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Dr. Rai: "This is the worst way to restart the economy"

(WBAY)
Published: May. 15, 2020 at 9:55 AM CDT
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Wisconsin counties and municipalities are taking a patchwork approach to allowing businesses to open following the Wisconsin Supreme Court's decision overturning Safer at Home.

Some counties are choosing to open, but encouraging businesses and customers to follow physical distancing guidelines and safety protocol

Currently, Wisconsin has no statewide plan when it comes to COVID-19.

for a list of local counties and municipalities and plans for opening.

Prevea Health President and CEO Dr. Ashok Rai appeared on Action 2 News This Morning to discuss how health care is responding.

"This is the worst way to actually restart the economy, because it is done without any checks and balances," says Dr. Rai

SAFER AT HOME RULING

"From a health care perspective, we don't have the luxury of getting political. We have to take care of the patients that are in front of us and those that we know are going to come see us.

"From a health care perspective, we were hoping for a phase-in approach. That way we'd be able to see as people started to return to work in a normal way that, if there were any issues, they could be dealt with at the time. Right now with essentially no rules, and thanks to our public health officer here in Brown County, Anna Destree, we have rules for a week, and hopefully in that time period a plan can be put together either with the state or locally, to re-look at the phase-in approach. The phase-in approach that was approved by the CDC, recommended by the President of the United States, adopted by the state of Wisconsin, was what we felt was the best thing and the safest thing for society. We were hoping we could phase in. Right now from a health care perspective, all we can say is that we're there for you when people get sick and we'll be testing people, and all we can do is hope for the best right now," says Dr. Rai.

"We've got a good amount of [hospital] capacity in the Brown County area, but that's a right now situation. If we have another breakout, which easily we could, and we actually don't even know if we've contained the initial breakout--that's why we're doing so much testing--easily health care could be overwhelmed. It would take one worker at a nursing home, or one worker at an assisted living to not be responsible after work, to go into one of these environments which is not safe and opened up, and then bring that into a congregant setting, and then we could have a numerous amount of deaths."

What about people who say, "If you don't feel safe, don't go out."

"That's easier said than done. And somebody who says that hasn't really paid attention for the last two months. The whole point of stay safe at home was to keep everybody safe, not just to keep a certain set of people safe, was to prevent the virus from spreading. So right now, if you want to go to work and make a living you should be able to go to work and make a living throughout the day. But if somebody after work then goes out into an environment that you don't feel is safe but they feel is safe, and in health care we feel we're not quite ready for yet, and then they contract the virus in these very tight settings--basically a human petrie dish--and they're out there in that congregant setting without any safety, without any masking, without six feet apart, they're going to get the virus. Now they're going to bring it into a workforce. And then the next person is going to get it. And then five more people are going to get it. And then 100 more people are going to get it. And then you have workplace breakouts. That's what we were trying to prevent through phasing in. In phase one, we were going to slowly open up and see how society did at following rules and making sure the virus was still in check. In phase two, you could have gatherings up to 50 people. You could go into a bar. And then once again, we would make sure it was safe to go into phase three. Without those safety checkpoints right now, we could easily get more and more workplace breakouts. It may not be food manufacturing. It could be a nursing home. It could be a hospital. It could be an engineering company. It could be a law firm. It could be any company that wants to get back online right now. This is the worst way to actually restart the economy, because it is done without any checks and balances," says Dr. Rai.

"We were on the verge of being able to open things up. I do think the way the numbers look now, we were on the verge of getting into that phase one where there would be more travel back and forth. The important thing from a health care perspective is we start monitoring symptoms, start monitoring our caseload. Are we getting more positive cases? That was the intent, and try to figure out why that was happening and how to control that. Was it a certain employer? Was it a certain activity? That was the point of phasing in. We've kind of lost that point now. So what we can do going forward, is when we start to see people are positive we do our best to try and work with the public health officials to contact trace, to make sure we can control what we see."

IMPACT

"It really depends on what the state decides, if the state actually decides anything. Right now it's not the governor's decision. It's the state legislature's decision. If they can actually decide on something. Otherwise it's up to the public health officials locally, in what's been called a patchwork. We may never know what the consequences are, because we would not have known what would have happened if we did it the right way versus the wrong way. At this point, from a health care perspective, we're just there to take care of you.

WHAT NOW?

"The virus hasn't changed and it's probably pretty excited--if a virus could be excited--due to the bad decisions that have been made so far. But really what you can do is do what we've told you for eight weeks. Maintain six feet. Wash your hands. Wear a mask. Go to the places you that you need to go to to get food, or where you can be outside. There's tons of outside activities that have opened up and opened up safely. Even small retail has opened up in a safe manner. There are ways to do things safely and phase things in, and that was what the plan was, and there's ways to do things improperly, and that's kind of what we have now," says Dr. Rai.

WEARING MASKS AT WORK

"So it really depends on what your desk environment is. We have a simple rule at our office. If your door's closed, you can take your mask off. If your door's open and somebody can walk in, you should have your mask on. If you're going to walk in the hallway, you should have your mask on. If you sit in a cubicle environment you should be wearing a mask at all times because there is no way you can protect yourself from someone interacting within six feet. Every employer setting, every work setting is going to be different. But that's at least what we recommend," says Dr. Rai.

THE CURVE

"The goal has always been to get the number of total cases and the volume that was going into the hospital below the hospital threshold to take care of them. We've done a very good job in Brown County. On the behalf of health care, thank you. So the point now is to continue to watch for spikes in that curve to make sure it doesn't get to the point where it overwhelms the health care system and then causes a collapse, which then affects everybody. When health care collapses, it's not about not being able to take care of COVID patients. It's not being able to take care of any patients. And that's not what you want to see for a society to function. So you want to make sure those total number of cases stays below that. We've flattened it below that, thank you once again. Now we're going to have to watch to make sure we don't spike up," says Dr. Rai.

REMDESIVIR

"We're really excited. Dr. [Manar] Alshahrouri at St. Vincent Hospital and St. Mary's Hospital, a Prevea physician, was able to request this. We requested it for eight patients. We got it for seven. It's really for those who are in the Intensive Care Unit. The point of remdesivir is to stop the virus from replicating in the body. Once the virus gets in there, the way it infects you is it keeps growing. It replicates. So more strands are developed. Remdesivir kind of controls that, and shortens the stay in the hospital, in the ICU. We don't have a whole lot of treatment options. This combined with the multiple patients we've been able to give the convalescent plasma to, provides us some hope. Because these patients are very sick. They've been in the ICU for weeks. As physicians, we want to provide hope and we really want to take great care of our patients. It was incredible to be able to get access to this drug. We went through a lot of work to get it. Other hospitals in town have gotten some as well. We were excited to get our allotment and be able to use it," says Dr. Rai.

SCHOOLS

"It's a tough question because we had a [statewide] plan, and now we don't. I think we're going to have to see how the next couple of months play out. How well we can do at identifying breakouts if they are there and controlling them, since we won't be phasing in, or unless the state does come to an agreement to phase in here, which we can still hope for within a week that that would happen. But say we have no plan. We'll have to watch things very carefully. I know in a school environment we can recommend physical distancing, but it's not easy. I think we're going to have to prepare our schools and prepare our parents for screening their kids before they come to school. Making sure if somebody has a fever or cold that they're staying home. Even if it's not COVID, just to reduce those risks. If we do have positive COVID cases that we can isolate and then turn a school off for a couple of days and then turn it back on to make sure they don't have spread. And if we do have a breakout in a specific school that we have a way to control that and to back down and go back and forth with distance learning if we have to. Ideally, we'll get back to school and have no issues. But we should be prepared for issues and try to be as smart as possible. Unfortunately we won't have a chance to phase into it unless things change here in the next week. So we're going to have to see how the next couple of months go and be very careful. And we'll also learn a little bit more about the effects of COVID-19 in children as more research comes out. We'll make sure that it is safe for our kids to go back," says Dr. Rai.

EXPOSURE AND SYMPTOMS

"The average time of showing symptoms after exposure is five days, but it can be up to 14 days. That's why all these phase-in opportunities have been in 14-day increments. Because it can take up to 14 days for that virus to show up. On average, it's five days. If you're demonstrating no symptoms, but it was a close contact--somebody you live with, your spouse, somebody you work in the same office with and you're not able to physical distance and there's been no mask present within five days of that five-day period. Understand a negative there does not mean you don't have the virus and you could be asked to isolate for up to 14 days if it's a close contact," says Dr Rai.

TESTING

Brown County's community-wide testing for all people who live or work in the county goes until May 22.

to sign up.

"Right now we're testing everybody, so that includes people without symptoms. That's not going to continue. The purpose of testing people without symptoms is surveillance testing. See what exists in the area. In reality, you should only be testing people with symptoms and that will happen after next Friday (May 22) when asymptomatic testing goes away. And that may come back if we have breakouts just to assess an area. But really after the surveillance testing is done here in Brown County, we'll match what other counties are doing, which is basically testing if you have symptoms, and making sure that everybody has the ability that if you do have a symptom, that you can get tested right away. All that infrastructure will be set to go by next Friday," says Dr. Rai.

"Knowing what's in your environment helps us reopen. We won't have those results--remember it can take up to five days to get a result, or even seven days depending on what's going on with the National Guard and what's going on in Madison--so if you look at the 22nd being the last day we're doing the surveillance testing, really the 29th would be the farthest we'll be looking at all the data. But we'll have most of it by the 26th, which was the original date to reconsider opening things back up, at least through phase one. So we'll have that data, we'll be able to look at that. The public health officials will be able to look at that and make some decisions that say, it's OK to start phasing back in. Once again, the state has to do that and we're not what that's going to be."

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