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Transcript of JoCo on the Go podcast 2/17/20

Theresa Freed (00:00):

On this week's episode, you'll hear from Johnson County medical experts about our coordinated response to the coronavirus. You'll hear what the virus is and why it has people concerned. You'll also learn how to protect yourself and those around you from contracting it. Although there are no cases in Johnson County, find out how we would respond if a case was suspected and confirmed in our area.

Announcer (00:20):

Whether you live in or just love Johnson County, Kansas, JoCo On the Go has everything Johnson County. Here's what's happening and what's coming up in the community you call home.

Theresa Freed (00:34):

Thanks for joining us for JoCo on the Go, I'm your host, Theresa Freed, a Johnson County resident and employee of Johnson County government. Today we're talking about how to prevent a coronavirus in our area and keep it from spreading, should we ever have a case in the County. But first we're going to learn what it is and why people are so concerned. We have with us an expert from the Johnson County Department of Health and Environment Health Services Director Nancy Tausz. Thanks for being with us. This topic has been in the news quite a bit, but many people might not be familiar with what the coronavirus is. Can you talk a little bit about that?

Nancy Tausz (01:07):

Sure. the coronavirus, which we now call COVID-19, that was a couple of days ago, we came up with a new name. It's just a new coronavirus that is a, we call it a novel virus. It just causes respiratory illness in people and it can spread from person to person.

Theresa Freed (01:23):

Okay. And why are we hearing about it now?

Nancy Tausz (01:26):

It was discovered just at the end of last year. So it's, like I said, it's a very new virus.

Theresa Freed (01:31):

Okay. And can you talk a little bit about how to originated, I mean, why are, why is it happening?

Nancy Tausz (01:36):

It was just discovered during an investigation in China when they were doing an exam on someone. They looked at markets in China. They looked at whether it was originated, maybe from bats or snakes or that, that type thing.

Theresa Freed (01:49):

So we don't have any suspected or confirmed cases in our area. Is that right?

Nancy Tausz (01:52):

That's right.

Theresa Freed (01:54):

Okay. So very good news there. But there was a suspected case in Douglas County this year and we heard KDHE talk about that and obviously the Lawrence area. But that was later found out found to not be the case or a person with coronavirus. So what is the process of identifying whether someone is infected?

Nancy Tausz (02:13):

Well, first you have to look at, at the individual person, did the person, first of all, travel to China, they were in mainland China. Were they in Wuhan? Were they in Hubei in the last 14 days? All right if they weren't in China or in any of those identified areas, that risk is very low. Now also, if you have someone who has been in contact with someone who actually has been diagnosed with a case within the, you know, the 14 days incubation period, sure. Then you need to look at that. But the risk is very low in our area.

Theresa Freed (02:46):

Okay. And how serious is the issue? So if someone does contract this, what's, what are the risks there? Well

Nancy Tausz (02:51):

The risks are like any, again, it's a respiratory disease. If you look at like flu or a lot of other diseases have the same type of symptoms, respiratory symptoms, a cough, a fever or shortness of breath. And it would depend each on each person individually. What is your immune system? Do you have co-morbidities? You know, I mean other diseases, diabetes, cancer so that it affects your immune system or young people, old people. Again, it's similar to looking at another disease like that.

Theresa Freed (03:20):

Okay. So is it as dangerous or more dangerous than the flu?

Nancy Tausz (03:24):

Well, it doesn't seem right now, again, you have to remember this is a very new virus and things are being discovered every day and we get new information every day. Again, it just really, the transmission does not seem to be as fast a transmission as the flu, at least right now. And that means as many people as it can infect. A compared to measles, a measles case can potentially infect 18 people. This is looking at maybe infecting two, but again, that could certainly change.

Theresa Freed (03:58):

Gotcha. Okay. So how exactly does the coronavirus differ from the flu in the ways you can get it? Is it, is it or is it the same?

Nancy Tausz (04:06):

Well, again, it's, it's a virus. What we do is we look at the person and your transmission risk. If you were in contact in close contact, say six feet within a 10-minute period without we call PPE, but a mask or protection, then that would be a risk of transmission right there.

Theresa Freed (04:28):

Okay. Is there any vaccine or cure for it at this point or does it just take like a regular virus take time?

Nancy Tausz (04:35):

It would just be symptomatic treatment. There's no vaccine right now or an antiviral that, that would, that would work for that.

Theresa Freed (04:41):

Okay. So like with the flu, you can, you can take something to shorten the duration, but not this.

Nancy Tausz (04:46):

You can take Tamiflu and hopefully within a 48-hour period. Yeah. But there's nothing like that for this right now.

Theresa Freed (04:52):

Okay. And how can we prevent it in Johnson County?

Nancy Tausz (04:55):

Well if you don't travel to China or if you are not in contact with anyone who's been to China or any of those, those areas that I specifically said. If you are sick, period, stay home. If you're sick. And again, this is flu season, please, if you have not gotten a flu vaccine, get a flu vaccine but stay home if you're sick. And that means you from work, that means your kids from daycare, school and wash your hands. Those are the best preventative measures we can do right now.

Theresa Freed (05:21):

Hello. Hey, good advice there. At what point should someone not feeling well suspect that this is a possibility and what are the, what do they do to contact or report it?

Nancy Tausz (05:30):

Unless you were in those areas? If you were in those areas and you do develop symptoms, again, a fever, a cough or shortness of breath call, call the health department. And then we can do some screening.

Theresa Freed (05:45):

So I'm just trying to imagine like, somebody in our County getting this, you might be in contact with somebody not realizing it.

Nancy Tausz (05:52):

Well again, look back at your travel history. I have been on an, airplane. Maybe, I didn't know if someone from those areas was on the plane. You would just need to be tested and that, that would just be an assessment by, by us, by the state health department and go from there. But again, this risk is very low. The CDC and the global quarantine is you know, routing each, each flight from those areas to mainland China and the Hubei and Wuhan into 11 different airports right now. And they're notifying state health departments and then they're notifying the locals. So there is a process in place there to try to decrease any, any exposure or transmission.

Theresa Freed (06:35):

Okay. Good to know. And we do have a webpage at Johnson County set up which has some good, helpful information about what coronavirus is. And you know, a lot of the things that we talked to you talked about today. So where is that?

Nancy Tausz (06:48):

It's at jocogov.org/coronavirus.

Theresa Freed (06:53):

Okay. Very simple. So if anybody has questions about that, they can also contact of course the health department and if you suspect that you might have it or have come in contact with somebody, just contact you guys. Okay. That's great. And thank you for being with us.

Nancy Tausz (07:06):

Thank you for having me.

Theresa Freed (07:07):

Continuing the conversation about the coronavirus. I'm now joined by Dr. Ryan Jacobsen, the EMS system medical director. Thanks for being here.

Dr. Ryan Jacobsen (07:16):

Yeah, thanks for having me. Appreciate it.

Theresa Freed (07:17):

All right. Just to start off with, can you tell us a little bit about your role in the County?

Dr. Ryan Jacobsen (07:20):

So I serve as the County EMS medical director. I'm an emergency medicine physician who's also board certified in prehospital medicine and been in this role for almost seven years now and serve as the medical director for the fire departments and Johnson County MED-ACT as well as the 911 dispatch center.

Theresa Freed (07:39):

Okay. And earlier in the episode we heard about what the virus is. Now we want to talk a little bit about the work that's being done behind the scenes to prepare for the possibility that this could show up in Johnson County. So can you talk a little bit about that coordination?

Dr. Ryan Jacobsen (07:51):

Yeah, that's a big question and there's a lot of moving pieces and I know you've talked with public health and other folks, but there are a number of layers to providing a community response from a fire and EMS perspective. One of the first things that we decided to do when the coronavirus was the novel coronavirus occurred was to meet with the fire chiefs and the MED-ACT chief and emergency management communications director Ellen Wernicke. And we sat down and discussed in conjunction with the county health department should we be turning on some advanced screening or enhanced screening at the dispatch center? So we did turn that on a couple of weeks ago. And what that does is if a caller calls 911 and they screen positive for flu like symptoms, cough, fever, respiratory, ill subject type of things, it allows them to further interrogate the caller. Have you been to mainland China in the last 14 to 21 days? And if the answer is yes, then we would consider that someone a person of interest potentially. That will be notified, the crews will be notified on their way to that 911 call that we may have somebody who traveled recently to China, which is a high-risk area, and to use appropriate precautions. So that's one of the first things we did at the 911 dispatch center was do some enhanced caller interrogation. The other piece of that is if someone reports that they have contact with a confirmed case or a suspected case, so that would also put them in a higher risk category.

Theresa Freed (09:21):

Okay. And is it typical that somebody might call 911 if they are having flu like symptoms or maybe somebody in one of those higher risk groups? Maybe more likely. Okay.

Dr. Ryan Jacobsen (09:31):

We process tens of thousands of calls a year through the 911 center. Everything from can you change my battery out to my on my fire alarm to I'm having a cardiac arrest, to someone in my family's died suddenly. We have every extreme in between and people absolutely call one for a lack of transportation, one for if they're acutely ill and sometimes influenza common pneumonias. People can get quite ill with those and have respiratory difficulties. They can go into profound shock. They can require oxygen, they may be too weak to drive themselves. They may have no one else to come get them. They may suddenly decompensate. So we get people calling for every number of thing and, and common colds, influenza type syndromes, coughs, fevers. We get phone calls for that all the time.

Theresa Freed (10:14):

Okay. So this really could be the first line of defense to contain the issue, right?

Dr. Ryan Jacobsen (10:19):

Absolutely. It's a layer a, it's a step accepted standard for dispatching. The international academies of emergency dispatch is we use their medical dispatching program. And they're consistent in their guidance. So when we turn this on, it's a very scripted questioning. And if they meet a certain criteria, we will do some of the enhanced caller interrogation, which will allow for the crews to know before they get to the call, as they're going on the fire truck or in the ambulance before they arrive. The dispatcher will notify them that this is a patient, potentially they'll see it on their screens that this is a potential patient. You should use potentially some enhanced personal protective equipment and be cautious in that patient because there's an exposure to a high risk event. So it is a first layer.

Theresa Freed (11:02):

So I know that you are in communication with say the hospitals as you're transporting. So is that also part of the process where you're letting them know in advance so they can take some, some precautions so they can also contain?

Dr. Ryan Jacobsen (11:14):

Absolutely. One of the things that we've done with guidance to the fire and EMS crews from my office is ensure that they notify the hospital that they're transferring, transporting to very early. So we're running a call in Overland park and they want to go down to KU or to Olathe Medical Center. We want to let that hospital know in advance that we have a patient who's been to mainland China. Or that we have someone who has been exposed to a suspected or confirmed case, which we have none locally of course had that happen. We would like that hospital to have as much lead time as possible to prepare a patient space in the hospital. Every emergency department hospital has their own internal infection control policies and procedures place. We want to give them enough advance notice to when we arrive at the emergency department that they're preparing that negative pressure room for instance, to quarantine that patient in the emergency department or wherever part of the facility they're going to go. They also may move people from the waiting room or move people out of the hallways and minimize contact and also get their providers in the appropriate protective equipment. That takes a little bit of time sometimes. So we're encouraging the providers to make sure and give advanced notice, which we always give advanced notice, but to tell them that we're concerned here that this could be a novel coronavirus patient, which again, we have nothing like that currently. But should that be the case, they would notify the hospital so they can make preparations in advance.

Theresa Freed (12:32):

Okay. It sounds like this is very similar to the flu, but the reason it's so concerning is it because it's new? We don't, we didn't, don't know that much about it and we don't have a vaccine, we don't have effective treatment and other than just, you know, symptomatic. So is that understanding correct?

Dr. Ryan Jacobsen (12:50):

So this is complicated. The coronavirus is a simple common cold virus. We see it every single year. In the hospital, we test people for a panel of viruses frequently when they come in. And that's not an uncommon tested, perform. And we see coronavirus positive every year. This is a common cold, flu type of a virus that anybody can get. And you and I might have as a sniffles cough fever, never go to the doctor. And this is in that family of viruses. They think it's transmitted very similar to the similar to the influenza a virus, which is cough, cold, sneezing, touching, rubbing snot, things like that. Like any other common cold virus. So it's very what we think is similar. The issue with that is that every now and then a virus within that virus family can have a novel presentation that the community has never seen. For instance, a bird flu, the avian flu the pandemic flu, the Spanish flu things that the world population hasn't really been exposed to the pandemic H1N1 flu back in 2009, that was a novel. It's an influenza virus, same family, and there's no difference. Communicates the same transmits the same in theory, but every now and then we get a a group or citizens or the public that aren't immune to, that. We don't have a herd immunity at all. And when you get a novel virus like that, that can also be, especially virulent, mean some strains of viruses can be more severe. And we see this periodically throughout our history where we have various peaks and troughs of certain types of viruses being predominant. Some may harm kids more, some may harm adults, more elderly folks. And they may target a certain type of patient. And this is no different. This is a novel coronavirus that we haven't seen before. And the concern is that it could be more virulent, meaning it causes worse disease than a typical coronavirus. And we don't know a lot about this yet. The CDC is constantly working on this and World Health Organization and all the appropriate folks who are investigating this. But it's really hard to know. It's just that it's novel and it could be more virulent. But I also like to point out that they think the case fatality rate's around two to 4% right now, that's not good. I mean, if a hundred of your friends got sick and four of them were going to die, that's a terrible thing. But they also don't really don't know how many people actually have this. There are many, many, it could be hundreds of thousands or millions of people that are infected with this that never seek medical attention. They never get formally tested for it. And it may just be a common cold and there's some subpopulations that get a very sick response to that. But we really don't know the true incidence of it. So it's very hard to measure epidemiologically something like that, especially in China where we have much more limited access and the communication issues.

Theresa Freed (15:22):

So is this one of those things that it might stick around a couple of years and then go away or we just don't know at this point?

Dr. Ryan Jacobsen (15:27):

It's hard to know. The experience we have is with SARS and MERS, which were you know, over the last 20 years. Those are the two other events with a coronavirus that had a similar increased virulence and spread through a population, but those were contained and those stopped being an issue globally. I envision that we'll have a similar, we'd have a similar course with this novel coronavirus we only learn more.

Dr. Ryan Jacobsen (15:50):

We're only better at containing things. You know, travel restrictions, you know, the quarantine, soft quarantine monitoring folks. We do this pretty well. And I especially, I think in the developed world, I think obviously it's easier to contain these types of things. But again, just like influenza thousands and thousands of people have already died this year, just in this country alone from influenza. And you can imagine that there are many, many millions of people that get it and never even seek care. Again, it's dramatic when someone dies from this, but overall the proportion of people dying is still small compared to the potential impact of something like an Ebola where the case fatality rate was very high, you know, high likelihood of dying as opposed to this. It may just be a common cold in many people and we really don't know the true incidence.

Theresa Freed (16:34):

Okay. And I know the CDC, as you mentioned, is closely monitoring and providing guidance. So they are the authority here in our country. And so that information is coming down to all the medical providers and emergency response. So what is the level of coordination, not just with Johnson County, but what are we doing in coordination with other medical providers in Johnson County?

Dr. Ryan Jacobsen (16:54):

So we work my office, the office of the medical director works very closely with the the Johnson County Department of Health and Environment and their disease containment folks. And we are an email communication frequently about what we're doing to the dispatch center and we're all on the same listservs, if you will. The email communications are shared very broadly, along with MED-ACT leadership, the emergency management communications director and their leadership as well as all the fire departments that operate. And we also share those things with police departments. For instance, we recently put in a policy that we were telling fire and EMS providers about a potential case that we were concerned about en route, but police officers run our 911 calls. So how do we get ahold of a police officer that might run into an emergency response show up on scene and not having idea that this patient may be a higher risk person. So we worked on that and said, Hey, how are we notifying our law enforcement partners in this? Because they run 911 calls and we've now developed, worked on a process to, if we're going to inform our fire and EMS crews en route, we will also inform, attempt to inform the dispatch center for the officers involved responding as well so that they can have advanced notice. So there's a lot of oversight and a lot of overlapping interaction. We work with the hospitals. We kind of serve. My office kind of serves as a liaison to the hospital community and healthcare community as it relates to fire and EMS response. We have a lot of cross collaboration. The Kansas City fire and medical director Kansas City, Kansas medical director for their fire and EMS. Lawrence's medical director. Wichita, Sedgewick County's medical director. We're a very tight group. We speak frequently, always texting and talking about, Hey, what are we doing? What are you doing? So we're kind of always aware of how we're responding in the region in the state with us.

Theresa Freed (18:40):

Okay. That sounds good and we'll just end with any advice for residents. Is this something we need to be panicking about or just simply be aware of?

Dr. Ryan Jacobsen (18:47):

Not at all. And I think the biggest take home, which we should be doing a year round, but also during influenza season is stay home. if you're sick, keep your kid home. If they're sick, cover your cough, cover your sneezes, use the alcohol based hand sanitizers, soap and water, cover those little flimsy disposable masks. If you have to be out and about in a closed space with people, you're most infectious when you have a fever and you feel terrible, but you might be infectious the day or two before you even know you have symptoms. Always being cautious in these seasons is good. And then of course seeking medical assistance from your doctor if you have any concerns. Absolutely no cause to panic at all.

Theresa Freed (19:26):

All right, well thank you so much for all that information.

Dr. Ryan Jacobsen (19:28):

Thank you.

Announcer (19:30):

You just heard JoCo on the Go. Join us next time for more everything Johnson County. Have a topic you want to discuss? We want to hear from you. Follow us on Facebook and Twitter at JoCoGov. For more on this podcast, visit jocogov.org/podcast. Thanks for listening.