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so this is the first uh in a series of virtual covered uh town halls that we’re planning on on hosting which are intended to uh uh inform our community about the current state of where we are in managing the kobe 19 virus and this really couldn’t come at a better time um so before i go any further you i know all uh are all socialized to hear about numbers when we start talking a little bit so as of uh yesterday the main cdc has reported 3992 total cases of total 19 remain and 36 in hancock county now remember these are these numbers represent the number of positive tests that have been that have been identified people with positive covet since the beginning since the beginning of our testing process and the 36 in hancock county is 36 people who live in hancock county that have reported positive tests now the reason this is uh this is such a good time for us to have this conversation was after several months without any positive test results our hospital where we run a lot of tests has recently received confirmation of three new cases and we’ve also received an increasing number of calls from visitors they who have received some positive test results after their arrival so one of the things we want to point out is that visitors who test out of state that receive positive results after traveling to maine are not captured in the data at all and people who do test here in maine but have an out-of-state address they are counted in names total but not necessarily in the county where they’re reser but not in any particular county so they could have tested positive uh have a philadelphia address but uh but uh be in in hancock county when they have a test and get the results uh they are not included as a hay county resident so that has created a lot of confusion that we’ve worked hard to try to uh to try to just help people understand how that data works um but we also having having visitors who arrive from out of state without any results in hand and find that that they’re positive that creates a particularly challenging situation for us but to mitigate this uh i’m very pleased to report that uh we met with uh commissioner gene lambrow and dr nirav shah uh yesterday and we are establishing a new pilot contract tracing partnership to address this issue so this partnership will grant us public health jurisdiction to use the sarah alert system in a way that hasn’t been done before to log and trace these visitors so our community has done a really really spectacular job at keeping covert 19 precautions in place and because of this the incidence of covert 19 in our community has remained low because of this partnership we have a greater opportunity to make sure that the that the public health precautions that we have available to us as maine residents through the state cdc is also available becomes available to our visitors who have to rely on a a state health department in their home state so today you’ll be hearing from two of our practitioners on the front lines of our coronavirus prevention efforts at mdi hospital uh kate worcester and j.r krevins jr kate worcester is a certified physician assistant who has been our primary cova testing practitioner and has taken a lead role in counseling and providing contact tracing assistance to residents and visitors and dr j.r krebs jr is chair of infection prevention at mdi hospital and has been a guiding force of our covid19 preparedness response he has an extensive background in public health and emergency preparedness and in the

management of infectious disease so after after kate and jr speak there’ll be a qa session at the end of the meeting if you have a question please use the chat feature at the bottom of the zoom screen a moderator will be monitoring uh the chat box for questions and we’ll answer them if time permits we will stop after our first speaker and if there are some pertinent questions that can be answered on a timely basis we will uh will interject those but again i remind everybody we will try to answer questions at the end and any questions that do not get answered on on the telecast will be answered directly with the people asking you questions so now please join me in welcoming cake worcester thank you ready coronavirus disease 2019 is a pandemic influence in the first half of the year 2020. the virus is rapidly spread to many countries presently in our community there are confirmed cases of coca-19 many of these cases are persons who have been tested to travel to this area and receive the results their test results after arriving many of these persons do not have any symptoms of coping 19 there is no community transmission at this time the following talk is on basic facts about clovid19 what symptoms to monitor for how to be tested and how to reduce workplace transmission of the virus i’m also going to highlight what to do when you’re tested and what to do if you’re found positive for govid19 december 31 2019 hospitals in china reported a cluster of pneumonia cases of unclear etiology with the use of real-time reverse transcription polymerase chain reaction or rt-pcr this was identified as a novel coronavirus labeled as severe acute respiratory syndrome coronavirus ii later also known as coronavirus disease 2019 or as we know copic 19. coronavirus is not a new virus this is a virus that has gone from animals now to humans compared to stars covet 19 uses the same mechanism of entering host cells but at slower speeds however coca-19 accumulates more in the system compared to stars this explains why covet 19 has a longer incubation period and is more contagious while sars presents with more symptoms and disease severity the spread of covalent 19 unfortunately is rapid and the transmission is from close contact airborne and droplet about 44 of the transmission is estimated to occur between before symptoms arise or the pre-symptomatic stage about 18 of cases remain asymptomatic closed contact is defined as within less than six feet for greater than 15 minutes regardless of whether you’re wearing a mask or a facial covering unless it is fitted as an n95 mask or other personal protective equipment symptoms tend to resolve after 10 days in 90 of patients their symptoms resolve after about 10 days severe cases for hospitalized patients can continue shedding for up to 25 days after the initial symptoms will arise severe cases also have 60 times more viral load than our mild cases people are thought to be most contagious when they are most symptomatic otherwise experiencing fever cough and or shortness of breath and or pre-symptomatic however there is transmission from some asymptomatic individuals therefore maintain safe safe social distancing is always in force mask wearing and hand hygiene at all times here is a as a picture i did here with showing our incubation period and your symptoms where at the bottom you’re showing your latent period and your infectious period according to a timetable so you can see that during the incubation period and your onset of symptoms you’re actually becoming infectious while you’re incubating and not yet exhibiting your symptoms your resolution of symptoms you’re still infectious during that period of time when you’re having your resolution of symptoms go ahead what to know about cobit 19 coronavirus or quebec 19 is an illness caused by a virus that is spread from person to person most patients will present with respiratory type symptoms and a fever copic 19 symptoms can range from mild or no symptoms to severe illness severe illness tends to happen in patients over the age of 65 who have underlying illness including hypertension coronary artery disease and diabetes mellitus about 41.8 percent of the patients we see would develop acute respiratory distress syndrome otherwise known as arts this condition presents with worsening shortness of breath increased work of

breathing and hypoxia the lack of oxygen this typically presents in the first five days of illness 81 of cases are mild do not require hospitalization 14 are severe and 5 are critical mortality increases with the severity of the disease severe cases have an unpredictable prognosis solely based on their clinical presentation what the medical provider wants you to know about coca-19 typical symptoms of copic 19 are going to be fever cough shortness of breath sore throat loss of taste or smell body aches diarrhea some patients do not have symptoms they refer to as asymptomatic patients the time of onset of symptoms as few as two days or as long as 14 days after the exposure most patients exhibit symptoms in the first five days after their exposure how copic 19 is spread the virus is thought to spread mainly from person to person including between people who are in close contact with one another which is thought to be about six feet through respiratory droplets when it’s in close contact less than six feet higher risk when you’re in closer contact for greater than 15 minutes contact with an infected surface that a person then touches their own mouth nose or possibly their eyes testing if tested for coping 19 the test current test format is to do pcr testing this is done with either a nasopharyngeal swab or a pharyngeal or an anterior nerve swab this form of testing will detect approximately 90 of cases and patients with symptoms that type this type of test is more accurate than those without symptoms so those patients who actually have symptoms we’re going to have a higher sensitivity than those that are asymptomatic most people will not be aware when they are exposed to coping 19 if you develop any of the symptoms of copin 19 contact your primary care provider at mdi hospital or the cobot hotline which i’ve placed on the slide if you become aware you were exposed to someone who’s covered 19 positive by a confirmed case a patient should immediately self-isolate and contact the copin 19 tent my workplace recommendations for you if an employee contacts the employer with any of the symptoms that placed before of covet 19 they should be instructed to contact their primary care provider mdi hospitals hotline or the cove intent employee is instructed to not return to work the primary care or the cobit-10 provider will determine if testing is indicated presently each employer does have different policies in place we certainly follow those policies in regards to when the employee can return to work from a medical provider’s standpoint if testing is felt to be indicated the employee will remain in isolation or quarantine until the results are complete and symptoms have resolved the employee then can return to work these are my current recommendations i give to employers i encourage employers to cohort their employees into groups of less than 10 in the workplace this will limit the workplace transmission and if an employee is found to be positive contact tracing can be done more efficiently all employees should wear a mask when working in a distance of less than six feet of each other and encourage frequent hand washing ideally sanitizing each time they contact a new patron have a single point of entry do daily checklists of symptom monitoring before employees enter your building if an employee has any of the symptoms there to return to home self-monitor and contact their primary care provider the hotline or the tent itself if you’re testing for copic 19 you’re to return to home you’re going to maintain a strict home quarantine as defined below and to be told not to leave your home no distributing of goods foods or supplies do not go to the grocery store it is recommended that no one in the home is to leave if family members have to leave the home avoid unnecessary contact with persons outside the home wear a mask in social places wash your hands before leaving the home and sanitize just before shopping if you’re unable to isolate in the home please please do so if you’re able sorry to isolate in the home please do so use a separate bathroom when possible everyone in the home should practice frequent hand washing avoid touching your hands and your face testing results the time to receive your covet 19 test results is going to be variable according to how many tests are actually sent and which labs are receiving them most tests right now are returned in two to four days until test results are complete you are to assume your test may be positive maintain strict home quarantine versus isolation as highlighted above mda hospital does have a rapid stephen test but this is reserved for emergent hospitalized patients emergent surgical patients and frontline medical providers that must return to work in the next workday the test cartridges are limited presently it is unknown when this supply will be replenished therefore this form of testing is being conserved you will be contacted by a medical provider when your test is complete if your test is negative you can return to social distancing while continuing to self-monitor for any

symptoms of covet-19 if your test is positive you are to remain in a strict home isolation and a minimum this will be 10 days you will be contacted by a medical provider who performed the test with specific instruction as to when your isolation can be lifted as determined by a case-to-case basis protect yourself and others there is currently no vaccine to protect against coca-19 the best way to protect yourself is to avoid being exposed to the virus that causes this virus it is to stay home as much as possible and avoid close contact with others close contact is defined as less than six feet you’re at an increased risk if you’re less than six feet for greater than 15 minutes wear a cloth face covering that covers your nose and mouth and public settings clean and disinfect frequently touch surfaces wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains at least 16 alcohol if you contact a confirmed covid19 positive person you may be tested for covid19 as determined by the medical provider typically in the cova tent approximately 30 percent of contacts will be asymptomatic approximately 10 of the contacts will become coveted cases if found to be positive you’ll be instructed to maintain a 14-day period of isolation you will continue to do self-monitoring during this 14 day period you will be released from isolation when likely non-contagious 10 days and improve symptoms for three consecutive days and without fever brief word on the super spreader which was a question definition the word is a generic term for an unusually contagious individual who has been infected infected with this disease in the context of the coronavirus iron scientists haven’t narrowed down how many infections someone needs to cause to qualify as a superstretch but generally speaking it far exceeds the two or three individuals researchers initially estimated that the average infected person will infect what makes someone a super spreader we don’t know yet what it is about the biology of some people that causes them to be super spreaders it might have something to do with the increased viral load and shedding more virus than is normal but we still don’t know what would trigger this let alone how to identify that through practical means the most common presentation for the super spreader would be a mildly symptomatic person who continues to ascend attend social gatherings without the use of a mask this is more likely to occur in a densely populated area with poor mask compliance these are my clinical caveats covet 19 is in our community this will start to spread rapidly unless we as a community work together to reduce the transmission the use of a mask should be essential presently social distancing must be maintained to reduce transmission i encourage employers to cohort their employees into groups of less than 10 to reduce the workplace transmission if a patient has a negative test result and their symptoms have resolved an employee can return to work presently at mdi hospital we have adequate supplies to test symptomatic individuals and those known with positive contact with the covet 19 case this may change as our numbers increase universal universal access to testing is essential to identify track and control covet 19 um so we do have a few questions that have come through um one of the first of which was is there actually community transmission on mdi no there’s not at this time there is not okay um and then another question was what is being done at present to prevent the subjects from out of state from transmitting the virus to others in our community have they been mandated to quarantine and how is this being enforced um so and the official state mandate of course is if you’ve been tested outside the state and you’re waiting for your test result you are expected to be isolated be quarantined until your test result comes back and if people are following the state rules they are in a residence if they’re renting a place or if they’ve come to some room they’re on their property there and they are not interacting with people outside their own household some people are no doubt not following that um and that’s why as i think most people listen to this are aware we as a community uh the business community all the towns have been involved the hospital and i know ellsworth has a very similar type program to try and get the best possible compliance with masking both by patrons and by staff and restaurants and also in i know in bar harbor i don’t know about

in ellsworth the setting up of outdoor service at restaurants so that people who do decide to go out for meal don’t have to go into a place ideally they should eat at home and the availability of takeout so those are all ways that we as a community protect ourselves from people who are either unable or unwilling to follow the rules there is no legal enforcement being done by the state at this time and then the last question that i received was mdi hospital sent out a statement that 35 non-residents have reported a positive covic case but in yesterday’s main cdc update dr shaw said that it was about five people are you both talking about the same thing and where does the discrepancy come connection so the the 35 number that’s been badgered around was is actually a cumulative number uh since uh since we started keeping track of the calls that we received and it includes not just people who call to tell us that they have recorded positive results but uh also their close contacts of theirs so that that that was an estimate it does it was never intended to reflect uh a uh a current uh status of what’s in our community uh the um uh in our discussions uh with dr shaw and commissioner lambro yesterday uh we discussed the fact that we’ve had a sudden we’ll call it a rash and of course we’re a small community so small numbers constitute a rational times uh within the past week and a half so it’s in the mask i usually wear within the last week and a half uh we had uh about a half dozen people i think five in the last week maybe seven in the last week and a half of folks that have called to tell us that they had received a positive result uh since they arrived in maine and it’s that it’s that acceleration of these reports which again is is not totally unexpected this is what we were concerned uh would happen as the summer progresses and again i think uh the exciting thing for me is that i think our community and the state have done a great job of uh positioning ourselves so that we can work to manage this uh this situation the positive cases as well they were family members that were the contacts only and they were maintaining quarantine within their home when they found the results okay um and then there was another question um the travel community has suggested that during a 14-day quarantine you can hike bike et cetera that seems a bit contradictory what do you think so i i could lauren i answer that remind me to answer that when i’m done talking because that’s a perfect time for me to start talking okay go ahead okay so i’m j.r krevins i’m a physician here at the hospital before i was a physician i did study physics an undergraduate level and all that stuff is coming back in a big way um in fact about a third of about a third of the reading that i’ve been doing lately is really physics and engineering based stuff and so i’m going to be talking about the same things as kate was but very in a little more depth about a few of the topics um so people can really understand when we think about transmission and about how to prevent transmission i’m initially going to talk without slides it’s because i’m more used to that and then we’ll switch into slides when we start talking about vaccines at the end so people have heard lots about the transmission of this virus it’s incredibly contagious far more contagious than flu far more contagious than saurus not as contagious as measles um so in fact it’s so contagious that it’s been somewhat hard to study how it has spread and so we it probably spreads by multiple mechanisms the first one i’ll talk about is spreading on surfaces based upon both the physics and physiology of the virus itself and the increasing epidemiologic data this is almost certainly the least important uh the way the virus enters your cells is it has to attach to a mucous membrane the eye the lining of the nose the lining of the throat or lungs and it has to be there in sufficient quantity a small number of virus

particles won’t succeed in infecting you so if it’s on this table it has to get from the table to my hand from my hand into my eye with enough viruses at once to infect me it turns out that’s not that common and just basic good sanitation is what’s really necessary along with good hand washing and that’s not the biggest place you need to be putting a lot of our efforts and then there’s these two methods of transmission which we separate officially in hospitals because we have to um but the um they’re really a spectrum not two different things there’s something called droplet transmission and airborne transmission um and these are commonly confused when people talk about them and it’s but it’s really an artificial distinction because one gradually becomes the other droplets basically are large particles they literally impact us uh or we breathe them in as a single large particle when someone coughs on you and you feel it um and but these are large droplets and like any other drop like a drop of rain they will fall to the ground and almost all of them will fall to the ground within three feet and way over 90 percent by six feet from the person who excreted them in most conditions so unless you’re directly hit by these they fall to the ground but then smaller droplets and sometimes small droplets are produced when somebody coughs or sneezes some of the droplets they produce are small or a medium-sized wrap one if it doesn’t fall to the ground really rapidly part of it will evaporate especially in dry air and when it evaporates then you’re left with a little tiny residual called a droplet nuclei which contains concentrated viruses and now it’s light enough a mist not a raindrop that it will float in the air for a while and those can be breathed deep into the lungs so that’s droplet transmission big things like raindrops or even small raindrops that fall and particles that are light enough that they float around the reason that matters is the protection against them is a little bit different but when you actually get to the clinical studies not as different as people make it out to be so drama transmission being directly impacted um and a simple mask and perhaps a face shield if you’re in a high risk situation is certainly enough to protect you very well against almost all droplet transmission a simple mass like i’m wearing right now allows air to flow through it it’s got very small holes it would certainly stop a droplet a tiny piece of aerosol could go around it and that’s what’s called airborne transmission and that’s actually inhaling a floating particle particles too small to seed too small to field into your lungs to get complete protection you need a fitted respirator which is either what they call an n95 mask or a papr hood and that will give you essentially complete protection from it uh if it’s airborne uh but also interestingly so will good ventilation if you’re in an open area where things are rapidly blowing away and getting diluted uh that will also improve this the situation enormously and the important thing to recognize is something called the inoculum effect which is yours actually that that’s a great interruption that was materials management page we’re one of our big issues is getting supplies in nowadays so we’re always glad to be interrupted to hear that we’ve got more supplies coming in so the inoculum effect is something probably some of you have read about and it’s fancy words and it’s it’s this it’s a fancy way of saying it takes a lot of germs of this germ to cause an illness while this germ is very contagious in the sense that it’s good at spreading it’s not it does take an inhalation of a fair amount it’s more like being attacked by a cloud of mosquitoes um than a german shepherd um you don’t have to you know you’re not going to get sucked all the blood out by one mosquito um and if you only inhale a few germs or get a few germs in your eye it generally doesn’t cause illness or if it does cause illness it’s very

modern because of this in order to keep most of us protected most of the time the world is not perfect we don’t have to eliminate every germ we really need to get the numbers way down um and i’m going to throw out some numbers and these are the numbers from about four weeks ago there’s been some refinement up and down and some of them in argument since but they’re pretty much the same um yeah let’s pop this up so uh a six foot distance go back a couple sides sorry back two slides nope back back sorry yes so if you look at the chance of getting the infected um whether it’s passing someone in a store because you’re both looking for the same brand of noodles for a minute or whether it’s sitting in a conference room for an hour with your boss talking to a bunch of interested people on the video conference by being six feet away from art right now uh i if he was contagious um i am about five times less than if we were sitting right next to each other but he’s wearing a mask that mask cuts his ability to make me sick by about a factor of six i’m wearing a mask that protects me by about a factor of six and these actually turned out to be multiple multiplicative so this gets really safe really fast if everybody follows the rules if art was contagious right now and i was sitting next to him as kate said the odds are probably about 40 that i would be infected by the end of this hour almost 50 50 by being six feet away and both of us wearing masks even if he’s infectious the chance that i am going to be infected is 180 about one in 500 even sitting together talking loudly for an hour i mean it’s because we have the multiple layers of protection um face shields which we’ll mention they protect the wearer by a factor of about three there has been a bunch of back and forth about how much they protect other people from you uh i just saw some nice studies out of an aeronautical engineer doing high-speed laser photography in his basement not kidding uh it’s actually published in the go journal because it was a great study but people have to work from home and um probably face shields are significantly less effective at keeping germs in and i want to mention the key importance of ventilation when you’re outdoors the risk is dramatically less for three reasons one reason is that there’s just lots more air to carry the droplets away the second is a simple social one it’s much easier to stay six feet from people outside in general corner of cottage you mean not so much but most places it’s pretty easy to stay six feet from somebody most of the time except maybe two or three seconds passing on a trail um and the third reason is an interesting one uh viruses are a very tiny set you know there’s a saying that the reason it’s so hard to kill a virus is it’s not alive um which is actually true viruses are not living creatures they’re a set of instructions to tell your body how to make more viruses and if those instructions are basically naked instructions floating around it’s like having a sheet of tissue paper with lettering on it um not without a cover on it uh a book coverage so uh ultraviolet light is really good at messing up those instructions and making them unreadable which you don’t want you why should you you want the virus to not be readable so this gets back to the question you asked which i have actually heard two different people from the state at the same presentation give slightly different answers to the legal rule which is a very good rule is to stay on your own property or if you’re renting stay there

and not go out at all that’s the law there is a reality that if you are walking along and i think the phrase i think that like the me the thing of the day dr shaw was on the phone a country road or something you know like if you’re renting in selmsville and you’re on one of those back there’s old logging roads out of stonesville you know you can keep a six foot distance from other people um that people talk about doing that it gets to be a gray area very fast carriage roads yeah i think they can get busy but they’re wide uh gorham mountain trail on a sunny saturday afternoon good luck with that and and so i would say that the onus is on the person they have to not create the circumstance where other people cannot maintain safety um it’s one thing to you know go to the end of your driveway and pick up somebody delivering takeout uh to go downtown to downtown bar harbor and wait in the takeout line um is not maintaining social distance um so um so we talk about risk each contact is a risk if there’s more people around more chance that one of the people you’re with is infected if you are the one who is infectious if you’re around more people more chance you’re going to infect someone else um the more time you spend in the infectious environment um if you are you know in a store for 10 minutes you know picking up some hardware parts is different than spending three hours with the same number of people um in a meeting environment city um some activities are much more produce lots more droplets coughing and sneezing obviously if someone’s actively sick interestingly singing dancing exercising dramatically increased numbers of droplets even if people are not coughing or sneezing while they’re doing these things or shouting also um so kate talked about super spreading people which occur um something that interests me more is and it’s a huge issue for communities more than super spreading people our super spreader events which of wh you know you periodically read about them the most recent one that was the children’s camp in one of the southern states ymca camp they were way over 200 positives and a lot of the kids didn’t get tested because they got a bunch of kids together they did ymca camp things complete with cheerleading let’s see oh let’s stand on top of each other’s shoulders while shouting um and uh singing crowds bars exercise classes um these are the events where you can suddenly infect very large numbers of people funerals weddings um and and those type of events because they put together all the things you don’t want large numbers of people for a period of time close together breathing loudly generally not masked so um i want to talk about kids for a minute because that’s really important we have a month till school starts and one day last week i actually saw two headlines right next to each other on my newsfeed one said kids have children have much lower case numbers and another one said school children shown to be highly infectious they’re like what and because one study was looking at all ages of children and their sample was predominantly teenagers and one sample was a very careful scientific study by age and by pediatricians and there is reasonable data that say that kids who are under 10 so when people talk about children you have to really look by age kids who are under 10 are probably less infectious the data is not great yet so i would say that kids under 10 are probably less infectious not definitely the other thing is all the time though where people say oh kids won’t wear masks or can’t wear

masks actually kids are better about wearing masks than adults i have yet to see a newspaper article about a child who took out a pistol or assaulted somebody when asked to wear a mask well you can sort of like see those adult articles every day about adults um you know i’ve been a teacher i’ve been a camp counselor you know kids will do anything for jolly rogers um so sometimes when people you know hear about this you know they look at what’s happening in other states um and they look at some of the projections they feel like this is there’s nothing we can do and we’re not helpless um almost anybody can wear a mask including the people who don’t think they can including kids remember protection’s multiplied you can make yourself and everybody around you safe um but also the risks add up we need to avoid crowded situations we need to avoid noisy on math situations i mean noise is interesting there are some studies that have shown the level of background music in a bar correlates to the chance of a super spread revenge because when the music is louder everybody starts talking more they also drink more which is why the bar does that so um wear masks close the bars open the schools so we’ll talk about vaccines because that was a question that came in in the screening thing so let’s talk about the what the biology is interesting the vaccine which currently is the farthest along um are what’s called a messenger rna vaccine which is essentially almost a synthetic virus you’re actually not given the vaccine itself what you’re given is a tiny injection of genetic material rna that doesn’t contain information to make a virus it just contains the information to make the target protein one specific target protein that doesn’t cause any harm to the body but the body will learn to react to it’s of it of course is very efficient because your body makes most of the protein it appears to be very very safe because you’re giving a small amount of our messenger rna to the body but messenger rna is something our bodies are full of already with a natural product and the body that makes its version of the spike protein since it’s new to the body you become you develop an immune response to it this is a very great idea but this is a novel technology this would be the first messenger rna vaccine if it comes along another way of making another way of making a vaccine is something called a live virus vaccine which is where you take a harmless virus adenoviruses are used for this commonly and you genetically engineer that adenovirus which is a harmless virus to carry thus and express the sprite protein germ so the this virus that is not dangerous to people will multiply in your body deliver a bunch of the spike protein which you’ll become immune to so you don’t give the people coronavirus to become immune to it you give them this non-inf this unknown dangerous stress this is a technology we’ve used before for vir for vaccines it’s not as it’s a newer technology but something that’s out there the most the classic way to make a vaccine is to actually take the protein from the that you want the body to develop an immune reaction to along with an adjuvant which is a chemical that encourages the body to develop immunity um and there are and like the hepatitis b vaccine which is a very potent well studied vaccine is done like this you use a monoclonal use a modified bacteria to produce large amounts of the spike protein and then you get with an engine it’s that’s a very classic like 40 year old technology um and so these are all being developed right now go ahead um what we’re doing clinical trials right now to determine the efficacy and the side effects how much of it the dosing um whether or not you need one dose or two doses some of these vaccines will need two doses for a durable effect a lot of vaccines do we don’t yet know that for these vaccines a really really important concept and different vaccines have different effects

is whether or not the vaccine or even natural infection gives you mucosal protection so mucosal protection means that when art infects me it i breathe it in i i get the virus on my mucosa and i kill it so fast it never grows on my mucosa it never grows in my throat and i can’t give it to kate personal protection would mean that it would grow in my throat in my nose i would i wouldn’t get sick i would be asymptomatic but conceivably i could still pass it on obviously a vaccine that gives complete protection is better than one that only protects because that prevents you from that protects the whole community not just you and different vaccines are that way so um there are vaccines out there it’s interesting we’ve been told that we are going to have a vaccine by the beginning of the year in actual production and distribution i think that’s possible um the moderna which is the first one listed up there uh has had phase one and phase two studies published and it is starting to has started page three phase three that’s one they’re talking about having available for use at the end of this year but what clinicaltrials.gov which is where you register the trials says that the people doing the study think that they’re going to finish their studies in october of 2022 two years from now obviously there’s some hope that it could be done a lot faster uh to be honest the tremendous outbreaks in the south are making it easier to do the studies um but that’s sort of interesting to me the disconnect between what the researchers are saying and what the government is saying um a very different technology the adenovirus which is the austro-zenico which is out of england which will also be worldwide distribution they are predicting that they’re going to have vaccine available for use next winter or spring but their official publication date is supposed to be next summer a year from now um and the pfizer vaccine which i don’t think is actually part of the operational warp speed officially and according to verbal statements not in writing their study leader says that they think they’re going to have results in either december or january and they have also started their phase three trials all of these vaccines are doing uh something which has historically never been done before which is they are all starting bulk manufacture of the vaccines now which takes months on the hope that it works so that we don’t get the situation that in january we say okay modernity works and oxford asked his indica work and we’ll have it for you in four months the idea is that they’re going to make literally billions of dollars worth of vaccine in the next four months and hope it works which would be great uh if it works but it’s not a promise some possible back issues with the vaccines um the fastest a vaccine has ever been developed is four years so we’re not looking at trying to change the mile time from four minutes to 350 uh we’re trying to run a one-minute mile um nonetheless i think it’s actually quite possible um we don’t know if the response to the vaccine or the infection may wane um there is some early data that says that um it’s not going that it appears to be durable uh so far there have been no cases as far as anyone knows of reinfection and people who had wild type uh infection uh we discussed earlier about immunity being personal versus herd immunity and then there’s a interesting social issue the first vaccine we give may be sort of effective it may not be the best vaccine how is society going to react if a year later we’re like okay we want everyone to get vaccinated again and then there’s questions around who should get the vaccine first and whether that will be required um i’m going to real quick go through birch bay stuff just so people are

interested we’ve done a lot of stuff to protect birch bay um we’ve got a lot of training from both the staff and the residents visiting is limited based on state and federal guidelines and ability of the the residents there go out on excursions under very specific guidelines and generally accompanied to make sure people stay safe next um we have worked very hard to get adequate ppe for our staff there unlike a lot of well we’re actually technically not a nursing home or an assisted living but we have nursing home level uh ppe and better uh and good training and we have avoided any infections so far there as far as testing which i know is a question that has come up we have tested our staff currently which is both by state and federal guidelines only the only time residents should be tested is if there is evidence of either exposure or illness we are exceeding the requirements um as far as our testing of staff and we actually had one staff member who was infectious on their initial screening but ppe works due to the fact that they followed their the rules on how to behave safely even though they were infectious uh they were found on screening they they weren’t sick um they had infected none of their co-workers and none of the residents so personal thoughts i use to guide me as i think about this stuff um things are changing literally between when i started writing this talk four days ago and now i had to revise some of the slides we don’t have all the answers now but we have to act now um this this was not an unforeseen or unforeseeable event this has happened before in history and it’s going to happen again the risk is real and but it can be reduced timeline most likely we’re going to have vaccines starting this winter with decent coverage by summer if we’re lucky and i’m suspecting we may have a decent antiviral drug available by winter as well and final thought i want to leave people with if we choose not to control the spread we can expect one or two million americans dead in the next two years and it’s a choice all right so we do have some more questions that have come through one of which was with more cases in our community is it still safe to go to the hospital absolutely um we have first of all just to clarify to get some clarification uh that 35 case number that is the number of folks that have called that uh report uh that they’ve received positive uh results from elsewhere but that’s through the entire season so far and we had five last so that’s the distinction um but the hospital you know as as as both both dr krebbins and kate have described uh we do not currently and and have not as of yet had any community transmission through uh through our community at our hospital we take the position that our our ultimate goal is maximum safety both for our staff and for for our patients so we have uh as we would always have um very strict adherence to infection control guidelines and there’s a specific set of infection prevention guidelines that have been uh have been sorted through through the medical community in the cdc um that our that our staff are here too we have we’ve done revisions to our building we have revised our staff our our clinical schedules all with the guide to assuring that people uh are adequately protected both in terms of personal protective equipment as well as appropriate social distancing so i i i often joke that uh that there’s a perception that hospitals are kind of dangerous places and maybe if we had a full hospital full of colder patients that might be the case but uh i don’t feel anywhere i i don’t feel as safe anywhere as i do when i’m in this hospital definitely absolutely yeah i agree too um could you guys kind of more definitely

um clearly define the terms isolate and quarantine jared is really good at this one okay we talk about it all the time so um quarantine comes from the you know my sister who might be listening and is going to laugh because she’s a classical scholar parent anyhow it’s it’s an italian word for 40 days because certain italian cities during the plague would make ships anchor offshore for 40 days not if anyone on board was sick but to see if anyone got sick so quarantine is when you are suspected because of where you came from or who you are or who you’ve been near but you’re not sick you are isolated which is alone and quarantine can be in a group you are isolated alone when you are defined as truly infected and interestingly enough isolation can be shorter than quarantine because once somebody gets sick their body will clear the virus but if somebody’s been exposed it sometimes take a while for the virus to start growing so it’s sort of interesting sometimes isolation can be shorter um another one is do any of the panelists have recommendations for facial covering slash protections if and when schools reopen i would recommend the wearing a fake shield as jr did with his point of six and the numbers looking at how much we have a risk reduction by being in close contact with each other asking kids to not be you know to be greater than six feet from each other um is is going to be difficult and so wearing a mask is going to protect them that much more kids will be are more accepting of masks than we are as adults um so certainly i would recommend wearing a mask if school and go with school events yeah no question yeah there are quite a few have come through i don’t think we’re gonna get to them all but i’m trying to pick some ones that we haven’t really covered yet um i haven’t seen any specific recommendations for ventilation in publicly facing businesses for example keeping the doors and windows open in the post office or restaurants um perhaps this should be made because um you point out it helps protect us there is a state recommendation for that there is okay there’s definitely and there are with the coming of winter there’s a bunch of stuff looking at uv irradiation like high up in the room where the uv doesn’t hit you but it hits the recirculating air um i’ve already i mean our engineer has already told me he’s locked in a good price on oil for this winter because we’re going to be exhausting warrior from our hospital this winter um okay um now here’s a classic summer question what about swimming what are the risks um indoor pool versus outdoors in a lake clearly outdoor is safer than an indoor anytime you’re going to be indoor you’re going to be in an aerosolized environment too with the pool and the kids and the ventilation so outside would be safer lake would be safer than a pool more spaced out the more farther apart everybody is their wrist goes down it’s a good idea um is there a pull the plug plan if exposure here spreads uh do you mean for the hot for the hospital we have a four layer five four stage plan of which we’re in stage two and we have all kind and stage four has three stages in and of itself so we have a whole set of plans for what we do with increasing number of cases of different types that we revisit every week or two based upon supplies and science the state also has its plan that i don’t know but i know they track the numbers very closely um both are some numbers and other people’s numbers yeah one of the things that i hope the public is is hearing in all of this that we are as an organization we are very committed to to both uh our patient safety and our employees safety as well as our community safety and and part of what we’re trying to do today provides support and education for the community to help keep keep our communities safe one of the ways that we are working to assure that happens is we literally have an incident command structure

where some of the key members of the leadership that involved this effort literally meet daily and we’re reviewing current data uh comparing notes with uh with what other best practice organizations are doing and really working very hard to make sure that we’re providing services and support at a level that’s commensurate with the science and with the with the environment at that time and for people understand that the things that could affect that are not just here one of our limiting factors which we’ve gone back and forth on in terms of what services we can provide is what supplies we can get which often has more to do with what’s happening in florida um than it does here like as kate mentioned we can’t do we’d love to be able to give everybody rapid tests but we have a last time i checked we had 180 kids left and i get a report periodically with exactly how many kids of each type are left all right so i have two last questions i think we have time for um is it safe to have your teeth cleaned at the dentist right now the uh we operate the community dental center in southwest harbor and uh so some of the modifications that uh we made in that building is to increase the ventilation and i think we’ve installed hepa filters there um and plus we again did not open the facility until we had enough we had restructured some of the flow so that there was adequate distancing the building air flows needed to be needed to be safe as well as assuring and with dental care in particular which is really challenging as jr mentioned the level of ppe they use is significant but again it’s critical that everyone that’s involved in the process be appropriately protected okay and then lastly um are there any super spreaders um people and events in our area currently that you’re aware of yeah can i answer all the phone calls that come through that are positive there enough perfect all right okay so thank you uh thank you all so much for for joining us today and i want to especially thank our two speakers for giving during the time and the and the attention to uh preparing for today you know um as i said we’re very committed to uh to the community’s safety and one of the ways where we’re addressing uh that the safety in our community is through uh partnership with the uh down east kobe 19 task force uh in conjunction and in partnership again with with the state uh we are providing asymptomatic works workforce testing uh to a cohort of front-facing tourism workers um this is a the goal of this program is to detect any potential carbon 19 outbreaks as early as possible which will allow us to not only protect those front-facing tourism employees but also help reduce the threat of exposure for the entire community and we are very pleased that so far we have had a zero positivity rate uh in that program now uh any future positives uh will be part of the reporting again in uh uh in the total test results that we that we maintain on our website so okay so uh you know it was interesting when uh christy mcguire our chief operating officer and i met with uh with dr shaw and commissioner lambert yesterday um we had a an interesting and interesting discussion because as i said they uh they’ve helped to support this pilot along with the jackson laboratory and our hospital and a couple of very generous donors in our community and so we were talking about the results of this program we were talking about solutions to uh to improve the uh the contact tracing that goes on but uh it was uh it was all within the context of that we are in the middle of a pandemic and it is absolutely critical that we need to be continuously addressing safety and continuously addressing understanding where this disease is in relation to our community and to the science so kobe 19 is here there are

there are people in our community uh that are positive um and it’s just important to remember that with adequate protections and with adequate protocols uh we can continue to do the things that we need to do to protect our community and we we really really strongly encourage all of our residents and visitors to remain hyper vigilant in their precautions so masking physical distancing and hand washing continue to be the best tools we have to spread this uh to spread this disease in this case uh do as i say not as i do you need to have a mass that fits properly in order to do that so thank you again for for joining us today and for your commitment uh to the health of your neighbors and our community and we we will continue to keep you informed on the situation as things move forward and we very much appreciate you tuning in today thank you

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