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Dr. Rai talks hydroxychloroquine and new technology on tracking COVID-19

Dr. Rai discussed this topic, back-to-school safety for staffers and some new technology and studies on tracking possible coronavirus outbreaks.
Published: Jul. 30, 2020 at 8:10 AM CDT
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GREEN BAY, Wis. (WBAY) - A study has found the effects of malaria drug hydroxychloroquine to be harmful. The drug has been touted as a potential treatment for COVID-19 by President Donald Trump and a group of doctors in a video that's been pulled from social media.

"So at this point--and this may change as more research comes out--but at this point that drug and that drug combination is definitely not recommended," says Prevea Health President and CEO Dr. Ashok Rai.

Dr. Rai discussed this topic, back-to-school safety for staffers and some new technology and studies on tracking possible coronavirus outbreaks.

HYDROXYCHLOROQUINE

The malaria drug has been touted by President Donald Trump as a way to combat COVID-19. A recent study found that “evidence on the safety and efficacy of these therapies is limited.” FULL STUDY: https://www.nejm.org/doi/full/10.1056/NEJMoa2019014

“It comes down to what we have available to us in science. The scientific method here would be to ask a question, research it and come up with an answer. You’ll always have anecdotal experience--in other words ‘I had a patient, I tried this, and it worked'--but a real study is taking a large group of patients, finding the ones you give the drugs to, the ones you don’t give the drugs to, and seeing if it truly works and if there is any harm. The New England Journal of Medicine last week published a pretty good sized trial--667 patients--where they broke them up in three groups--those that didn’t get the drug, those who got hydroxychloroquine, those who got hydroxychloroquine with zithromax or azithromycin--and they found that those two groups that got the drug there was no benefit in it. And actually, they showed changes on their EKG which were harmful and they showed liver enzyme changes that were harmful. So right now we have a drug that has been researched in a peer-reviewed study, in a good journal, that says it doesn’t help and it can hurt, and it actually did hurt those patients. So at this point--and this may change as more research comes out--but at this point that drug and that drug combination is definitely not recommended.”

DOCTOR VIDEO

A video of a group of doctors touting hydroxychloroquine was pulled from social media for making misleading claims.

"I think it's really important for us to make sure we have good scientific knowledge and basis for our recommendations in health care because people do listen to us, and it's dangerous if we say the wrong things.

“The physicians there were saying things about hydroxychloroquine in specific that made the medical community uncomfortable because there are dangers associated with it. The way the drug was being recommended, the way that it was being talked about, really wasn’t based on the research. Some there may quote the recent study through Henry Ford Health System in Detroit where it talks about how it did decrease mortality. But it’s important to understand when you read that study, it’s talking about they use it in the hospital. They did not randomize their patients. And they specifically in that study say you need another study to prove its safety and that it works. And that’s what we saw in the New England Journal of Medicine where they actually did randomize people in different pools. They showed it didn’t work and it could cause harm. That’s how we base our medical decisions. You can’t just base it on what you’ve observed, because there is long-term harm. And that’s why those videos were pulled.”

SCHOOL STAFF SAFETY

“As a health care provider, when this broke out, we had a lot of concern not only for ourselves, but our staff. Our nurses, our medical assistants. It was really emotional, even for me as a leader, to have our people on the front lines, and what they could be exposed to. So I empathize with the teachers and I understand the anxiety. And we all should be doing that. I know a lot of people’s focus that are parents are the children. And we should focus on their safety because they usually can’t advocate for themselves. But we want to make sure our teachers, our janitors, our food service people in schools are safe as well. The mitigation plans that the school districts have worked on--and they’ve worked a long time on these--are meant to protect the student and the staff. But the mitigation plan, once again, is only as good as the environment that the teacher is going into. If it’s a current outbreak, those mitigation plans may not be as effective. So we need to follow what’s going on in every locality and make sure that we’re not in an outbreak setting. And if we’re not in an outbreak setting, do we have the right precautions in the school setting to make sure that we prevent one? That we are keeping the teachers safe as well as keeping the students safe. This is as much, if not more important for the teachers who are at higher risk than maybe the student. And they need to be part of the conversation.”

TRAVEL AND HYGIENE

Should people bring their own cleaning supplies to hotels?

“I think it’s really important to look at the facts that transmission off of a surface isn’t as likely as it is from the air, but it can happen. So if you feel comfortable disinfecting the area, I would recommend at least disinfecting those really high-touch areas: door handles, drawers, closets, the sink. Those are areas where people have touched a lot where there could be a higher amount of the virus sitting there. But once again, it depends on where you’re staying and how often they’ve cleaned it. What’s more important is to let that room and the air conditioning, or whatever HVAC system they have going, exchange air for a good amount of time between the last person leaving and you entering.”

NFL AND TESTING

“The NFL is actually doing a really good job about this, and I know that may seem to be a hard thing to understand. But they are not using public resources for their testing. They, like many companies around the world, have contracted with a private lab to do that testing. They are not using resources that are dedicated for the public such as what we do in the Brown County area as far as public testing goes. Their test actually leaves town, it’s run on a machine, and it comes back. Because they’re sending a smaller number of tests at a time, they can get a turnaround time that’s faster. It’s no different from the rapid machines that exist at all four hospitals here in the community. We can do small groups of people rapidly if we need to know about that situation. They have a contracted lab where they can do that and they’re not using public resources. And because their numbers are smaller--they’re not testing 1,800 people per city, per day, they can actually get that test faster.”

WASTE WATER TESTING

“So there’s a term called water-based epidemiology looking for diseases in our waste water and seeing if it can predict what’s going to happen in the public. So people are actually looking for COVID-19 in waste water and seeing if it’s an early predictor of a breakout. I think in La Crosse they’re looking at it, they’re looking at it across the country where waste water plants and medical institutions and research institutions are partnering to look for the genetic evidence of COVID-19 in the waste water. Look at it over a serial amount of time and if it’s increasing, does that correlate with the breakout in the community? So some interesting research and a different way to give us an idea of what’s going on.”

WISCONSIN TREND

“You’re seeing that up-down-up-down of the percent positivity but it’s still remaining above five percent and it’s still trending in the wrong direction. So what we need to be able to do is bend that trend in the other direction. In other words, every day over 14 days continuously going down. You’re going to have a couple peaks in there, that’s why we draw that line, and making sure we get below five percent.”

SWIMMING SAFETY

“So it’s important to remember when we talk about droplets, and sometimes I think we assume everybody knows what we’re talking about, we really are talking about the droplets that we expel from our mouth. Those that you can’t see or that you could see that could be carrying the virus. When we talk about water in general, it’s not that the virus can’t live in that environment, but it likely won’t be reproducing at a high level to infect you. Especially when you talk about a pool, because the chemicals we use in a pool such as chlorine and bromine will actually inactivate the virus. I’m not saying you should go an drink the pool water. More importantly, the pool water is probably safer if the virus was within it.”

MASK WEBSITE

Prevea has set up an educational website on masks at: http://www.prevea.com/For-Patients/Masking-tips-and-resources

“We get a lot of questions on masks, like all health care providers do. How to wear them. Where to wear them. When not to wear them. How to make them. And we decided to put that all on the website in our educational section so people can look at it and get the education they need. They’re cited. There’s resources whether it be the CDC or other professional resources on mask wearing so people have all the information they can. With everybody from schools, to ordinances in cities, to stores requiring them, the questions keep coming--and they’re good questions. We wanted to make sure that we had a consistent answer to them.”

SMART RING

Some NBA players are wearing a smart ring as part of a study tracking possible COVID-19 outbreaks. CLICK HERE for a story on the rings. Dr. Rai is also trying one out.

“Being somewhat of a tech geek, I heard about this through the NBA and wanted to see for myself. It’s actually part of a larger community student through the University of California-San Francisco. Where you wear the ring and it’s looking for changes in your body temperature overnight, your resting heart rate, your sleep patterns, your exercise patterns. So it’s giving you data if you’re a health-focused person as well. But it’s looking for early predictors that you may be positive for COVID-19. In the middle of the night, it’s measuring my body temperature off of a baseline. So last night, I was about .6 degrees below my baseline, so nothing to be concerned about. I got three hours and 57 minutes of sleep. That’s probably something to be concerned about but that’s my own fault. It looks at my resting heart rate, and it was a little higher last night. So it’s looking at those things and then it asks you, you go online and you do a survey as part of the study. And it’s trying to correlate all those data for those who turn positive, and see if we have some early predictors to the disease.”

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