This is an edited transcript of an interview on Wednesday, Oct. 28 with Dr. Richard A. Bunio, Cherokee Indian Hospital Authority executive clinical director, about current COVID-19 issues. Chris McCoy, director of EBCI Communications, is the host. It is aired via Cherokee Cablevision Channel 28, livestreamed by Communications (replays online may be seen at several tribal social media pages).
In this edition, Dr. Bunio addresses questions of the community gathered from the Cherokee One Feather Facebook page.
What if someone has a fear about being misdiagnosed?
We have had tests that have come back false positive or false negative. Particularly some of these rapid tests that are being done. They are not as good as the one we send out and it takes a couple of days to come back. So, yes, it is possible to have a test done and get a result that is not completely accurate.
If someone tests positive for COVID-19 and also has the flu, how do we know that they are being treated properly?
As we get into flu season, we are probably going to get to a point when the flu activity goes up so much that we will be testing for both. There are a couple of companies that are coming out with a test that does test for both with one single swab. I think that is probably going to become the standard moving forward. There is a medication that does work for the flu. It doesn’t work for COVID. Even in years past, we know that, if we think that somebody has the flu, we will go ahead and give them this medication. It will shorten the illness by a few days. The key is, in this winter, we are going to have to test for both just to be sure that we are not missing (anything). It is possible to have two infections at the same time. We think getting flu shots this year is vital. We are working with Public Health to set up as many flu shot events as we can. Of course, flu shots are available at the hospital. We want as many people to get flu shots as possible so that you’re not faced with that tough choice. You’re feeling sick and your wondering, “Do I have the flu? Do I have COVID?”, it is just better not to get sick and a flu shot can prevent that.
Are there any negative side effects to getting the flu shot?
Some people feel a little bit sick for a day or so. Usually it is the people who are getting it for the first time. I get it every year. I have already had mine. Aside from a little bit of a pain, it doesn’t affect me at all. I think it is really important that everybody get it. You might get a mild illness. You might get a little achy. But the majority of people don’t feel anything. If you have had the flu and you’ve been down for a week or ten days, you know how miserable that is.
If a person dies from the flu and was only treated for COVID, what then? Who is at fault for that?
I really don’t think it is about fault. First of all, we are going to treat you, as a patient, based on how you are doing. We use tests to guide our treatment. We don’t rely on them exclusively. If your oxygen level is low, we are going to give you oxygen, whether that is caused by the flu, or COVID, or pneumonia. And a lot of the treatments right now are very supportive. As I mentioned, there is a medication for the flu. We are now using Remdesivir for COVID, if you are bad enough to be in the hospital and in the ICU. It’s not perfect either. We are going to treat you as a person, not just use a test.
Is it safe to cook food in your home and give it to others outside of your home?
Yes, I think it is with a couple of precautions. There is no known transmission of this virus by eating, from food. There is a potential to catch it from contact, if you touch something with the virus on it and touch your eye, nose, you can get it. So, if you want to do that, I actually think that is a smart way to share a meal. I would recommend that the person who is preparing the plates wear a mask, wear gloves or at the very least, wash and sanitize their hands. And then have people come and pick up their food while still maintaining social distancing.
What evidence supports the recommendation that people who test positive and continue to test positive are not contagious after their 10-day isolation? Many jobs require negative testing to return to work because of the job and people that it serves such as elders and children. Are we chancing it by sending positive people back into the community without a negative test result?
This is one that can be confusing. All the evidence that the CDC has reviewed indicates that a person with a normal immune system will not be contagious 10 days after contracting the virus. They no longer recommend a test. No if you have an impaired immune system, it can take up to 21 days for you to clear the virus. The best advice is to talk to our public health professionals. They do this all the time. They will interview you and tell you what the best time is to come back. Some workplaces are still insisting on a negative test before they will let people back. We are certainly willing to advise them on what will be safest. All I can say right now is that the CDC says that after 10 days you are released from isolation. I know it is difficult for someone who feels fine and wants to go back to work. We’re not testing people every day in the hopes that they get the negative test or the two negative tests. This was an early recommendation, the two negative tests. We no longer do that. So, we are spacing it out. I believe we are offering to test people one per week until they get a negative test.
Why are some community events that result in positive individuals announced publicly and others are not?
If we know everybody who was at that event and we can get in touch with them, there is no need to publish it. But sometimes, people are attending events and they have no way of knowing or remembering who was there. As a public service, Public Health will put out an announcement that says that if you were at this location on this date you should consider getting tested. It is just a way to make sure that we capture everybody who was potentially exposed at what could be a super spreader event that they go ahead and get tested so that we can try to control the outbreak that we are having right now.
Are casino employees who test positive shared with the Tribe? Are those numbers shared with the Tribe?
All people who test positive have to be reported to the state. They are also reported to the county and to the Tribal health department. Our tribal and county health departments are constantly in contact. Everybody who tests positive, we are going to know about it.
If you have antibodies will you always test positive?
If you have antibodies and you do an antibody test, yes, that test will always be positive. But that is not the test that we do. An antibody test tells us that you have been exposed to this virus at some point in the past. We do a test that looks for the virus itself. If you have antibodies, our test is still accurate to tell if you have virus. If you have antibodies and you have recovered, no, our test should be negative as well. We are looking for the RNA of the virus. It (the test) is so sensitive that any little bit of virus even if it is dead or it’s a fragment, the PCR will pick that up. Where the antibody test is a blood test.
Is it safer to work indoors or outside where there is more air flow?
Outside is always better where the wind is spreading the virus, it is diluting it out. We don’t know how many viral particles it takes for it to establish itself and infect you. So if you are outside, the more airflow, the better. If you are inside, they recommend that you open windows if the weather allows it. And the direction of the air flow matters a little bit. If you are six feet away from me but the air is blowing towards me and you start coughing that could put me at risk. But in general, outside is better because you’ve got more room and you’ve got more airflow.
What do you need to use to clean your house and vehicles after you have tested positive?
I guess that depends on what you are trying to do. If you have tested positive and you are going to be on your 10-day isolation and you are not going anywhere, it is a good idea to clean high-touch surfaces if other people are going to be around you, but the longest the virus was found to be active was about three days. So, if you just don’t drive your car for three days, the virus is going to die. Now there have been some recent studies where they picked up the virus over a longer period of time, but we have not established whether or not it could infect anybody. I would say if you want to wipe that down with an approved cleaner that’s fine, but if you just sort of leave things alone for three days, generally the virus (will die). It is not a very hardy virus. It won’t survive. And particularly if it is exposed to ultraviolet light, that tends to inactivate the virus.
If you test positive for the virus, how likely is it that you can get it again? If you do get it again will the symptoms be as bad as before? If you didn’t have symptoms the first time, might you have symptoms the second time around?
We are seeing people catch the virus a second time. So yes, it is possible. We believe that most people with a normal immune system will have some degree of immunity for about ninety days after they have had the infection. We don’t know if it will be worst or better the second time. We have seen both. We have seen some people who catch it a second time and they are in ICU and it is actually a little bit worse. We are still learning about this. I think the important thing to emphasize here is that mask wearing, social distancing, hand washing, it is a good idea to keep doing that even if you think you have some degree of immunity, because we just don’t know how long that immunity is going to last. We believe also that the 3 W’s are also effective in preventing flu and that if people will practice them that we will also see fewer flu cases this season than we have had in previous years. So, in combination with people getting the flu shot and wearing masks, we should see less flu this year.
So are any of the recovered Cherokee patients experiencing any long-term effects from COVID? And if so, how is the hospital preparing for an influx of patients over the coming years that are experiencing long-term effects from COVID?
We are seeing some patients that are experiencing long-term effects. They don’t tend to be things that require people to be hospitalized again. We are seeing some mental fogginess and fatigue, and other things like that. The hospital is prepared to help these people in the same way we would help anybody. Call your primary care team. They will do what they can. Some of these things are just going to take time. And I think that is something that we have emphasized before that this not something you catch and get better. Many people are having effects that go for months. We just haven’t had this virus around for long enough to see how a small group of people are going to be affected for a long time. It is a new virus, and we are just learning. I can’t tell you if it is going to be affecting you two years from now because we haven’t had the virus around for two years.
How soon will we be getting a competent vaccine because we know how to make viral vaccines? Why is this different?
We are hopeful that we will get a vaccine at some point this winter. The vaccine trials and the science behind them is good, but it is being rushed. Most vaccines will take sometimes five or 10 years before they hit the market, and these are being pushed because of the severity of the pandemic. I don’t have a crystal ball. I would like to think that we will have the vaccine by January. We don’t have the luxury of testing this vaccine and watching you for a year to see how effective it is going to be. What we need here is time. We are getting a great response to the survey that was sent out. We don’t think everybody is going to want the vaccine right away. And we are not going to force anybody to get it. When we get our allotment of vaccine, we are going to give it to the people who are the highest priority first and then we are going to roll it out to hopefully everybody who wants one.
Why are people who have knowingly been exposed not being advised and instructed to quarantine while they wait for the appointment to be tested? I understand the wait period, but shouldn’t they be quarantined to avoid spreading in the meantime until they get tested?
They should be. I am confident in saying that anyone who is a direct contact is being advised to quarantine. Generally, that happens when one of the Public Health nurses talks to them. Now there are some cases where people think they are a direct contact and through the course of the interview, we determine that they were not really exposed at all, in which case you do not need to quarantine. Everybody who is a direct contact should be advised to quarantine for 14 days and as we said before, even if you get a test and test negative, you still have to quarantine for the 14 days.
Do Natives handle the virus differently from non-Natives?
I don’t think there is any evidence to show that Natives as a group handle the virus differently. Except for the fact that we have a higher incidence of co-morbid conditions – diabetes, obesity, smoking. We do have a population that has a lot of these conditions and those are conditions that make a person tend to have a more serious course of illness. COVID is a respiratory, lung, infection. Anything that interferes with your lungs’ natural ability to fight off infection, which smoking does, among a lot of other negative health factors, is absolutely going to increase your risk.
Would you suggest outdoor activity for some of our older folks that might have some underlying conditions?
I think getting out and getting some exercise is always good. Outdoors is better than indoors by far. Getting out and getting a little sunlight and a little vitamin D is good for people. So yeah, I think that is a good idea.
Can you clarify the quarantine period?
It is important to contact Public Health or let Public Health contact you. The quarantine period is the period when we are waiting to see if you are going to get the virus. So that is 14 days after your last contact. If you have a positive test, you are not in quarantine, you are in isolation and that is generally 10 days from the date of the positive test or 10 days from when your symptoms started. So if you waited a few days, come in and got your test, we are going to go back a couple of days so that you have got another eight days to go before you are released from your isolation. It is a very common thing that people get confused. Quarantine and isolation are two different things. And that is why they have two different time periods. If you are on quarantine and eight days into your quarantine, you develop the infection or you get symptomatic, then you have got another 10 days after that. If you have ongoing exposure, like if you live with someone, we are going to wait until that person is no longer contagious and then quarantine 14 days after that last day.
Are the rapid tests even that accurate? I know someone who was recently tested at the ER. It was positive but once they were transferred to another hospital, they had multiple tests that came back negative.
The rapid tests as a group are not as accurate as the RNA tests, the PCR tests. We have seen some false positives and some false negatives. The advantages of the rapid tests are that you get a result rapidly. Sometimes within 15 minutes. The disadvantage is they sometimes don’t give us an accurate result. If you get a positive test on a rapid test, as long as you behave like that is a true positive until we can figure out…if we stopped you from going to gatherings and going out for two days while you wait for that other test, I think there is some value in that. What we don’t want is for someone to get a (rapid) test and it’s a negative to feel free to go out and not wear their mask. Testing doesn’t eliminate the need to wear the mask and social distance and staying away from mass gatherings.
What protocol or procedure was put in place by Tribal Council and the Hospital? Any quarantine building set aside or emergency backup ventilators, masks stored on the Reservation for that purpose?
We started planning for this back in March and we meet weekly, particularly Public Health and the Hospital to just try to access the situation. You have seen it. It is changing. We are trying our best to stockpile masks and personal protective equipment. We have plans in place should things get out of hand. We are not seeing as big a…we are seeing a surge here no doubt…but I can tell you that if you look at one of these maps of the area, we are surrounded by red-red is bad-Tennessee, South Carolina, Georgia-we are surrounded by red, so it is just a matter of time before it gets even worse here unless we do what we are supposed to do. We have to be really careful about that.
Do you have a plan for worst case scenario?
We do. We are limited. A lot of times we come up with plans for standing up extra space or tents and it is just really hard to get that stuff. So, we are working on that right now. We’ve been working on this for months.
Any advice for Halloween?
I think you have got to have a safe Halloween this year. I have seen people being really creative about that so kids can still dress up and have a socially distanced way for them to pick up a bag of candy. So I think we just have to keep in mind that this is not a normal year. I wish it were. We are all in the same boat and we are going to sink or swim together.