Weekly COVID-19 updates with Dr. Bunio (July 29)

by Jul 29, 2020Front Page, Health, NEWS ka-no-he-da




Each week, Chris McCoy, director of EBCI Communications, interviews Dr. Richard A. Bunio, Cherokee Indian Hospital Authority executive clinical director, about current COVID-19 updates and news.  It is aired via Cherokee Cablevision Channel 28 and livestreamed by Communications. 

Here is an edited transcript of the Q&A session on Wednesday, July 29.  All answers presented below are from Dr. Bunio who has been in practice for more than 20 years.  

“We are at COVID risk level red. (Per the tribal government’s new tribal dashboard) Green is good. Yellow is caution. Orange is watch out, and red is not great.” 

Early in the spring, experts suggested that the heat of the summer would retard the spread of COVID. Has that proved to be the case?

“We are not seeing that and all you have to do is look at Arizona and Florida to know that it is not slowing it down. One of the things is that when it gets hotter, we tend to go indoors and when you get indoors, the virus can spread. We do know that sunlight does help to kill the virus. So sunny days are a little bit better, but it is certainly not 100 percent. So no, it is not the miracle we thought it would be.” 

Do the UV light “cleaners” work for phones, masks, etc.?

“I can’t speak to any particular product, but UV light does work. We are actually looking at that to sterilize some of our N95 masks. It can be used to decrease the time you need to wait before you go into a room. One study I looked at showed that in direct sunlight, 90 percent of the virus was killed after about 7 minutes. If you wait another 7 minutes, you are up to 99 percent. That plus the wind, that’s pretty good. But, as we have said before, you can catch the virus in a second if somebody coughs near you even if you are outside. So, I don’t want people thinking they can go without their masks outside. It’s still a risk. Around here, I think it is pretty safe. I don’t wear a mask when I am out in my yard or even if I go for a hike. But, if you’re in a city or in an area where you will be potentially encountering people, it is a good idea to at least have your mask handy to be able to put it on when you might come within six feet of somebody. And definitely indoors, you should just wear it.”

We are at COVID risk level red. What does this mean?

“We are seeing an increase in cases. We wanted to make sure that the community is aware. We are not changing a whole lot of our advice. We are just saying follow the three W’s like we have said before. One of the things we have to be particularly careful about is people are getting a little stir-crazy, cookouts, parties, I know people want to see their families and friends, but that is where we are seeing some of this spread. It’s those mass gatherings where we just can’t control things. We just can’t.”

Can you explain the risk levels? I am still confused. 

“Green means you really have everything under good control, but you still have to do your testing and contact tracing. When you get to yellow, you have to do that more rigorously. You have to be more aggressive. When you get to orange, you have to make sure you have a very sophisticated and robust contact tracing and we do. But we have invested a lot of time and manpower in having one of the best contact tracing teams anywhere. So, if you have a good contact tracing team, you can just leverage that and try not to get to red. But when you get to red, that is when you have to start thinking it is going in the wrong direction; is there something else we need to do? And I can’t say exactly what that would be. That is a decision for leadership to make. Looking at the schools, I think that was a decision that was made by looking at the local and North Carolina data. I think the time wasn’t right to have the big in-person class.”

“We are hoping to see it level off in North Carolina. I was just on a call this morning, some of the chief medical officers in Western North Carolina and our sense is that North Carolina as a whole might be starting to level off, we’re not sure, but Western North Carolina is still going up a little. We just have to be real careful. We have been relatively spared.”

Now that we are in COVID risk level red, what should we be doing differently?

“I think it is the three W’s again. It’s following that advice religiously. If you are not doing that, then you should be doing that differently. There are a lot of people out there who are following that advise 100 percent of the time and thank you. That helps. If someone is inviting you to a party or a cookout or a big mass gathering -this has been a real bad one for spreading virus. The more people you have in a small space, the more chance that one of them has got the virus. When you are yelling or singing or talking, you spread it and we have seen some large numbers in these choir practices spread it.”

“Really it is the number of people. The state says we are trying to limit that to 10. It is a mitigation or control strategy. If there are 10 people and one of those is positive, we only have to track down 10 people and get them tested and try to clamp it down. If it is 50 or 100 people, the chance that someone in there has the virus goes up, cause there is more people, the difficulty in controlling it goes up because you go from one case to potentially 50 within a couple of days. That’s really hard to keep up with.”

Can you explain the graph regarding “New Reported Cases per 100,000”? This doesn’t make sense to me since we are not even close to 100,000 community members. How is that accurate?  

“We need to compare ourselves to a standard. New Reported Cases per 100,000 is one that this model that uses the color, that is what they use. So, one case here is like having 8 cases in a community of 100,000 people. So when you look at the graph and it says there are 21 new cases, I think we are up to like 28, averaged, that doesn’t mean we have 21 cases every day, it means that if we had 100,000 people here, we would have had 21 cases. So then we can compare ourselves. The reason we do it is so that we can compare ourselves to other places in the country and know are we doing better or worse. We can compare ourselves to North Carolina, Western North Carolina, and so that tells us if we are on the right track or not.”

There are significant delays in testing, some people can test Friday and get results back by Monday, while others are still waiting 10+ days for the results. Why?

“(We noticed an increase in delays in getting back results and started contacting the lab) We send these out to the lab companies, because we send these out to a nationally recognized lab, and they were just overwhelmed. Some cases we could identify as super important and a priority. And we could still get those back in about two or three days. But a routine test was taking longer and longer. I got really upset and said this is not good enough. We have got to get our tests back. We were getting tests back and the person had already completed their quarantine period. So, you cannot do contact tracing when the test delay is that long. It’s useless. We started last week; we are in negotiations with a different lab company who is actually working with our lab to work on some of the paperwork. We are also very close to getting an additional rapid test and that is going to help a lot; mainly because we need as many testing options as we can before winter when, my prediction is we are going to see a little bit of a spike in cases.” 

Why can’t we just do rapid testing?

 “The rapid tests are not as accurate. Some of the early studies say that they are about 85 percent accurate. When we first started down this road, I said I would rather have a test that is right 85 percent of the time in 15 minutes than a test that is right 100% of the time two weeks later. So now we are looking to develop a combined strategy where we use the rapid test then we might have to back it up with the other one. (We think we have enough tests to do the combined strategy) Two advantages to the rapid test we are using is that it is self-contained. They are also cheaper to make and this company says they can make as many tests as all the other tests out there combined. This is the same technology that we have been using for years to do our strep tests.”

“Here’s what I want the community to know. I am real sorry that this happened. We were really upset about it. We’ve already taken steps to improve it. But it is going to take us a couple of weeks to get caught up. So, we are in the red. We have got to be really diligent. We have got to try not to be put in the situation where you need a test. So, if you never went to that cookout where we picked up a positive, I don’t need you to come and get a test. And that is just going to help so that everybody who needs one will get their test and will get their results.”

What are the psychological effects of the virus?

“The virus can affect us psychologically in many ways. People getting down and depressed. There are a lot of people who really need a lot of social contact, interaction with family and friends. This is particularly difficult for people who live alone. That is why people get fatigued. They get tired of staying home, and they just go out. I understand that. When people catch the virus, it can really affect people for months and months after they have had it. They are very weak. They can’t do the stuff they used to do. And that kind of sets some people up for a possible depression. The virus is affecting us all. We just need to support ourselves even if it is just virtually, making a phone call or Facetime.”        

The updates are currently being broadcast live on Wednesdays at noon.