Coronavirus Q&A No. 2 transcript

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RBC | The HT and RBC Public Health co-hosted a second live Facebook Q&A Monday, April 13. Public Health Director Alice Harvey responded to questions on a wide variety of topics, including the use of ibuprofen, recommendations regarding cloth face masks, herd immunity, and whether or not RBC already had a rash of undetected coronavirus cases in December and January.

Watch the full video here, or read the transcript below.

Scrub to these times in the video for specific questions:
0:10 – Is ibuprofen safe?
2:44 – Do I need to shower and wash my clothes after I leave my home, and how should I launder my clothing?
7:58 – Where are we at with antibody testing, and testing in general?
12:00 – Is there any evidence or indication COVID-19 was present in Rio Blanco County in December and January?
18:33 – How effective are the tests?
21:37 – How long is this going to last? Would it be better to pursue herd immunity?
24:52 – What about the reopening of non-essential businesses?
24:58 – How long will we need to keep practicing social distancing measures?
27:29 – What about salons and spas and other close contact professions?
28:44 – Who should be wearing face masks, really?
31:38 – Are people with well-controlled diabetes considered high-risk?
32:43 – Is two more weeks of social distancing going to be long enough without restarting the cycle?
33:00 – Have cases peaked? When will that happen?
34:15 – What mental health options is the county offering?
35:46 – Will the county provide relaxed guidance contrary to state orders?
36:21 – Is state science the only science the county looks at?
37:19 – Why is school construction still happening?
39:22 – Do case counts include people who have recovered or only currently active cases?


Here’s our full transcript:

Niki: Starting over after technical difficulties. So we’re here with Alice Harvey. She’s our Public Health Director for Rio Blanco County, and she’s got some questions that we’ve shared with her about coronavirus and COVID-19, and she’s going to respond to those.

Our first question that came in through our survey was about the use of ibuprofen and people concerned about that making them more ill, causing problems. Alice, what are the current recommendations for ibuprofen and NSAIDS?

Alice: Sure, that’s a very good question and thank you very much Niki and Caitlin for having me on again tonight. I really appreciate it.

So in terms of ibuprofen, this came out, this warning came from some observations that were made by doctors, a team of doctors in France, early on, who noticed that some of their patients were getting sicker faster with the use of NSAIDS. And NSAIDS, by the way, that does include – it’s not just ibuprofen. So it’s aspirin, naproxen and some others. It doesn’t include Tylenol. But they were concerned because some of their patients were getting sicker.

The WHO [World Health Organization] initially put out a statement that ibuprofen should not be used, but they have since retracted that statement due to a lack of evidence, and this whole thing is just so new. There’s so much data we’re collecting and there’s so much we don’t know about the virus itself.

So we would still like to say to not use ibuprofen unless Tylenol is not working. So use Tylenol first (acetaminophen), and just because there is a hypothetical risk still; they’re still studying it.

It has to do with NSAIDS increasing a certain kind of protein on the surface of our cells. So there was thinking that this particular protein might be involved in the binding of the COVID virus to our cells, and then it may have been causing the infection to act faster. So our recommendation while we’re still waiting is to use acetaminophen. First, reach out to your health care provider before you use NSAIDS if your fever is not controlled with Tylenol just to be safe since the jury is still out on this one and we are not the clinical experts by any means on this topic as well. So we definitely want to go with whatever our health care providers suggest, and you know our advice never takes the place of your doctor’s advice, if Tylenol is not working, not doing the job to control your fevers.

Probably the best, the safest way to go until we have more evidence proving the validity of this claim one way or another.

Niki: Okay, and people should be paying attention because everything is changing so fast.

Alice: Exactly, yes. Definitely.

Niki: On a dime, it seems like. Okay, our second question that came in was from somebody that said they read about needing to take a shower and wash all their clothes after they go out to the store or to the post office and wanted to know if that was good advice or if that’s going to an extreme.

Alice: So another really good question. So a couple of things here. This is extreme for the layperson. However, I’m gonna go over a couple of things.

Infectious disease experts are pretty much saying in general, you don’t need to shower or launder more frequently than you normal would, unless you’re in high-risk situations, and that’s the key here. So a shower if you’re in contact with people for any reason like in your job, then it definitely can’t hurt to launder your clothes, be extra careful and wash them after that contact.

Now, health care workers or people caring for people who are sick? Then yes, definitely. And we really emphasize that with anyone who has close contact in their job because they … could potentially have respiratory droplets on their clothing and their skin, even though the virus is much less likely to live on clothing.

The best research coming out of John Hopkins right now – that’s the place that’s doing a lot of research on how long the virus lives on different surfaces – you’ve probably all heard by now they’re looking at about 72 hours/up to 72 hours on plastics. I think it’s 48 hours on stainless (steel), 24 hours on cardboard. There’s no definitive studies on fabric, it’s a little harder to study. They’re saying probably a few hours, at most a day, but we recommend definitely caregivers and health care workers shower after shifts and not let their clothes contaminate their homes, take off their shoes, et cetera.

That’s pretty much the general rule for health care workers, but then it’s similar to face masks. We’re not gonna say, “everybody needs an N95 respirator, not because it’s not more protective than a cloth mask, but because we’re raising that based on exposure level and risk leve. But I think that the biggest take-home point, although the experts don’t recommend/don’t say it’s necessary.

There’s a couple things to think about here and this is why I say, “hold on a second and let’s think about this.” So cleaning and disinfecting the high-touch surfaces and avoiding touching those when you’re in public is your best bet. There’s no evidence that taking extreme measures of precaution will necessarily help you any more than if you really, really live by the hand hygiene and disinfecting of those contaminating high-touch surfaces. Those are the rules, that’s what’s gonna help you, but we also know that we don’t live in a perfect world. So your neighbor might not be adhering to the rules. You might have stopped at the grocery store, said ‘hello’ to them, they might have sneezed or coughed on you. I always think about, what if they touch the cereal box before me, and then I came and touched it. I say this not to scare anyone, but really to say these fears are totally validated. So most importantly, experts are worried that the preoccupation with things like showering and laundering the clothes will take the place of the more important measures: washing your hands, maintaining the six feet between you and other people in the store. The recommendation is to take precautions based on your risk level. But on that note, it definitely can’t hurt to wash your clothes after you’ve been in a public space, definitely not rewearing clothes after you had any interactions during the day. So maybe not every time you walk back in the house you need to wash your set of clothes, but thinking about who you are exposed to, what level of contact you had. So I really like that part of the question that said in terms of when and where. Really, that’s what you should be thinking about if you’re in any situation. Say if you go to the post office, you run into somebody and you’re in close contact, because we realize that’s gonna be unavoidable at times. So then the answer would be yes. Why not? You know, take a shower and wash your clothes, but as a general rule it is extreme to, and just knowing what we know about the virus so far, that is not the highest risk that’s posed to you, getting on the clothes in the grocery story. So I hope that answers that question.

Niki: I think that does answer that question. There’s probably gonna be people that will shower and wash their clothes anyway. Just because.

Alice: Right, exactly. Oh and one last thing on that, Niki. I was just going to say – important, because I do get questions about this: regular detergent works. So the virus has a lipid layer. It’s like a fat, a fatty outer layer. So just using plain (that’s why washing your hands with soap and water works) regular washing detergent is fine, and the hottest water you can use is better.

So when you work as a nurse in a hospital, you do kind of come home, shed your clothes before you go in the house. So maybe not to that extreme, but I think taking your shoes off when you walk in the door, going straight to your room, taking your clothes off, having a laundry basket and just being conscious of those types of things. And then not sharing shower items. Those are some other things you can do to eliminate or reduce the risk a little bit.

Just a different way of thinking about things than most of us have applied for a long time.

Niki: Okay, third question, and the third question and the fourth question are going to kind of go together. The third question is about antibody testing. Can a person be tested to find out if they have the antibodies for COVID-19 if they think they’ve been previously infected? That’s question three.

Alice: Okay, so the answer to that is not yet. It is not currently available. However this is the kind of thing I’d like to go into in my weekly updates, bu there’s far too many details. So this is a good opportunity. So currently there have been antibody tests that have been developed. They’ve been given an emergency authorization to be used.

The FDA has given an emergency operation for authorization for them to start being used by some commercial laboratories. So those things are starting to happen. There’s a task force that will be presenting, a Colorado task force that will be presenting. They’re doing a big assessment right now on the findings of all these new tests and commercial products that we should have by the end of the month. The governor promised that before the public health order/stay at home order was lifted so that we can really start to make a road map for testing in the future. At public health, we’ve pre-ordered some of these. I know the hospitals will be working on this also. So the answer, really, is not right now. But as far as to where and how, there’s not one yet, but we’ll be passing that information along as soon as we have it. The reason why the answers to testing questions are never simple is because it’s really not simple. It’s crazy. It’s probably the one thing that drives me the most nuts in my daily life. The testing landscape is changing constantly, so as you know, this is a national issue in terms of lack of resources and supplies, and so we’re fighting every day here to bring as much testing capacity as we can as fast as possible to our county. So we’ll continue to be completely transparent about that. Clearly our priority has been and will continue to be supporting those who are really ill or have underlying conditions, the most vulnerable like frontline workers, and people who live in nursing homes, et cetera. So we’ve been really lucky here in that we’ve been able to do that testing for those high-risk groups this whole time because of our two incredible hospitals. So that’s fantastic. We’ve been able to facilitate testing on some level. There are some places in Colorado where they don’t have critical access hospitals and I will be completely honest with you in telling you we have gotten zero test kits from the state. However, we started planning early on for the worst, so we’ve got orders with various private vendors. So there’s a whole lot going on. We do expect to be able to fill in the gaps with testing eventually, including antibody testing and what that will look like and who it will be and what scale it will be on and who will be testing, of course. Those are all questions that I don’t have the answers for yet. But I can definitely tell you that we’ve been very lucky to have the testing availability here for those who needed it the most thus far, but we’re constantly working on ways we can expand that in the near future, so that’s really the best answer I can give you.

Niki: Possibly by next month when we do this again. We’ll have more answers to that.

Alice: Yea, definitely by next month I would think. Next couple of weeks we should be getting that task force report. It’ll really kind of say, okay, here’s what antibody testing is available. Here’s what we’re recommending and here’s how it’ll kind of roll out. And I always joke around it truly is like in the movies. I’ve gone back and watched Contagion. I watched that the other night and just had, like, this is just crazy how realistic it is now. But you know when you see everybody scrambling, scientists scrambling to make the vaccine and make the testing – that’s all really happening. And so I’ve been trying to keep on top of that while at the same time, fight with people for test kits, and just really try to balance it out and we’ve been working. Again, we’re just so lucky to have our hospitals because if it wasn’t for them, we would have been in a much worse place as far as testing is concerned. So we’re very grateful for that.

Niki: So that question rolls into the next question. I know you’ve had this conversation with people. I’ve had this conversation with people. There was a wave of respiratory ailments that came through our county back in December-January that weren’t flu. People were tested for influenza, their test came back negative. But they look back and they’re saying, “all of my
symptoms fit. I think we already had it.” What’s the likelihood of that? Or is there any evidence for that?

Alice: That’s probably the the million dollar question and I actually love being given the opportunity to answer this question because there’s so much that goes into it. In fact, it’s hard for me to even formulate an answer that is short and succinct because there is so much to talk about here. The answer is the likelihood is low and there’s two reasons for that and I’m gonna talk about two different things here. Number one is based on just the virology studies that are being done on the mutation of the virus itself and I would like to show a website. I’ll share my screen after I talk about it a little bit to explain that and then the second part is based on analysis that we’ve done on the clinical presentations in the community, so looking back to January as well as we can. So the first part and a lot of people probably have Googled and seen a lot of these things, but I will share a really great website with you. Virologists have been tracking the viral mutation of this virus and what they do is they study the genetic material. So they’re at the point where they can actually map those mutations and that’s what they’ve been doing. The more samples they have the more they can study. They actually have a pretty good handle on the timeline for the history of when and where it started and how it traveled over the past few months. Now there’s a ton we still don’t know, okay. Tons. So definitely don’t take this as we know everything because anything’s possible, but do we think it was here in December? The answer is definitively no on that one, for as early as December. They haven’t figured out all the bits and pieces like which intermediary specs. You’ve probably seen pictures on the news. They’re trying to figure out what went from bat to what animal, et cetera, et cetera, but in terms of geographically, the have been able to map this. So there’s this big database called Next Strain (link) where geneticists are continually analyzing the growing collection of these viral samples so they can update the family tree of the virus. So I’ll show you that in just a second. So they’ve determined pretty confidently that was not spreading in December in the US and again, this is based on the RNA sequencing of the genome and it’s way too smart for me to really explain it well, but I’ll show you this website that makes it visually easy to see.

But it’s likely that it was introduced in January in some places in the US and you know, of course due to our capabilities to do comprehensive testing right early on, it’s very likely that some of these earliest cases in New York and Washington, for example, were missed. And that more, we’re probably talking February at that point. So in Meeker and Rangely in January, February? Highly, highly unlikely.

The second reason for that is the clinical picture, and Kelly [Christian] and I have actually been at public health, you’ve heard me Niki, talking about it, rambling on about this health database at my updates I do monthly for the commissioners and we were actually pretty close to launching this new health database and this was the very purpose for it. So we were and we’re still planning to do that. Hopefully within the next year, we’ll be able to get this database launched where for the first time ever, and we’d actually be one of the first counties in Colorado to do it as well, which is really exciting because we’re so small, but it would basically draw on data from both our hospitals so that we could do things like this where we can track trends like okay, for example, it’s flu season. Let’s see how many flu-like illnesses we have during flu season. Is it normal for this time of year, or if it’s not, what symptoms are we seeing in people, and the very purpose of this is so we can do this very thing and that’s to kind of figure out what’s going on with various viruses in our community any given year. So, of course, we didn’t have the ability to do anything at that level because that database isn’t developed yet, but we didn’t see a distinct increase in the number of sick people that meet that covered profile. So even though, even if it was higher than normal, you know for this time of year, which at this point, we can’t say because we didn’t have that data tracked on that level. We never had, we didn’t see untying that was mimicking COVID, typically higher and at the rates where it would have been, you know, indicated that it was spreading in our community. In our high population of people with underlying medical conditions also, we would have expected to see more seriously ill people, which we did not. So we’re so thankful and grateful for that, and in some ways, obviously, it’s like no news is good news. So in this case, it’s like no data means we’re not quite sure. However, we can definitely say that anyone who’s in the hospital and ill with those symptoms who are sick and needing hospitalization qualified for a test and so we’ve done, I think 85 at this point. One has been positive, a few pending, so if we’ve got 82 negative tests then clearly there’s other things going around. And we’ve noticed on our self screener tool, and I’ll share that too in just a second, that even with the responses we’ve had there, we only had four people who had the fever. And we know that based on the data we’re collecting nationwide and globally from people who have tested positive, that’s the number one shared common symptom. So there’s definitely something that was going around that was making people pretty sick and presented as a pretty bad cough. We did notice actually we had a cluster investigation in November of another thing, which was definitely not COVID, but something that had occurred. It seemed to be attacking younger people. It looked like a type of pneumonia. We never had a definitive diagnosis, but we studied it a little bit just to see kind of what was happening with it because we noticed there was an uptick. Everyone recovered and again, it kind of inspired us to continue pursuing this database so that in the future we could look back and go no, actually we had the exact same number of sick people this year as we did in years past. So that’s the long answer to that. We don’t, we haven’t seen anything that would indicate it.

One last thing because I get a lot of questions about the sensitivity of the test. So clearly the sensitivity of the test is not perfect. The numbers as the data is coming in … we’re looking at anywhere between 60 and 75 percent sensitivity, meaning it’s very possible to have false negatives. However, based on the fact that we’ve had all the negatives we’ve had, you would still expect to see some of those to be positive.

Obviously, they’re not all false negatives and those people were sick with something so this is where we talk about confirmed cases versus presumptive cases and all of those words you hear thrown out there. That’s why it’s clear as mud, because it really is, but I hope that answers that question.

Niki: Do you want to share those screens?

Alice: Oh yeah. Yeah, Let me do that real quick. Thanks for reminding me that I was going to do that. So the first website is just fun to look at. Again, it’s way above my pay grade but it shows you. Let me just go back actually. This is called Next Strain. So this is that global database all these scientists are putting their information in, and if you look, it updates this pretty frequently. So as they study the genome, this is where they’re mapping. Okay, here’s where it was. Here’s the location. Here’s what the mutations look like. So that’s how they can kind of track and see and this is again, as you can see back here. Here we’re looking at back in December. They got almost a hundred percent confidence that it was originated in China at this point, so then you can see where they’ve detected it going across the world. So this is one thing to kind of check out that explains that a little better. And then I will show you the self screening tool really quickly. This is our new website. We do have a lot more data on there now if you haven’t checked it out in a while. We’re showing more kind of how we’re tracking suspect cases. Most of these, again, people who have been tested and have been negative. We don’t necessarily think these are COVID patients or suspected COVID cases. However, where we have to take it, we have to act like any of these could be, so that’s why we’re tracking it. But this is what the self reporting form looks like, and so you just go on and you fill this out. It really doesn’t take long, and then you submit that. It is entirely anonymous and you can actually put the date of when this starts so even if it was back in January, February, and you had something that you thought might have been similar to COVID, you can go in and fill this and then that will allow us to look back and say you know, let’s look at what these people are saying and make some presumptions there from that data.

Niki: Thank you. That’s very helpful. Then the next questions that we had. We’re starting to hear people saying, “when can we get out of lockdown? When can we get out of quarantine? When can we stop doing all these things that we’re doing? Wouldn’t it just be better to let everybody out and establish herd immunity and just keep the elderly people locked up?” So is that … what’s the drawback there?

Alice: Sure. There’s lots of drawbacks to that. However, I mean I will definitely say that I know at this point everybody is definitely like, “Oh boy. How long can this go on?” Life must go on, right? And I understand that completely and we’ll continue on my weekly updates to share kind of what we’re hearing as far as how long these things are going to last. So I won’t go into that right now. To answer the questions specifically, the answer is absolutely not. Unfortunately, it’s just hard to understand what herd immunity actually means. So the best way I can describe it, of course, it’s hard to predict anything in a pandemic, especially when the situation is changing every day, literally changing every day. But one thing we do know for sure is that this thing spreads fast. In reality, we normally achieve herd immunity with the aid of vaccines. So with no vaccines presently available, if you crunch the numbers, that means that 70 percent of the entire population would have to be infected to truly achieve herd immunity. There’s absolutely no way we would keep that from spreading to older adults by, you know, keeping them locked up. That’s impossible, and those who had underlying conditions, and so if you look at the fatality rate, even though it’s potentially less than one percent, if you had 70 percent of the entire population, and you take one percent of that, I mean, it’s obviously the one percent of all of the 70 percent of the people in the country could die. I mean, it’s clear that’s a catastrophic outcome. And if you’re 70 or older, it’s closer to eight percent fatality rate, so you really just have to ask yourself. Clearly, there’s other realistic practical points like with 10 percent of all of our infections needing to be hospitalized, there’s no way our health system could handle that amount of people and again, all at once, too. So unfortunately herd immunity, it just isn’t a solution. But eventually, and this is where I like to kind of explain to people, that will happen. That will only be when we have a vaccine developed and not a second earlier. But at that point, we really will be able to stop it. You know, eventually life will get reintegrated and that normal activity will get reintegrated, we’ll be able to generally get back to normal, but you know the idea of not doing the lockdown and just letting everybody get out there, get it, get sick so they can get immune, it’s just entirely impractical. Another way to explain that would be like with the flu. So if we did not have a vaccine for the flu, we would have lots and lots of kids dying every single year. We already do have a lot of kids die every year from the flu, so I don’t even wanna think about going back into a world, which I know no one would, either, of what it used to be like when we lost lots and lots of people to communicable diseases before we had herd immunity, in a large part what we can contribute to the use of vaccines. And so I think it’s important to understand that realistically, how you get the best outcomes is by having this temporary lockdown. It’s awful, but again, it won’t last forever and it allows us to manage it in less than that huge impact on our communities.

Niki: We’ve had a couple of questions come in from people on Facebook. Anything on when non-essential businesses will open? That’s not coming from your department necessarily, that’s coming from the state.

Alice: Yeah.

Niki: And how long do we need to, how long do you think we will need to continue practicing social distancing and these other measures? Is that just going to be long-term?

Alice: That part will be longer than the orders. So the best way that we can, and this again, I definitely don’t have a crystal ball, but from what we can tell, we’ve done a decent enough job with social distancing in the state. We’re hoping, we’re hopeful, the governor’s stating that so far, we haven’t heard anything to the contrary that they will be able to be lifted. The stay at home order will be lifted on the 26th. Hopefully after that there will be kind of, again, it will be like a restoration of all those things, will happen in a step-wise fashion, so you can definitely expect – I know beause my kids ask me every single day, “when am I going to hang out with my friends?” and I say well, my best guess is that after we have that stay at home order lifted there will still be recommendations limiting social contact. We still don’t want gatherings of larger than 10 people … the critical infrastructure workers, the non essential workers, getting people back to their jobs. That’s gonna be priority number one. In terms of looking ahead, my guess is that we’ll be able to hopefully, again, this is all if we continue to do a good job. If we have a massive influx of cases in Rio Blanco County, it might be different. We’re hoping that won’t be the case. So as long as we’re still vigilant, we can slowly just get back to that normal life and be able function. Very last, then, would be just like when we started this thing. There will still be a recommendation for a long time that people continue to socially distance and hand hygiene. Those types of things are not gonna go away any time soon. But in order to look forward to the near future, I do think we’ll see life getting back on the rails and we will guide you through that every step of the way. So we’ll put out education explaining what’s been lifted, what you still have to do, what you still can’t do. It will be easier that way than it will when we went into it. It all happened so fast and it just caught us all by surprise for sure. It was a good move so that we were able to really take control, but I think it’ll be a lot clearer when we come out of it than when we all just jumped right into it.

Niki: Okay, and along those same lines, and this is from a salon owner: how long until we go back? How long until they can do hair again? How long until you know, temps (temperatures), masks … is there going to be, because that’s very hands on. It’s very personal.

Alice: Oh my gosh, yes. And you know, I’m asking that question myself personally too, believe me. I think, again, it’s all about priorities. So the biggest priorities are going to be critical workers getting business back on the line. I think with restaurants, obviously that’s one where they’re still open because they’re serving people food. So I think that will be a big priority because we want to get that industry back and going. I do think that with the hair and nails and a lot of those things, that will involve the person to person contact, I think we’ll see those recommendations get lifted, but they’ll still just be recommendations, very possibly. The recommendation that those masks need to be worn and additional precautions need to be taken for quite some time. So I mean it’s, in some ways it’s good news and bad news, but the good news is it’s working so I think that’s really, really key to remember.

Niki: Okay. We’ve got a couple more questions that have come in from Facebook, but I wanted to, we had this. Our last questions, our last prepared question, was about face masks. I went to the post office. I saw one person. I had somebody call and say there’s one person in the post office with a mask on and the other nine people that were in there standing next to each other weren’t wearing one. So who needs to be wearing a mask and when?

Alice: So the face mask recommendation is currently for everyone when going into public spaces or anywhere that you might walk past a vulnerable individual. Sneeze without knowing you have it and then unintentionally pass it on, because we know a large part of this came from the knowledge that I think the number they’re throwing out there now could be potentially as high as 80 percent of the cases could have no symptoms or mild symptoms. So I mean, these numbers are just terrifying. Currently, if you’re committed to social distancing and hand hygiene, you know, it’s truly not as important (mask wearing). I can’t stress that enough. I mean like for example with kids wearing masks. Someone asked me, are kids supposed to wear masks and the recommendation is that kids wear masks, also. However, the big problem or course is the proper use of it. So if the child, if you have a young child, ideally, you don’t take them to the grocery store because they’re going to be touching the mask and trying to get adjusted on their face and then they’re going to touch the counter and so you’ve completely defeated the purpose. So I think the CDC’s recommendation clearly says everyone wear cloth face [covers] … the recommendation is voluntary … that everyone wear cloth face coverings in public settings where you have a lot of community-based transmissions. So the funny thing about this is, this could change. If we happen to get an outbreak here, you could hear me saying next month this is even more important now than ever that you wear a face mask because we’ve got the stay at home order lifted. We’re getting back into normal life, but oh my goodness we have, you know, 20 new cases here and we want to make sure we keep it under control so wear your face mask, be extra vigilant with hand hygiene. So I think it will constantly change and, you know, thinking about the scenario if you try to go places when there’s not as much traffic. If you go to the post office, you’re going during hours when you’re not going to be in line, you’re just going to check your post office box, not talk to anybody and come out. We all know that’s almost impossible in Meeker, probably, and in Rangely, too. But, you know, so I think having, just having that discussion in limiting your visits, making a point to avoid people during those trips is huge there for people who just adamantly don’t want to wear them. Some of those people come from a good place in that the mask is imperfect and it’s definitely not protecting them. So it’s about social responsibility and at this point definitely we recommend everyone’s wearing them when they’re in those public spaces.

Niki: So okay, good to know, and then we’ve got a couple of questions. This person’s diabetic, but it’s well controlled for several years. Does that still put them in the higher risk category?

Alice: You know, they’re still saying diabetes in particular, and I think that has something to do with the immune response. There’s so many more studies coming out. What we’re finding, new things every day. They’re finding certain types of people with other things that you wouldn’t even count as a chronic condition are potentially playing a role. Of course they’re looking at the genotyping and understanding, “are some people more susceptible than others?” Why did, you know, why do kids seem to be not as susceptible? So there’s just a lot of different things that we’re finding and that’s coming out. So for now, I would say yes, because we’re not a hundred percent sure how this thing works, and so even though it’s well controlled, you know, your diabetes can still definitely take a toll on your immune system as it’s tied in to your immune response and could be.

Niki: And then this question: Is two weeks long enough or will that restart the cycle? And I think you kind of addressed that already by saying that we’ll be restarting or re-entering normalcy step by step and then I would assume watching for any kind of spike or increase to determine if that’s going to cause a problem and then need to pull back.

Alice: Yeah. It’s a fine, it’s a really fine balancing act because now that we flattened the curve, we’re looking at mid-June for a peak in Colorado, which a peak again is where 50 percent of your cases come after that point, so it’s not necessarily, it’s not exact science, but what they’re looking at and having flattened it a little bit, we’re still going to have cases. There are still going to be hot spots within the state and that could very well be here. So we have to think of it and the answer. Is two weeks enough? I mean, probably not, but we also have to balance that with people’s lives and people have to get back to life. So how you do it is again, going to be so important that everybody doesn’t go, “woohoo, it’s over. we can get back to our life. We only had one case here and we all had it in January, so I think we’re all immune and everything’s fine.” And then I think it’ll, it could really nip us in the butt big time. So I think it’s just going to be being careful and you know, following the orders as seriously as we can as they come out and then slowly, yes, slowly getting back to life.

Niki: Can you see the chat?

Alice: I can’t really I’m just seeing the names, I don’t see the actual questions.

Niki: Mental health issues. As far as what the county is providing or offering, what’s available?

Alice: That’s a great question. So we do, Mind Springs does have a COVID hotline and that was in our flyer that just went out. I think, I believe we posted that on Facebook, we can repost, but we also do have a new resource tool we put together specifically for mental health. So we’ve tried to include not just the hotline numbers but like, you know, is Alcoholics Anonymous still happening? Who can you call if you need help with substance abuse? So we’re putting together another resource that’s specific to mental health and that should be done pretty soon, and we’ll be circulating that and posting that also because that’s a really good question. We did put in for a grant for some money to get some iPads purchased so we can help people with telehealth accessibility. That’s something we’ve actually wanted to do for a long time. It’s been on our list for increasing the access to care for mental health services and that’s a public health initiative for one of our five year goals. So that’s another thing that could be coming down the line. There’s a lot more telehealth options coming available, so we’re hoping that can be a way to connect some people so we’ll be focusing, of course, on those things in the coming months as well as getting that all out to you. It’s a great question.

Niki: Okay, and then we’re going to do a couple more questions and then I think we have to, I think our Zoom meeting officially comes to a close, so I’m looking at these trying to see.

Alice: Lots of questions, that’s awesome.

Niki: That’s good. If in the next week, science reveals that herd immunity is a viable strategy with measured reintegration and reopening and the hospitalization rate is low, would the county issue relaxed guidelines that may be in contradiction to the governor’s stay at home order?

Alice: No.

Niki: Okay, that was easy.

Alice: Well, it’s not going to happen just based on what herd immunity actually is. Now, the question as to if we have, if we don’t have, I mean. If we don’t have cases, a lot of cases and hospitalizations, we’ve done our job. We’ve done our job right by adhering to these orders as they’ve come out and so the answer to that is no, because I’m not willing to take the change.

Niki: Okay. Is the state science the only science that dictates county health policy?

Alice: Like CDPHE? Absolutely not, no. We get our information from a variety of sources. So you’ve seen me and if you watch my Friday updates, I reference lots of different websites like Johns Hopkins, for example, is leading the world on a lot of research. So we do our own research. We have epidemiologists at the state. It’s funny, I’ll pick them up, pick up the phone and call them and they’re like, “Gosh, Alice, that’s a good question. I have no idea. Let me know if you find an answer to that.” So everybody’s learning. This is all about doing evidence-based research and like, that’s exactly what the name of the game is on this one. So we pull information. Actually, I probably get more information from non-state resources than I do from the state resources. They’re an excellent support structure, but the science and the information we have is coming from lots of different places internationally, nationally, and then a variety of sources, so that’s a great question, though, I think.

Niki: Yeah and then the last question is why can they continue to work on construction of the school, and I think from what I’ve heard in meetings they are, construction is considered an essential service. They are practicing social distancing and following all the rules and guidelines and they are also gauging whether they can do that safely and whether they can continue to work safely and that’s why they’re still open, because they’re considered an essential service.

Alice: Yes, and a little bit further though on that one. So it’s not just any construction. We are deterring anyone from doing, like, residential or non-community (construction.) If you look at the orders, and this isn’t … there’s a lot of information on the CDPHE website. But schools and hospitals are counted as community infrastructure. So it’s not just the construction piece. We still as a county could say, “we don’t think you should be doing that. It’s not worth it to our community for that to continue.” So like, in Routt County, for example, they stopped a lot of the second homeowners from doing repairs on their homes and those types of construction activities. So it’s the, construction isn’t a catch all, but the fact that it’s a school or a hospital is kind of … and the fact that they’re adhering to these orders pretty closely. They’re doing a vigorous screening process. We’ve been working with them from day one, so that makes us feel a little more confident. We also understand the impact to our community, if we were to halt those operations, would be pretty severe. So again, it’s almost a fine balancing act. But we have also reached out to them this week to discuss. We would like to make sure that those construction workers are respecting our county citizens and adhering to all of those recommendations offsite as well as onsite. So we’ve been working on that as well, in addition to what we’ve been doing with the companies themselves.

Niki: Okay, thank you and then last one, I promise. Are counts including people who have recovered, or just active cases? So if we’re looking at a number for the state for X number of people are confirmed, does that include people who’ve recovered as well as people who are actively ill?

Alice: It does. It includes anyone who has tested positive. It also includes anyone who’s epi-linked. So that means if we, we actually haven’t had many, we’ve had one here. If someone has a known positive and they have symptoms, but you know they don’t necessarily need to go to the doctor. They’re doing well or maybe they had symptoms at a time when the person who tested positive had symptoms. They can confirm that as a case. There’s a variety of different factors you have to have to have a confirmed case that’s not got a laboratory confirmed diagnosis. So they’re tracking. So those numbers include all of those as well, actually and on the CDPHE website where they put, they do explain that in the header. So if you read that, it does explain it a little better on what those numbers actually stand for. But the guess is that there’s a lot more cases obviously than that. You know, potentially triple. I’ve seen a few numbers thrown out there, so again why we’re, you know, driving home the importance of these orders and that we, you never know. The cases in Garfield and Routt continue to rise, so you know, we’re highly aware of that and wanna make sure we catch. It’s not just about the test. We want to make sure we catch any potential cases and report those to you all in a way that makes sense.

Niki: Right, all right. Well, thank you and we will share those links again on our website and on our Facebook page and if people have questions they can either obviously get ahold of you or they can get ahold of us and we will pass those along and we’ll continue doing this.

Alice: Absolutely, I’d love to. And anyone can email questions any time if they need a quick answer. They don’t have to wait. I’m happy to, if you forward it to me, I can reach out as well.

Niki: Okay, thank you. Thank you so much

Alice: Thank you guys. I really appreciate it.

NIki: All right. You have a good night.

Alice: All right, you too. Buh bye.

Niki: Bye