SL Area Chamber and Franklin County Discussion on April 15

April 16, 2020

The transcript of the question and answer session with Franklin County Public Health Director, Katie Strack, is edited for content and length.

 

This interview occurred on 4/15/20 and is updated with current information.

 

This is Patrick Murphy with the Saranac Lake Area Chamber of Commerce and we are doing a quick question and answer session with the Franklin County Department of Public Health. I wanted to thank Katie Strack for being with us today to help answer some questions about what's happening with the COVID-19 response at a county level and what can we look at in terms of guidance on how to deal with what everyone is trying to work through. So I want to thank Katie for being on the call today. Thank you, Katie.

Oh, you’re very welcome

 

Given that we started seeing it up here a lot later than they saw it downstate, is there an anticipated peak date for this area?

 
I would say no. I would not be able to project any kind of peak at this point because we're still waxing. I'm waiting for the waning part of it but I think we're still in a waxing phase. So I don't believe - in my personal and professional opinion for Franklin County, I do not believe that the county has reached its peak just yet. I think there are more positive cases that we can measure through testing.
 
 
If someone in the community does think that they have it - if they are showing signs and symptoms, who should they contact?
 
Well, first and foremost, they could and should make a telephone call to their doctor, don't go to the doctors’ office, don't go to the hospital, don't go to an urgent care. Call your doctor first. And speak to your doctor and describe your signs and your symptoms and let your doctor evaluate your case and find out from the doctor what the next desired actions may be. We are coming out of flu season so much of this could have been mistaken as the flu. It's also allergy season so that really takes a provider to determine: are they having upper respiratory type symptoms or lower respiratory type symptoms? And COVID-19 is a lower respiratory disease. It presents itself more...best I can describe it is more pneumonia-like. So we would look for fever, cough, shortness of breath. So I would say start with your doctor. If your doctor feels you need to be tested he will most probably provide an order at one of the COVID testing clinics and you go over to the clinic and follow their procedure. Many say call and someone will come down to do the test. You know, each of the COVID sites have their own procedures as far as that goes, but I would start first with calling your doctor, reviewing your signs and your symptoms...and follow-up in terms of what would your doctor want you to do.  
 
 
And Katie, that's pretty important to have that dialogue with your doctor and with your health provider because they can help guide you in understanding what your symptoms might be and how your symptoms might be related to the disease or not related and how you should go about isolating yourself if there is a suspected transmission. Is that true? 
 
 
Well I would say if the doctor makes a diagnosis and they may order the person to have a test, they may not. They may clinically diagnose this disease. Once they clinically diagnosed the disease it is reportable in New York state so the regular reporting responsibility of a provider reporting a reportable disease to the county would have to occur. So our flag would be the report of the communicable disease and then we take a certain number of actions once we hear that a physician is diagnosing, or a care provider is diagnosing COVID-19 disease.  
 
 
So how important is it for testing in our area and how available are the tests and are there plans for expanding testing? What have we heard from New York state on that front and locally what’s available for testing in our area?   
 
 
Locally, the testing is limited. And that’s based upon supply so it’s limited for hospitalized patients where COVID-19 disease is suspected: it is limited to healthcare workers, first responders, congregate care staff, PD, COs, and those who are requested by public health. So we are still in a limited mode at this time.  
 
 
When someone is tested positive, what happens to that individual and what type of follow-up is there with the person in question and how does the county help track that and keep an eye on where these people are and what happens to those individuals?
 
I can start with a couple of weeks ago: Clinton County, Essex County, and Franklin County agreed to switch to a more definitive methodology for the providers to diagnose and that was because we had limited testing. So using the World Health Organization’s definition - someone who has fever and cough or shortness of breath would be the sentinel signs and symptoms of COVID-19 and just jumping back to the testing for a bit  -  one COVID test we know is about 70% reliable. The second test on the same person only brings a 90% confidence that the test result is correct. So when you hear me talk about fever and cough or shortness of breath, with or without the test, that allows the provider with enough information to go ahead and make a diagnosis. So once the provider reports that reportable disease to us, we contact them. And we have a conversation with them. And we let them know you have now a diagnosis of COVID-19 which is an acute and communicable disease, and because their person likely has symptoms they would be placed in isolation. And same as quarantine, nobody in, nobody out. Isolation though we really would need to assure that the person can stay in their own room. That they have their own bathroom. If not we go through extensive cleaning requirements in between persons if a bathroom needs to be shared. We also do what's called “contact tracing.” And we find out who the person may have potentially exposed and we know now - which has changed - now we go back 48 hours from when the person first displayed symptoms. A couple of weeks ago we only went 24 hours and so what we learned is that you need to go back further in the tracing to try to aggressively mitigate and contain the germ, particularly - obviously - in Franklin County. So we do contact tracing and ask, “what did you do? Where did you do it? Who did you see? Who did you talk to? Where did you work? Where did you play? Where did you do everything?” And with that we contact the people who have been in contact with that individual who now is in isolation and those people, if they have symptoms, will be placed in what's described as “mandatory quarantine.” Those who are well, without symptoms, will be placed in quarantine. And for those who are in isolation - based upon our capacity - we try to do at least one home visit a day with everybody in isolation, followed up with a call. So we have interactions with somebody in isolation twice a day. Whether it be a porch visit or someone at the door or someone contacting them saying, “take your temperature; let me see you.” So we want to know that the people have no signs and symptoms or that their signs and symptoms that they have are resolving or the same, and we ask them to take their temps twice a day so we check on them and do a health screening twice a day for those in isolation. For those who have symptoms in quarantine we will call them at a minimum of twice a day and find out, “what's your temperature? What are your signs and symptoms? Are they the same? Getting better? Getting worse?” And those who are in quarantine without signs and symptoms we offer the state department of health robocall which checks in with the person on a daily basis and says, “how are you feeling? What are your signs and symptoms? Do you have a fever? Check your temperature.” And those then on 14 days are either ordered back into isolation and quarantine, or they are ordered out of isolation and quarantine, and are given materials directly to them. And 14 days later if you're feeling better and you’re seemingly healed and there's no temperatures going on, we order you out of isolation or quarantine. If you still are sick we may extend the isolation or quarantine another duration of an incubation period of the disease which is 14 days.  

 

The amount of follow up and thought and intention and everything that you folks are doing to keep track of this just seems dizzying. And there's so much that you’re doing to try to track this and keep track of everything that it's interesting that the three counties coordinated at some level on trying to think of a way that we can find some common diagnostic tools to deal with some of this outbreak.  

 

It did allow the ability and we did encourage many providers: don’t forget your diagnostic talent. They didn't go away just because COVID is novel and just because this is new and just because we're in a pandemic. It's ok to diagnose by clinical signs and symptoms this disease. And so I believe that that afforded providers back confidence that they had all along and that is: use your talents. You're a provider. Diagnose it and let us take it from there. So it is quite a bit of work that we’re undergoing right now.  
Switching gears a little bit, what kind of information and guidance is being sent to the local businesses to make sure that they’re aware of the proper public health guidance. More simply put, what are the current guidelines and who is deciding what they are?

 

Very recently updated guidance came out by the state Health Department and Agriculture and Markets which are predominantly the regulators for businesses where there's groceries or food. Note I said “updated” because this guidance - all guidance - has changed multiple, multiple times. So what happened potentially Monday is no longer the guidance by Thursday. So very recently the state DOH and the Agriculture and Markets put together a joint guidance to help those folks and local businesses provide as much as possible different types of strategies to reduce transmission of the disease within their communities and within their stores​ .  
 

 

Who is helping put out these guidelines at Department of Health and Ags and Market? What is the “quality control” that's occurring to make sure that these businesses are following these guidelines?  

 

I would say that in order to prepare the guidance I know that the state epidemiologists are involved for Ag and Markets and also may include disease specialists, maybe veterinarians because Ag and Markets cover a very large area. So the best I could say is that either the CDC scientists and experts put it together or the state and Ag and Markets experts put it together...as the guidance change, it's not like they got it wrong in the first place. It's like things changed and so we have to adapt because no one’s been in this pandemic before. So it would be incumbent upon the regulators to ensure that the businesses are following the guidelines. So they are the ultimate quality control. They are what's called the “permit issuing official” and so it would be incumbent upon them to go ahead and visit the businesses. I know sometimes if something comes into the EOC where folks are asking the question, somebody at the EOC or myself would be referring them specifically to: maybe you need environmental health at the state Health Department. Maybe you need Agriculture and Markets depending upon what your question is. So any quality control follow-up and guidance and any type of findings and any type of punitive activities would come from the regulators and that would be the state Department of Health and Agriculture and Markets.
The only thing I would add also is...the requirement for face coverings. If in fact anyone is dealing with the public...A simple kerchief across the face is adequate and meets the requirement. I know many organizations are making face masks - I don’t know what else to call them. I should say face covering because I would like to reserve face masks for those that are the surgical masks and the particulate respirator masks...So although that standard did come out I would think it maybe would be a little hard for folks to be able to comply with that and there's no option. They have to comply. So you may see people with kerchiefs around their faces in order to comply with the regulation. So that's the hard part about it is, where do you get the supply? And the supply chain has of course been an issue.
 

 

Since this interview occurred the Chamber has sourced reusable cloth face masks for essential employees interacting with the public. Contact ​director@slareachamber.org​ to request masks.
 

 

 

And if there’s questions locally for folks in Franklin County what’s the hotline number if they have questions about the status of things - about needing to get assistance or volunteering?

 

Franklin County Emergency Operations Center
(518) 481-1111

 

Alice Hyde (medical questions)
(518) 481-2700

 

Adirondack Medical Center (medical questions)
(518) 897-2432

 

Office of Aging delivering meals to 60+
(518) 481-1526

Social Services (518 )481-1894 (518) 481-1806

 

Behavioral Health
(518) 521-5818

 

People traveling to the north country must self quarantine for 14 days. Stay home unless you have to go out. Wash your hands. Disinfect anything. Keep paper towels in your car. If you have to pump gas you can use napkin or paper towel on gas pumps. Wash your hands as soon as you get home and it's one ABC or two happy birthdays!


I think a lot of people have been going through their ABCs and happy birthdays. So I appreciate your time today Katie, I know you're incredibly busy and you have a lot going on so on behalf of our members thank you for your time and helping to answer some of our questions. Thank you Katie. 

 

 

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