From the dome to your home. Ramblings, mutterings, keen observations and things you ought to know out of Helena from the mind of Phil Drake.
Karl Milhon tells me he had more than a couple questionscome to mind while reading about and monitoring the coronavirus:
One was: Is this the zombie apocalypse or the flu from Hell?
Ive received a few emails and a couple calls from Milhon since early Friday. Hes 64, retired and living in Montana City, and according to his resume he once was the supervisorof the communicable disease epidemiology section for the Montana Department of Public Health and Human Services from 2011-2019.
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Great Falls Tribune reporter Phil Drake(Photo: TRIBUNE PHOTO/RION SANDERS)
He has a lengthy (five-page)resume, telling me he started off at the "sharp end" and worked his way back to academia. During our conversation he mentioned his work during the AIDS epidemic decades ago, adding he told nearly 100 people they had tested positive.
And his thoughts about a zombie apocalypse or flu from Hell?
I breathed a big sigh of relief, he says about numbers coming out of China that showed 80% of the those infected by COVID-19 did not need hospitalization.
Its not the zombie apocalypse. Its the flu from Hell, he said. Thank God its not killing babies.
I spent probably close to an hour on the telephone with Milhon on Friday and have received several emails from him. It was on a day I really didnt have an hour to spare, but Im not complaining, no one does.
Milhon said he has some questions, and that certain questions are not being asked during the pandemic. I agree, there are lots of questions, but right now I feel I am on a runaway train and doing patchwork reporting until this locomotive slows down.
As I write this Saturday morning, Montana has 129 confirmed cases of the respiratory illness known as COVID-19 and one death attributed to the respiratory illness. My thoughts are with the family of Jim Tomlin, 77, who died Thursday in a Kalispell hospital.
My jaw is still agape that this is happening. I dont have a very good poker face any more.
I asked Milhon if April 10 is a reasonable goal for stay-at-home orders to be lifted and for life to return to some kind of normalcy.
Its just getting wound up, here and nationally and internationally, you can hear that from anybody on TV all day long, he said. Its just getting its feet under it.
He tells me it depends on what you want to accomplish.
Emergency department technician Katrina Malson, left, and critical care nurse Molly Spaeny, center, test a patient for coronavirus in a drive-thru testing center outside the hospital in Billings, Mont. Friday, March 20, 2020. For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.(AP Photo/Matthew Brown)(Photo: Matthew Brown, AP)
These things tend to come in waves and if you relieve pressure on mitigation it will increase again and open things up, Milhon said. If you lessen the social distancing you will increase the transmission.
He said it depends how long it takes to get a handle on this.
I asked, with my fingers crossed, if warmer weather will keep the respiratory illness at bay.
Milhon threw me to the mat on that one.
It's going nuts in Florida, where the temperatures are in the 70s-80s and its humid, he said.
Milhon said Montana is different than New York City, noting that population density is a big factor, so we are lucky in a sense.
He also said that those that got a handle on it were places like Hong Kong, Singapore and South Korea, that had experienced such emergencies in the past, like the SARS (Severe Acute Respiratory Syndrome virus)which infectedpeople in China in 2003. It spread to 26 countries, tallied 8,000 cases and killed about 800, according to information I was able to glean from the internet. And China was criticized for reacting slowly and downplaying the seriousness of the virus.
They know what this means, he said. They have experience, but we did not, we just caught the peripheral edge of SARS and they had prepared in ways we did not.
Milhon said these countries had robust testing infrastructures in place very quickly" and "robust community containment in which they put people in a quarantine.
He said community containment is where you are able to identify the source, determine relationships and quarantine those contacted until out of incubation period.
Karl Milhon(Photo: VIA KARL MILHON)
We can still do that in most places in Montana, he said.
And he said there are some points where you can no longer identify where a person might have caught it, and you enter a different phase.
And that is community mitigation, which the Centers for Disease Control and Prevention describes asa set of actions that can be taken by all to "help slow the spread of respiratory virus infections."
Milhon said a person may have it and not know it or just feel off and have a cough. But for a period of time they can transmit to other people.
The biggest problem public health has is understanding the burden of disease, he said, adding the burden is all of the people within a population who have the disease. The other subset is all those cases that were mild and not seek medical care.
When put two together you will see the burden, Milhon said.
He said up to now everyone is focusing on testing the diagnosed cases.
Milhon said what is truly important is what we dont yet know, the cases where the person does not seek medical care.
He said the R naught factor, which I first took as "Are Not,"is still not known: How many people on average does case transmit to. He said studies on that are all over the place.
Milhon said there are things people can do to slow that spread, which is community containment where try to stop it, if not stop it then community mitigation.
Right now in Montana we are doing a little bit of both, he said.
Milhon said the less people interact the less opportunity the disease has to spread.
He said there are double digits in some of Montanas more densely populated counties, such as Gallatin and Yellowstone.
Anytime you see cases that are single digits, that means you still have a chance to probably contain it, unless you have someone not cooperating in isolation for quarantine, he said.
Milhon said in most cases you talk to people and they knew where they caught it.
But once you have people and talk to them and they say I have not gone anywhere, all I am doing is living my life, going to the grocery store and filling my gas tank. I dont know where I caught it from. That is when you take a deep breath and know you have a problem, he said.
He said New York City and Washington state represent what could happen, not what will happen.
Milhon said Gov. Steve Bullocks orders are trying to reduce those opportunities for it to spread.
I asked him his opinion of how President Donald Trump is handling the situation. Milhon paused.
He said the robust pandemic system and human infrastructure in place to deal with these kinds of situations had been cut.
The funding had been stable, but added public health always needs more. He said the head had been cut off"the organism that was created to deal with this.
I beganall this by mentioning Milhon has questions about what is going on in the state level. They are more than just a couple questions. But here are a couple I will pose today.
1. Hes wondering if there could be more information on areas of the state that may have community transmission going on where there is no indication of where person might have contracted their infection.
2. Will state and local health departments providelocations and time frames for at-risk people in association with COVID-19 in situations where an infected person might have been in a public place where they might have transmitted the disease to others? The governor's orders do limit the potential for this, but not completely. He said this is already done for foodborne outbreaks.
3. And he makes a request:that anyone who has stockpiled any masks or gloves to take some of it to their local health department. They can make sure it gets to the health care providers who need it most, he said. Please, they are the ones that will take care of youor your family if something happens and they do not have enough.
Dome Lights appears Sunday, unless the villagers catch me. Email me at pdrake@greatfallstribune.com or call 406-231-9021. Im based in Helena. Mail me at P.O.Box 1601, Helena, MT 59624.
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Dome Lights: Are we in the zombie apocalypse or flu from Hell? - Great Falls Tribune
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