Frederica Freyberg:

The overflow field hospital located at State Fair Park started accepting COVID-19 patients this week. With cases surging across the state, hospitals in hotspots like the Fox Valley and northeast Wisconsin are expected to be able to transfer patients to that alternate care facility. Hospitals in that part of the state have been sounding the alarm on numbers of COVID patients coming through their doors, including our next guest. Dr. Paul Casey is the medical director of the emergency department at Bellin Hospital in Green Bay and thanks very much for being here, doctor.

Paul Casey:

You’re quite welcome.

Frederica Freyberg:

Well, Wisconsin’s field hospital, as we’ve said is, is accepting COVID patients now. Do you expect to have to send patients there?

Paul Casey:

We actually talked about that earlier today. A couple problems with the field hospital. The first is it’s 120 miles away, so it’s not logistically that convenient for our patience’ families if we send somebody 120 miles away. Although the COVID patients typically can’t have visitors. The other problem is that there’s a severe limitation to the severity of illness that the facility can handle. They have to essentially be ambulatory. If they’re diabetic, they have to be able to check their own blood sugar. The nurse to patient ratio is 1-7 so really it doesn’t offer the same level of care we can give in the hospital. So that’s going to be a limitation.

Frederica Freyberg:

Interesting. You provided us with a graph of the daily count of admitted patients with COVID-19 at your hospital. Clearly the numbers go way up starting in October. Other than sheer numbers, what do you want people to know about who these patients are and who’s most at risk?

Paul Casey:

So, that graph shows a striking rise in cases that actually started the last part of September. And I get a daily report that details the number of patients we have in the hospital. And you can see from that graph that we had kind of a nice little hump or wave back in the spring and then by, I think it was the 3rd or 4th of June, our hospital was down to one COVID inpatient. End of September, I started to notice the report I get daily, the numbers kept rising. So I plotted that all out on an excel spread sheet, generated that graph and I went, oh my goodness, we’re in for trouble here. Look how rapidly this is rising. That’s exactly what we’re seeing. And we’re seeing people of all age ranges — I shouldn’t say that. Ranging from late 20s to 70s and above. The vast majority of patients we’re seeing are 50 and above. The most vulnerable in terms of risk for mortality are elderly people. The overall mortality rate for the COVID pandemic in general is about 1% of those people who get it will die. If you’re above 70, 30% of those people will need to be admitted and 30% of those will die. The older you are, the more medical problems you have, the more risk of you dying from the disease. And that’s exactly what we’re seeing. We’re seeing elderly people who don’t go anywhere — and I ask patients when they come in to the ED very sick, I say, where do you think you got it? The other day I saw an elderly man in his late 70s who said, I don’t know. My wife and I stay home. We haven’t been anywhere. I said, who comes to visit? He said my grandchildren bring my groceries. So that’s the only way that family could have gotten the virus. And that’s the theme we’re hearing over and over and over. We had a small family birthday party, just ten of us. Nobody was sick so we thought we were safe. Turns out one of those was asymptomatic and spread it to other people and then the vulnerable ones in that population, the older people and those with other diseases are the ones who have to be hospitalized.

Frederica Freyberg:

So what would the message be there then? I mean it’s kinda like it’s not necessarily people cramming into bars or going to so-called “super spreader events,” but would that then make us believe that we should all basically be trying to self-quarantine?

Paul Casey:

The message is if it’s somebody you know that does not live in your immediate household, you need to take the precautions with that person when you get together. So I’m not saying we shouldn’t get together. But when we have meetings in the hospitals, we all wear masks. We have the tables labeled to where we can sit so we’re properly socially distanced. If you have a small family birthday party with ten people and those people aren’t living with you in your household, you should all be wearing a mask. It sounds harsh to have to say that, but that’s the only way we’re going to stem the tide of this pandemic, is not spreading it to each other. And the spread is occurring from family members or close friends. You know, you go out — I had another patient who was pretty sick. She was in her early 60s. I said, where did you get it? She said, well some of us decided to go out to a bar one night. We were all feeling fine. We thought we were safe but six of us got it.

Frederica Freyberg:

Wow. What are your projections about how long this second wave could last?

Paul Casey:

So we’ve actually done some local modeling, and the local models predict that this second wave will peak mid-November. So this will be another bell-shaped curve just like that first hump. So that takes this pandemic or this wave of the pandemic — (audio breaks up) — through this year’s holiday season.

Frederica Freyberg:

That is truly frightening. We very much appreciate your work. Thank you for what you do and thanks very much for joining us, Dr. Paul Casey.

Paul Casey:

You’re welcome. You’re welcome.