by Kathy Tretter
Recently a reader sent the News a missive with 16 questions for which he/she was seeking answers concerning COVID-19 and its impact on Dubois County. We reached out to Dubois County Health Officer Dr. Theodore Waflart and also checked the Indiana Department of Health website for statistics. In addition, Dr. Christopher Bunce, Memorial Hospital’s Infectious Disease Specialist, provided or expanded upon answers to some of the questions.
Q) What treatment is given if one tests positive?
A) None, unless the patients gets sick, visits his or her doctor or the emergency room. If treatment is required doctors and Memorial Hospital follow the regiment outlined by the CDC depending on severity of infection, including steroids, Remdisevir and other medications. Oxygen may be used in the hospital but that number is difficult to assess because the use of oxygen is routine.
Non-hospitalized patients with a mild to moderate case with certain symptoms may be given an antibody treatment, available for outpatients. This treatment would depend on how great the risk is of disease progression.
Dr. Waflart explained that how a person will react if he or she contracts COVID-19 is puzzling, because some with comorbidities, don’t get sick while relatively healthy people with no underlying conditions sometimes do.
Q) Are Zinc, Z-pak and hydroxchloroquine used early, as have been found effective elsewhere?
A) Hydroxchloroquine has not proven effective and the side effects don’t outweigh the risk.
One of most recent studies, published in the New England Journal of Medicine on November 19, 2020, stated that no noticeable difference or improvement resulted in those who took it compared to those who received a placebo. In fact Hydrochloroquine affected liver enzymes as well as changing EKGs, which could throw the patients into arrythmia.
Dr. Waflart knew of no studies concerning Zinc (although said it could be beneficial in senior citizens who may be zinc deficient). A Z-pak is an antibiotic and may be used in treatment.
Q) If not, can one request this treatment?
Dr. Waflart assumed if requested the patient could be treated with Hydrochloroquine but since he does not treat patients he was unsure. Dr. Bunce provided the answer to this question. If requested do not expect to receive it. He said, “It’s up to the doctor and most doctors who know what they are doing recognize there is no proven benefit whatsoever.” This fact has been backed up by solid clinical research.
Q) What is the breakdown of “positives” by age group?
Dubois County positives as of Thursday, January 14:
Age 0-19 — 875
Age 20-29 — 880
Age 30-39 — 790
Age 40-49 — 779
Age 50-59 — 880
Age 60-69 — 587
Age 70-79 — 309
Age 80+ — 235
Q) What tests are used for “positives” as there have been numerous false positives? Have people re-tested and been to be found negative?
A) PCR (the nasal swab) is the most reliable test. If the result is positive the patient almost certainly has COVID-19 as the accuracy rate is 99.7%.
If it comes back negative it is a different story as statistics show 25% are false negatives.
Dr. Waflart said the advice has changed on testing and now the recommendation is to be tested on the fifth day following exposure.
If a person is exposed and opts not to test he should quarantine for 14 days. The CDC now says if your work or commitments are extremely important and you have no symptoms you can return after10 days if you haven’t been tested or seven days if you test negative, However, Dubois County Health officials do not advise anyone to follow the seven day protocol, nor does Dr. Bunce.
Anyone who is symptomatic can get a rapid test at the test site in Jasper and receive results in 15 minutes at the former Ruxer golf course on Clay Street.
This test is not as accurate as the PCR. If the rapid test is negative but the symptoms continue, people are advised to get a PCR test within two days following the negative test.
Antibody testing is also available that would show if a person previously had COVD-19 and possibly was asymptomatic; however, it doesn’t show when that person had it and since reinfection is possible this test probably doesn’t serve a purpose.
Q) What are the range of symptoms and which are most dominant symptoms?
A) According to the CDC, the following symptoms may mean infection:
1. Fever or feeling feverish (such as chills and sweating)
3. Mild or moderate difficulty breathing
Muscle aches or body aches
Vomiting or diarrhea
New loss of taste or smell (almost assuredly COVID)
Congestion or runny nose
The highest percentage of patients with COVID-19 generally exhibit the top three symptoms.
Those with allergies who sneeze or cough routinely should note that if something feels different they should get tested.
Q) What is recovery time by age group?
Dr. Waflart explains this depends on so many factors, such as how sick the patient was to begin with, noting older patients often take longer to recover.
Here’s the rub. Some seemingly get over it immediately or the symptoms abate within 9-10 days, then realize several weeks later they are not back to normal. For some it may take several months. “There is no one size fits all.”
Q) What percent have been hospitalized by age group?
Dr. Waflart does not have those statistics but knows older people are more likely to end up in the hospital. Dr. Bunce said patients who are obese, have chronic kidney disease and/or diabetes are the most likely to be hospitalized, i.e., be affected more severely. He said much research is ongoing to try and determine the “whys”.
Q) What is the death rate by age group?
A) For Dubois County:
Age 50-59 — 6
Age 60-69 — 8
Age 70-79 — 23
Age 80+ — 33
Q) Of those who died, were there other conditions present that could have caused death?
A) Definitely a lot had cormorbidies or underlying conditions, so this is a factor in addition to age.
This is, however, a complex question that cannot be answered without extensive research.
NOTE: Individuals age 70 and older account for about 11% of the state’s population but represent 42% of COVID-19 hospitalizations and 78% of deaths in the state, according to the Indiana Department of Health, just to give some perspective.
Q) What was length of stay for patients: Shortest, longest, average by age group?
A) According to Dr. Bunce that question cannot be quantified, there are too many variables. Melanie Powell, Memorial’s Director of Business Development and Marketing said the length of stay for COVID-19 patients has been 1-27 days with the average being 4.56 days.
Q) If a patient died, was it at home or in the hospital?
A) Most deaths occur in hospitals and nursing homes.
Q) If a patient died, how long were they sick until passing?
A) Again not an easy answer but most people die within two to three weeks, although some make it for a couple of months.
Q) Who are the local doctors who specialize in COVID-19 care?
Dr. Christopher Bunce, is Memorial Hospital and Health Care Center’s infectious disease specialist but all local doctors and nurse practitioners are treating COVID-19 patients.
Q) Is Remdesivir used here?
A) Yes, Memorial Hospital and Health Care Center uses it. According to Dr. Bunce, one of the most exciting additions to the arsenal are antibody treatments. He said when the patient is really sick steroids are preferred.
“The vaccine is still the best answer,” he asserted.
Q) How many people need oxygen?
A) This question could not be answered, although Dr. Bunce noted it is a criteria for hospital admission. A low oxygen level is the most serious indicator when a decision is made to admit, as lungs are responsible for oxygenating blood and low oxygen levels can have all sorts of adverse implications.
Dr. Waflart concluded, “I wish we could get the people in this county to take this seriously. We’re trying to keep our county open, not trying to shut anybody down, but a lot of people and businesses are too flippant and too unconcerned. Other counties are doing better than we are.”
The letter writer issued concern that many people are too scared to leave their homes. “We need to encourage people to get outside in sunshine and fresh air to strengthen their immunity.”
Medical professionals agree. Go hiking, get fresh air, but above all always wear a mask when in a business or among others not in your home. Wash your hands as frequently as possible and maintain at least a six foot distance even when masked.
Dr. Bunce says, “Above all, sign up for the vaccine. if you are 70 and over do so today either by calling 2-1-1 or visiting https://ourshot.in.gov. The 60+ age group will be next.