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“We’re going to see death numbers rise”: Dr. Rai on COVID death increase and hospital situation

Published: Oct. 1, 2020 at 7:49 AM CDT
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GREEN BAY, Wis. (WBAY) - Wisconsin reported 27 deaths in COVID-19 patients Wednesday, the largest one-day total the state has recorded during the pandemic.

Prevea Health President and CEO Dr. Ashok Rai joined us Thursday on Action 2 News This Morning and said the state will see death numbers rise as cases surge and hospitalizations increase.

Dr. Rai joins us each Tuesday and Thursday morning. Have a question for the doctor? Email news@wbay.com.

WISCONSIN COVID DEATHS

“We unfortunately refer to deaths as a lagging indicator. What normally happens in this type of virus situation is we see a lot of spread initially, a lot of positives. We saw those spikes a week or two ago. And it continues to grow. That doesn’t go away. And then hospitalizations follow that. We went from 70 in the hospital over the weekend throughout the city to now over 90 in the hospital this week. Then unfortunately you start to see the deaths. Those who have been hospitalized or those that are coming in basically dying and us trying to resuscitate and not being successful. That’s what happens farther along into this virus path. That’s the part we want to turn around. So now we’re going to see the death numbers rise, because unfortunately it is that lagging indicator.”

HOSPITAL SITUATION

“If you look at our two HSHS partnered hospitals, St. Mary’s and St. Vincent’s, they continue to grow in cases. I know our colleagues at other hospitals here in town are also growing in cases. It’s important to understand that total number of cases is layered upon all the other medicine we’re practicing. The trauma accidents that are happening, the car accidents, the heart attacks, the strokes that are happening. And then you add on 90 extra cases, that’s what makes it so tough. Twice, three times a day, we’re meeting to say, ‘Hey, can we take that next patient or do we have to transfer?’ So far we haven’t had to transfer our own patients. But sometimes we can’t take patients from other hospitals right now.”

FIELD HOSPITALS

“It’s a state put up National Guard acute care facility. It’s a conversation we’ve had with DHS. Just like ThedaCare’s having. Every community’s having. It’s not specific to one organization. It’s really all of us having that conversation. Basically, it’s a makeshift hospital. Think about using the Resch Center and taking that over and having cots on the floor of the Resch Center. That would be what an acute care facility could look like. It’s not ideal. It’s not where you want to get your health care. It’s not inside a hospital. It’s mainly for the COVID patients. Maybe those who are not that sick but still requiring medical care. But what it does is it drains staff from the state. Because the National Guard, that’s the citizens army. That’s our employees that would be called up to work in there, leaving hospitals more stretched. So definitely not an ideal situation. Not a route we want to go to unless we have to.”

WISCONSIN SITUATION

How do we compare to big outbreaks in Texas and other southern states?

“I think we’re a little worse. I don’t mean that in a scary kind of way. But if you look at large cities in Texas such as Dallas, when they have a 20 percent positivity rate, their health care systems are significantly larger than ours. We’re not really designed for that here in Brown County. When you start to see 18, 20 percent positive in Brown County, and you look at the infrastructure that’s available and what it was designed to do, it wasn’t designed to take care of a situation like this. So actually it scares me a little more that we could get overwhelmed faster.”

COVID DENIERS

“It’s impossible, I think right now, to get people to truly listen and change their minds. We hope we can. I don’t want to give up that hope. Don’t think of it as being scared of the virus. If you don’t even believe that the virus is that bad, I get that. But understand that there’s certain people that are going to get sick from it. It may not be you, but those people are occupying the hospital beds that you might need for something else. That you might need if there’s a car accident. Or if you’re having chest pain, or you’re having symptoms of a stroke. That’s the nightmare situation that we were always trying to talk through. It wasn’t the virus taking over and killing everybody it infects. It doesn’t. We know that. But it’s infecting enough people to create enough stress on the health system so we can’t do everything else we’re supposed to do for you. That’s the concern we have.”

HOLIDAY VISITS

College students are coming home from school during the Thanksgiving break. How do high risk parents stay safe?

“Any time you have somebody high risk in the home, you have to try to be safe. Sometimes it may seem a little ridiculous on being safe, but even wearing a mask at home might be the best way to keep you that way. Physically distancing, especially in the immediate of that child coming home. Even 14 days, making sure they don’t exhibit any symptoms of COVID-19. And then over time, as you live together, relaxing that. You also have to make sure that child coming home is being responsible when they leave the home. If they exhibit any symptoms, getting tested right away, and doing the best you can to protect yourself, even within the home.”

HOW LONG UNTIL SYMPTOMS SHOW

“It can definitely vary a lot. It’s likely not going to be the next morning. The state of Wisconsin and the CDC has recommended, if you’ve been exposed when to get tested, around day five or day six because that’s the most common timeline for you to start exhibiting symptoms. It could be anywhere in that 14-day time period. Or like some, you’ll never exhibit any.”

SCHOOL SAFETY

“It’s really a tough set of conditions in the type of outbreak that we’re seeing locally in Northeast Wisconsin. You gotta do the best you can do, especially with hand washing and mask wearing. It’s really important for that symptom screening in the morning for parents to keep kids home if they have symptoms. For teachers to stay home if they have symptoms. And in the situation where you can’t physically distance and you now you’re going to be interacting with people for longer than 15 minutes, effectively quarantining. So if a teacher is positive in that class, there’s a good chance you have to quarantine the whole class. And making sure you’re paying attention to public health recommendations regarding that.”

VACCINES

“Right now, we’re looking at what’s going to be the effectiveness of the vaccines that are available here late winter. Then we need to read those studies, learn about that. Stacking a vaccine on top of a vaccine does bring in a whole other set of questions and a set of research that will not be completed any time soon. So for right now, I think the recommendations are going to be stick to one vaccine, assess its effectiveness, and then let us learn more.”

NFL AND CARDIAC TESTING

"One of the scariest things, especially in an athlete, is the development of myocarditis. That’s an inflammation of the muscles of the heart which is caused by COVID-19. It’s something that we’ve discovered here over the last six months. It’s been researched a lot in athletes because a general person who would get myocarditis still at risk, but an athlete who gets it and then puts their heart through the stress they normally do puts them at risk for sudden death. It’s hard to know if you have it or not without a significant cardiac workout. Usually starts with a lab test, then off to an EKG, and sometimes cardiac MRI. There’s been a couple studies out there in the Big Ten that say even a third of the athletes that were tested positive for COVID-19 who did not have symptoms had evidence of heart damage that they did not know about. That’s what the NFL needs to figure out before they put a player back out on the field.

“It’s probably one of the biggest ones we worry about because it’s indolent. You don’t know that you have it. You just feel tired. You don’t realize that you’re feeling tired maybe six weeks out from recovering from COVID-19 or three months out, because actually your heart was damaged at some point. So we need to make sure you get that work up with your regular physician as well.”

SECOND INFECTIONS?

“We’ve only been doing this for six months and throughout the world maybe for eight or nine months. We just don’t have enough evidence of that. Even tracking true reinfection has been difficult for us. It’s hard to say what happens after 90 days. We’re actually hoping your immunity lasts longer than 90 days. We just know we have evidence of it for 90 days. As far as reinfections in milder cases, we have yet to see good evidence of that. But research is being done on it.”

TEST RESULTS

“It depends on the kind of tests you’re getting. Right now we have the Sofia Antigen Test. It takes 15 minutes, but it’s only reliable if you have a lot of symptoms and it’s positive. If it’s negative and you have symptoms, we still have to test you. So I think it’s really important to understand which tests. The PCR test can take 48 hours. Sometimes it can take a few days, depending on what’s going on in Madison or Milwaukee, the different labs, as well. It really depends. The rapid ones may be not reliable as you think.”

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