Vital Signs: Staying safe from infectious disease

Vital Signs episode cover art
On this episode of Vital Signs we talk about new COVID isolation guidelines, measles cases in Minnesota and the early emergence of ticks.
MPR News

Each month, Dr. Jon Hallberg joins MPR News host Cathy Wurzer to talk about topics that are important to your health and take a deep dive into medical news.

Hallberg is a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School.

In this installment of Vital Signs, he breaks down possible changes to COVID-19 isolation guidelines, measles cases in Minnesota and the early reappearance of ticks in the state.

Use the audio player above to listen to the full conversation.

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Audio transcript

CATHY WURZER: It's Minnesota Now. I'm Cathy Wurzer. Time for our segment Vital Signs. Every month we'll be talking about topics that are important to your health. And take a deep dive into medical news or what's top of mind at the doctor's office. Joining us right now is Dr. Jon Hallberg, a family medicine physician at Mill City Clinic in Minneapolis and a professor at the University of Minnesota Medical School. Hey, thanks for joining us again.

DR. JON HALLBERG: Oh, my pleasure, Cathy. Thank you.

CATHY WURZER: See, I'm a little confused, and I'm thinking there may be listeners as confused over the CDC'S COVID isolation guidance. Right now, the CDC advises folks to stay at home for at least five days if they're positive. Now they're thinking that's not necessary. What do you think?

DR. JON HALLBERG: Cathy, we're confused also. When we got this news, one of my triage nurses just about lost it because we've been toeing this line of-- this is the thing that we do. That if you get it, you've got to be home for five days. And there's nuances around that and then now we're hearing this. And there's a lot of reasons for it. Of, course I think to some extent it's acknowledging what people are doing anyway.

People are having a hard time isolating. If you live at home, you don't have a lot of rooms, you've got several people, you really can't be isolated. And I think people are just finding it harder and harder as time goes by to adhere to that five-day rule.

CATHY WURZER: OK. Yes, I understand it is hard. But what does it do for the spread of this illness?

DR. JON HALLBERG: Well, that's the thing. It's like the recommendation is acknowledging what people are doing. And I know that a number of people are really concerned about this because they're saying it's really not following the science. Nothing changed about the transmissibility of this. We know that people are shedding virus. So it's acknowledging what people are doing but not really taking into account the science of it.

That being said, it's really supposed one could argue common sense or what we've been recommending for people who have had colds over the years or influenza. And probably bottom line is, if you're feeling sick, please don't come to work. Don't go to school. Stay at home. Rest. But this is just, yeah, I think it's just heading in a way that is trying to align itself more with what we've been doing for decades in terms of recommendations.

CATHY WURZER: OK. So let's talk about another infectious disease if we could here, measles. Recently, the State Department of Health reported its third measles case. I remember last year there weren't any measles cases. But the year before there was an outbreak, 22 cases. Are we looking at a potential outbreak here with just the three cases?

DR. JON HALLBERG: Oh, you certainly hope not. I mean, any case of measles is not a good thing. Measles is probably the most transmissible virus there is. It is so easy to catch if you haven't been immunized. It stays in the air for a long, long time. We had two cases and now it's up to three, so it's not like this huge arc upward. But too soon to tell with that. But I think that-- like so many things. We were so careful for the better part of 3 to 4 years.

And now viruses are spreading, of course. And this most certainly is because you've got folks who are behind with immunizations or haven't gotten them, haven't chosen not to receive them, talking about kids, of course. Yeah, we're going to be watching this very, very carefully.

CATHY WURZER: You mentioned kids, of course, being the main focus of this. But can anybody get measles? I would presume, yes, if you're not vaccinated, right?

DR. JON HALLBERG: Yeah. I mean, well, absolutely. I mean, if you're an adult and you've never been vaccinated, you've never had it, you could. Most older adults born before the 1950s certainly have had exposure to these various diseases and carry some immunity. But the thing is, I mean, as we get older, we discover this, with pertussis, for example, that we are immunizing against it. But as the years go by, immunity wanes.

And then you can get that. And we thought pertussis, whooping cough really as an adult. But it can happen. And so certainly the more young people, children who are not getting immunized, it creates a pool so that this virus can have a bigger home and then absolutely spread to the broader population.

CATHY WURZER: So I was reading about this outbreak of measles. It was another article dealing with measles. And it was really eye opening because I have a feeling that most people don't understand how serious measles can be. I mean, you mentioned it's a highly infectious. And some of the-- never read the comments on a story, I know. But reading the comments of this on this particular story, it was clear that the vast majority of those who read the story just didn't really buy into the fact that this can be a very serious disease.

What do you say to patients who are like, yeah, measles, whatever, it's a childhood disease, no big deal.

DR. JON HALLBERG: Well, it's all historical context. I mean, I'm so grateful that we are alive when we're alive. That children aren't dying in childhood from infectious diseases that are readily preventable by giving immunizations. Measles is one of those. I remember from medical school we talked about the three C's of conjunctivitis, coryza, and cough. And coryza is watery eyes and just looking miserable and then the rash.

And it's completely preventable. And so I think that it's just the time in history that we're at right now where people just don't see this, don't know anything about it. Many and most clinicians don't know much about it because we just simply don't see it. It is a absolute triumph of effective immunizations that this is no longer something we have to think about. So I can see why people aren't too worried about it. It's just because we don't have any experience with it.

CATHY WURZER: Can it be fatal, by the way?

DR. JON HALLBERG: Oh, yeah. It can be fatal. I mean, good news is, the vast majority of the time, it's not fatal. But it can be.

CATHY WURZER: So we were talking last month about the warm weather impact on cold and flu season. So we're going to talk about something that is another warm weather issue. And of course, I cannot believe that I'm even going to bring this up at this time of the month. But already ticks have been spotted outside because of this really warm weather, no snow cover, that kind of thing. What do you suggest? I hate ticks.

What do you suggest if folks are going to go out for a hike, take the dog out for a walk in the grass, somewhere where ticks can be found, even so early in the season?

DR. JON HALLBERG: So technically, if you're going to be out in a grassy area, you should wear light clothes so that you can spot the tick. They're very dark in appearance so they would pop out if they're on light clothing. Should be long clothing, so pants and a long-sleeved shirt. Tuck their pants into their socks.

But if you pause for a second and think about that, that's how many of us are actually going to do that. Maybe a wiser thing easier thing is to spray some bug spray around your ankles with DEET on their shoes and around the ankles and socks. Most ticks are going to latch on or jump on lower in our bodies. I too hate ticks. I hate the idea of a parasitic relationship with the human.


DR. JON HALLBERG: It's just awful to think about. So yes, so there are things to do and then there's probably practical ways to get around that.

CATHY WURZER: Yeah. So of course, ticks can carry Lyme disease. And so many people that develop Lyme disease say, oh, don't go there, it's just really awful. It just-- some of the symptoms can be really tough to deal with. How do you know that you have the disease? Do you need to go run to your doctor to get tested? How does that work?

DR. JON HALLBERG: Most ticks are not the black-legged ticks. We used to refer to these as deer ticks. So most ticks are the common wood tick dog ticks. So there's-- first of all there's that. Not every deer tick carries Lyme disease, so just a way of saying that not every single tick is going to result in any infection and certainly something like Lyme disease which is the most common tick borne illness. So I think if you've discovered a tick, it's been there for 24 to 36 hours, it's clearly had a meal, first of all you want to take it off using tweezers as close to the skin as you can.

Ideally save it. Most of our clinics have microscopes. I've done this. We take a tick, look under the microscope, make sure it looks like a black-legged tick. And then we can decide, do we treat empirically? If we catch it early, we can treat with a medication like doxycycline, just a couple pills together and that's it. If it's like someone's had an infection and if anyone listening gets a rash, the classic bullseye rash, the erythema migraines rash, we would probably treat that twice daily for 10 days with an antibiotic like doxycycline.

I think by and large, gone are the days where people had a mysterious illness, and it turned out to be Lyme disease. I think we have a much higher sensitivity to it, both from the public standpoint and from the clinician side. If someone's been outside, they have aches and pains, a little feverish, stiff joints, they recall having a rash, well, we're going to be thinking Lyme disease. And then do a blood test.

The blood test is very effective at detecting whether someone had Lyme disease or has Lyme disease and whether treatment is necessary.

CATHY WURZER: I know you are busy. Thank you as always for talking to us.

DR. JON HALLBERG: Oh, my pleasure. Thank you so much.

CATHY WURZER: We'll have you back on next month. Dr. Jon Hallberg is a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School.


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