PITTSBORO — The News + Record sat down with Layton Long, director of the Chatham County Public Health Department, and Dr. Stephanie Freese, member of the Chatham County Board of Health and owner of Polaris Equine Mobile Veterinary Clinic, to talk about all things COVID-19 in Chatham, from why it's called COVID-19 to the potential for spread in Chatham to why numbers of tests and positive tests may not be reflective of the full story in the county.
The interview was broadcast on Facebook Live on the Chatham News + Record's Facebook page on Tuesday, March 25, and the full video can be found by clicking on the link here.
The following transcript has been edited for clarity. Sprinkled throughout are links to other News + Record stories as well as information from the Chatham County Public Health Department, Centers for Disease Control and N.C. public health officials, as well as links to definitions of terms used during the conversation.
Additionally, this Q&A was conducted prior to the Wednesday, March 25, announcement that three more individuals had tested positive for COVID-19 in Chatham.
LL: The World Health Organization announced the official name of the disease that is causing the corona virus outbreak which emanated from China. The name of the coronavirus disease abbreviated COVID-19. CO stands for Corona, VI for virus and D for disease. And of course, the 19 is related to the year in which it was first identified.
SF: So COVID-19 is the name of the disease. The name of the actual virus itself is SARS-CoV-2, and that stands for severe acute respiratory syndrome, the coronavirus and the number 2 because there was a SARS that you're probably familiar with in the media several years ago that was also a respiratory disease. And so that is why there's a name for the disease that'd be COVID-19. There's a name of the virus and then Coronavirus and novel Coronavirus novel simply just means new.
And then Coronavirus is an umbrella for lots of different smaller definitions of that virus. So like the word weather where you can have thunderstorms and you can have sunny days and you can have rain showers, Coronavirus, we have lots of different diseases and smaller viruses, denotations that are under the umbrella of Coronavirus.
LL: A lot of this has been in the media and has remained consistent throughout this outbreak. The disease usually has symptoms similar, very similar to flu: cough, fever, and particularly a shortness of breath. COVID-19 typically causes mild symptoms, mild respiratory symptoms. Most people are going to be able to get over it without hospitalization. Although there have been reports of severe severe illnesses with resulting in death and hospitalization, respiratory symptoms alone are not necessarily the indicator of COVID-19. So, if you're having fever, cough, flu-like symptoms, then certainly you might want to consult with your medical professional about where to go from there. And just a reminder, we are still in flu season, and it could be the typical flu that we experience every year.
LL: The difference is, the communicability of it is significantly different. It is a much more highly infectious to the public and it spreads much more rapidly. The biggest concern is that flu, typical flu, a certain small percentage of people will need medical care beyond what they can do at their home — 1 or 2 percent of my understanding of people that will present (to the hospital) in any given flu season. What they're seeing with this particular coronavirus is that it's upwards of sometimes 20 percent of people will need assistive care beyond what they can manage at home, which is why it's critically important that we try to flatten this curve of infection, because if you wind up having that many people presenting at the hospital, it can overwhelm our medical systems.
SF: R0 [pronounced “R naught”] stands for the reproductive rate of the virus. But there's actually a lot of information that goes into what the R0 actually is. So in layman's terms, the R0 is a number that says if I am sick, how many people do I spread it to. So for the seasonal flu, that is one to one — if I'm sick, I might give it to one person. For this novel virus, and it causes COVID-19, they are estimating that R0 to be somewhere in the range of three to four. That number is changing as we learn more about this virus. But that should give you an idea of how much more easily spread it is. You know how quickly the flu can go through a population because you're familiar with the flu. It's been around for years. We see it every year. This virus hasn't been around. So we don't really know how it's going to go through a population except for to say much more effectively, it's going to spread faster than you can think it possibly would because it does spread from one person to three or four people instead of just a singular person.
And the reason that that is so particularly effective for this particular virus is that it's able to be spread when you're not symptomatic. This is why social distancing is so important in trying to slow this disease down and trying to prevent your loved ones from getting ill. If you are feeling just fine and you go to visit your grandmother, and because it is her birthday, you give her a kiss on the cheek or a cute little nose rub or whatever it is that it that your grandma loves the most, two days from now you might feel ill and you would have already potentially infected your grandmother. So that is why all of these social distancing measures that are in place that are quite obnoxious for daily life are so important in trying to slow this down.
LL: There are highly susceptible populations to this virus, particularly those over 65. Those with underlying health conditions are at highest risk. And so you certainly want to keep it out of those populations. And it is our responsibility, all of us. It doesn't matter what age you are to practice social distancing. Even if you are going to get over the virus — and there are applications for young people that show that the virus has lingering effects, even though you do eventually get over it — do you really want to be the one that infected your grandparents or their neighbors because we're not practicing sexual distancing?
SF: One more very important difference between the coronavirus and the flu, aside from the higher mortality rate, is the fact that we actually have a vaccine already for the flu. So we have measures in place that we can take to try and slow the flu down if there's a particularly bad flu season. And I know there's a lot of talk in the media right now about possible treatments for the coronavirus, but unfortunately, at this stage, none of them have been proven to be successful. Because we don't have any kind of mitigation, there's no treatment, there's no vaccine. That is what makes this disease so scary. There's just nothing we can do except for the social distancing, accepting the personal hygiene to slow it down.
LL: And I think we mentioned a minute ago about flattening the curve. We've heard this term and it’s critically important. We're not going to stop the spread. I don't think that's a reasonable expectation at this point. But what we can do is hopefully slow down and lower that spike so that our systems are able to manage and provide health care, not just for those that are going to get sick, but for the other care that is needed in the community on a recurring routine basis.
LL: I think is certainly a factor. If you're looking at communities that have a predominantly young population, then probably the numbers would change, not the percentages necessarily but the actual numbers of people involved with increased medical care would certainly factor into that. One of the things that we've seen out west, with (COVID-19) running through a nursing home like that, it can spread very rapidly and have pretty dramatic impacts. So yes, age is certainly a factor. Yes, age will be a big concern moving forward and protecting those populations, again, to reiterate, is our ability not to protect ourselves, which is important, but to protect others.
LL: I’m one of those in that situation. I have very elderly parents that are being cared for by my sister. But a lockdown of that magnitude would most certainly come from the governor's office.
We're in a kind of uncharted territory right now with all of this, and our healthcare leaders and our policy makers are navigating some very complex decision-making processes and trying to factor in multiple factors into those decisions. My estimation would be that there would have to be some concessions around those kind of issues. There is no good answer with a lot of these questions. And so what they try to do is a cost-benefit — what is the cost versus the benefit gained — and they're going to try to reach the best conclusion they can.
But I guess to respond directly to the question, the answer is, I would expect that there would be some considerations for those individuals that have to care for elderly parents or others situations in the home.
If you are that specific caregiver — to use my own experience with my sister, she has been read the riot act from me about (this) — don't come in contact with anybody. Make sure that before you go visit the parents that you've washed your hands thoroughly, that you wipe down things. Nobody has to come in the house except for her [my sister]. All of those kind of things. You kind of think through on an individual family level, to see what if and what can I do to make things better at my level.
SF: To address the concerns of people who are bringing groceries to their elderly relatives — I'm actually also in that situation and I have asked my parents to stay on their farm because of concerns with asthma and age.
Think about the surfaces that you touch. We now know that the coronavirus can live about a day on cardboard, so your cereal boxes and your popcorn boxes, those kinds of things. If you can pick them up from the grocery store, put them somewhere that your elderly relatives have access to and ask them to wait a day before touching that box, that box is now much safer for them than if you give it to them directly.
Other metals are a little bit longer — we’re looking at three days. So if you're picking up canned goods for your relatives, ask them to wait to touch the canned goods for three days. Alternatively, you can also sanitize them. But I know there's a big concern with a lack of sanitizer available to the general public. And so if you don't have access to it, it's not the end of the world. And the virus will die on surfaces that are inanimate. It just takes one to three days depending on the kind of surface it is.
LL: The testing guidance is changing. It's changed a lot in just a couple of days. Most people are aware that initially we had one case in Chatham County, then we had two more following that.
And I think that one of the things I want to emphasize relative to testing is that the change that has come down is related to the designation that it is now community spread in North Carolina. So that being the case, the testing has shifted. And there's a lot of reasons for this shift from “we're going to test anybody that is sick or presenting” to “we're going to test people that meet certain categories.” And your doctor would be the one to screen out whether that was appropriate for you, based on your conditions and your health status at that time whether or not it would be appropriate for you to be tested.
As far as the state health department or the local health department working through the state lab, we have very specific criteria for making those referrals. Right now, as a general rule of thumb, we're looking at, as far as the state public health lab, essential personnel, first responders being tested because we want to make sure that those people are capable of moving back into the workforce
The focus on testing, I think, really should in the public's mind move away from the actual “who's got it, who's in our community and where is it” and all these questions to, “let's just assume that anybody that you approach potentially has it.” It doesn't really matter what part of the county that people live in. You need to treat everybody, and it’s not that everybody has it, but practice those social distancing practices that keep you from becoming infected. That is going to apply if the person in front of you is infected, or the person is not affected due to social distancing.
Say, your neighbor voluntarily says, “I'm infected” — stay safe, stay away if your neighbor next door to you. It really doesn't change the dynamic of what you should be doing as a person. I was in the grocery store the other day yesterday. I tried to manage my space so that I am not interacting closely with people, Just as a matter of what I do.
SF: I think it's important to define what community spread is so that people have a better understanding of why we're using that term. So, from a fun epidemiological standpoint — and I know most people don't think science is fun, so you're going to have to forgive me. When we are tracking an outbreak of any disease, you start with the people who have symptoms, and then you try and trace it backwards to wherever it started. And as long as there is this tracing where you can say, “Person A touched Person B who kissed person C,” that's contract tracing, and we know exactly where the virus is.
When we talk about community spread, that means Person F showed up with symptoms, and we have no idea how they touched Person A, B or C. So at that standpoint, it's exactly as Layton was saying, we then don't know where it is. So it could be anywhere. It probably isn't everywhere. But you'd have to pretend like it is everywhere in order to save yourself or your loved ones from possibly becoming exposed to it. And again, that is such an issue with this particular virus and this particular disease, because it can be spread without symptoms.
LL: When we got the initial cases, the health department knew those individuals, we were in contact with them. We were following them, we were tracking them, tracing, and I actually issued isolation and quarantine orders for those individuals. And they were getting testing done. Because they were the first case, we knew where they were, and we were trying to manage it at that level. And that's what the state was doing initially in the process.
And at this point, with community spread, that’s, I guess to use the analogy, the horses out of the gate. We've had them in a corral as long as we could contain them, but now they're out. And so we just need to realize that knowing the individual is really not relevant at this point.
The Health Department absolutely has a legal obligation to protect anybody's personal health information and their privacy. If you're that individual, you would certainly want that allowed for your personal privacy and protection. So I want to hope that the message here is that the focus is doing those behaviors that protect us all. As Dr. Freese very well stated, we have to make an assumption that it could be anywhere, that we can be in contact, and knowing whether it's in someplace in southern Chatham or western Chatham or eastern Chatham is really not relevant. It's more about managing your own behaviors — social distancing, sanitizing, protecting your family in the same way — and making sure you're communicating that to your family. This is the way we stop this.
SF: I think the the focus on the number of cases is very understandable. We're trying to ascertain our own risk levels – are there three, are there five, are there 20. But because of the way that the testing guidelines have changed, in order to protect your first responders, your your doctors, your firefighters, it's going to make the numbers appear falsely low. We're not testing the general public — the vast majority of whom should survive and and get over this virus without a lot of medical intervention. We're trying to save the tests for the people who truly need it in order to protect the community as a whole.
But that means the number of cases in Chatham County being officially at three is probably pretty inaccurate. So again, the only thing we can really recommend is to practice the social distancing to practice the hygiene and, instead of trying to track individual cases, we're now trying to mitigate the the worst of the situation on the healthcare system.
LL: The whole premise of doing these closures is to reduce the possibility of people coming into contact with a case or somebody that has the virus. Are they going to be effective? Time will tell. They are certainly prudent. And that's why the state health department and the governor's offices recommended them. The less you have people in congregations — like in dense congregations, like schools or churches or sports events and those kind of venues —when you're looking at an R0 of what this virus carries, if you've got one infected person and a very densely crowded event, then the probability of that virus being spread to multiple people increases dramatically versus not having the event. So you significantly reduce that probability. So that is the reason for the closings.
If you're in a business where it’s a high-touch environment, like a hairdresser that sees multiple people — if that particular hairdresser was infected, then she or he would obviously have an opportunity to spread the virus to multiple people. So those kind of venues being closed is just a means of trying to lower the probability that multiple people will be affected by at least one person.
LL: The health department receives the initial guidance from the state that goes out to all of our healthcare providers in the county and statewide. We push out that information to all of our local providers. It goes out in an email blast and fax to the local providers and we are a reference for them. (Our) communicable disease staff is in routine contact with local medical providers. I’m on conference calls with the UNC Medical System routinely and other local medical providers in all these calls as well. I think the biggest thing so that we're all walking off the same page and working and using our resources. I know it's been in the news — PPE, the protective gear that our medical staff need is in limited supply, making sure that we're making best and most efficient use of that equipment.
SF: A lot of that originated from a particular case in Hong Kong of an elderly dog that was in a house with an infected patient and then they were able to swab the virus from the dog's upper respiratory tract. And that dog never had antibodies in its system, as far as the current reports are showing, so the dog itself did not become infected.
The dog is essentially what we call a fomite, which is a surface, a surface that you can touch and pick the virus up from. So if you cough on your dog's head, and then you take your dog to the park and someone goes, “Oh, what a cute dog,” and then pats it on the head, your dog is not infected from you and then passing it to that person, your dog is essentially an elevator button that somebody is touching. And then it has the potential to them to become infected themselves.
But we're not worried at this stage of your dogs or your cats or any of your household beloved animals getting sick from the virus itself. They just might simply be a means of spreading it, which is why you you really need to limit your animals’ contact with people who aren't already in your household.
SF: One of the things that people probably don't think much about, because they typically view veterinarians as dog and cat veterinarians, is that the vast majority of us learn a lot about epidemiology, and related to how to take care of a large animal systems.
So how do we slow rabies down? That's a communicable disease. And a lot of that is regulated by veterinarians rather than with the MDs. And we've looked about how to prevent spread of respiratory disease in cattle in feedlots so that your steak doesn't have to have any potential history of having had antibiotics at some point in its life. There's never any risk of antibiotics actually being in your food because there's a withholding time. That means if I give a cow an injection, that cow cannot end up as steak until that is guaranteed for that injection to have been removed from its system. But there's an awful lot of epidemiology that goes into veterinary medicine, because we look at animals more as a herd than compared to human medicine where it is very individualized specific care.
Now separate from that I am absolutely a gigantic nerd and I had been following this from the very beginning back in December. So I have given several presentations on the topic, looking at all of the different numbers and all of the different countries and trying to track the spread in a way that is then useful as my position on the health board to help everybody else understand what might be coming and what we can do to try and stop it.
The last answer to your question is that we were talking about coronaviruses as as an umbrella. Many of the corona viruses that are already well known are actually animal diseases. So we see a lot of gastrointestinal coronaviruses, fecal oral disease transmission in horses, in cattle, and there's a coronavirus that causes FIP [fecal infectious peritonitis] in cats. That background was really really useful for me and making recommendations at the beginning of this when we didn't know anything about this novel coronavirus.
We say (that) if coronaviruses are all like fingers, and this new coronavirus is like the thumb. Well, it's obviously different because it doesn't look like the others. But it still behaves in a similar manner to the other coronaviruses. And so that's where we were drawing some of our initial recommendations and our initial condition.
LL: As far as helping your medical providers try to manage — again, I hate to keep harping on this, but social distancing, because if you don't become sick, then you don't become a burden. So those things that you have control over — I think that's what a lot of us are feeling like right now, a lack of control. You do have control over your own behavior. And by doing that, you can reduce the chances of you getting this disease and by doing that, you lessen the probability that you will be a burden to your medical provider.
If you are a medical professional and you want to reach out, you can go to our website. There's a link there for anybody that wants to offer assistance, as that would be available for people to do. Also make sure that you're taking care of yourself.
If you're worried but you're not sick, don't call your doctor's office because they're getting inundated by calls right now, as is the health department. So use discretion, and when you are sick, reach out to your medical professional, but try to use some discretion in that regard.
SF: I'm going to ask you also to use some common sense. So if you look hard enough on the internet, you can find almost anything reported as a cure or a preventative for the coronavirus. And some of it is very benign, like eating extra onions. And some of it is actually very dangerous like drinking bleach.
So as much as we're all really concerned, as much as we want to protect ourselves as best as possible, listen to your health care providers when they say right now there is not a treatment, there isn't a preventative, there isn't a cure.
Don't try the diluted bleach drinking, don't, listen to what medications might possibly be useful for this and a specific situation, and then try and get your hands on them to try and use them preventatively. Those are not going to be useful situations, and in fact they can be dangerous, that are then going to put you in a hospital which is exactly where you're trying not to be.
LL: We've certainly are aware, and our PIOs [Public Information Officers] have been trying to manage a good message to the general public around rumors. Get your information from a reliable source. Anybody can post anything on social media and get something started. Do not rely on that as a source of information. Go to reliable sources — the CDC, National Institutes of Health, any of those official sites is where you should get your information, or the governor's office, but do not rely on social media for good information.
Rational reasonable fear is a good thing. It can protect you. Irrational fear is called panic, and that serves nobody's interest. And so if we all follow good common sense, and use rational fear, we will get through this, and I think that's the message is that we want to be thoughtful in our process. We want to think about how our actions affect other people, including our own family, and try to behave accordingly.
LL: I’d be terribly afraid to make any kind of prediction on that.
SF: We're probably going to look at a new normal. You’re probably never gonna think about shaking hands the same way as you did several months ago. And you might not value the amount of time that you can spend in pajamas the same way that you did six months ago, and for those of us like myself, who are extreme extroverts, and just love physical interaction and and face-to-face interaction, it will be an absolute adjustment. I'm going to have to learn to love the sound of my own voice just a little bit more than I currently do in order to protect the people I love.
LL: We’re holding together, some days more than others, but we're here for the public. It is our core mission. It is why we exist. It is. It is a public health department. We do a lot of individual services for the community. But at the core of our mission, the reason we exist is to help the public's health and that's what we're striving to do.
Our staff are like every other business and agency in the county and we've been impacted by this in terms of how we operate. We’re home basing people that can be home-based. We're trying to do rotations in the office so we have fewer people in the office. We have a mandate, internal mandate that anybody entering the building has to stop and wash their hands before they go any farther in the building. We're trying to emphasize the social distancing while we're in the building.
Our communicable disease staff have certainly been under the largest pressure initially in this phase, and they've done a tremendous job. I'll have to acknowledge our internal PIO Mike Zelek and the county's PIO Kara Dudley, who are in the room. They have really, really been under the gun trying to push out information and craft messages for the public interest. This is huge part of what we do, getting correct information out.