but what I’m hearing from our epidemiologist in our community of communicable disease nurses is that it’s a small number of our cases, locally. And if there’s some easy way for us to you know, pull those out, we certainly will. It’s not a hesitation to give the number, it’s just that we really don’t have, if you asked me off the top of my head, I’d say you know maybe less than 10 of our identified cases to date have been there, it could be that it’s a bit more than that, but it’s really not a large number.  I would say just to amend that- or to add to that- that what what we’re tending to see more is this issue of relatives for instance, visiting, who then go home and find out they’re positive in their own County and that impacts us here. As well as our residents, who go to visit someone who then finds out they’re positive.  So that is sort of the inner plate, we’re seeing more commonly here.

10 mins 50 sec in:  

Media Question: Mendocino County’s Public Health Officer has been able to disclose more information surrounding locations of positive cases, businesses that have had positive cases and their dashboard provides a more in-depth overview. Why is Humboldt County unable to be more transparent? 

Answer by Dr. Frankovich: 

So, I think you know, there’s really two questions there. One is the dashboard- and I would say that you know, you know obviously, I take a look at other dashboards, too. I think we have more than some, we have less than others in terms of what we report out on our dashboard or choose to report out.  We really have tried to focus heavily on putting metrics there that are meaningful for people for our population, and particularly if they’re gonna impact behavior. When I look at Mendocino, I think the only things on their dashboard they report differently or they report more regions to their County, and then the other thing that they report is they report on a daily basis how many in the hospital, how many and ICU, that type of thing. 

In our case, we’ve, you know basically, every time we add a data point to our dashboard it means staff time is is taken from response to just finding those numbers- and so, in this instance to have a communicable disease nurse or somebody who is basically trying to follow someone’s hospitalization course from their medical surgical bed on a given day to an ICU bed back to a medical surgical bed back out the door, you know, and report that in an accurate way every day- I’m not sure has great utility. I think what we’re trying to convey by reporting hospitalizations is how many of our patients get moderately to severely ill, and need to go to the hospital, and I think that’s an important thing for people to know.

In terms of our regions of the county, again, I cannot emphasize enough that you know, the cases are signed to the region of the county by where they live- not by where they work or where they’ve traveled within the county- and there is absolutely, you know, from that standpoint, it’s really important that people understand that wherever they go, they are exposed to risk within our county potentially. So, I think that’s important.  <

In terms of businesses, I do want to say that, you know, it’s always a balancing act you know, when we have businesses where there is a concern about public intersection, that is important for people to know about. That is an instance that we report, and we have done that if it is incidental to a business, and they it’s simply not a public exposure issue then I would argue that it’s not particularly productive to do so.  It doesn’t improve your safety as a consumer and it may be a disincentive for people to come forward, or for employers to even want to identify people who are ill in their business.  I think it all keeps us safer for people to feel like we are being judicious about whether we are, you know, putting them out there for something that may be beyond their control and is not really important to public safety.

13 mins 50 sec in:   

Media Question: We’ve been told there was a confirmed COVID-19 case of a local casino worker, with at least several co-workers believed to be exposed. Can you comment on whether this is the case and whether there’s any indication customers may have been exposed?

Answer by Dr. Frankovich: 

I think it goes to our previous question.  If there’s, again, a significant concern about public exposure with the case, that we feel needs to be addressed, then then we certainly can do that. In cases where there is no intersection with the general public, that is not information we typically put out there.  And again, I just want to emphasize to people but if you go to a casino or any large gathering place with large numbers of people, I think it is wise to assume that you may have an exposure.  And the same thing if you go to a large family reunion.  Frankly, it is reasonable to assume that you may have had an exposure when you bring in family from out of the area to visit and stay in your home. You may have had an exposure, and I think in all these settings we just need to bear in mind that as we go forward, that likelihood will increase.

15 mins in:  

Media Question: Regarding the types of social gatherings currently prohibited by shelter in place, has Public Health considered a harm reduction approach to educating the public on the subject?

Answer by Dr. Frankovich: 

Well, obviously you know, even in some of our media and in the Board of Supervisors meeting I’ve mentioned this. I think that, you know it’s a difficult situation, we know that the absolute safest thing for our residents in our community is to have people not gather.  At the same time, I am not unaware of the fact that some level of gathering happens in our community. And so, I think people who’ve been listening are pretty clear by this point about what constitutes safer versus riskier behavior. You know, bringing together a small group of friends, if that’s going to happen- doing that outdoors is safer than doing that indoors. The safest thing is not to do it at all.  Adding more people to that group means you’re exposed to everyone that they’ve been exposed to potentially, and so your risk grows with every person you add to your gathering.  Frankly if you throw in additional ingredients like people who have traveled outside the area, that probably amplifies your risk. So yes, we look at harm reduction as important. 

That being said, the state is very specific that there is no safe gathering size at this time. No allowed gathering size.  So I asked people to note that masking is helpful- is always useful,  facial coverings- helpful to reduce risk wherever you are..  Just, sorry.  I just can’t resist to add that piece, because you know, it’s important!