Oct 16, 2020

COVID-19: My Story Episode 7-Dr. Scott Pauly

Posted Oct 16, 2020 11:50 PM

Dr. Scott Pauly: I am confident in telling you if we would have even more participation in community testing, we would have less cases in the hospital. We would have less cases in the nursing home. We would catch patient zero earlier and not be dealing with patient 55, 56.

Nick Gosnell: Welcome to COVID-19: My Story. I'm Nick Gosnell. What you're going to hear this week on COVID-19: My Story are the comments of Scott Pauly. He is a doctor with the Hutchinson Clinic and he spoke to the Board of Reno County Commissioners on Tuesday at their meeting as they were considering the new health order that was put into place this week by Interim Health Officer, Karen Hammersmith. His impassioned comments, definitely worth listening to, here on COVID-19: My Story.

Dr. Scott Pauly: Our numbers are up and not just by...our numbers, we mean the positive test rate, it's here. So grateful for our representatives from the hospital and Karen for speaking on this. It has, to use Chuck's words, fully penetrated our community. I also want to echo Chuck that we are the canary in the coal mine, but to the other counties of Kansas. I was on a 7:00 AM meeting with a group I'm on called the Kansas COVID work group for kids, a mixed specialty group of pediatric specialists, pediatricians, family physicians, psychologists, psychiatrists, sports medicine, who have helped develop the gating criteria for the Kansas Department of Education. They are looking at us because they're not here yet. And I told the representatives on there who many of...are the head of their health department for their respective counties, you probably are here. You just don't know it. And they said, we agree, because they're probably not testing enough and their little community hospitals aren't full. And I begged the people in the community to think of why, because they don't go to those community hospitals. They come here, they go to Wichita. Our patients at times go to Wichita. We have a immensely robust healthcare system. Here. We are not the tertiary care centers for the region. Once you overwhelm the tertiary care centers and overwhelm us, you're leaving this up to providers like myself, who are trained to ventilate and intubate people, but I haven't done it in 12 years. I'm lucky to have three pulmonary critical care, young, bright colleagues in town. And I'm grateful that they're here in this timing. Otherwise you would have myself and my partners there intubating, proning, paralyzing and ventilating your family members. Not that we're not good, but I do not want the practice again.

Dr. Scott Pauly: The elderly in our community and those who are younger, but vulnerable with chronic conditions are scared. They're scared of this virus. They are scared of their own families and of you and me. I hear it on a daily basis. They are not getting help from their young family members with groceries and other tasks because those family members will not wear masks and do not believe in COVID. And these older people think they don't matter to their own family. And they do not have the voice to express that to them. Because the dialogue in this community and elsewhere is being driven by politics. Vocal people who, whether they know it or not, are apparent leaders, and they're leading people down the wrong path. I see it every day. As I told some others, some wonderful educators on the phone yesterday, COVID finds its way to my doorstep and every other provider's, whether we're telling you about masks or not. I would rather encounter it in a preventative, prophylactic, mitigating manner than have to be the boots on the ground treating those who are, like Chuck said, downstream. Hospital data is lagged data. I'm using that term from somebody I immensely respect who is an educator and a superintendent. There is other lagged data out there. It is worthless to me. It tells me that it's gone to hell in a hand basket. Well, I already knew that. I want lead data, the positive test rate, what the transmission is doing in this community. That is how we dictate what we do next to prevent where we are now. We have difficult decisions to make regarding our community and schools. We do this all the time. During times of inclement weather, for example, ice, snow. We make the decision to close school for the safety of our staff, the faculty, the students, and their parents. This gets real. We've lost an educator within the past year and a half on a day of inclement weather that we can't take back, that nobody made the wrong call, but it happens. We would all go back to that day and take it back for that family. And we all know the mourning and the psychological stresses on the students because of that. This pandemic is an inclement situation. It's just lasting longer. The virus has been stepping on the gas and people in this community have been stepping on the gas with it. School is fundamental. It's important to the students, social, educational, nutritional maturation. For our most vulnerable students, it is the safest place they're at during the course of a year. But we have to balance that also with the safety of them, their family members, outside of school, there are psychological ramifications of not being in class. There are also psychological ramifications of being a nervous student who is worried about your parent with the comorbidity or your grandparents. So somebody can't come to me and tell me all students are anxious and depressed cause not being in school because I'll show you a whole bunch of them that are anxious. Cause they're there. And we're in the red zone and they've learned enough math and history in their educational facilities that they know where we're at better than some of these parents and other community members who are in denial. People with comorbidities do not deserve to die from this. I hear it all the time that person had a comorbidity, look around this room, guess who doesn't have a comorbidity. And even the ones that you think don't, might. Not all the 31 year old teachers with comorbidities. I have a feeling, a few are afraid to raise their hand to their colleagues and say they have type one diabetes. We put in an immense effort as a society to protect the most vulnerable. We educate the most vulnerable. We have community, county, state programs to support them. Many of us don't realize we're now the most vulnerable. We need to get real. School's important. I love sports. But I love you all more. Including the ones with comorbidities. We have lost individuals who now have a spouse left and were on the precipice of retirement, their diabetes or hypertension or obesity, didn't kill them. COVID killed them. I don't know if they had five, 10, 20 years left, but if I'm able to retire someday, I'm not planning on doing it in three years at 40. I'm planning on doing it when most others hope to and I hope my retirement doesn't start with my demise from COVID or something else. I'm long winded on this other conversations because I'm passionate about it. and I'm confident. These are not just my opinions though. I'm repeating to you the data and the expert opinion on this, not the paranoia, not the quote unquote research somebody does via their Google search. I'm not a smart person, but I'm smart enough to seek out the people who are. I advise the County to do the same. Be careful who you listen to. And we're in the red because we're in the red. As Karen mentioned, having kids in school is important and she said it correctly, but I want to emphasize it. The way to get them in school is to improve the transmission in this community, not to change the rules, to get them in school, despite the risk. The percentage of cases in the general population are high enough that there are students entering school with it. The schools are a Petri dish of exposures. Those students comparatively are at low risk for morbidity and mortality from it, but they in turn take it home to their parents and many times grandparents were the caregivers who in turn work, some work in nursing facilities, some work for the county, some work in my place of employment. That, in turn increases the person in the community more it's a vicious cycle. But the difference between these students and their parents and grandparents is that the parents and grandparents are at higher risk for morbidity and mortality. I did not want it to get to this point, but we are experiencing the lag data in this cycle has led to it. On behalf of my inpatient intensivists, the community has got a problem and it needs to stop when we're still the canary in the coal mine, and not the example of where not to go.

Nick Gosnell: Dr. Pauly said the experts he talked to actually would have wanted a more draconian health order than the one the county put out earlier this week, limiting gatherings to a hundred people with lots of exceptions. He understands that that's not where we are as far as policy, but he wanted to reemphasize the danger.

Dr. Scott Pauly: We want normal like it was before. Well guess what? 9-11 happened and it's called post 9-11. You can't go back. You can't go back. That's how history works. I hope we find a normal like it was, but you don't do it by sticking your head in the sand. 9-11, we lost two major impressive buildings with lots of wonderful people in them. I'm not sure the exact numbers, my guess would be three to five thousand people. Our response to that was a war. Changing how you travel forever. Changing how we view our interactions on a global stage. We have had over 200,000 excess deaths this year, compared with years prior, I'm not saying they're COVID or not COVID, they are excess deaths. We have had deaths in this community. Do I know what our response should be? No, but we're trying, in retrospect, we will learn. And I hope we erred on the right side.

Nick Gosnell: Pauly was asked why testing is so important.

Dr. Scott Pauly: Let's rewind two or three weeks. I am confident in telling you if we would have even more participation in community testing, we would have less cases in the hospital. We would have less cases in the nursing home. We would catch patient zero earlier and not be dealing with patient 55 and 56 from that case four to five weeks later. If you're only testing symptomatic people, you're fishing in a pond full of trout. You're going to catch a trout. You're a percentage of catching a fish, goes through the roof. The positive test rate is a proven metric, both in the medical and epidemiological world that tells you two things. One, do you have too many cases, but more importantly, are you not testing enough because you need to test more to decrease transmission. The positive test rate in testing is just as important, if not more important than the masks, handwashing and social distancing, it's hard to implement in our country because of the wonderful things we have such as freedom for communities that countries that can do it more forcefully. They've suppressed their positive test rate to less than 1%, some less than 0.5. We will never get to that point. We're looking for a magic number of 3.6% of the population per month. It's at that point that we feel, I hate using the word feel, but we're in the infancy in some data that you get a realistic impression of what the transmission is doing in the community. We've reached that, we did briefly. We touched it. Our positive test rate was in the high orange. The virus is outpacing us. We have so many symptomatic people coming. They're getting tested and they've increased more. My number of 250 per week previously, it was based on what we had been testing in the community weekly in the symptomatic world. We were trying to match those up, to get unskewed data. We need more community testing. We need more people to show up. The positive test rate is the most important lead metric in any gating criteria or retrospective look at how a community is doing. Community testing has suppressed our positive test rate by about 10%. So if you want to see what the red really looks like, pull out our community testing numbers. On the flip side, if more people would have come to community testing this weekend, instead of the 140, maybe it would be in the orange. If they would've showed up three weeks ago, even better. Cause we would have caught four or five cases that were the first to disseminate it to at risk populations. Community testing, it's for those who have the time for those who are already retired for those who could benefit their employers or their colleagues by getting tested and find out they're positive, don't avoid it for fear of isolation, do it for those others. For that mom, with the two jobs and the multiple kids. I want all of us to be careful with our words and what we know and what we don't know. Sometimes I say things as Scott, Scott doesn't know anything about this. Scott shouldn't be listened to on a microphone or put in the paper or talk out at a local anything spewing off my opinions because Scott also ends in Pauly M.D., which I'm not bragging about. I'm not proud of honestly, I don't think I deserve it, but because of that in our positions, what we say and not being careful with it gets magnified and carries a lot of weight. Even when we are saying it off the cuff. I trust my plumber. He's an expert. I trust my pathologist because I'm not an expert. I trust the pilot flying my plane because he's an expert, the pulmonologists trust respiratory therapists, because they are the experts in their respiratory therapy. I am trusting those experts in this who have weighed this and use the data in their opinions. We're all welcome to have our opinions, but I'm addressing everybody here. And I apologize for my tone, but we gotta be careful. Because what we do is pressing our foot on the gas with the virus, whether we know it or not. When everything shut down, people likely weren't going to the hospital because out of fear and we may have had some morbidity and mortality because of that, it's unmeasurable. What he is saying is we may experience that differently now if we don't combat the virus, we will get overwhelmed with the virus and there will be no room for the heart attack, for the appendicitis, because we wouldn't be at hospital with crickets because we shut down. The problem would be a hospital full of COVID. We don't want to have to take care of COVID. We want to take care of the other things that are inevitable. Again, I apologize for my tone. I'm tired. I'm tired of COVID.

Nick Gosnell: Those the comments of Dr. Scott Pauly from the Hutchinson Clinic at the Tuesday, October 13th, 2020 meeting of the Board of Reno County Commissioners, edited for length and clarity here on COVID-19: My Story. If you have a COVID-19 story, feel free to email us at [email protected] You may be a guest on a future episode of COVID-19: My Story. If you have yet to be tested as part of the community testing in Reno County, there are several dates still upcoming. To set your appointment, call (844) 834-3657 and listen to COVID-19: My Story next week on hutchpost.com and your favorite podcast app.