The Governor’s Order, What it means for you, and Important information about Testing

Today, Idaho’s governor Brad Little announced his much-awaited decision as to the fate of his March 25, 2020 order to stay-in-place that would have expired tonight at midnight. His decision was to extend the current order until April 30 and to amend it to include three new provisions:

  1. Anyone traveling to Idaho from out of state other than those coming to seek medical attention, must self-isolate for 14 days;
  2. Non-essential businesses that can re-open and sell their services or products by curbside, drive-in, drive-through, mail or delivery can do so; and
  3. Those non-essential businesses that cannot re-open safely can still undertake efforts to sanitize their facilities, order personal protective equipment, make policies and procedures to implement social distancing, and otherwise prepare for an eventual reopening.

What does this mean:

  1. Idahoans have done a great job with social distancing, washing our hands, working from home, restricting our travel, etc. It has flattened the curve, but flattening the curve does not mean it is over or there is no longer a threat.
  2. We can’t give up now. Our efforts have undoubtedly saved lives and prevented us from overwhelming our hospitals. The more cases of COVID we prevent, the fewer times we expose our health care workers. While the Governor has made a great compromise to allow more Idahoans to get back to work and to help our businesses recover, the truth is that the virus is not gone, the overwhelming majority of Idahoans remain susceptible and letting up on our infection control practices will simply cause a new wave of infections, hospitalizations and deaths.

This leads to a lot of questions:

  1. When will we be able to get back to normal?

This is the most difficult question. The only thing I am relatively certain about is that it won’t be this summer, as it seems most of the White House briefings and tv pundits seem to suggest.

Everyone has seen the models on the internet and on tv that show a bell curve and show that the number of cases comes down to zero sometime over the summer. I just can’t figure out why. I can only think of four reasons that could possibly happen, and I don’t think any of them are likely. First, the virus could mutate in such a way that it no longer is transmitted efficiently. That is possible. RNA viruses such as the coronavirus do mutate fairly frequently, but generally not to the degree of changing its fundamental nature. So, yes, that could occur, but it would not be reasonable for us to plan on it.

Second, we could develop a medication that if taken at the onset of symptoms might prevent the illness from becoming severe, requiring hospitalization or causing death. Again, possible, but I don’t think we should be planning on that.

Third, we could have so many people who become infected that we develop so-called herd immunity, which means that there are so few susceptible individuals that the virus cannot efficiently be transmitted. We are not sure what percent of the population would have to be infected to achieve herd immunity through natural infection, but virologists seem to think it is more than 50 – 60%, and perhaps in excess of 80%. I simply cannot imagine the scenario by which more than half of all Idahoans are infected by this summer. Our hospitals would be overwhelmed and the death count would be horrible.

Fourth, we achieve herd immunity, not through natural infection, but by vaccination. However, no one believes that the vaccine can be ready in less than a year, and that is if everything goes perfectly.

So, I think we will be dealing this virus for the next year or two. Certainly, not at the level we have been, and most likely in ebbs and flows, but it seems some level of continued social distancing will be necessary until we have a vaccine and can immunize a sufficient percentage of the population.

  • Can we just test people for the virus and if they are negative, allow them to return to work?

No. The test for the virus is a test that you have seen on tv where a healthcare worker sticks a swab way back into someone’s nose. There are now some other ways to get the sample for this test. It is a test that identifies portions of the virus. The presence of virus is often used as an indicator of infection, but the presence of virus does not necessarily mean infection.

Nevertheless, even if a test were negative today, that wouldn’t mean someone would not be infectious the next day. The test’s best use is to look for evidence of the virus in the setting of symptoms consistent with COVID-19. It simply is not a practical method to screen a workforce that is asymptomatic to determine who might be infected.

  • Can we screen employees for antibodies and then if positive, allow those persons to return to work without the need for social distancing and personal protective equipment?

Not yet. There is only one antibody test that has received an Emergency Use Authorization from the FDA, and that was just a little over a week ago. An Emergency Use Authorization (“EUA”) is not the same thing as being FDA approved.  An EUA is issued when there is an urgent need for the product, but we don’t yet know its effectiveness. The EUA allows a new product to be put to use and requires that as it is used, the manufacturer will submit data to the FDA that will allow it to determine its effectiveness. So, first of all, the antibody test is not yet widely available. Second, we don’t know whether a positive test might result as a result of cross-reactivity with the ordinary coronaviruses that people have been exposed to, and therefore might not be specific for this novel coronavirus infection. Even if a positive test does mean that the person is or was infected with coronavirus, we don’t know whether that means that the person is immune to subsequent infection with the coronavirus, and if so, for how long?

2 thoughts on “The Governor’s Order, What it means for you, and Important information about Testing

  1. Dr. Pate, thank you for sharing your guidance and expertise during this critical time. My first question is if you find the IHME model too optimistic for Idaho, and if so in what ways specifically? I have read that this national model – while simply meant as a guiding tool – may show a peak too early and overstate the effects of the social distancing measures in the U.S., and particularly in more rural areas. The AHA had different projections as well as individual state task forces. My second question is whether this pandemic will raise awareness for the importance of vaccinations. We are looking for a ‘cure’, and that future cure looks like what we have had in the past for the measles which should be eradicated but is not. Is this an opportunity to educate the public on what we should do once the cure for COVID is created?

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    1. Hi Laura,

      Excellent questions. Yes, I think that the IHME model may be too optimistic, simply because I haven’t seen other models that tend to come to the same conclusion (and I have seen a lot of models!). Now, it is also possible that other models are too pessimistic. I have two major critiques of most models out there. First, most are not forthcoming about exactly what data sources they are using and what assumptions they have made. After all, those are the two things that drive any model. When you are not transparent about these things, it makes it very difficult to determine whether you agree or disagree with the model and how likely you think the model does project the peak, magnitude, and duration of the illness. My second critique is the one I have written about. Why do any of these modelers believe that there is just one peak? It doesn’t make sense. I’m willing to be educated, but so far, I have not found anyone who can explain this to me.

      As to your second question, I pray to God that will be the case, but fear it won’t. It just breaks my heart that people are endangered by contagious diseases that we know how to eradicate, but refuse to do so.

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