♪ Welcome to This Week in South Carolina.

I'm Gavin Jackson.

Two weeks into the year 2022 and COVID-19 cases continue to break records.

Tonight we talk with SCDHEC Director Dr. Edward Zimmer and Prisma Health Dr. Steve Shelton, about the current wave of the coronavirus, testing capacity and new CDC guidance.

But first, here's more from this week.

The first legislative week of the year started with Governor Henry McMaster outlining spending priorities in his budget, which includes $3 billion more for lawmakers to appropriate with and $2.5 billion dollars in American Rescue Plan money.

<McMaster> These funds that are here now - and this is a lot of money coming from the federal coffers that of course ultimately comes out of our pockets.

We have to pay this money back.

We have to be careful that we spend it on the right things.

But the good news is because of the way that our people responded to the pandemic... We did not close.

We were careful.

We were measured.

We are not digging out like they are in a lot of other states.

So we have opportunities that they don't have.

<Gavin> The Senate gaveled in Tuesday under a new President, Senator Thomas Alexander.

<gavel pounding> >> The Senate will please come to order.

<Gavin> The Oconee Republican took over the top spot after his predecessor, Harvey Peeler, stepped down to become Senate Finance Committee Chairman following the death of Senator Hugh Leatherman in November.

The Senate focused debate this week on certificate of need legislation, which deals with the regulation of medical facilities.

Republican leader Shane Massey and Democratic leader Brad Hutto expect redistricting and medical marijuana to be priorities in the coming days, as well as education.

>> In-school learning is the best learning and we got to get back to that.

And we've also... we've lost teachers due to the pandemic.

We've got to talk about teacher retention, recruitment, training of new teachers, teacher pay raises, those things that we need to make sure that we get our children back in school with qualified teachers in front of the classroom.

So if you asked me what needs to be done, that's got to be done.

I mean, here we are recruiting world class industries to South Carolina, based on the fact that we've got a workforce in the pipeline, if we don't get the K through 12 right, we don't have the workforce in the pipeline.

<Gavin> In the house, the Judiciary Committee approved its proposed congressional map, redrawn based off of 2020 census data.

>> We believe that the plan the ad hoc committee has put forward to you is a necessary next step to achieve the fundamental constitutional goal of equality in voting and is in accordance with the guidelines and criteria adopted for this redistricting cycle and complies with the United States Constitution, the South Carolina Constitution, as well as federal and state law.

<Gavin> But Democrats weren't thrilled with it.

Specifically, the attempt to make the first congressional district less competitive.

>> What we did...was move all the black people out of Congressional District One that are in Charleston County, and pack them into the sixth congressional district.

<Gavin> The Senate will mesh that proposed map with its version next week and return it to the House soon after.

Joining me now to discuss the latest on COVID-19 in our state is DHEC Director, Dr. Edward Simmer.

Dr. Simmer, thanks for joining us.

<Dr.

Simmer> Thanks for having me.

<Gavin> So Dr. Simmer, we're in the middle of a surge right now, I want to get you to just give us clear guidance on what folks should be doing if they've been exposed to COVID-19, if they've come into contact who's been exposed to COVID-19.

What should they be doing when it comes to testing, quarantining and possibly isolating?

<Dr.

Simmer> Sure.

So there's a difference between quarantine and isolation.

Quarantine is what you do when you've been exposed, but you don't know that you have a disease.

Isolation is what you do when you've actually tested positive; you have COVID.

So let's talk about quarantine first: Quarantine, it depends on whether you're what we call maximally vaccinated or not, if you're maximally vaccinated, and by that, we mean you've had either the two doses of the Pfizer or the Moderna vaccine, or the one dose of the Janssen vaccine, and if you're eligible, you've also had the booster, that which only means five months after the two dose vaccines or two months after the Janssen vaccine.

So if you've had all that, you don't have to quarantine.

So if you have all the vaccine that you're eligible for and you're exposed, you don't have to quarantine.

However, you should wear a mask 10 days and get tested on about day five.

And certainly if you start developing symptoms of COVID then you should isolate until you've been tested and know that you're negative.

But in general, for the maximum vaccinated folks, quarantine is not required.

If you're not maximally vaccinated, then you should quarantine for five days, get tested by day five, and then if you're negative, you can go back to your normal life.

And if you, of course, also have no symptoms, but that's the key thing: no symptoms, negative test on day five, then you can end the quarantine.

For those who actually have COVID, then that's what we call isolation.

For isolation, you should stay inside, stay away from others for five days, and get, you know, obviously get treatment if you need it.

If you start to become seriously ill, you'll want to seek treatment, talk to a provider.

The other thing with isolation is once you have no symptoms, you can come out of isolation after that fifth day, but you should wear a mask for a total of 10 days.

So it's really... for isolation, no symptoms and at least five days after either your positive test or you started to have symptoms, and wear a mask for a total of 10 days.

<Gavin> And Dr. Simmer, when people are quarantining waiting for a test result, they should also stay away from folks and be masked at all times too?

<Dr.

Simmer> Yes, that's correct.

<Gavin> And then when it comes to if you do test positive, a lot of people are wondering, do I have to wait until I get a negative test back; until I get back to normal essentially?

Or is it once, you know, a day after or two days after maybe symptoms subside?

That's when I know maybe I'm not as infectious and I can kind of get back to life as normal.

What's what's the best rule of thumb there?

<Dr.

Simmer> You don't have to get retested.

What you should do, though, is wait five days.

If you've had COVID, you should wait until five days after you have no symptoms.

<Gavin> And but, you know, you see some people saying "I get this test" or "I've gotten some sort of antibody test" and they say, "I still have a very big viral load when it comes to this."

Is that really indicative of really how infectious someone is?

Or is it just what's in your system right now; maybe you're not as infectious.

<Dr.

Simmer> Really, we don't know for sure, using the test, what an appropriate viral load is.

So really, the test is either positive or it's not.

And again, it's really up to symptoms and duration.

So once you've been five days without symptoms, that's what counts, not the test at that point.

So you don't have to get retested, so if you had a positive test, and you had no symptoms, you should isolate for five days.

And then if you're doing well, wear the mask for total 10 days, but you can go out after day five.

<Gavin> Dr. Simmer, when you hear people say, "Oh, the vaccines aren't effective," or "What's the point of getting a vaccine if everyone's getting these breakthrough cases?"

What do you tell people, when you hear that?

<Dr.

Simmer> I tell people to look at the data.

You know, there are breakthrough cases.

And there are more breakthrough cases with the Omicron variant than we had with the earlier ones.

However, you're still much less likely to get COVID if you are maximally vaccinated.

Also, I think, very importantly, the vaccines are very effective at preventing people from being hospitalized or dying from COVID.

There are still a few folks who do unfortunately, you know, get hospitalized or die from COVID who've been vaccinated, but the risk is much less than those who are unvaccinated.

So what the vaccine is really good at is protecting you from severe illness.

<Gavin> And what about the role of natural immunity or if someone's already been exposed or had COVID before?

Even if it was, you know, recently, or, you know, maybe it's sometime last year?

How does that mesh with what's going on here?

<Dr.

Simmer> So natural immunity is generally thought to be protective for about 90 days.

After 90 days, natural immunity starts to wane.

Now, that's not to say you don't have some protection after that, you probably do, but it's not as good as being vaccinated.

So we tell folks, you know, even if you've had COVID, you know, as soon as you're out of isolation, go ahead and get the vaccine, because the vaccine will boost your immune response, it will give you better protection.

So yes, for the first 90 days, you're pretty well protected after you've had COVID, but we still tell folks to get vaccinated.

And certainly after that 90 days, your risk is going up if you don't get vaccinated.

<Gavin> Well, Dr. Simmer, let's talk about testing on this Omicron wave.

I'm assuming we're expecting a seasonal surge anyway, with the holidays like we did last year.

That was our roughest time last year going into the holidays after those as well.

And then, I'm just wondering, why DHEC maybe didn't ramp up the testing, when it expected not only to have a seasonal jump, but then we got word that the Omicron was here.

And now we're finally seeing, you know, eight lane testing facilities in Columbia, at least.

And you know, the turnaround times are still very long to get these results.

Was DHEC prepared for this wave?

<Dr.

Simmer> We did ramp up our testing, knowing that the holidays were coming.

We didn't ramp it up enough.

We didn't fully foresee how bad Omicron was going to be.

So we did increase our testing.

And the other issue is there's only so much testing available.

So we certainly did buy additional tests, add additional testing sites, we continue to do that, you know, we're up to over about 320 testing sites now.

As you said, we're opening up some large testing sites, for example, at the mall in Columbia, and so we're doing everything we can to boost both the testing availability, and also the speed of getting results back, which we know is very important.

You know, a part of that, too, is we're buying a lot more at home tests.

So, you know, if you're waiting in line, you may well see somebody coming along the line and offering you an at home test that you can administer to yourself at home or to your family, and get results that way.

So we are certainly doing everything we can, we just are in the process now of buying an additional million, what we call 'point of care' tests - tests that are administered at testing centers.

But certainly, we did not fully anticipate the volume that we got, especially around the first of the year, we did have some very significant backups.

We also had one of our contracted labs, because most of our lab testing for COVID is done through contracted labs, we had one that fell very far behind, both because they had some folks out with COVID and I think they weren't quite ready for the volume either, and they didn't tell us that as quickly as we would have liked, and so we're working through that backlog.

You know, so we've done a couple of things related to that: we've moved more tests to other testing companies that are better able to manage the load.

You know, and what we're advising folks is if it's been about a week, and you still haven't gotten your results, and you've got symptoms, get retested.

And obviously, we hate to ask people to do that, and we apologize for the delays, but that's really the best thing.

If you haven't gotten your results, you still think you may be symptomatic, go ahead and get another test.

<Gavin> When we talk about testing and these case numbers, I mean, they're just extraordinary.

We had 87,200 cases last week.

The week before we had 52,300.

You know, just breaking records back to back.

Deaths are still lagging.

Of course, that's what happens in this situation we've seen, but based on the data you're seeing right now, where are we in the surge, and what does that death data suggest to you at this point?

Are we still in the thick of it?

Do you think maybe things are maybe plateauing at some point?

How do you see this data?

<Dr.

Simmer> You know, we have seen a bit of a downturn from the record high numbers we were seeing last week.

Now whether that's really going to continue, I think we have to wait and see.

You know, I think where we are right now is probably near the peak or at the peak.

And based on experience elsewhere, South Africa, the United Kingdom, where this really started early, or even some states that had it earlier than South Carolina, it does seem like, you know, after three to four weeks of peaks, then it drops down pretty quickly.

So we're certainly hopeful that's going to happen here in South Carolina.

You know, my hope is that although we won't be back down to where we were, say in June of 2021, that we will be doing much better, even by the end of January.

And certainly into February, I think we'll see the numbers declining.

Now, the other thing we've noticed with Omicron is that although certainly people do get very seriously ill and can die from the Omicron variant, it's not as severe on average as with the Delta variant we had before.

You know, so you're right, the death numbers are lagging.

I think we will see some increase in deaths, unfortunately, but I'm very hopeful it won't be nearly to the degree that we had last fall.

<Gavin> Yeah, that's when we really didn't see that surge, I think of about maybe 480 was our peak.

And right now we're - per week and right now, we're around 100.

So, nothing really spiking at the moment like you're saying, but Dr. Simmer when we look... at the latest on treatments too, you know, a lot of these people in the hospitals are unvaccinated, talk about treatments and the availability of those treatments right now, when it comes to hopefully saving some of these people's lives.

<Dr.

Simmer> Sure.

So, you know, one of the challenges with Omicron is that we talked a lot about monoclonal antibodies with Delta, and they were very helpful.

And there were three different ones that were available.

Unfortunately, two of those, regen-CoV and BAM/ETE are their names don't seem to work very well against Omicron.

The third one Sotrovimab does.

And we do have, about ...we got - we treated over 700 people with Sotrovimab just in the past week.

We continue to get supplies of that... that comes to us from the federal government.

We got 450 doses last weekend, where we anticipate getting significantly more about 750 this coming week.

So, that's good news.

So, that is available.

We have 41 different sites across the state, mostly hospitals that do offer that.

You can certainly go to our website and find where those sites are, but you know, presumably, if you're getting that, you're seeing your doctor and your doctor should know where those are too, and if they don't, your doctor can call us and we will make sure that we route the patient to a site that has it available.

Other treatments, there are some oral treatments now.

Molnupiravir is available.

Paxlovid, which is probably a little bit more effective than Molnupiravir based on the data, but those are both available.

Those are available through Walgreens pharmacy, certain Walgreens pharmacies, and those have - You have to have a prescription, but if you've seen your doctor and your doctor thinks that would help you, those are convenient.

Like I say, you can take them at home, and have been shown to reduce the severity of symptoms in many patients.

<Gavin> ...Dr. Simmer, we have about two minutes left, I want to ask you.

The White House is sending military medical teams to several states right now.

We have about, 1900 people hospitalized, 57 in pediatric hospitals, too.

Kind of a worrisome number there, I think it is a record, but I want to ask you, how our state's hospitals are doing right now, and if we've ever requested any such assistance from the White House for such medical teams, and if we're fully staffed, how you see the hospital situation, right now with this surge?

<Dr.

Simmer> Great question.

We have not asked for one of those teams at this point, although we certainly are ready to, if we think we need it.

Right now our hospitals are managing the inpatient load, There has certainly been an increase.

But...we talk with the hospitals on a very regular basis, and right now from the inpatient side, they're managing the number of ventilators, we have, the number of intensive care beds we have is sufficient to meet the need, thankfully.

Where we're really seeing a problem more is in the emergency rooms and the urgent care centers.

We've had a lot of folks go there for testing.

We ask folks to please don't do that.

Please don't go to an emergency room or an urgent care center unless you're actually ill and need that level of service, because that's where we're really seeing the problems in terms of getting people taken care of.

The other thing I would note is that, you know, we do have the National Guard available.

We have some National Guard troops deployed right now supporting the effort, and certainly have the ability very quickly to get more if we need to.

<Gavin> Gotcha, and really quick, doctor, just your advice right now to folks watching at home.

<Dr.

Simmer> If you're not vaccinated, get vaccinated.

If you're eligible for the booster, get that as soon as you can.

Wear a mask, socially distance.

...I would avoid going out into big, large public events that you don't need to.

Right now, I think if we take the appropriate precautions now for the next few weeks, I think by February we'll be looking a lot better.

So, we just need people to get vaccinated, wear the mask, socially distance, and we'll get through this.

<Gavin> Great.

That's DHEC Director, Dr. Edward Simmer.

Thanks for joining us, sir.

...thanks to everything you guys do over there, do at DHEC.

<Dr.

Simmer> Thank you.

>> For a look at how hospitals are handling the surge, I'm joined by Dr. Steve Shelton.

He's an emergency medicine physician at Prisma Health and the hospital's incident commander.

Dr. Shelton, thanks for joining us.

>> Glad to be here.

Thank you.

<Gavin> So, Dr. Shelton, we just talked to Director Simmer over at DHEC.

The state is in the thick of this surge, right now.

What's it like where you're at, in Prisma Health in the Midlands and just, if you can give us an idea about system wide what it's looking like?

<Dr.

Steve Shelton> Certainly!

We are feeling the effects of this Omicron surge.

Omicron is moving through our communities like wildfire, and with the volumes of patients out in our community, you can imagine some of those are requiring hospital care.

We've actually just reached our peak and passed our previous records over the past two years of numbers of inpatients that we're seeing.

>> What's...that peak like?

What's it like, right now?

<Dr.

Steve Shelton> The peak is within our system at Prisma Health.

We're a little over 550 patients.

Within the Midlands, we're at 225 in-patients in our facility.

It is a little bit of a unique surge that we're seeing.

In the past we've had very intensive amount of intensive care unit patients, much heavier use of ventilators, in that.

This one seems to be a little lighter, as far as the acuity.

We're not seeing as many ICU patients, but we're still seeing a large number of patients that still need support in our basic care areas.

<Gavin> So when you're talking about this strain, how do you address it?

Are you reaching a point where, you know, you're at capacity?

Are we close to that point?

<Dr.

Steve Shelton> Capacity is an interesting, interesting question.

Capacity, relying on bed space.

We have bed space.

The challenge that we see at this point is staffing.

As you can imagine, the rapid spread in the community has also affected our staff.

So, we have a fairly large number of team members who are also sick.

So, that does make it difficult to staff all the beds that we currently have.

So, we're actively working on processes to make sure that we can provide the proper care, we can manage our team members who either are sick or had exposures to make sure that they properly quarantine, but get them back to duty as soon as we can safely do that, provide care for our patients.

<Gavin> So, when you talk about that with capacity, are you able to have any more patients come to the hospital?

You're out here in the Midlands, or, what's that look like maybe where you are specifically?

<Dr.

Steve Shelton> Yes, we are still able to manage patients we've been able to manage and take care of the ones that we receive.

Now sometimes there's difficulty with movement of patients in the system being that, admitted patients may be held in the emergency department longer than we'd like.

We recognize that waits to be seen in the department may be longer than we like based on some of that, but we are still providing the care that our community needs.

>>...Dr. Can you kind of give us a typical day.

...you were telling me a moment ago that you were working till one in the morning.

You got back in the office earlier today.

Is that typical for you?

What are you and what are some of these nurses and doctors on the frontlines experiencing day to day?

>> Certainly, our team members have stepped up.

As we mentioned, staffing becomes an issue when we have a large number of team members that are sick.

So our team members have stepped up, we have plenty that are working extra, picking up extra duty to make sure we cover for those individuals who are not currently able to work and are isolated due to illness.

So, team members are actively doing that.

This has been a marathon as I often describe it at sprint pace.

So, we actively have to watch our teammates to make sure our team members to make sure that they're okay.

But they have stepped up.

The big request or the big concern that's really concerning for us in the health care system are the number of individuals that are unvaccinated.

We love to provide care for folks.

we want them to get better.

But we also recognize that this is a treatable disease.

Vaccination has been shown to decrease the acuity or the severity of an illness, as well as the decreased risk of hospitalizations.

With our system.

roughly 80% of the hospitalized individuals are unvaccinated.

So, that's kind of stressful on some team members knowing that we continue to care for individuals who likely could have been kept out of the hospital with a simple vaccination.

>> Is it frustrating for you and medical professionals to see these folks who are unvaccinated who are essentially shunning one form of medical science and then accepting another form by coming to you all for a treatment?

>> It is difficult.

The vaccination process has been proven safe.

We've obviously across the country and the world administered millions of vaccinations, and there have been minuscule amounts of side effects or complications due to that.

However, we have seen the definite effects of COVID response and the illness and long term issues that we have seen for a lot of individuals that are sick.

So, we are frustrated by those who choose not to be vaccinated.

And it does create a stress on our healthcare system.

>> And when you talk about, you know, seeing the peak so far, do you expect things to go higher at any point or...are they going down?

Or what do you expect hospitalizations to do at this moment right now, like we said, 2000, folks, statewide, not just Prisma, but statewide, all the hospitals are hospitalizing COVID-19, right now?

What's it like when it comes to where you guys think things will go?

<Dr.

Steve Shelton> Within our system, we're continuing to rise.

We have heard that some of the cold weather states, the northern states are starting to see a peak.

But for us, we're still currently on a rise, there are still significant outbreaks.

With the testing, we are still seeing high percentages of numbers of positivity, as much as one in three positive patients that are positive that are tested.

So there's still a lot of disease in our community.

We anticipate we will continue to see some rise.

<Gavin> And Dr. Shelton, we were talking about staffing.

...I've heard some reports from different places about folks having to go to work sick is that the case at all in Prisma Health, to your understanding?

<Dr.

Steve Shelton> It is not in our system.

We have a very active employee health program, who evaluates all of our team members to make sure it is appropriate to return them back to care.

The CDC did make some additional guidance, we do have some flexibility, if we reach crisis mode, there is...opportunities to ask individuals to work who are potentially sick, but we are not doing that within Prisma Health at this point.

They're actively being evaluated, making sure they meet their isolation periods, and once they do, and are approved, able to return back to work safely.

<Gavin> Are you worried that you might reach a tipping point, at some point?

<Dr.

Steve Shelton> There's always that worry.

I, as an emergency manager always have to assume the worst and hope for the best.

So, we're preparing for those situations if necessary, but at this point, we're optimistic we're working through this effectively.

We've got a lot of team members that are very engaged, making sure that we can provide the community what they need.

<Gavin> ...Dr. so staffing isn't an issue.

What about supplies?

Do you have enough masks?

Do you have enough gowns, and what about treatments and therapies for folks who are hospitalized?

<Dr.

Steve Shelton> As far as the specific supplies for in house, the personal protective equipment, the number of ventilators, the number of oxygen devices, we have a good supply.

Our logistics group has been very active from the beginning here and placed us in a very good position.

Now, nationwide, there is a shortage of some of the treatments that are out there.

There is a newer oral medicine that has been provided for treatment, and there are very limited supplies in South Carolina.

In addition to our workhorse for some prevention, the monoclonal antibodies and we've been very active in the use of those in the past.

The two workhorses, specifically the products from Eli Lilly and Regeneron are not effective against Omicron.

There is a third product that is available, Sotrovimab.

which has been proven effective and we have diverted completely to using it.

But as a reference, we only received 48 doses of that within the Prisma Health, Midlands to administer over the next week, so we have very limited supplies of that.

We have made an upgrade.

The National Institute of Health has authorized what was an in-patient treatment called remdesivir, which is an anti-viral medicine to be used as outpatient for a three day infusion.

And we actually started doing that, to provide a gap to make sure we can treat as many folks as we can.

But, to give you a reference, in our infusion center, we get about 60 referrals a day for that treatment, and we roughly only have 10 to 15 doses a day, we can allocate.

So, that is a large number of individuals, we've had to turn away and we've not had to do that in this disaster yet, or this pandemic.

<Gavin> So, with that being said, Dr. and 30 seconds left, tell me what you want people to know about what's going in hospitals and this pandemic, at large.

<Dr.

Steve Shelton> At this point get vaccinated that will be a major impact not only for this surge, but potentially future surges.

Testing is important, but we do ask that you not present to our emergency departments just for testing.

There are active sites in your community DHEC has a great local testing locator site.

The other thing is use those things that have protected us in the past, masking, social distancing, and hand washing will help us get through this.

<Gavin> Very good.

That's Dr. Steve Shelton.

He is an emergency medicine physician at Prisma Health and the hospitals' incident commander.

Thank you, Dr. and thank you to all those medical professionals right up there on the frontlines dealing with this virus.

Thank you so much.

>>Thanks for sharing our story.

>>To stay up to date with the latest news throughout the week check out the South Carolina Lede.

It's a podcast that I host twice a week that you can find on South Carolina Public radio.org or wherever you find podcasts.

For South Carolina ETV, I'm Gavin Jackson.

Be well, South Carolina.

♪ closing music ♪ ♪