Lori Walsh: We know more about COVID-19 and coronavirus than we did last week, including the potential impact in South Dakota. This weekend members of the White House Coronavirus Task Force warned of the difficult days ahead and said states without statewide stay at home orders, that includes South Dakota, were putting people at risk. So what do you need to know to be ready in South Dakota, at least as much as you can be? What questions do you have about how this virus behaves and how you can protect your family from getting sick? What are the things you can control? Dr. Chad Thury is Regional Director of Clinical Quality and Family Medicine Physician with Avera, and he's joining us now with the latest. Dr. Thury, welcome. Thanks for being here.
Dr. Chad Thury: Thank you so much for having me today.
Lori Walsh: How are you and the healthcare providers at Avera doing right now? There's an incredible strain as you get ready for a surge and deal with these early cases.
Dr. Chad Thury: I think the medical providers are holding up well, and it's certainly a different day and time for medical providers and a different routine that we're trying to fall into as far as how we operate clinics and hospitals.
Lori Walsh: All right. Let's talk about what we know about this virus that we didn't know last week because things continue to change. Where do you want to begin there?
Dr. Chad Thury: Well, I think from the standpoint of the virus, the big thing that probably came out the end of last week was the recommendation from the government to have everybody wear face masks even out in public as far as a cloth face mask, and I think some of that is based around the idea that a large number of patients with COVID-19 are asymptomatic and by wearing a mask, the idea is that hopefully we're preventing viral particles to get into the air and ultimately infect other people.
So that's a big change, this idea that we could potentially be asymptomatic and spread virus to somebody just by breathing and being close to them and not necessarily only through coughing, sneezing and aerosolizing the virus. So that's been a big change, and I think the other thing we continue to watch from the standpoint of treatment for coronavirus and looking at all the studies and different research that's been going on with different medications and plasmapheresis and that type of stuff is also something we keep a close eye on.
Lori Walsh: Are we learning things? I know Governor Kristi Noem said in her press conference don't pay attention to the news out of New York, and I want to be clear about that. She's talking to people who are binge watching a tragedy and it's feeding into their anxiety, but what she doesn't mean, I don't think, is that we aren't learning things from doctors in New York and from what's happening in some of these other countries and other cities where they are considered hotspots or epicenters or what have you. Are doctors that you know of really relying on anecdotal information about how to treat people when they come in? Let's talk about that a little bit as far as what we're learning from the people who've had to deal with thousands of cases.
Dr. Chad Thury: Well I think one of the benefits of all of this being in a rural state in the middle of the country is that we do have the opportunity and the fortune to learn from other systems that are going through this already, but you're right, we got to be careful not to just take little anecdotal bits of information from providers and we really need to take the time and learn as much as we can from studies that are done. So, we try to look at evidence-based things as opposed to just anecdotal thoughts that a provider in one part of the country may see from their specific experiences.
Lori Walsh: And explain to people a little bit, normally you have a peer review, these things take time, but these are extraordinary times. How many papers have already been published? I read this weekend that it's more than 50 have already been published, which is unheard of. What are we learning that is the best data, the best evidence based research that we have right now about treating this disease in the hospital setting? We know a lot about how it spreads, but what are we learning about treating it in the hospital?
Dr. Chad Thury: Yeah. I think the best evidence and our best locker approach is probably going to be more with the immune globulin therapy at this point in time. I don't think beyond anecdotal thoughts from other people as far as certain medications, antiviral medications, hydroxychloroquine, chloroquine, that type of stuff, there's not a lot of great evidence that that works, and we just don't have the duration of research trials to say that for sure or not. But I think what we are seeing with some of the research is that the immune globulin therapy is hopefully going to be our best option to treat those patients that are severely symptomatic.
Lori Walsh: Tell me what that is. Explain immune globulin therapy.
Dr. Chad Thury: Yeah, so the idea is that we all make antibodies once we've been infected with something, and so when people have had an infection with COVID-19, our immune system is activated and makes antibodies to fight off that infection. And with immune globulin, the idea is that you take a serum from people that have been infected with immune globulin before and you'd take that serum and immune globulins and then infuse those back into patients that are currently symptomatic and not doing well and provide them with those antibodies to help fight off the infection and ultimately decrease the severity and the duration of their clinical course.
Lori Walsh: Is that something that's available now? Is that something that's being studied now?
Dr. Chad Thury: That is something that's being studied now. Its usage is limited to clinical trials, as far as I'm aware of. We do have providers here in Avera that are more involved directly in those talks as far as how do we get immune globulin, when can we use it and developing that standard protocol for when to use it in dosing and so on.
Lori Walsh: Talk to me a little bit about surge planning and how ... now that a state like South Dakota has had some time to prepare for the number of cases that seemed to be indicated we will receive, how is that surge capacity planning going at Avera? How do you know when you're ready? Are you ever ready?
Dr. Chad Thury: Well, the surge planning has been going on for weeks even before the state came out with their expectations end of last week on Friday, so the surge planning has been going on for us for a while. We're working on various things as far as from our regional facilities all the way down to our rural clinics and communicating between different groups of physicians and administrators.
We're also looking at how do we increase bed capacity within our hospitals, once again across the spectrum from large regional facilities all the way down to local facilities. How do we provide support to those facilities from our ICU doctors centrally, our hospitalists centrally as well, and how do we build up our support for patients before they go into the hospital, so continuing to increase staffing and availability for our Avera COVID hotline. Also trying to build up our home health and the abilities and capabilities that they're going to have as we're discharging more patients from the hospital.
One of the things that is going to happen with this surge is going to be more need for palliative care. There's going to be a lot of sick people and unfortunately there's going to be increased mortality with that, so having a good palliative team set up as well to handle the surge. And then once again looking at different things as far as preserving our PPE, trying to get more PPE in to the hospital and clinics, as well as ventilator resources. So multiple different facets that we're certainly looking at as we try to build and plan for this surge.
Lori Walsh: Are providers being recruited, cross trained, taking volunteers to go to different areas? Talk about the human aspect of that because in some ways creating more beds or creating more hospitals spaces can happen very quickly but getting someone who has never worked in this area spun up and ready to provide professional level care might be a bigger challenge. Talk a little bit about staffing.
Dr. Chad Thury: Yeah, you're certainly right. We talk about the limited amount of PPE, but as the surge comes on, we're going to need more physical bodies to help with the surge, and that goes all the way from physicians and nurses all the way down to food service, housekeeping, all that type of stuff. So we really got to build up our employee force, but you're right that there's also some cross training, and as the surge comes up, we've got a process that we're talking about where we're taking clinic staff, which the clinics are going to be less busy at the time of the surge, and trying to cross train them and prepare them as best we can for jobs in the hospital, working in the ER, once again helping with home health and palliative care and other areas of need as well.
Lori Walsh: Do you believe that in South Dakota that we're doing everything that we can to keep people safe at this point?
Dr. Chad Thury: I think we are. I think it still goes back to those basic tenants to try and flatten the curve, and I think if we do our job and everybody in South Dakota does what they're supposed to as far as social distancing, practicing good hand hygiene, if you do go out and shopping and get groceries or do things that you feel that you absolutely need to do make sure that you're staying six feet apart, limiting the size of gatherings and all that stuff. I think that is going to be what we need to do. I think looking at some of the numbers, we're making a difference, we're increasing that rate of doubling time as far as the doubling of COVID infections, so I think we just need to keep doing what we know we need to do. I know that's frustrating for people and it's hard to do, but I think that's the necessity of this time.
Lori Walsh: Say more about that. Let's dig into flattening the curve a little bit with the science of that because now we have, as of over the weekend, we had 240 cases and we expect that number to go up today. It seems like those numbers are going up by larger ... It's a bigger number every day. It's growing by more, but yet we're hearing that the efforts in mitigation are working. Help people understand that exponential increase and what that looks like in South Dakota with our actual numbers.
Dr. Chad Thury: Yeah, so you're right. The change in numbers is going to continue to go up, and it's going to continue to rise here as we're predicting through the month of April and into and through May and early part of June. But what we look at is how fast does it take for that number to double, and the longer that number is, then the better we feel that we're doing as far as these preventative strategies. And so looking at some of the data, we've shifted that from about three days doubling time to about a four day doubling time, and so if we can continue to stretch that out, that's going to flatten the curve, it's going to prevent the surge from getting as high as it otherwise would have, and it's going to delay when that surge will hit.
Lori Walsh: For people who are frustrated that they're staying at home, and this is a listener question as well. They're doing everything that they can, they're minimizing everything but they know that other people are going to the bars and the restaurants that are open, the places, the businesses that are still open. What can you say to those people who are doing the right things? Are they at less risk than the people who aren't? Are you ever getting rid of your risk altogether? How low can you make your own risk? Because the fear from some of these people I'm hearing from is, "I've done everything I can, but I know these other people aren't. Are they putting me at risk?" How personal is that?
Dr. Chad Thury: Yeah, I can understand their concern and yes, the more people that are not adhering to these recommendations and guidelines as far as social distancing and stuff, that is going to potentially impact the number of people that someone that is following those guidelines could potentially come into contact with that would have coronavirus. So I think all I can say is do what you can, take care of yourself, follow the guidelines as best as you can and work on social distancing and just be an advocate as much as you can to encourage others to continue to do that as well, and I think being an advocate is probably the best thing you can do. And leading by example.
Lori Walsh: Yeah. Can we do better? Do you anticipate us doing better in increasing the amount of time it takes us to double our cases? The governor is set to hold a press conference today at 12:30. If cities or if the governor issue stricter guidelines about who can go out and when, would that make a difference in how we flatten our curve, and how long would it take to see the results of that?
Dr. Chad Thury: Well, certainly from a scientific standpoint, yes. The less people are out, the less people are having contact with each other, the more you're going to flatten that curve, and the debate ultimately in what the governor and other leaders have to weigh is the impact of how far we go as far as social isolation and also the impact on our daily lives, the economy and so on. They've got good people around them that help them get the information that they need and to make those difficult decisions, but if you look at countries that have really enforced rather draconian stay at home guidelines and methods, it does impact more greatly that curve and flattening it.
Lori Walsh: Address if you would, Dr. Thury, this notion of if we issue a stay at home order, we're kicking the can down the road and sooner or later people go outside. Governor Noem said repeatedly, "If everybody stayed home for 14 days, this virus would not be gone," and we've heard from other medical professionals that said, "Okay, in theory if everybody stood six feet apart and froze for 14 days, yes it would be gone."
People are getting confused about this idea of if we're stricter about our stay at home measures that basically this is just going to last longer. And then we see countries like Great Britain who originally seemed like they were going to go with this, "Well, a lot of people are going to get sick but we're going to keep the economy going," and they did a quick turn to say, "No, the death toll is really just going to be astronomical if we do that," and went to a stricter policy.
Help people understand, if you could, this idea of staying at home and doing this social distancing in a really intense way. Does it just prolong what's happening or does it actually reduce the impact of the virus?
Dr. Chad Thury: Well, it prolongs what is happening, but it also does reduce the impact. And so if you think about the thought of let's just let the virus spread and we'll deal with the consequences, well that shortly overwhelms our health care systems and what we can provide for healthcare and hospital beds, ICU beds, that type of stuff.
Yes, once we get through the surge, coronavirus is not going to go away, whether we do strict social isolation or a lesser form of social isolation, it's going to be around for a while. We're going to have to continue to monitor it and track it until we get to a point where there's either a vaccine or there's a herd immunity with a large portion of the population already having coronavirus.
Lori Walsh: All right, so the basics for people, one more time. The big change is wearing masks is recommended now by the CDC. If you don't have surgical masks or particle masks, use those cloth, those homemade masks. Dr. Thury, what's the final word on masks at this exact moment, understanding it might change?
Dr. Chad Thury: Yep. So this point in time, recommendation would be if you are out going to do shopping, whatever it may be, that you should have on at least a cloth mask to help prevent potentially spreading this to other people if you are asymptomatic and do have a COVID.
Lori Walsh: Wash your hands, maintain that social distancing. Any other final thoughts? Those things that are basic that really haven't changed?
Dr. Chad Thury: I think one other thing I'd add is we talked about social distancing, but I try to remind people that that doesn't mean we need to be socially isolated. We talk about the mental health aspect of staying at home as much as we are and limiting that physical contact with other people outside of your home. But I just encourage people to try to find ways to be socially involved with others using technology, and I think that's going to go a long ways as far as mental health and getting through this difficult time.
Lori Walsh: Dr. Chad Thury is Regional Director of Clinical Quality and Family Medicine with Avera. Thanks so much for your time, Dr. Thury.
Dr. Chad Thury: Thank you.