Oct 02, 2020

COVID-19: My Story Episode 5-Elliott Koester transcript

Posted Oct 02, 2020 9:50 PM

Nick Gosnell: Welcome to COVID-19: My Story. I'm Nick Gosnell. We're taking a bit of a different approach to the podcast this week, as I had the chance to interview Reno County epidemiologist, Elliot Koester. Here is our conversation on COVID-19: My Story.

Elliot Koester: There's many different types of epidemiologists, actually. So there's infectious disease. There's say opioid abuse epis. My primary role with Reno County has generally been an infectious disease epi. So my main goal is to figure out how you've acquired such illness as COVID-19. How did you get COVID-19? What behaviors or where did you go that may have led you to acquire it? Then my next goal is to see how you're doing the first time I call, but see what risk factors or what other individuals may be at risk. So, who's in the home. How are they doing? Are they healthy? And then prevent the spread, prevent the spread within the home and also prevent the spread within the community. Within the home, it would be isolating yourself or say if there was a say, salmonella, making sure that individual does proper hand hygiene when they're cooking or eating or after using the restroom or anything like that. So then also prevent the spread within the community. Say, if an individual with salmonella was a chef, we wouldn't want them to work. Whereas if they were in another line of work, it would be more appropriate, same with COVID and that's where those isolations come in.

Nick Gosnell: When making the decision how broad to make this circle of people that you find out about, part of this is where people work and what their circumstances are and so on. My guess is that somebody who is a sole proprietor and owns their own business and works by themselves may have a different circle than somebody who say is the greeter at Walmart, for example.

Elliot Koester: Yes, absolutely. And depending on the scenario of that job, so the individual who works by themselves, they can still probably continue to work by themselves at home. The greeter at Walmart that becomes a little bit more difficult. So that's where we could potentially use the media, the radio, the newspaper as an avenue that says, hey, said greeter was positive. We know they were there from 10:00 AM to 2:00 PM on Tuesday the 25th, you know, random day. Then if we felt like there was potentially enough exposure, say if the greeter wasn't wearing a mask or say, if the greeter was actively coughing and the greeter just thought it was bad allergies, the greeter doesn't know, but we would put out something in a press release that says, hey, if you were at a, what did I say, Walmart or Dillons? Whatever facility you were at within this timeframe, you may have been exposed. Okay. But we wouldn't mention that it was the greeter.

Nick Gosnell: All right. And so there are some counties that have done similar things. I noted earlier in the epidemic McPherson County actually talked about Dillons employees, at least on one occasion. I think there may have been more than one but that is a strategy you might use if it were appropriate for the individual situation, if you could do so without identifying the individual.

Elliot Koester: Absolutely. And one of our biggest concerns is not identifying an individual who is positive. We try to protect the individual who turns to be positive. We try to protect their information. It's utmost importance.

Nick Gosnell: So with regard to COVID-19, obviously the protocols are a little bit different for each different illness because of the incubation periods of illnesses and those sorts of things. It's different for something that only lasts a couple of days, or maybe that has other external symptoms than it is for something like COVID-19 where the window of potential infection at least is a little bit wider. There's a lot of this stuff that I guess what real people probably want to know most is, if I am found to be a close contact of somebody that has COVID-19, what happens then?

Elliot Koester: I would make contact with the person who tested positive, the individual who tested positive. I would ask them who are their contacts? Technically, they could refuse, but we would like them to share that information so we can reach out to their contacts to help protect their contacts. When we do call that contact, we figure out when exactly they came in contact with the confirmed positive. And we don't even tell the contact where they were contacted with to protect the confirmed case, unless if the confirmed case is okay with us saying, this is where you came in contact.

Nick Gosnell: Let's say it was the hypothetical Walmart employee we've been talking about. You wouldn't tell them that it was at Walmart. You would just say it was someplace you went on X day or something like that. So you might be able to narrow that down to get the timeline, right. But you wouldn't give them any identifying information.

Elliot Koester: Yes, potentially. So say it was a Walmart employee...say I'm the Walmart employee, you are my friend from high school, you came in, we chit chatted for a while and I named you as my contact or as a contact, but I don't want anybody to know my name. So, you would receive a call from the health department saying, hey, you were exposed. Sorry, we can't necessarily tell you how you were exposed because we're protecting the confirmed case. However, we do like the confirmed cases to give us permission, to let them know how they acquired it, because it makes it, just the whole process that much easier and also lets the contact have a peace of mind of where they came in contact with.

Nick Gosnell: Let me be clear. There's nothing specific about that particular place I could have used Dillons I could have used any of the other businesses in town as a hypothetical. This is just simply a hypothetical. Let's not get rumors spread around here at this point. But Elliot, as we continue to talk about the epidemiological process, the investigation, that's your job. I don't know if anybody ever remembers the six degrees of Kevin Bacon game. You know, he was in a movie and then he was with somebody else who was in a movie and so on. That's kind of what you're doing here. You're trying to figure out where everybody went and what they're doing.

Elliot Koester: Imagine a spider web. So have the very center of the spider web. And then you have all these interconnecting pieces that go out wider and wider and wider. Say the very central part of the spider web is said individual who is confirmed. Then we try to make a spider web picture of all of their contacts. And our main goal is to prevent that spiderweb from getting bigger.

Nick Gosnell: The spider web of contacts with COVID-19, it's difficult to do that because of how infectious it is, I would imagine. That's why we hear about so called clusters of cases. Can you explain from an epidemiologist perspective, what a cluster is?

Elliot Koester: So, a cluster is a group of individuals who most likely acquired it in a certain location a certain event say we could have a cluster at the radio station where you had a certain amount of households, different households that have become infected that are either associated with the radio station or work at the radio station. So say if the mailman came to the radio station and ended up testing positive from the radio station, he would be associated with that cluster, along with the other individuals who worked for the radio station.

Nick Gosnell: Like the one for Hutchinson Community College, some of them may have been employees or students or people who went to an event there or the one at the prison employees or prisoners or people that work in the cafeteria or whatever. Those are different possibilities.

Elliot Koester: Yes.

Nick Gosnell: As we continue through this, it is really important for people to understand that that spider web...that's your goal is to knock that spider web down.

Elliot Koester: Yes. COVID-19 is spread through droplet. You know, coughs, sneezes, spit in the air. And that spit stays in the air for a little bit of time and then falls to the ground. And if I walked through that spit cloud or through that cough or something like that, that's how I potentially acquire it. And that is very difficult to potentially stop. Whereas something that...MRSA, MRSA is spread through contact, it's much easier to keep somebody home or preventing the spread of MRSA than it is something that is droplet or through coughing and respiratory. What also makes it very difficult is the amount of individuals who are asymptomatic.

Nick Gosnell: Something else that we probably ought to talk about is viral load. In other words, the amount of virus it takes for people to come up as positive, not even necessarily that they are or are not sick, but that they are found to be ill by the testing.

Elliot Koester: Let's take us for example. So, we both were coughed on by a positive the same day. Maybe I got coughed on a little bit more. So my viral load, the amount of virus I inhaled into my respiratory system could potentially be higher. So my onset of symptoms could happen earlier. Whereas you may have not even received, you might have not inhaled enough virus even to make you sick, cause we're both healthy. But if you are healthy, I'm an individual who has co-morbidities. I have other illnesses that weaken my immune system. Then we both get coughed on. We're both exposed to the same viral load. However, your body has the ability to protect itself from that viral load. My body does not have the ability to protect for how much virus I received, also when it comes to testing the viral load's important, because say if I was positive and I sneezed on you today, you might not pop up within a test within two days or three days because the virus hasn't replicated or grown enough for the test to even pick it up within that time frame.

Nick Gosnell: That's where there's a concern about testing, because you want to be sure that the people that you say are positive are positive and the ones that you say are negative are negative. We talked to Dr. Degner about this in the first episode of the podcast several weeks ago, if he has a challenge, that's it. He's wanting to have a test that is better at telling him definitively one way or the other, for somebody. From an epidemiological perspective, you'd love to see the same thing too, because as you're going back through and being Sherlock Holmes, you'd sure love to have better evidence.

Elliot Koester:

Yes. And absolutely. You know a worst case scenario is somebody pops positive on a test and they do the confirmatory test. I do all the investigation and it turns out they were negative. Other than, you know, me spending time with this individual, this individual's...they're worried for themselves, their family, what it means they've already gone through. If I can work from home or if I can't work from home, it's just a bunch of extra stress on that individual that was sadly unneeded, but happened.

Nick Gosnell:

The most important thing is if you want to keep yourself from getting a call from you, in other words, you want to try to stay away from getting infected. It really is about basic hygiene, right? We want to wrap up with sort of those thoughts.

Elliott Koester: Basic hygiene is huge. And with anything basic hand hygiene is always important when it comes to the mask wearing the mask wearing is important for yourself and for the individual. So I, when I wear a mask, I'm protecting you. And when you wear a mask, you're protecting me. Masks are not a hundred percent, especially these cloth masks, or even the surgical masks. They're not a hundred percent. We know this, but it's better to protect yourself with something than nothing and also wearing a mask helps protect those individuals who have a higher perception of fear of COVID-19. Those individuals who are older, who do have comorbidities or who have weakened immune systems for whatever reason you wearing a mask helps alleviate their fear.

Nick Gosnell: Fear, perception of fear is something we hadn't gotten to, but I can't let you go without talking about it. There are people who say, you know what? I'm going to be fine. I'm healthy. Even if I get this, it's not a big deal. And then there are those who say, listen, I've got A, B, C, D that are all wrong with me. If something happens, I am much more statistically likely to pass from this. And yet those same two people have to interact within the community. That's gotta be a difficult balance to strike.

Elliott Koester: Our perception of fear of COVID-19 and many other things is different than say on the West coast or East coast or even Oklahoma or Missouri, where you are at geographically helps determine your perception of fear. Older adults, immunocompromised individuals, individuals with comorbidities. Their perception of fear of COVID-19 may be higher. Whereas, everybody else who is younger, has a good immune system, no comorbidities. Their perception of fear is lower. Being able to respect both sides allows individuals to work within the community together.

Nick Gosnell: Our thanks to Reno County epidemiologist, Elliot Koester for joining us on COVID-19: My Story. We'd like to tell your story. Feel free to email us with your COVID-19 story at [email protected] and listen each week to COVID-19: My Story on HutchPost.com and your favorite podcast app.