A list of questions was presented to the LCDHD staff by the media. Those questions, and the answers given, are provided in the following article for the readers of the Clinton County News.

The media updates are presented bi-weekly and the Clinton County News will continue to participate in those briefings so we can better keep our readers informed

A media Zoom meeting was held October 21, 2020 for our media partners and community.

Our panel consisted of:

Shawn Crabtree, Executive Director

Dr. Christine Weyman, Medical Director

Stuart Spillman, Environmental Health Director

Tracy Aaron, Health Education Director-moderator

A list of questions was presented to our staff by the media. If you have questions for our next media zoom meeting, feel free to contact the health educator at your local health department or reach out to Melonie Williams at the District Office at Melonie.williams@lcdhd.orgor 606-678-4761 x 1127

.Dr. Weyman

Q1 -I am hearing of people who have tested positive who are released from isolation only days later. They spend less time in isolation than someone who is in quarantine due to potential exposure. No new testing is required. What criteria is used to determine when someone is released from self-isolation after testing positive?

This may happen for two reasons. Antibody tests become positive 10 to 14 days after onset. Hence a positive antibody test means the person is over their infection and no longer contagious. The other scenario is when someone has symptoms, but tests many days later. We count from symptom onset, not test date.

Shawn/Stuart

Q2 -Several people have questioned how school districts are opening to in-person classes when, according to the Metrics Diagram, they are listed in Red which states that all in-person classes are to be suspended. Just a question I have heard. Can you address this?

By law, the Board of Educations have the authority to decide when school goes and when to call out. The metrics diagram is a tool for the school to use, but is ultimately not mandatory that schools follow it.

Stuart

Q3 -I am a business that runs box fans each day while I am open to the public. Will this put my workers or my customers at risk to contract COVID-19?

No, it is a best practice to increase circulation of fresh air into a space. This does not, however preclude the use of facial coverings.

Dr. Weyman

Q4-Is the COVID oral rinse that I have been hearing about a good testing option? Will we ever have this option for testing in this area and how reliable is it?

The Oral DNA company has approval for using an oral swish sample to do PCR testing. To my knowledge no one in our district has this test yet. Researchers in Louisville are testing the method.

Shawn

Q5 -As of Wednesday morning, October 21, the Governor’s report still shows two deaths in Clinton County as a result of the COVID-19. LCDHD reported the third Clinton County death on October 10, and the fourth death in Clinton County on October 14. How long does it take for the reports to sync up?

It isn’t uncommon for the state to be two to four days behind our reporting. We report things in much more “real-time”. The state has to go through additional validation steps.

Q6-People are asking for recommendations for social connectivity for elders without internet. If you have any thoughts or resources to share that may be good.

This question was accidentally skipped. We will pick up next meeting.

Dr. Weyman

Q7 -What is the generally expected rate of false positives and false negatives regarding the most common tests used for SARS-COV-II?

Approximately five percent. The false positive and negative rates are dependent on the incidence of the disease in the community. Lower incidence produces higher false positive rates.

Q8 -Why isn’t this important and valuable metric widely known and discussed?

We have discussed this at many of our media/public updates.

Q9 -How do you distinguish between a patient receiving a false positive test result, versus someone that actually has SARS-COV-II but is presenting asymptomatically? Are there serious efforts to tear these two apart?

Unfortunately, there is no way we can distinguish between these two scenarios. History helps, such as contact to a known case makes it a likely true positive. Some people test positive and are asymptomatic at the beginning and develop symptoms a few days later. We have had a 16 percent asymptomatic rate. If the PCR testing labs would give us the number of amplification cycles needed to reach a threshold, we would be in a better position to determine if a positive was true or false.

Q10 -Why do the testing labs insist on exceeding the recommended number of amplifications (spins) of the PCR test –against the recommended upper limit set by Nobel Laureate Kary Mullis (inventor of the PCR test)? Other than an attempt to produce as many false positives as possible, what purpose would this serve? Why do you accept this practice and continue to hold the PCR test as adequate?

The PCR test was calibrated to be sensitive and not miss positives in symptomatic people. Using it for surveillance of asymptomatic people increases false positive rates. Knowing the number of amplification cycles can give an approximation of viral load. We are not given these values by the lab.

Q11 – A recent case in Nevada reported to show a man who had tested positive, had fully recovered, but then re-contracted it 48 days later. There are now similar reports from Hong Kong, the Netherlands, and Belgium. If true, what does this have to say about the usefulness of the antibody mechanism-based vaccines being developed?

There have been a handful of repeat infections in the world, all with different strains. We know that antibody levels wane, but the cellular immunity (T cells) seems to retain its memory. We will have to wait and see how that will perform. A vaccine may need to be given repeatedly especially if the strain changes.

Shawn

Q12 – Can you walk me through the specific legal rationale that allows you to call for the violation of our constitutional rights (freedom of assembly, exercise of religion, etc.) in order to enforce your approach to pandemic mitigation? Can you point me to any exceptions in the constitution that allow violations of these inalienable rights – specifically any that mention communicable diseases? How do you define inalienable rights? Can the KY governor supersede the US constitution and require you to take this action?

State law directs public health to respond to communicable diseases. I’m not a lawyer or able to debate the Constitution. We follow KRS, KARS and, when in effect, Executive or Court Orders.

Shawn/Dr. Weyman

Q13 – How can we be in a pandemic when national excess deaths haven’t exploded?

Not all diseases result in high death rates. However, COVID-19 has a significant death rate. In Lake Cumberland, about one in 50 have died. This, on a world scale, is two to three times higher than a terrible flu season; and, on the national scale, several times worse.

Q14-How have ALMOST ALL incidents of the flu or pneumonia disappeared during this crisis? Be specific. Is there a precedent for this occurrence? What would be the mechanism?

This is just the beginning of flu season and we are just now starting to see cases. COVID-19 didn’t start in our area (or Kentucky) until around March of 2020, after last year’s flu season was largely concluded.

Q15-Without a cure or a vaccine, how did SARS-COV-I cease to be problematic? Why should we assume SARS-COV-II won’t follow the same course?

Every pandemic runs a unique course. They all have different rates of infection, mortality, and a different herd immunity. We won’t know COVID-19’s herd immunity for some time after the conclusion of the pandemic.

Q16-Why was the original course of “flatten the curve” abandoned which was to be used to advise us regarding when we could loosen the draconian lock down approach?

The first “flattening of the curve” was achieved via the economic lock-down. The lock-down was abandoned, not because it wasn’t good at controlling the spread of the disease, but because society couldn’t live with that level of restrictions. We believe if people would mask, social distance, avoid crowds as much as possible, and if businesses would follow the various prevention practices, we wouldn’t need any further economic shut-downs.

Stuart

Q17-Why do we attempt to quarantine the uninfected (which is effectively impossible –think groceries, utilities workers, police, medical, etc.) instead of the normal procedure of using quarantine for only those infected or the most vulnerable?

It is very normal for us to isolate positive cases and quarantine close-contacts. It just usually isn’t done on this scale and for this length of time. Consider STDs, TB, or food related illnesses. They are much easier to trace and contain through isolation and quarantine. We know we won’t contain the pandemic through contact tracing. The goal is to slow it until there is a vaccine.

Shawn

Q18-Why are the most vulnerable communities (Africa, the homeless in the U.S., the slums of India) presenting with far fewer cases (and especially death) than other, more affluent communities?

Probably because there is no good way to track the true numbers in these areas.

Stuart

Q19-I continue to have questions about enforcement of mask mandate, but it seems businesses are not taking it seriously and there appear to be no consequences. Examples-like Kroger in McCreary County where there is no effort to make customers wear a mask, despite Governor Beshear’s call for a “no shirt, no shoes, no mask, no service” approach. Will enforcement efforts be increased at some point?

We have operated up to this point on a complaint-based system. We have not issued fines to this point. In speaking with other health departments across the state, they have not or ceased doing so due to different problems. They have also, like us, stated they get just as much compliance through education. Masking compliance is going to take a cultural shift to ever become widespread. We would recommend since there is no way the health department can possibly police every business and every citizen that everyone not patronize businesses that do not follow the mask mandate.