Consider This from NPR - Q & A: Dentists, Reopening Businesses, And Contact Tracing

Episode Date: May 2, 2020

A dentist, epidemiologist and NPR journalists answer listener questions on 'The National Conversation with All Things Considered,' NPR's nightly radio show about the coronavirus crisis. Excerpted here:- NPR's senior business editor Uri Berliner and epidemiologist Dr. Jennifer Nuzzo discuss reopening nonessential businesses- NPR's health policy reporter Selena Simmons-Duffin on the logistics of contact tracing- Dentist Dr. Suhail Mohiuddin on when a dental problem is urgent enough for an in-person visitIf you have a question, you can share it at npr.org/nationalconversation, or tweet with the hashtag, #NPRConversation.We'll return with a regular episode of Coronavirus Daily on Monday.This episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

I'm Kelly McEvers, and this is Coronavirus Daily from NPR. Today, a dentist talks about how his practice has changed and how patients can tell if a problem is urgent enough to justify an in-person visit. Also, some states are allowing non-essential businesses to reopen. Others say it's still too soon. Contact tracing is a key tool to help decide. NPR's Selena Simmons-Stefan explains how it works. Public health experts and journalists answer your questions in these excerpts from the radio show

The National Conversation with All Things Considered. Here's NPR's Michelle Martin. More than 30 million people have filed for unemployment in just six weeks. And as weeks of stay-at-home orders continue and jobless numbers climb, state governments and businesses are looking for ways to get people back to work. In Georgia, for example, a number of businesses have been able to reopen their doors this week under specific guidelines. Regina Herschel has a hair salon in Atlanta. Regina, hi. Hi, how are you? I'm good. How are you doing? I'm doing well.

So you were closed for a month. What was that like? Oh my goodness, it was horrible. Being in business, you know, for yourself, it's hard to close your doors for a month and get no income. So here's a question. I don't know how you can socially distance when you're doing hair,

but how are you managing that? Are you wearing gloves, masks? How are you adopting these new guidelines to keep you safe and your customers safe? Okay, to keep myself and my customers safe, we both have to have on masks. I'm wearing a shield as well. You can't socially distance when you're actually going here, but majority of the time, you're behind the chair, so you're behind the person. And we're just keeping our conversations to bare minimum. We're wearing plastic gloves. And as far as like, if we're not servicing the customer at that time, then we're six feet apart from them. But we're just allowing one person in the salon

at a time. Oh, okay. Well, best of luck. Keep us posted on how it's going. I sure will. Thank you guys for having me. All right. That is Regina Herschel, and she runs a hair salon in Atlanta. I want to bring in NPR senior business editor Uri Berliner now, and you've been reporting on how bigger companies are trying to or planning to reopen while also adhering to social distancing guidelines. What have you found in your reporting? I've been focusing a lot on companies with offices, essentially the white-collar workforce, and these employers are being super conservative about reopening. You know, they focusing a lot on companies with offices, essentially the white-collar workforce, and these employers are being super conservative about reopening. They have a lot of workers working remotely at home, and they're going to keep those workers at home working remotely for quite a while longer.

And when the workplace does start to open up, I think we're going to see staggered shifts to prevent too many people from being in the office at any one time. You may have an A team and a B team and they don't interact. You may have temperature checks when you get to work, masks at desks. And you know, those open office plans that got really common, they're going to be totally reconfigured. There's a lot to figure out, like the break rooms, kitchens, the air that flows through the building. And a lot of employers are trying to sort all this out right now. So our parents, and we have a question to that effect from Vicky in Massachusetts who writes, for parents of six to 12 year olds, when businesses reopen, what provisions are made for non-essential workers who have no daycare because schools and summer camp programs are closed? Uri, what about it? Yeah, this is a really tough one. And it's, I think it's one of the biggest obstacles to bringing more people back in the workplace.

You know, what I'd say to Vicki is if there's any way that she can do her job remotely, that's the best option, to work at home with her kids at home. Now, I know that's not always the case for everyone. Not all jobs can be done from home. Maybe a flexible schedule is an option where, you know, she works a certain schedule and then a spouse or a friend steps in and helps with the kids. You can ask your employer for a flexible schedule. If all that fails and that is not an option, no flexible schedule, you can't work remotely, there is one other option, though maybe it's not the best one. I've talked to labor law experts

and they say you can quit your job and file for unemployment. Under the pandemic benefits that are being offered, if you're an employee and your kids are at school or out of school, there's no daycare. You can quit and you can apply and you'll get federal benefits. That's $600 a week from the CARES Act. Here's another question from somebody in the event planning industry. And this is from Michelle in Orlando who says she's really struggling to make ends meet. Here it is. For all of our small businesses here in Central Florida, all our event-related companies, wedding planners, event rental companies, caterers, and all the specialty businesses that serve the wedding and event market. At this trying time, we want to understand how can we survive with all the high overheads

that a lot of the businesses here in Central Florida have. We can't retain our employees. We can't pay the rent. So we're really looking for answers and help to understand because a lot of the government programs are really not going to help make a dent in the situation. Yeah, I mean, the event business has just taken a huge hit, whether it's conferences, concerts, sports, event planning. And it's a really difficult situation. Like if her employees are not on the payroll, perhaps you could apply for a small business loan and try and get some of those employees back on the payroll. But this is a really tough business to be in right now. I know some people in the event planning business are discussing, you know, creative ways to organize digital events in a really smart, clever way. And they're thinking ahead, not for now, but when there are events,

maybe smaller events, rather than a huge wedding, a smaller one, rather than a big conference, a much smaller one with very strict hygiene standards. And here's a question I want to be sure that we get to because we've heard this a number of times over the course of the last couple of weeks. This is from Joanne in California, who wants to know why mortgage companies are expecting to collect payments after a 90-day grace period. She writes, there won't suddenly be three times the income when things start to reopen. And she wants to know why the government isn't discussing this issue with companies. What's the deal with that? First of all, this shouldn't be happening. Federal housing regulators say

they should not be doing this, and that borrowers should go back to the lenders and say, no lump sum payments after grace periods. And how do they do that? Write a letter? What do they do? Call them up. The federal regulators have been quite open in saying that there should not be any balloon payments, like four months of payments after you've had three months of grace period. You can go back to your lender and say, no, I want another option, like putting my payments at the back of the loan. NPR's Rui Berliner is with us, and we are joined once again by Jennifer Nuzzo. She's an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security.

Our next listener has a question weighing on a lot of people's minds. Sophia from Carbondale, Colorado. Is it too early to start reopening? Are governors changing tone so rapidly because of the pressure from the right with the protests being egged on by the president? There you have the science and politics here competing with each other, one thinks. So what do you think about this? When is the right time to start reopening? Well, politics aside, there are clearly a number of pressures on governors. You know, these measures are really difficult. People are experiencing tremendous economic hardship, and that's a really hard situation for governors to be in. That said, in terms of whether or not it's the

right time, I mean, the data are clearly still worrisome, particularly in a number of states. Governors may see short declines in cases, but they're possibly not seeing the full picture, particularly since testing for coronavirus is so constrained still in the United States. And a number of the states that have been talking about opening in particular don't seem to be doing enough testing. And here's another question. This is from Amanda. Hi, my name is Amanda. I'm calling from Chicago. I wanted to know how do we safely return to regular life given there's no vaccine and treatment and that there are predictions that there will be spikes again in the fall?

Is there a way to avoid spikes in cases without a vaccine? Well, so we have to remember that the social distancing that we're doing right now, that so far has produced promising results in terms of slowing the spread of infection in the U.S., is not a cure. It doesn't eliminate the virus. It's a pause button. So as soon as we release those measures, if we don't do something instead, the cases are going to come back up. So that's just something that everybody should realize. Hopefully the places that are thinking about releasing the restrictions have plans in place to identify individual cases, isolate them, do contact tracing. There's a lot

of things they have to do on the individual case level that takes a tremendous amount of resources and a lot of planning. And unfortunately, many of the states that are considering it, I don't think have those plans in place. So we have to continue to be worried about being exposed to the virus once the measures are in place. Look, there's not going to be a normal right after this. It's not going to be like going back to pre-COVID life. There's still going to have to be restrictions. Vulnerable Americans are going to have to continue to protect themselves and potentially shelter for quite some time. Okay, we have one last question for Uri here. This is from Diane in Virginia, who's wondering what eating out might be like after restrictions are lifted. Would we require food service personnel to wear masks? Because as human beings, when we speak,

we naturally spit or saliva is excreted from the mouth. Okay. Yeah. What about that? We see some restaurants are reopening. What plans are they using to do that? Yeah. In some restaurants restaurants that's happening right now at Taco Bell, KFC, Pizza Hut, your employees are wearing masks. We'll probably see a lot more of that. You know, tables will be moved farther apart to achieve social distancing. You may be seeing disposable menus, plates and utensils, single-use condiments, things like those little packages of ketchup instead of bottles of ketchup.

Okay. Doesn't sound very elegant, but I guess we'll go with that. That's NPR's Uri Berliner. And also with us, Jennifer Nuzzo, epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. Thank you both so much for talking to us today. Thank you. You're welcome. A moment ago, Jennifer Nuzzo mentioned contact tracing. States are hiring contact tracers to interview people infected with COVID-19 in an effort to gather information about how the virus might be spreading. To answer listener questions about how it all works, I spoke to NPR's health policy reporter, Selena Simmons-Duffin. Welcome. So good to hear from you. Hi, Michelle. Nice to hear from you.

So let's go to the questions from listeners. Our first is from Brenda in the San Francisco Bay Area. Let's listen. Can you please explain how contact tracing will take place? I am a nurse in the emergency department, and I have tested positive. My question is, was exposure from a patient or another co-worker or perhaps someone at the grocery store? How does one person trace back their exposure versus an entire nation? Thank you so much. That's a great question.

So, Selena, what do you think? So, the idea of contact tracing is forward-looking. So it's not to try to trace back who you might have gotten it from. It's to try to trace who you might have exposed when you first had the virus. And those people might not be sick yet, but they might be in danger of getting sick. So to do this, a contact tracer would call Brenda and ask her to think back to who she had contact with for two days before she had symptoms. And the CDC's definition of a contact is someone you are within six feet of for about 10 to 30 minutes. So then Brenda would give a list

as best as she could recall of who she might have been close to. And then those people could be reached and asked to quarantine. And that's how you stop the train of transmission. Oh, interesting. So she's not trying to think about who infected her, she's trying to think about who she may have unwittingly infected before she knew. Well, that's important. So let me just note here that Brenda told us that she is well again, she has been cleared to return to work tomorrow after several weeks in isolation. So I just wanted to let everybody know that Brenda's doing well. So we're very glad to hear that. Okay.

Our next question is about how this all works. I keep hearing people say we're going to need an army of contact tracers. So I've got a lot of questions about that. What skills and equipment these contact tracers need? Who's going to pay them, how will they be hired, managed, and how will their performance be evaluated, what kind of information technology support will they need. Selena, so what do we know about that? Well, there's a lot packed in there, but the good news is that public health officials know how to do this because they do it all the time for things like HIV and syphilis or measles or tuberculosis. The skills that you need

to be a contact tracer are really most importantly empathy, because the people you're talking to are sometimes sick and they're often scared and you need to earn their trust and respect their confidentiality. In terms of equipment, you don't need a lot. One contact tracer I spoke to in D.C. explained to make his calls, he goes in a windowless room in his basement and he uses a special headset and a computer program that can safely input people's private information. And as for the questions about hiring and paying for this new workforce, I think state and local health departments are scrambling to figure all of that out right now. There is a push for Congress to specifically fund a contact

tracing workforce, but it hasn't yet. And in the meantime, some states are hoping to use volunteers to be able to scale this up without a ton of cash. Selina, you mentioned privacy. So here's a question we got about that from Robin in Jonesville, Arkansas. I have a daughter that works as a healthcare professional in a senior living center where two residents have tested positive, unfortunately, one of which has died. She and her colleagues have not been given the identities of these persons and have been told that the family did not want that information disclosed. How are they to do complete contact tracing without this information? Are there public health exceptions to HIPAA?

Selena, I think that's also a great question. And it's tricky because I think everybody who's been to the doctor in recent years knows about, you know, HIPAA. How do you answer this question? Right. It totally is tricky. In a public health emergency, the rules around health privacy bump up against the need for actionable public health information. The federal government here has dialed back certain privacy rules. For instance, you mentioned going to the doctor. You usually get a written notice about HIPAA, which is the Health Insurance Portability and Accountability Act. That's been waived. So you're not getting those written notices right now. In this specific case that Robin's talking about, HIPAA isn't really an issue, according to some law professors I ran this by. Some facilities will just cry HIPAA when there's health information at play.

And the truth is you can do a lot to notify people they've been exposed without revealing names, like looking at visitor schedules or medical appointments and letting the contacts who were in touch with those two residents know that they have been exposed so that they can quarantine without saying who exposed them. OK, here's another question. I think we have time for a couple more. This is Cindy. Here she is. Hi, this is Cindy from the great state of Georgia. Instead of hiring 300,000 public health workers to do contact tracing,

would it not be more efficient to have the federal government establish an online self-reporting tool that public health officials could start to outreach based on the data provided by the patient? Selena, what about that? There are two reasons why I do not think that would work very well. First of all, the government would have to build it. And second of all, people would have to fill it out.

And one of the reasons why contact tracing works is that it's personal. It's kind of an art to earn people's trust and encourage them to voluntarily do something for the greater good, like isolate and not leave their house for two weeks. So if this is a nameless, faceless website asking you to input your contacts to the government, I don't think a lot of people would comply. And in public health, the more people who participate, the more effective these methods are. Well, it's a little like the census, isn't it? I mean, you were encouraged to self-report,

but the government still sends a bunch of people out to follow up, right? Yeah, that's a good point. Okay, here's a question from Jean who wants to get involved. How do I apply to be a contact tracer? I've tried online searches. I called my town human services, but I really don't know where to go from here. Selina? Yeah, it's a total patchwork. There's no like national portal to raise your hand for this work. I know a lot of people have this question because I get

emails and tweets every day from people who want to do this and are trying to figure out how to get these jobs. I think a lot of health departments are just in the planning stages here. I know in Massachusetts, they worked with this nonprofit Partners in Health a few weeks back to start hiring 1000 placers. And I found those listings easily online, and other states might just be a few steps behind. All right. That is NPR's Selena Simmons-Duffin, who reports on health policy. Selena, so nice to hear your voice. I hope to see you in person again soon, sometime. Likewise, Michelle. Thanks so much. I'm Ari Shapiro with today's last excerpt from the National Conversation with All Things

Considered. Many dentists' offices around the U.S. are closed except for emergencies, and many of you have asked us, what makes a visit urgent? What should you do if you have a mild toothache that you want to keep from getting worse? To answer your questions, I spoke to Dr. Suhail Mohedan. He runs a dentistry practice in Chicago. Thanks for joining us. Thanks for having me, Ari.

I mean, to start, I'm curious what your practice looks like now that you can't meet patients in person. Like, what are you doing on a typical day? So we basically have come down to only emergency visits. So we run a pretty large practice in downtown Chicago. So we see about 250 people a day with 20 doctors. So we've kind of brought it down to basically only two doctors and maybe about 10 visits a day and just purely emergent visits. So we're just focusing on things that are like pain, swelling, or kind of major issues. So you say you're focusing on things like pain, but there's pain and then there's pain. Like at

what point is the pain bad enough that somebody should consider coming in, even if it is perhaps a risk? Usually, you know, we get most concerned about swellings and like infections. Those are things that we usually are the most concerned about, but even things like can't sleep through the night, those are things that we usually want to see, but more routine things like cavity fillings or sensitivity, we usually try to just help manage patients' issues at home. So that's kind of what we've been doing. Okay, well, let's get to some listener questions. And the first one actually comes from very close to home.

One of the producers on this show, Mia Venkat, had a question for you. My cavity filling came out a couple weeks ago. The pain is manageable, but I'm worried it might get infected or something. So I'm just wondering what I should be doing to make sure my situation doesn't get any worse. I don't want to risk going to the dentist right now because I don't have much pain and doesn't feel like an emergency, but I also don't want to risk it potentially getting infected. Okay, so I'm sorry, Mia, for your pain. And Dr. Moheddin, what would you advise her? I'm sorry, Mia, for your pain. And Dr. Moheddin,

what would you advise her? I'm sorry, Mia, by hearing about your pain. But you know, I think like the main thing that we want her to focus on is just keeping the area really clean, brushing twice a day, flossing. I also think using like a fluoridated malterance would be really helpful to, you know, if there is some decay, that can help slow the growth of that decay down. And really focusing on not foods that are really acidic or, you know, full of a lot of sugar. I wonder, you know, these kinds of practices and modifications seem realistic for a week, a few weeks, maybe a month. But if we're going to be in this situation for months, plural, at what point does it just become unrealistic? You know, and that's actually a question that a lot of dentists are now facing.

These are kind of situations where we start kind of using our clinical judgment on whether we think that a patient should come in and get something done. And usually it's good communication with the patients. And that's what really what we've been doing in our practice, whether that's talking to the patient over the phone or email and kind of figuring out where they are, right? And if they do need to come in, you know, what are the risks about coming in and communicating those things? So we're trying to keep not only our providers safe, but the patient safe as well. Yeah. Let's go to our next question from a listener in a tough situation. Hi, my name is Janet. I live in Oregon City, Oregon, and I have, I believe I have an infected implant and I have swelling and inflammation and pain.

And I'd like to know if this is serious enough to be taken care of under the current treatment restrictions. I mean, does this sound to you like something that she should come in for or even go to the emergency room for, perhaps? I usually get really concerned about infections, right? And when you say swelling, that's usually pretty concerning to me. I would say the first thing to do is contact your local dentist that you've been seeing, whether, again, through phone or through email, and explain to them the situation that's happening. You know, what we're usually doing is, if it's something that we think we can manage with time,

right, we'll prescribe an antibiotic and kind of check up on the patient. But at times where we think, you know, going to the ER is probably the right solution is where you have pretty severe swelling of the face, of the neck, of the eye, trouble breathing, trouble swallowing, trouble opening your mouth. These are things that if you are experiencing those things, the ER may be, you know, the right place to go. I know a lot of GPs have started doing telemedicine. Is that something that you've been doing more over the last few months? You know, we have. When we started our practice a few years ago, our focus has really been about virtual communication with our patients. And, you know, we don't really do FaceTime or virtual

consults, but they're more asexualized. You're not saying say ah into your webcam? None of that. More just kind of dealing with the problem. And that's kind of something that we've been focusing on from the beginning. And it works really well because we're able to decrease emergency appointments by 30 to 40 percent. And that's kind of been like the crux of our practice has been actually better access to care. Okay. Well, our next question comes from a listener named Kevin. When will it be safe for us to go back to the dentist to get a checkup

and cleaning? And are there conditions we should be looking for at our dentist to know that it's actually safe to actually go there? You know, I was wondering something related to this, which is if I miss my six-month checkup and it goes seven or eight months, is the world going to crumble, or is that just fine? So, you know, for more routine care, it's probably going to be fine. Even small cavities, we're not super concerned about that. And really, I think what the ADA is kind of recommending is really following the social distancing guidelines, right? Follow your local states, see what the plan is from that standpoint, and then talking to your dentist and communicating with them, you know, what really is something that needs

to be done or something that really can be pushed back until the times are a lot safer. All right, Dr. Suhail Mohidhan is a dentist in Chicago. Thank you so much for joining us today. Thanks for having me. That's it for today. You can join the National Conversation with all things considered week nights on your NPR radio station. And if you have a question, go to npr.org slash national conversation or tweet with the hashtag NPR conversation. We'll be back on Monday. I'm Kelly McEvers, and this is Coronavirus Daily from NPR.