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Dr. Mendoza: Schools are precursor for what to expect this fall, ‘gold standard’ for success indoors

Coronavirus

ROCHESTER, N.Y. (WROC) — Monroe County Public Health Commissioner Dr. Michael Mendoza sat down with News 8 Monday for a wide-ranging conversation on the state of the pandemic locally.

Topics discussed includes rising cases, increased contact tracing efforts, social gatherings, movie theaters, schools, college campuses, flu season, vaccine development and more. Here’s a full transcript of our one-on-one with the public health commissioner:

Are case numbers increasing?

Kayla Green: Are you concerned about a recent uptick on COVID-19 cases locally?

Dr. Mendoza: It certainly concerns us to see these increases in the numbers, but what would really concern us is if we didn’t really have a good explanation for it. As I see it now the community has been reopening even more; we’ve had schools now reopening and with that the interactions that go along with schools and sports and so forth.

So I think what we’re seeing is not unexpected but certainly concerning. We want to follow it, we want to make sure to emphasize all the precautions we’ve been talking about all along and now is a really important time because as we look ahead to the colder months and as people start to go indoors for all of these activities, it’ll be a different game.

Kayla Green: Can you clarify how much of an uptick we’ve actually seen recently in Monroe County?

Dr. Mendoza: When you look at the day-to-day trends it really hasn’t been much of an uptick. You know, some days will be at 20 and some days will be at eight, but when you look at it on balance, at most maybe a slight increase.

We’ve certainly had a lot more activity because we’ve been doing a lot more tracing, a lot more quarantine, identifying these cases in the schools, really out of an abundance of caution — so there’s been a lot more activity here in the Health Department, even though the numbers publicly don’t really show much.

As expected with schools?

Kayla Green: With schools reopening, and some new cases being reported, how do you think it’s going?

Dr. Mendoza: It’s not surprising because a lot of our community works in some fashion with a school. Certainly all of our kids go to school in some fashion, and so to sort of see its impact on the schools is not surprising.

But thus far, knock on wood, we really only have one transmission that we believe happened within a school. The rest of the activity that we’ve seen has largely been a reflection of what happens outside of school; the activities, and the gatherings, and all the things that people are talking about. So far so good, but trust me, every time I see a student that is positive we make sure we really dig deep and make sure we can find an explanation for it.

Kayla Green: Do you think keeping case numbers low in schools is sustainable?

Dr. Mendoza: That’s certainly our goal. That is our goal, and to be honest with you, the schools have gone above and beyond to keep the children, and staff, and teachers safe. I think they are in many ways a gold standard for how it could be done indoors.

Our kids who have been going to school have been indoors for hours at a time and that we haven’t seen any obvious surges from schools — I think we would’ve seen that by now if our schools weren’t doing the right thing. So I think what we’re seeing is a reflection of the schools, and the superintendents, and the teachers long, long days and weeks of hard work over the summertime really paying off.

Ages of new cases

Kayla Green: This past weekend, there were five new COVID-19 cases each day for people under the age of 19 — do you attribute that to schools reopening?

Dr. Mendoza: I have to look at those ages because when I look at it by actual age, a number of them are 18 and 19 year olds — so those aren’t going to be K-12 students. So one point to remember about the numbers that we release is that those are numbers as we learn about them, not as of that day or the day before. So today is Monday, we’ll learn about results that came in yesterday, but may have been collected in a range of dates say from Wednesday to Saturday.

So what you’re seeing on any given day isn’t actually a picture of what happened on any given day, but that aside, what we saw over the weekend there are more cases that are in younger kids, and those are the cases that we’ve been talking about in Penfield and West Irondequoit. Those kids are in those numbers, but like I said, not very many — as far as we could tell — transmissions within schools. These are transmissions that are happening in school age children outside of the four walls of their schools.

Colleges vs. K-12

Kayla Green: What about colleges? Seems like they still have low case numbers, have you heard anything else about large parties or anything concerning?

Dr. Mendoza: Trust me, I’m sure there are some gatherings happening and I think we can all assume that, but I think we can also assume our college campus community and the students are taking precautions.

Like I said we are far enough into the school year that if we were going to see something take hold we should’ve seen something by now. So I do think the college campuses, have again, stepped up to the plate, and have taken the precautions, and have done a lot of planning. So I think this is a reflection of their efforts

Pool testing and saliva swabs

Kayla Green: SUNY Brockport is doing pool testing with mouth swab tests, what are your thoughts on the reliability of that test?

Dr. Mendoza: I think the science is still early on that. It certainly is promising, I don’t see any risk involved with it because the way they’ve set it up, and I think other campuses have set it up, is it’s really an initial pass. It’s a way of over-testing, but they’re not cutting corners so if they find anything concerning they’ll go back to using the traditional test that we are comfortable with, we’re used to.

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The whole state is involved in essentially a large trial and error to see if this works, but in the meantime while we’re determining whether it works or not, we’re not cutting any corners, so for now I think it’s something to follow, but it certainly isn’t there to be widespread.

Going indoors

Kayla Green: As it gets colder and people are forced to be inside more, and can’t do things like outdoor dining anymore, are you worried about increased transmission?

Dr. Mendoza: As I step back and look at this, I am reminded that none of us has gone through this before. As much as we can, we borrow knowledge from what we know about other respiratory viruses. So far we’ve been able to borrow quite a bit from influenza, from the common cold, from others, but none of these things are COVID-19. So we are going to learn for the first time a lot of things about COVID-19 that we didn’t have the opportunity to learn about in March and April because it was already kind of the end of winter.

But we do know that indoor transmission is much more likely than outdoor and as the air temperature drops and as the humidity drops the assumption will be that it is easier to transmit in dryer air as compared to humid air. So those are all things we’re going to be watching for. We also know the value of masks, and we also know that masks can be incredibly protective, especially indoors and that was something we didn’t appreciate fully back in March.

So I think we’re going to be entering a period where it’ll be game time again: We will be asking of the community again to take these precautions in the interest of themselves and taking care of their friends, and family, and loved ones, but we’re watching as the months get colder — we’re definitely going to be watching.

Restaurants

Kayla Green: Was it required of restaurants to have a specific air filtration system, like it was required of gyms?

Dr. Mendoza: That was not required of restaurants.

Kayla Green: Does that concern you?

Dr. Mendoza: The jury is still out as to how much of a role filtration plays and certainly how much of a role airborne transmission plays. Our belief is that the transmission is primarily airborne from person-to-person, but once it gets sort of circulated around a larger system, the thought is that it doesn’t have as much potency, if you will.

I think the gym idea was out of an abundance of caution given the potential to have a large number of people in an enclosed space, even as large as a gym, for hours or an hour and a half. So I do think the primary risk is still that person-to-person transmission of respiratory droplets within six feet primarily, that we can reduce by wearing our masks, by reducing that time, and by maximizing that distance

Movie theaters

Kayla Green: There’s only a few areas that haven’t reopened yet; movie theaters, regular theatres, live music venues. Some people think it’s strange movie theaters haven’t reopened, what are your thoughts on that?

Dr. Mendoza: If we were to open movie theaters I think the given would be that we would all have to wear masks. Movie theaters are safer in the sense that there isn’t generally a lot of talking in a movie theater — not like a bar or a restaurant where there’s not only talking, but sometimes loud talking. I think the risks can be mitigated in a movie theater.

That being said, it’s a large venue and people are in the dark and you can’t necessarily see what’s going on — you don’t have that awareness and you are fixated on a screen. So there are features to movie theaters that do make them more risky. The challenge with the movie theater is that it’s a large group of people and if there were to be an infected person there that didn’t wear their mask that’s going to be a petri dish for infection for other people. So it really comes down to risk and benefit. I like movies like the next person, but if you have to compare movies to other venues,it’s a balance.

Kayla Green: Is that also what the governor is thinking with not reopening movie theaters? I talked to some theaters last week who say they aren’t sure why they’re not allowed to reopen.

Dr. Mendoza: I can’t comment on the governors rationale, but I do think it does parallel what we’ve seen in the science. That was what I put up there in March and as you can see theater, concerts, sports venues; that was the bottom right hand corner. Those were the most risky activities and so we laid this out based on the science and the governor more or less followed my plan.

It’s not secret, it’s the way the science has unfolded and so the governor has generally followed that. You can’t open everything at once and there has to be a pace, a cadence to opening things and so I think that’s what you’re seeing.

Flu season

Kayla Green: With flu season here, how can people tell if symptoms they have are the flu or COVID-19?

Dr. Mendoza: It’s difficult. A lot of the symptoms of COVID can be confused with the symptoms of influenza. So in general check with your healthcare provider. We don’t want people at home trying to make these clinical decisions on their own. I think it’s valuable to have a professional available to evaluate what’s going on.

The consequences could be serious. If someone is assuming one and it’s the other and proceeds accordingly in the wrong way, then that could be a very serious illness for that person or their family. So we want people to check with their healthcare provider. The symptom that seems to be unique to COVID that we haven’t really seen in the others is this loss of taste or smell, but it turns out that’s not an easy symptom for a lot of people to observe. Once you have it it’s somewhat obvious, but a lot of people wondered “Is that what I have?” So we want you to check with your healthcare provider.

Kayla Green: Can you get both at the same time?

Dr. Mendoza: Absolutely. There’s no reason to think that you couldn’t get both at the same time. Theyre independent of one another. In fact we see this in the hospital unfortunately, where somebody’s immune system is already taken a hit from one and then they’re susceptible to another. Or not even in the hospital, in my office I see people, typically older in age, or with other medical concerns, when you’re down a little bit you’re susceptible to other things.

Kayla Green: From what you’ve seen and heard, do you think people are taking flu shots more seriously this year?

Dr. Mendoza: I’ll tell you, I think so. I think people are taking it more seriously. I think people understand that they don’t want to themselves get sick, and more so perhaps than any other usual year, and I think that recognition that we don’t want to tax our healthcare system too much is also on people’s minds as well, because the curve that we worked so hard to flatten in April and May, really referred to the curve of demand for healthcare services. If we can blunt that demand, and keep our hospitals available to take care of people that need to be in the hospital in the end our community wins.

COVID-19 vaccine update

Kayla Green: Any updates on a vaccine?

Dr. Mendoza: There are trials ongoing, even here at the University of Rochester. The medical center is participating in I think at least two or three trials, but I think the data is not yet out, they are still enrolling individuals to participate in those studies. I want to emphasize it’s important to enroll people of a diverse background because that’s how we learn about science as it applies to a diverse background, but no we are not seeing anything yet in the way of a vaccine coming out before the end of the calendar year for sure.

I would say even into the spring it would be very unlikely to have a widespread availability of any vaccine so I think for the near term, the foreseeable future, it’s really about taking these mitigation precautions; the masks, the distance, washing our hands, all the things we’ve been talking about — that will be the way we stay the course at least for the several months to come.

False positives

Kayla Green: Something some people are still confused about are false positives. What can you tell us about false positives, are they common?

Dr. Mendoza: For those of us in medicine this isn’t a new concept because every test has a false positive and a false negative rate. And that has somewhat to do with the test itself it also has something to do with the circumstances in which you get the test. So before you get a test you have a clinical suspicion in your mind that says ‘I think it’s gonna be this or I think it’s not going to be that.’ We do tests in medicine to confirm our diagnostic impression, and we’re doing the same thing from a public health standpoint.

We’re utilizing these tests to confirm or to refute our public health impression. So it’s not new to us to have false positives and false negatives. So when it comes to COVID, the false positive, for example, would be if we used the PCR test and somebody who has already had the infection, they’ve been under isolation, it’s been more than 10 days they’ve cleared their infection, but they can remain quote “positive for months.”

That test can be positive for months. Is that a false positive? In general we think it is because they’re not infectious and they’re generally not sick, but is the test result positive, yes. So is that a true positive or a false positive? It depends on your reason for ordering the test and so it is a little bit muddy, it is a little bit confusing, and I think the best thing to do when it comes to interpreting these tests is to check again with your healthcare provider or check with us here in the health department.

So when we order tests we will coach people in how to interpret that result or that individual for that family or for that situation, but just because you see a positive doesn’t mean you’re sick and just because you see a negative doesn’t mean you’re not. So when it comes to a public health crisis like this, frankly I’m more concerned about false negatives because a false negative might give somebody a false sense of reassurance that they’re not sick when in truth they may be becoming sick, depending on when the test is repeated. It’s a complicated picture so we can provide information on that, but at the end of the day we want people to check with a healthcare provider.

Kayla Green: So if someone is a false negative, is that because they’re still in their incubation period when they get the test?

Dr. Mendoza: It can be because you collect the specimen too early in the illness when the viral load isn’t high enough to hit the threshold that the test is designed to detect. So that would be an example of a false negative, yes.

Kayla Green: But if someone tests positive, they’ve definitely had COVID at some point in time?

Dr. Mendoza: So if you’ve had it, the question is when and if you have it in the context of symptoms, that generally means you have had it more recently. But if you get a positive and you’re asymptomatic, though it’s a little unclear because we know that 40% of people are asymptomatic in their active period. And so that’s where you have to go back and do the detective work to see when they might have gotten it and if you’ve got a good story because they were exposed to somebody who has actively symptomatic then you would be more inclined to conclude that was an active true positive as opposed to a false positive.

Testing

Kayla Green: How often should people get tested?

Dr. Mendoza: It really depends on everybody’s individual circumstances for the purposes of surveilling somebody who’s, for us as a community, trying to understand what is the true prevalence of COVID in our population. You know, weekly it’s probably plenty. For an individual person we know that people who work in nursing homes are getting tested weekly and they were getting tested twice weekly because the stakes are higher.

So part of it depends on the risks of not getting tested. For nursing home employees the risks of not getting tested are potentially that they have an asymptomatic infection that they’re not aware of and if there’s a slip in the protocol or just by nature they may introduce that infection into a nursing home that’s got great consequences. So it really depends on the circumstances and it depends on the test too. In general I don’t advise more than weekly for the average person but like I said it really depends on the individual circumstances.

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