Dr. Rai talks Brown County influx, increased testing ability and a possible 2nd wave

Published: Apr. 22, 2020 at 9:32 AM CDT
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Brown County continues to report an increase in coronavirus cases linked to spread at companies, and it has local hospitals on edge.

"Any time we see an uptick in outpatient cases we're worried about the influx into the hospital. As we know there's a certain percentage of these patients that can get very, very sick and tie up resources very quickly," says Prevea Health President and CEO Dr. Ashok Rai.

Dr. Rai joined us on Action 2 News This Morning Wednesday to discuss the outbreak, a new at-home testing kit, the increased availability in testing, and some news about symptoms and treatments.


"It's hard to know the exact cause of it, but if you really do look at our jump in numbers, and so many have been tied by public health to a few companies in town where public health and the CDC is involved. So it's not unexpected that we'd have that jump in our ranking right now. It seems to be in those smaller clusters. It doesn't seem to be throughout the community. But there's a chance it could keep expanding," says Dr. Rai.

"Any time we see an uptick in outpatient cases we're worried about the influx into the hospital. As we know there's a certain percentage of these patients that can get very, very sick and tie up resources very quickly. You can go from nobody in the hospital to 10 people on the ventilator in 24 hours. So we're all on edge. We're making sure that these patients are well monitored. The CDC and public health have given us guidelines to make sure they're tracking this patients. We hope they all do well. But from a health care perspective it does create concern about resource utilization here locally."


"So really we follow the directions from public health and they're getting their directions from CDC. Right now, what they do is they screen for people that could be at risk factors. The same kind of screening questions we ask if you come into the clinic. And if anybody answers 'yes' they get tested right away and quarantined. So that's a very effective public health model to screen, test and quarantine. And that's what they're doing to help those companies control the situation, help the county control the situation. But really, public health is doing a great job by being there and making sure that's followed through on."


"When public health is asking about close contact, they're really talking about those who you live with. Maybe if you have a second job, those who you work right next to, or right within your immediate job, if you had close contact. They're not asking did you go to X grocery store and go up and down the aisles. That would be impossible to contact trace that. They're looking at your family. Did you maybe violate the social distancing rules or the physical distancing rules? Did you go to a get-together with other families? Did you go to a backyard barbeque? Those type of things that you shouldn't be doing. They're going to ask about so they can do real contact tracing," says Dr. Rai.


Health officials in Milwaukee

during the April 7 election.

"Unless you knew that the person that you were voting next to or that you were in contact with had COVID-19, it's really hard to know that it came from the election. It could. It would mean that since the election, you've pretty much done nothing and you've been at home. Which, for a lot of people is not a reality, because they're out grocery shopping and touching things that come into their house. They could've gotten a package. So it's really hard to exactly tie it to the election. But obviously this environment of the election did create a risk and there's no doubt about it that we had an increase in cases from it. But to say that we had seven cases or 10 cases, I don't know how they're actually going to track that," says Dr. Rai.

"We're kind of just at the end of the time frame. But really right now, with the state's new rules on testing, if you have any symptom at all related to COVID-19 you should be tested and you can be tested, which is a big change from last week. And now that we have the ability to test you should be doing a virtual visit and then scheduling yourself a test, and going to one of the respiratory clinics and getting yourself a test."


Georgia Gov. Brian Kemp

by the end of the week. Tennessee Gov. Bill Lee wants businesses up and running by next week.

"I haven't looked at the southern states' trend in numbers, but President Trump's task force is pretty specific about the 14-day gate before you should start opening up. Maybe they've accomplished that. I don't think the CDC's said anyone's accomplished that to my knowledge. But really you have to look at that plan, accomplish getting through that 14 days, very similar to the state of Wisconsin's plan, which was structured around the president's plan. So if they haven't done that, all they're doing is basically saying all the scientific evidence that went into creating that plan, 'we really don't care about that, we're going to do our own thing.' There's a significant amount of risk there. It's somewhat of a gamble to be honest with you. And you could wind up having a significant outbreak of cases that are likely not going to be employer-related or nursing home-related. They're going to be community-related. And the only way you can contain that is really rewinding the clock and staying safe at home again."


"COVID-19 is going to be with us for a long time. We expect different resurgences of the virus. I think what's really concerning people and what the CDC director is talking about, is having the virus layered on top of our normal influenza season. Patients have been known early in this process to have both and they get much worse. So that could once again create an overwhelming situation for health care and create significant situations for patients. So a lot of planning will go on between now and then. One of the biggest things we'll be probably doing is making sure people get their influenza vaccine so they don't have that risk of that concurrent infection. We could see a significant rise in COVID-19 cases. We could see significant rises in deaths because of people getting both viruses together. Health care has to prepare. We have to get our personal protective equipment ready. We have to be ready for surges. All that planning we've done now, we'll likely have to have that in place for winter time as well."


"Unfortunately people are not coming in with their chest pain. They're not coming in with the pains they need to come in that could be serious, stroke-like symptoms. They're staying at home. You should really think about early on in our broadcast we talked about staying at home and don't come to the emergency department if you have COVID symptoms. We've kept those patients out of our emergency department. We have special places for them to go. There's actually no safer place, no cleaner place right now that the emergency department. So if you have something wrong you should be seen," says Dr. Rai.

"I think people misinterpret elective as something you don't need. It's just something we thought we could delay for a period of 30-days-to-six weeks to allow us to have the capacity to make sure that we could implement things in the hospital to make sure you're safe, such as masking, such as COVID units being built specifically to keep those patients away from regular care. As the health systems prepare to open up here in the first or second week of May, understand that we've all taken the similar precautions to make sure that environment is ready for you. Things will be different. Your doctor will be wearing a mask. You will be wearing a mask. If you're having surgery you may be tested for COVID a couple days prior and asked to quarantine. There will be some minor inconveniences in that situation, but you're going to get your needed health care done."


"If we rewind six weeks ago it was really hard to get a COVID test. You had to be in the hospital. You had to be somebody who had significant risk factors. Then we added health care workers. Then we added people who work in prisons and nursing homes. And then first responders. And you had to have a significant amount of symptoms for that. The state has actually lowered that bar significantly. That just happened in the last week. So I think people are still looking at where the testing criteria was a couple of weeks ago. Right now, any symptom, you can get tested no matter what your risk factor is. That's pretty significant and we expect a higher volume of testing. You still want to use that virtual care environment or go to one of the respiratory clinics if you have symptoms to get a test. Once again, you still have to have a symptom to have a test. It's not for people who don't have symptoms. But the bar has been lowered significantly. And the expectation from the governor and the state is that we test a lot more people every week going forward," says Dr. Rai.

"At what point do you start testing asymptomatic people? Right now if you test somebody with symptoms and they're positive, you know they're positive, you can do the contact tracing. If you know they're negative, you can still give advice about symptom monitoring and quarantining. For somebody who has no symptoms and you're testing, all that means is today you don't have coronavirus. But 15 minutes later you could walk outside and be exposed to somebody and then three-days or five-days later have symptoms and have it. That asymptomatic testing, we're trying to figure out what place it has in the overall strategy of the containment of this virus. The CDC may come out with some recommendations, and that combined with antibody testing, to really understand what the prevalence of the virus is in certain periods of time going forward. So there may be waves of testing as well for people who have symptoms or people who don't have symptoms."


"I really have to give credit to my colleagues at Bellin and Aurora, at Door County Medical Center, at Holy Family. We've all been meeting. And more importantly, public health has been there with us. So we get an update from public health and we get to see what direction we get from them as well. So these employer breakouts is a great example. We get updates from them. They tell us where they need us, when they need us. Bellin and Aurora responded earlier this week. We have people on site from Prevea today helping with one of the companies. The collaboration is basically something we've never seen before. It's all in the best interest of the community. We're health providers. We've all taken oaths to do what's right for the community. But the level of collaboration has been great. We share 20-30-40 times a day we're talking about who needs PPE here? Who needs help with testing there? What are your processes for pre-operative clearance as we approach the new day? All that's been shared amongst the systems," says Dr. Rai.


to start selling an at-home kit. You're using a different kind of swab, not going as deep in the nose, going into both sides of the nose to get the sample and you're sending it in. So it's not available to everyone yet. Really, they're reserving it for health care workers and first responders. And they're still asking you if you have symptoms or not to see if you qualify for the test. It still has the same limitations. There could be operator error on getting the right sample so you could have a false negative. They walk you through that. But this is the first one approved. And LabCorp is a pretty reputable lab that we've actually used for our send-out tests in the past. So we'll see how this takes off. You still need a physician'ss order," says Dr. Rai.


A study at U.S. veterans hospitals found that 28 percent who were given malaria drug hydroxychloroquine and usual car died. That's compared to 11 percent who received usual care alone.

to read more information about the study and how it was conducted.

"So any time you have a new virus, a new bacteria and we start just throwing things at it without research you're going to find out what works and what doesn't. Sometimes the hard way. The VA looked at this in a small study and realized that hydroxychloroquine maybe was not helping people--maybe was even hurting people when they looked at how many people died on hydroxychloroquine and that was higher than those who didn't. And they're a small study. It goes to show that every treatment needs to be well studied and you have to understand that there's no real benign medication out there. In other words, everything can cause harm. And we knew hydroxychloroquine could cause sudden death, heart issues, and we had to use it carefully. And we've used it carefully. But now that we know that maybe there are other drugs that work better, it's likely going to take a back seat," says Dr. Rai.


"The skin conditions, the ones that are being reported that we've seen, are really due to that small blood vessel clotting. Remember, coronavirus, as we've talked about it, creates an inflammatory reaction throughout your body which causes blood clotting. Those tiny little blood clots towards the tips of your fingers or toes can cause some discoloration or some skin lesions. We've also seen reports of other types of skin lesions not related to clotting. So as we learn more and we research more we'll see which ones are truly related to COVID and some may be just incidental skin findings or they just happen to happen. But really what we've noticed for sure is looking at those small blood clots and what it does for the skin."


"I think my answer is going to disappoint at lot of people out there when I say it depends. We need to make sure that we continue to have that downward trend. And as you look at the phases from President Trump's plan and Gov. Ever's plan, which are extremely similar, if you look at those phases, by phase three you could technically have a wedding. So there's a gate to get through and two more phases to get to to get to that point. And nobody knows how long it will take us to get there because we need to see that continuous improvement and not big spikes as we start to open things up. Is that the middle of summer, end of summer or fall? That's hard to predict. And when you actually have your function, a wedding, a graduation party, whatever it may be, there's probably going to be different kinds of safe practices. You may not have that many people at a table. You're going to try to create distancing. You'll find different ways to celebrate certain traditions that happen. To create some spacing at those venues. That's going to be different for the people planning the wedding, the people hosting it or whatever event it may be. There are going to be some significant changes as we start to slowly re-gather in groups."


"It's important to understand that any underlying chronic disease condition--and obesity in itself is a chronic disease and does create challenges for us in health care when managing that. Especially because people with obesity likely could have Type 2 Diabetes which makes it harder do manage," says Dr. Rai.

"And then obviously this is a respiratory virus, so if you smoke or if you vape, you're going to do worse than somebody who doesn't because your lungs are damaged through your own habits and then you add a virus on top of it, you're going to do much worse."