This morning (7/8/20) Cynthia Borgen, Director of Beltrami County Public Health updated Dan Houg and Maggie Montgomery about the jump in the number of Covid-19 cases in Beltrami county over the last few days. Here is a transcript of that interview (audio below):
Cynthia Borgen: We started to identify a couple cases last week. And then as we looked at potential exposures, that has kind of rapidly expanded. We've identified one social group that really has experienced a significant burden of Covid. Again, that's a group of young individuals who share households as well as social activities. And as a result, we have at least a group of a dozen young adults that we've identified where 10 of them have tested positive and two came back with negative tests. Then there are additional contacts that we're still either waiting for the test results or waiting for those individuals to go in to get tested.
Dan Houg: So are those 10 symptomatic at this point, or are they all just walking around feeling fine?
Cynthia Borgen: The group had been out and about prior to experiencing any symptoms, and then a couple of the individuals started to experience some symptoms a few days before the weekend of the 4th. Then two went in to get testing to see if they did indeed have Covid. When they went in for testing, they started chatting with the rest of their group, letting everybody else know that they were not feeling well.
The first positive showed up on last Thursday, which would have been July 2nd. At that time, they connected with the rest of the group and we started following up as well, and encouraging everyone to get tested, to quarantine, and then for those who were ill to stay isolated.
Maggie Montgomery: I hear a lot about asymptomatic people with Covid-19. Do you know, is that generally just at the beginning of a disease when they've been infected, but they haven't actually started to feel ill yet? Or do people actually experience the entire Covid-19 without ever exhibiting any symptoms?
Cynthia Borgen: Well, it’s a little bit of both. For many individuals, they never will exhibit symptoms, at least not ones that they recognize. For others, what we find is it's more they're pre-symptomatic or that they might not recognize any of the symptoms right away. We are learning so much more about this disease as it goes on. With many folks we've identified that one of the first things they noticed is that their sense of smell or their sense of taste is off, and that can be an early one.
Fever is something that we talk about a lot. And if you have a fever this time of year, you probably should go get tested for Covid, because that's not as common among other diseases. Some of the symptoms of Covid are very common to many other diseases. With this group there's a couple who haven't experienced any symptoms. The rest have had pretty mild symptoms. And it really varies. It can be headache, gastrointestinal issues, respiratory issues, sore throat, drippy nose. So it's really sometimes challenging to determine when it's a cold and when it's Covid. So we're encouraging folks that if they do have those symptoms and they are concerned that they may have been exposed, that they should call their health care provider and go in and get tested.
Dan Houg: Do you have any advice for people trying to discriminate between seasonal allergies and Covid? Is there any kind of kind of baseline markers that you say you should probably get tested if you have something?
Cynthia Borgen: The MN Department of Health and the governor have kind of put together a document that's on the Stay Safe Minnesota website that's titled “Is It Covid-19”. It looks at the common symptoms for Covid-19, for the flu, for a cold and for allergies, and kind of lays out what symptoms happen often, sometimes, rarely, or never. And that's a fun tool to kind of take a look at.
There are other screening tools that are available on the CDC website or other places. I would recommend if folks are concerned that they call their health care provider. And just have that chat about, “these are the symptoms...” If they know they've been exposed to someone with Covid, they should definitely go in and get tested. Otherwise, that's what the health care providers do, is talk through what symptoms do you have, what are you concerned about? And then identify whether or not it's a good idea to get a Covid test.
Maggie Montgomery: Does this one group of people account for all of the cases - the new cases that we're seeing in Beltrami County - or is there other community spread going on?
Cynthia Borgen: This is a significant number of our new cases but there are... for example, yesterday we were informed about six positive cases. Three of them were part of this cluster. And the other three were individuals not related to the cluster.
Maggie Montgomery: So it's in the community, it sounds like?
Cynthia Borgen: It certainly looks that way as of yesterday. We have several people that we were not able to identify any links to this cluster or to previous cases. We've had additional cases, but they've typically been one or two at a time. And for several of them then there was transmission that happened within family group or a house group. And now…there were a couple of those that we also were not able to identify where it might have started early on. A lot of them were travel related. And now with this group, we're still not sure where it started, who maybe had it first. We just recognized that within the group that socialized together, that was a really high number of them. I mean, it's very unusual to have 10 positive cases out of a group of 12. That's really concerning that that the transmission rate is that high among this group.
Dan Houg: Do you anticipate any drive up testing in Beltrami County where you don't have to go through provider, but a person can just get in their car and, you know, just go get tested without having essentially the cost of a doctor's visit?
Cynthia Borgen: Currently you do need to go through a provider to get tested here. If we do see these numbers start to increase, then we will work with the MN Dept of Health, as well as local health care providers to determine whether or not it's a good idea to set up that broader community testing. That has been a model that several communities around the state have followed. And that's certainly something that that we will consider as we watch these numbers. Right now, we're very able to manage the testing demand under the way the system is currently set up.
Maggie Montgomery: With all of these folks exhibiting symptoms, you must have to do contact tracing. Do you have enough people to manage that?
Cynthia Borgen: Well, we continually explore that. We work in partnership with the Minnesota Department of Health. We do a quick screening of most of these individuals. And then the Minnesota Department of Health follows up with a more thorough investigation for their tracking and for the numbers that they keep on their website. We are more concerned with making sure that the individuals have what they need to be supported in their isolation or their quarantine. And then we also are on the lookout for, you know, places where community spread could be happening.
So with this cluster, we've identified that several of them have played in softball leagues and volleyball leagues. So we have been in touch with the organizers of those leagues and they're aware of the concerns about potential spread within those activities and are then taking steps to help to mitigate that risk. So the softball league determined that perhaps they were canceling games for the next couple weeks and then they will re-determine whether they want to do anything additional.
We've seen a couple of the work sites that the positive cases have worked at have taken the steps to close the work site and do some deep cleaning, encouraging or requiring all of their staff to get a test, and then are waiting to open until they are assured that the staff they have working are not exposing any of their customers or patrons to Covid.
Maggie Montgomery: Is that something that businesses can determine on their own, how responsible they want to be about that testing and basically protecting the public? Or is that something that the Department of Health gives advice about to them?
Cynthia Borgen: So there certainly is guidance that's out to businesses that has been developed as part of the governor's executive orders. And that does provide guidance on how to manage their business when they have a positive case. You know, some businesses are very public facing and have a lot of the general public come through their doors every day. Other businesses have very limited public interaction directly. And so it really is dependent on what the business is, what it looks like, what they've had set up.
And we’ve found that some of them are really very concerned about this. One individual that actually tested negative as a part of this group was provided a hotel space by their employer to sit out the quarantine period, because even though those folks tested negative, there is potential that because they continue to have exposure, that they will test positive at a later date. And so this person's employer was concerned for the business. So out of the concern for safety and the rest of their of their employees they want that person to wait out that quarantine period so that they can come back to work and not be worried about exposing others. So businesses are taking different steps. As businesses have opened they have been required to complete a Covid preparedness plan so they have the steps already identified that they'll take if there's an exposure in their business with employees, with customers. It does vary. And of course, as you would imagine, some take it much more seriously than others.
Dan Houg: If a family has a member, let's say, that is asymptomatic but has tested positive, is there a realistic way that person can isolate at home?
Cynthia Borgen: Well, sometimes; and other times, no. So if you have a separate bedroom, a separate bathroom, that the individual who needs to be isolated, or quarantines can kind of hang out there and not mingle with the rest of the family members, then those family members can start their quarantine while the sick individual is still being isolated. And, as you can imagine, in some homes that just doesn't work. If you have, you know, smaller children or single parent family or just a household where you can't separate them, then the whole family kind of needs to wait until the infected person is through their isolation period - and at that point, start the 14-day quarantine. So it can be a pretty lengthy process for folks who don't have access to space where they can separate from the rest of their family members.
Maggie Montgomery: You know, we've been hearing a lot about racial and cultural disparities in this pandemic. What are your thoughts about this in our area, and particularly with the Native American community here?
Cynthia Borgen: So we have had a few cases that of individuals who are affiliated with the Red Lake and Leech Lake band. We have weekly calls with Red Lake and with Leech Lake too, as well as surrounding counties, so that we can have those discussions about, you know, ‘what do you know that's happening? What do we know that's happening? What are things we need to do?’
So, for example, with the softball league that we talked about, one of the teams that was played was a team where some individuals lived up in Red Lake. And Red Lake has been connecting with every one of those individuals and encouraging them to be tested so that they can do what they can to mitigate any exposures that happened on the reservation.
Maggie Montgomery: What do you think; how are we doing in this community? Do you think that people, enough people, are staying six feet apart and wearing masks?
Cynthia Borgen: Well, until this last week, we really hadn't seen many cases. You know, I totally understand the, what they're calling it, the ‘Covid fatigue,’ where people really just want to get back to their normal life. They want to get back to their sports leagues and going out with their friends to have a meal. It's really hard to find the right balance. And so that's one reason why we are encouraging folks right now to really think about what is that balance for you as an individual, both in the concern for your own health as well as the health of those around you.
With some of these individuals, before they realized that they were exposed to Covid, they've been visiting with their grandparents and their parents who potentially could be at high risk. I am hoping that this is kind of a wakeup call for the community, that we all step back and think about what we need to do individually and then what else we can do in our circles of influence, whether it is as a business owner, as an elected official, as a public health director. What can we do in our role to help make sure people have the information they need to make those smart choices about what level of risk they're comfortable with? And then what can you do around wearing a mask, staying physically distanced away from other folks, socializing just with small groups and being really thoughtful about what establishments to go to. And then when you go to a restaurant, to make sure that they're complying with the spacing requirements and that folks come in, sit at their tables, and aren't really walking around, mingling with the guests.
Maggie Montgomery: This last group of folks - and statewide, really - we're seeing a big rise in Covid-19 in the 20-something and even into the 30-something age groups. Have we had any cases, in Beltrami County, have there been any cases in congregate living at all?
Cynthia Borgen: We've not had any of the residents in congregate living test positive with Covid. We're monitoring. We did have a staff person in an area congregate living setting test positive and we're concerned about the potential within this cluster that we're looking at because a lot of this age group might work as staff in some of those facilities. So we haven't seen any yet, but we're keeping a real close eye out. When we do the investigation with these individuals, we talk about where they work and if they have visited any of those types of facilities. So we do our best to be aware of that so that we can make sure that those facilities are aware of any potential exposure. And then there are plans in place that every one of those facilities has that they will begin to implement if there is a positive exposure in any congregate living facility.
Dan Houg: So if someone is developing symptoms of Covid and they said, well, I'm just going to ride this out at home, is there a threshold that individuals at home should use to go in to the hospital or go in to a doctor?
Cynthia Borgen: Yes. Actually, the health care facilities talk through that with individuals as they come in for testing. We have identified that we certainly need to be watching for dehydration, which can happen with a fever, especially if you have a sore throat and might not be drinking and eating as much as normal. One of the big concerns we have is that especially with healthier people, they can compensate for decreased lung capacity. So with some individuals, they'll actually go home on a monitoring program and have a thermometer to keep track of their fevers, but also an oximeter to keep track of the oxygen levels in their blood. So there certainly are a set of symptoms that individuals are informed about, and things to watch for, as to when you need to reach back out to your health care provider and talk about whether or not you need to be seen again, or potentially need to be hospitalized.
Dan Houg: I know a lot of people have bought the pulse oximeters. Is there a threshold as you're taking your own values, where you should go in, even if you're not feeling that terrible?
Cynthia Borgen: That's a discussion that you need to have with your medical provider. You know, there are some folks who have lower lung function and they operate at a little bit lower blood oxygen level regularly. So it is going to be an individual issue that you would need to talk to your provider about.
Maggie Montgomery: I have one last question for you. This seems like a lot of responsibility right now. How are you doing?
Cynthia Borgen: Well, actually, I am leaving today on a long-planned vacation. I am heading out of town, which I've only done once in the last six months since this happened. I am going to visit my grandchildren and I will be watching closely about any potential exposures I might have. And I will have to determine then when I come home whether or not I'll need to quarantine myself, depending on the risk level that I may be exposed to while I'm gone.
But we have several other staff here at Beltrami Public Health that will be stepping up, and I am sure I will not be missed at all.
Cynthia Borgen is Director of Beltrami County Public Health. Their phone number is 218/333-8140.