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LIVE: Update on COVID-19 in the Door Community

On October 8th and 19th, Dr. Jim Heise, Chief Medical Officer at Door County Medical Center, and Susan Powers, Health Officer at the Door County Department of Public Health & Human Services, held Facebook Live Q&As designed to answer frequently asked questions and address concerns about the SARS-CoV-2 coronavirus pandemic. The following excerpts and highlights from the Q&A cover the most discussed topics.

Note: The format that is used below to present questions and answers does not follow the original order and format of the two Facebook Live events. Instead, questions and answers have been reorganized so that related topics are covered together. Additionally, content may have been edited for length and clarity.

Quarantine and Isolation

Why is one longer than the other? “Quarantine and isolation are two different things,” Ms. Powers comments, adding, “Isolation is for someone who is ill, quarantine is for someone who has been exposed to the coronavirus and may develop symptoms.”

Isolation: If you develop the symptoms of COVID-19, and test positive for the disease, you are asked to isolate so that you don’t spread the disease to others. The duration of the illness—not the infection—is on average 10 days. “If after around 10 days, your symptoms have been resolving, and at the end of that period, you have one day where your symptoms have resolved, you can end isolation,” Ms. Power says. Essentially, at that point you are no longer likely to be contagious.

Quarantine: If you have been in close contact—within 6 feet for 15 minutes or more—with someone who has tested positive for the SARS-CoV-2 coronavirus, you will be asked to quarantine for 14 days. The difference in time has to do with the incubation period of the virus. “The course of the disease,” as Ms. Powers notes, “is different from the incubation period.” If someone does become infected with the coronavirus, the incubation period can last up to two weeks and symptoms can appear at any point from between 2 to 14 days. If, during the 14-day quarantine, you develop symptoms and test positive, you would then begin the 10-day isolation period.

When can I return to work and when can my kids return to school? If Public Health determines that you have been in close contact with someone that has tested positive for SARS-CoV-2 you will be asked to follow the 14 day quarantine and not return to work or school until then end of that period—even if you have received a negative test. “It is entirely possible that you test negative on day 7, become symptomatic on day 10, and then test positive on day 12,” Ms. Powers says.

If you do test positive, it is important to note that Public Health believes an infection does confer some level of immunity. “If you have tested positive,” Ms. Powers notes, “and you are re-exposed within 90 days after your positive test, you don’t need to quarantine again—the state feels you’re immune during that period.”

Following protocols means others won’t have to quarantine. Dr. Heise comments on the importance of following protocols—masking, social distancing and washing hands: “What people miss when they don’t wear a mask or socially distance,” he says, “is that if you end up getting COVID-19 and you test positive, the next thing that happens is Public Health determines who were you close to, who were you within 6 feet of for 15 minutes or more. Sometimes that ends up being 20 to 30 people. And now, you have affected the lives of all those people very adversely because they have to quarantine as well.”

Testing

Why do test turnaround times vary? Most testing at DCMC is performed in-house. These are the polymerase chain reaction (PCR) tests that require a nasal swab an generally take around 48 hours to produce results. A few reasons that tests can take longer are as follows:

  • Tests are prioritized: People exhibiting more symptoms or severe symptoms are prioritized. Additionally, school children and essential workers—firefighters, EMS workers, and healthcare workers—are also prioritized.
  • Tests are sent to Madison: For non-essential workers and people with mild symptoms, tests are sometimes sent to a lab in Madison called Exact Sciences. 3 to 5 day turnaround times for those tests are common, but if they are very busy, it can take up to 7 days to get a result.

Advances in testing capabilities at DCMC. Regarding testing, the goal at DCMC is to perform 100% of tests in house by the beginning of November, and Dr. Heise says “New instrumentation is coming on that will allow us to test not just for COVID, but for influenza and other respiratory illnesses as well,” which will allow medical staff to rule out other illnesses that could be causing symptoms similar to COVID-19. Additionally, rapid antigen testing, which uses saliva instead of a nasal swab, is now available at DCMC. According to Dr. Heise, “Antigen testing will be reserved for symptomatic patients that come into our emergency room and for hospital employees that have symptoms,” because accurate antigen testing requires a high viral load and concurrent symptoms.

Treatment

If you have worsening COVID-19 symptoms, when should you contact your doctor or hospital? Dr. Heise says, “If you have received a positive COVID test, you should go to the doctor or the hospital—or at least call and ask—when you begin getting short of breath. If you’re having a hard time catching your breath, that’s a good time to get checked out.” If your blood oxygen level is below 94%, at that point you would be admitted to the ER.

What medications and treatments are currently available at DCMC? In a sea of seemingly bad news surrounding the coronavirus is this bit of good news: hospitals are getting better at treating COVID-19. Currently, there are three treatments available at DCMC:

  • Dexamethasone: A common steroid that has been found to reduce systemic inflammation in patients with severe COVID-19. This steroid has been found to reduce the mortality rates by up to 30%.
  • Remdesivir: An antiviral medication that, put simply, stops the virus from replicating. Remdesivir is the first COVID-19 treatment approved by the FDA.
  • Convalescent Plasma: A transfusion of antibody-rich plasma donated by another person who has already had the SARS-CoV-2 coronavirus and therefore already developed the antibodies needed to fight the virus.

What is not available? The polyclonal antibody cocktail (REGN-COV2) made by Regeneron that President Trump received as part of his treatment is “still an experimental treatment that is not widely available,” says Dr. Heise. He adds, “It is available, usually in larger medical centers, but for compassionate use only.”

Hospital Capacity

What is Door County Medical Center’s plan for the current surge in cases and is there enough room? DCMC is a 25-bed critical access hospital. Currently, because the hospital has repurposed some areas, it can double the number of beds to 50 if the need arises. “We have recently had 31 patients in a 25 bed hospital,” Dr. Heise remarks, adding, “So, I don’t have concern for my family or yours—if we need to take care of you we can do that.” Additionally, if a person needs more advanced care than DCMC can provide, they can be transported to one of the hospitals in Green Bay.

“The only limiting factor,” Dr. Heise says, “is staffing—that is, not having enough staff. And, that is common in many hospitals right now.” In order to adjust for staffing needs, some clinic appointments, physical exams, routine appointments and elective surgeries are being postponed, usually by a week or so. Dr. Heise adds, “That doesn’t mean we’re stopping them permanently, it means we are just postponing them and assessing the situation everyday.”

“It’s safe to assume that the virus is everywhere in Wisconsin. When you go out in public, expect to encounter COVID and adjust your behaviors accordingly to prevent contracting the virus,” says Ms. Powers. DCMC strongly encourages the Door County Community to continue to be vigilant in practicing all preventative measures like masking, distancing and hand washing, and to quarantine or isolate when necessary. If you need to get tested, the National Guard is currently providing testing every Monday through December 7th , alternating between the Sister Bay Fire Station (2258 Mill Road) and the Sturgeon Bay Fire Station (421 Michigan Street). The remaining Sister Bay testing dates are: November 2nd , 16th and 30th . The remaining Sturgeon Bay testing dates are: November 9th and 23rd and December 7th . To pre-register, please visit: https://register.covidconnect.wi.gov/en-US/.

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