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How is SD is Planning for a Coronavirus Outbreak

President Donald Trump plans to brief the nation this evening on U.S. efforts to prevent the spread of the coronavirus. The World Health Organization and the Centers for Disease Control are advising communities to assess their readiness and educate the public. Meanwhile, South Dakota is experiencing widespread influenza activity across the state, including hospitalizations and deaths. Dr. Josh Clayton is the state epidemiologist. He joined us for an update on the flu and on the state's readiness for a COVID-19 outbreak. This interview aired on SDPB on February 26, 2020. You can listen to the audio version here:

Lori Walsh: Welcome to In The Moment. I'm Lori Walsh. President Donald Trump plans to brief the nation this evening on US efforts to prevent the spread of the coronavirus. The World Health Organization and the Centers for Disease Control are advising communities to assess their readiness and educate the public. Meanwhile, South Dakota is experiencing widespread influenza activity across the state, including hospitalizations and deaths. Dr. Josh Clayton is the state epidemiologist and he joins us for an update on the flu and on the state's readiness for a COVID-19 outbreak. Dr. Clayton, welcome back. Thanks for being here.

Dr. Josh Clayton: Thank you for having me.

Lori Walsh: Let's start with the flu. What can you tell us about how the 2019-20 flu season is shaping up so far in South Dakota?

Dr. Josh Clayton: Well, we definitely are still seeing widespread influenza transmission across South Dakota. We, over the past week, had over 1700 new laboratory confirmed cases, as well as 52 hospitalizations and two deaths, and our numbers are kind of increasing and we have not reached that peak yet for flu season. And so, it's important that individuals recognize steps that they can take to reduce their risk of illness, and that would be, first and foremost, getting their flu vaccine, taking appropriate respiratory precautions, you know, coughing and sneezing into a tissue or into their sleeve, and making sure that they're washing their hands frequently with soap and water or alcohol-based hand gel.

Lori Walsh: Same question as always, is it too late to get your flu vaccine if you haven't done so so far? Do we have enough? Is it targeting this flu strain effectively? And how long does it take to really build up that immunity once you get the shot?

Dr. Josh Clayton: So we do know that the flu shots is the best way to prevent illness. It does take about two weeks to have that full immunity develop from the time that you receive the flu shot, but it is not too late. We want to make sure that individuals recognize that, you know, we're still trending upward in terms of the number of flu cases that we have, and that means that we still have the other half of the flu season yet to go. So even if you've not gotten your flu vaccine yet, now is a good time to get it.

And it does do a pretty good job of preventing of the influenza illness. The vaccine efficacy studies just came out last week and showed that overall, for influenza A and B, the vaccine is about 52% effective at preventing illness, but that also means that there's some effect on reducing the number of hospitalizations and deaths as well.

Lori Walsh: How does this season compare to other years? What do we know as far as the hospitalization and the death rate and the activity in general?

Dr. Josh Clayton: So we know that in total, we are seeing more of the laboratory confirmed cases. Some of that is due to a difference in the tests that are being used at clinics and hospitals across the state. They have switched to a different testing type, and so we're actually counting them as laboratory confirmed cases, where before, they were only counted in aggregate. So it looks like our numbers are just drastically higher than we've seen in past years, but that is mostly due to the change in testing that has occurred over the past few years. And so I would caution, you know, if individuals are looking back at the number of laboratory confirmed cases in past years, just to take that into account.

But, you know, we looked at our hospitalizations and our deaths and we have a total of 14 deaths so far this year, and we typically see, in a given flu season, about 40 to 60 deaths. So, so far, we have a lot of transmission, but it has not been quite as severe as in past years.

Lori Walsh: Tell me a little bit about what you want from people. What's the ideal situation as far as reporting? Because when you start coming down with some of those symptoms and the fevers, do you stay home or do you go to the doctor? First regarding your own care, and second, as far as reporting and tracking this kind of information, what does that do for the state Department of Health? So first off, do I go in right away because I can shorten the duration of the flu if I show up at my doctors? Is that good for me to go in or stay home and wait it out?

Dr. Josh Clayton: So, it does depend a little bit on, you know, whether you're in that high risk group or groups for more severe complications due to influenza. Individuals who are less than five years of age, who are 65 years of age and older, who are pregnant or those who have chronic medical conditions are at higher risk of influenza complications, including hospitalization and death. And so, that does to be part of your decision making.

The other side of it is that, you know, most of the illnesses that we see are self-limited that, you know, by staying home, and the big thing is staying hydrated, you are able to weather the worst part of that influenza infection, and most people don't necessarily require going to see a doctor or even being hospitalized due to influenza. The major trigger is, you know, if that fever stays high for a prolonged period of time or if you or your loved ones are not able to continue drinking fluids in order to avoid dehydration.

Lori Walsh: Tell me a little bit about this idea of staying home, because that's an important part of prevention too. A lot of South Dakotans, you know, we show up for work even if we don't feel our best.

Dr. Josh Clayton: Yes. That is so true. You know, I think that does kind of represent some of the hardworking individuals that we have here in South Dakota, and the important thing to know is it's not always the best thing to do when you're sick. And that's kind of true for really any of the respiratory diseases out there, but more so with influenza just because of some of the serious complications that we can see with individuals who are sick with flu.

When you do become ill, that fever is going to be probably the number one factor that you'll want to take into account. If you actively have a fever, which is greater than 100.4 degrees Fahrenheit, that really should be an indication that you stay home and avoid spreading whatever illness it might be, including influenza.

Lori Walsh: I like the idea of talking too about just being prepared for some of these things before they happen. Because when you get sick, I remember getting the flu one year, my daughter and I both got sick and she had a fever of 106, and I remember looking at it and just falling back asleep. You know, I was so sick that I couldn't even take care of her. And then later on, I realized how dangerous that was. And, you know, making those preparations now for what will you do if this comes into your home is always a good plan. Be prepared. It's the season.

Dr. Josh Clayton: That is so true. You know, whether we're talking about some of the other respiratory diseases that tend to circulate around this time of year, you know, RSV, which tends to be a little bit more common among younger children, or whether we're talking about the flu, you know, making sure that you have stuff at home to be able to care for yourself and care for your loved ones, and just having that plan in place of, you know, when do we need to seek medical care because this might be a more severe infection.

Lori Walsh: We're talking to Dr, Josh Clayton, he's the state epidemiologist, about the widespread and severe flu transmission we're seeing right now. And now, let's talk about complications because the coronavirus and the news about the coronavirus is certainly complicating how people think about this flu season. And also, we're being warned right now to prepare for it. So the President of the United States is being joined by officials from the Centers for Disease Control and Prevention today for a press conference and we'll carry it live. We'll go to the NPR live coverage at 5:00 PM Central, 4:00 Mountain, to bring you the President's remarks and remarks from the CDC officials. Josh Clayton, coronavirus, COVID-19 here in South Dakota. How are we preparing? Where do you begin as state epidemiologist?

Dr. Josh Clayton: Well, we have been preparing for quite some time now. You know, this is not something that has really kind of come out of the blue. We have known about the novel coronavirus and its transmission within China since early January. The state is monitoring the situation. You know, you have seen some of the reports in national news about state departments of health monitoring individuals who have returned from China, and that those individuals, starting the first part of this month, first part of February, are being, you know, monitored by public health officials to make sure that those travelers don't develop the symptoms of novel coronavirus.

So we are really looking at are individuals developing, you know, a fever, a cough or shortness of breath that might indicate that the novel coronavirus has spread to the lungs. And so, we have, you know, been monitoring the situation, been working closely with CDC, helping keep informed our healthcare partners to make sure that they are prepared if we have an individual that needs to be evaluated and what that means for testing and what that means for the public health follow up, really to make sure that individuals who had been exposed to a case of this novel coronavirus are notified and allowed to self-monitor for infection.

We're at a little bit of a review point in our planning. We have seen the novel coronavirus spread from China to other parts of the world, South Korea, Italy, Iran, and the Department of Health and the CDC and healthcare and other folks are now ratcheting up our planning efforts to make sure that we're able to prepare for additional introductions of novel coronavirus into the state.

Lori Walsh: Do we know if we have had any people in South Dakota who have been notified of their exposure or who are currently quarantined in the state or elsewhere?

Dr. Josh Clayton: So what we do know is that there have been 15 total cases in the United States. That has not included South Dakota. Those states that had novel coronavirus cases from returning travelers included Arizona, California, Illinois, Massachusetts, Texas, Washington and Wisconsin. So it has been a very limited number of States. Individuals may have also seen some of the discussion of bringing the US citizens, you know, back to the United States from Wuhan or from the Diamond Princess Cruise Ship. There have been additional cases novel coronavirus identified among those individuals.

But all of those cases have been outside of South Dakota and they are under isolation to make sure that they do not spread the virus to other individuals. And we, you know, currently in South Dakota have not had any cases. We've not had any persons under investigation, which would be our suspect cases, and we have not, you know, had to evaluate anyone who had traveled to China.

Lori Walsh: Are public health officials rethinking the notion of quarantine and it's effectiveness now that we know that this is a virus that is transmitted similar to the flu? It's just very difficult to stop. Is quarantine still... I guess what I'm really wondering is at what point is the quarantine not effective as more and more cases are reported?

Dr. Josh Clayton: And that is a very, you know, difficult thing to try and evaluate. We know that one of the best things that we can do, whether we're talking about flu or we're talking about novel coronavirus, is to, for those individuals who are positive with the infection, to reduce their risk of transmission by isolating them in a hospital or in a facility or at home. The quarantine of individuals has been effective in the recent past because we've had these limited introductions, and we've always been able to link back to, you know, which cases have been, or which individuals have been exposed to cases.

When we start to have larger sort of community transmission where we don't know who exposed individuals within the community and have some difficulty in tracking that and establishing that link, that's going to be where quarantine, you know, really does break down and we need to look at other ways to reduce risks, such as social distancing and making sure that individuals are, you know, keeping their distance from individuals who may be ill.

Lori Walsh: Does South Dakota have the test kits necessary, the protective gear for healthcare workers necessary to handle a potential novel coronavirus transmission in the state?

Dr. Josh Clayton: That is something that is part of our preparedness plans is to make sure that we're evaluating what we have in stock at all of our healthcare facilities across the state and reserving, you know, that for the care that needs to be provided, both now and for in the future. And so, there are some guidances out there, you know, from CDC that help healthcare facilities make sure that they're using PPE when it's appropriate and where it's appropriate, in efforts to make sure that we always have that PPE available for those healthcare workers and for other individuals who may be providing care.

Lori Walsh: Can you be more specific about where you're at in that review process? Does that mean we're gathering the numbers and thinking mathematically how many would we have to have? Does that mean we're already prepared for a certain number of cases? Can you just break that down a little further place for people?

Dr. Josh Clayton: Sure. So we have already spoken with our hospital systems to identify, you know, what are their PPE needs now and what do they have available to them, either in the hospital or available from their suppliers, to meet current needs and to meet some future anticipated needs. You know, we also have the capability of helping support those hospital systems by sure that we're moving the appropriate medical supplies around to ensure that we have them where they're needed.

And the other thing, you know, that we always have access to, and this is something that we have just as a larger medical supply, is access to federal stockpiles of medications and PPE and things like that that could be utilized in an emergency situation. And so, you know, that's something that the federal government manages and, if states request it, is available for situations such as this.

Lori Walsh: One of the challenges with coronaviruses, we're hearing, you know, if you think you have symptoms, stay home. Don't go into your clinic and present yourself there. Stay home and call for some kind of help. And then we just talked about the flu and those people who are, you know, underlying risk factors should go in. People are starting to get confused and a little afraid even, maybe they shouldn't be yet, but that's human nature. Do you just put it out of your mind for now and just treat it like it's the flu because we're going to know when it comes here? You've got people on cruise ships right now that are coming back to South Dakota, you've got people flying in from all over the world. Help people understand how they should think about this and think about symptoms that resemble the flu or something else if they get them.

Dr. Josh Clayton: So, you know, we know where the novel coronavirus is currently circulating, and we are doing followup with individuals who are at elevated risk of, you know, getting sick with novel coronavirus as they travel internationally. So I think there is that separation of, you know, if you have not traveled internationally, and even if you've traveled internationally, not traveled to those countries that have been impacted, you are more at risk of kind of the seasonal viruses that we see like influenza. For those individuals that are at some elevated risk, the Department of Health is working to monitor those individuals and make sure that if they develop symptoms that, you know, we're working with the healthcare system to evaluate those individuals for novel coronavirus.

So, you know, your general South Dakota resident that is developing fever or cough, those are also the signs and symptoms for influenza. And so, you know, you need to think of what sort of risk might you have had. And right now, you know, individuals who are in the community should be thinking influenza. For those who have traveled specifically to the countries where we have novel coronavirus, we need to just make sure that we're taking precautions that it's influenza and not novel coronavirus.

Lori Walsh: Dr. Josh Clayton is the state epidemiologist, and Dr. Clayton, we'll invite you back for updates on the flu and coronavirus as we learn more information tonight at 5:00 PM Central, 4:00 Mountain. President Trump addresses the nation about efforts. He'll be joined by officials from the Center for Disease Control and Prevention so we have a bigger picture of American efforts to stop the transmission of a coronavirus here at home. Dr. Clayton, thank you so much for being here with us. We appreciate your time.