Here & Now

State Epidemiologist Answers Questions about COVID-19 Crisis

Frederica Freyberg:

For more on COVID-19 in Wisconsin and from “Here & Now,” visit pbswisconsin.org/news.

The virus is coursing through our state’s population, even as we try to slow its spread. We have medical questions now for State Epidemiologist Dr. Ryan Westergaard. He also joins us by skype. Dr. Westergaard, thank you very much for joining us.

Ryan Westergaard:

Thank you for inviting me.

Frederica Freyberg:

We knew there would be deaths, as the numbers of people testing positive for COVID-19 continue to rise, but what should we steel for in terms of more?

Ryan Westergaard:

I think the picture is concerning right now because what we’ve seen in the data from both this week in Wisconsin and nationally is that we really seem to be in an acceleration phase of the epidemic. Where we’re seeing the number of cases increase day by day. And with that, we know there’s a subset of people who are going to have severe disease of all the people who get diagnosed. So I think we can expect to see increased numbers of deaths. I think the things we’re doing to mitigate the spread of the virus in community is going to determine how many, but certainly we’re going to see more in the coming weeks.

Frederica Freyberg:

People are, of course, very afraid, and we hear conflicting information, but of the most at-risk population, what should the elderly and those with underlying conditions be doing right now?

Ryan Westergaard:

I think the message for everyone but particularly for people who are medically vulnerable or fragile is to stay home and prevent contact with other people. It’s not the kind of recommendation we like giving people, but at this moment, with a very contagious virus circulating in the community, the best strategy we have to prevent infection is for everyone to stay in place. And also when you are out in public, for doing essential things, to be very vigilant about hand hygiene and sanitizing surfaces. Things that we all know prevent the spread of germs out in public.

Frederica Freyberg:

We now hear that younger people are also very much at risk. Has that messaging changed?

Ryan Westergaard:

Well, it hasn’t changed in that we’ve known from the beginning of the epidemic in China that young people have developed severe illness and some have died. The risk, meaning the percentage of people who have severe illnesses in the under-50 or under-40 age group is quite a bit lower. Here in the U.S., the data that we’ve seen in the past week looking at the first series of hospitalized patients was that the mortality rate for people under age 50 was lower, 1% or less. Where among people in their 80s, it was higher, as 10%. So all people are at risk of becoming infected with the virus. The risk of having severe complications when someone is infected varies quite a bit by age. But I think the risk — the message for everyone is that if no one is immune to this virus. Everyone can be infected and everyone does have some risk of getting quite sick.

Frederica Freyberg:

One viewer asks, I work at a Target store. Should I be taking a shower and changing my clothes as soon as I get home?

Ryan Westergaard:

I don’t think so. I think the most important message is — comes from how we know these respiratory viruses get spread. And that’s through respiratory droplets, so coughs and sneezes but also from touching contaminated services. So people that are in public, the most important thing right now is what we’ve been referring to as social distancing. So keeping at least 6 feet of separation from other people. The other thing that’s very important, and I would say particularly important for viewers who work in public settings, is hand hygiene. So hand washing with hot water, alcohol-based hand sanitizer, the more the better. So those are the really highest impact strategies that everyone should implement if you have to be out in public and working.

Frederica Freyberg:

So is it safe to go to the grocery store or pick up takeout?

Ryan Westergaard:

Yes, I think it’s safe to do that if people pay attention to the infection prevention things that we’re talking about and we’re knowing about. Overall, the restrictions on gathering are really to reduce the probability of getting in contact with the virus [unintelligible] to as low as it possibly can to slow the spread in the communities. But certainly, people need to get their basic needs met. If people need to be out in public, need to get food. So there’s risk of being out in the community when there’s an infectious disease spreading, but we still encourage people to make sure that they’re getting all of their needs met and doing things like getting food and going to the grocery store.

Frederica Freyberg:

Even with hand washing and cleaning and distancing, should we all just assume that most of us will be infected with this?

Ryan Westergaard:

Well, I think the answer to that really depends on how well we execute the types of things that we’re recommending. It’s certainly not a foregone conclusion that most of us will become infected, but the virus is contagious enough that if we did nothing, the possibility of the majority of people would become exposed and infected. But we really believe if we do these activiti– these restrictions on gathering. We focus on hand hygiene during this period of the epidemic where it’s starting to spread in communities, we can keep that as low as possible. So it’s really up to us on how well we heed these lessons and implement some of these processes.

Frederica Freyberg:

Do we have enough ICU beds in Wisconsin?

Ryan Westergaard:

We do. That’s something we’re actively monitoring. We’re in communication here at the Division of Public Health with hospitals around the region to know what their capacity is under normal circumstances and what their surge capacity is. So we have a handle on those numbers and we’re trying to keep it updated in real time. I would say that– whether that becomes — whether we put a strain on those resources, again, really depends on how well we execute these public health interventions.

Frederica Freyberg:

Another viewer asks if ventilators get to the critical supply level, how will it be determined who gets to use one?

Ryan Westergaard:

Again, I’ll say again the most important response to that question is whether we get to that point really depends on how well we control the spread of the virus. And that’s something that’s in our control. We have a finite number of ventilators in the state. They are manufacturing more and there’s also strategies that health systems are doing to free up more [unintelligible] more ventilators. For example, canceling elective surgery in outpatient settings so we have more. So all of what we’re doing when we talk about stopping the spread in the community, it’s all aimed at this health system capacity question. So we don’t have to– we want to avoid having to make those really challenging decisions about who gets a ventilator and who doesn’t. Now that is possible. In some areas of the world have had to come up with that. In those strategies, we really try to focus on doing things that are equitable and transparent and having guidelines that everybody can follow and agree to. Some of the considerations are sort of how much benefit can come from the ventilator use? Meaning people who are highly likely to recover will be offered ventilators. People who have less– are more gravely ill might be given a short term of a ventilator to see if they respond. In some cases we may need to really focus more on palliative care for patients that don’t seem to be responding. So there are decisions that we make all the time in ICU care. And we’ll just have to be very deliberate and very open about it if we get to that. But I think the most important priority is that we’re doing everything we possibly can to preserve our health system capacity to provide ICU-level care to everyone who needs it. Hopefully we’ll be fine in that regard.

Frederica Freyberg:

We know we also have a shortage of protective gear like masks for healthcare workers. One paramedic that we spoke with said if it comes to that, they will use scarves or sheets and cut them up and make masks out of them. How close are we to having to do that?

Ryan Westergaard:

Well, the shortage of that personal protective equipment is really a big concern. We’re encouraging all of our health systems and other partners like pre-hospital care and EMS to take inventory and let us know how many days or weeks supply they have. We just received shipment from the Federal Strategic National Stockpile and have been able to allocate additional supplies to places that need it. And we’re actually prioritizing areas that are really high critically need, like first responders and local EMS. So we’re preparing for this. We’re trying to make the best use of all available resources we have and giving people advice about sort of the best strategies to conserve and make use of these resources wisely, but it’s something that we’re really following closely.

Frederica Freyberg:

Is there more coming from that strategic stockpile?

Ryan Westergaard:

I think that’s still to be determined. The Wisconsin state also has a stockpile of a large number of masks that we’re allocating. So we’re trying to be the best stewards of those resources that we can. At the same time, encouraging other areas of the supply chain and increasing manufacturing to make sure that we have personal protective gear.

Frederica Freyberg:

Now Wisconsin has ramped up its testing but you wrote in a memo this week that only the most critical patients can be tested. Why?

Ryan Westergaard:

Well, the way that we framed it was that we need to prioritize testing for patients for whom it’s most important to know quickly. And that really comes to hospitalized patients. There’s a couple reasons for that. Spreading the virus inside hospitals, both to healthcare workers and other patients, is really one of the most important things we want to try to prevent. So we want to make sure that we know those answers to those questions of who has COVID-19 in the hospital or other healthcare settings as urgently as possible. So if we have to make choices about what tests get done quickly, if we have a longer turnaround time, we need to prioritize those. Now the other reason is that a lot of people with mild symptoms of COVID-19 don’t really require medical care at all. And right now since our recommendation for everyone in the population, whether you have a mild cold or you have influenza, is to stay at home. Recover at home, and protect those around you from potentially becoming infected. Knowing the result of a COVID-19 test isn’t as important for everyone. In fact, from an infection control perspective, the advantage is actually being able to support people remotely. Not have people come in and get tested in a healthcare setting. So it’s another strategy we’re trying to use to preserve healthcare resources. When people who are young have mild illness, even if they have COVID-19, our message is most people are going to be able to recover. Call us if you have concerning symptoms by any means but you don’t necessarily need a test.

Frederica Freyberg:

Excuse me, doctor. With just about a minute left, in a letter to the FDA, Wisconsin’s Congressional delegation described extreme challenges in hospitals across this state in getting reagents and even swabs to conduct the test. How long does Wisconsin have before it runs out of what it needs to complete the testing?

Ryan Westergaard:

We’re in conversation nearly daily with our laboratory partners. We have two public health labs in Wisconsin, in Madison and Milwaukee. An increasing number of clinical labs and hospitals, they have been very open and collaborative in terms of taking inventory on an ongoing basis of how many ingredients or reagents they have to do the tests and are actually sharing, when necessary, to make sure that they have enough supplies. So we are not in a position that we are going to run out and not be able to do the testing that we need right now, but we’re actively looking at that.

Frederica Freyberg:

All right, Dr. Ryan Westergaard, thank you, thank you very much for your time.

Ryan Westergaard:

Thank you.

Frederica Freyberg:

For additional reporting on COVID-19, go to our partner website at WisContext.org. You’ll also find answers to frequently asked questions about the virus.