FAQs with Governor Herbert and Dr. Dunn

During the weekly COVID-19 press briefing on Thursday, July 30, 2020, Governor Gary Herbert asked state epidemiologist Dr. Angela Dunn, from the Utah Department of Health, some of the persistent questions he hears from Utahns about COVID-19. This is a summary of their discussion:

You can watch this conversation on the Governor’s Facebook page here.

Gov. Herbert: There are a number of questions that keep coming up. Let’s separate fact from fiction and give us better context.

1. Comparing COVID and Influenza

Gov. Herbert: What is the difference between our traditional flu and a COVID-19 pandemic?

Dr. Dunn: We know that COVID-19 is certainly more infectious and more deadly than the annual flu. Already to date we’ve had twice as many hospitalizations and five times as many deaths due to COVID-19 compared to last year’s flu season.

There are also some key differences:

Flu, we have a vaccine and we have known treatment with the antivirals, and we don’t have that information yet for COVID-19. There’s just so much we don’t know about the virus that causes COVID-19. That makes it more dangerous and unpredictable moving forward. 

It’s really important that we do everything we can to protect ourselves against flu because we are going to enter flu season. We all need to get our flu shots so that we can continue to stay safe from all respiratory viruses and protect our healthcare capacity. We just know a lot more about flu, we’ve got a vaccine, and we have treatment, and already COVID-19 has caused more hospitalizations and deaths this year alone.

2. How much more deadly is COVID than the flu?

Gov. Herbert: You mentioned it’s more infectious. It’s more deadly. The mortality rate in Utah is at 0.7%, less than 1%. Nationally it’s 3.5%, compared to flu, which I’ve heard is 0.1%. We do have some advantages with a vaccine, which we don’t have with COVID-19, but tell me exactly, and tell the the public, how much more deadly is the COVID-19 than is the flu?

Dr. Dunn: Because COVID-19 is something we just identified in December 2019, it’s going to take the scientific community time to understand exactly how much more deadly it is than flu. As this pandemic evolves and we get more information, we’ll  be able to more accurately say how deadly COVID-19 is.

I think something to anchor to though is knowing that already in 5 months of COVID-19 in Utah, we’ve had five times as many deaths due to COVID-19 compared to flu season last year, which is an 8-month season. So it has already claimed more lives than flu.

3. What data does the state use to make decisions

Gov. Herbert: We’ve talked about case counts. What’s the most important data that the state uses for making our decisions, and what data is available to the public?

Dr Dunn: From a public health response perspective, we look at our data to identify which populations are carrying the biggest burden of COVID-19 and what interventions would most help those populations.

So we’re looking at infectiousness, death toll, but also access to testing to make sure that we have as many prevention measures in place as we can to protect those at highest risk for severe disease due to COVID-19. 

On an individual basis, the information on the coronavirus-stage.at.utah.gov website is really important for the public to understand how the spread is going in Utah, and the impact that our own individual actions can have.

We know that since individuals have started wearing face coverings more in the past month, we’ve seen a drastic decrease in cases. So we know that the individual actions we all take can help populations as a whole be healthier throughout this pandemic. 

4. What is the difference between case numbers, infection rates and transmission rates?

Gov. Herbert: Again, along that same vein, we hear about case numbers, we hear about infection rates, we hear about transmission rates. Can you explain the difference between those three?

Dr. Dunn: Case numbers that we report from the health department on a daily basis are just the actual numbers of individuals getting infected.

We also look at rates by geographic area, so that it takes into account the underlying population. So the denominator of Salt Lake County for example compared to Iron County, which are very different populations. And it helps us to understand if those populations were the same, is the infection rate the same, so that we can identify the true burden of disease. (Editor’s note: This is similar to looking at a percent of the population in each county. Instead of per hundred, like a regular percentage, we look at rate per 100,000 people.)

And then we also talk about transmission rate. And that’s how likely one individual who’s sick with COVID-19 is to infect another individual. The measures that decrease that transmission rate before we have a vaccine are going to include wearing a face covering, staying home when you’re ill, and practicing physical distancing.

Right now our transmission rate in Utah is estimated to be below 1.0. So that means that every individual who has COVID-19 is spreading it to less than one other individual and that’s contributing to our declining cases.

5. How do we determine if someone dies from COVID-19?

Gov. Herbert: Another question I get all the time is, how do we in fact determine if somebody died based on a COVID-19 infection?

Dr. Dunn: The health department is notified of every individual who has COVID-19 and then passes away. We work with the clinicians and our medical examiner to determine the cause of death. Just because someone has COVID-19 when they pass away does not mean that they will be counted as a death due to COVID-19.

We actually investigate those cases to make sure that the cause of death is related to COVID-19. So if that individual had not had COVID-19, they would not have passed away. So all of our deaths are specifically due to COVID-19, and I’m very confident that we’re capturing the deaths accurately.

6. Is mask wearing making a difference in Salt Lake County?

Gov. Herbert: The question people ask is, “Is Salt Lake County getting better or is the rest of the state just getting worse?

Dr. Dunn: That’s a really good point. We know that Salt Lake County is seeing a true decrease in cases. Ever since about two weeks after the masked mandate went into place, we’ve seen a really sharp decline, and that’s also contributing to our overall statewide decline in cases.

For most of the pandemic, Salt Lake County had contributed to over 50% of our cases statewide, and now they’re at about 40% to 45% of our cases statewide. So they are dropping quicker than our surrounding jurisdictions across the state.

The good news is that right now, all of our jurisdictions are seeing a decrease. So we’re going in the right direction statewide, but Salt Lake County specifically is carrying a lot of that burden in terms of decreasing really quickly and allowing us to see the trend go lower statewide as well.

7. Please explain the true recovery rate

Gov. Herbert: Our website says that currently, 67% to 68% of the people who’ve contracted COVID-19 have recovered. And so, we have people think, “Well, we’re only getting about two-thirds of the people recovering from the virus?” And yet our mortality rate is at 0.7. Can you explain what the truth is about the recovery rate of the people of Utah going through this process now, these last five months?

Dr. Dunn: Recovery rate is something that is not well understood across the world and in relationship to this pandemic.

We are using a very crude definition of recovery: If you’ve been identified with COVID-19 and you haven’t passed away within three weeks, we’re considering that recovered.

And we recognize that that’s not true recovery. We know now that individuals, even if you haven’t been hospitalized, can take several weeks to a month to actually fully recover. And we’re learning more and more about the long-term effects of COVID-19. 

Dr. Angela Dunn, Utah Department of Health

Recovery is one way that we are tracking people who are potentially still infectious, and still out there in the community with COVID-19, recognizing that there are a lot of limitations to that number. Of course as we’re progressing through this pandemic, we have more cases coming in over the past weeks and months than we did at the beginning of the pandemic.

Our recovery rate will lag as well, because we have more individuals being diagnosed every day with COVID-19 and it has to be three weeks before they’re considered recovered by our metric right now.

Gov. Herbert: I guess Dr. Dunn, it depends a little bit on how we define recovery. If recovery is defined as “you didn’t die,” then 99% of the people that get it are recovering in Utah.

8. What are some long-term impacts of a COVID-19 infection?

Gov. Herbert: We also know that there’s some residual impacts and some concerns. What are some of those uncertainties that people who contract COVID-19 will have over the long term?

Dr. Dunn: This is something that we are looking at nationally, and scientists are trying to figure out worldwide, what does that long-term effect of COVID-19 look like? We only have had a few months here in Utah to really try to understand that. And we know that there are some individuals that have problems breathing, and engaging in exercise and activity that they engaged in prior to COVID-19 for some weeks after having the illness. So that is an evolving aspect of this pandemic and something that we’re all trying to really understand completely, so we can identify who has actually recovered.

9. How do we know if we are overwhelming the healthcare system?

Gov. Herbert: We’ve talked about the importance of what we do as a community, as a state, to make sure we don’t overwhelm the medical system, the healthcare system. I know we have about 4,200 hospital rooms in the state of Utah. Are we in danger of overwhelming the healthcare system through hospitalizations?

Dr. Dunn: We work very closely with all of our healthcare systems to identify their capacity to take care of COVID and non-COVID patients. That is something we really need to have our finger on the pulse of as we enter flu season.

Currently, we look at number of hospital beds available: non-ICU and ICU beds and COVID patients and non-COVID patients taking up those beds.

For hospitalizations overall (non-ICU beds) we have robust capacity there. We haven’t really gotten near overwhelming our general hospital beds.

It’s the ICU beds that are more limited. We have somewhere between 500 and 600 ICU beds available in the state of Utah. Are they adequately staffed? Can they provide high level of care for COVID patients? That’s something that we really need to protect moving forward as we move into flu season. So that’s why it’s so important that everybody get their flu vaccine when it becomes available in September.

Gov. Herbert: Thank you, Dr. Dunn. We appreciate those frequently asked questions and your answers.

My concern really is not with the deadliness and the infectious rate of COVID-19, but potential long-term residual impacts where it hurts people’s lungs and their sense of smell and taste.

This is not like the typical flu. It’s worse than the flu. We know the best way to prevent the spread of the COVID viruses is not new:

  • Practice social distancing, which is defined as six feet from one another.
  • If you can’t social distance then you should be wearing a face covering, a mask.
  • Stay home when you’re sick.
  • Wash your hands frequently.

I’ll just conclude that part by saying that 76.4% of the people of Utah who died from COVID have had at least one underlying health condition. The statistics show us that the vulnerable populations (elderly, and those who have underlying conditions) are most impacted. So let’s all do our part as good citizens of this great state to help slow the spread of this coronavirus and protect our neighbors.