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Scott Webb (Host): Welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb, and it's hard to fathom, but we're entering the third year of COVID-19 and this pandemic and with variants like Omicron and other likely variants in the future, it's a good time to have on Dr. Ettore Palazzo. He's the Chief Medical and Quality Officer at EvergreenHealth.

And he's here today to discuss the latest guidance for COVID-19 testing and when we should seek care. So Doctor, thanks so much for your time. We were just kind of speaking off the air a little bit that we're still here. We're still talking about COVID-19 and can you give us a snapshot of what it's like at EvergreenHealth and other hospitals in the region, as we continue to respond to this latest wave of the pandemic. We're talking specifically about Omicron.

Ettore Palazzo, MD, FACP (Guest): Sure. Well, looking back in nearly two years of this pandemic, it has been very interesting to see how the various challenges have come forward for healthcare in general, with the different dynamic phases of this. And no question, the Omicron wave is very different than any previous time in the pandemic. EvergreenHealth and other hospitals in the region are seeing the most COVID-19 hospitalizations, compared to any other time in the pandemic. Really looking at it in the last month, it's been a tenfold increase in hospitalizations. And no question it's challenging. That stated, I personally am optimistic knowing that case counts have started to decrease in King County where we're at. And we're starting to see a plateau in hospitalization. It's absolutely humbling to see the continued response of our healthcare workers, not just here at EvergreenHealth, but just everywhere, standing up and continuing to do their work in what is proving to be probably the most challenging time in the pandemic for us.

Host: So let's talk about the shifting realities in terms of the guidance and when we should be tested for COVID-19.

Dr. Palazzo: Great question. And no question that with the current Omicron surge, the significant increase in transmissibility associated with this variant and the resultant increase in symptomatic individuals has challenged testing capacity. It's also informed how we should go about testing now that we see that this particular virus does appear to be less severe and how that might play into who should be tested and when.

Even though testing capacity has been challenged, state, local and federal public health agencies are doing everything they can to increase that testing availability. And that certainly has helped. Right now the primary recommendation is if you have signs or symptoms of COVID-19, and those include things like fevers, chills, sore throat, nasal congestion, runny nose, cough, of course, muscle and body aches; then it's very important to get tested as early as possible, regardless of your vaccination status. And that will help inform what needs to happen from the standpoint of isolation or quarantine to help reduce transmission.

And we do have increased availability of home testing kits and the usage of those to help in this scenario. But one of the key points is determining what is the best place to get tested, understanding some of those same challenges we talked about earlier with hospitals and emergency rooms, being very busy right now. And, testing at a testing site or using home testing kits be more appropriate. And that's really important in this phase of the pandemic.

Host: Yeah. So let's talk about that. I have some at-home tests, as I'm sure many people do. And there was a program where you could log on and you could grab yourself, I think it was four for free from the government. And when we think about the at-home tests, obviously we're not doctors and nurses, but we can follow instructions. And so what's your sense of how effective are those at-home tests? Because they're so coveted, right? They're so highly prized. When should we use them? Maybe you can kind of take us through that.

Dr. Palazzo: Sure. So there are different testing methodologies available out there that have different sensitivities. The at-home tests also known as antigen tests that look to detect particles of the virus, in nasal swabs. Those are what's primarily available for home testing. And the sensitivity is such that we do pick up on individuals that have a viral load that would be consequential that certainly could lead to a scenario where even if asymptomatic, you could transmit to others. So right now, if you are mildly ill from COVID and not having symptoms that would require you to come into the hospital and we can talk about what that would mean. If you're having symptoms, a home test is absolutely appropriate to utilize, to determine if those symptoms are COVID-19.

And if positive then inform what you should be doing from an isolation standpoint. The fact that individuals that are sicker coming to a hospital that may need more intensive care and we need to have a more highly sensitive test to ensure we understand what's causing that, things like molecular tests. You may have heard of PCR tests. Those are utilized often in a hospital emergency room scenario to identify what needs to be done next as patients are entering into the hospital to receive care.

Host: Yeah. And so when we're at home and we have as you're sort of describing those typical COVID-19 symptoms, they also kind of sound like typical cold and flu symptoms as well. And so I think that that's one of the tricky things for all of them, is trying to determine, okay, well, is this runny nose COVID or is this runny nose a cold?

And would it be prudent to just sort of default, you know what let's rule out COVID first and if it's not COVID than it probably is a cold versus just assuming it's a cold it's winter. What's your recommendation?

Dr. Palazzo: Yeah right now, and that is the challenge with this particular virus that has some of the exact same symptoms that we would see from the common cold or the flu. And so, knowing that we do still have the goal of trying to reduce transmission; if you have those symptoms and you have a home test available to you, it's absolutely appropriate to utilize it in that scenario to identify if this is COVID-19.

If you don't have a test available to you, and you're not in a situation where your symptoms require you to come to the hospital for additional care, then it's not a bad idea just to simply assume that you may have COVID, maybe you had an exposure that would inform that scenario and follow an isolation protocol that would fit with that to still reduce the chance of transmission even if you do not have a confirmed test.

Host: Yeah. And can we talk a little bit about the difference between a quarantine and isolation as I've come to learn, those are not just a matter of semantics. They are a little bit different and maybe you could help folks kind of understand the difference between the two.

Dr. Palazzo: When you are asked to isolate that is in the specific scenario of having a confirmed infection or highly presumed infection. So if you have a positive test, then an isolation protocol is absolutely important to reduce transmission. So in that situation, regardless of vaccine status, the recommendation from the CDC is to isolate for five days. If your symptoms are improving after that five day period or nearly resolved, then you can discontinue isolation, but be sure to wear a well-fitting mask for an additional five days beyond that. Noting that most transmission for SARS COV2, the COVID-19 virus takes place in the one to two days prior to symptom onset and two to three days after symptom onset. So that's isolation.

Quarantine speaks to a high-risk exposure, but that you may not have the disease. So if you've had a high risk exposure, which you know generally is being within six feet for 15 minutes or more of someone with known infection. Then in that scenario, the recommendation is to do a quarantine protocol where you are at home, or away from others for a five day period as well. And, depending on your vaccine status, and this is where things have changed recently, the determination of what to do next, falls into place. And if I could, we could talk a little bit more about that. So this is where things have changed a bit based on vaccine status. If you are up to date on your vaccinations, so that means you are fully vaccinated. And if it's beyond five months from that time period, having received a booster, then a high-risk exposure does not require you to quarantine. However, you should still test at five days to ensure that you haven't developed an asymptomatic infection. Those that aren't up-to-date with their vaccination status, then should fully quarantine, keep themselves away from others for five days. Test on day five. And if you're not having any symptoms or your test is negative, then you can discontinue quarantine. Still very important to continue to wear a high quality well-fitting mask for an additional five days or more.

Host: Yeah, it does seem that it comes back to the mask a lot of times. Let's talk about the latest treatment options for people who either are positive or presume to be positive.

Dr. Palazzo: Well, this is one area that things have evolved significantly compared to what was available for really what was just those patients that were sick enough to be in the hospital to receive, IV antiviral therapies like Remdesavir and some of the other immunomodulatory therapies that helped prevent some of the challenges that come with severe COVID.

Recently we have received additional therapies like new monoclonal antibody therapies for those in the outpatient setting that are at high risk for progression to COVID-19 and those are an important armamentarium to help prevent the progression of disease. We did know that some of the earlier monoclonal antibodies that were available, like things like Regeneron, no longer are effective against the current Omicron variant.

So, there are new monoclonal antibodies, both for pre-exposure prophylaxis, so before you might be exposed to COVID, and for those that then develop COVID, to receive a therapy that reduces your risk of getting sick. Oral antivirals like molnupiravir and Paxlovid have now become available to help in that outpatient setting as well.

I think it's important to know that right now, the availability of these medicines are quite limited, and we look forward to increased availability. So those medicines are being reserved for those patients at highest risk for potential development of severe COVID. For those that just have mild illness, no other chronic conditions that would lead to a progressive disease scenario, we recommend that we would do what we do for the normal cold in and make sure you monitor for progression of symptoms, but do the isolation and quarantine protocols and not necessarily worry about needing a specific therapy at that time.

Host: Yeah, it is amazing how far we've come. And so great to have your time today and wanted to ask you if someone has to get a test before going back to school or the workplace. And we talked a little bit about the home testing, when we think people who have to be tested in order to go somewhere to do something and not just for their own purposes; do you think at the home tests are acceptable or appropriate or do you believe that they should be tested at the doctor's office or the hospital?

Dr. Palazzo: Well, in that situation, if you are being asked to test for a workplace scenario or travel, I would confirm with that governing body on what type of COVID tests they're requiring. In most instances, a home test or an antigen test are acceptable, in that situation. And as we talked about before those options for testing including home availability, as well as testing centers that offer the antigen type testing, I think is appropriate. But, confirming what test is appropriate per their regulatory protocols, I think is important to help inform that decision.

Host: Yeah, that's perfect. We can just say, ask them, say, will you accept a home test? Right. So, this has been so helpful. So educational. I'm sure listeners will agree. They're all nodding their heads right now. As we wrap up Doctor, what's the most important thing for the community right now to know about COVID-19, the response to COVID 19, you know, what would be your takeaways?

Dr. Palazzo: Well, think I would say that each individual should know that they can make a difference, of course, in their own health and the health of their community through straightforward measures that are tried and true. And top of that list is getting vaccinated. Currently at EvergreenHealth, the overwhelming majority of patients that are hospitalized with COVID-19 are not up to date with their vaccine and no question that is the best defense for possible need for medical care going forward.

And this holds true even for the current Omicron variant. Know that everyone aged 12 and older are eligible for a booster dose right now five months after their second dose of Pfizer or Moderna, two months after their initial dose of J and J. So that's so important. Masking, wearing the highest quality mask when you're around others, ensure that it fits properly. And then remember to continue physically distancing when possible. Indoor spaces can be challenging if you need to gather, make sure that you're doing it in a well-ventilated space. And outdoors is great, even though we're in the winter time. There's great weather ahead that will allow for that. Finally, we at EvergreenHealth want the community to know that we are here for you. We ask that you don't delay routine healthcare visits. This will help avoid more advanced medical needs in the future. And we can't thank our community enough for the support for our healthcare workers, to take these steps, to keep themselves safe.

Host: Well, that's perfect. You are an awesome guest and a wealth of information. And your level of optimism is reassuring. You know, because it's difficult. We all have had these periods over the last two years with ups and downs. And then I get to talk to someone like yourself and I feel a little bit up again, a reason for optimism. So as you say vaccines, boosters, masks, distancing, all the things that we've learned that are effective against COVID-19 over the last two years. So Doctor, thank you so much for your time. You stay well.

Dr. Palazzo: Thank you. Thank you for the opportunity.

Host: And that wraps up this episode of Check-Up Chat with EvergreenHealth. Head on over to our website at evergreenhealth.com for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.