June 30, 2020

Since Idaho moved into Stage 4 of economic re-opening, there has been a resurgence of Covid-19 viral cases in both Idaho and Eastern Oregon. Even in rural Malheur county, the virus is spreading more rapidly, tripling case numbers in the last 15 days. See HERE to look at Idaho viral counts (look for Covid-19 demographics Tab).

In Idaho, the 18-29 year old age group is experiencing the greatest number of cases.

The spread in this age level may be due to a perception that young people are not at risk for serious consequences of getting ill. Unfortunately, this is not always true and the risk to others is significant due to an average 20-day viral shedding period. One infected person, with or without symptoms, can infect numerous other people, who then go on to infect others. As shown below, older persons are paying for this infection with their lives.

Death rates are not currently rising, but I suspect that these numbers will climb once the virus has longer to damage infected lungs 2-4 weeks after initial infection. For survivors, detrimental effects due to a powerful lung infection may be long term.

The politicalization of common sense prevention measures may be providing an avenue for the virus to spread. The virus is highly contagious and is easily spread when given the opportunity. I encourage everyone to practice safe measures of social distancing and face coverings in public in order to reduce the risk of getting ill.

Covid-19 is not like other flu virus. Covid-19 is dangerous, not pleasant, and expensive if hospitalized.

Sharing is usually a fun activity. In the case of Covid-19, sharing is not recommended.

It is theorized that Covid-19 viral spread on cruise boats occurred thru air ducts, rather than direct person-to-person contact. Air purifiers designed to catch viral particles may be a prudent addition to workspaces.

Choosing the right type of purifier is important. Filtration size matters.

The Covid-19 virus is 0.12 microns in size.  

HEPA (High Efficiency Particle Air) purifiers are designed to capture 99.97% of 0.3 micron diameter particulates. Although 0.3 microns is larger than 0.12 microns, a NASA article indicates that they are probably helpful for particles much smaller in size, especially when combined with a granular material such as activated carbon. (For people who like reading technical articles, Click HERE to read NASA’s article).

ULPA (Ultra Low Particulate Air) purifiers are designed to capture 99.99% of 0.1 micron diameter particulates. These purifiers may be marketed as Ultra HEPA or Hyper HEPA. Since 0.1 microns is smaller than 0.12, these purifiers are designed to capture viruses.

There are numerous products on the market. Dr. Rodgers is not affiliated with any air purification company, but here are two ULPA product lines to help you begin your search.
IQAir captures down to 0.003 microns. Click HERE to learn more.
Intellipure captures down to 0.007 micron particles. Click HERE to learn more.

Avoid purifiers that dispense ozone or ions into the air without any physical filters.
These machines make dust heavier, thus moving dust from the air column to your floor or counter tops. They don’t actually remove anything from the environment. Additionally, ozone is a respiratory irritant and environmental pollutant causing damage to indoor plants.

What types of test are available?

 There are two categories of tests available.

Diagnostic Testing: Polymerase Chain Reaction (PCR).  Presence or Absence of the virus.
This is a done by looking for viral RNA. Obtained with a nasal or throat swab. One test company also provides fecal sample testing.

A positive test confirms that you have the Covid-19 virus.

A negative test indicates that you do not have the virus OR that you are in the initial stages of viral infection.  During initial stages of infection, viral counts are low and may cause a false negative result.  If you have symptoms and test negative, a repeat test 1-2 weeks later is important to confirm test results.

Sample collection. Samples can be obtained via oral or nasal samples. Most tests are limited to hospitals and public health institutions.

Fecal PCR testing. There is evidence that the Covid-19 virus may continue to shed via the fecal route up to 5 weeks after clearance in the respiratory system.  This test is available with physician ordering only.
A fecal PCR test is not officially diagnostic for Covid-19, but may help determine:

• If a Covid-19 patient continues to be a risk to others.
• Help determine transmission risk from an asymptomatic person with possible viral exposure.
• Possible infection in someone with Covid-19 symptoms.

For locations for Diagnostic Testing, See Article Can you get tested for Covid-19?

Immune reaction testing:  Immunoglobulin IgM/IgG. 
Currently only FDA approved tests are available and are limited. Testing availability should increase in the near future.

This blood test evaluates an immune response to the virus.  Immunoglobulins are important immune proteins that react to infection.

It is NOT diagnostic for viral infection.  It is NOT diagnostic for immunity. 

This test evaluates for an early or ongoing immune response to viral exposure.

• IgM. IgM immunoglobulins rise from ~ day 7 to 21 days after initial infection. IgM does not remain in the body after this initial infectious stage.
• IgG.  The body starts building IgG immunoglobulin ~14 days after initial infection and remains for longer periods of time. It is unknown how long IgG remain elevated after exposure to Covid-19.
• At the time of this article, Crush the Curve Idaho offers an IgG test to anyone who wants to be tested for ~$100.  Their test may be helpful to determine an immune response, but only 13 days after a positive PCR test or 17 days after symptoms start. It is not reliable for people who never had symptoms. Click HERE to sign up for a test.

Because test supplies are limited, Covid-19 diagnostic testing continues to be reserved for people with symptoms or high-risk populations. Read CDC symptom list HERE.

If you suspect you have a Covid-19 infection, here is what you can do to get a diagnostic test.

1. Call your physician office to determine if they are testing patients.
2. If your physician is not offering a test, you may go to a drive up test centers.

Southwest Idaho Residents.  Central District Health has a list of drive-up testing locations. Please see each location for their criteria for testing.  Prices vary.

• St. Luke’s – Ada, Elmore and Valley Counties
• Saltzer Health
• Saint Alphonsus
• Primary Health
• Crush the Curve
• Cole Diagnostics
• Rite Aid, Meridian

Malheur County Residents. Malheur County Health Department is beginning to provide Drive-up test centers on specific days.  New test sites locations are provided via press releases HERE

To determine if you are eligible, please look at the criteria HERE.

The next drive up test site for Malheur residents is in Vale. See bilingual Flyer HERE

For more about testing, see Article Covid-19 Testing: Diagnostic and Immunity

May 11, 2020

The last month of stay at home orders has been a challenge for everyone.  Now that states are starting to re-open, it is important to keep yourself and those around you safe.

I hope the following information helps answer questions and guide you in the following months.

1. With the economy starting to re-open, does this the Covid-19 virus is gone?
2. How many cases are there in my county?
3. Should I continue to social distance?
4. Am I at risk if I’m not over 65?
5. Shouldn’t we get it over with and get the virus already?
6. Can we beat this virus?
7. Should I get tested?
8. Are tests available and what does testing mean?
9. If I’ve had Covid-19, am I immune and can I pass it to others?

1. Since the economy is starting to open, does this mean the Covid-19 virus is gone?

No, the virus is not gone. However, it is theorized that due to most people experiencing mild symptoms, most infections are not tested and infection numbers are under reported.  Fortunately, Idaho and Oregon have relatively few cases of the virus and the infection numbers are stabilizing.

2. How many cases are there in my area?

The following May 10, 2020 data was obtained from John Hopkins Coronavirus Resource Center Click HERE to see up to date information.

Oregon (stats based on 2019 Population 4,217,737)

• 3228 confirmed Covid-19 cases and 127 deaths.  
• Positive tests: 4.2% of the those tested
• 4% mortality of confirmed cases.
• Malheur county reports 14 confirmed cases and zero deaths.
• Tested (PCR): 75,450, representing 1.8 % of the total state population

Idaho (stats based on 2019 population of 1,787,065)

• 2230 confirmed Covid-19 cases and 67 deaths.  
• Positive tests: 6.4% of those tested.
• 3% mortality of confirmed cases.
• Tested (PCR): 31,961, representing 1.8 % of the state population.
• County data in Southwest Idaho
  • Ada county reports 733 cases and 19 deaths
  • Boise county reports 0 cases and 0 deaths
  • Canyon county reports 272 cases and 6 deaths
  • Gem county reports 16 cases and 0 deaths
  • Owyhee county reports 8 cases and 0 deaths.
  • Payette county reports 17 cases and 2 deaths
  • Washington county reports 1 case and 0 deaths

3. Should I continue to social distance?

Yes.  

As business open, some people may feel that social distancing measures are not needed. This is a misguided assumption. The virus is highly infectious.  Continuing safe social distancing measures will help reduce the spread of infection and ensure an open economy.

The best way to reduce viral transmission is for EVERYONE to practice preventative measures: 

1. Social distancing: maintain at least 6 feet from other people.
2. Wear a facemask in public covering both nose and mouth.
3. Washing hands with soap for 20 seconds after being in public. 

4. Am I at risk if I’m not over 65?

There are more total cases of Covid-19 for those age 49 and younger, but the mortality rate is higher for those ages 50 and greater.

Idaho cases and deaths per age group.  ( May 9, 2020 click HERE to see source )

Age	Idaho Cases	Deaths / % total Deaths
18-29	460	0 deaths / 0 %
30-39	352	0 deaths / 0 %
40-49	362	0 deaths / 0 %
50-59	368	2 deaths / 3%
60-69	282	9 deaths / 13.4%
70-79	162	13 deaths / 19.4%
80+	154	43 deaths / 64.2%

Younger people may feel safe from the disease’s mortality rate, but younger people have developed blood clots or died from Covid-19 and there is a risk of transferring the virus to others. Risk factors that may worsen Covid-19 symptoms for every age group include smoking, vaping, diabetes, and asthma.

5. Shouldn’t we get it over with and get the virus already?

There is an argument to open the economy and let the population be exposed to the virus to develop community-wide immunity.  The problem with this argument is the lack of evidence about how strong immunity occurs after exposure.  Furthermore, it is unknown the long term health concerns after viral exposure. Blood clotting may be an acute symptom, but it is not known if there are lingering effects of the virus. Patients who survive the disease after the use of a ventilator may experience long-term heart and lung damage.   Preventing the disease means preventing long-term health consequences.

Additionally, current viral hotspots of the virus where social distancing was not implemented (ie, meat packing plants and prisons) demonstrate rapid viral spread followed by numerous deaths.  The virus then spreads to the greater adjacent communities, putting more susceptible individuals at risk.

It is extremely difficult to protect vulnerable populations such as older persons, those with inflammatory disease, and those with immune deficiency disease. Without everyone participating in social distancing, people may die.

Social distancing will reduce the time the virus remains in our communities.  Until we have universal testing, contact (exposure) tracing, and isolation of those effected or exposed, the virus will continue to spread.

6. Can we beat this virus?

Yes, with discipline and time.  The Smallpox eradication story is a profound lesson of a collective will to eradicate disease.  Smallpox ravaged the world for millennia (it is found in Egyptian mummies) and yet many Millennials may be unaware that their parents were vaccinated against it.  (For those millennials reading this: ask a Baby Boomer about their distinctive smallpox vaccine scar.)

Depending on the strain, Smallpox had a 30-90% fatality rate. Most people died about 2 weeks after contracting the virus. Smallpox killed hundreds of thousands yearly. For those who survived, many were blind and scarred for life.  Smallpox was a monster compared to Covid-19.

Small pox was eradicated in 1977. Eradication of this millennia old, rampant, lethal virus was accomplished with vaccination, identification and isolation of infected individuals, and isolation of those exposed.

We can deal with the Covid-19 virus.   We know how to

• Reduce exposure (social distancing, wearing masks, washing hands).
• Test and care for those exposed.
• Improve our immune systems (eat well, sleep well, immune supportive nutrients) Click HERE for Dr. Rodgers suggested list of immune support.
• Isolate and care for the infected.
• Develop vaccines.

What we do in the next year will determine how well we will have learned our lesson from past viruses.  We can defeat this virus if done properly.

7. Should I get tested?

The CDC has issued guidelines for testing priorities.  Click HERE to learn if you qualify for a viral detection test. 

For most people, testing is based on the presence of symptoms. The CDC has recently expanded its symptom list to include:

1. Cough
2. Shortness of breath or difficulty breathing
3. Or at least two of these symptoms:
   • Fever
   • Chills
   • Repeated shaking with chills
   • Muscle pain
   • Headache
   • Sore throat
   • New loss of taste or smell
4. Some patients also experience nausea, vomiting, diarrhea

Anecdotal stories include some positive tested patients without cough symptoms.

If you feel you are eligible for a test, please contact your medical provider to discuss your symptoms.  

Stay up to date with the CDC’s symptom list HERE

8. What types of test are available?

 There are two categories of tests available.

Diagnostic Testing: Polymerase Chain Reaction (PCR).  Presence or Absence of the virus.
This is a done by looking for viral RNA. Obtained with a nasal or throat swab. One test company also provides fecal sample testing.

A positive test confirms that you have the Covid-19 virus.

A negative test indicates that you do not have the virus OR that you are in the initial stages of viral infection.  During initial stages of infection, viral counts are low and may cause a false negative result.  If you have symptoms and test negative, a repeat test 1-2 weeks later is important to confirm test results.

Sample collection. Samples can be obtained via oral or nasal samples. Most tests are limited to hospitals and public health institutions.

Fecal PCR testing. There is evidence that the Covid-19 virus may continue to shed via the fecal route up to 5 weeks after clearance in the respiratory system.  This test is available with physician ordering only.
A fecal PCR test is not officially diagnostic for Covid-19, but may help determine:

• If a Covid-19 patient continues to be a risk to others.
• Help determine transmission risk from an asymptomatic person with possible viral exposure.
• Possible infection in someone with Covid-19 symptoms.

Immune reaction testing:  Immunoglobulin IgM/IgG. 
Currently only FDA approved tests are available and are limited. Testing availability should increase in the near future.

This blood test evaluates an immune response to the virus.  Immunoglobulins are important immune proteins that react to infection.

It is NOT diagnostic for viral infection.  It is NOT diagnostic for immunity. 

This test evaluates for an early or ongoing immune response to viral exposure.

• IgM. IgM immunoglobulins rise from ~ day 7 to 21 days after initial infection. IgM does not remain in the body after this initial infectious stage.
• IgG.  The body starts building IgG immunoglobulin ~14 days after initial infection and remains for longer periods of time. It is unknown how long IgG remain elevated after exposure to Covid-19.
• Crush the Curve Idaho offers an IgG test to anyone who wants to be tested for ~$100.  Their test may be helpful to determine an immune response, but only 13 days after a positive PCR test or 17 days after symptoms start. It is not reliable for people who never had symptoms. Click HERE to sign up for a test.

9. If I’ve had Covid-19, am I immune and can I pass it to others?

Unfortunately, the strength and duration of immunity created after exposure to Covid -19 is unknown.   It is ASSUMED that one may become immune to the disease and not contagious. Unfortunately, this assumption has not yet been proven. It is hoped that survival of a Covid-19 infection will impart immunity to this viral strain for most people

Covid -19 Update March 18, 2020.

Idaho Naturopathic Medicine and Rosehill Wellness are taking the following precautions to ensure your safety during the Covid-19 crisis.

• Offering video remote consults or phone visits as alternatives to in-person visits. Both Tele-health Video and Telephone visits can be booked from idnatmed.com or your patient portal. Tele-health Video visits require the patients to have access to video access on a phone or computer. Phone visits are available for established patients only.

• We encourage remote access visits, but we are open in office on a limited basis. In the office we are sanitizing all surfaces, doorknobs light switches, etc. before and after each patient visit. Sanitizing all medical equipment after each patient visit.
• Taking temperatures of all patients presenting to the office.

• Acupuncture visits are available extremely limited for acute pain only, and for patients who do not have any of the risk symptoms/exposures. Please see below.

What we ask of you:

Please do not show up early to the office. Wait in your vehicle until your appointment time. This will reduce exposure to yourself and others.

Do NOT present yourself to the office if have the following risk symptoms/exposures:

• You have been in contact in the last 2 weeks with anyone exposed to Covid-19.
• You are returned from a geographic area with an active Covid-19 outbreak within 14 days of your appointment.
• You have cold and/or flu symptoms within 14 days prior to your appointment.
• You have or had a fever within 14 days prior to your appointment.
• Click here for Center for Disease Control information about what to do if you are sick.
• If you meet the criteria listed above, please obtain a Covid-19 test.

Testing is important for those who have been exposed to the virus. Unfortunately, at the time of this newsletter, there is no local or state coordinated testing program. If the virus continues to spread, the criteria and opportunities for testing and testing may change.

Dr. Rodgers does not provide Covid-19 testing.

Current guidelines provide testing only for those have a fever, cough, sinus discharge, body aches, shortness of breath AND had known contact with a Covid-19 patient or traveled in affected geographic areas, OR severe respiratory distress without a known source of exposure.

If you meet these criteria:

If you HAVE a primary care medical provider: CALL your provider and ask if they provide testing.

IF you DO NOT have a primary care medical provider: Primary Health urgent care centers and many St. Luke’s and St.Alphonsus urgent care facilities are providing testing. You need to CALL a facility near you to determine if testing is available on a walk-in basis.

Testing is important to determine if one needs to socially isolate or quarantine to reduce transmission of Covid-19. Even if most people experience only mild symptoms, the risk of transmission is for those who may experience life-threatening symptoms.