Answering Your Questions On Reopening In San Diego

Speaker 1: 00:01 This week, San Diego County narrowly avoided more business closures and school reopening delays. The region's case rate placed us just below a threshold that would have triggered restrictions yet again, the back and forth over what can open. And when has left San Diegans with many questions about reopening, and we asked you to share them with us KPBS health reporter, Taran mento collected our audience's questions and asked infectious disease specialist, dr. Christian roamers to reply Speaker 2: 00:28 Dr. Ramers. Thank you for joining us today. Thanks for having me. So we have a lot of questions from our listeners. Let's see how many we can get in in the next 10 minutes. Steven Johnson asks, why are we not being told where the community outbreaks are located? He wonders why it's important to keep that information confidential when it could help people avoid contracting the virus. Speaker 3: 00:52 It's a good question. It's one that the press has been being has been asking the County officials really all along and different counties have taken different approaches to this. For example, Los Angeles County I think is very public with where the outbreaks are occurring and the response that I've heard from the County officials. And again, I don't work at the County, but in speaking for them, they've said that it is difficult to get contact tracing information when you basically publicly post this information. And as soon as people feel scared to provide information that makes that job a lot more difficult. Speaker 2: 01:22 And I will say KPBS has obtained some of that information by zip code and publish that. And we are part of a lawsuit that is against the County to provide more detailed information on the locations. Right? So I've heard our next question comes from listener, Jacob primers. Hi guys. My name is Jacob Reimers. My question was around opening up movie theaters in San Diego know, are they open? I've heard that they're open. And if they are, do you have to wear a mask when you go? Speaker 3: 01:53 Good question. So we are all learning as we go about what can be open to what can be closed. And maybe this is a good time to talk about the States, a color coded opening the criteria. So, you know, this is a, I would say science based approach to how we should open up our society versus not we've seen over and over and over again in different countries, in different counties that when you open up too fast, things get out of control. One of the real kickers that people don't talk about is the stuff we do today shows up in two to three weeks. And what everyone's worried about is things getting out of control and then not being able to pull things back because of something called exponential spread, where you have a real multiplication of, uh, of those cases. So I'm bringing up the, uh, the state criteria here, movie theaters under the red tier, which we're currently in say that they can be open with modifications at a 25% maximum capacity or 100 people. Whichever is fewer. Now they don't address masks, but in terms of any risk that you have, whether it be being on an airplane, being out in public, being in movie theaters, I personally think universal masking is a good idea. It's worked incredibly and there's great scientific data for decreasing transmission. In other settings, Speaker 2: 03:04 Let's go here from Mindy. Here's her question. Once a vaccine is approved, what would we expect rollout of the vaccine to look like? How long will it take, um, how will specific priority groups, um, be determined who gets to decide what those look like? Um, and at what point will vaccination coverage be considered high enough, uh, to allow for broader reopening of activities? Speaker 3: 03:30 Great question Mindy. So a lot of people are thinking about this right now. I think you've heard the CDC director, Robert Redfield in front of Congress the other day, uh, alluding to this that, you know, people just think it's going to be a switch that we flip and everybody gets the vaccine. That is not how it's going to happen. So there will be a limited amount of vaccine available in the beginning. And there are some very smart people thinking about how to phase this out. The one that I would refer you to is from the national Academy of sciences, engineering and medicine. Who's developed a very beautiful, um, uh, phased approach where phase one, two, three, and four sort of allowing the, uh, the populations at highest risk to go first, uh, with a lot of data and a lot of thought behind this, they've used our experience with pandemic, influenza, preparedness, Ebola vaccine, all this kind of stuff, even smallpox. Speaker 3: 04:15 And there's basically a phase one that, uh, gets a high, high risk healthcare workers are first in line, as well as first responders, such as firefighters and policemen phase one B would include everybody of all ages with comorbid and underlying conditions who are at the highest risk of dying of COVID. And then also included in phase one is older adults living in congregate settings. And that specifically nursing facilities phase two brings in more essential workers. And there's a detailed explanation of what an essential worker is. That includes people like farm workers, people working in meat, packing plants, um, teachers definitely also people of all ages with comorbid conditions, um, people in homeless shelters in group homes and congregate settings, not included earlier, such as prisons and jails. And then phase three gets more to the general population with young adults, children, uh, other essential workers, phase four would be everybody. Speaker 3: 05:04 Now the timeline of that, obviously it's going to take a while. So even if we have 10 million doses, by the end of the year, that's going to go to healthcare workers first, and then people with diabetes and hypertension, or, or who are older, who have highest risk. And the last thing I'll say is that we are already starting locally to discuss this, how it actually rolls out. We'll have to do with our existing systems with CDC and local health jurisdictions, but people are already starting to talk on the local level at San Diego County about how we're going to roll this out. Final part of your question is when do we get to herd immunity? Uh, the best modeling that I've seen is that we have to reach about 70% in order to have a real population effect of herd immunity. What does that mean? Speaker 3: 05:43 It means that the combination of having had COVID and having immunity from the actual infection, plus the number of people that get vaccinated needs to reach about 70%. And I'll tell you the one thing I'm very, very concerned about, and everybody, I know that's an infectious disease, public health doctors concerned about this is if we have enough vaccine hesitancy or reluctance of the population to get the vaccine, we may not get to that 70%. I've seen a recent survey that said 50% of Americans right now are prepared to get a vaccine. This is a moving target because of course it all depends on the transparency of the vaccine research protocols. Speaker 2: 06:17 Thank you. So our next question comes from Laura car. Here it is. How do we keep our kids and our family safe, if and when schools re reopen and require us the kids to go back to? Speaker 3: 06:30 Well, this is a very complicated question. I don't know if I can answer it in one minute or less, but the one major point I think has been lost a little bit and not emphasized enough is that school based transmission is totally dependent on community-based transmission. Our schools are not isolated islands. They exist within communities, students that go to school, interact with older people who are their teachers, their administrators, they come home to older people who are their parents. They interact with their grandparents. A school is completely embedded in a community in places where we've seen successful face-to-face school. Reintegration have been places that have already flattened the curves so much in the community that it looks like it's safer. The CDC recently issued a, uh, also a color coded guide to say, when it is safe to go back to school and it does have to do with basically community transmission as the most important factor. I think it's a little bit arbitrary to choose what level of community transmission is safe enough, but the people at the CDC sort of chose actual thresholds there. So that I would say is the overall point of when we know it's safe. Speaker 2: 07:31 This next question comes from a listener who's choosing to remain anonymous. They would like to know can dr. Ramers address the PCR cycle threshold being used in the labs that do stand Eva county's test and explain why it is considered precise enough to dictate public policy and business in school. Reopenings. Speaker 3: 07:51 So let me start with what a PCR cycle threshold is. A PCR is a chemical reaction that amplifies very, very small amounts of DNA or RNA from a virus or bacteria. The cycle threshold refers to how many of those cycles it takes to actually get a positive result. So the higher number you get, the lower amount of virus is actually there. What we've seen is that in people, for example, who get infected with COVID and they have a positive PCR test, if we were to test them after their infection, in many cases, it stays positive for weeks, six weeks. I had a patient who had an eight week positive, um, COVID test after being sick. And we know that person is probably not infectious. So the question is, is PCR too sensitive, and there's a lot of discussion about bringing in a different kind of test like an antigen test, which really would only detect those who are very, very infectious at the initial rates of infection versus a PCR, which really is, is a very, very sensitive test. Speaker 3: 08:47 And some people have said too sensitive. Now I think the question is getting at maybe over counting cases and counting positive PCRs as people that maybe don't necessarily have severe enough COVID, but really that's the standard test that we have right now. Uh, and PCR tests are really the best that we have. So they are the most sensitive and the most specific tests that we have right now, I will address the question and say that a positive PCR after somebody already been diagnosed with COVID is pretty useless. We can actually not use that, but that's not used in the case count. Initially, it's just a single positive. It tells us if somebody has COVID, you do not need to have a followup test. Once you've been positive. Once we use days and symptoms of 10 days and being symptom-free in terms of determining infectiousness, Speaker 2: 09:29 The next question is one that we hear a lot, and this one comes from Chris Davis or wondering why the kids haven't been a higher priority as, uh, all of the plans have sort of manifested or making all these innovations to allow restaurants to open outdoors and now indoors, and to do all of these things. And just wondering why there hasn't been a more concerted effort to make things work for kids. Speaker 3: 09:51 Boy, that's a really important question. I think in a cynical way, we would say that, you know, kids don't generate major economic productivity, the way that bars and restaurants do. Uh, it's a, it's a philosophical question that I think we need to think about as a society. What's more important to us open bars or open schools. Speaker 2: 10:09 Well, we have run out of time. Thank you, dr. Ramers so much for your expertise and taking the time to answer these questions. Thank you. Appreciate it.