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Conversation With Appalachian District Health Department Director of Communications & Compliance Melissa Bracey About COVID-19

By Tim Gardner

High Country Press reporter Tim Gardner recently conducted an interview with Melissa Bracey, Director of Communications & Compliance for the Appalachian District Health Department (AppHealthCare), which serves Watauga, Ashe and Alleghany counties. The interview is solely about the Coronavirus, an ongoing global pandemic of coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2).

The COVID-19 outbreak was first identified in December 2019 in Wuhan, China. The World Health Organization declared the outbreak a Public Health Emergency of International Concern on January 30, 2020, and a pandemic on March 11, 2020. As of October 16, 2020, more than 38,900,000 (38.9 million) cases of COVID‑19 have been reported in more than 188 countries and territories, resulting in more than 1,900,000 deaths; approximately 27 million people have recovered from the disease.

The pandemic continues to rage around the world, including in the North Carolina High Country. Gardner’s interview questions and Bracey’s answers about what specific measures AppHealthCare has underway to help combat the disease and stop its spread as well as related topics follows.

Melissa Bracey

High Country Press (HCP): For those who still may not know, what are the symptoms of Coronavirus (COVID-19), and when should a person be tested to determine if he or she has the disease?

Melissa Bracey (MB): Symptoms of COVID-19 include fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting and diarrhea. More details about COVID-19 symptoms can be found at the Center for Disease Control (CDC) link here

We recommend testing for someone who:

  • Is experiencing COVID-19 symptoms,
  • Has been in close contact (6 feet or less for 15 minutes or more) with someone known to have COVID-19,
  • Is at higher risk of developing severe illness (65 years and older, have an underlying health condition or chronic condition),
  • Works in a frontline role or business where social distancing is hard to maintain,
  • Lives or works in a facility where social distancing is hard to maintain like a congregate living setting, healthcare facilities or home care,
  • Is part of a historically marginalized population who may be at higher risk for exposure,
  • Has attended protests, rallies or other mass gatherings where potential exposure may have occurred because social distancing may have been difficult to practice.
  • Participates in activities with or lives in a location where there has been a cluster or outbreak announced in the past 28 days 

There are several entities like congregate living facilities where regular testing of employees and residents is conducted to prevent and slow the spread of COVID-19.

HCP: What are the two different types of COVID-19 tests and what do they entail?

MB: Currently, there are two tests that are widely used – 1) PCR/molecular test and 2) Antigen or rapid test. Both tests are administered by a nasal swab. The PCR test is administered and then sent to a laboratory to process the results. The antigen test results are known within 15 minutes but should be “backed up” with a PCR test if the antigen test is negative. This is because the antigen test can give a false negative so additional testing is recommended to ensure better accuracy of results. Antigen tests are recommended for individuals who are symptomatic or where there is widespread transmission in a community or setting. 

HCP: What are the different results a person can receive from COVID-19 tests such as positive, negative, inconclusive, etc.?

MB: Someone can test positive, negative, or inconclusive. If someone tests positive that means the COVID-19 virus has been detected. If someone tests negative, the COVID-19 virus is undetectable at the time the test was administered. When someone receives inconclusive results, it is recommended they be tested again. When someone receives a test result (positive or negative), it is important to note this is a point in time result and only reflects a snapshot of time. It does not mean someone may later test positive or negative. 

HCP: How long does it take to get results from a coronavirus test?

MB: Currently, most tests result in two to four days. The North Carolina Department of Health and Human Services (NCDHHS) provides updated information on testing turnaround times (link here). 

HCP: Are certain people more likely to get COVID-19 than others and who are they?

MB: COVID-19, like other viruses, can infect anyone. There are individuals who are at higher risk for severe illness with COVID-19 and those are individuals 65 years and older or those with underlying health or chronic conditions like asthma, high blood pressure, etc. 

HCP: What are the step-by-step follow-up quarantines and treatment measures the APP HealthCare takes once a person tests positive for COVID-19 in the counties it serves or at one of its medical facilities?

MB: As the public health agency providing quarantine and isolation guidance through our AppHealthCare region, once we receive notice that someone has tested positive for COVID-19, we reach out to them to instruct them to isolate and complete a case investigation. This is an interview with a trained public health worker who simply asks questions to identify where others may have been exposed.

One of the primary purposes of this investigation is to determine who the known positive individual has had close contact with. Close contact is defined as 6 feet or less for 15 minutes or more (cumulative 15 minutes). Once the close contacts are determined, we reach out to those individuals and instruct them to quarantine for 14 days from the last date of exposure to the known positive individual. 

HCP: How long does Covid-19 immunity last after a person afflicted with the disease has recovered from it?

MB: We are still learning about COVID-19 and any immunity someone may or may not have against reinfection. At this time, someone is not believed to be reinfected with COVID-19 within a period of 90 days after their latest infection. This doesn’t mean they are immune to COVID-19, just that they are not thought to be infectious to others during that 90-day time frame, though they may become ill after their initial infection.

A return to activities usually consists in meeting current recommendations of having ten days from the beginning of symptoms or positive test, improvement in symptoms, and no fever for 24 hours without fever-reducing medicine. A negative test is not generally recommended to return to activities as someone may still have detectable virus in their system long after they are infectious to others. 

HCP: COVID-19 can create severe and long-lasting physical medical problems on those it afflicts. Healthcare professionals are working feverishly to treat it successfully, while medical scientists and researchers are doing the same to find a vaccine to successfully combat it and stop people from being afflicted with it.  In what ways are your health departments’ staff members providing help to COVID-19 patients with any mental anguish they may develop because of being diagnosed with the disease?

MB: We know that this pandemic has taken a toll on individuals’ mental health, regardless of whether they physically get sick or not. It is important to take care of our mental health. There are things we can do to take care of our health which includes eating a healthy diet, getting physical activity regularly, managing chronic diseases, staying connected with family and friends, and finding ways to manage stress, to name a few.    

HCP: Coronavirus has often been compared to Influenza (flu).  In what ways are they similar and different?

MB: Again, it is important to note that we are still learning about COVID-19, but there are similarities and differences to the flu. Both COVID-19 and flu are respiratory viruses so they are spread in a similar way and can affect someone’s respiratory system which can present as difficulty breathing or shortness of breath. Some of the symptoms associated with COVID-19 are the same as the flu. The CDC outlines similarities and differences of COVID-19 and the flu at this link: (see link here).  

HCP: Can a person develop both COVID-19 and the flu during the same time span?

MB: Yes, it is possible to have both viruses at the same time. As we get further into the flu season, we will closely monitor flu and COVID-19 since the symptoms are similar and we don’t want to overwhelm our healthcare capacity with both viruses at the same time. In order to prevent flu, we encourage everyone to get a flu vaccine this year. By consistently practicing the 3Ws (wear a face covering over your nose and mouth, wait at least 6 feet from others and wash your hands or use hand sanitizer), we can slow the spread of COVID-19, flu and other respiratory viruses. 

HCP: It has been said that by some that COVID-19 is just a hoax or it is politically motivated to help defeat Donald Trump as President and will go away if he is elected as President on November 3rd.  Doctors, medical scientists and other healthcare professionals have repeatedly warned that the virus is real, not a hoax, and that the election has absolutely no ties to COVID-19.  What response would you tell those who may think that Coronavirus is still a hoax, not as serious as the medical professionals and the media may state and/or that it is politically motivated?

MB: This virus is real and is affecting people each and every day. We have had multiple people hospitalized or even die due to complications of this virus. We live in a world where infectious viruses and other diseases are a part of our daily life and now COVID-19 is a part of it. This pandemic has made it more apparent than ever that each person’s health is affected by the community as a whole and in order to slow the spread of this virus, it will take all of us.

HCP: In what ways is the App HealthCare working to better educate people about COVID-19?

MB: AppHealthCare workers have been providing education to the community throughout this COVID-19 response effort. We have bi-weekly calls with county stakeholders to provide a platform for discussing current guidance and ensure there is a dedicated time for Questions &Answers for partners. We have been publishing a COVID-19 situation update that includes key points and current data as it relates to each county (Watauga, Ashe and Alleghany). This report is published on our website weekly. We continue to provide education through our social media channels (Facebook and Twitter). 

HCP: Do you have any other comments you would like to add?

MB: We are witnessing increases in COVID-19 cases locally and encourage everyone to consistently practice the 3Ws, maintain good hygiene, regularly clean and disinfect surfaces and avoid large gatherings or parties. These actions help to prevent and slow the spread of COVID-19. As we get into flu season and have COVID-19 circulating as well, we urge everyone to be diligent, show your love and take actions to reduce your risk of exposure to these viruses.