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COVID-19 Positivity Rates And Hospitalizations Up

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>>UNIDENTIFIED PERSON #1: Support for Noon Edition comes from Smithville - fiber internet, streaming TV, home security and automation in southern Indiana. More information at Smithfield dot com. And from the Bloomington Health Foundation - partnering with local organizations and citizens to invest in programs that address our community's health needs. Bloomington Health Foundation - improving health and well-being takes a community. More at Bloom H F dot org.

>>UNIDENTIFIED PERSON #2: It's 12:07. WFIU Bloomington having some technical difficulties bringing you Noon Edition. We'll be back online with you just as soon as we can. Please stand by. Thank you.

>>BOB ZALTSBERG: Welcome to Morning Edition. This is Bob Zaltsberg from WFIU and WTIU. And we are having some technical difficulties but we think we've got them sorted out so that we can go ahead and have a show. First we operating remotely as we have been the last few months but we had some (unintelligible). Today we're gonna be talking with various people about recent trends with...

>>: (CROSSTALK)

>>THOMAS HRISOMALOS: ...Computer on. I'm not sure which one I should use.

>>BOB ZALTSBERG: And so I think I can hear one of our guests. Dr. Tom Hrisomalos is with us today. He is an M.D. with the IU Health Southern Indiana Physicians provider and he specializes in infectious disease. We also have with us Graham McKeen Assistant University Director of Public and Environmental Health at Indiana University, and Shandy Dearth is joining us. She's the director of undergraduate epidemiology education at the Richard M. Fairbanks School of Public Health at IUPUI. We have had - we did have invited - we had invited Julie Thomas from the Monroe County Board of Commissioners and Jill Raines a chief of clinical quality at Green County General Hospital. But we only have room for three guests and myself today because of our technical glitches. So that's who we're going to have. So I hope that - I hope you're all here. Dr. Tom, I heard you so hopefully you're...

>>THOMAS HRISOMALOS: Yes, I'm here.

>>BOB ZALTSBERG: Yeah, good to hear your voice. So I'm going to start with you and just talk about you know we've had a lot of discussion about how the numbers are rising rapidly around the state. I know Monroe County's numbers are - have been rising somewhat. How - you know what are the key numbers that we should be looking at in Monroe County to see how we're doing here?

>>THOMAS HRISOMALOS: Well as you - I mean as you know we sort of watch a lot of different numbers. We watch the positive cases. We watch the percent positives. We watch the hospital admissions. To me in taking care of patients of course the number of hospital admissions is always very telling. That wouldn't necessarily reflect how many cases we are seeing, particularly in the younger age group. And I certainly understand that we're seeing a lot of cases in that 20 to 29 year old age group. Those would be individuals who obviously would not usually end up being hospitalized. But we have seen a increase in number of cases I would say starting at the very end of June and then throughout July. And I would - I'm hopeful that maybe here in the last few days we've seen a little bit of a plateau in our hospital admissions. So that might be a positive. But I think you know this was not unexpected. People are out and about more since some of the restrictions were lifted and that just allows for greater transmission.

>>BOB ZALTSBERG: So I think one of the numbers that we've talked about before - I think when we have Penny Caudill on the phone - was Monroe County had a very low rate of actual infections based on the number of tests. And I think it was hovering around 3.3 percent but the latest number that I saw was about four and a half percent.

>>: (CROSSTALK)

>>THOMAS HRISOMALOS: I think Indiana as a whole has been running close to 9 percent - 8.9 I think is the last thing that I've heard reported. And Monroe County has been about half that, about 4.5 as of most recent numbers that I've seen. And you know 5 percent is sort of a threshold. You want to really keep that as low as possible, and less than 5 percent indicates that you are doing OK.

>>BOB ZALTSBERG: OK. Shandy Dearth from the Richard M. Fairbanks School of Public Health at IUPIU, so we - you know again what stats are you looking at statewide? And I know we've had some - there have been - I think it was Dr. Anthony Fauci that suggested earlier this week that Indiana could be headed for being a hotspot at some point. How concerned should we be?

>>SHANDY DEARTH: So he's referring to the positivity rate. So as you guys were just mentioning the numbers, looking at how many people are actually coming back positive, now that we've got such good testing capabilities around the state, looking at the percent positive is a really important key indicator for us. And as you mentioned, those numbers are starting to go up. So if we look at the last seven-day average for the state of Indiana, we're at 6.9 percent. So as you mentioned those numbers are slowly increasing. And Dr. Fauci was right that as we're reopening things, students are coming back, that sort of thing, we're starting to see some uptick in cases. And so we're keeping an eye on that. And then we're also keeping an eye on hospitalizations because it's important to make changes if we start to see too much of a surge on our hospital system.

>>BOB ZALTSBERG: And what are we seeing now as far as hospitalizations?

>>SHANDY DEARTH: So we are starting to see statewide an uptick in hospitalizations. They at this point are still half at what we were seeing back in April when we had that really large surge. So it's not as bad as it was obviously back then. But we want to make sure we take precautions so we don't get back to that same state.

>>BOB ZALTSBERG: OK. And now I'm bringing Graham McKeen on now. He's Assistant University director of Public and Environmental Health at IU. And of course the students are going to be coming back. There's a lot of discussion about...

>>UNIDENTIFIED PERSON: Will for now be joining Fresh Air with Terry Gross in progress.

>>BOB ZALTSBERG: So I want to ask you, Graham, about what we're seeing you know around campus and what kind of things that you're really keeping an eye on.

>>GRAHAM MCKEEN: That's a good point and something we're really watching very closely obviously. And I think one other demographic to kind of be keeping an eye on in the state is the highest demographic across the state the 20 to 29 year age demographic currently. And that's even more significantly higher in Monroe County specifically, and so we're seeing a lot of this spread in some of these younger populations. If there's anything good about that, of course they're likely to experience a lower infection. And so our big focus right now is those that are coming to campus and getting those folks at arrival testing - point of care testing - those that are moving into Greek houses, into residence halls and then also having another test offered to all off campus students as well. So that's really our goal is to start with the lowest viral load as possible in the community and hope that you know we're able to have containment and work through the processes for contact tracing and quick identification and those quick public health controls that you need like quarantine and isolation.

>>BOB ZALTSBERG: So I know that IU is really starting to - will be starting to have a lot of students coming back in the next week probably. I mean tomorrow's August 1st. That's when students start coming back here. So I read some indication that there is like a four step plan for all students that are to be going into residence halls. I mean can you explain what's going to happen? When a student drives back into Bloomington with their parents to go into one of the...

>>GRAHAM MCKEEN: It changes every five minutes so just wait five minutes and it might be changing again by the time they enter the program here. But again those that are coming into on campus residences and Greek houses have a requirement for a pre-arrival test. We understand some of the equity issues and availability and getting some of those tests across the U.S. So we are also doing that on arrival testing too. And that will be again a point of care test or rapid test, antigen test - slightly less sensitive but in public health you know we're willing to trade quantity and speed for a little bit of sensitivity in comparison to like a PCR test. And so those moving into residence halls will be funneled through a process to get the onsite testing and get the clearance test, the rapid results, and then be able to move on to do the other checking items for moving in. Those off campus will have collection sites and places that they can come to to get that test because they're going to arrive at different times. That off campus test will be a saliva based test. But there has to be sent off for analysis. So there's a couple of days turn around there. It's not protective from a public health standpoint because you can't take immediate public health action on a positive, but we are asking our students to follow those healthy behaviors and minimize their exposures until they get the results so that if they are positive that we can make accommodations for any isolation, quarantine and contact tracing.

>>BOB ZALTSBERG: We're talking about the latest trends and the latest news about COVID-19 on Noon Edition today. We are experiencing some technical difficulties. But we have three guests that we have on the phone with us. Shandy Dearth is Director of Undergraduate Epidemiology Education at the Richard M. Fairbanks School of Public Health at IUPUI. Graham McKeen is Assistant University Director of Public and Health Environmental Health at Indiana University. Dr. Thomas Hrisomalos is an M.D. with IU Health Southern Indiana Physicians and he specializes in infectious diseases. You should be able to contact us by Twitter at Noon Edition or you can send an e-mail to the news at Indiana Public Media dot org. I want to get very quickly to a question that we had even earlier this week. And I know we have talked about this a number of times before. But I just want to see if anything's changed. So Dr. Tom you can answer this first. We had a question come into the station this week that says - it actually is kind of a statement. It says COVID has been proven to be no worse than our seasonal flu. So why aren't we back to work yet? Can you comment on that?

>>THOMAS HRISOMALOS: Well, I mean I've heard the same thing many times. And the fact is COVID is worse than the seasonal flu. When people are comparing statistics, they're not comparing statistics that are collected and analyzed in the same way. So they may look at some numbers and say oh gee, this doesn't really look a whole lot different than the flu. But the numbers aren't - if they're not analyzed, collected in the same way then they're not comparable. The risk of mortality particularly to elderly populations with COVID is probably at least 10 times if not more than seasonal influenza. And if you wonder about that, I mean you can do some simple thinking like when is the last time you recall seeing that there were 150,000 deaths due to influenza in a season? When's the last time you recall during the seasonal influenza outbreak that places like New York City were pushed to the brink of capacity for ICU beds and similar situations in southern Florida and Texas and Arizona? We haven't seen that with seasonal influenza and that's because COVID is more dangerous and has a higher risk of mortality than seasonal flu does. You'd have to go back to 1918 and the great influenza pandemic to see something that is similar.

>>BOB ZALTSBERG: You know we've talked about this on this program several times. I know there have been - this question has been asked and answered a number of times. Can any of you suggest to me why it keeps coming up and why people don't seem to be getting the message that it's a lot more serious than the seasonal flu?

>>GRAHAM MCKEEN: I think a lot of it is it's almost a blessing and a curse the more I think about it you know. Would our public health response with those healthy behaviors be different if this had a higher mortality rate? I think the fact that you know 43 percent of us or whatever are asymptomatic and have no symptoms and the fact that many people that do get this to have what you could call even a very minor illness. But it's still such a strange virus. So I think it's that kind of mixture of it maybe not appearing as serious as it is but it is serious. Back to Tom's point, you know I think if the true infection fatality rate, when you add in all those asymptomatic and mild cases, it's probably point six percent. That's not a super deadly disease but that's still five times more deadly than the seasonal flu. And it's really about the law of large numbers, right? And so as you have unfettered and uncontrolled spread or as you really you know remove these restrictions, you're going to see this because the majority of us still are susceptible to the virus. And so it's just those numbers and the percentages that can make it so deadly, as Tom had mentioned. You know some of these critical care capacities are pretty low in areas and they can fill up. And what's another issue with that is you know we can definitely look at hospitalizations. You would definitely want to be tracking that. But it's such a lagging indicator for a rise in cases. I think we're seeing more of that with healthier populations getting impacted and more testing - it's not enough but more testing picking up some of those more mild and asymptomatic cases. But the psychology of this is fascinating.

>>SHANDY DEARTH: And I would like to point out that we don't know the long term outcome of these cases. So even though up to 40 percent of people might not show symptoms, we're starting to see more and more literature in the medical journals indicating that some of these people, even though they were asymptomatic but tested positive may possibly have some heart or lung damage. So we can't automatically assume that once they're healed they're OK like you might be with regular influenza. So we think there could be a lot of brain manifestations down the road that we just have not seen yet.

>>: (CROSSTALK)

>>GRAHAM MCKEEN: It really is. I mean some of these people have long term symptoms. It's definitely not the flu.

>>SHANDY DEARTH: Yeah.

>>BOB ZALTSBERG: If you could expand on that either of you? You know sometimes there are stories that come out or posts on social media that will say well you know if you really look at the numbers a lot of these people didn't die from COVID, that they died from something else. But I remember reading something not too long ago about how COVID attacks all sorts of different organs and can cause death in a lot of different ways. So can you tell me I mean did I read something that was accurate or can you expand on that for me?

>>: (CROSSTALK)

>>GRAHAM MCKEEN: I can certainly say you know from a medical standpoint that those distinctions sometimes get a little bit artificial. I mean if you are critically ill and end up on a ventilator because of COVID and then die of a stroke or die of a heart attack, well what was really the precipitating cause of death? You know the COVID was the underlying cause although it may be attributed to something else. Interestingly to expand upon what was said about chronic manifestations, if you look at some of the studies that have come out of Europe recently from Italy for example they report that about 85 percent of individuals who have recovered from COVID two months after they've recovered 85 percent are still having manifestations whether they be coughing or respiratory symptoms or fatigue. And so this certainly does appear at least in a significant percent of the population to have lingering effects.

>>BOB ZALTSBERG: So we're talking with several experts about COVID-19 here on Noon Edition today. If you want to contact us you can find us on Twitter at Noon Edition. You can also send a question to news at Indiana Public Media dot org. We had a question come in earlier this week about a treatment, so I'm going to ask maybe Dr. Tom you could take this one. But Debra asks why are people using Neoral for COVID-19? The 100 mg is now unavailable for people treating autoimmune diseases like Lupus nephritis. Can you answer that?

>>THOMAS HRISOMALOS: There have been - the manifestations of COVID seem to be divided into two periods - the early period due to viral replication and viral infection and the latter portion due to immune manifestations, the immune response against the virus. And so treatment is both using antiviral drugs like Remdesivir and using anti-inflammatory immune modulating drugs to help decrease inflammation. And so Dexamethasone is the most common immune modulating drug that's being used. But others like Tocilizumab and Cyclosporine and all a bunch of others have been tried or are in trials or being experimented with. So those are not approved treatments but you can - might understand why those things are being tried.

>>BOB ZALTSBERG: Yeah. So what kind of progress has been made about different kind of treatments?

>>THOMAS HRISOMALOS: So you know there's three treatments that are - three or four treatments that are sort of readily available. One is the investigational drug Remdesivir that received emergency use authorization by the FDA. That's the drug produced by Gilead and it's an antiviral drug. And so we've been using those - that drug in individuals who are hypoxic. Their oxygen levels have dropped. And there is clinical evidence to show that it shortens hospital stay and has a beneficial effect. We've also been using Dexamethasone, a steroid medicine because studies out of Europe showed it significantly reduced mortality in people who are hypoxic or on ventilators. So those are fairly standard for most patients who are admitted to the hospital with COVID. Other anti-inflammatory drugs are being used in an investigational way - Interleukin inhibitors and so forth - when you're trying to decrease the inflammatory manifestations. And convalescent plasma is also available. And we've used some of that but we are using that as part of an investigational protocol. The protocol that we're part of is through Mayo Clinic. And so when we do that we do it with informed consent and all the remaining investigational process.

>>BOB ZALTSBERG: So Tom, we were talking hospitals and hospitalizations before and you know we started getting questions about what's going on with the IU hospitals in our area. Can you give us an update on that?

>>THOMAS HRISOMALOS: Well, we have seen just as reflected in the numbers that others here have mentioned, we saw a bump up in cases over the last two or three weeks, an increasing number of inpatients. It did not, as mentioned, get out of control to speak as it was threatening back in April. Our numbers are certainly less than that. But we certainly have seen an increased number of cases - both the Bloomington, Bedford, Paoli altogether as well as the whole IU Health System. The mortality, the number of deaths have remained very low. And I think that's just because we've learned a lot about how to treat these folks. Patients are treated with high flow oxygen. We try and avoid intubation and mechanical ventilators if we can. We're starting these antivirals and anti-inflammatory drugs right away when people come into the hospital. And I think all of that - and we've learned how to treat things better. I think all of that has made a difference.

>>BOB ZALTSBERG: OK. And so we've had - you know there are a lot of things that have happened since we last had a conversation about this. Major League Baseball has opened up. The NBA has opened up. Some of major league baseball is shut down. So you know what - when you look at the national situation, you know, what kind of headway are we making? I'm going to let Shandy address this first. But what kind of headway are we making? Are we starting to get a handle on this or are we still just sort of in the early stages of trying to get a grip on it?

>>THOMAS HRISOMALOS: Now this is Tom Hrisomalos. I don't have any expertise in that area but it's certainly interesting to see how different organizations are trying to deal with this. You know you have the NBA basketball you know organization putting people in a bubble and that seems like that has been pretty successful. And you see other sports trying to struggle with how they can minimize spread. It all comes back though to the common things that we know work. And those are things like wearing masks and social distancing and avoiding large gatherings. And if we can accomplish those things whether it be in sports or schools, then we have a chance of being successful.

>>BOB ZALTSBERG: So let's get back to the idea of schools getting back in session and Graham I want to ask you to address this because I know you've been watching what's going on in Monroe County. So you know what's going to happen when - you know if you could just weigh in on what the schools are going through to try to figure out how to start safely this fall.

>>GRAHAM MCKEEN: Obviously I think they're going through a lot. And this is - it's such a difficult balancing decision in terms of how to approach that. Back to that earlier point, you know I think if we had fewer cases obviously, if we had better containment those decisions would be easier. And again you know the greatest economic strategy, the greatest strategy for our children, for education systems, is to control the virus. And you know we've lost that containment. The last time we talked about this things seem to be steadying out a little bit. We were beefing up the centralized state contact tracing system. But we had these kind of early re-openings and we're seeing the highest cases yet. So just that alone is an incredible challenge. You know the mental health benefit, the just general benefit of children developing and being in school is so important. So there is that balance. We think still very young children are less likely to transmit the virus to others. But it's still possible. The risk is not zero. A study out of South Korea a couple of weeks ago that was 65000 participants, the highest range of transmissibility in a demographic to others was ages 10 to 19. So it can happen. And of course you know we can't put these folks in a bubble. And of course there has to be other adults there. And it becomes extremely challenging if you're trying to reduce capacities in schools and on buses. And how do you go about that? So a lack of a federal coordinated response nationally to get this under containment, you know those are the reasons why we are pursuing - our aspirational goal - right? - is essentially what I would call mitigation testing, autoimmune surveillance testing. You're testing everybody all the time. And that's what we're trying to work towards at IU. We want to do thousands of tests per day because we feel that's really the only way forward. You know we're hiring an army of contact tracers available throughout the system. Shandy can speak to - they have an agreement with API to hire two or three hundred additional contact tracers on the ground for Marion County to work with Indianapolis Marion County and within the Fairbanks school. And so those measures, they're old school. And we've been saying this literally for six months, Bob and Tom. This was six months ago when we got on her the first time to the day. I thought I was tired then. But it's those same things. And it's not really fancy. You know, stay away from each other. The mask has evolved. But that's obviously - the solution that's obviously the science. Those two things are so imperative. And that's really the only path. And I think too something to keep in mind for anyone is you know that right now the definition of when you get exposed in the community from a CDC guidance is being within six feet of somebody for 15 minutes or more with or without a mask. So keeping that in mind and really trying to limit your duration of contact if it has to be within six feet or less will save you from having to be quarantined or identified as a close contact and being out for two weeks or maybe more depending on the situation. So it is an incredible challenge. And we're seeing that because we've lost containment because of what's happened in the south because of these 60000, 70000 cases a day. That's like a Wuhan per day in the United States. You can't have containment. And that's why we're seeing a lot of smaller school systems with less resources and larger school systems obviously with K through 12 delaying, going online, re-evaluating like we are here. So I'm not going to sugarcoat it. It's an incredible challenge.

>>BOB ZALTSBERG: Yeah. So if you have a question or a comment about our efforts to contain the coronavirus, you can contact us News at Indiana Public Media dot org. And we will ask your question. We will also - we are also on Twitter at Noon Edition. We're having some technical difficulties today. This entire show will be archived. We will guarantee you that you'll be able to see the or to listen to the whole show at some point if you've missed part of it today. But I think we're coming through on our radio now, I hope. And otherwise if you have questions please send them to us and we'll take them to our experts. So Graham, this might be for you again too. We've - you know there's been a lot of comparison between the U.S. and other nations. I mean are there other nations that really did keep this contained and are not seeing any kind of second wave?

>>GRAHAM MCKEEN: There are several. I don't really have a good handle on exactly which ones and how they all went about it. But there are several. And again that goes back to a national strategy. And again going back to the economic strategy is it should be to control the virus. And so that's where places that are able to put in early lockdowns, national mask mandates, robust testing similar to you know Taiwan, South Korea, Vietnam. Some European nations are starting to see a little bit of a second wave throughout the EU it sounds like. Other countries are also seeing significant surges and are handling it rather poorly in South America. India has an incredible number of cases as well but it can be done. It again goes back to that you know you can't really have patchwork policies and patchwork decision making during a pandemic. You know it doesn't know borders. It doesn't know demographics. And so therefore that's why we really failed nationally. One, you know we didn't implement travel restrictions enough to keep it out. Two, we weren't testing enough or the right people. We had a very narrow criteria to test people the very beginning of this. Some of that was due to the lack of availability of tests. Testing did not come online as quick as it should have. And so all those things you know it's hindsight is 20/20 here. But clearly those are things that could have really helped us move along. And just we have missed that step. And so that's why you're seeing some of these restrictions being reimplemented. And it's early but you're seeing those kinds of things in some of these states where we have some really high counts in Arizona, Texas, and Florida. Some of those are starting to level off and some of that is part of the messaging. Some of that's part of the behavior. Some of that is some of the restrictions and the masks.

>>BOB ZALTSBERG: So the masks - let's talk about those for a minute because the state now has a mask mandate that started on Monday the 27 and before that Monroe County implemented a mask mandate. So should we start to see at some point maybe those mitigation efforts helping the numbers improve? How are we going to know that the mask mandate is making a difference? Dr. Tom, can you address that?

>>THOMAS HRISOMALOS: Sure. And one I know that the mask issue has been very controversial. And a lot of folks site well you know back in March the CDC and other organizations did not recommend masking and yet now they do. And there's a lot of criticism in that regard. I would remind people that back at the beginning of this epidemic we didn't understand that there was such a large percentage of people who could transmit the disease who were asymptomatic or pre-symptomatic. We didn't realize that because when we looked at SARS coronavirus infection back from 2003, we didn't see that. And so we were assuming that this virus acted in a similar way. And so we didn't understand the value of the public wearing a mask in that sense to prevent transmission. And we were also trying to conserve a very limited supply of masks for the health care workers. So as we've learned over the last weeks and months about asymptomatic transmission being a major factor in this epidemic, it became obvious that wearing masks would make a significant difference. I think the mask mandates are a good idea. I wish that when we were at sort of a nadir of cases back in maybe mid to late June, that might have been the time not to take the foot off the gas but to enhance and try and consolidate our gains rather than sort of losing ground. There are obviously lots of different types of masks. There are cloth masks, surgical masks, N 95 masks. It looked like masks are best at source control. So if you have an infection and you might be asymptomatic, if wearing a mask prevents you from spreading it to others that's the major advantage. They also do offer some protection in preventing you from acquiring infection. I think to have maximum effectiveness of mask wearing you have to have most of the people wearing them. You know if you have half the people wearing them as they go to the grocery store and half the people not, that doesn't achieve what you need. You need 80, 90 percent of the people wearing them all the time in public. And I think if you can achieve that, yes, we will see a decrease in number of cases. It certainly lags. It'll be two or three weeks at least. But I think it would be having a significant impact.

>>BOB ZALTSBERG: So now we have - we do have mandates so that you know at least the store managers - you know they're sort of put in a awkward position where they have to police this. But they're in a position where they can say you're not coming into the store without a mask. So we would think realistically we could reach that 80 to 90 percent now that the state has a mandate. Now that you know the local communities have them.

>>THOMAS HRISOMALOS: Yeah. I would think so I would just encourage everyone to understand that we have the tools that we have are relatively limited and we need to use them to decrease the transmission. You know we all want the economy to be open again. We want stores and restaurants to be open again. To get there, we need to do what we can to stop the spread of the virus and simple things like you know as we've said before, avoiding the large groups and staying distance and wearing masks and so forth are all - what are the tools that we have. And so we need to use those.

>>GRAHAM MCKEEN: And yeah. They're not fancy, right? And you know they're all imperfect. And I think we all need to understand that. Everything we're doing is not protective 100 percent but they're all worth taking. And if you stack them up you know then that will provide that protection. And just seeing you know public health and science kind of being politicized and polarized and questioned, and these are basic things. I mean we did this during the 1918 pandemic as well. So I think a lot of it you know it goes back to trying to alter that behavior. And a lot of what we're trying to do at the University and in some of those things with pre-arrival, arrival testing is setting an expectation of behavior and starting it early so that we can be successful. So much of this is about the behavior science.

>>BOB ZALTSBERG: Yeah. We need to - do we have Shandy back?

>>SHANDY DEARTH: I'm here.

>>BOB ZALTSBERG: Oh good. So you've been listening to the other two guys talk. So I just want to give you an opportunity to weigh in on anything you heard that you want to add something to.

>>SHANDY DEARTH: No, I think it's important. We're just going to have to normalize mask use. And the point about it is on the stores to make sure that's in use, I mean think about no shoes, no shirt, no service. I mean that became very normal for us. And so I think we can eventually get to the point where we have mask use be very normal. And I think it is important to do a statewide mandate. It was required because when you have these individual counties doing mask mandate, that doesn't help us much because obviously people don't just stay within their county all the time. So the movement in and out of different counties, in and out of different states, that's why it's so important for large geographic areas to have a mask mandate.

>>BOB ZALTSBERG: So one thing that I've said - I may have even said it on one of our previous shows. But it seems like with mask wearing and with a lot of this that you know people want to talk about my personal freedoms and you're not going to make me wear a mask and I can do what I want and all that. It reminds me of the secondhand smoke debate that we sort of went through and pretty much it's not eradicated cigarettes. We got it to a place where cigarettes are not welcome inside stores, are not welcome in crowds of people. And you know communities have and states have laws that say you can't smoke not because it's necessarily just bad for you but because it's bad for everybody else. So you know am I wrong to think that this is a parallel?

>>SHANDY DEARTH: I think they're very similar. I think about seatbelt use as well. You know when I was a kid it wasn't mandated. And now you just don't think twice about putting on your seatbelt when you get into your car. Same thing with helmet laws in some other states. It's very common for all the motorcycle riders to have helmets. And so again we just have to set the expectation and set that norm and build it into the infrastructure. And then it's just something that we can follow. And again there's proven science behind the fact that using these can make a difference. So we need to follow the science.

>>THOMAS HRISOMALOS: And again, yeah. They're not - you know they're not N 95s. We get that in public health. We don't - we just want any bit of protection that we can and enough people using them. And that's something we always deal with in public health is this individualism kind of issue. And to go back to the word it is public health. This is about everyone. And not wearing a mask can contribute to spread. It's disrespectful honestly to others. And all it's really doing is going to prolong this event. So again you know the sooner that we can all emerge is really dependent on the sooner that we can control the virus. And so you know that's why these measures are so important and why we are seeing what we're seeing with these numbers in the country right now is the lack of that understanding.

>>BOB ZALTSBERG: We've had a question and it's really it relates to a study that came out not too long - (unintelligible) there was a - I think it was a study that studied economics in college towns. And it basically said that IU Bloomington is the most vulnerable college town economically at least to an outbreak like this. And I know that you know you guys are all involved with public health. But can you talk about the just the vulnerability of a college town like IU Bloomington with a very high percentage of its population younger people and the vulnerability to a pandemic like in covid 19. I know a lot of it's probably common sense. But can you just talk about you know what the situation that IU Bloomington is in. It's a community that's built on a big university. Its economy runs because of the big university. How vulnerable are we here in Bloomington?

>>THOMAS HRISOMALOS: I think that particular study - you're right Bob. That was that was all based on economic factors and not health ones or potential resulting in you know critical care capacities and things like that. Of course an outbreak can lead to that but that was strictly economic. But that is a good point. And you know if our inability to have people on campus and to be at work to have school and have events and graduations and athletics, obviously that has a huge impact on the local community. And so I think that's something that the city and county have been aware of. And I think they're trying to diversify that a little bit and have over time. But obviously if we can't have in-person schools we need to de-densify our campuses or that you know the massive population that makes up Monroe County - excuse me - that's going to have severe detrimental effects. And so that's why we're trying our best to set up the system to have the most success with surveillance testing, medication testing and then more robust contact tracing and case investigation and all those protocols and things that we can control on campus. Of course our biggest challenge will be what could happen off campus. But I will say - and big respect and thanks to Monroe County and the City of Bloomington for taking those steps and that the new health order that has recently come out that's going to help us tremendously. And those are the kind of things that we need to kind of help us navigate this.

>>BOB ZALTSBERG: Let's broaden out to Indianapolis a little bit there. And again I know Dr. Hrisomalos you work for IU Health. Shandy you're at UPI Indianapolis Indianapolis. 500 is coming up. And there's now a little conflict between you know IU Health which is the health care provider for the five hundred and Indianapolis Motor Speedway because the speedway has gotten, from Marion County, the go ahead to have 25 percent capacity in the stands for the 500 mile race in August. And IU Health is encouraging them not to do that. So I just wanted to talk about that issue a little bit. I mean the the law - the the state that the governor's executive order says no crowds of over 250 unless you have a plan, a mitigation plan. And as I understand it, the speedway has that and got approval from the Marion County Health Department. But why is it - what makes it a bad idea or an okay idea to have 85, 80 thousand people going to the Indianapolis 500 in a few weeks? And Dr. Tom I'm going to ask you to start that.

>>THOMAS HRISOMALOS: Sure. I saw that on the news. I was not aware of any of those discussions. And so you can understand why it would be a concern to bring a large group of people together. And you know how are they going to get in and how are they going to get out? And I'm not aware of the IMS's detailed plan. Maybe others have more information about it. The way I view it is you need enough barriers to transmission to feel confident that you're not going to have a lot of transmission and create an outbreak. And we're used to thinking of that in health care. You know when we have patients in the hospital, a private room is a barrier. Washing your hands going in and out is a barrier. Wearing a gown IS a barrier. Wearing a mask IS a barrier. We establish barriers. When you're doing an event like the Indianapolis 500, it's the same kind of logic being outdoors is a barrier because transmission is much less efficient in the outdoor environment, spreading apart wearing masks. I think we'd have to have you know the details to know how successful this will be or not. But you can certainly understand the concern.

>>BOB ZALTSBERG: Right. Shandy have you been following that?

>>SHANDY DEARTH: I mean only through the news myself. I've not been involved with a planning piece of that but I can say - I think part of the concern too is not just the event itself but those days leading up to the event, as anyone who's been around a speedway area before 500. You see lots of people in the restaurants and bars that sort of thing. So I think there's some concern from IU Health for those events leading up to you as as the actual event. I do know with that capacity will still bring it down to about 100000. That's still a lot of people. And there is a massive mandate. But again how do you control too many people in a restaurant. How do you control too many people in line for food? That sort of thing. So there are a lot of pieces like that that have to be very well planned in order for people not to be clustered together. So yes it's great that it's an outdoor event. But it's still a lot of people together even when wearing masks and what could be a close proximity. So I can see why there is some concern on the IU health side.

>>BOB ZALTSBERG: Graham a different kind of setting here in Bloomington. You know there's college football that happens every fall. IU gets probably between 35 and 45000 people at those games. This year, we are still planning on having a college football season though that could change at any minute. If there is such a thing, what kind of recommendations would you make to the university for how it should go forward?

>>GRAHAM MCKEEN: Well the first thing in Indiana we're a homegrown state. And so I think the first call - and I know athletics is planning for various scenarios and how to do a socially distanced stadium with that as a potential possibility. But right now we have some limitations with our health order for gatherings as well. And so I'd really want to work with the Monroe County Health Department with any specific plans but the fewer the people the better. Obviously outdoors, as we said, is better. But again the best current policy for events is likely to not have them or be spectator lists. And I think we're seeing some of those challenges already. You know we talked about the bubble being somewhat successful so far for the NBA. But of course you know teams like the Marlins had half their players test positive on day two of the season. And so that's the real challenge even these groups that have the resources and the resources that we have it still presents a challenge during this time. And so I know the Big Ten that has gone conference only for this fall, you know I still think it's probably 50/50 is whether they move to the spring. I know the conference is looking at ways they can do testing and provide that equity across the conference. But there's still a lot yet to be figured out there. But it goes back all the same the same public health measures we would advise on for gatherings.

>>BOB ZALTSBERG: Right. So I wanna go back to the masks. We only have about three minutes on the program. I want to go back to masks for a minute. And I know that none of you are in city or county government. But I believe there is a hotline to report what seemed to be the most significant or egregious mask and social distancing violations. Can any of you - or would any of you offer us to offer any tips or ideas for you know just all of us who are out there in the community if we see you know a group of students, we see a group of non students that are gathering together that seem to be ignoring the basic guidelines that should be in place? First of all I guess do any of you know what that hotline number is? And Dr. Tom you might be the most the most logical person to know what that number is. But can any of you just sort of offer - I know again your public health people - but what should the public do to try to make sure to police each other?

>>THOMAS HRISOMALOS: Well I don't know the number off the top of my head. But you know this creates obviously a difficult circumstance. We would like to educate people, make them understand the value of the mask and make them understand that they're doing it for their fellow residents and that we're all in this together and get cooperation. You know that may not be entirely feasible. But I always explain to people you know if you look around the United States the 15 states that instituted mandatory masks rules to begin with had a drop in covid cases. There are many reported situations where the amsks has been beneficial so you try and convince people. Other than that you know the rest of us are not going to be able to enforce mask wearing other than by a positive message and a positive encouragement. And hopefully that will that will make a difference.

>>BOB ZALTSBERG: Yeah. So in the last minute or so that we have - Shandy I want to ask you and Graham. You're both connected with universities. We don't really talk much about you IU but I assume that there are similar regulations on Indianapolis campuses are in Bloomington, correct?

>>SHANDY DEARTH: Yes so mask use required across all the IU campuses. And then anyone moving in to IUI dorms will be tested before they move into the facilities as well.

>>BOB ZALTSBERG: Okay. Well I think where we're running out of time. I just really want to thank all three of you for your patience today. We've had some technical glitches and you've - the content of what you've offered has been terrific. So I want to thank you Shandy Dearth from Richard M. Fairbanks School of Public Health at UPI and Graham McKeen. Thanks for being here with us. Graham, asst University director of Public and Environmental Health at Indiana University and Dr. Thomas Hrisomalos. Doctor Hrisomalos has been with us several times too, M.D. with IU Health southern Indiana physicians specializing in infectious disease. Thank you all for being here and for all your patients with us for Noon Edition and for producers Bente Bouthier, John Bailey, Mark Chilla, engineers Matt Stonesifer and Mike Pashcash. Im Bob Zatsberg. Thanks for listening.

masks

(Lauren Chapman, IPBS News)

Indiana announced its first confirmed case of COVID-19 in March.

According to one popular research model, about 1,000 Hoosiers were initially predicted to die of the virus between May and August.

But when stay-at-home orders were relaxed, the model's projected deaths by August jumped to 5,000.

As of July 30, there have been 2,733 deaths in Indiana.

This month saw spikes in single-day case increases and hospitalizations. White House Health advisor Dr. Anthony Fauci warned that Indiana was among the states experiencing early signs of a more serious coronavirus outbreak.

In response to these warning signs, Indiana Gov. Eric Holcomb announced that the state would not move forward into stage five of its "Back On track" plan. The original plan was to move into stage five and have businesses working at full capacity after July 4.

Both the state and Monroe County now have mask mandates.

This week, we'll be talking about where Indiana stands in fighting the spread of COVID-19 and what the next steps might look like.

You can follow us on Twitter @NoonEdition or join us on the air by calling in at 812-855-0811 or toll-free at 1-877-285-9348. You can also send us questions for the show at news@indianapublicmedia.org.

Note-This week of our guests and hosts will participate remotely to avoid risk of spreading infection. Because of this we will not be able to take callers live on-air.

Guests

Julie Thomas, Monroe County Board of Commissioners president

Shandy Dearth, director of undergraduate epidemiology education at the Richard M. Fairbanks School of Public Health at IUPUI

Graham McKeen, Assistant University Director of Public and Environmental Health at Indiana University

Jill Raines, Chief of Clinical Quaility Greene County General Hospital

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