Lori Walsh: Welcome to In The Moment. I'm Lori Walsh. The situation with coronavirus in South Dakota is changing rapidly, as we expected. The update for today, there is one new positive case in Minnehaha County that brings the positive cases in Minnehaha County to four, total statewide positive cases are 10. The negative testing has been from 494 tests that were negative and there are currently zero tests pending in the state of South Dakota as that's been reported by the South Dakota Department of Health.
Dr. Kevin Post is Chief Medical Officer with Avera medical group. We're going to bring you a coronavirus and COVID-19 update on preparedness now with Dr. Post. Dr. Post, welcome. Thanks for being here.
Dr. Kevin Post: Thank you, Lori. Happy to be here.
Lori Walsh: A lot changed over the weekend, but it's all part of the ongoing planning at Avera. Tell us a little bit about what's new this Monday that transpired over the weekend. Let's start there.
Dr. Kevin Post: Yeah. I think over the weekend some of the planning has transitioned more into the mode of how do we focus on only the services that we need to provide that are essential. How do we work through our operations so that we can serve our workforce, our personal protective equipment, also possibly limiting procedures so that we have enough intensive care beds, ventilators available for the sick patients should that occur. So at this point, we're not completely limiting all of those activities, we are just developing a strategy of how our operations would work, should this worsen.
Lori Walsh: That's pretty much in guidance with the CDC and what we're hearing is being asked of hospitals across the nation. How is Avera working with state government and federal government on those preparations, especially when it comes to capacity issues?
Dr. Kevin Post: Very closely. So more locally, and on a state level, we have been working with the governor, the different health systems within the state as well as the State Department of Health to have a consistent policy as we move forward, for sure, when it does come to triaging patients, bed availabilities, should it lead to that. So on a national level, we follow very closely what the CDC, or the Center for Disease Control, does use for recommendations and we try to follow them closely as well.
Lori Walsh: Do you feel like you're getting what you need from the federal government and state government?
Dr. Kevin Post: Yes. This far, we've been very happy with the response from them. This of course is a very fluid situation so things change rapidly. What we were doing two days ago might be slightly different now today because of the progression of the outbreak. However, we do overall feel fairly satisfied with both our national and statewide cooperation.
Lori Walsh: One of the concerns that we're hearing a lot from listeners, and I want to talk to you a little bit about the process for testing and a treatment if you have symptoms, or if you have a confirmed case of COVID-19. What we're hearing is a lot of people who want to be tested and can't. We saw the state numbers released now, 494 cases have been negative, 10 are positive, and this is across the state. But there's zero pending right now which would possibly lead for people to infer that a lot of people who have symptoms aren't getting the tests they need. So let's talk about process for testing. Where do you want to begin there?
Dr. Kevin Post: Yeah. The process for testing, which we developed a guideline for that as well, is basically a set of questions that we ask patients to see if they qualify. There's an initial three sets of questions that has to do with the onset of fever, cough or new respiratory symptoms. And then out of them three questions, if you screen positive for one of those, you move on to a second set of three questions that is based more on your personal risk factors, or if you've traveled to a high risk area. Based on how you screen there, you'll be placed in a low, moderate or high risk category. And from there we direct patients onward, the moderate high risk category, to a testing center. And that's how we determine how we ration out who can have the test so that we keep enough of the tests available should the need arise to test those people that meet the criteria, to be more likely to have the condition.
Lori Walsh: You said rationing out tests, and we were listening to the president say that these tests are available to anybody who wants them. Help reconcile those two statements for me, please.
Dr. Kevin Post: All right. There are enough tests available for those who do meet the criteria. Our concern is if you just randomly start testing people that don't meet the criteria that, at some point, we may run short on supplies of the test. The other concern is when you do start screening people that do not meet the criteria, then what happens is, you may end up having some false positives as well, which is absolutely what you do not want in this situation.
Lori Walsh: Explain that more, false positives.
Dr. Kevin Post: A false positive is when you run a test on a patient and it comes back positive, but all tests have a small degree of error to them. So if you started running too large of a volume on tests on patients that did not qualify, eventually you may have some positive tests that aren't a true positive, which you don't have a great way of sorting out. [crosstalk 00:05:23].
Lori Walsh: Okay. And is that something that we don't really know about coronavirus yet, but we know about influenza or other viruses? Is that part of this being a novel coronavirus, or is that standard, concern?
Dr. Kevin Post: That is fairly standard when it comes to testing. Yep. Yep.
Lori Walsh: All right. So four people, and I'm not saying this has happened at Avera because I don't know the answer to that question, but for people who are saying, "I have a fever and I have a cough, and I called the number that I was supposed to call and I was told I don't qualify for a test." Hypothetically, can you tell people what might be going on there?
Dr. Kevin Post: Hypothetically, I would say, if the health system functions like Avera, hypothetically based on what their symptoms were, they possibly did not meet the criteria for the test, and that's if the questions were directed. Now, to be honest, not all health systems are handling all of this in identical ways, so depending on which health system you called, their process may be slightly different. So I cannot speak for all those health systems.
Lori Walsh: Right. Fair enough. And you mentioned testing centers. How is Avera expanding their testing centers? What are Avera patients facing when it comes to, "Hey, it's time for you to get tested," where they going?
Dr. Kevin Post: Yep. So with our call-in number, when you do qualify to be sent for testing, then we do have testing centers located in Sioux Falls, and then throughout our regional sites. And we then direct the patient to the nearest testing center by them and then they go there for the process of being tested. And following them being tested, they then go home and they are asked to self-quarantine or stay out for approximately three days and until the test results are available. In the meantime, of course, do the basic things of proper hand hygiene, washing, social distancing where you're keeping yourself away from your loved ones and, of course, not going out in public until you know if you are positive or not.
Lori Walsh: Are you implementing drive-thru testing, expansion of testing services? What does that look like for Avera's plan?
Dr. Kevin Post: Avera does have some drive-thru testing sites, but to access those sites you have to screen positive to be tested. You can't just show up at a drive-thru site and be tested. You still need to go through the process of calling in the Avera line to make sure you qualify to be tested. What we do not want is a rush of patients going to a testing site, expecting to just be able to drive through and get the test without meeting criteria.
Lori Walsh: Right. One of the names of this game is that everybody has to stay informed, and stay calm and think of their neighbors because there are situations here where we've seen people stockpiling, and same thing. A testing site could be overwhelmed by people who are not on the schedule to be there. We really need to be paying attention to that. Tell me a little bit about the testing itself and what labs you're working with to get those test results back.
Dr. Kevin Post: Right now, the tests are mainly being ran at the South Dakota Department of Health. That is where primarily the test results are coming back now. Now nationwide and even locally with our systems, we are looking at other testing options if this does become more of a larger case volume, can there be more lab sites available that can run the tests for a quicker turnaround time and as to not overwhelm the state lab. And, of course, you have to meet certain criteria before you can be certified to do that.
Lori Walsh: Again, important to note that that's all changing day-by-day as well. For people who have, we mentioned clearing the decks of elective surgeries and things that can wait, people are being asked for those things to be postponed in a reasonable way. For people who have chronic conditions that they're normally ... the cancer patients, the asthma patients who just need a refill of medication, somebody who's broken a hand or something. How are those patients getting the healthcare services that they need right now? And are you recommending any changes to how they contact their providers?
Dr. Kevin Post: Yes. That's a very important question because you're exactly right. The standard medical care of all the other conditions needs to go on. So what we are doing is, hopefully triaging our patients as they come in and those with the coronavirus symptoms, we will try to quickly triage them offsite if they are stable enough, to hopefully keep our clinics as healthy and disease-free as possible. Because you're right, the other patients do need to be seen. So what I think those patients with high risk conditions should do, is contact their primary care provider's office prior to coming in to make sure that it is an appropriate appointment, it needs to be done, or whether it could be triaged and done over the phone. And then following that, the provider will give them education on where they can best be seen.
Lori Walsh: Avera is known for their eCARE services and we heard the president over the weekend talking about removing regulations or trying to help telehealth move forward in a more aggressive way. Are you seeing any potential there for expanding eCARE services? It seems Avera was pretty poised in the marketplace to respond to that. What do you know?
Dr. Kevin Post: Yes. And I do think this is a great opportunity for Avera to help out with our telehealth experience and expertise. In fact, as recently as this morning, we are in meetings discussing how we can, for sure with the government regulations being lifted, how we can advance our services there. That really offers a lot of things we can use. We can use our providers at different locations to service throughout our entire network. It also avoids contacts for both the patients and the providers. And I definitely see it as an opportunity where we can make care more accessible for the public.
Lori Walsh: You mentioned a call-in number and the next question is about people who don't have a primary care provider because they're uninsured or they just haven't found a doctor yet because they didn't need one. Now what number should they call?
Dr. Kevin Post: I do not have the Avera number right in front of me to call off of mine. What they would want to do, they could contact their primary provider if they have access to one, and we would be able to provide them with that number. I can pull it up here as we speak to help to provide it with you. And I think I have it here, the phone number is 1 (877) 282-8372.
Lori Walsh: 2-8-3-7-2. You can find information at the State Department of Health at kova.sd.gov as well. There's a South Dakota COVID information hotline for the state of South Dakota as well, (800) 997-2880. We're going to keep putting those numbers and contact information up on our website at listen.sdpb.org and at sdpb.org.
Dr. Kevin Post, we really appreciate the update. Anything else that you wanted to make sure to tell people, because one of the things we're talking about is how seriously to take this. And Dr. Anthony Fauci said over the weekend, if it looks like you're overreacting, you're doing it right. Do you agree with that statement?
Dr. Kevin Post: Yes. And that's a common question. I completely agree it. If I could have one thing I would like to bring to the public is that now is the time to be acting before we are in a severe situation where there are a lot of cases. What we do right now within the next week by staying calm, washing our hands and especially doing the social distancing, and by that I mean staying away from large crowds, not going out when you don't need to, is what we can do to hopefully prevent a large surge of patients that would overwhelm the healthcare system.
Lori Walsh: Do you have confidence in the people?
Dr. Kevin Post: It may seem too early, but it is not, it would be my plea.
Lori Walsh: Do you have confidence in the people of South Dakota that they're willing to unite and band together, and do that? And it seems like something that we're particularly poised to be able to do.
Dr. Kevin Post: I do. I think we have great people in the Midwest and I think we will come through.
Lori Walsh: All right. Thank you so much, doctor. We appreciate your time.
Dr. Kevin Post: All right. Thank you.