On Monday, July 20, the Blue Light Podcast interviewed Dr. Diane Kennedy, a physician at Sanford Health in Luverne. Dr. Kennedy has been practicing family medicine for more than thirty years, twenty-seven of which have been in Luverne. The podcast’s Tyler Ramsbey interviewed Dr. Kennedy on the current science behind COVID-19, masks, and testing.
In the interests of full disclosure, Ramsbey noted that Dr. Kennedy is his aunt. Ramsbey also disclosed that he was saddened the issue of public health has become political and divisive, and very pointedly noted that the entire interview was conducted from a factual, medical, scientific point of view, and he was hopeful that preconceived notions could be put aside and folks could learn from the information presented. All questions were those submitted on-line by Blue Light Podcast followers.
The interview has been viewed over 24,000 times since it aired, and received high praise from commenters on the quality information presented in a fact-based manner. Due to the length, the Gazette was unable to transcribe it in its entirety, but highlights are below. Responses are edited for length and clarity. The full episode can be found on Facebook by searching for the Blue Light Podcast page.
Ramsbey began with the question that has been the longest-lasting since it hit U.S. shores. Is the virus a hoax, is it man-made, no different than the flu, and are reactions all fear-based?
“It is not a hoax,” responded Dr. Kennedy, “and I would encourage all those people to join me in an exam room with a patient with a temp of 103 and a cough, and feeling horribly ill, with shortness of breath. It is real. The difference between COVID-19 and influenza is, we really don’t have any baseline immunity to COVID-19, so we’re all immune-suppressed with regard to COVID-19. There have been other coronavirus infections, there’s lots of them in livestock and in people, but we haven’t ever had a coronavirus exactly like COVID-19.
“When you compare the numbers- when you look at the number of flu deaths in the peak week of 2018, it was 1,626 nationwide. In April, there were 15,455 COVID deaths the week of April 21st, so the numbers aren’t even close.
“The other thing with influenza is that we have an influenza vaccine. It’s not always perfect, but it helps. If you get the vaccine, you usually don’t get as sick. [Right now,] we really don’t have anything like that to offer. We also have oral medications we can use to help treat influenza. We have IV antiviral medications we’re using now, but we just don’t have any oral ones that we can treat as an outpatient.
“We also don’t understand COVID-19 like we understand influenza. We’ve been dealing with influenza for [many] years and have lots of scientific data, and we just don’t have that with COVID-19.”
Ramsbey asked about masks. He noted that this is probably the biggest debate going on right now, and he began with the biggest issue that’s been surrounding them: why were they not recommended in the beginning, but now they are a must-wear?
Dr. Kennedy began her response with the acknowledgment that it’s complicated.
“It’s unfortunate that they weren’t stressed in the beginning. There were a few reasons for that; the first was that we didn’t have any masks. For the first 4-5 weeks of the pandemic, I did not have a mask to wear in the clinic. We saw what happened with toilet paper. If everyone went out to buy masks, we weren’t going to have any masks for the healthcare workers that were taking care of really sick people. At that time there wasn’t really a big prevalence of sick people in the country, so you really needed to concentrate those supplies where they were needed. Another thing we know now that we didn’t know then was that 35-40% of people are asymptomatic. They don’t have any symptoms, yet they’re spreading the virus.
“That makes it difficult to stop the spread, because if you don’t know that you have it, why would you stay home and avoid getting other people sick? It became obvious that we had to do something to help stop the spread, and that’s why masks started to be encouraged. The mask was initially to protect others. You wear the mask so that when you cough or sneeze or breathe or talk or sing, the larger particles, which the COVID virus hangs onto, don’t spread to other people.
“Now there are some studies showing that by you wearing the mask, perhaps it decreases the viral load that you receive, so it’s not just protecting others, it’s also protecting yourself a little.”
Ramsbey asked about masks potentially being harmful, whether it’s by re-breathing carbon dioxide or moisture build-up. He stated that he has worn a mask every time he’s gone shopping, and he has yet to “fall down unconscious and knock myself out. What do you have to say to those who believe masks are dangerous?”
“Masks are not dangerous,” Dr. Kennedy replied. “I wear one twelve hours a day; I’m doing just fine. That’s why they’re protecting other people more than yourself, because you have a lot of air flow through a mask, including small particles, including virus particles. You’re just trying to catch the droplets.
“Now if you had to wear an N-95 mask all day long, that would be a little more difficult to do, because it does act more like a respirator. But you do still have good air exchange.
“If you’re looking for good resources for true answers, Sanford has the “Facts over Fear” website, and the Mayo Clinic has a nice website as well.” Dr. Kennedy also noted the CDC and Minnesota Department of Health are good resources, too.
Ramsbey wondered what the best masks were, and Dr. Kennedy responded that at least two layers are preferred in a mask. A pocket for a filter is a good idea.
“A lot of people are using furnace filters,” she said. “While a mask is only as good as the materials it’s made out of, at the same time, it’s only good if you can wear it. You need to find a mask that’s comfortable, that you can wear. Current recommendation is that it’s two layers, and I think cotton is as good as anything because it’s a lot more comfortable. They say that 180-count-thread cotton would be the best option, or at least that count. If you hold the material up to a bright light, the less light that it lets through, the better that it is.” She noted everyone can buy masks or even make them out of a t-shirt and rubber bands.
Face shields help to keep masks cleaner, and they protect eyes and mucous membranes, and it’s possible they help protect by themselves, but she noted that she prefers a mask over a face shield. Goggles (similar to those worn by lab scientists) work as well to help protect the eyes, to keep them from being a portal of entry for the virus.
Ramsbey then asked about immunity, wondering if those who’ve had the virus need to wear a mask.
Dr. Kennedy responded, “The virus is far too young [for us] to know that. We don’t know how long the antibodies are going to last; we don’t know if it’s 2 weeks, 4 weeks, a lifetime. Also, unless you’re going to wear a t-shirt that says ‘I’ve had COVID I’m safe’, how are others going to know? It’s easier to wear the mask and respect everybody else.”
Ramsbey, who is also the pastor of Garretson’s Renovation Church, moved onto the recommendations for churches.
“This is tough for me,” Dr. Kennedy responded. “Churches have been shown to be a high-risk exposure area.”
“I agree with you,” said Ramsbey, “but what Christians are going to say is, ‘Well, we can go to protests, or we can go to restaurants, but we can’t go to church. The government is restricting our freedom to go to church.’ Explain scientifically why you say that.”
“Scientifically, part of the issue is singing,” Dr. Kennedy replied. Viral particles are spread easily when singing. It’s also a time of congregation and sharing, and it can be very difficult for people to socially distance during that time, she noted. Ventilation also plays a role, since most church buildings are older. Masking may help, but on-line or outdoor church are wonderful options to have. Population vulnerability is also a factor, with many congregations skewing toward older ages.
Avoiding crowds is best, regardless of indoor or outdoor, said Dr. Kennedy.
Ramsbey then moved on to questions about symptoms and illness. Particularly, he asked, why are some symptomatic, why don’t all members of a household get it, and why do some people get it so much worse than others?
“If I knew that answer,” Dr. Kennedy said laughingly, “I would be a very important person in this world. I think that is the part that’s been so crazy about all this. The fact that children don’t always get sick, the fact that 35-40% of people are asymptomatic, the fact that household members can sometimes not get it- even though household is the most likely source of spreading. It seems that people with diabetes, with obesity, with chronic lung and chronic heart conditions are very high on the list for getting very sick. People of color are also high on the list. I don’t know how much of that has to do with healthcare inequalities in this country. We don’t know yet. This is a very new virus. We’re only what, six months into this? It’s going to take us a while to figure this all out.
“You don’t know if you’re going to be the one that’s going to get very sick or not,” Dr. Kennedy reminded viewers. “I’m going to be honest, in the early part of this pandemic, it’s been kind of scary for all of us in healthcare and probably everybody in the country.”
Now that we’re a little further along, people are showing a willingness to take more risks, she said, but no one knows yet who’s going to be worse off than others. Some who were infected may find they’re still having issues that impact quality of life years from now.
“I don’t think it’s worth the gamble of not following current guidelines in trying to keep yourself healthy,” she said. She continued by pointing out that if everyone could all hunker down, the U.S. could get to the point where a lot of lives are saved. Treatments are getting better, and scientists are well on the way toward developing a vaccine. Following the rules and wearing masks can allow for everyone to do the things they want to do, go to school, and open the economy back up.
Ramsbey then asked, “The CDC said that if everyone wore masks for 4-6 weeks, we could get the virus back under control?”
Dr. Kennedy responded that yes, she believed it could happen. “Not very many people in the building I work in are getting sick, and if they are, you can trace it to outside the hospital. We’re all wearing masks all the time in the clinic. While we are seeing patients with COVID, we’re not getting it.
“Also, look at countries where they do have mandatory masks. Look at the Twin Cities. They were really peaking, and then they had a mandatory mask recommendation, and it really slowed down their peak. I think it is important.”
With regards to beliefs that the virus has been around since the beginning of winter, especially with the nasty colds and respiratory viruses that were seen last season, Dr. Kennedy noted that they’ve done antibody testing and almost all of them have been negative. Those who tested positive for antibodies had a travel history.
Ramsbey then asked about vaccine safety and efficacy. Dr. Kennedy stated that she doesn’t know because that’s in the future, but safety is still important to the companies that are working to produce it. It’ll be an inactivated virus, not a live virus, which helps reduce potential side effects. Dr. Kennedy said that she’ll be willing to be the first in line to receive it once it’s offered.
With regards to testing for the virus, Ramsbey asked if people are double-counted in a tally if they test positive once, and then test positive again 14 days later. Dr. Kennedy refuted that, saying that once someone is in the database, any follow up testing isn’t added. She noted that while initial recommendations were to get a second test to be cleared, they are beginning to move away from that, and are stating that once 14 days have passed from the onset of initial symptoms, people are no longer infectious and are okay to go back to work.
Ramsbey brought up the difference between testing for the virus and testing for antibodies. Could antibody tests be increasing the number of coronavirus cases, but actually diagnosing other, less virulent coronaviruses?
Dr. Kennedy responded that no, this is not the case. “The COVID-19 test is looking for the virus. It’s not a perfect test, there is a 20-30% false negative rate. It’s a PCR test, and very few of those tests have false positives. Those are like, 1%.”
“So, if anything, the numbers would be downplayed by the test, not increased?” confirmed Ramsbey.
“Yes,” said Dr. Kennedy. “So you could easily have a negative PCR test [for the virus] and a positive antibody test 4-6 weeks later, which means that you had the virus. The antibody test looks for the immune response to the virus.”
She continued by noting that some antibody tests start out positive, but then eventually after a few months may be negative, which means scientists, doctors, and public health officials currently don’t know exactly how long immunity will last.
“As we get more time out with this virus, we’ll have a better idea of how long the antibodies stay positive and what this all means,” she said.
As far as rapid testing versus long-wait testing, Ramsbey asked why some people get one test and not the other. Some people are waiting 5 or more days to receive their results.
“I can only speak to what I know Sanford is doing,” Dr. Kennedy replied. “There are some rapid tests that the emergency room can use. We only have so many a day that are allotted, due to reagent and testing supplies. The other test is about a 4-hour test. So why is it taking 5 days? It’s because everybody’s testing with the 4-hour test, and we’ve prioritized people. People over 65, people with chronic medical conditions, and people who are healthcare workers, are prioritized. They get their tests back in about 24 hours. Other people aren’t as prioritized, and that’s what makes this so difficult to control this infection, because we’d like to be able to tell you in 15 minutes if you’re positive. Then you can go home and hunker down, stay there for 14 days.
“If you’re symptomatic, if you’ve had a COVID test done, especially if you’ve had exposure or even if you’ve had the classic symptoms, you need to consider yourself positive until you get that test result back. Because, like I said before, there’s a 25-30% false negative rate, so even a negative test might mean that you have it, so you really should hunker down until the symptoms are all gone. And that’s really hard to do, because we want to be able to tell people right away. And that’s one of the limitations of testing.”
Even with those limitations, Dr. Kennedy said Sanford and Avera likely don’t want to limit testing, because the more tests they have completed, the more they know about where the virus is.
However, meeting criteria in order to get tested can be interesting. For instance, Ramsbey pointed out how during the early months, South Dakota public health officials were only allowing testing of people who had traveled outside of the country and were symptomatic, while at the same time stating there was no community spread, despite no testing for it. He asked what some of the criteria for testing were.
While she is only able to speak to the criteria being used at Sanford, Dr. Kennedy said she doesn’t have any strict criteria to follow. She can test those who are symptomatic, or those who have an exposure risk. It does depend on how much testing the facility has available. Some states are having a harder time getting enough tests than others.
Ramsbey then asked about the protocols for healthcare workers who test positive. Are hospitals alerting patients if they were exposed?
“The current risk for infection is 15 minutes of exposure to someone not wearing any PPE (face masks). Since we’re all wearing masks and following PPE guidelines, when a hospital employee tests positive, the Department of Health will contact that person [who is positive], and ask who they’ve all been in contact with. Those are considered low-risk exposures. I don’t believe those people are contacted. I have not checked with our policy, but I believe they aren’t contacted because we have all our PPE on. If [hospital employees] are symptomatic and they’re at high risk of [getting] COVID, they’re immediately taken off of work.” Employees are only allowed to return after 10 days after onset of symptoms and 3 days without fever.
Ramsbey asked what it is like to go in for a test.
Dr. Kennedy said they don’t want the first step to be going into the clinic. The first step is to call the clinic, and they’ll set up a video visit. They don’t want barriers to testing, so if a person is symptomatic and wants to be tested, they’ll get the testing set up. A video visit allows the physician to discuss quarantine and treatment.
“The test is a nasal swab,” Dr. Kennedy said. “It’s a fairly deep nasal swab, you’ll be aware of it. But everyone can handle it.”
Tests conducted in Luverne are then sent to Sanford in Sioux Falls by courier, who makes the trip three times a day. This helps to expediate the tests.
As far as drive-through testing is concerned, it all depends on who’s running the test. Criteria may be different if it’s the Department of Health conducting it or if it’s a local healthcare system. Drive through testing is labor intensive, but it’s important, especially if there’s a community hotspot, Dr. Kennedy said.
Ramsbey ended the questioning by asking about the two or three most important things to do to in order to fight against COVID-19 and to protect healthcare workers.
“I think the first thing we need to do is wear masks,” said Dr. Kennedy. “I think we do that out of respect for other people. You’re respecting the fact that you might have COVID and not know it, you’re respecting the people around you and making sure they don’t get sick, and it’s just the right thing to do. I don’t understand the barriers.
“I feel that everyone that wants to open up this country and get everything going and make everything back to normal, it can be really darn close, you just have to have a mask over your face. And get over yourself, I mean, it’s not really about you. It’s about protecting other people.
“I hate wearing masks too. I hate it [and] I wear them all day. By the end of the day, my throat’s dry, I feel like I have a cough, I’m sure I have COVID. The next morning, I wake up, I don’t have it anymore. It’s not fun, but it’s what needs to be done.
“The second thing is, be aware of your symptoms. If you have a loss of taste or smell, and a little bit of a cough, be aware of it, and go in and get tested. Until you know whether or not you have it, we aren’t going to make any inroads into stopping this infection.
“And the other thing is, take care of yourself. If obesity, smoking, diabetes, those kinds of things increase your risk for getting COVID, look at your lifestyle and say, ‘What can I do differently? How can I improve my health so that if I get sick, I won’t get as sick?’”
Dr. Kennedy also reminded viewers to get their flu shot this fall. “You can imagine what it’ll be like, everyone’s going to be inside,” and spreading other viruses too. “This will complicate things with COVID thrown into the mix.”
The mixture of viruses, or getting one right after the other, is still unknown. Another spike in COVID cases this fall is very likely, because everyone will be inside.
And one more thing, said Dr. Kennedy. “I’m sure everyone has seen the anecdotal evidence of the two hairdressers that were positive for COVID. They took care of 149 clients during the time that they were infectious with COVID. They were masked. I don’t think anybody got sick.
“If we all wear them, we’re protecting each other, and that’s the right thing to do.”
