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“Nightmare Situation”: Dr. Rai talks local COVID surge and impact on community

Published: Sep. 29, 2020 at 9:00 AM CDT
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GREEN BAY, Wis. (WBAY) - “I would say right now that we’re in a nightmare situation in Brown County.” That’s how Prevea Health President and CEO Dr. Ashok Rai describes the COVID-19 surge in our area.

Dr. Rai joined us on Action 2 News This Morning Tuesday to discuss hospital capacity, how human behavior is impacting the ability to control the virus, and the new Brown County Dashboard. He also answered viewer questions about the upcoming deer hunting season and school spread.

Dr. Rai is joining us each Tuesday and Thursday morning. Have a question for Dr. Rai? Email it to news@wbay.com.

“NIGHTMARE”

"I think the key point, what we had in May that we don’t have right now, is that we had a plan. We had a plan to phase things in. The point was never to return to full normalcy until we had a vaccine or a treatment. We decided to flick a switch and try normalcy. The phase-in plan that was in place--and remember it was a federal plan that the state adopted, so it came from the current president. It was a plan to phase us in in small phases. In other words, let’s go from 10 people to 25 people. Then you could actually throttle back and forth. What’s working and what’s not depending on the percent positivity. We lost that ability to do that at the end of May and because of that we’re in the situation we’re in now. There’s a lot of other factors that are in there. But now it’s hard to even pinpoint what we could change to really control it again.

“I would say right now that we’re in a nightmare situation in Brown County. The whole country’s looking at us. That percent positivity, the hospitalizations combined with it, it’s a nightmare right now.”

SURGE IN CASES

“If we were to go back to the spring and you look at what’s different, is we had a situation where we knew there was an outbreak. We had the meat packing plants, we had assisted livings, we had different factories. We literally could narrow it down to a ZIP code, which we did with the CDC, we were able to go in there, test effectively, isolate effectively, and then do some testing throughout Brown County to bring that number down. Today, we’re testing almost double of what we were doing at that time period, and we have lost control. At that point, we had human behavior on our side. People were at stay safe and home and we were able to contain it. Today, despite testing twice as many people per day than we were doing at that time, we just don’t have human behavior on our side. We don’t have that ability to say stay safe, keep the hospitals at a functioning rate, none of that is working right now. So we have two problems in front of us and we can’t test our way out of this without human behavior coming back towards our side.”

HOSPITAL CAPACITY

"Our HSHS hospitals are no different than the other hospitals here locally. Everybody is getting to a census or a number of patients that are in the hospital that’s an extremely high number. Physical spaces are one thing, staff to take care of them is another metric we look at. So everybody’s in a stressed state. [Director of Bellin Health Emergency Department] Dr. [Paul] Casey did a great job educating people about that this last week and that education needs to keep going forward because that situation hasn’t changed.

TEST KITS

“Generally we would ask for about 5,000 and we would get 4,500 to test the community and that would get us through the week. Then there was up to 6,000 to 7,000. This week we asked for 10,000 just to get us through the week. And that’s triple booking every single one of our slots in the testing trailers, which are filling up very quickly. Which I know is frustrating to the community. We’re trying our best to get more people through testing. But with just such wide community spread, once again, without human behavior on our side, it’s hard to get control of it.”

BROWN COUNTY DASHBOARD

Brown County COVID-19 Dashboard: https://www.browncountywi.gov/community/covid-19/general-information/

“I’m really happy that Brown County Public Health has done this. We’ve been looking for county-specific data. People have asked for this for a long time. It takes a lot of work for this to do. It’s not just like flicking a switch in the background. I think all of the data is very important. They’ve really brought out the key statistics that we need to look at. Probably the one we’ve talked about the most is that percent positivity. And to be able to look at it over 14 days. We’ve always talked about that, not to look at it at a single day. You can see that in the bottom right where it says 15 percent. That’s a really high number. Remember our goal was to be below five percent for the World Health Organization for us to go out in public. And really, I think this is going to be great for people to look at every day for making some key decisions going forward.”

HOSPITALIZATIONS

What determines when a COVID-19 patient is hospitalized?

“There’s a lot of components that go into hospitalization. Number one, we want to make sure the patient’s stable. Things like their blood pressure, their heart rate. And one really important characteristic is how much oxygen they need. Is their oxygen level normal without any supplemental oxygen--we’re not having to give them any--or do they need oxygen? Those are the types of things that will determine if you need to be in the hospital. And we see the whole gamut when someone presents to the emergency department these days. Some people are presenting with a really low blood pressure and a really low oxygen level. That’s an immediate intensive care admission, versus somebody who might just need a couple liters of oxygen but still can’t go home. They can be admitted to a general medical floor. So a lot of components go into that decision.”

HOW LONG ARE YOU CONTAGIOUS?

“The CDC and their guidelines would say after 10 days, you’re no longer contagious if you’re done with your symptoms. So if that last 24 hours after that 10 days you’re symptom free, you’re no longer contagious. You can still test positive for many weeks after as you shed the virus, but it’s not a replicating virus any more. So it’s 10 days and then you should be good, per the CDC guidelines, for about 90 days from a chance for reinfection. That’s the evidence we have today.”

DEER CAMP

“Twelve people in a 1,000 square foot building, there’s no way you’re going to be able to distance and be safe. You have to remember, if you test five days prior, if those 12 people interacted with nobody else in those five days and completely isolated, that might be a working strategy. But it’s not really realistic. You’re only negative at the time we test you. So you have that four days of becoming infected. You may demonstrate no symptoms and all 12 people could get COVID really quick in that specifically closed environment. Obviously the best place to physically distance is up in a tree. Just making sure when you get down, you’re not with other people.”

ARE CASES COUNTED MORE THAN ONCE?

Can the same person be counted twice as positive and therefore inflating the numbers?

“It’s a great question. We get it a lot. It’s something that the state has had to work through and the county’s had to work through. So actually, they go through their data and they now pull out duplicate numbers to make sure their numbers are accurate. So what you’re seeing now is pretty accurate. They’re pulling out duplicates. Some people have tested positive three or four times in a row at a time when employers were requiring that to come back. As we’ve said, you can be testing positive for six-to-eight weeks after your initial one and there’s no reason to re-test. So the state is pulling them out now.”

PREVENTATIVE CARE

Is it safe to get a mammogram or other preventative care?

“It’s not requiring an overnight hospital stay, a mammogram’s not. When we deal with a COVID patient they’re not going to be in the mammogram suite, they’re not going be where you would be getting your preventative care. So it’s super important that you maintain all of your good health care, including preventative care such as a mammogram or a colonoscopy. Those things are necessary to keep you safe.”

TEACHERS AND SYMPTOMS AND CLASSROOMS

If a teacher has symptoms, should classrooms be immediately quarantined or wait for test results?

"This is what I consider a super complicated question. It’s a frustrating one because I have to say ‘it depends.’ If that teacher say is in an older grade and has been really good about physically distancing, wearing a mask from the rest of the class and has to leave because of symptoms--number one, if you have symptoms you should not be back in that classroom--is waiting for a test, a substitute situation in that class may work.

“Say it’s a younger grade where physically distancing has not been possible, and those symptoms are pretty consistent with COVID-19, or it’s an older grade where they have not been doing the physical distancing they need to, public health and the school may decide to quarantine that group, even while a test is pending, or waiting for that test. So it’s really important for public health and the school to be discussing every one of those situations as quickly as possible. And making that decision as quickly as possible. It will not be a consistent decision. It really depends on the environment that teacher works in, the type of class they work in, do they coach a sport, all of those things will come into that equation, so public health and the school need to talk that through.”

WORKING OUT

“Keep working out. Go outside. Try something new. Try something you wouldn’t want to do in public. There are a lot of great online apps out there. My wife is trying to get me to do barre which is a type of workout that I would never do publicly. But online app, I’ll give it a try. Do something different. Give it a chance.”

Copyright 2020 WBAY. All rights reserved.

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