City officials organized an online town hall meeting last Thursday evening, June 18, to try and answer some community questions regarding the COVID-19 pandemic. The town hall also saw some special guests from the state level take part in the Q&A session: Chief Medical Officer Dr. Anne Zink and Dr. Joseph McLaughlin. Representative Dan Ortiz also participated in the web conference.
As the doctors had a limited window of time to take part in the town hall meeting, city officials spent previous days before the town hall collecting questions from the public, which were then asked via Borough Manager Lisa Von Bargen. Many of the questions revolved around COVID-19 testing and what the future of the pandemic might look like for Alaska and Wrangell.
Assembly Member Julie Decker asked, through Von Bargen, what the limitations of COVID-19 tests were, and why people could not completely rely on only test results to understand the virus and its spread. McLaughlin answered that there are various limitations, depending on which test is being used. The primary limitation of a PCR test, for example, is its sensitivity. Right now, the PCR is the gold-standard test, he said, but they do not know what proportion of patients who are infected that the test misses. However, he said that it is likely a small percentage, somewhere between two to five percent. Relying on positive results can also be a limitation of COVID-19 tests, he added. Fortunately, McLaughlin said, PCR tests have a high specificity so their results can be very trustworthy. Other types of COVID-19 tests have varying degrees of sensitivity and specificity, he said, which is why the state holds the PCR test up so highly.
"When we get a sample in the lab, we also see there can be a lot of problems with sample collection, as well as in transport," Zink added. "There's other ways the test might not be as sensitive, and it's also good to remember that with this virus, you see the highest viral shedding right before someone gets symptoms and early on in their disease course. It goes down over time, so it also depends on the timing of it [the test]."
Another limitation of fighting COVID-19, Zink said, is that there is no good way to get a clinical diagnosis of the virus. Symptoms of COVID-19 match symptoms of a variety of other diseases, she said. That means the tests are really useful for confirming COVID-19, but it also means that the test only really shows whether or not a patient has the virus right at a certain point in time, when the test was taken.
Several questions revolved around the topic of "viral shedding." Viral shedding is when a virus is exiting the body, McLaughlin said, such as through respiratory secretions. It tends to peak shortly before or the day of someone showing symptoms of COVID-19. A COVID-19 patient will be at their most contagious when viral shedding is peaking.
Of course, not every COVID-19 patient shows symptoms. Asymptomatic transmission of COVID-19 certainly happens, McLaughlin said, but they do not currently know to what degree it occurs. An asymptomatic patient, someone who is infected but is not showing symptoms, is different from a "pre-symptomatic" patient. A pre-symptomatic patient is within a few days of showing symptoms of COVID-19. That time period is when viral shedding is at its highest, McLaughlin said.
"From a science perspective, about who's asymptomatic and who's pre-symptomatic, it's an interesting question," Zink said. "For the individual, on what that means and if I should get tested or not, or do I have COVID or not, I think it actually matters less because there's so much viral spread in the pre-symptomatic and mild disease category, and that's why I think we just really need to treat everyone like they've got COVID these days."
There was also a question of whether or not it was a good idea to get a flu shot during the COVID-19 pandemic. Flu symptoms are very similar to COVID-19, McLaughlin said, so they want to try and minimize the number of flu cases this year so they can better identify and handle COVID-19 cases.
"The flu shot is highly, highly recommended," McLaughlin said. "It's recommended for everybody six months of age and older ... Flu is definitely something we do a lot of messaging around to promote the vaccine and respiratory hygiene, ways to prevent transmission of influenza. It is not required, but it is highly encouraged."
Ortiz also took the opportunity to ask a question. He wanted to know if school districts could expect any state guidance on reopening for the fall semester, with a current spike in cases throughout the state. Zink said that they have been working with Commissioner Michael Johnson, with the Department of Education and Early Development, and they sent out a three-phase outline of a reopening framework for schools to follow.
There were also questions from the public on whether or not school officials and parents would be notified if a positive case was found inside a school, and why the state was not putting out a generic reopening plan, instead of letting schools organize their own reopening. The doctors said those questions would be better directed to DEED and Johnson, but Zink said they are working with the education department on a communication tool to make sure students and parents are informed, while also protecting the individual patient's privacy. They may not necessarily notify the school directly, she said, unless the patient had been in the school or there was some other exposure to the school.
City officials also took the opportunity to answer some more local questions during the online town hall. Von Bargen said, for example, that the city was looking into Memorandums of Understandings with other businesses to help cover the cost of employee testing, similar to what they did with Sea Level Seafoods. No concrete plans have been made yet, though.
She also clarified that the alternate isolation site, the Sourdough Lodge, is available for use by positive COVID-19 patients who need to isolate from others. It is available for travelers without a home of their own, or fishermen, or even locals who want to isolate away from their family members.
In other news, Von Bargen said that Wrangell has received about $3.8 million dollars in CARES Act funding. A significant amount of that is going to be used to cover costs of staff time during this pandemic, she said, who have been repurposed for COVID-related work. There are a number of ways this money is being allocated, she added, such as $400,000 for community support programs, $60,000 for the Sourdough Lodge lease, cleaning supplies and hand sanitizer, a new ambulance, and improvements to school and city facilities, among others. Right now, she said approximately $2.5 million has been allocated but not much has been spent.
There was also a question about a lack of followup information regarding Wrangell's COVID-19 cases. Wrangell residents heard a lot when the city's COVID-19 cases were first announced, Von Bargen said, but information regarding followup testing and the number of close contacts being tested has not been forthcoming.
Public Health Nurse Erin Michael agreed that this was an area of improvement for her department to work on. Each new positive case is an opportunity for Public Health to improve their communications with other state and local entities, she said.
Ortiz also had news that the Department of Commerce, Community, and Economic Development is going to be making more funding for small business relief available.
"The way they're going to do that, it's my understanding that prior to this new ruling, if you will, people who have received any form of federal funding, let's say PPP funding for example, they could not qualify to apply for any of this $290 million in small business relief," he said. "However, after yesterday's meeting, people who have received $5,000 or less can now apply for part of that $290 million. Also, there's the option if you have received PPP funds greater than $5,000, but that you returned those funds, you can also then apply for [part of] the $290 million."
A recording of the town hall meeting can be found online, on the City and Borough of Wrangell's Facebook page.
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