Wilmington Health's Dr. Paul Kamitsuka On Staying Safe During Thanksgiving, What's Driving New Cases

Nov 18, 2020

The number of Covid-19 cases in New Hanover County continue to rise. WHQR talks with Wilmington Health's Dr. Paul Kamitsuka about what you need to know before celebrating the upcoming holidays.    

Rachel Keith: Dr. Paul Kamitsuka is the Hospital Epidemiologist at New Hanover Regional Medical Center. And he's also an Infectious Disease Consultant at Wilmington Health. Dr. Kamitsuka, thanks for speaking with us.

Dr. Paul Kamitsuka: My pleasure.

RK:  I've heard NHRMC’s Dr. Philip Brown give two presentations recently, one for the New Hanover County School Board and the other for the Wilmington City Council; what he's been saying is that he's expecting our next wave to arrive in January or February. Is that your conclusion as well?

PK: I think it all depends on how people behave over the holidays. And this is critical, because the surges that have been occurring in other areas of the country, as well as when we had them, it is directly correlated with whether people are masking and socially distancing. Sounds like a broken record, but this is in fact true that if people relax the distancing guidelines, then we would expect a surge in cases.

And this is particularly important over the holidays, because the small or medium size gatherings, especially in the home, are what is currently driving the pandemic. And we tend to let our guard down when we are with friends and family. And we have to just assume that anybody who's outside of our household, our immediate household is potentially infected with the COVID virus and behave accordingly. And so the message both Dr. Brown and I've been really trying to get out there is the vital importance of masking. And particularly, even if you have a relative coming over that if they're not part of your immediate household, then particularly indoors, everybody has to be masking and distancing. And this is what we would need to do to be able to protect our local community and our hospital from being flooded with patients with COVID.

RK: Is what we’re seeing right now, is that a result of this pandemic fatigue, the fatigue of hearing case numbers? How are you trying to talk to the public about this?

PK:  I think right now, we have to get through the winter. I think recent reports about the vaccines, both the Pfizer, as well as Moderna, are promising. We're waiting to see the data with regard to both efficacy and safety. But if in fact, they proved to be both, then we would want to go ahead and encourage everybody who can to get the vaccine, and that would really start the ball in terms of eradicating this illness from our shores. But we have to get through the winter first.

So far we've had a quarter of a million deaths from COVID and COVID is surging across the country. Just over the weekend, for example, in South Dakota 60% of all COVID tests that were done were positive. That's just an extraordinary statistic. Fortunately, in this community currently, right now, we're at about 8.89% week to date at New Hanover hospital, so we're still at a manageable rate. But if people do not adhere to the precautions, then we could quickly get into a situation where our hospital is going to be overrun with COVID patients.

RK: I think it's hard for people to visualize what that would really look like and what would really happen. So how could you explain to them what that physically would look like and how they would experience it?

PK: So for example, right now, there are less than 30 people that are hospitalized at our hospital. When we get into the 50s, that's when it really does start to strain the system. We start filling up the ICU. And that not only affects people with COVID, but with any other medical diagnosis. Let's say you present with a heart attack and need ICU care. If all the ICU beds are filled with COVID patients, then there's no place for you to receive care. That's the concern.

And when we started getting into the higher numbers, we had to sort of think about outside the box, how do we make more room and contingency plans, for example, as other communities have done to set up a field hospital to house other patients who are less sick to be to be able to create room for care, that obviously is not something we want to have to do, because I think the the standard of care would would inevitably decrease compared to what we're able to offer now. So and you know, the key thing, the key message we want to convey is that that is a preventable situation. But behavior depends upon the behavior of all of us as citizens to do the right thing so that we don't get into that kind of dire situation.

RK: And is there something that you'd like to see on a specific level of government to change this situation that we're in right now?

PK: There needs to be a national mask mandate, there needs to be national leadership, it really cannot be done effectively, state by state. If you have varying regulations by state, then, inevitably, the doors open for surges to happen. This is illustrated pretty clearly to us back after Labor Day.

After Labor Day, in the emergency room at New Hanover, we saw one patient after another come in positive for COVID. And it turns out that they were part of a group. And what they had done for Labor Day weekend was to rent a van and drive down to Georgia where the bars and clubs were still open, and have a good weekend. But without social distancing, they all came down with COVID-19, and then returned to this area. And that's where we found that they were positive. But again, the groups like that would be involved in spreading the virus, unknowingly, because they may have been asymptomatic.

That's one of the things that's really problematic with this virus is that up to 40% of cases of COVID-19 patients don't have any symptoms, but they are contagious. And therein lies the problem. So we really need national leadership, a national mask mandate, as well as an efficient as possible a distribution of the vaccines when they become available. And in addition, we desperately need more testing capability. We're still struggling this far into the pandemic with having enough tests to be able to test as much as we really need to be doing to attack this pandemic.

RK: Is it your impression that people when they’re socializing that they can only see who’s in front of them, but they’re not necessarily thinking about who they also socialize with. I mean have people really dropped their guard, making their social nets a lot wider because of that pandemic fatigue we were talking about earlier? 

PK: Yeah, exactly. And so, if I were to invite people outside the house into my house, number one would be masking. But also, I would only invite people who I have a fair amount of confidence that they are really attending to the social distancing. So that they reduce the risk that they're likely to get infected.

But you know, I think, I think a lot of people just aren't thinking along those lines. And you know, like right now in South Dakota 60%, test positive, that's just extraordinary. And I heard an ICU nurse from there talking that they have patients who are dying of COVID in their ICU, gasping for breath, but they still don't believe that it's COVID that, in fact, is causing their demise. So there are a lot of people who still believe this is a hoax, even if it's on their deathbed, which I found just to be extraordinary, and also so extraordinarily sad that they don't grasp that.

RK: And as you mentioned earlier, the holidays are fast approaching, so what is your lasting message for our community?

PK: What we, in our family, what we are doing for Thanksgiving, basically, we have family around the world. And we are planning to have a Zoom dinner, where the individual households basically time their Thanksgiving dinner to be at a particular time, everybody gets on a Zoom call, we have computers up so that we can all see each other and basically have Thanksgiving dinner together, everybody can talk, and so forth. And so that we don't have to get together personally, where people from different households could risk transmitting the virus to others.

If someone is to get together with family, then it's very important if they're from different households, everybody has to be masking and preferably if there's going to be a meal shared that if possible, outside with outside heaters to make them more comfortable. And because you can't eat and mask at the same time, it would be important for different households to come together to be separated preferably by six feet, and outdoors again is more safe than indoor eating.

So again, the most important thing to remember is if you have people from other households coming in, no matter how closely you're related, particularly if you're indoors, everybody has to be masked, do the hand hygiene and try to keep distance. And I know that puts a damper on celebrations. But that is what would be required to help ensure the safety of people involved.

The other thing is, a lot of people are getting COVID testing. But I would hasten to add that all a negative test means is that you're negative that day. So let's say you get tested two days later, you drive up to wherever to spend Thanksgiving, you could in the meantime, convert to positive. And so the negative COVID test really is not particularly helpful in terms of telling the group that you are not COVID positive at the time that you do get together. Much more important would be people going up to a gathering that they are really distancing before the event so that the likelihood that they will become infected is thereby reduced.

RK: Dr. Kamitsuka, thank you so much for your time today.

PK: Sure. Glad to be on, and Happy Thanksgiving to everybody as happy as we can possibly make it, but still being safe.