Answers from the experts

Local government and health officials answer community questions about COVID-19
On Friday, April 10, local government and health officials held a joint town hall meeting online to answer questions from the community concerning the novel coronavirus, COVID-19. The town hall meeting was facilitated by Amy Ventetuolo, a public information officer for Washoe County. The following is an abridged transcript of the town hall, beginning with opening statements from the mayors of the cities of Reno and Sparks and Washoe County Commissioner Bob Lucey—followed by questions submitted by community members and answers from officials.

Opening Statements:

Reno Mayor Hillary Schieve—Thank you so very much. And thank you to our regional partners for having this important community conversation. I’m really grateful to be here and to invite our community into really finding out more information about what this crisis entails. I also want to thank our entire community for doing a tremendous job right now with social distancing and staying home for Nevada. It’s incredibly important right now that we flatten the curve. And we know that we are doing a tremendous job, so I want to thank everyone in our community for doing such. And, again, let’s spread kindness, not the virus.

Sparks Mayor Ron Smith—Thank you very much for including me in this town hall. This is such a great way to answer some very important questions. These are trying times and very difficult on all of us, but please remember we are all in this together. My thoughts and prayers go out to the families that have lost loved ones and to those that are battling this disease now. Many of us think there is nothing we can do, and feel helpless. But there is something we can all do, and that is stay home for Nevada. And there’s something else we can do as well. Due to the COVID-19 pandemic, suicides across the nation are on the rise. We are challenging all community members, city and county leaders, organizations, businesses and agencies to be part of the solution to prevent suicide by taking some important 25-minute training called SAVE. [The training can be accessed here: https://psycharmor.org/courses/s-a-v-e/.] … This training is offered through the Department of Veterans Services and PsychArmor. It will help us all recognize the signs, and help someone that may be contemplating taking their own life.

Washoe County Commission Chair Bob Lucey—Thank you for having me. I’m proud to be a part of this first virtual town hall meeting we’re having today and taking time to hear from those on the front lines that are fighting COVID-19 in Washoe County—and listening to our concerned citizens and the questions they may have during this trying time. I want to thank Mayor Schieve and Mayor Smith. We’re all standing side-by-side with our leaders here, along with the Health District, to address the ever growing needs of COVID-19 here in Washoe County. This is a very serious issue that we’re dealing with, and the only way we’re going to continue to combat that is as a unified team. I think you’ve seen that through our regional partners and how they’ve been continually working together to address the current needs. Now more than ever, as we continue to see the spread of COVID-19 continue to grow here in Nevada, people are being beyond inconvenienced, not being able to go to the stores and whatnot, and parks and golf courses. Those are challenges that can be overcome. What can’t be overcome is the loss of life. The threat is continuously real. And it’s going to get worse before it gets better. Right now … please stay home for Nevada.

Town hall Q&A:

How should you treat symptoms if you’re not sure you have COVID-19?

Dr. Travis Anderson, Northern Nevada Medical—As far as treating symptoms of COVID-19, we’re recommending patients treat it just like the common cold—so lots of fluids, Tylenol for fever or body aches, and then monitor for severe or worsening symptoms such as shortness of breath, persistent chest pain, any symptoms you can’t control at home. And if you are feeling very unwell and you’re not controlling your symptoms, contact your primary care doctor. And if you’re feeling really unwell and need to be seen immediately, get a ride to the emergency department or call 911 and get an ambulance to come and get seen.

When do symptoms become an emergency?

Adam Heinz, REMSA—It starts with trouble breathing. And this infection does cause patients to be a little breathless, but if you’re having shortness of breath—or you’re having trouble breathing—that would be a sign of an emergency, as well as persistent pain or pressure in your chest, any type of new confusion or any time you’re unable to wake somebody. And then something we call cyanosis, which is kind of a blueish color around the lips and face. In addition, it’s important for people to know that we’re obviously talking about COVID—but there are other medical conditions that continue to be endemic within our community, and that is that people will continue to have heart attacks and strokes and appendicitis. So those signs and symptoms, it’s so very important to make sure that you’re calling 911 for those things in our community.

How does COVID-19 progress in a patient from being in a hospital to being in an ICU and then progress to being on a ventilator?

Dr. Paul Sierzenski, Renown Health—We have data that was released by the CDC just two days ago that, in general—when looking at about 14 states—about five patients out of 100,000 actually get hospitalized. If a patient needs hospitalization, there’s a small percentage of those individuals who actually may need to advance to the intensive care unit. And the primary aspect of that has to do with the work of breathing, as you’ve heard how this virus attacks respiratory status, as well as their ability to oxygenate. If their ability to oxygenate is diminished to the point that it can’t be supplemented with other means, they may need to be placed on a ventilator. And that is the primary reason patients with COVID end up entering the ICU. The other is that there may be other side effects from this virus, including overwhelming infection from sepsis or—ultimately—as we talked about, or as you may have heard, acute respiratory distress syndrome.

What is the length of time the virus remains alive on surfaces?

Dr. John Hess, Saint Mary’s Regional Medical Center—Unfortunately, this particular virus is fairly hardy and so can remain transmissible for quite some time outside of the body. There have been a few studies on this. The CDC actually has more information posted on this. The New England Journal of Medicine actually published a study less than a month ago, kind of giving us guidelines. And this is sort of what came out of that. First, it’s important to know that our food and water do not seem to transmit the virus. When you’re eating or drinking, you don’t need to be fearful that what you’re ingesting could give you the virus. That being said, what food or liquid are packaged in could potentially carry the virus. And, so, these are some sort of household items you may have or come in contact with, and this is the length of time that, typically, these things can be infectious. Copper—which would be certain pots and pans—the virus can remain viable for up to four hours. Cardboard—which might be like packaging boxes—can remain viable for up to a day. Plastic or stainless steel—which is really most of our surfaces, whether it be door handles, light switches, countertops—unfortunately, the virus can remain viable for up to two to three days. And that goes back to the social distancing, wearing the masks that are no recommended.

How long does it linger in the air?

Dr. Bret Frey, Washoe County Medical Society—The physics of transmission are becoming a little bit more clear over time as we get more information. It’s probably important for the viewers to appreciate that there is a respiratory droplet, which is a larger particle size that typically is greater than five microns and settles after a cough, for instance, in a room—and settles pretty easily onto surfaces. It doesn’t stay aerosolized in the air very long at all. But there is a bioaerosol, a component to this, which puts health care providers particularly at risk when they’re doing aerosolizing procedures—and these bioaerosols could also be in play with normal speech speech, for instance, the louder someone speaks or if they have different speech mechanics than the next person, they can actually have these bioaerosols go into the air. And we believe this could be helping transmission out in public, and that’s why it’s so important for everybody to wear some sort of mask when we’re out and interacting with others.

Where do I go to get tested?

Kevin Dick, Washoe County Health District—In order to get tested, we’re recommending for people to contact their primary care physician or contact our hotline at 775-348-2427, and we’re only asking people to make those contacts for testing if they have symptoms and are concerned that they have COVID-19. When you call our center, we will then ask a series of questions about your symptoms and about you, so that we can determine whether you meet the risk criteria that we’re using for the people we have come to have samples collected for testing. So that will depend on the symptoms you’re exhibiting. It will depend on what types of underlying conditions you may have, your age—factors that help us identify who we believe are the vulnerable population that we need to prioritize for those tests. We’ll also be prioritizing health care workers and first responders for that testing. And if you are scheduled for testing, we’ll provide you with a time and the location to come through our drive-through test location. If you’re working with your health care provider, they can work with you to arrange for testing through your health care system. If you’re having difficulty working with them for that, you might want to contact an urgent care facility that’s associated with your health insurance and health care provider to talk with them about opportunities for testing, because test samples are also being collected and submitted for testing through our health care systems.

Do we have enough space in our hospitals, and will we reach or exceed capacity in the coming weeks?

Dr. Sierzenski, Renown Health—I think the first thing to say is that we are prepared. If you look anywhere in our news and media, hospitals not only in our county but around the country are preparing for a potential surge. And I think that’s where we need to focus. The key with this is that we will stay prepared and remain prepared if we all do our part to make sure that we’re following social distancing. That’s what impacts flattening the curve. But we have been preparing for weeks, in addition with our partners from both the county and the state, so we are prepared. But we’re asking everybody to do their part so we can save lives.

Dr. Anderson, Northern Nevada Medical Center—Northern Nevada Medical Center as well as Renown, Saint Mary’s and all of the other partners in the region have coordinated almost daily about their efforts. All of our hospitals have initiated tents to accommodate the increased volume and to protect patients and staff members, both inside of the hospitals and out. Our hospital, just like the other hospitals in town, has dramatically increased our ability to see patients and their capacity. I think we’re all fearful of the amount of patients that will come through. But, fortunately, we’ve had enough time to adequately prepare. And I feel like our hospital partners across the region will do a good job of taking care of our patients.

Dr. Hess, Saint Mary’s Regional Medical Center—I would like to reiterate what my two colleagues have both touched on. I think there’s been a community-wide effort to make sure we’re prepared for a potential surge. And we’ve all increased capacity. I do also want to point out that I think all of the hospitals have created significant restrictions within the hospital to prevent any type of spread within the hospital. One of my colleagues touched early on the fact that there are still people out in the community have heart attacks, strokes. And one of the great fears we have right now is that those patients are not seeking care because they’re afraid to go into the hospital. Please do not be afraid to go to the hospital. The hospitals are taking precautions to avoid transmission of the virus within the hospital setting. So, please, do seek care if you have those other issues. … I think we’re very well prepared for a potential surge. All of the hospitals have significantly increased capacity.

How is it determined that a COVID-19 patient is recovered?

Dr. Frey, Washoe County Medical Society—We’ve had to kind of go down a non-test based strategy most of the time with respect to whether somebody is recovered or not from COVID. And, usually, recovery is based upon significant and consistent improvement of symptoms. The CDC is recommending, and I think everybody should really follow this strictly, that they can consider themselves on the road to recovery or mostly recovered when you’ve had a number of things happen. And one of them is three days without any fever and no use of any kind of fever reducing agents like Tylenol. And just to reiterate, at this time we have enough information to probably say that using things like NSAIDs—or things like Aleve or Motrin—to treat your fever with this illness is probably not a could idea and could lead to some additional problems. So we’ve asked people to use Tylenol to reduce fever. Second is just the overall improvement of your respiratory symptoms—if you’re feeling less short of breath, if you’re able to do household chores or go on a walk. And the third thing is that you want to have seven days go by with no symptoms. … We believe the viral shedding continues to go on even when you’re symptom-free for quite some time. … For those that have recovered, please continue to wash your hands and maintain social distancing and masks over the face—because we’re not sure how long viral shedding can occur.

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