Jackie Hendry: Each week, we turn to local healthcare leaders to discuss the latest information about the ongoing COVID-19 pandemic. Today, we hear from Dr. David Basel. He's the vice president for clinical quality with Avera Medical Group, and he's also a pediatrician and internal medicine physician. Dr. Basel, welcome to In The Moment. Thanks for being here.
Dr. David Basel: Thank you for having me, Jackie.
Jackie Hendry: So plenty of news in the past week, but I want to start our segment with this. What do we know today about COVID-19 that we didn't know last week?
Dr. David Basel: So as we look across the state of South Dakota, numbers still are staying pretty flat and maybe slowly trending upward in places. I've been following these numbers really closely through the course of this, and it's interesting how it's changed from some of our initial assumption that this was going to be hitting everywhere at once. Now it's kind of like all politics are local. Now we're in kind of this time period where everything... we've got lots of, at least a certain level, of COVID across the state that's smoldering and it's more about kind of seeing where it flares up in different parts of the state, in different parts of the country, and trying to get those flares out before they coalesced into a Prairie fire. It's kind of the way I describe it these days.
Jackie Hendry: Right. It seems at least the kind of flares or little clusters that I'm hearing about, of course the largest one that made headlines early on was the Smithfield situation at the meat packing plant here in Sioux Falls, and it sounds like the other clusters that we're hearing about; DemKota, Jack Link's, a lot of these other kind of meat plant related situations. Where else are we starting to see some of those flares crop up?
Dr. David Basel: Yeah. So you're exactly right. The Sioux Falls area, at least as far as Avera's numbers have been going, have been falling really for the last month [crosstalk 00:02:16] slowly. We still have a fair number of cases, but not nearly what we did months ago. Other parts of the state really have taken over being a little bit more of hotspots. West River continues to be an area that we watch pretty closely, especially as tourism opens back up. What will that look like as we get more people coming from outside of the state into the state? It's that monitoring phase where we're just ready for wherever it's going to pop up.
Jackie Hendry: Talking about that travel, especially folks maybe from out of state coming to tourist attractions; West River, or even just folks locally. I remember early on hearing that these very high percentages of folks who will end up with COVID-19 won't show any symptoms, which is so much of what makes people so nervous and makes this a very complicated situation. At this point in the game, do we have a better idea of the rate of asymptomatic infections? Or what can you tell us about that level of the situation?
Dr. David Basel: Yeah. So, that is really interesting. One of the things that we're really going to be paying attention to and learning as we go through the next several months is that spreading pattern. You're hearing terms like super-spreaders right now because a lot of the times it seems like a few individuals can really spread it to a lot of individuals, and then other positive individuals don't spread it too much. There's some growing data that maybe children don't spread as much as adults do, and so there's some of that data coming out that there's certain differences between people that make them more likely to spread it than others. Going back to that number of how many asymptomatic people are out there, that's a really interesting question. Couple of things that we've done recently was the antibody tests becoming out there, or serology. Your immune system, you get exposed to COVID and you create antibodies as part of the immune response to fight that off and then you can detect those antibodies.
We ran a couple of studies here looking at all of our ED department, all of our frontline patient-facing staff, and gave them opportunity to all be tested, and then another one of our clinics here in the Sioux Falls area, and then another one of our rural clinics to see how many people in pretty high-risk healthcare occupations had shown evidence of being exposed and infected. The numbers were actually really surprisingly small, like around 1%, even in this high-risk group. Showing that still 99% of our healthcare workers still haven't been infected, meaning that we're all still at risk. But the good news is all of our [inaudible 00:05:12] and masking and stuff has been really effective at keeping our healthcare workers safe. So similarly, the state now is starting to do what's called zero prevalence or antibody testing, looking at trying to see what number of people have been exposed so that we can get more of a handle on that. So over the next couple of weeks, I think we'll get a lot more feel of that as the state starts to do some of those type of studies.
Jackie Hendry: You mentioned a research coming out showing that children may not be as capable of spreading this virus as far as adults. I remember a few weeks ago we were hearing more and more about how this virus is manifesting in children very differently than in adults. What else, if anything, do we know about how COVID-19 impacts kids?
Dr. David Basel: So one of the other things is the inflammatory syndrome that you've probably heard about. This is a relatively rare one, but it is pretty significant illness; can cause cardiac heart toxicity in children if you're not careful. So children aren't totally immune from this and it's something that we actually have to watch, but it's certainly lower levels of hitting them than, say, influenza does.
Jackie Hendry: Is there still a fear as far as a resurgence of cases, as we see a lot of these mitigating ordinances and things like that start to relax?
Dr. David Basel: That's certainly the million-dollar question, isn't it? So there's no doubt that early on the public was so helpful to us, and we are so grateful for everybody's efforts on social isolation. Gave the hospitals and healthcare systems the ability to get out in front of this without being overwhelmed; get our supply chains re-established because everything was still disrupted by exports from China being shut down, and so just trying to get gowns, and gloves, and masks, and testing supplies; and get all of that re-established to enable us to get back on top of this. Also, allowed us time for some of these treatments to start coming out. We're getting some doses of remdesivir in the state. Plasma, convalescent plasma, has really taken off and we've got quite a few doses of that, that we've given over time. So it's given us that time period to get out in front of this.
Now, certainly on board, everybody's got to be getting back to work carefully, and starting to slowly reopen back up. We're just going to have to wait and see. So far, we haven't seen a big uptick from when we started opening back up again, other than some of these hotspots, and so monitoring that through the summer. But certainly, the numbers have not fallen away to zero by any means. They're just staying steady, which means we are at risk for seeing this break back out again. One of those things, unanswered questions, is still how sensitive is this virus to UV and, say, heat, and will that be enough heat to keep it at the smoldering level at least through the summer and into the fall, and then what will happen later in the fall? Like I said, now it's more a case of monitoring because there's so many variables and all of those things. So trying to watch those trends really closely and seeing when they start to pick back up again is kind of what I'm doing.
Jackie Hendry: I want to talk a little bit about testing policy. By that I mean, in the beginning of the pandemic you were pretty much only tested for COVID-19 if you had very particular symptoms or if you went to a particular place. That has shifted as we've gone on, for instance, with the state supporting testing of all nursing home residents and staff and things like this. I bring this up because with the situation, with large protests and other demonstrations continuing in South Dakota and around the country, I'm just curious, if anything, with those being such large gatherings, if that might play into testing policy. If someone calls with concerns about symptoms or something, will that be part of the question, "Have you attended a demonstration recently?" or something like that?
Dr. David Basel: Yeah. So definitely there's been almost week by week evolution of testing strategies, especially as we've been able to reestablish some of those supply chains. So the amount of testing supplies that we have available to us today versus even a month ago are significantly higher. In fact, now the state has really been in discussions with us and talking about the different priorities for testing, and Avera is now very happy to say that we're testing all symptomatic individuals at this time. Before it was, earlier in the spring, it was only if you were a high-risk group and symptomatic. Now as the testing supplies loosened up, we can test anybody that calls in that has one of the 10 symptoms there that qualify you, and so that includes people... Certainly, we're worried about any large group gathering. Puts you at risk of it, especially if it's an extended period of time, if there's not a very high percentage wearing mask, and so certainly some of these demonstrations fall in that.
Even if you attended one of these demonstrations and you're not symptomatic, we're encouraging people to closely monitor their temperature and symptoms so that if they do develop it, that we can get them out of circulation and from further spreading it as quickly as possible. But definitely an increase in the number of people that we can test. Those longterm care testings, we've tested over 2000 people in a two-week period and less than a half of a percent of those in longterm care were positive, which was a great, nice, low number to have in that setting. So just our ability to do some of those sorts of things have so significantly improved in the last few weeks,
Jackie Hendry: We've got a couple minutes left, Dr. Basel. Run through it again for us. It always is nice to have a reminder. What are the things that we should continue to do, even as some of these ordinances and things are lifted? What should we continue to do to protect ourselves and those around us?
Dr. David Basel: So it's all about the basics of social distancing. So it's still keeping that six foot of space between you whenever possible. When you go out in the public, wear a mask. I can't stress how important that is when you're going to be around other individuals. We call it forced control. Even though you're feeling like you don't have any symptoms right now and you think you're at low risk, you never know when you are developing that. So by wearing a mask, we're being able to prevent people from giving it to somebody else before they even realize they have it. That's such the key of keeping this down, keeping things from flaring back up again. There's that social distance thing, wearing a mask, and then the general good practices; washing your hands, hand sanitizer, cleaning high-traffic surfaces like door knobs and stuff like that. But the two biggest ones is keeping your distance and wearing a mask whenever you're out in public around folks.
Jackie Hendry: Keeping a distance, wearing your mask. Even if you're outside, wearing a mask?
Dr. David Basel: It depends. Like when I'm in my own yard, I certainly don't wear a mask. When I'm walking if I feel like I can keep a good distance away from people, I haven't been wearing a mask. But if I'm going to be in any type of a crowded condition, certainly when I go to grocery store, even when I'm in the parking lot at the grocery store I've got my mask on and stuff. So, anywhere that you can. I get it. I mean, wearing a mask when it's hot out there is not fun. I hate the heat in general anyway, and so I hate wearing the mask when it's in the heat, but I do it to protect the others around me.
Jackie Hendry: My guest has been Dr. David Basel. He's the vice president for clinical quality with Avera Medical Group, also a pediatrician and internal medicine physician. Dr. Basel, thank you for your time today. We always appreciate it.
Dr. David Basel: I appreciate having the opportunity.