- We are entering the most concerning and deadly phase of this pandemic, leading to increasing mortality that just days ago from Deborah Birx, coordinator of the White House Coronavirus Task Force.

"We're in for a whole lot of hurt.

It's not a good situation," said Dr. Anthony Fauci in a recent interview.

"All the stars are aligned in the wrong place as you go into the fall and winter season.

With people congregating at home indoors, you could not possibly be positioned more poorly," Fauci continued.

COVID cases are surging nationally in Texas and in the Permian Basin, just as we enter into the holiday season, hoping to spend it with family.

But tonight we ask, "Can we safely gather at Thanksgiving?"

I'm Becky Ferguson and this is "One Question."

(dramatic music) Can we safely gather for Thanksgiving?

Tonight we talked to the experts.

Two men on the front lines of the COVID battles in the basin.

We'll also visit with a professional counselor on strategies for coping with our changed celebrations.

But first, Dr. Larry Wilson is vice president for Medical Affairs at Midland Memorial Hospital.

Dr. Rohith Saravanan serves as chief medical officer for Odessa Regional Medical Center.

We have come to look to these gentlemen and count on them in the months since COVID became a part of our lives.

Welcome, thank you all so much for coming.

- Thank you for having us.

- I wanna start off by just asking how are y'all?

- In Midland, I think our medical staff and our hospital staff are a little tired, but they're very resilient.

This isn't the first time we've been through a spike and we are going through a spike currently.

And I think people have learned from prior experience how to sort of be in it for the long haul, sustain and make their way through it.

So I think people are doing well, but they really would like this to be over.

And it's not gonna be over too soon.

- Yeah, I think we're in the same situation in Odessa.

I mean, we look at our region as a whole and our three hospitals, Midland Memorial, Odessa Regional, and Medical Center are sort of regional accepting hospitals for a lot of the counties surrounding us that look to us to take care of their patients.

So we're at a point now where our hospitals are starting to get full and we are struggling to get those patients in to provide the level of care we need.

So it's time for all of us to try to curb the spread and prevent this from getting any further than it is.

- Well, you've already gotten to my next question, which is how are we doing in the Permian Basin with regard to COVID?

- I think in the last two weeks, it's been spiking dramatically in West Texas and in the Panhandle in our area.

I don't recall a time in the past where our hospitals that we refer to have been on diversion as much as they've been on diversion lately.

- [Becky] And tell us what you mean by diversion.

- Unable to accept patients that we have to transfer to them.

We as was mentioned, we are accepting hospitals for surrounding smaller hospitals all out throughout the region.

And we do that willingly and gladly to, you know, to support our region.

But there are some patients that are more complicated than our size hospitals can manage.

So we lean on Lubbock University Medical Center or Covenant Hospital.

And in other cases we might go to Dallas and other areas like that, and many of those hospitals have been on diversion as well.

So we're reaching farther and farther and being more creative in trying to help make sure we get patients to us, number one, but then also get them from us 'cause when those places fill, we're receiving patients.

We currently have in our hospital now, patients from the Panhandle, Dumas, et cetera.

Have patients from Bryan, Texas in East Texas.

- Wow.

- From all over Texas because when they start reaching, they go concentrically farther and farther away from themselves until they find a place that can accept them.

And so we in, as long as we could, we continue to accept patients, but we've been on diversion quite frequently in the last week ourselves.

- Yeah, even as far as patients from New Mexico, there was a call that came in even from Tennessee for transfers, so it's, everybody is somewhat overwhelmed.

There are two metrics I think that really help us understand where we are in this pandemic, especially in our region.

The two metrics that we follow are the positivity rate.

If you take a number of tests that were done and how many tests are positive, that's one, and the other is the hospitalization rate.

What percent of our operational beds are filled with COVID-related cases.

So the positivity rate we look to be under the 5% range to call it reasonably well controlled.

We are now at 30 plus percent for positivity rate.

That means one in three people getting the test are positive and that just puts it in perspective.

And then the hospitalization rate, we like it to be under 10% or so, so we can manage our hospital's capacity to care for all the other medical conditions that we don't talk about as much anymore because of COVID.

But COVID-related cases has taken about 15% or more of our hospital capacity.

To a point where we're having to go on diversion and say, "We can't really accept any more because we want to have the capability to take care of even the other medical conditions that walk in."

So those two metrics are important for us to follow and to try to get under control.

- Are the metrics similar for Midland?

- Ours are a little worse actually, our positivity rate is very similar.

Now, on top of that, we are currently, at our testing center, we're testing only patients that have symptoms or a reasonably high risk of an exposure.

So it skews your numbers a little bit, but similarly we're over 30% positive the last several days.

Our census of patients in our hospital for this time of year has never been so high with both conventional patients, as well as COVID patients.

And the number of COVID patients is over 25% the last several days.

So we, we are well beyond the, I think you may be aware that the governor had put out some expectations around numbers of patients, that if you're exceeding, I want to say 15% was it, 15% of your patients are COVID, then it's time to start locking down and being more protective about what you're doing.

And we've been exceeding that for the last couple of weeks regularly, and it doesn't seem to be getting any less.

- Which brings us to the question of the day, can we gather safely for Thanksgiving?

- Right.

So there was a very good article by an infectious disease doctor giving some guidelines for people trying to travel and go home for the holidays.

And if you read through them, they're rather restrictive and you know, really I'd call it draconian, you know, in terms of what must be done.

Almost to the point of being unrealistic for people to actually follow them.

But it gives you perspective on how big a risk this is considered to be.

If you have somebody that doesn't live or cohabitate with you regularly coming into your home, they should be treated like a stranger.

If they want to minimize their risk, they should cloister themselves away from others for a week or two before they even travel, wear their mask and all the other protection while traveling.

Interestingly, air travel seems to be relatively safe compared to getting a bunch of people in a bus or a car because the HEPA filters, you know, the high efficiency filters that they have on airplanes and the circulation of the air is pretty protected and they're having people mask and stay separated.

So the travel itself is probably not as much of a problem as what you're bringing home with you.

And we're accustomed to getting together for holidays and everybody's a family, we're close together and we're socializing in close proximity to one another and we don't treat Uncle Joe or Aunt Sue as though they're a stranger.

But unfortunately, under these circumstances we should, or we're gonna be spreading more and more.

This has been very well-recognized in the last several weeks that small gatherings are a large producer of the high positivity rate that we're experiencing currently.

- Yeah, that's, that's exactly right.

The gatherings, the social gatherings are what is coming out in the, in the world, in our country as the super-spreaders.

You know, that word is used more for bigger crowds, but those small gatherings is really where COVID is being spread.

So for Thanksgiving specifically, we as human beings, we wanna share joy, we wanna share company, we wanna share food and we wanna feed our family, we wanna feed our friends, it's all instinctive.

And it's important that we figure out how to use those instincts in a safe manner during this holiday season.

We have enough evidence from several different cull holidays that have passed since the beginning of this pandemic, to know how it can be done safely.

For example, when we talk about Thanksgiving, there is always a possibility for us to get together remotely.

To share food and be able to enjoy that remotely.

If we need to get together in person, then we can maintain six foot distance.

We can keep our masks on and we can still share that time together.

Those are the things that I think, even the CDC will put out enough of those guidelines to look at and to say, "Okay, how do you celebrate safely?"

And those things are out there that we can look up and everybody can be able to celebrate Thanksgiving.

- And I think we frequently talk about how being outdoors is safer than being indoors.

- I hope that the Thanksgiving period is warm weather so that people can have their gatherings outdoors, that would be much safer.

- I also read there's been a big surge in the sale of outdoor heaters.

- Ah, good.

- Folks are in fact, Dr. Fauci talked about how he had gotten an outdoor heater to put on his porch to maybe share a meal with his next door neighbors, not his daughters.

We've been at this for quite a few months, and I know that folks are getting what they call COVID fatigue.

And I think that means we're dropping our guard.

So can you talk a little bit about that?

- Sure, and it's been a long time.

All of us want it gone, no question about it, but you've heard this message so many times over and over and until it actually personally affects you or your family doesn't feel as real.

I've used this before.

It's hard to feel like you're saving the world when you are sitting on your couch and watching Netflix.

And I have said that before because that's what we expect you to do, actually help save the world is sit at home on your couch and not go outside.

I mean, get exercise, et cetera, but the fatigue is a real problem right now.

The important message to give now is that there is hope, and there is light at the end of the tunnel and we can see it.

You know, a vaccine is what we look to to say, "How do we get control of disease burden in our community?"

And that's out there and it is going to be coming to us very soon.

We just don't know the exact timeline yet.

We want it to be safe, we want it to be effective, we don't want any other motivations pushing the vaccine out, but that is coming.

And so if we can hold on until then and follow through with these precautions, we will come out of this tunnel looking a lot better than if we all get sick and there's multiple deaths and there are so much hospitalization and there is stress to the healthcare system, not being able to care for the other disease processes that all too exist, so.

- I've noticed among some of the folks that I know that there is a feeling that if I haven't gotten it so far, I must be immune.

- Right.

Yeah, I think there's a fundamental issue with this virus and it's been a wily virus, there's no question about it, but it, 80% of the people that get this virus are gonna have minimal to no symptoms, but they can still be spreading the infection.

And if somebody is fortunate enough to not get very sick from the virus, they may then walk away saying, "It's not that big of a deal, people are overdramatizing it, they're making a bigger deal out of this than it really is."

But you can talk to anybody who's in healthcare and you can recognize that there's, of that total population that gets the virus, 15% of them get sick enough that they're going to end up in a hospital at some point in time.

And 5% or so end up in critical care units.

And that's a significant subset of that population.

And to give you a little bit of a perspective back in 2009, when we had the H1N1 virus, influenza virus, that many people consider to be one of the more lethal influenza viruses we've had in our country since the 1918 flu pandemic.

That virus had a fatality rate, when somebody was infected with it, of 0.02%.

This virus has a 0.32% lethality rate, which is something over 30 times more lethal than the H1N1 in 2009 was.

This very real, but if you don't get it in that context and you're not sick, or if you don't have a family member that gets really sick, it's easy to minimize it.

- Well, I also, in addition to the hospitalization rate and the death rate, there is a concern about ongoing damage for folks that get the disease.

And there seems to be sort of a randomness to it, that you don't know if you're gonna get it, where you feel bad for 10 days, which we would all take that, or you're gonna get it where you're going to have lifelong consequences.

Can you talk about some of those lifelong consequences?

- Sure.

I mean, as much as we know about it, we can, but mostly we don't and that's why we call it a novel coronavirus 'cause it's so new.

We don't know what the long-term consequence is going to be, yet.

We have seen several studies that come out in kids, in adults that have, you know, different things that go on with their heart and their brain and long-term effects, but it is still very unclear.

So nobody can put a finger on it and say, "That's what the long-term complication of this virus is gonna be."

So that is something important for us to follow, but we won't know that just yet.

And there is no way for us to predict how sick somebody actually gets.

You know, this might be actually a good time for us to also talk about viral load.

One of the things we talked about before was how to prevent yourself from getting exposed.

The best way to explain this to the community is to understand that what we are seeing now is that based on how much virus you get, you may or may not have severity of symptoms based on that also.

There's many other factors, but that is one of the factors we need to look at.

So when you look at exposure, we usually define that as about 15 minutes or more in a 24-hour period, cumulatively, within six feet of somebody who had the disease without some personal protection on like a mask.

But it's different when it's a 20 minute conversation with somebody where you're sitting outside at a coffee table and it's different when you have a household contact that coughs and sneezes on you right next to you in bed.

So there is a difference in the amount of virus you actually get.

So if the community can think about it in that sense and reduce the load of virus they would receive from any one person because of the asymptomatic carriers we talked about, 80% of the people not knowing that they even have it and they might not have symptoms.

It is important to treat everybody as if- - As if they do have them.

- they have it.

And so decrease your chance of getting much of that viral load and that's the best way to look at it when you talk about prevention of spread.

- I think the key point that he's making there, I think is an excellent one.

It's about time of exposure and the circumstances of exposure, as you alluded to, doing outdoor gatherings or being in a well ventilated environment, we're in a large studio here, we're sitting five feet, six feet apart from one another, this is a pretty safe environment to be in an unmasked.

If we were doing this for a profession and you're gonna be in your office for hours on end, I would be masked even in this setting because it just decreases, mitigates the risk of exposure to the virus.

- What are y'all's greatest fears going forward for the next couple of months?

- I think there's a couple, one is what you were just alluding to, this concept of, you've heard the terminology perhaps of long haulers or people that have recovered from the virus, but then continue to have ongoing symptoms for a long time.

And we don't know what those things are gonna mean or how long they're going to last, but speaking to our cardiology colleagues and our neurology colleagues, we're seeing cognitive deficits in people that are lasting for months and potentially for the remainder of their lives.

There's people that have recovered with a respiratory tract infection are lucky enough to get off of ventilators.

Once they've been on a ventilator, they're gonna have scarring in their lungs that's gonna be there, probably for the rest of their lives.

There's patients that have recovered from heart-related symptoms and they have cardiomyopathy or a diseased heart that could affect their ability to be as athletic or as active as they once were because of inefficiencies.

Again, we don't know, hopefully there'll be recovery from some of these things, but maybe, you know, maybe these are gonna be long-term things that people are going to have for a very, very long time.

The more important thing today is, as we've just been talking about, we are seeing quite a spike, we're seeing a burgeoning of things going on in our community.

And our hospitals are getting, really to the point where we're saying, "No mas," you know, we can't manage more.

I would love for all of us to acknowledge that this is real, that take the mitigating stance, take the precautionary behaviors, slow down the spread of the disease.

We're not going to stop it until we have the vaccine, but we can slow it down to a point that we can tolerate the amount of disease in our community without overloading our hospitals, overloading our resources to manage them.

- Thank you gentlemen so very much for coming today and for your tireless service to our communities, we really do appreciate it.

Up next, how might we shift our paradigms to make the most of our changed celebrations?

Bryn Dodd is a licensed professional counselor with Agape Counseling Services of West Texas.

Welcome.

- Thank you for having me.

- Thank you so much for coming.

We're talking about safely gathering for the holidays, for Thanksgiving if we can.

I read the other day that 27, only 27% of folks are gathering in the normal sort of traditional way.

So lots of us are making other plans and I'm wondering if you can help people sort of shift their paradigm so that it doesn't feel as sad to not gather with their families.

- Yeah, Thanksgiving and you got Christmas coming up, and those are really important times.

We look forward to those times throughout the year.

And so spending time with family is important and not being able to do that or not being able to travel and maybe do some of the traditions, it's going to be very difficult for people.

I think we all anticipated this was gonna be over within a few months and it's not.

And we don't have any concrete answers of how long this is gonna last.

And so it's really taken a toll on people's mental health in the way they see things, in the way they're thinking.

Something that, you know, in counseling we work a lot with is it's called cognitive reframing.

And basically that is just controlling your thoughts and emotions and focusing on something different than what we are focused on in that time.

And so human nature is that we focus on the negative, we find the negative in things, and that's just every one of us does it.

And so when we're reframing, we're stopping that negative thought or, you know, the doomsday thought, and we're replacing it with something different, a different positive outlook, and that's really what it is.

You know, when you talking about shifting your paradigm, it really is all about seeing things just a little bit differently.

And we can do that in a healthy way and still get through these holidays.

- I read one way of looking at it was instead of, "I don't get to see Grandmom this time, I'm keeping Grandmom healthy."

- Right.

- To be, just another way to sort of reframe not being able to, to be with your relatives.

- Yes, and I think focusing on that this is a temporary situation.

That this is not something that we're anticipating lasting, you know, several years, you know, physicians are actively working on a vaccine and people are making really great progress in that.

And so having the idea that this is temporary, and it's one season that we're going through, will help as well.

- I've noticed this as the disease continues that we're dropping our guard.

And a lot of people are starting to feel as if they are immune.

Can you talk to us about what's going on in our heads that make us think that that's the truth when it's not?

- Well, I think there's so much controversial information out, and social media is one of those, you know, social media's is great for certain things, but then it's also can be pretty damaging to our mental health and our thought process.

And so all of us are getting a lot of false information come through and conspiracy theories and things like that.

And then also, if you haven't been affected by the virus, or you haven't had somebody closely related to you affected by it, it might not be as severe to you as it may be to someone else.

But I think that people are tired of the virus.

I think, you know, they started out being very strong with supporting the mask mandates and listening to the CDC guidelines and our local physicians and think people are tired now.

And so that's the scary part is that people are not following the guidelines and they, you know, their mindset is that they're just kind of over this.

And so I think that's where we're kind of seeing some of the problems surface.

- Some virus fatigue.

We're also seeing, I think sadness and anger and depression.

- Yes.

- Can you tell me what you all are seeing at a Agape?

- Yeah, I think, you know, we always see some of those things, especially anxiety, but I think over the last six months for sure, fear and anxiety have been something that I think pastors are preaching on, tons of psychologists and counselors are writing articles about those for people.

So fear and anxiety is a huge piece of that.

And then, you know, throw in the isolating, not being able to go to work maybe face-to-face, or being around family, you throw in some depression with that.

During this time, people have lost loved ones and not been able to have proper funerals or memorial services or even be with that person 'cause they couldn't travel.

And so you have a whole lot that we're seeing.

One of the other dynamics is we're seeing is that a lot of people were working from home for long periods of time and they had kids that were doing schoolwork at home.

And managing and balancing their work and school and being around your family a lot more than you normally are, creates some tension in the home and some different dynamics.

And so we've seen a lot of people coming in for parenting issues and relationship issues through this.

- Have you counseled folks on strategies for celebrating the holidays in times of COVID?

- Yes, this is something that's definitely, throughout the last, you know, through the pandemic the last six months we've worked with people, we're now coming up on holidays, but people have been celebrating birthdays and anniversaries and things like that that have surfaced since this started.

And so, although we're coming up on our major holidays, this is something that people have had to deal with since March.

And so really just giving them outside of the box ideas.

I know that people are kind of tired of Zoom.

Most of us are doing work on Zoom and it was kind of neat at first, you could play around with it and have fun and I know people are a little tired of that.

But, you know, before this interview, I was really thinking about, you know, 20 or 30 years ago, what would we have done?

And we are really blessed to have the technology we are that we can see somebody and hear them while they're talking and that makes a difference, there is a connection there.

And so really shifting that thought process that, yes, it's not the same, we're not in the same room with them, but we can see them.

And we actually have some connection with them.

And, and you know, lots of people have been sharing ideas of what their plans are for the holidays.

And so getting together and doing meals outside, spreading tables out.

If you feel like you need to wear a mask, then let's be respectful and let's wear masks.

There's so many different ways that we can think outside of the box to still celebrate the holidays.

- Well, it seems to me you're telling us that we need to focus on what we can do.

- Yes.

- Instead of what we can't do.

- Yes, there's so much in this world right now that is out of our control.

And the one thing that we can control is our thoughts and our emotions, that's what we have control over.

And so if we can change the, the negativity and the way that we're seeing things right now, and focus on something that changes our whole mindset is gratitude.

And that goes right into Thanksgiving, gratitude is all about what we're thankful for.

And unfortunately, I think we have really focused on the things that are not important.

And so what is important during this holiday season?

It's really what we have and what we're thankful for.

And so if we can do anything that focuses on gratitude, whether it's writing a letter to somebody every week, picking up the phone and telling somebody how much they mean, even complimenting ourselves through a hard time, that's gratitude.

And it changes all of the chemicals in our system, it makes us happy, it changes that depression and anxiety.

There's studies that show that gratitude really changes our mental health.

- Wow, Bryn, thank you so much for those inspiring words and thank you so much for coming today, I really appreciate it.

- Yes, thanks for having me.

- Up next, art matters.

Our painting tonight comes to us from the Museum of the Southwest in Midland.

It's entitled, "Thrown, West Texas Rodeo," by Jon Flaming.

It's part of the museum's current exhibit called Westland.

And it's part of Fleming's latest body of work that explores cowboy culture and the rural Southwest.

This painting depicts a fallen cowboy crouching as he looks furtively over his shoulder.

Flaming, a native Texan, has worked in permanent collections in a number of Texas museums.

Finally, thank you for watching "One Question."

We'll be back each Monday at five following "Basin Life with Krista Escamilla," where we will answer the questions you want to know from the people who know.

If you have a question, send it to us at OneQuestion@baseinpbs.org.

Up next, "BBC World News America" with Katty Kay, followed by "PBS NewsHour".

I'm Becky Ferguson, good night.

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