COVID Q&A with Dr. Brad Holmes

At Aspen Valley Hospital, Dr. Brad Holmes is one of three hospitalists, the physicians who provide care at the bedside, managing patients who have been admitted to the hospital.

Dr. Holmes is also a member of the Medical Advisory Team to Pitkin County Public Health, and sits on a number of committees at the hospital responsible for setting protocols for ensuring safe care for all patients during the coronavirus pandemic.

“If you’re feeling sick and feel you need to come to the hospital, by all means do so,” he said. “We have set up all kinds of systems to protect people from exposure to COVID-19. We’re the community’s hospital, and we are here to take care of people who need our help.”

Dr. Holmes sat down (virtually) for an interview to answer some of the common questions that are being asked as the economy restarts and the stay-at-home restrictions are eased.

AVH NEWSLETTER: As Aspen moves forward with its Roadmap to Reopening, why is it important for our community to adhere to the Five Commitments to Containment?

Dr. Holmes: We can’t detect everyone who has the virus. People with minimal or no symptoms can spread it without knowing they are doing so. The Five Commitments are designed to reduce the spread of the virus, and protect everyone in the community:

• I will maintain six feet of social distance.
• I will wash my hands often.
• I will cover my face in public.
• I will stay home when I am sick.
• I will get tested immediately when I have symptoms.

The virus levels grow when an infected person spreads it to more than one other person, and the virus disappears if it spreads, on average, to less than one person. The goal is to limit that spread, that way the virus will die off or at least not surge. The commitments are designed to do that.

Is warmer weather going to help reduce the spread of COVID-19?

We can be hopeful, but we don’t really know with this virus.

If we adhere to the commitments as a community, we’re going to reduce transmission of the virus. Fewer people will be infected, which means fewer hospitalizations, less deaths and in general less people getting sick and having to miss work. We’ll be able to keep business open. I think those are all the reasons to stick with this. If we go the opposite direction, the community will have to go back to the way it was with stay-at-home orders and businesses shutting down once again. Nobody wants that to happen.

Is it really necessary to wear a mask? Why?

Yes, you should wear a mask. We know that by wearing homemade masks there is a good chance you will to some extent reduce your chance of getting the virus. And with people who have the virus but don’t have symptoms or have minimal symptoms, wearing a mask will reduce the amount of viral particles they expose other people to. When they sneeze or cough, the secretions will go into the mask, making it less likely they will infect other people.

Most experts believe that wearing a mask really helps. But it’s not one hundred percent effective, which is why it’s important to maintain a 6-foot distance from other people, wash your hands frequently, and live by the other commitments.

Can you bust this myth? The COVID virus isn’t any more dangerous than the flu.

COVID-19 is unlike any respiratory virus that I’ve seen before. Even here in our small town, we’ve had a number of people end up hospitalized and severely sick with COVID-19. We know it can adversely affect older people, but we’ve seen younger people end up very sick and on ventilators and life support.

Even the milder version that does not require hospitalization is not a pleasant experience. People have come out publicly and said that even though they did not end up being severely ill, it was a terrible experience that they never want to go through again. This includes young, healthy people and even elite athletes like Vonn Miller from the Denver Broncos.

It is also more contagious than the flu. Some estimates I’ve seen indicate it is twice as contagious as the flu.

What tests are Aspen Valley Hospital currently using?

We are using a variety of tests, including PCR testing of nasal swabs and saliva as well as antibody testing, but we are constantly re-evaluating to determine which tests available are the most accurate and will get us the results the fastest.

Currently, the samples are being collected and then sent out to an outside laboratory, but AVH has recently ordered a PCR test that we’ll be able to perform here in our facility. Instead of a 48- to 72-hour turnaround time, we should be able to have results in a couple of hours. We are working to secure a steady supply of these tests, just in case we get another surge.

How is PCR testing different from antibody testing?

The PCR test tells you whether or not you have the virus in your system right now. When somebody comes in and they are sick and we want to know if they have the virus, this is the test that we use. In order for this type of test to work, we need to get a swab or a sample that actually has the virus in it. Then we run it through the PCR machine that will detect whether it’s present.

The antibody test is a blood test that detects if you have antibodies to this coronavirus. It does not tell us if you have it right now, but does show whether you have been exposed to this virus sometime since the outbreak began. With the antibody test, we think it takes two weeks or so before you will have antibodies in your blood that we can detect. We also know that some people will not develop antibodies at all.

It is important to keep in mind that these tests are not perfect. With PCR testing, about 20 percent of people who actually have the virus end up testing negative. Antibody tests can also produce false positives, meaning the test result comes back positive, but you’ve never actually been exposed to the disease.

Can you bust this myth? COVID really only affects vulnerable populations, like those who are age 60 and older.

People of all ages are at risk. Aspen Valley Hospital had to transfer a few people on life support to other facilities. These weren’t older people who are considered to be at high risk of severe illness. They were people under 50 years old who did not have significant underlying medical problems. I know of people in their 30s ending up on life support elsewhere in Colorado.

That being said, older people, especially over 70, are at much higher risk of having severe complications from COVID-19. The same is true for people who have underlying significant medical problems.

When will it be possible to get an antibody test for the community?

It is currently available through people’s primary care physicians. But we want to caution people that even if you test positive, you should not lower your guard. We simply don’t know yet whether people can be re-infected by the virus and then spread it to other people. And as I’ve said, these antibody tests are not perfect.

Using the Five Commitments is the best way to protect yourself and everyone else in the community.

What are some recommendations you have for keeping healthy and maintaining physical and mental wellness during this crisis?

Taking care of yourself is important. Make sure you’re eating well and getting regular sleep and plenty of exercise.
Finding time for yourself to do something that you enjoy can make you feel better. Yoga and meditation can be helpful. Being outside can be good for you both mentally and physically. The weather is great now, so I encourage people to do something they love, whether it’s a run, a hike, biking, fishing or some other activity.

Also, connecting with friends and family can help. Even though we’re not able to see the people we care about in person as much as we would like, the world today allows us to interact with each other easily over video chat and with phone calls.

Do you have anything else to add?

We’ve made a lot of progress and shown we can start to suppress this coronavirus and are now working to open things back up. Unfortunately, the virus is not going to disappear. We are in this for the long haul, which is why it’s important to stick to the Five Commitments and get tested if you are sick. That way we can keep the virus suppressed and continue to do things we love.