Ep. 51 - LiveWell Talk On...Social Distancing (Dr. Nate Brady)

St. Luke's Emergency Department

First Available Time :

UnityPoint Clinic - Express (Peck's Landing)

1940 Blairs Ferry Road
Suite 104
Hiawatha, Iowa 52233

Closed Patients
Waiting Now

Urgent Care - Anamosa

1795 Hwy 64 East
Anamosa, Iowa 52205

Closed Patients
Waiting Now

Urgent Care - Hiawatha

1001 N. Center Point Road
Suite A
Hiawatha, Iowa 52233

Closed Patients
Waiting Now

Urgent Care - Marion

2992 7th Ave.
Marion, Iowa 52302

Closed Patients
Waiting Now

Urgent Care - Westside

2375 Edgewood Rd SW
Cedar Rapids, Iowa 52404

Closed Patients
Waiting Now


Ep. 51 - LiveWell Talk On...Social Distancing (Dr. Nate Brady)

episode 51

Ep. 51 - LiveWell Talk On...Social Distancing

   Subscribe so you never miss an episode!

   Apple Podcasts | Google Podcasts | Spotify | Pandora | iHeart Radio |   
   Google Play Music | Stitcher TuneIn SoundCloud 


Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Nate Bradyphysician, St. Luke's WorkWell 

Dr. Dustin Arnold:

This is LiveWell Talk on social distancing. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health - St. Luke's Hospital. COVID-19 is spreading throughout the community from human to human through coughing, breathing, perhaps even talking, because of this social distancing is recommended at all times. Here to give some more insight into exactly what that means, as well as, recommendations on the best practices, Dr. Nate Brady, Physician at UnityPoint Health St. Luke's Work Well Clinic. Welcome.

Dr. Nate Brady:

Hello. Thanks for having me, Dustin. I've been here for a couple of years and this is the first time you've invited me on the podcast. So...

Dr. Dustin Arnold:

Well, we were desperate.

Dr. Nate Brady:

[Laughing]

Dr. Dustin Arnold:

No. Nate, I'd like to talk today about social distancing. What does that mean? Why the mask? Why not the mask? How does this spread? Maybe dispel some myths and then talk about some of the work that you're doing to make this easier to do. Let's talk about, how does the virus spread?

Dr. Nate Brady:

Yeah, so one of the things that we've grown to understand, there was a lot of talk in early days and I don't know why we didn't just remember that we already know how infections spread, but for some reason this one has thrown us for such a loop we feel like we have to start over with Coronavirus. But, there is no doubt that this spreads through not just droplets with a cough or a sneeze, but just through being close to people. So there certainly are droplets and it would be worse to have somebody cough in your face but we know from many, many, investigations of outbreaks that people who are just having lunch together, people who have a party together, people are in a conference room, if there's, eight or nine people, there are several stories where we've realized that just talking to people is a good enough mechanism for giving someone the Coronavirus. So, following that, it becomes more important for us to be doing a universally masking strategy. In particular, one of the aspects of the virus that makes it tricky and why a universal approach rather than "here's what you should do when you're around sick people approach." Why that becomes so important, is that people are able to spread the virus before they even know that they're ill. So, this is a very tricky one to try to get good prevention measures because you have people walking around who are not even coughing yet who are able to spread the virus. So for that reason, using universal masking is a really smart approach.

Dr. Dustin Arnold:

Yeah as we've said before, China probably was not as transparent as they could have been.

Dr. Nate Brady:

[Agreement]

Dr. Dustin Arnold:

Italy was a perfect storm. And so we have been reactionary in working on false premises, on a lot of the treatment.

Dr. Nate Brady:

You bet.

Dr. Dustin Arnold:

Et cetera. So it is good to come back and take a look at this and when this is all over we'll realize how much we've learned.

Dr. Nate Brady:

You bet.

Dr. Dustin Arnold:

And how wrong we were in some things and how right we were on others.

Dr. Nate Brady:

Yeah.

Dr. Dustin Arnold:

So, talk to me about this though. Okay, I'm going to play the devil's advocate here. Herd immunity. You can't get herd immunity unless you have a vaccine of course but in this situation until it spreads around. So, why shouldn't I just get out there and spread it around?

Dr. Nate Brady:

Sure. That would be a decent idea if this wasn't a very deadly virus. So I would argue against that concept even if we didn't have a flu shot. I don't think it would be a good idea for us to be spreading flu on purpose for that reason. But the herd immunity concept, it doesn't apply very well to Coronavirus because the number of deaths that we'd have along the way. You could certainly use that method, but you'd have to find a way to get a good 50 to 60% of people to live through the virus and walk around immune. So, it would be too much death, that's one thing. Our hospitals couldn't take the load as you know, we've spent a lot of time worrying about getting ready for surges. Then the other thing that's peculiar about Coronaviruses, as you remember, the Coronavirus that we have now is very closely related to the regular Coronaviruses that caused the common cold. It's just a fact of medicine we've never had a medication that helps for the common cold and we've never had a vaccine for the common cold because they are so able to mutate.

Dr. Dustin Arnold:

Exactly.

Dr. Nate Brady:

And in addition to the mutation, this one is likely to trick us in a new way, even if we get a bit of immunity going, but also, it's not the case with those kinds of viruses for some reason that when you're immune, you're immune. So you can get the same Coronavirus, you know? There's four other, at least, I don't know, at least four other named Coronaviruses that people get year after year.

Dr. Dustin Arnold:

There's a total of seven.

Dr. Nate Brady:

Seven? Oh.

Dr. Dustin Arnold:

Four of the common cold.

Dr. Nate Brady:

[Agreement]

Dr. Dustin Arnold:

That only causes about 15% of the common cold, 85% of Rhinovirus.

Dr. Nate Brady:

Sure.

Dr. Dustin Arnold:

And then the three: SARS, SARS-2 and Mers.

Dr. Nate Brady:

Sure.

Dr. Dustin Arnold:

To make a total of seven. You're right.

Dr. Nate Brady:

Thanks. So, getting back to the herd immunity concept...

Dr. Dustin Arnold:

Right.

Dr. Nate Brady:

It's never worked for the cold. So I think for this virus is the absolute wrong approach. That works best, I don't know if you're old enough to be in the era when if people had Chickenpox, you didn't separate them. You know, one kid in the family got Chickenpox, you just let everybody get it because what are you going to do with six kids? Right? You're not going to--

Dr. Dustin Arnold:

Right, right.

Dr. Nate Brady:

Keep them in quarantine for... And we now know how hard it is to quarantine people, but that was a limited illness that lasted a couple of weeks and most people got it. And you just got through it. So, then you'd have lifetime immunity in almost all cases. This is basically the exact opposite of that.

Dr. Dustin Arnold:

Okay. Well, what is what exactly social distancing? Just explain it.

Dr. Nate Brady:

Sure.

Dr. Dustin Arnold:

Just what is it? It doesn't sound good though if you think about it.

Dr. Nate Brady:

Yeah.

Dr. Dustin Arnold:

I'm going to socially distance. That just kind of has a negative tone to it if you will.

Dr. Nate Brady:

Yeah, I'd rather be close to people rather than a distant person.

Dr. Dustin Arnold:

Right, right right.

Dr. Nate Brady:

It's been hard for extroverts like me to learn to be...

Dr. Dustin Arnold:

We're socially isolated.

Dr. Nate Brady:

Yeah. I think more in terms of... I visualize kind of the virus's path from one person's lung to another. That's how I think about this distance concept. Certainly that you can do stuff telephonically and you can do zoom meetings and stuff like that. But within our lives and within our work lives, what are we actually trying to accomplish with this distance thing? And I try to think of what a virus has to do to get from one lung to another. And granted it can survive for a bit of time outside, but it's probably 90 something percent of the time this virus is affecting people who are close in either breathing or coughing near each other rather than being passed through objects. So, It needs to go from one wet warm lung to another warm wet lung. So what are the things that would be ideal for that virus? Well, it would love for you to invite five, six friends over and have an intimate gathering in a small room? That would be ideal. Everybody chatting and laughing and talking. That would be a great way to spread. And like I was saying, we know many instances of that kind of effective spread. So, I picture a person's exhale like, like the old humidifiers they used to have where you could actually see right near the humidifier the little vapors coming up.

Dr. Dustin Arnold:

Right, absolutely.

Dr. Nate Brady:

As you get two, three feet away, there's no more vapor, right? As you get across the room, you'd want to put that vaporizer near you if you wanted it to humidify your air.

Dr. Dustin Arnold:

Correct.

Dr. Nate Brady:

You wouldn't put it in the corner. So, we just need to flip that. We need to picture our mouths as the vaporizer or the thing that's generating sort of a mist and realize that there's a good chance if you haven't had the virus, there's a decent chance, one to two percent probably in the community, that you're walking around breathing something out that is severely dangerous. So I picture that puff dispersing little by little and as it gets farther and farther away from people, it's less and less dangerous. So the six foot rule it doesn't really come from any hard science that people... locking people in rooms and trying different breathing scenarios, but it comes from sort of the industrial hygiene world where they know how gases of a certain particle size will disperse in a room. So six feet plus, if that virus wanted to leap from me to you, it would have a lot of trouble. That's the concept. When you add the... We can talk about the different ways of doing the masking... When you add one more barrier, in particular, if you wanted to clamp that vaporizer, if you want to clamp somebody's mouth, you would want to put the the object that was going to block it right on the thing that's emitting the vapor in the first place, which is why wearing masks on ourselves, is very protective of others if we happen to be sick. The most important step is to do that just in a public minded way. I'm going to wear a mask so I don't infect you today. So, if it crosses the six feet or whatever it is, there's going to be some amount of virus particles in that person's exhaled air. It's going to be a much lower. So it's secondarily, you would want the receiver to also be wearing a mask. But obviously best would be, if I mask, you mask. That virus now has to somehow leave me in enough density to be infected, to be a particle size that'll float. It's got to get through my mask. It's got to float across the space. It's got to get on the outside of yours. You got to inhale it. That's a lot of --

Dr. Dustin Arnold:

Yeah, yeah, yeah.

Dr. Nate Brady:

-- steps. So it starts getting, if you just think that through. Two people in masks, it starts getting impossible to spread the virus almost. The little bit of talk about the types of the masks real quick. Keeping N95's aside, because that's just not a necessary thing for most interactions. We don't need to be filtering all of the air to 95%, to keep this virus away because we're going to have a few feet between us. Unless you're doing procedures where somebody is coughing and hacking. If you just compare surgical masks and the cloth masks, the good news that's been coming out, seems to be, the cloth masks are pretty effective. The homemade mask are pretty effective. When we were talking about this in March, we didn't really have a lot of data. I even sent you that one article saying --

Dr. Dustin Arnold:

Right, right.

Dr. Nate Brady:

Hey, look, some people even had more infections with cloth masks and that's where I was coming from. In the meantime, all of a sudden we have a lot of mask research coming out and what they've discovered in their doing, the way you would as an industrial hygienist, they're passing air and they're putting particles through these masks, how good a job did they do? Well, they think that most of the homemade masks are maybe 30 to 60% filtering of the type of particles that you'd worry about for these small droplets. If you get 30 this... surgical masks are about 70% most of the time. N95s are close to 99 for the particle size we're interested in. So, if I got 30 to 60%, you're wearing a cloth mask because they're reusable, and we can wash them, and they're not taking them away from people who need to do patient care. Well, we've got 50% better. Multiply that by another 50% you add six feet. Again, you're getting to the level of... It's just a very, very, very small risk. It starts to almost be impossible if you start thinking of it from the kind of the viruses perspective of trying to get from me to you.

Dr. Dustin Arnold:

But you have to wear the mask appropriately too, you know?

Dr. Nate Brady:

We see a lot of that.

New Speaker:

[Inaudible]

Dr. Nate Brady:

You bet.

Dr. Dustin Arnold:

Not wearing it appropriately.

Dr. Nate Brady:

It's got to go over the nose. It's got to not be a kid's size when you're a full grown man.

Dr. Dustin Arnold:

Right.

Dr. Nate Brady:

You got to try a few of them on. I mean, people's faces are different sizes and shapes. I've had several that get donated to the hospital that I've had and I look through them and I've realized there's a certain type that works for me, but I also go home and I adjust them. I put a little stitch here, I put a little stitch here. I put my pipe cleaner through the nose so it'll clamp down. Those kinds of things. I think if you get a little bit creative, you can have, like I say, the benefit of that is you take it home and you wash it and it's fresh again tomorrow and we're not using the resources.

Dr. Dustin Arnold:

It's so hard right now with everything's observational.

Dr. Nate Brady:

Absolutely.

Dr. Dustin Arnold:

Because we don't have enough data to look at it.

Dr. Nate Brady:

Well, good point. I'm talking about studies. These aren't exactly studies, these are observation reports.

Dr. Dustin Arnold:

Observation reports.

Dr. Nate Brady:

Yeah. Everything's being published without peer review.

Dr. Dustin Arnold:

Right, right.

New Speaker:

[Inaudible]

Dr. Nate Brady:

But it is hopeful. The literature is hopeful on the masking situation.

Dr. Dustin Arnold:

And I kind of have a pet peeve where they compare it to influenza --

Dr. Nate Brady:

[Agreement]

Dr. Dustin Arnold:

-- and this is not influenza. It's different organisms, different receptors, different spike proteins.

Dr. Nate Brady:

Good point.

Dr. Dustin Arnold:

That it's just not a fair comparison to say, well, influenza kills as many people or...

Dr. Nate Brady:

You bet.

Dr. Dustin Arnold:

We don't see 52 year olds with simply hypertension and obesity, moderate obesity at best, with ARDS in ICU every January. We don't.

Dr. Nate Brady:

[Laughing] Right.

Dr. Dustin Arnold:

So to compare this to influenza is just incorrect.

Dr. Nate Brady:

Absolutely.

Dr. Dustin Arnold:

Because these are the patients we're seeing in ICU. It's a different sort...It's a different virus. So you get a little frustrated with that or I do there. I'll get off my soap box.

Dr. Nate Brady:

Yeah. It just needs [inaudible].

Dr. Dustin Arnold:

But this is my podcast so I can get on my soapbox when I want to so...

Dr. Nate Brady:

You can do whatever you want. You can keep going. You want me to --

New Speaker:

[Inaudible].

New Speaker:

[Laughing]

Dr. Dustin Arnold:

Well, alright. I can't. Although I've been sheltering in place for about 15 years with the exception of work and school and that's my daughter's basketball games, et cetera, mass. But, we can't all social distance... we can't live in a cave.

Dr. Nate Brady:

Yeah.

Dr. Dustin Arnold:

So, if I have a job or circumstances where I'm going to be around other people. Give me some recommendations.

Dr. Nate Brady:

You bet. Everyone needs to be thinking about, as they return to work, maybe they've been in work, but if they're trying to improve what they got going at work. The social distancing is probably number one. It's probably more important, in the world of OSHA, the PPE is supposed to be the last consideration. First, you're supposed to engineer the toxin out of the plant in the first place. Then you're supposed to find ways to distance things so people are not exposed as much. If you have to bring in a really toxic chemical to your plant, because of what you make, you try to have people never be anywhere near it. The last thing you do, and this is because all else has failed from the engineering standpoint, is put somebody in a mask and wear gloves and that kind of thing. It's actually shield. A person is considered a pretty low bar in the world of OSHA. So, just with that perspective in mind, same thing if you work in an office. Let's say you have a a law office that's really busy and you're supposed to have 24 people there on the daily basis. You need to figure out: A.) What are we going to do about our meetings? That should probably move to telephonic for the foreseeable future, maybe a year or two. B.) What do we do about people who have shared offices? Is there a way we can get... If you're gonna sit there all day for eight hours, can you actually separate people? Should some of these people be working from home? Is there a way to stagger the times? Maybe, there's only two or three times a week where I need to be there in person because I actually got to drop off those documents or I got to print that stuff, right? I do have to sit one on one with the guy that does whatever function. I think pretty much every workplace is struggling with this already but the first thing I would do before relying on masks at my work, would be to figure out how do I make it so I wouldn't even need a mask. How could I have so few human interactions that I actually felt safe walking around? So that would be about the schedule. That would be about the way you space people. That would be about finding ways to not do things in person that we're currently doing in person. I would do all of those first before the masking.

Dr. Dustin Arnold:

Okay. What's my risk of going to Casey's or the grocery store?

Dr. Nate Brady:

I personally wouldn't go into Casey's or the grocery store without a mask and I would apply that same rationale though. I also wouldn't go unless I really needed to go. I was telling Chris that I had a Coca-Cola emergency yesterday, so it was my first time in the grocery store in several weeks. I was pleased that I saw in my little Hy-Vee drug probably 80%, 90% of people were wearing masks. They've done a lot for us that they've separated some things, but I do think there's risk there. Somebody has a case of coronavirus and they don't know where it came from and they say they've been mostly... They haven't been at work, they've been at home. The first thing that will come to mind is Casey's, the grocery store. Where are you seeing people? One of the things I think people can do if they want to be as sort of vigilant as somebody like me is about it. Because if you're doing pickup at a restaurant for instance, certain restaurants are doing a lot. You get there and all the cooks are wearing masks, the guys wearing gloves. The place where I am still getting Mexican, they have the dirty pens in the [inaudible] every time somebody uses a pen they put it over here and then they clean them and you don't use... They're making sure that people aren't touching things even. And they're all wearing masks and there are not that many people there. So I feel really reassured if they're doing that upfront they're probably doing a good job not coughing on my food before they give it to me. I think everybody's got a different view of what they're willing to tolerate. I've got kids of varying ages and one is almost sheltering in place, but my 20 year old son is real active and he's kind of in the mindset of, well it's not killing a lot of 20 year olds. So what we've said is well, he's got a mask when he comes over to our house. The rest of the family members were not masking. But just trying to be reasonable. Moving a lot of stuff outdoors, that's been one of our biggest... We've had a few birthday parties this spring and we've just stood outside [laughing] had cake outside because we want to see the people that we're close to, but we don't want to be inside with them.

Dr. Dustin Arnold:

It was my 16 year old, my 15 year old turned 16 yesterday.

Dr. Nate Brady:

[Agreement].

Dr. Dustin Arnold:

And we did the drive-by birthday party, which is outstanding because it's like 15 minutes long.

Dr. Nate Brady:

[Laughing].

New Speaker:

There's virtually no cleanup.

Dr. Nate Brady:

You didn't have to buy anything. Yeah.

Dr. Dustin Arnold:

Yeah. You know, surprised her. She didn't know it was going to happen. So that's a credit to her sister for keeping that on the down-low. But that might be something I could go with. [Inaudible] Virtual weddings. We just drive by the church and honk.

Dr. Nate Brady:

We could speed a lot of stuff up.

Dr. Dustin Arnold:

Yeah we could really become efficient. While I have you here, I want to talk about two things for sure. I want to talk about the work that you're doing.

Dr. Nate Brady:

Sure.

Dr. Dustin Arnold:

And the best practices you're recommending. But I want... before I forget your background on occupational industrial medicine. Why the packing plants? Why is it such a... Is it the close quarters that they work? I've worked in factories in college I guess, going into college --

Dr. Nate Brady:

[Agreement].

Dr. Dustin Arnold:

And we were spread out. It wasn't a packing plant, it was industrial factory. So tell me why is that such a problem?

Dr. Nate Brady:

I've got some theories and these are totally unfounded, but I'll tell you what I know. And you know, as an occupational medicine doctor, I do get to tour a lot of factories. That's one of the fun... we've got field trips, basically. I've been at most of the big buildings that you see around here. I've been in them. I have never done a packing plant one though. Most people say they take a good little break from eating chicken or pork or whatever after that after they go, because it's hard to take. It's hard to see people slaughtering things, right? But my understanding is that people do work very close, from the interviews of the workers. I hear a lot of this shoulder to shoulder, we do a lot... it's loud and there's airflow and everybody's wearing a bunch of equipment and that kind of thing, so it's hard to hear each other. So they do a lot of shouting to each other if they want to give each other directions. It's probably a lot of face to face time. If you just think about... And my understanding is that Waterloo opened up again yesterday and they've done a great job. I was listening to the sheriff this morning on the radio saying that he feels pretty good about where they're going. So that aside I think it's a lot of people very, very close. I think it's cold and that might matter. It might be humid and that might matter. Those kinds of things. That might be a good way [inaudible] a virus to each other. But the other factor is, and I see this everywhere, is people will practice good hygiene when they're doing their job and then forget all about it when they're on break. So all those workers, they got a lunch break, right? They're all probably changing clothes together in the locker room because they have a whole set of gear.

Dr. Dustin Arnold:

Right?

Dr. Nate Brady:

People are driving to work together. People are probably showing up in vans. They're probably showing up in groups of tens, sometimes. So my suspicion is that probably not all of the risk is coming from the packing house. It's coming from the breaks of doing the work, actually, when people are socializing.

Dr. Dustin Arnold:

Speaking of that break, you have to take them, right?

Dr. Nate Brady:

Yeah.

Dr. Dustin Arnold:

You have to have lunch. Tell me social distancing when I'm eating.

Dr. Nate Brady:

So here's where people start objecting to my best practice advice. I really don't think people should be eating together right now. I think it's a small sacrifice to make for you to sit over there. If we go down to the cafeteria, I would choose the table that's farthest from you. I just would. Again, it's just that that distance factor. People want to take off their mask and have a normal interaction. I just don't think it's time for it yet. I don't think we're close to... we're all sort of getting used to the fact that this thing is here, but the raw numbers just don't support us taking off our masks and having lunch together yet. I would say that people need to time their breaks. We've done this in my office because we've got a lot of people... we're focusing on this all day long. One of the main things is staggering the break times so we only have two people down in our area where there normally would be six or eight people enjoying each other's company. But as you're pointing out, it's a little bit lonely. It's a little bit sad, the social distancing thing. I just think it's worth the sacrifice temporarily and hopefully this is a six month, one year problem. Not a three year problem.

Dr. Dustin Arnold:

Well, I'm not confident, and I've said this before and I don't want to be a Debbie Downer, but the chance of them having a workable vaccine is very low.

Dr. Nate Brady:

I know. [Nervous laugher].

Dr. Dustin Arnold:

We've had no successful... if I need to be corrected, let me know. No successful RNA vaccines.

Dr. Nate Brady:

Right. Although it's a pretty new approach, right? So there's room for innovation probably.

Dr. Dustin Arnold:

But they mutate so frequently and that's why it doesn't work.

Dr. Nate Brady:

Yeah. That's my understanding too. Between you and me, well not between you and me, I guess we're podcasting. My thought is it's as likely this virus mutates itself out of being so virulent as it is that we solve it. And the constant mutation --

Dr. Dustin Arnold:

Yeah in viruses, unlike the movie with Dustin Hoffman, they don't become more virulent.

Dr. Nate Brady:

Right.

Dr. Dustin Arnold:

They become less virulent. So they can continue their life cycle, if you will.

Dr. Nate Brady:

I think it's really important that we don't contradict Dustin Hoffman though.

Dr. Dustin Arnold:

Yeah.

New Speaker:

[Inaudible laughter].

Dr. Dustin Arnold:

I've been thinking about sending [inaudible] out to find a monkey and drive around like that movie just to give him something to do.

Dr. Nate Brady:

[Laughing]

Dr. Dustin Arnold:

But that's another podcast.

Dr. Nate Brady:

Yeah. So with that in mind are you projecting in the hospital and in the clinic? Are you thinking we've got a multi-year... We've got new organism we're living with?

Dr. Dustin Arnold:

I think we do. I think the virulence is dropping off compared to others. I think the United States has done a good job of mobilizing what resources they have and I feel comfortable with it if as long as we be smart. I'm an advocate for... We're starting to get things started back up with... I think that's fine.

Dr. Nate Brady:

Sure.

Dr. Dustin Arnold:

I think we're going to have outbreaks in clusters and we have enough resources and I'm just speaking with Eastern Iowa to share between the hospitals. So if Waterloo gets in trouble, we'll send help. If we get in trouble, they'll send help. Every couple times a day I'm talking to Dr. Meyers over at Mercy sharing data and practices. So I feel comfortable. I don't think we'll get overwhelmed.

Dr. Nate Brady:

[Agreement].

Dr. Dustin Arnold:

And that's the whole point. So anyway, tell me about the projects you've got going through your office.

Dr. Nate Brady:

You bet. So, at some point I got assigned to be working on this full time and I'm... talking about getting back to normal. I'm seeing patients again this week and I'm gradually increasing my clinic hours because we're not in such a panic. We do seem to have a good handle on it. But for awhile, it was full time employee health, full time, just working on Coronavirus risks. So what we had to figure out how to do with our large employed population that's at particular risk is how to test and track and make recommendations on isolation, make recommendations on return to work for everyone that has possible exposure to Coronavirus. The system is already in place because we do that sort of thing for TB. We have a way of tracking flu, RSV. So we have infection control already going on well in the hospital. What we've never had though is something this scary, this dangerous, this new, where we weren't sure how it was spreading and that seemed to be spreading to a lot of people who are otherwise healthy as you mentioned, having young healthy people come down with this illness is quite unusual. The scale and also the unknowns of this particular virus causes us to switch what we were doing of a very large scale employee health operation focus just rather than on injury, which is our usual [inaudible] to focus on infection. So we assigned originally we had up to eight nurses working on the phones and the tracking and the scheduling and getting people through the illness telephonically and then getting back to work. We're down to just a few now because St. Luke's and the system has done such a good job with all these prevention measures that our number of people who were actually getting sick is going way, way down. As you know, I report the numbers every week. We tested 60 people last week and we only had one positive so, 60 to one ratio that means whatever we're doing is working. So I'm feeling very optimistic that we are getting back to normal and I think a big part of that, even though you would think we have so much more risk because we're actually caring for everybody who's ill, is that what we're doing works. All of the separation tactics work. All of the universal masking. It's really brought our numbers way down. That's why I've gotten to be such a big advocate of the masks because I just saw a drop off to almost zero as soon as -we were able to get every single person, even the nonclinical people, wearing the cloth masks. I just think that it's making all the difference.

Dr. Dustin Arnold:

In combination with other things we're doing. I think --

Dr. Nate Brady:

You bet. It isn't just that. Good point.

Dr. Dustin Arnold:

Yeah.

Dr. Nate Brady:

That's only one piece.

Dr. Dustin Arnold:

Right. Right.

Dr. Nate Brady:

But I agree with you. I feel very hopeful about where we're going. It's still in the community. It's not going to not be in the community for a long time, but there's ways to exercise control over the virus. So.

Dr. Dustin Arnold:

Yeah, I think either you had two choices. You could either let it tear through the community and pick up the pieces afterwards. Or you could shelter people in place. They're both extremes and they both solve the problem but at significant costs, whether it's more mortality or the economic impact, which --

Dr. Nate Brady:

Sure.

Dr. Dustin Arnold:

We could have a whole other podcast and we've had some about mental illness and depression and suicide rate with unemployment.

Dr. Nate Brady:

Absolutely.

Dr. Dustin Arnold:

So that's another concern there that we just cannot ignore. But I think the compromise we're coming to, we're getting smarter. We've only been doing this for six, eight weeks, something like that, you know?

Dr. Nate Brady:

It feels like a lifetime. [Nervous laughter].

Dr. Dustin Arnold:

It does. It does. But I think we are getting smarter. We're learning and that's what's important. Well, this has been great information, Dr. Brady. Thanks for stopping by. Again, that was Nate Brady from St. Luke's Work Well Clinic. For the most up to date information on COVID-19 visit our website at UnityPoint.org or to the Centers for Disease Control and Prevention's website at CDC.gov. If you have a topic you'd like to suggest for the COVID-19 pandemic, please shoot us an email at StLukesCR@unitypoint.org. In the meantime, wash your hands, cover your cough, and confine yourself if you're ill and practice social distancing.