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“It’s well above what we can tolerate”: Dr. Rai on what needs to happen to fix the COVID crisis

Published: Nov. 12, 2020 at 7:30 AM CST
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GREEN BAY, Wis. (WBAY) - “From a health care standpoint, we’re tapped out. Our beds are getting full every day. Nurses are exhausted. Physicians are exhausted. We’re exhausted. The solution has to be outside of our walls now,” says Prevea Health President and CEO Dr. Ashok Rai.

Dr. Rai joined us Thursday on Action 2 News This Morning to talk about the surge in Wisconsin and how the community and our elected officials need to help fight this battle against COVID-19.

Dr. Rai joins us Tuesdays and Thursdays. Have a question? Email news@wbay.com.

WISCONSIN IN “UNCONTROLLABLE STAGE”

“It’s hard to look at the numbers day by day. There’s a point where you just have to say ‘it’s really bad.’ Whether it’s 40 percent positivity or 38 percent positivity. That two percent doesn’t really matter. It’s well above what we can tolerate right now and still save lives. I don’t know why it’s continuing to get worse. From a health care standpoint, we’re tapped out. Our beds are getting full every day. Nurses are exhausted. Physicians are exhausted. We’re exhausted. The solution has to be outside of our walls now. It’s no longer health care’s only job to fix this. We need help from the rest of society. We need politicians to get along. We need people to agree on a path that will work. We’ll advise from a scientific standpoint, but at the end of the day, we can’t make people change their behavior. I can’t force people into a testing site to get tested when they have symptoms. There are a lot of things outside of health care’s control. So right now we’re just trying to do our best to take care of patients that continue to come to us.”

IMPORTANCE OF TESTING

“We’re doing it for your own benefit. When a health care expert or a physician or somebody else from health care gets off the air, people have some interesting criticisms for them online. We get that. We’re still there to take care of you. Our recommendations are purely there for the benefit of health of the society and the community. And getting tested is for that benefit. I think that locally elected officials, federal officials, state officials need to understand the consequences to the people that are turning positive and the people that are around them, and address that so we can get past that noise and just deliver health care. So when we tell somebody to get tested and they’re scared about missing 10 days of work, that fear because they’ve lost that income protection, needs to be alleviated. And health care can’t alleviate that fear. Health care alone can’t solve this. We need everybody at the table. We can’t just say get tested anymore, understand the consequences of that positive test and not have that addressed by people outside of health care.”

ANTIBODY DRUG

Prevea has a site ready for the newly approved antibody treatment.

“We’ve worked on it, in this week we’ve been moving like crazy, because you want to find a site where you can infuse this drug. Number one, we don’t know how much of it we’re going to get. We’d love to have a lot of it, but we know we have to wait in line with everybody else. Then make sure we have the right patients identified. So going through the testing sites as somebody is identified as high risk, make sure we follow that if they’re positive, make sure that we have a way to get in contact with them because they could benefit from this and not be in the hospital. We had to find a site away from all the other patients, but close enough so we can still get an IV med in there. We’ve worked through that this week. Now we’re just waiting on the drug.”

BIPARTISAN AGREEMENTS

Wisconsin Republican Assembly Speaker Robin Vos has signaled he’d be willing to work with Democratic Gov. Tony Evers on a way to fight COVID-19.

“Any time that you can get people together to solve a problem we should be encouraged. Especially when they come from different angles, because they’ll both bring different ideas. Hopefully both bring great ideas. We’ve given all of the science to the politicians and the public. We’ve given our recommendations, now they have to kind of do their part and figure out what’s right and what’s practical. Not everything that we say is practical, we understand that, but there has to be some practical solutions coming forward.”

VACCINE

How long until after the vaccine is released that we can feel safe?

“That’s a question I think we all want an answer to. We don’t have that yet. A lot’s going to determine that. Number one: when we get it. We’ve heard it’s ready. We want to look at that safety profile. There’s a couple that are getting ‘ready’ and they need to go through the FDA process. Then how quickly we can get it to the public. Remember, there’s certain tiers that are going to get it at certain times. I think one of the biggest issues about when can we start feeling normal, is what’s the uptake of that vaccine going to be? And what I mean by that is, how many people are truly going to get it? And remember, it takes about 30 days for it to work. So you start counting from there. So say you’ve got 50 percent of the population immunized within a two-month time period. Maybe that three months after that you can start feel a little more comfortable, normal at that point. We’ll be looking at numbers within the community. We’ll be looking at hospitalizations. All of that will play into effect in when does normal return.”

NO SYMPTOMS AND CONTAGION

What’s the contagion timeline for people without symptoms?

“It’s another great question because we don’t quite know. So you have to take the most conservative approach. By that I mean, what’s going to be the safest approach? We know that once you’ve been infected, the replication timeline of that virus is about 10 days. Research is pretty solid on that. Even vaccine research re-showed that to us. So we have to assume if you didn’t have symptoms, the day you got tested is day one or day zero. So it’s 10 days from the day you got tested is the safe protocol for being isolated. Wish we had a better number than that. Because obviously if you had symptoms, and they started three days before you got tested, your isolation period is actually shorter than if you didn’t have symptoms. But to be safe, if you didn’t have symptoms, it’s 10 days from the day you got tested.”

ASYMPTOMATIC CASES AND DEATH

Can people who test positive without symptoms die from COVID-19?

“The people who unfortunately pass away from COVID-19 are the ones that have the symptoms. In other words, we’ve seen the effect of the virus on the body to a significant degree to cause organ damage to end your life. They may not be all pulmonary symptoms or all lung symptoms. They could be cardiac symptoms. But there are symptoms involved with those who have lost their life. For those that don’t have symptoms, it’s thought that the asymptomatic don’t have any of the long term effects either, that we’ve seen, but the most concerning thing is how they spread it to other people.”

RAPID TESTS AND ACCURACY

"Every single test only shows you if you’re positive or negative the day that we swab you. It doesn’t predict the future. It only shows what’s happening at that time. The Rapid Test is a really good tool because it helps us screen a lot of people over a short period of time. And it’s really good if you have symptoms. In other words, if somebody has symptoms and that person is positive, we know we’re done. In 15 minutes, we know that we need to isolate you and we’re done. And that’s really important, especially in an outbreak situation, to get control of this virus.

“The PCR, the gold standard, is really good for that asymptomatic person or who we need to understand more about. And just that general surveillance and screening people, we’re going to catch more people with that than we would, say the quick screen. The quick screen is really good if you have symptoms.”

EXPOSURE AND TESTING

A viewer’s daughter tested positive on Sunday. The mother was with her for two hours on Friday. The mother called her provider to see if she should get a test, but they said it was not necessary unless she developed symptoms. What’s the right answer here?

“Number one, it depends on the level of exposure you had to your daughter in those two yours. Was your daughter home with you? Were you guys talking to each other without masks on within six feet of each other for more than 15 minutes? A true exposure. Did you hug your daughter? One of those types of situations. If any of that happened, you need to quarantine. We recommend, no matter symptoms or not, and so does the state, that you do get tested in quarantine around day five or day six. So if you’ve had a true exposure, and I think that’s what the provider may have been trying to discern in your phone call, did you have a true exposure with your daughter? Was she at home at the same time? If so, day five or six is when you should be tested, symptoms or not. Earlier, if you develop symptoms.”

HOLIDAY GATHERINGS WITH GRANDCHILDREN

A viewer wants to get together with his family for the holidays. Several of them have had COVID-19. He has not. His grandchildren have not. Is it OK to get together if they wear masks and try to maintain six feet? Would it put his wife at risk to spread it during her visits to assisted living?

"I think the thing we sometimes overlook, and as the holidays are coming about, this is probably the thing that concerns me the most, is the risk factors children play in COVID-19. Because we don’t hear a lot about children being admitted to the hospital with COVID-19, because not a lot are, a very small amount, and children don’t get as sick, which is true, we haven’t seen grave illness, we’ve seen bad illnesses, but not really bad to a greater extent in the pediatric population, we think we’re fine being around kids. What we don’t pay attention to is how much kids can spread COVID-19 without having symptoms or having mild symptoms. Dennis, you have not had COVID-19, you should not be around your grandchildren because they could spread the disease to you. "

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