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Dr. Ashok Rai answers viewers questions, discusses nursing home outbreaks, and a shorter quarantine period

Published: Nov. 26, 2020 at 10:07 AM CST|Updated: Nov. 26, 2020 at 11:10 AM CST
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GREEN BAY, Wis. (WBAY) - Prevea president/CEO Dr. Ashok Rai came into our studios Thanksgiving morning to answer more viewer questions about the COVID-19 crisis in Wisconsin, including questions about vaccinations, in-person schooling, and school sports. He also discussed coronavirus outbreaks in Minnesota, the CDC’s consideration of a shorter quarantine period, and the success of antibody treatments for local patients.

“I had COVID in October. Should I worry about being a carrier if I go someplace for Thanksgiving?”

I think the number one answer there is, this is the day to stay home with the people that you live with, remembering the people that you can’t be with so you can be with them next year. If you have had COVID in the last 90 days, after the first 10 days after recovery you’re considered to not be transmitting the virus. And all the CDC says about that is, you would not have to re-quarantine if you were exposed in that 90 day period and likely would not need to be retested. Those are the only two things you get out of having COVID right now. We don’t know about protection, so the safest thing you can do is stay home.

“I’m older and have underlying health issues. Will our health care providers be notifying us when the vaccine is available, and how will they be prioritized?”

That’s actually a great question and very timely, because that’s what health care providers are working through right now. We actually had a call yesterday with our electronic medical record (EMR) vendor, EPIC -- it’s the same medical record used by other medical systems here in town -- about how to actually mine the data in our EMR to track the medical records, find out who needs the [vaccine], and track those people so they get it. So we’re working through all of that. Expect this to be somewhat of a push and a pull: A push is us reaching out to you to make sure you get vaccinated, and a pull, you contacting your primary care doctor to make sure you get it. Be a combination of both. This is going to be the largest operational lift in health care history, and we’re still working through it, but hopefully by the time we’re ready to start giving it to the public we’ll have those lists ready.

“I’m concerned about schools that aren’t virtual right now. Should schools be virtual with the status where we’re at right now?”

I think the last part of that question is probably the most important. The American Academy of Pediatrics would say the best place for a child to learn -- and I would fully agree -- would be in person in school, but they also have that caveat: if the surrounding area of the community, the spread of the virus is under control. That’s not true in our community. So when you put the two together, I think every school system needs to make a decision: Do they have enough staff? Are they able to truly keep people safe? And I think a lot of people measure about the outbreak in the school as a measure of how good they’re doing, but it really needs to be a measure of that and how the community is doing. You cannot create a bubble when you have a percent positivity of 37 and 40 percent in your community. We’ve seen that in long-term care. Just because kids aren’t getting sick doesn’t mean they’re not carrying it, so you have to add all that up when a school district is making that decision. As health care providers, all we can do is give you the data, give you the facts, and then systems and boards need to make those decisions.

We’re not advising them whether to go virtual or stay in-person. We’re just going to give them the facts and make sure they’re doing the safe things. At the end of the day, they have to make the decision they feel is right.

“School sports, football is outside, but basketball season, now we’re talking inside in a facility. That kind of changes things.”

You know, it does. Definitely, in outdoor sports we have that air-conditioner of Mother Nature moving air around. You won’t have that at basketball. And basketball is a contact sport; you’re going to definitely be within 6 feet of each other, if you’re playing it well, for longer than 15 minutes. I think the key thing about the indoor sports season is what it means if there’s a single positive on a team. There’s a single positive on a team and they’re practicing together, they’re benched together, you likely will quarantine that whole team. So for every single child that turns positive on that team, the rest will be out for 14 days, and that’s out of basketball and outside of school. They’ll be out of school, they’ll be home. So, understand the consequences of playing as well.

“I have a friend who really needs help in their home. What safety precautions should I take if I stop over to help her out?”

That’s a tough one. Obviously we’d say, stay away if you can, but if you’re that person’s health care provider or home care provider, then make sure you have the personal protective equipment that we would wear when we’re protecting others and protecting yourself, which would be a surgical grade mask, a face shield, an isolation gown, gloves that are changed everytime you’re interacting. That’s what we would generally do when we’re a caretaker for somebody else.

“My church is offering a communion cup as a common cup to anyone who goes to my church. What are the risks of taking communion at church in a common cup?”

A common cup, no matter how much you’re sterilizing it, is still a risk factor because of the liquid that’s in there. So I would advise using single cups. A common cup has its risks. No matter what you do to that surface, it still has risks.

Article continues below the video of the second interview

Nearly 300 nursing home residents in Wisconsin died of COVID-19 in a four-week period October 12 - November 8. In Minnesota, 90% of nursing homes experienced an outbreak.

“It’s an unfortunate setting, and I think initially the approach a lot of people in public took was, ‘Let’s protect our most vulnerable, those in nursing homes. So, let’s keep them in there, let’s avoid the visitors, and then we can go and do what we want to do,’ and I think we’ve proven that, time and time again, an outbreak is impossible to control if society or what’s going on outside of the nursing home is out of control. So when you have a percent positivity like we do, you can’t create that bubble that everybody wants to create in a nursing home, because people do want to come in and out, staff comes in and out. You can test and test and test. You still need to be able to control what’s going on in the community. What you’re seeing in Minnesota is no different than what you’re going to see here in Wisconsin and what you have seen. And all it takes is one positive, because it’s a congregate setting, everybody’s at risk, it spreads so quickly.

Prevea Health antibody treatments

We’ve been using the Lilly monochrone antibody drug, and we’ve been using it as an outpatient [treatment], and even when we start to see these outbreaks in long-term care, contacting them and bringing them into the infusion center for that, to see if we can prevent them from getting sicker. That’s the whole point. This is not for a hospitalized patient but someone who could get hospitalized and preventing that. The other drug that’s becoming available is Regeneron. I think we’ve heard a lot about that, and now that’s becoming available and being delivered to us. The biggest difference between the two: The Lilly drug takes 2 hours to infuse, the Regeneron drug takes 6 hours to infuse, so we’re just trying to figure out the logistics behind that and how we can make that happen.

You get frustrated at times. You get people tested and then they’re positive and you just wait for them to get sicker so you can do more for them in the hospital. It’s nice to try to prevent that for once. And people have been getting better. I don’t know if it’s the placebo effect or the drug, but so far so good, and we’re happy but we want to make sure that everybody has access to it. So, those that need it, those that are older, those that have chronic diseases, if you turn positive and you start having symptoms, let your doctor know so we can get that drug for you.

CDC considering shorter quarantine time

You’re looking at the risk-benefit in this situation: The risk being more spread, the benefit maybe being more compliance with a shorter time period and less economic impact and less psychological impact on people. The confusing part is, we’re at halftime right now. It’s changing the rules at halftime. And also, the State of Wisconsin has to adopt that, and local public health has to adopt that, so we’re not ready for that yet. I think everything’s being reviewed and we’ll see what comes in the coming weeks.

Dr. Rai’s concerns this week

We’re doing better. I like to say -- and I think sharing good news is important -- our numbers are starting to trend down, our hospitalizations are slightly trending down. Staff are coming back. We’re doing a little bit better. How our behavior this week translates into that continuing to do better will really matter. I really want to make sure that people stay home and continue to get better, continue to get those numbers down, continue to open up more hospital beds, get the numbers better so kids can go back to school sooner than later. Those are the things that we really worry about right now. And you know, that’s probably our biggest stress right now is things look good and they continue to stay good.

Vaccine planning

It’s hard to plan for something you don’t know when you’re going to get, what you’re going to get and how much you’re going to get, but we’re trying. This is going to be a long haul. This is not going to be a one-week thing. This is going to be, you know, in increments, the first increment being the frontline staff, law enforcement and critical staff members, and then growing to those that have illnesses and everybody else. But how to get them in, how to get them immunized, how to keep track of them, all of that we’re working on right now, and there’s a lot of planning going on right now.

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