The focus of the Nov. 24 health and human services portion of the Aitkin County Board meeting was devoted mainly to one topic – the COVID-19 pandemic.
Riverwood Healthcare Chief Medical Officer Dr. David Taylor attended the meeting virtually to provide another opportunity to answer questions from the county board.
HHS Director Cynthia Bennett spoke briefly on the pandemic before handing off to Taylor, who appeared remotely via the county’s WebEx meeting system.
“As we all know, our COVID-19 numbers are rising quickly, especially in Aitkin County,” Bennett said. “Which has an impact on our health care systems.”
Taylor’s Q&A was moderated by Erin Melz, the public health supervisor for Aitkin County. Melz thanked Taylor for coming in, adding that the county “appreciated his partnership and collaboration.”
Taylor stated bluntly at the start of the chat, “Unfortunately, the surge is here.”
Taylor said that the situation with hospital beds in the state is becoming more difficult. What Taylor called “tertiary care” centers that handle emergency care – both COVID-19 and not – are getting to the point where they are asking Riverwood not to send them patients.
“They’re making their own surge plans,” said Taylor, adding that not all the ICU beds are filled with COVID-19 patients, but they are mostly full.
Taylor added that 30-50% of the hospital beds at Riverwood have been filled lately with COVID-19 patients.
The problem, he said, isn’t just beds –it’s keeping the staff healthy. More staff members are now being diagnosed with COVID-19.
“We have them at home recuperating,” Taylor said. “So, they aren’t working.”
The first question Taylor was asked was about herd immunity, and whether people should just plan on getting sick and “getting it over with.”
Taylor said that was originally how he was thinking, and that with the pandemic originally expected to last three to seven months, the focus was on spreading out the infections so not everyone has the illness at once.
However, now that the country is nine months into the pandemic, he said it was clear “the illness doesn’t work that way.” Taylor highlighted Sweden, which had tried that route, adding, “they’ve done very poorly.”
“Their death-per-capita rate is higher,” he explained. “I think it would be hurtful, both from a loss of life perspective and to our economy, to let us achieve herd immunity as fast as possible.”
Taylor added, though, that protecting at-risk populations should be prioritized.
The next question Melz proposed was how to tell COVID-19 from allergies or a routine cold or influenza.
The short version from Taylor was: you really can’t.
“I wish the answer was, ‘here, here’s how you tell the difference,” he said. “I would recommend, if in doubt, get tested.”
The hospital is running about 500 tests per week.
Along those lines, Melz asked Taylor to explain positivity rate.
“It’s a percentage of positive among those tested,” Taylor explained, “Yes, numbers are higher because of the number of tests being performed.”
“However, so are the number of tests coming back positive. As an example, if 100 people were tested and 20 came back positive, the positivity rate would be 20%.”
Right now, Aitkin County is averaging between 25-30% in terms of a positivity rate.
Commissioner Don Niemi raised the question about rapid testing – a testing format where results can be back within an hour.
Taylor said Riverwood was fortunate to receive an allocation of rapid testing kits, but the numbers of those allocations has continued to drop, which has the hospital limiting that test to patients who arrive facing potential emergency surgery, front-line personnel and patients who are going to be admitted.
Taylor admitted that the return time on testing – which is averaging between two and five days – is a concern.
Taylor also clarified when people should be tested.
“You can have the illness, get tested at the wrong time, get a negative test - and still have the virus,” Taylor said.
Because the prevailing test is the nasal swab test, that test would indicate being tested on day three of the symptoms. Before that, and after day seven of symptoms, the accuracy of the test can drop off.
Adding into the complexity is the fact that not everyone develops symptoms in the same time frame. Most, he said, develop symptoms on days three to five, but some develop symptoms as late as 14 days after exposure.
“Day five to seven is kind of the best chance to find out if you have got it,” he said.
Taylor also addressed masking again, which he admitted is frustrating since the guidelines have changed since the beginning of the pandemic.
“I feel for everyone’s confusion,” he said. “It turns out masking is a lot better than we thought it was.”
He said masks are not a cure-all, but they do limit the spread of the virus because they buy time for someone who is exposed to a person who is contagious.
He admitted he’s not an expert, but that masks are an effective tool right now that people should use.
The next question had to do with the fact that most people who end up with COVID-19 will have minor symptoms.
Taylor answered that by breaking down the numbers. “Even if 99.5-99.7% of people recover,” he explained, “That is still a huge number of deaths.”
“We’re still talking about half a million deaths, give or take,” he said.
In addition, COVID-19 has a longer recovery time, meaning people are in the hospital longer with severe symptoms.
Taylor pointed out that while COVID-19 isn’t the Black Plague or the Spanish Flu, “It’s more significant than a seasonal flu bug.”
The next question addressed Gov. Tim Walz’s most recent order, which put a four-week pause on a variety of activities around the state – including restaurants, bars and fitness centers.
Most schools in Aitkin County have also gone to distance learning for grades 4-12 through Jan. 15. Taylor said that his opinion is that the youngest students should be in school, but that the problems schools are running into is the staffing situation.
With the deer-hunting season and the holidays, Taylor said he felt that the four-week pause probably wouldn’t be long enough, because not enough adults were following guidelines.
“If we all adhered to the guidelines, we’d be doing a lot better,” he explained. “It’s the adults, the 40-, 50-, 60-year olds, who are spreading the disease.”
Finally, Taylor was asked to address the vaccine situation. He said that the competition between companies and the capital interests involved would likely make the vaccine safe.
“There is inherent incentive to do this as safely as possible, with this speed,” Taylor said. However, he added, “It’s going to be a challenge to get enough doses out.”
Commissioner Laurie Westerlund asked how much the vaccine would cost, and whether it would be affordable.
Taylor said it was his understanding that insurers and insurance companies will cover the vaccine like they would a flu shot.
As for the uninsured, Taylor wasn’t sure, but he added, “We don’t want people charged for something that is a public health measure.”