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Dr. Rai talks COVID spike in young people, return to football

Published: Sep. 17, 2020 at 7:59 AM CDT
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GREEN BAY, Wis. (WBAY) - Wisconsin has seen a big spike in COVID-19 cases among people ages 19-24. That coincides with universities doing robust testing and screening of their students.

“The point of finding that disease, the point of testing more, is now isolating them, quarantining their contacts, and controlling COVID-19,” says Prevea Health President and CEO Dr. Ashok Rai.

Dr. Rai joined us on Action 2 News This Morning to discuss that trend, the Big Ten’s decision to play football and viewer questions.

Dr. Rai joins us each Thursday on Action 2 News This Morning. Have a question for him? Email news@wbay.com.

YOUNG ADULTS

“We have to remember in the state of Wisconsin all of the age groups have trended upward, but definitely a huge spike in 18-to-24, and that’s our college-aged students. In a good way, the University of Wisconsin System throughout are testing their students. Every campus has a different methodology. In other words, this age group, no matter where you look in Wisconsin, is getting tested more. Which we would expect to find some disease. So you’re going to see that spike. The point of finding that disease, the point of testing more, is now isolating them, quarantining their contacts, and controlling COVID-19. Remember, COVID-19 needs a human to live. So we’re trying to prevent that human-to-human spread. The only way to prevent it is to test, find out who has it, and then isolate and quarantine around that person. So we’re going to see a spike in college-aged students because we have a spike in testing in that 18-to-24 as well. Something to be concerned about and watch, but there is an explanation for it."

BIG TEN TO PLAY FOOTBALL

The Big Ten reversed course on their decision to delay fall sports. The football season is set to start the weekend of Oct. 23-24.

"I’m not in the room and don’t have a vote, so I’m not sure what they were looking at that’s different now than say August and early September to say, ‘it’s OK and safe to play now.’ Especially with what we see going on at all the Big Ten campuses with positives. Even UW saying we can’t go to class for two weeks but suddenly we can go out and play football and practice. So there are some concerns there. I think the biggest concerns are really from a health perspective for that student athlete. There is data out there that says if they have COVID-19, that they need to be cleared pretty extensively to make sure they don’t have any cardiac disease so they don’t have any issues of heart failure or even sudden death on the playing field because they could of had asymptomatic COVID-19. It is interesting that one article and one actual research study on this came out of the Big Ten. So I’m not sure what other articles were used or other research was used to make the decision. They’ve made the decision, so now we have to do what’s best for the student athlete. Hopefully they’re screening them effectively.

CELEBRATING THE PACKERS

There will be no fans at Lambeau Field this Sunday as the Packers host the Detroit Lions.

“What we worry about right now--understand that we don’t have fans for a reason--so we shouldn’t go out and try to create that situation of congregation just because the Packers aren’t letting us in the stadium. We should understand that it’s important to cheer them on and watch them from home in a small setting, not in a group of 50-to-100 people. Because that’s where we’re going to see COVID-19 spread. That’s why they don’t have fans. And if we do want to get into the stadium at some point, we’re going to have to control our percent positivity. So we have to be smart about it.”

IS COVID GETTING WEAKER?

“Really wouldn’t say it’s getting weaker. I’d say we’re finding better ways to deal with it, especially when it comes to a hospitalized patient. A lot of the therapies we use today we didn’t have back in April and May. Convalescent plasma is a lot more readily accepted and used. Dexamethasone is a drug we’ve had around for a long time but using it for COVID more recently. And then remdesivir. So I really wouldn’t say it’s getting weaker. Or hospitalization numbers are slightly down. I think our mortality is a little bit down. Patients are still staying two-to-three weeks in the hospital. But it’s definitely not getting weaker from what we can see it’s doing to patients. But we do have better therapies now.”

FALSE POSITIVES AND FALSE NEGATIVES

“Every single one [test] is a little different. A PCR test that we generally like to use--that’s the gold standard--has a one-to-three percent, depending on the manufacturer, chance of a false negative and pretty similar chance of a false positive. Definitely not 50 percent. Even the antigen tests that we use are not in that range at all. They’re more like 10-to-15 percent areas of error, which is still pretty acceptable when you’re trying to screen a mass setting like that. So right now, so I would say it’s definitely not 50-50. It’s important to know when someone has that repeat positive, everybody wonders, do they get counted 14 times if I got tested 14 times in a row? Actually, the Wisconsin DHS takes all of that and reconciles it, and pulls those out and only counts a positive once for a person.”

HOME TREATMENTS

Are antibiotic ointments able to prevent COVID-19?

“A triple antibiotic ointment may have been recommended in a pre-procedural type of situation. Really for bacteria. We’re talking about a virus here. The antibiotic ointment isn’t going to do anything to COVID. If you’re trying to create a barrier to try to prevent the virus from escaping you or some sort of barrier of entry, that would be a mask, not an ointment.”

WHEN TO QUARANTINE

"Once you get that call from public health, once you’ve been told you’ve been in close exposure--and once again that’s not everybody; that’s within six feet for 15 minutes in a day and those four other categories we’ve talked about for close exposure--and you’re told you need to quarantine, you get up and you go home and you quarantine. And you stay home. That’s what quarantine is. Even if you feel great. And this is going to happen a lot with employees and children, too. Seeing an entire class sent home to quarantine. That entire class should not be socializing with each other. They should be at home. No matter if they feel great, they should be quarantining. And yes, you leave immediately. As far as the surfaces, it’s good to just do that standard cleaning for the employer to do. As far as letting that area rest for 72 hours, that’s definitely not a recommendation. Giving it a day to make sure. But more importantly, getting that person out of the environment, at home and quarantining, and keeping them home.

Prevea quarantine guide: https://www.prevea.com/For-Patients/Your-Wellness/Resources/What-does-it-mean-to-self-quarantine-for-COVID-19

“It’s probably our most commonly asked question. It’s the most common reason people would message me. What do we do about the quarantine? So there’s five scenarios we walk through. When you’re supposed to start your quarantine? When does your quarantine end? And once again, who needs to quarantine and who doesn’t? I think there’s a mis-perception that ‘I live with somebody who is quarantining, that means I need to be quarantined?’ No. If you live with somebody who is isolating because they’re positive you would need to quarantine. But if you’re living with somebody who was sent home from school or sent home from work because they need to quarantine, you don’t need to quarantine.”

POSITIVE TEACHERS AND CLASSROOMS

"Anybody who is symptomatic and gets tested should be isolating. Isolating is quarantine-plus-one. You’re staying in a part of the home, not even interacting with anybody else in your home if you live with somebody else. Nothing needs to be done with the class until we know what’s going on with the teacher. Same thing with an employer setting. The teacher needs to isolate. Obviously that’s up to the school district then if they have a substitute teacher that would be ideal. Then once we know about what happens with the teacher, then we can start that contact tracing. Was that person, depending on the grade level, able to maintain that six feet? And then we can deal with the classroom at that point forward.

TESTING AT HOSPITALS AND CLINICS AND POSITIVE RATE

Some hospitals and clinics have stopped testing people prior to minor procedures. Has it affected the overall positive rate?

“Definitely when you’re screening a lot of people that didn’t have any symptoms and you had a low percent positivity, I think we were at one percent, and you stop doing that, it’s going to affect the overall numbers, and the overall positivity rate is going to increase. Let’s just say that those pre-procedural things that we were doing for those minor procedures--that was our form of surveillance testing in the community. We probably need another form of surveillance testing in the community to look at it. We don’t know what that’s going to look like just yet, but it definitely has affected the numbers.”

TESTING TRENDS

"Even though we saw that 20 percent positivity, to take that into context, it was one of the lowest days of total number of tests being done. That’s why we encourage people that we need to do more testing to find more of the disease to basically control it. Our trend line is going up on a percent positivity, and that’s unfortunate. Some of it has to do with spikes like that. But it’s also important not to focus on a day or even three days, but to look at this on a 14-day timeline. Our percent positivity is higher than what we need it. Those 17 percent, 20 percent spikes had a lot more to do with not testing enough people and still having a good amount of cases at the same time, that created some of the anxiety, I think.

“Number one, we need to continue to educate people on when to get tested. It’s if you have any one of those myriad of CDC symptoms. And even mild symptoms such as a headache or fatigue. I think people are also getting tired. I think we all are getting tired of COVID and even talking about it all the time. And people are somewhat getting a little fatigued and maybe ignoring it. And this is the worst time to do that as we head into influenza season. So we need to make sure people are getting tested. And I don’t think people understand that even if you don’t have symptoms, there are certain cases, such as being exposed, that you should be tested.”

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