Winona Health Medical Technologist Erin Rako loads an antibody test in the laboratory at Winona Health.

Winona doctors explain COVID basics


(12/2/2020)

by CHRIS ROGERS

 

It’s not just public health officials and the government telling people to wear masks, social distance, and stay home when sick or exposed to COVID-19. Local doctors — the same ones Winonans turn to for checkups, broken arms, and heart attacks — explained why these measures are crucial to preventing the spread of the virus.

 

What’s at stake

The virus is invisible, but for these doctors and other health care workers, its impacts couldn’t be more concrete. “I think this is the worst it’s been, and it may get worse, to be honest,” Winona Health Urgent Care Physician Dr. Ian Young said. Winona Health’s eight-bed intensive care unit was completely full for at least one day last week, and hospitals across the region are at or near capacity.

Many people only have mild symptoms from COVID or none at all, and advancements in treating the disease have helped drive down hospital stays and deaths. However, the sheer number of people getting infected right now means a lot of people are getting seriously ill at the same time. On top of that, health care workers’ exposure to the virus while out in the community is squeezing the staffing capacity at hospitals and nursing homes.

“We have to realize medical resources — they are not unlimited,” Winona Health Geriatrician Dr. Jennifer Forsyth said. “Certainly we have not closed down our facility and we are still seeing patients, but if this surge continues, things could be more dire.” She added, “A lot of health care institutions are at their max. Health care institutions are struggling with their staffing, and we want to slow [the virus] down if we can.”   

“If that continues to ramp up,” Young said of infections and hospitalizations, “that means we might see what we saw in other European countries like Italy, where they are putting patients in hallways and pulling staff from other departments.”

That scenario could bring tragic consequences for some local families, but there are things every citizen can do to help prevent it. A growing body of evidence shows that steps to contain the virus work if people follow them.

 

Do masks work?

“Yes,” Winona Health Emergency Department Director Dr. Chris Watras said. “There have been lots of studies that have time and time again shown that face masks do work.” Forsyth echoed, “We know that masks are effective.”

A U.S. Centers for Disease Control (CDC) roundup of evidence for the effectiveness of face masks cites 45 different scientific studies showing that face masks reduce the risks of spreading COVID. A study of a coronavirus outbreak on a Navy aircraft carrier found masks cut transmission risk by 70 percent. A new study from the Mayo Clinic found that wearing masks and social distancing produced dramatic reductions in viral spread. “We found the most important measure for reducing the risk of exposure to COVID-19 is to wear a mask,” Mayo Clinic Radiology Department Chair Dr. Matthew Callstrom said.

How can a couple layers of fabric stop a microscopic virus? Watras explained, “Whenever you’re talking or doing anything like that, there are some droplets that do come out of your mouth, and at least the fabric masks will help prevent some of that droplet spread.” When worn over a person’s mouth and nose, masks cut down on the amount of droplets that come out and how far they travel in the air, Watras stated.

“They’re catching some or the lion’s share of [droplets] and reducing the spread and reducing the severity of it if you get it,” Young said. “It’s not perfect,” Young continued. “It doesn’t prevent everything, but it doesn’t hurt you to put it on … It’s like wearing a seatbelt. It’s very, very mildly inconvenient, but it’s been proven to save thousands of lives.”

Minnesota Department of Health (MDH) officials have stressed that masks alone or social distancing alone aren’t sure-fire safety measures. Rather, they’re meant to be layered with other safety precautions. Each one reduces the risk some, and collectively, they reduce the risk significantly.

Masks aren’t new, Forsyth pointed out. They’ve long been used to control diseases that spread through respiratory droplets, such as tuberculosis or influenza, she noted. “I know there’s a lot of skeptics about masks, but as a medical community, we’ve done it for a long time, and we know it’s effective,” she stated.

Surgical masks are more effective than cloth masks, and two-layer cloth masks are better than single-layer neck gaiters, Forsyth said. Still, she added, “Something is better than nothing, and we want people to be wearing a mask if possible.”

Are masks safe for people with lung conditions? Yes, Forsyth responded. Citing a study of people with chronic obstructive pulmonary disease (COPD), she said, “Those people with COPD wearing masks had the same oxygen saturation as people with COPD not wearing masks.” Forsyth added, “It’s uncomfortable sometimes having something on your face, but physiologically, it doesn’t really affect air getting in.”

 

Social distancing works

It’s human nature to get together. Sadly, it’s the nature of the coronavirus to spread when people are close together, breathing the same air.

Talking, coughing, sneezing, singing, or just breathing can release viruses into the air, according to the CDC and MDH. Outside, Forsyth said, “We’ve got breeze, and we’ve got wind. But when you’re enclosed [indoors], that doesn’t have anywhere else to go but in the room with you. So it can be very infective when you’re in a closed space and in the same room as somebody.”   

“It, unfortunately, is an important thing,” Young said of social distancing, the recommendation to stay at least six feet apart from others. In a similar vein, health officials recommend avoiding large gatherings altogether. “It’s such a contagious illness that if one person in a group of 20 has it, even if everyone is wearing masks, there’s a pretty good chance some people are going to get it,” Young stated.

Young mentioned one doctor he knows who had been exposed to COVID-positive patients hundreds of times at work, but never got infected. However, that doctor’s spouse got infected while at a small social gathering and brought the virus home, according to Young. That goes to show, he stated, “Protective gear works, and social gatherings are bad.”

Staying apart from people is hard. It’s especially difficult in nursing homes, where residents are both at great risk of serious illness and death, and are facing harm from the health effects of long-term isolation. “It’s really tough,” Forsyth said. “I’ve seen more depression and cognitive changes in the last eight months than I did ever before, and I think that’s because people aren’t able to be as social as they used to.” The doctor, who worked at a Winona nursing home racked by infections and deaths this spring, added, “But I have also seen the worst of the worst, and I know this virus is very infective and it spreads very quickly. So distancing is the one thing we can do to protect our population, I think that’s something we need to try to do.”

Forsyth continued, “Even with the current state — with the spread just exploding in the last couple weeks, that social distancing piece is going to be really important trying to slow things down.”   

 

Isolation and quarantine will save other people’s lives’

Isolation and quarantine are fancy words for staying home and away from others. Isolation refers to people who definitely have COVID, and quarantine refers to people who might have it, such as people who were exposed to an infectious person. The bottom line is those people need to stay home, except for testing and emergency medical care, to prevent spreading the virus everywhere they go.

“It is vital,” Watras said of quarantine and isolation. “It is a key part of stopping the spread because you can still be passing and shedding virus even if you feel OK.”

The CDC recommends that people who test positive for COVID isolate until all three of the following criteria are met. First, it’s been at least 10 days since symptoms first appeared — or, for people with no symptoms, 10 days since their positive test. Second, they have gone at least 24 hours with no fever without taking fever-reducing medication such as aspirin. Third, their other COVID symptoms — except the loss of taste and smell, which could last for weeks — are improving.

Most COVID patients can recover at home. “If you do have COVID and your symptoms aren’t that severe, the best place to be is at home, quarantining and isolating and taking care of yourself,” Watras advised. “If you are having symptoms where you are really short of breath and having trouble catching your breath doing normal activities, walking around the house, that would be the time to come in,” he added. The CDC recommends calling 911 and seeking emergency medical care if COVID patients develop persistent pain or pressure in the chest, new confusion, an inability to wake up or stay awake, or bluish lips or face.

People who are “close contacts” of a COVID-positive person should quarantine for 14 days since their last exposure, the CDC recommends. A close contact means being within six feet of an infectious person — regardless of mask use — for a total of 15 minutes in a 24-hour period, according to the CDC. People who hugged, kissed, shared utensils or drinks, or got coughed or sneezed on are also considered close contacts. People with COVID are considered infectious two days before symptoms begin or, for people with no symptoms, two days before their positive test.

Exposed people should continue quarantining for the full 14 days even if they test negative, according to the CDC and MDH. That’s because the coronavirus has a 2-14-day incubation period. During the incubation period, people start out with a tiny amount of virus inside their bodies — too little for a test to pick up — but the virus will slowly multiply and develop into a full-blown infection, Watras explained.

“So you can still be in the incubation period, where you’re feeling fine and you test negative for the virus,” Watras explained. “You can have a negative test one day, and then a couple days later, you can test positive once the virus reaches a certain level in your system.”

Not everyone is following these guidelines, MDH and Wisconsin officials report and local citizens have admitted. “It’s hard to have very minimal symptoms yourself and totally change your life for two weeks,” Forsyth acknowledged. “But now, with everything exploding, now is the time to take it seriously and really follow those guidelines. I don’t know how we’re going to control unless people really do quarantine and isolate.”   

“It is tough,” Young said. “And all I can say is that they’ve proven it’s helpful and it saves lives to quarantine. It may not save your life, but it will save other people’s lives to quarantine.”

Watras knows it’s difficult. “My wife had a high-risk exposure recently, and we had to isolate. So I stayed in a separate part of the house. I stayed in the basement for two weeks,” he explained. “It was hard to do. It was difficult on our relationship … But it was the right thing to do so that I could still go to work and take care of other members of the community.” Fortunately, his wife didn’t wind up getting sick.

 

Symptom-less spread

All of these COVID safety precautions are important for people to practice, even those who feel completely healthy, because people can spread COVID without feeling sick, Watras, Forsyth, and Young said.

At local nursing homes, Forsyth said, “There were so many times we would test a staff member, that staff member would be negative, and then five days later, they would develop symptoms. When you take a test, that test is really only good for that moment, and you might become positive the next day.”

 

Stay safe, Winona

People really can make a difference by following these guidelines and being on the lookout for symptoms, Forsyth said. “The more people can self-monitor and do some of those infection control practices, the better for everyone,” Forsyth said. “The better for me, the better for the nursing staff, and the better for the people who live [at local nursing homes] and stay there.” She added, “Though this kind of sucks right now, it’s not going to be here forever.”   

Young encouraged Winonans to wash their hands regularly, cover their coughs and sneezes, and wash their hands immediately after coughing or sneezing to help prevent the spread of COVID. “Don’t touch your face, because obviously, if you have it on your hand and touch your mouth, that’s a good way to spread it,” he added.

Watras reminded Winonans not to ignore other serious medical issues during the pandemic. He pointed out that the Winona Health Emergency Department is outfitted with lots of negative-pressure rooms — meaning no air leaks from the room to other parts of the building — that help keep COVID from spreading within the facility. “The ER is ready to handle the emergencies,” he said. “We are going to make sure we take care of people regardless of whether they have COVID or some other emergency.”

Chris@winonapost.com

 

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