Jackie Hendry: South Dakota saw record COVID-19 case increases multiple times last week. We now welcome Dr. Jason Knutson a Family Medicine Physician with Avera Medical Group. He's going to walk us through the COVID news from last week, and also give some guidance for parents who are navigating this unique back to school time. Dr. Knutson, welcome to In the Moment, thanks for joining us today.
Dr. Jason Knutson: Thank you.
Jackie Hendry: So we saw those large increases last week. We had a couple of days with more than 300 new COVID-19 cases each, what are we seeing that's driving the increases?
Dr. Jason Knutson: Oh, I just think it's a combination of things, we're seeing a lot of traffic due to the rally I suspect, and school getting started again, and colleges getting started again. All of those things are probably key, but also big gatherings, like the races we've been seeing, the auto races, we've been seeing a few come out of those, well, quite a few coming out of those places as well. So lack of social distancing and not wearing masks and things like that. Those are the things that are probably driving this.
Jackie Hendry: And as we mentioned earlier at the start of the program last week, for a couple of days, the Department of Health under reported some cases due to what they called a reporting aberration or a technical glitch in their system. From watching comments on social media over the weekend, that glitch has led lots of people to lose their faith in the data that's being reported. Is that a fair response to something like this? How should people view goof ups like that?
Dr. Jason Knutson: I don't think so. I think the State's done a nice job. As far as I am aware of, that was about the only time this has happened and I could be wrong on that, but we follow the numbers fairly closely and they were reported a couple of days later. So I don't know what happened, but I wouldn't lose faith. I mean, those numbers were reported, they were just reported later. The news was not good anyway, so it's not like they didn't report it at all. They just reported it later and said they made an error. So I don't think it's a big deal. I think we should have faith in those numbers and move forward from there.
Jackie Hendry: I want to shift now from that data question to questions about testing. I know the CDC recently adjusted its testing recommendations. Now no longer recommending testing for people without symptoms, even if they've been a close contact of a positive COVID-19 case, how does that impact the approach Avera has been taking to testing?
Dr. Jason Knutson: I think it differs completely, for a while we were doing the same thing, but it was only because we didn't have enough tests. There was a big shortage, and we're still worried about those tests, the testing numbers and the supplies that we have. But right now we have enough to test asymptomatic contacts and we're continuing to test those. I think the CDC may have went back on that recommendation shortly after they made it. So if we've got the test, I think it's important to be testing those asymptomatic contacts. But the biggest thing that we need to realize is that if we do test asymptomatic contacts and they're negative, it really doesn't mean a whole lot, it just means that they're not shedding the virus at that point. They still need to quarantine and assume that they will have it or have it at that point moving forward.
So a positive test will potentially allow someone to get back to work a little bit faster, but the benefit is that we can track those people and do contact tracing with those folks that are asymptomatic at an earlier time. But it doesn't mean they don't have it or won't get it in the near future.
Jackie Hendry: Is there a time window of, if you know you've been a close contact, but you don't have symptoms, do we know enough about the virus yet to know a time window when that viral load will be enough to potentially show on a test?
Dr. Jason Knutson: Yeah, usually it's between four and five days as most people are going to be positive at that point, but it can take up to 14 days. That's why it's so important to have that 14 day quarantine. It's another thing that makes this virus so difficult to deal with, as it can be different in every individual. Some people will test positive very quickly and some people won't test positive until quite late.
Jackie Hendry: A question I've received is, our neighbors to the North in North Dakota have tested about twice as many people for COVID-19 as we have here in South Dakota. Do we think we have an accurate picture of what the virus is doing in South Dakota? Or do we need to ramp up testing? What are your thoughts on that?
Dr. Jason Knutson: In a perfect world, I think we would be testing a lot more people and more frequently. I just don't think we have enough test for that. That being said, I think it's okay what we're doing. And at Avera We're basically testing the people who want to be tested at this point, unless they have no exposure and no symptoms, we don't test those people. But I would personally like more testing if we could get it, I think that would be great. We could be testing potentially people in high risk situations very frequently to make sure that we don't have asymptomatic spreading the disease in those situations. But we're just trying to do the best with what we have at this point.
Jackie Hendry: Right. Shifting to the topic of back to school. We've got students back in the classrooms and parents already looking ahead to that cold and flu season. And a question from a parent I got was how should parents navigate when to get their kids tested for COVID-19, as we start seeing more seasonal ailments with sometimes very similar symptoms to COVID-19?
Dr. Jason Knutson: It's a great question. And it's pretty easy to answer at this point, but it's frustrating. The answer to that question is any symptom, at this point that is listed on the COVID symptom list is COVID until proven otherwise. So if you have a runny nose, what we're hearing right now is people think, oh, it's just my allergy's. Well, sometimes it's COVID. If I have a stuffy nose or if I have diarrhea, headache, sore throat, fevers, chills, sweats, all of that stuff could be COVID. There are plenty of people out there who get no symptoms or just a stuffy nose or a little cough or a headache that have COVID. So at this point, there's going to need to be a lot of testing. So what I would recommend to parents is that if they have any of those symptoms, they get their children or their loved ones checked.
Jackie Hendry: And what I'm inferring from that is don't be shy about potentially getting your kid tested several times over the course of the semester, if they're showing symptoms.
Dr. Jason Knutson: Yep. You're exactly right.
Jackie Hendry: What's the advice when it comes to getting a flu shot this year, is it too early right now? Or what are we looking at for that?
Dr. Jason Knutson: Right now, I'd say the earlier the better, that being said, we don't have them in our clinic yet. So I'd say as soon as we have those, I would recommend people get those. And that's huge because if you can take away, if we get the immunization pretty close to accurate this year, and we can shut down influenza pretty well, that's going to be a huge load off for testing and people getting sick, because the picture will be confused a little bit. That being said, we're coming up with a task to, actually it's probably ready about now, but it's got influenza, COVID and RSV some of the famous fall illnesses in one test. So we can swab once and get all four of those, influenza A and B, RSV and COVID done in one swab. So that's going to help a lot, but people just need to be ready to get tested. And if they can get that influenza vaccine, that will definitely make things a lot easier.
Jackie Hendry: How much are individual healthcare systems like Avera or others working with school systems in their area, as far as testing and other strategies?
Dr. Jason Knutson: Yeah, quite a bit actually, a lot of the universities are doing contracts through Avera and probably other universities are doing them through different health systems. But we've had a lot of meetings with quite a few different school districts on advising them, how to open up and how to try to stay in school as long as possible. And so those conversations have been very valuable and they continue to go on as we move forward through all of this.
Jackie Hendry: Going back to this idea of testing asymptomatic people, it's becoming a conversation in some school districts around the State to designate teachers or other school staff as essential personnel. Which would rather than having teachers quarantine for 14 days, if they've been exposed, if they're able to get a negative COVID-19 test, they don't necessarily need to stay out that long. And they can come back to school a little sooner to alleviate staffing concerns, things like that. To alleviate those staffing concerns, of course, would be one of the benefits to that move. What could be some of the potential concerns for a move like that?
Dr. Jason Knutson: So if you test asymptomatic folks, there's a 35% false negative rate. And with some tests it's even worse than that, depends on the test that the hospital system is using. So the hard part about that is that if we do a negative test on, for example, a teacher, they're asymptomatic but they were exposed. We have a negative test that doesn't mean they don't have COVID. So obviously they'd have to be wearing their mask, they'd have to be wearing a shield. The risk is that you have a teacher who is positive, who could potentially be spreading that illness to lots of other people. That's the downside of it. But it's a very difficult situation because if we look at it, it's hard to get subs for a lot of school districts already. So when we start throwing in the quarantines and the exposures and all of those things into the mix, it makes it very difficult to have school. So that's one of the biggest hurdles that we need to get through, but there is definitely quite a bit a risk sending a potentially positive person back into school.
Jackie Hendry: Which kinds of tests are typically the most accurate when we look at the different ones that are available?
Dr. Jason Knutson: Yeah. So there are quite a few of them out there. The Abbot test was quite popular early, and that has lost a lot of favor because the false negative rate is quite high. If you have a positive with an Abbott test, it's pretty accurate, but the negatives you can't really rely on. So almost all the hospital systems are using testing now that's very accurate. So a lot of them are 97 to 99% and then the error rate is due mostly to how the sample was received basically. Did they get the sample up far enough into their nose or not, but we have some new tests that are very accurate that the nasal swabs that are a lot better tolerated. So we're moving in the right direction.
Jackie Hendry: I hear or see different Facebook posts and hear different stories about the potential for a spit test that I think a lot of people would find more appealing than having a big swab go up your nose. Is that something that's actually very close to being possible for COVID-19?
Dr. Jason Knutson: I hope so. We have a meeting about it this Wednesday. So we've talked about it a little bit, and I'm hoping that that's going to be something that we can do. If we can do that in high numbers, that would be fantastic, if we could get enough, the swabs and the reagent and all of those things for it, but it's an easy test to do, it's well tolerated. So the initial data that I've seen on it shows that it's pretty accurate as well. The big thing will be how much of it can we get?
Jackie Hendry: Talk to us about speaking of new things on the horizon, this idea of expediting a potential COVID-19 vaccine on the national level. Part of that response is fast tracking potential solutions that makes some people nervous, they think, is this vaccine as safe as it needs to be for me to use it? Talk to folks who hear that headline and aren't sure what to make of fast tracking a vaccine.
Dr. Jason Knutson: This one's tough because obviously all of us are hoping for a really good vaccine that works well so we can get back to a much more normal life. I think it would be fantastic. All of us want it to happen fast, I want it to happen fast, but at the same time, I want to know that it's safe as well. In the medical community, one of the things that is really important is, we need to be able to tell people who get these vaccines that they're safe. So I'm a little bit nervous rushing into it. I want to know that it's effective and safe. I just don't want to lose credibility with anybody if something were to come out and then have it not be safe. As a physician, I would love to know that that the vaccine is safe. Now, if they do rush that and they tell us that it hasn't been tested as much as they would like, I think that's fine if we give that, but we need to be telling the patients exactly that.
So we could just explain that this is a new vaccine. It has, or has not been tested. It is, or it may or may not be safe and then they can make that decision for themselves. But it would be great if we could get a great vaccine and just have us know that it's safe. So I really don't want to cut any corners unless patients want to do that and they're aware of the risks. But I would, in a perfect world, it would be safe and fast.
Jackie Hendry: Any closing thoughts for families listening to this concerns or questions that you're hearing that you want to address as we wrap up today?
Dr. Jason Knutson: The main thing is just like what we've said before, the biggest thing that we can do right now is stay away as much as we can, try to do the six feet apart, social distancing, get your masks on. That's the best way to do all of this. And I'll say it again, that if we want to stimulate our economy, if we want to keep kids in school, keep kids on the football fields or the volleyball courts, or cross country, golf courses or wherever they're running on that day, try to wear your masks, not even try, just get them on, do the best we can. Stimulates the economy, it helps in every way, it helps decrease the spread of the virus. And if everybody were to do this, we wouldn't be worried about COVID a whole lot. So most people right now, even the schools that are requiring them, the reports that I've heard so far is that kids are handling it very nicely, even the young ones. So I encourage everybody to do your part and see if we can get this thing shut down a bit and try to get back to normal.
Jackie Hendry: My guest has been Dr. Jason Knutson, Family Medicine Physician with Avera Medical Group. Dr. Knutson, thanks again for your time and for visiting with us today.
Dr. Jason Knutson: You're welcome. Thank you.