We Not Me COVID19 News

August 11, 2020

Sauk Prairie Healthcare Business Townhall - Covid 19

To submit questions or topic suggestions for a future Town Hall meeting, please email townhall@saukprairiehealthcare.org

Transcript:

Okay, good evening everybody. I'm Shawn Lerch, the CEO for Sauk Prairie Healthcare, and I'll be the moderator for tonight's session. First, thank you for joining us in our first virtual COVID-19 townhall. The townhall's purpose and format is designed to help answer questions from our business partners and to be a trusted resource as we collaboratively really navigate this pandemic. I want to stress Sauk Prairie Healthcare is committed to keeping our communities healthy and safe with vibrant and strong economies. Our partnership and support with the regional businesses is vital to supporting this mission. First, a few housekeeping items, all mics were muted during this townhall because of the large audience, but participants are encouraged to use the question section within the control box and submit questions throughout today's session. We will do our best to provide pertinent information on questions. Many of you have previously submitted along with additional questions raised today.

This includes time we will reserve at the end to address any of those submitted questions that we can get to. Also, Sauk Prairie Healthcare has created a business and community resource webpage, where all of the questions and answers will be posted and additional links to resources that are meaningful to our business community. This link will be sent out after today's session. Once the question section is updated.

Now, I am truly grateful to the esteemed panelists who are part of today's townhall session. COVID-19 is a novel virus that has impacted every part of our lives and will continue to present challenges for the foreseeable future. Fortunately, we are learning so much new information every day on how this virus is transmitted, affects our health and how to stop it from spreading. I am proud of the Sauk Prairie Healthcare team and our community health partners for being truly at the forefront and keeping abreast of the latest scientific research in our unified fight against COVID. This focus on science was a primary reason our early adoption and promotion of public masking and adherence with our other infection prevention strategies to keep our patients, our team members and our communities vibrant. You are part of that vibrant community.

I know our panelists are excited to share their insights with you today. So with that, let's open it up and we're going to start with Dr. John McAuliffe who provide his perspective on the impact of COVID-19 on our communities and our businesses. Dr. McAuliffe, please share a little bit about your background and role in community health and your perspectives.

Thank you, Shawn. Uh, and thank you for getting all of the, uh, members together and basically beginning trying to get the silos, talking to each other. Um, I've been a family practice doctor in the community for 42 years, and I've never quite honestly seen anything quite like this. And I've never seen the kind of reaction within the community that's actually more escalating as we go along and the tremendous amount of anxiety and the fear, uh, all because of there's a lot of uncertainty with this whole virus. And then the messaging keeps changing. And so again, uh, that's one of our main goals here is to how do we make that messaging consistent and based upon the best science. That's how you really start to address the fears, because as fear and anxiety escalate its very paralyzing and people that I see in the clinic day in and day out, they just have thrown up their hands and say, "I don't want to deal with this anymore."

I think they were fine for the first two to three months, but when it starts to be four and five months of no end in sight, they start to decompensate and just start to say, "I don't want to be bothered by this." And that's what we can't have. We've got to constantly try to reach out and connect with those people and to see how we can get them engaged because there's, there's numerous studies that, that show and Dr. Osterholm, uh, he's the world renowned epidemiologist from University of Minnesota, uh, says the virus is going to be around quite a while yet. And then when you look at communities, the incidence of this virus in the community will vary anywhere from five to 15%. And he says, it's going to be around until that gets up to about 60 to 70%. And we know how much pain and suffering has gone to get us to the five to 15%, but we're not even a quarter of the way there yet.

So we've got a long ways to go and everybody's got to be on the same page and everybody's got to be plugged in. And before anybody really makes any change there first has to be in an acknowledgement of the issue. And that's where I think a lot of people get hung up is that they haven't had training really in how a virus or how a bacteria are even worse. In other words, their reality is really dependent upon what they see, what they feel, what they touch, that's their reality. And if they can't see it and feel it and touch it or smell it, they don't necessarily believe in that. And we have to, as professionals, we have to engage them somehow some way. We can't turn them off. We have to try to understand their perspective if we're going to get them involved. And after, after there's some awareness, then before we can make any change, we have to accept that this is the reality.

And we also have to accept the belief that we can make a difference. And that's what will then empower us as we go forward. And there's lots of data now, largely from the World Health Organization. They've, they're not, uh, any random controlled studies, that will probably never happen, but they're observational studies over 172 of them have shown if we can, but get 90% of people to wear masks and to have some distancing that will bend that curve within two weeks. We'll notice a tremendous difference. And I think that that's what really needs to be our goal as we, as we go forward. And then there has to be the action that has to be the action, but it has to be internalized. And it has to become, by that I mean it has to become a habit. We just can't be thinking about it because of it's not habituated, we constantly go to the negative. And nobody likes wearing a mask --- there's irritation, there's shortness of breath, there's all these other things. But once it becomes habituated, we start to take it on and that's where we need to get, get to be as a community. Uh, and if we can do that to get these certain habits that we'll talk even more about, uh, then we'll make progress with deterring the, the rate of progression of this virus. And then I think our really our, our, our weakness now will become our strength and that's just, we have to become more educated. We have to become more unified in our approach to this whole problem.

Well said, Dr. McAuliffe. I couldn't agree with you more. What I would like then to move into Dr. Nathan Grunewald. He is a urologist with Saukk Prairie Healthcare. Dr. Grunewald leads our research effort, and he's going to provide some of the current state, what we've learned about COVID-19 and why is there that unified need to fight and have that urgency? So, Dr. Grunewald, if you could share just a little bit about yourself and then role within the community health in this fight against COVID.

You bet. Thank you, Shawn. Dr. McAuliffe you're a tough act to follow, so I'll do my best. Um, I, as Shawn said, I'm proud to say I'm a Sauk Prairie native. I grew up here and graduated from high school here, and I'm glad to have returned back to my roots. Uh, this is a great community and I'm happy to be here. Uh, I do, I am a urologic surgeon and I also serve as our innovation officer at Sauk Prairie Healthcare, uh, very much, uh, enjoy my time there. Uh, it's a great place to be. Uh, first I'd really like to thank all those participants who are on the webinar today, uh, for joining us. Uh, it shows real commitment to learning more about COVID-19. And I can't say enough that we in healthcare are very appreciative of the support. Uh, you are providing us today. In the long run your participation will be instrumental in minimizing the impact COVID-19 has on our communities. And quite honestly, your business. I've been asked to share a little bit about how this has evolved over time and why it matters to our communities. Uh, you know, in some ways it feels as though COVID-19 is not really a problem around here. We don't see it, uh, as, as in feel it as much as those folks in New York and the South have noticed. And I think, uh, why we feel that way is because much of our barometer was really set by the New York experience. We all saw it on the news. We saw the suffering, um, and we don't quite see that here in Southern Wisconsin, uh, not to the same degree, it's more hidden. I, and the reality is that we see and feel COVID differently in rural America. It's going to be more of a constant drip with the potential for a pretty big flood.

And that's mainly because we have limited resources and capacity to absorb those influx of cases. So with that though, why is COVID-19 such a big deal? After all that's why we're here. Um, and we have infectious diseases all the time --- , colds, flu, HIV --- those are all infectious diseases, just like COVID-19. Why is this so different? And it's because COVID-19 is a new disease. We've never seen COVID-19 before caused by a Coronavirus that mutated and the human population has never experienced this particular strain. And when it was first reported in late 2019, there was a lot we did not know about the virus. And what we learned and what we did early on for this brand new, highly contagious respiratory virus that, uh, as a terrible stroke of, uh, of life, it actually causes death. And in medicine, that group of characteristics is one of our biggest fears.

It's very difficult to control, and it takes a monumental feat amongst human to get this under control. As that virus spread, we saw the massive impact in Asia and Europe, from afar. We, uh, early prevention and treatment focused on using known information from other respiratory illnesses, particularly the flu.Our experience with the flu drove a lot of our early, uh, treatment and recommendations. However, what we've learned so far COVID-19 does not behave exactly like the flu. And over the spring and summer enormous effort has been mobilized in the medical and research community to sort out the very basic details on the behavior of this virus, its risk. And most importantly, how to prevent the spread and treat those who actually contract the virus. This is has included updating guidance and treatments as we learn more. Uh, and most of you remember that early on the focus was on social distancing and handwashing. We now know that face coverings are very much a very important step to preventing and stopping the spread. That took time to sort out, and there is still much more to do and look.

So if we kind of step back and really look at this at a high level, uh, I'll give you some numbers that, uh, to, to put it in perspective. For those of you who watch these, you know, the United States today has reported over 5 million cases, 163,000 deaths. Wisconsin has seen 62,000 cases and a thousand deaths. And note that of those 62,000 cases, 15% of those are in children. In Sauk County alone we've seen almost 450 cases. We've had three deaths related directly to COVID-19. It's important to note though, that this is the confirmed case counts. Uh, this comes from testing folks with active infection. Based on estimates from blood samples, we suspect that the actual number of US cases are closer to 40 million. That's a lot of people. And compared to the flu, which this oftentimes gets, uh, uh, compared to, depending on the particular flu season we have between 20 and 40 million infections in 20,000 to 60,000 deaths.Just looking at those US numbers for COVID-19, it's much worse.

It's not the flu. Uh, we don't know the longterm effects of COVID-19. And even if you use death as the barometer, it's still bad. However, what does COVID-19 really look like for us in our communities? Like I said, rural feels different. Well, it's clear we have some work to do to improve our situation. We don't see the same high numbers, like what we see in New York, LA or Chicago, simply because we don't have the same size population. So instead it's helpful to look at the case rates. This is the percentage of the population that's affected, uh, and the trends more importantly within that. And as we review the data, we look at our 14-day running stretch of time, and that's really to smooth out the individual variances that you experienced on a particular day. And when you drill down to Sauk County for the period ending, uh, August 6th, 4.4% of all tests were positive for COVID-19.

And in that short period of time, that's 164 new cases. And realize that cases are unique individuals--- there's no double counting there --- once you test positive for COVID-19, even if you get multiple tests and they're all positive case, counts represent one. It's you. Okay. Um, since the end of July, there's been a steady increase in the overall number of cases in Sauk County. However, for me, the most worrisome number of all of the stuff that's reported is the number of new cases that cannot be traced or linked to a known source. So when someone tests positive for COVID-19, we do our best to figure out where do they get it? And who did they expose? And, uh, and, and it's called contact tracing. In Sauk County that number is 37% of all positive tests in this past 14 day period. That means more than a third of the people who have tested positive we can't find where they contracted the illness and find a commonality to help slow or stop the spread. That is right now, our best defense against COVID-19. If we continue on this trajectory, we can expect another shutdown in the future. However, we have an opportunity right now to bend this curve as Dr. McAuliffe said, and move us back into a safer zone while we sort out the prevention and treatment options. This is where you come in. Helping us encourage the use of proven strategies to decrease the spread among your employees, your visitors, your patrons is one of the many pieces we need to build a wall between us and the virus. Doing so will allow us to return to more normal and buy time to finalize treatments, and hopefully a vaccine, when life can return to normal. Most importantly, though, we will be saving lives, possibly your own.

I thank you for joining the webinar and listening, and I know we're going to have a lot more great questions to come. Uh, thanks again, back to you, Shawn.

Thank you so very much, Dr. Grunewald. We're going to tee this one up maybe for a little bit, but there was positive news. And if you're willing to share, or, you know, at the end with New Zealand specifically where 102 days now recorded no community spread because of several measures, but they've been doing things the right way and their economies are thriving again. So I think we can talk a little bit about that as some examples would agree.

Okay, let's move on. Um, unfortunately, uh, Tywana German who's you all with us today, but just by voice, she had a little bit of an issue with her computer. But many of you recognize to Tywana who's the director for the Sauk Prairie Area Chamber of Commerce. Tywana has been extremely proactive in supporting our regional businesses as we reopen the economy and providing strategies, how we can keep it open. Tywanna is going to share some information, because she's worked a lot with businesses on different surveys and studies and specifically a QTI study, and really understanding some of those complexities facing our regional businesses. Tywana, please share a little bit about your background and your impact here on our community.

You should be live Tywana. Tywana are you there? All right. I think she's struggling and again, a little bit with the technology and you do have to, uh, give us a little bit of a break as we go into the new virtual world. Right? Well, with that, we will come back to Tywana, but we do want to move on and shift the focus a little bit again, back to our businesses and how we're supporting. Just like Sauk Prairie Healthcare, we're dealing with a lot of issues around our workforce, our team and Dr. Trevor Bus and Robbi Bos with our Vice President for Human Resources are going to help us better understand navigating workforce issues from teleworking to testing and really how we can keep our team members healthy in this COVID era. This includes an interest, like I said, on testing protocols, sick policies, safely returning to the workplace. In addition, as you know, addressing the stress and anxiety Dr. McAuliffe spoke to earlier. And first I would ask Robbi, share a little bit about yourself and then Dr. Buss. Okay.

Thank you, Shawn. And thank you everyone for taking the time to hear what words of wisdom I can offer as a, as you navigate through this difficult time that we're going through. Um, I think I would like to just start out by, um, letting you know that I've been in human resources for over 30 years. The last almost 15 of them have been here with Sauk Prairie Healthcare. Um, going through a pandemic in a healthcare organization, um, had its pluses and minuses. Its pluses, because I was blessed to be able to work with physicians like those you see here who could keep us abreast of the most, um, up to date knowledge, uh, that could be had, uh, as we tried to figure out how we were going to move forward. I would like to talk a little bit about, uh, the fact that I am sharing my perspective as an HR professional. Uh, I am not a lawyer. I do have some background working with, um, compliance areas and I'm going to talk a little bit about those. Um, I also want to acknowledge, uh, that if you are on this call, then you are an employer who is very concerned about providing a safe workplace while still remaining compliant with legal requirements that we all deal with. And to remain open and retain your workforce, we need to be able to make it easy for employees to trust that their jobs are not in jeopardy if they comply with public health requirements. Uh, we need to be able to communicate with them early and often. One thing I learned as we were moving through the pandemic is that even if you've shared something with employees, once it needs to be shared again and again, uh, to make sure that, that it remains fresh and it remains front of mind. Um, and it helps, uh, with becoming, um, creating that habit that Dr. McAuliffe talked about.

Uh, I would like to mention a few areas, uh, that I think all employers need to stay abreast of. And these may be things that you don't normally, um, connect with in your day to day business. But the first thing that I watched for as we went through the pandemic was what was the federal government going to do? What laws, what regulations were going to come down the pike that we needed to be ready to act on quickly? And the first of those was the cares act. It was made a little more confusing by the fact that the cares act applied to businesses with employees under 500. And so businesses like Sauk Prairie Healthcare who have more than 500 employees, uh, were not covered by it yet. Our employees were going to be aware of the provisions of that act changes to the family and medical leave act, um, requirements for paid sick time.

Those sorts of things were going to be front of mind for our employees. And so it was still important for us to remain connected to it. And one that I think didn't get as much play as it might have was the Americans with Disabilities Act, because we soon learned that there were going to be requests for accommodations from our employees. We also needed to be as up tp date as possible on unemployment insurance and any requirements that would change there as well as OSHA requirements. And I found that bookmarking all of those federal sites were, and state sites were, uh, critical for me to be able to go back and see how they were changing them from day to day. A couple of the questions that have come forward and that I've seen a lot and I'll go through them relatively quickly, um, is one, can require an employee to get tested?

And that was one of the first things that the Equal Employment Opportunity Commission gave guidance on. And the answer to that one was yes. Uh, any, any mandatory medical test must be job related and COVID-19 was, was definitely, uh, uh, consistent with business necessity. The next was can I require an employee to wear a mask? And, uh, especially during the statewide mandate, you definitely can. And employers do have the right to institute reasonable safety precautions to be taken within their workplaces. Um, another question that has come up is, do I have to tell other employees, if one of the staff have tested positive? And this is where it gets tricky. And, and again, I re I reiterate, I am not an attorney, uh, but there's, there are so many laws that come into play. OSHA, for example, does not require employees to note or employers to notify other employees if, uh, one of their employees gets COVID. But they must take appropriate steps to protect other workers from exposure to the virus.

And so these steps might be listen, we had an employee who tested positive. You may need to engage in additional cleaning and disinfecting of the work environment, notify your employees to monitor themselves for signs and symptoms of COVID. Um, the CDC, however, recommends that employers do determine which employees may have been exposed to the virus and inform them of their possible exposure in the workplace. You should do your best to maintain confidentiality of the employee who tested positive as much as possible. Uh, keeping in mind that employees may choose to be open about their diagnosis uh themselves. Um, the ADA also, uh, uh, requires confidentiality of the person's name, uh, but the method of disclosure, uh, would need to comply with applicable federal state and local laws. Um, policies to have in place during the pandemic...We learned quickly that policies that we did have were in need of updating and changing, and we needed to implement new ones.

The biggest one that we struggled with, uh, uh, defining was your attendance policy. If you are covered by the Cares Act, there are requirements for paid leave that you must follow, and this act is amended. It also amended the family and medical leave act. So there's lots of provisions in there that may apply to you if you have less than 500 employees. Uh, all of the professional organizations, including WSHRM recommend that employers be as flexible as possible with attendance. And that may mean having that, that very strict attendance policy of five absences and then the employee is, is let go is no longer going to be a program. Teleworking. If you have not got a teleworking policy, you should really put one together. Determine whether or not you will allow it if it's possible in your organization. And if so for how long will you allow it?

Are there certain employee groups that it makes sense to allow it for? Will you provide the equipment, the hardware, the software that employees might need to make teleworking successful? Will you allow them to telework from anywhere, uh, uh, uh, from their home within the state, from another state? Consider payroll implications of situations where the work is being performed out of state. What tax laws will apply if you allow that? Um, obligations to accommodate an individual who has an underlying health condition. If an employee asks you for an accommodation, you need to remember that the ADA, the Americans with Disabilities Act still applies. You'll want to consider each case on its own merits, and you'll make different determinations based on what you learn. Leave of absence can be an accommodation; consider implementing a mechanism for employees to utilize. We did this online at Sauk Prairie Healthcare and found that it was a much cleaner way for employees to make their requests.

And then lastly, what about employees who are just afraid to return to work for fear of exposure? Um, many employees are frightened that their returned to the workplace may put them or their loved ones at risk. Take the time to listen to those employees, listen to their reasons. Sometimes it's because the employee is themselves immunocompromised and may need an accommodation. Maybe they live with an elderly or at-risk relative, or maybe they're anxious that you haven't done enough to create a safe workplace. Listening to them and talking to them on a case by case basis will go a long way to reducing the anxiety that Dr. McAuliffe referenced earlier. Make decisions and determinations on how you're going to proceed keeping those, those laws. I discussed the ADA, the Cares Act, OSHA in mind, look for that telework option, granting leaves and adjusting duties, as much as you can.

Again, I want to reiterate that one of the most important things that you can do during this pandemic is to talk to your employees as frequently and as often as you can to reduce that anxiety. One of the things that Sauk Prairie Healthcare did was the CEO held a weekly, um, town hall meeting with all staff so that they could do a virtual meeting so that staff could connect with the CEO and hear directly from him how the organization was doing. Were they're going to be layoffs? It goes so far, uh, toward reducing rumors that create and raise anxiety that I highly recommend it. And we may even continue doing, uh, uh, town hall meetings on a frequent basis, even once the pandemic has passed. So that's what I wanted to share with you. I hope I've kept within my time. Uh, and I think I'm turning it over to you, Dr. Buss.

Real quick, Robbi, uh, we're going to keep you on just a few questions. Follow up, came through, I think absolutely pertinent to what you talked about and thank you. And specifically about you, you spoke to teleworking. Now, one of the questions came in, you know, we have team members who are teleworking. However, how long do you anticipate that going? What are some of the challenges you faced and how did you deal with that?

Well, that question has come up for us repeatedly and we struggled to try and figure out, you know, should we be bringing people back? Things seems to be settling down a bit. Um, how is the work being impacted, uh, by the employees working from home? And what we chose to do was to put employee safety as the number one, the number one issue to consider. And if the infection rate continued to increase, if we continue to see signs of community spread, then we decided that we were going to maintain teleworking for as long as, as it takes to get through those, those, uh, that situation. That said, um, not all employees can work from home indefinitely. And so we did gather a group of people together to talk through, um, what tools could we provide these employees that would make their jobs easier. This could be things like a dual monitor, uh, an additional phone line, uh, restructuring work, reassigning work, a redeployment of your staff to a different area if there's not enough work for them to do from home. A staffing pool for us in the beginning of the pandemic, when we had insufficient work, um, as a result of having to cancel our elective surgeries, created opportunities for employees to assist in other ways that were meaningful to the organization and allowed employees to maintain a connection with the employer that they truly valued in the long run.

Thank you very much, Robbi, uh, you know, Dr. Buss, we're going to put you on the spot a little bit, because there's a lot of questions as you saw, come in around testing, return to work, um, and those things along with, as we look at the schools. So if you could take us through that process,.

Hey thank a lot Shawn.

Yeah. Thanks for thanks for having me on, I have

Testing and interpretation of the rules regarding testing and, um, quarantine or isolation are probably the majority of what I talk about every day these days. It can be a little bit confusing and hopefully I'll be able to make this a little easier for people. Obviously the goals related to testing involve, uh, really keeping everybody safe in our community. Um, as was alluded to earlier, the way that you stop the spread of a virus is you, um, make it so that anybody who's infected can't infect anybody else. So you stop one chain or path of infection. Um, uh, if you have very few cases, you can track all those cases, nip it in the bud and it's gone, okay. Or you can at least manage a few small brush fires that come up from time to time. However, if you can no longer keep track of where everybody got their virus from, it gets a lot harder. That relates to a Dr. Grunewald was talking about, uh, something we call community spread rather than an identifiable an identifiable source. So, um, I like to break down the reasons to treat there's three main reasons that people come to get tested for coronavirus. All right. One of those is "I have one of the symptoms of coronavirus" okay of the COVID-19. The second one is "I've been told, I've been exposed to somebody who has been diagnosed with coronavirus." And the third scenario is "I'm just curious. They keep talking on TV that we need more people to get tested so I'm going to sign up, I'm going to do my part. Or, you know, I've had a sniffly nose maybe it is, maybe it isn't. I don't I have allergies. I don't know. You know, just some curiosity." Um, I will tell you that one of the things that makes the strategy of, um, tracing, uh, is related to the availability and turnaround time of our tests.

Um, and, um, another big challenge to getting this under control is the fact that there are asymptomatic people who have the virus and can spread it to other people. Asymptomatic of course means "I feel fine; I got no symptoms whatsoever." Okay. So first I want to we'll, we'll get a little bit more medical here. Um, I'm going to describe the symptoms of COVID. So you dial, if we go all the way back to February, March, and you go out to the CDC website and looked at what are the symptoms of coronavirus of COVID-19, it would have said fever or chills, cough, and shortness of breath or difficulty breathing. That was it. Okay. Um, as Dr. Grunewald alluded to over the, and, and actually so did Dr. McAuliffe, over the last five months, we've learned so much more about this virus that's never been seen on the planet before.

And as a result, we've learned, oh, there's more symptoms. And by the way, they don't have to be severe and you don't have to get real sick. You don't have to end up in the hospital. And maybe there's a difference based on other medical conditions, maybe age, uh, wait a second, nope young people get it too. So all of this has evolved over time because we started to look at it. We started to study it. So in addition to fevers or chills, cough, shortness of breath or difficulty breathing, we now include fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea. So that's the most recent list of all the different symptoms for which you should consider COVID-19 as a cause. Okay.

So remember those three reasons to test: 1) I have symptoms. So any of those symptoms. 2) I've been told I've been exposed or 3) I'm just curious. So let's talk a little bit about the, I have symptoms course and the value of testing and most important, I think to a lot of those watching, um, what do I do when I wait for the test result and how long does the employee have to be off? Okay. So if you have symptoms and you come in and get a test, when, while we're waiting for the results of the test, we assume the person is positive. All right. We don't know so they could be, therefore they should isolate or quarantine until we have that test result back. Okay. If the result comes back negative, we can say, okay, good. It's not coronavirus. As long as you are feeling better, especially if you don't have a fever, then you're allowed to go back to work, go back to school.

It's okay. All right. So that's somebody who has symptoms, who then tests negative. Let's say you have symptoms and you go in and you test positive. All right, so you've been off for the amount of time it took for the test result to come back. Now it's positive. Assuming, so healthcare needs aside, whether you need more advanced treatment, or you can weather it out at home, um, the amount of time that somebody has to isolate or not go to school or work is 10 days from the first day of symptoms. Okay. So if we look at the timeline day zero, I got symptoms. Day two, I went and got tested. Day four I got the results of my test. I still have six more days to be out until it's been 10 days since the first day of symptoms. All right. So if it's been 10 days out and you have not had a fever in the last 24 hours, and you are not taking medicines that would be the reason that your temperature is down and you're getting better, then the CDC says it's okay to go back to work again. All right. So remember this: infected people 10 days. This is the most common question I get.

Because we're next going to compare that to someone who's been exposed, alright? So somebody gets a phone call from a coworker. The coworker says, dude, I just tested positive for coronavirus. Um, I was told that you need to isolate. You need to separate. And if I were, you I'd go get tested. Okay? Maybe it was the health department that called them. Maybe it was their employer that told them you've been exposed as Robbi would encourage you to do. Um, um, uh, you need to leave and go get tested. Alright. And almost everybody thinks they just need to go get tested. Here's a big, big, important warning. It's not just go get tested. It's we've noted you've had a true exposure, so you need to be out for 14 days, no matter what your own personal test result shows positive or negative. It does not matter. It's 14 days. All right. So to make this a little more clear, let's define what an exposure is in the eyes of the CDC and based on the guidance that we're following, a true exposure means you've spent 15 minutes or more within six feet of a known positive patient. Okay. So remember, 15 minutes within six feet. Alright. Back to the example. So the patient employee is notified, hey, they've had an exposure. So they leave. If they choose to get tested, it could be positive or negative. If it's negative, they stay out until 14 days after the last exposure to the one who tested positive. Okay. So if it was at work and they worked with the person the day before, they have to wait 14 days, and then as long as they never develop any symptoms of COVID, they can go back to work.

All right. Um, now here's an interesting thing. Let's say the coworker gets tested and is positive day zero. The patient that we're now saying, oh, you were exposed go home, goes home on day one. And then day two, they start getting symptoms. They get fatigue, fever, achiness. They go in and get tested and miraculously, they get their test result back the same day. Don't hold your breath. That's very rare. But they get their tests back that very same day. They are one day past the day they were last exposed to the person known to be positive. Okay. They're no longer an exposed person. They're an infected person. They have symptoms. So this person needs to stay out of work for 10 days, not 14 but from the first day of their symptoms. Okay. So theoretically, and this is what's so weird and why it's so darn confusing. The one who's infected comes to work sooner than the one that was exposed.

Okay. One more scenario. The one that was exposed goes home. Doesn't develop symptoms until day six. Now they have symptoms. They get tested. They're positive. Now it's 10 days from the day they first started symptoms. All right. Just like I said, well, now that means they're out 16 days. Okay. So I hope I can't see nonverbal anything because I can only see the other panelists through this, but I, I hope that that kind of explains some of the timeline challenges that we face with all of this. All right.

Um, interrupt for a minute because it absolutely, and it's very complex. I want to remind all the audience, we will be posting those I'll say algorithms out on a webpage and releasing that. Because you know, as the physicians, absolutely they know this by heart and they follow the CDC and all of those updates. But for our business partners, it gets very confusing and we want, you know, invite any questions to reach out to us.

But this will be posted on our webpage, because this is one of the number one questions. So go ahead, Dr. Buss, thank you. And I'll clarify, I do not expect a single one of you to memorize anything that I just said. I just want people to understand that some days your employees are going to come back and say, I was told I have to be out 10 days. Somebody else is going to say, I was told I have to be out 14 days. Those are the two most common numbers you're going to hear. Okay. But there might be times when they have to be out at a different amount of time and this is why it's so complex. Okay. Um, I did get a list of a couple of questions from beforehand that I can go into and they're of course, more complicated scenarios that could play out as well.

I'm sure you guys are kind of thinking through those in your minds already. Um, the question specifically here, when should I consider sending an employee home from work? Um, uh, I think, uh, anytime a patient or one of your employees, complains of any of those symptoms, I think it's worth saying you should go, you should go home. I don't want you to exposing any of my other employees here. Go get tested, figure out if you have it or not. Okay. Um, I know that a lot of people say, but I always have a stuffy nose. Do I really need to go get tested? Um, for clarification, generally speaking, we are asking if somebody has had any of those symptoms and are they new or worsening in the last 14 days. So hopefully that helps you guys a little bit so that we're not feeling like everybody has to leave work and be tested.

Okay. So new or worse in the last 14 days. But remember that's a long list of symptoms. Um, uh, so you should request, hey, leave, work, go get tested, go get checked out if they have symptoms. Um, if you know that they have been exposed to somebody who has tested positive, um, and then obviously if you hear that one of your employees has tested positive, don't let them work, uh, unless it's been at least 10 days, they're fever free for 24 hours and they've not been taking medicines to lower their temperature. Um, another one, and this is a very common scenario here. My employee lives with somebody who was exposed to somebody else who tested positive. What do we do? Alright. Hugely important. Okay. So you can play that game forever. Right? I was exposed to somebody who was exposed to somebody who was exposed to somebody who's exposed to somebody else.

Right? Try not to go crazy thinking through all of those scenarios. Okay. What matters is, if the employee was exposed to somebody who knowingly tested positive or is unable to avoid being around somebody whose test is pending. They've got symptoms, they might have the infection, they've been tested and we're waiting for those results to come back. So, um, it's a unique, the specific scenario, my employee lives with somebody who was exposed to somebody else. As long as the one they live with has no symptoms, they do not have to stay home. They can go to work. Okay. But if that person who they live with has a fever, has a cough, that person they live with should go get tested. And until the results are back, your employee should not come back to work. Only after we know the results, do we determine, okay, false alarm it wasn't COVID then you can go back to work again. Okay.

Thank you. And a real quick tie in on that question because it's coming in a lot, uh, is really about timeliness because we keep talking about testing and, and the difference between the time you're tested and those results. Have we seen that calmed down? Because initially there were some reports, people are waiting up to two weeks for that test. What have you experienced or other clinicians?

Yeah, that was one of the points I made at the very beginning. Right? How long it takes to get a test result back really makes it a challenge to nip this thing in the bud. Um, for the most part most, so the time it takes to get them back has been variable. Alright. And it's been based on how many people in our entire country are trying to, or getting tested at any one time. Um, as well as the capacity for labs. The capacity for labs has just gone up and up and up. People are adding new labs, adding more machines to each lab. And so our ability to test has gone up. As that capacity goes up, the wait time goes down. So, um, uh, there's a variety of scenarios here, but I would say that the majority of tests are, um, come back within two to seven days, um, for people tested in Sauk Prairie. Uh, thankfully it's now been a long time since it took seven days to get a result back, we are much closer to the two to five day range right now. And at least in the last week we've been getting most of ours in two to three days. So, um, what it is today doesn't guarantee that that's what it's going to be next week, or if suddenly we're inundated by people with symptoms. So it certainly can vary. And in fact, um, as we come into a season where we tend to see a lot more people who have cough and runny noses and et cetera, this fall, um, it wouldn't surprise me if some of our wait times goes up as way more people get tested. Okay. Um, so let's see. I keep hearing about that quarantine is for 14 days. 14 days from when? All right.

So this is a really important question too. Um, quarantine for 14 days. What does 14 days mean? That's in the scenario where you were exposed to a known positive. So the time zero starts the moment you left that person that you were exposed to the last time. Okay. So if it's somebody, if it's a coworker the coworker has left now, so, uh, or the, the, whatever, the last day they were around that coworker is you start that is day zero. So you've got to wait 14 days after that last exposure. Here's the unique scenario, um, and it's not a fun one to consider. What if somebody lives in your, um, house is the one who's positive, you're doing your best to not get infected. You're separating yourself from that person, but you do live with them. And ah, yeah, probably we had 15 minutes within six feet of each other over the entire duration of their 10 days of illness.

Well then, um, 14, uh, 14 days comes from the last date of your exposure to that person while they could be infectious. Since that positive test could have been after that your own child, your own spouse had those symptoms only for three or four days, you got to wait until they're done with their 10 days. And then now your 14 days starts, okay. Um, 14 days from the last exposure to a known positive case. So that might be in the past. It might be in the future. Okay. Very, very valid question.

Uh, there was one final question that's related to traveling to a hotspot. Um, we talk about hotspots, um, like there's what the media calls a hotspot and then there's what the CDC considers a hotspot. Um, for purposes of our deciding whether somebody is at an elevated risk or not, um, we actually think more about is there community spread or is there not community spread? Okay. It turns out in the Sauk Prairie area, we have community spread as Dr. Grunewald said 37% of our positives we can't trace. Um, so since we already have community spread here, we treat you living in this town as being just as risky as flying to LA or Wuhan or wherever. Okay. Um, so that's testing in a nutshell, at least as far as it pertains to time off, uh, and isolation.

Perfect, Dr. Buss. And I appreciate that. That was, I mean, a tremendous amount of information. I really want to stress with the audience, we will have that out there on the webpage and we will have a follow-up link and email sent to all of the audience participants. So you can easily access that not only, you know, over the next couple of weeks, but to be that resource. Um, so more to come on that. So as we come back and I see Tywana's face, hi, Tywana welcome. Oh, again, many of you know Tywana. Uh, we're going to jump back a little bit. So Tywana, I know you've done a lot of work in working with our business partners, doing different surveys and helping strategies. Can you talk a little bit about that and some of the, um, surveys you've done?

Sure Shawn, thank you so much. And I do apologize to the panelists and the attendees for my technical difficulties. We rehearsed it, it went off without a hook, and leave it to me to bring the issue. So, um, thank you for Sauk Prairie Healthcare and our esteemed panel members for taking time to educate the business community. Um, as you've just heard from the various explanations, there are so many ways to manage this. And from an employer standpoint, there's really more questions I think, than there are answers at times. So I appreciate everyone, um, following along this evening, asking the questions. Let me just share with you that since March, uh, the Sauk County chamber directors have worked with leaders within Sauk County to develop surveys, to get a sense of what is the community feeling in terms of this pandemic and what are their preferences in terms of where they shop, uh, choices that they make for their family.

And so since about mid-April, when the first results came in, it was very apparent that Sauk Prairie residents really have a higher level of concern than our counterparts in Baraboo, Reedsburg, um, Spring Green. And some may say that's because of our closer proximity to Dane County. We do have a lot of influx of people driving into work, as well as residents who drive outside into Dane County and coming back. But one thing for sure has shown through the survey results and that's, we are more concerned. And just to put some data behind that in April's results, late May's results, mid-July's results, we were tracking consistently seven to eight points higher than those communities in a lot of the questions that we asked around concern and preferences. Um, over the last two weeks, the most recent results have come in and that spread has jumped from about 7% to 10 and 11%, depending on the question.

So what does that mean for you as an area employer? First impressions mean everything to the buyer, to those customers who are coming into your workplace. Make sure that your signage is clear, that you expect people masking, abiding by proper social distancing. I believe everyone now in Sauk Prairie to my knowledge is abiding by and respecting the state mandate of wearing masks, um, requiring your employees. But you as an employer need to be spot checking that situation. We have lots of employees that throughout the day, they may know your preferences, your tendencies. When you tend to stop by, do a walk and talk session, make sure that you're surprising them with spot check visits throughout the day. Make sure if you have cameras, that you are looking at different parts of the community to make sure that they are wearing the mask properly. And I say this to you, one I'm tired of technology and zoom calls, so I want to get back to normal, but your customers that are supporting your business, they're really afraid of this spreading further and causing additional mandates to stay at home. None of us want that. So, um, thank you for the work that you've done, make sure that the mask situation is being communicated. A great example of that is Piggly wiggly, right when you go in a huge sign showing their commitment. The other area that is very consistent for people is your cleaning practices. And that is something that I have not stressed as much. Um, I would encourage you the same way you're communicating how you mask and your requirements on that, that you communicate right next to that mask poster, the additional cleaning that you're doing within your workplace. And then finally, um, for any restaurants, uh, retailers that may be on the call, people are saying in their comments to us, they are making choices to only visit places who are offering outdoor seating, open air markets, really still a lot of reservation about going into enclosed spaces.

And so based on the way the numbers are tracking, tracking, and the way that people are reporting their feelings on this, as we do transition into the fall where typical allergies and cold season, there's going to be more people being tested. We anticipate those numbers may increase. And so I think anything you can do now to prepare, be proactive instead of having to be reactive, would be much appreciated by both the consumer and our medical community as well. So I'm happy to share any of these results with you. There are more recommendations. The second part to our kind of, um, training around this topic will take place on a Wednesday, September 24th. It too will be a virtual training with the presenters being the staff of the QTI group. And the topic is HR trends that we're seeing in this new world of work. And so a lot of it is going to be impacted by COVID. Uh, Robbi did a wonderful, wonderful job of talking about what you as the employer can do in terms of job sharing and, um, being flexible in your workspace and the requirements there. But we'll expand on that on September 24th, and we'll be communicating that view, uh, via all of our social media platforms and our electronic communications with members. So thank you again for coming. Thank you for the time, Shawn, and thank you to our esteemed guests today.

Excellent, excellent information to Tywana. And I guess I'll reinforce it all again, Sauk Prairie Healthcare, we are here obviously to keep people healthy and well, but coming, you know, many of our patients did not want to return to the hospital or to our clinics because of that fear. And it was almost felt that hospitals and clinics were the most contagious or most, most unsafe. So we really put a lot of investment to build the trust and confidence and just what Tywana spoke to from really demonstrating not only the masking, the distancing, hand hygiene, of course, but really diligent about cleaning and demonstrating that. And absolutely I'd be very open to sharing, you know, different strategies from what we did around disinfecting, including UVC lighting and others, that's really helped. And now what I am proud of and we're hearing healthcare and specificly, I'll say Sauk Prairie Healthcare that we are committed to quality and safety.

We are seen as one of the safest places in our community. So more to come on that, and we're more than willing to share because we want your customers to truly feel very confident and trust that they feel safe in your businesses. So again, thank you Tywana and look forward to that upcoming session and know Robbi will be very tuned into that too. Well, let's move on. We're going to turn a little bit with Dr. Janelle Hupp and Paul Fiscus. Uh, Paul is the administrator with Maplewood Skilled Nursing and Rehab Center. And Dr. Janelle Hupp is our medical director for infection prevention. Many of the submitted questions really centered around how to protect much what we're talking about, customers and better understanding those at-risk populations. This does include the strategies how to not only protect those at-risk populations in the communities, but also group home settings. So Dr. Hupp I'll first turn to you. Share a little bit about your background and then Paul.

Thank you, Shawn. And thanks for everyone who's joining the webinar today. I think this really shows the investment that our community has, and I'm so happy to hear Tywana talk about, uh, Sauk Prairie's investment in trying to make a difference in, um, tackling this virus. Um, I, uh, have worked with Sauk Prairie Healthcare for 15 years. I'm a flat lander, uh, but don't hold that against me. Um, we moved here to God's country 15 years ago and, uh, uh, I've been with Sauk Prairie Healthcare since. Um, I'm a family medicine doctor. Uh, our clinic is at, uh, in Mazo, a Wisconsin Heights Clinic, and I am the chair of infection control and also the medical director for employee health. So in those rules, uh, I've, it's been a huge learning curve this year. Um, but I am so fortunate to be surrounded by wonderful, um, hospital staff members and, uh, great, uh, employee health, um, nurse and infection control nurse.

So, um, we've all learned together. And one of the, probably one of the biggest things we've learned is that COVID-19 is really, uh, has really caused people to make lots and lots of difficult decisions. Um, and we've been forced to do some of that within our own work environment, but I know businesses have, um, been really taxed with making those difficult decisions. And I can't work with employee health without also sort of working with the community because our employees are part of the community. So, um, we have learned about the many ripple effects of, of COVID-19 and how one exposure sort of opens a black box, uh, for many other people to be affected and to miss work. And, um, it's, it's really, um, kind of mind boggling to, um, when you think about that ripple effect. So, uh, one of the areas or the area, I guess, that I've been asked to talk about are our vulnerable populations.

Um, we all remember early on in this pandemic, seeing the awful pictures from Washington state and the nursing home populations there that were affected and the many, many, many deaths that occurred in those settings. Um, that of course is the first population of people we think about when we think about vulnerable patients. Um, but that list goes on and I'm happy to say that the nursing homes in our service area have done a really excellent job at trying to mitigate and, uh, infection and protect the both their residents and their staff from, uh, infection and, uh, from, and really, um, it's involved in many difficult decisions. As you know, that nursing home population, uh, is that's one of the saddest things about this pandemic. They have faced great isolation, um, without having visitors and even physicians not being able to go into those facilities in some cases. Um, we're doing a lot of physicians are doing a lot of those visits via telehealth.

Um, and it's, uh, it's taxing nursing staff because they have to, uh, be the facilitators of those telehealth visits. Um, but that population of people is, um, probably is the most vulnerable population. Um, we know that the people in, uh, who are 65 and older are at high risk, but those who are 80 and over are at, uh, like 600 times greater risk of dying than the, than the younger 20 to 29 year olds. Um, so it's, it is, um, a population that we want to be certain that we are paying close attention to. Um, nursing homes in our communities have, uh, gone to, um, periodic testing of their employees. And, um, there's good reason for that. Um, their employees, many of them are contracted, so they are working not only at say Maplewood, but they might be, um, working at other facilities. So they, uh, are in and out of and interacting with many of those vulnerable folks.

So testing is important in those situations and the issue of lag time, uh, to get those test results is an issue, and we hope that that improves with time. Um, but that population of people, uh, is the most important to protect because they are at the greatest risk. Other vulnerable populations though include our people who have chronic illnesses. So, um, a patient who, or an individual with high blood pressure for example, is three times higher risk, uh, than someone who doesn't have a chronic medical condition to be hospitalized if they get infected with coronavirus. Um, a person, uh, who struggles with obesity three times higher risk of getting hospitalized. Um, if they get infected. Someone who has two chronic medical conditions, for instance, somebody who has hypertension and diabetes, they're four times or sometimes four and a half times at greater risk for being hospitalized with coronavirus.

And we have these people in our midst. I can tell you that in a day in my office, uh, 75% of the patients that I see have more than one chronic medical condition. Um, it's very common for people to have heart disease and diabetes or hypertension and kidney disease. So, um, and those people are working in our businesses. They are our coworkers. They are management. Um, so how do we protect those people? Um, well I think that really the improvement that I've seen in our community with masking is so huge, and we can't emphasize that enough. Masking and really emphasizing that in the workplace is going to go a long way in helping us pass this pandemic. Um, but the other things that, um, we need to think about in the work setting to protect those vulnerable people are, you know, trying to limit interaction with others.

And again, this has been about painful decisions. Um, maybe not allowing congregating in break rooms, um, not allowing potlucks and people bringing food in, um, making sure that people aren't sharing headsets and phones and, um, things that are near their face. Um, looking at ways to maybe improve air quality in workplaces. If you have, uh, individuals who are, you know, have risk factors, um, Robbi talked about, you know, offering options for work at home, or maybe separate office space to get them out of the mix, because it's really about limiting contact. Um, as Dr. Buss said, 15 minutes, uh, is considered a close contact. So you can imagine in a workplace with employees sitting across the table from each other in a break room, eating lunch, where they can't be masked, those risks are great. So, um, those are some simple things that we can do in our work environments to, um, help the cause.

Um, I know people are getting tired of virtual meetings, but it's important to continue with those. And, um, it's, it's, I know it's drawing on all of our patience. Uh, we, we are tired of it, but, um, limiting that, um, large group gathering is, um, so important and we need to be vigilant and, and put the fatigue aside. And if we can just do this for eight weeks, eight weeks, if we can be really, um, concentrating on keeping the masks on, limiting our, um, exposures outside of workplaces and places we have to be, and, um, washing our hands and, um, keeping our distance, uh, we will come a long way in getting past this. Um, there are a lot of, uh, people who look at COVID-19 and feel like, well, you know, only a small percentage of people ever goes to the hospital. Um, most people who get this, you know, feel crummy for a few days and then they get past it.

And isn't this just kind of like a bad flu? Well, the difference is that, um, we know that people can transmit this virus days before they actually become symptomatic. And it is much easier to transmit this virus than it is even the, the influenza. Um, so there is a difference in the transmissibility and there is a tremendous difference in how it affects that vulnerable population of people that I talked about, um, and their risk of hospitalization and their risk of death. So it is different than a bad flu. Um, it is much more serious and, um, again, protecting our vulnerable, uh, the, the vulnerable people in our midst, um, is important. Um, I, um, I have to say that, um, my, uh, patients who are, um, older, who come into the office are, um, they are concerned and most of them, yes, they'll admit that they're tired of being at home.

They're tired of, you know, being alone or talking to family members on the phone. They're also scared and concerned, and they understand the ramifications of, you know, if they were to get infected, what that could mean. Um, so we worry about them, but in my experience, many of them are doing better than my 20 and 21 year old daughters in dealing with this. Um, so, but, but we need to encourage each other. We need to encourage each other to just be patient, to stay the course. If we do this for eight or 12 weeks, we will be in a much better place. And, um, we will be in a position where we can take a breath. And, um, eventually we're going to get to the point where we can give a hug, shake a hand, um, it'll happen, but we have to be vigilant and diligent about what we're doing now.

Thank you so very much Dr. Hupp. Absolutely, you know, well said, and those tactics. Paul, I was hoping you could share a little bit also your perspective. We talk about, you know, I would see the geriatric population at risk, but also with your teams and the approach and the business to improve that trust amongst the community.

Sure Shawn, I'd be happy to, first of all, I'd like to apologize for the technological difficulties. Is the audio clear? Yes, we can hear you clearly. Good, glad to know. Um, as Dr. Hupp said, obviously um dealing with a population at probably one of, if not, the highest risk, uh, has been a challenge at our facility. Um, I think, you know, from our perspective, we just sat down in the beginning and said, look, let's, let's focus on safety for everyone. Uh, the residents, uh, obviously our staff and the families. Um, we, we took this extremely seriously from day one and I believe in my heart that that has really propelled us to the place that we're at now. Um, we focused on adhering to guidance, which as most of the other providers on, um, the town hall would probably agree, um, has zigged and zagged a little, uh, from time to time, but we've, we've adhered to guidance because, um, we believe that the experts are the folks that, uh, that have the most information and the most knowledge.

Um, we created habits early on and we remained diligent with those habits. And we've to this day, stuck with a process that was repetitive. Um, Robbi talked about communication being important. Um, not only once, not only twice, but ongoing, continuous as, um, things evolve and things have evolved in this environment. It's very difficult when we've had to sort of close the doors, um, to not only family members, but friends in the community, medical providers, vendors. Um, it's been very difficult sometimes for folks to understand, um, what's happening at Maplewood at this point, you know. And we appreciate so much, um, the folks who have helped us during this, this time. Obviously we've been what I call stubbornly cautious throughout the process, especially with things like quarantines and the admissions that we were, uh, basically severely restricting at one time and have slowly begun to take on a more regular basis.

And multiple of the folks on the panel have talked about disinfection and cleaning. We've been extremely diligent and we've learned a ton of things. Um, as I've worked with, uh, your material management person on a regular basis here over the last four months, Shawn, um, we've learned all kinds of things about, uh, personal protective equipment that we never knew before and cleaning products that, uh, uh, do things that we never knew they would. And I think that that's been extremely important. And as I mentioned, uh, restricting access, um, there was guidance about those things and we've been very, uh, forthright to folks. And I think we communicated very well. We've been extremely fortunate with the families and the partners here in the community, um, just meeting some of the daily challenges that, that face our population when they can no longer receive a visit from a loved one.

I was used to seeing them three or four or five or six times a week face to face. This is a very, very difficult thing. Um, and I just appreciate all the creativity from some of our staff members. Uh, we've probably done two or 3000 Skype visits or FaceTime visits. Uh, we're beginning to do, um, limited outdoor visits now with, uh, um, some very strict protocols regarding, uh, screening and distancing and masking. Um, these things are obviously bringing people back together on some level. Um, now, you know, we're kind of focusing now, I think one of the panelists mentioned earlier, you know, I think it's time to go focus on sustaining the energy. I think Dr. McAuliffe talked about it a little bit in the beginning. We can't stress enough how tired, um, and mentally, emotionally, and physically overwhelmed some of this team is, um, from what we've gone through. But, you know, we're, we're focused also on addressing the psychosocial needs of our residents, and, you know, there's been a lot of moving parts throughout this. And, um, these are things that they sap your energy at at a, at a period of five months or getting close to it. You know, we're, we're trying to create new communications and, you know, family interactions and focused on the wellbeing of the residents, especially our long term care folks, um, who have called this home. And there's some strict protocols that we're, you know, we're following to remain open for admissions. Our short term rehab is beginning to get going a little bit again. We're happy to serve the community as always. Um, we grouped those folks, uh, whether they are coming in, uh, new for the first time or whether they've had to be hospitalized for a short time and return. Uh, we group those folks in one particular area and there's a fairly strict quarantine process there. Again, um, most of this following CMS and then CDC guidelines. Um, as I mentioned, the outdoor family visits are are beginning again. And if any of our family members happen to be listening, um, we would love for you to schedule a visit. If you didn't hear about that, we've only been doing that for about 10 days now.

I just want to make sure I mentioned the staff, Shawn real quick. Our staff has been absolutely outstanding. I want to thank them through this process. Um, there has been a level of sticktuitiveness and diligence that is hard to describe. Um, and we just appreciate that extremely, uh, on our end. Um, and I think going forward, the, you know, some of the risk factors, um, are going to, are going to drive our industry as we move into the fall and winter time. Um, we're going to have to monitor the effect that this isolation has had on our residents going forward and ongoing. Um, you know, how long are the staff going to be able to hold up? Uh, you know, we're doing our best to continue to recognize, appreciate and support them. And, uh, you know, when will the testing process standardize in our world? Uh, as Dr. Hupp I believe mentioned, you know, our staff are being tested on a periodic basis. That will be, uh, uh, in concrete soon as how often we will be tested. We think that that's important. We think it's appropriate. Um, and I could talk about all the other challenges all day, but we're focused on being thankful and hopeful for our residents and our family and our staff. And, uh, I'd like to thank all the panelists that have been here, uh, this evening and everyone that's been working with us in the community, appreciate the opportunity.

Absolutely Paul and thank you. You hit a key thing. And it all, again, I'll remind everyone we're going to wrap up here. Unfortunately, we're running out of time, but please put in any questions, you know, that you have, and we will follow up on those on our webpage. As Paul really pointed out, we have the privilege I'll say to be in healthcare, and it's truly inspirational every day to see how we're affecting people's health and wellness. But we are going to be putting out there tips and tricks, how to keep morale up. People, and as Paul said, truly appreciate it because that's so important as we've talked about once what we're going through. All right, we're going to move into, um, I know Jeff and Dr. Furukawa, who I know our audience will stick with us because you've got a lot of important information. Dr. Furukawa, I'll let you introduce yourself first and why you're wearing a mask and then Jeff, Wright.

Okay.Thanks for having me. I'm very happy to be here. My name's Masaru Furukawa. Um, I've been with Sauk Prairie Healthcare for seven years now. It has gone by fast. I'm the medical director, uh, for the sports medicine group here. Um, I'm also the physician advisor for the River Valley School District. So I wear two hats. I do primary care. So I've had a few patients with COVID ranging from zero symptoms to unfortunately passing away. Uh, and some, some people who were very high risk who got very, very ill and they made it through. Um, and I, I have a sports medicine practice here, uh, at Orthopedic Associates. I'm wearing a mask because I don't have an office here and I'm using a patient room. And I think it's important for us to demonstrate that we're trying to even protect the environments that we work in, that that is shared.

And that's why I'm still wearing a mask. Um, but I also have a primary care clinic and sports medicine clinic in Spring Green. Um, so, uh, in terms of my background, um, I do primary care, but I also have fellowship training in sports medicine. Uh, I did my fellowship training at the UW where I took care of the UW athletes. Um, I took care of the UW football team when I was there. It was a privilege, it was wonderful. I also took care of wrestling. Um, women's soccer, um, women's hockey and track and field. So, uh, it's, it's a passion of mine, uh, to work with these athletes and keep them on the track or the field whenever I can. And that's why I was invited here to talk.

Jeff, what this segment is, obviously, employers are really looking to the school districts overall and Jeff has been an instrumental part, trying to coordinate a unified approach as we look at the fall and understanding the impact on businesses. So, Jeff. Well, thank you for just a few quick minutes. Uh, the Sauk County Health Department has put together a matrix for decision making and how many students should be in a school. And it's very similar to what Dr. Grunewald Dr. Grunewald spoke about at the very beginning of the session. It looks at the 14 day active case rates, the rate of community spread, the COVID-like symptoms in our emergency departments and the percentage of positive tests in the community. We now are able to use that, to determine what the capacity should be in our buildings. And in Sauk Prairie, we announced last night that we're going to open in a reduced capacity or hybrid model.

I'll wrap up saying that you can always reach out to talk to us or look at our website. SaukPrairieSchools.org to see our plans and our communication with our families. But I want to wrap up by echoing what Dr. Hupp and Tywana talked about and the importance of sending the message of masking, social distancing, and that the only way we get our kids back into school full time is if we kick COVID out of town and we need to do that as a full community and make that happen. So we can have students back in every school. It's 6:30. Well, we don't want to rush to the end and again, I know our audience will stick with us. Um, and we've had such great information come out, Dr. Furukawa, you know on the sports, I know several questions were coming through. As student athletes return, how can we make sure we're keeping people safe and even as they're coming back into the household?

Absolutely. Um, Jeff, you're absolutely right. Number one, I wrote right here, number one, control the disease in the community. That is how we're going to keep our athletes safe. Um, that, and specifically, since we're talking to the business community, um, you guys are truly seen as leaders in the community. Uh, if you're out there in the community, at the athletic fields or in your business, at a social function, if you're wearing a mask, people will see it. There's, you know, all of us here, we, we obsessively look at the curves. We look at the numbers, we look at the publications, but there's this human thing called observer bias, where we won't really make changes in something like putting a mask on in public until we see other people wearing it. So that's where businesses can really help the athletic community is, is, is helping out with the disease control in our community.

So other things about sports, again, all centers around controlling the disease in the community. So if you're a parent and you're out there watching a sport, don't be sitting together in the, in the, the bleachers, you know, practice social distancing, wear masks. If you can't sit far away from people, um, that's really important that allows our athletes to do what they love. Um, number three, if you, you know, your kids are going out outside of sports, you know, ask them questions or there going to be large groups, is it going to be indoors or outdoors? You know, it's just like driving, review the safety rules with your kids when you let them out. So again, number one is really controlling the disease in the community because when you look at sports, most sports, you're going to be outside. The transmissions are more going to be outside of sports.

And I've been talking to the UW team physicians, and we feel in the sports community, pretty good about the protocols. It's what people do outside of sports that we worry about. And that's where we have to focus a lot of our energy. So I think those are, those are the really big things. Um, so I had some questions specifically about how do I keep my kids safe in sports? Um, yes, you want to let your kids play sports. Oh, and before I go into to this, we think of sports as something we turn on, on TV, something to entertain us, it's a pastime. But the athletes in our communities, sports is sometimes more than entertainment. It's actually a lot more than entertainment. The UW our, our UW has already done research on the impacts of, uh, depression and anxiety on our student athletes. And they looked at those numbers and they found that before May of 2020, uh, only 30% of athletes ever described any kind of depression symptoms.

Now that is up to 68% in our student athlete population, right after the cancellation. So in addition to that, athletes reporting moderate to severe clinical depression went up by three and a half times. So it has had a profound impact on our athletes and our community. So certainly we want to do, we want to get athletes back on the field, but we also want to do it safely. And there's, there's tremendous positive benefits for these athletes to get back on the field. So I think aside from the community control of disease, I think before you let it lit up, let, uh, let let an athlete go back and make sure they feel safe because, you know, everybody sees this very differently. And this is true about your customers, your employees, when they see the news outside, we don't all perceive the risk the same. So make sure if, if you do have an athlete in your home to make sure they feel safe before they go out.

So I'm not going to go up too much longer, but couple things, couple big picture things, I guess, for everyone is one be flexible. Our athletics is, um, a lot of, how would you say conference level schedule level things. We're relying on the people who are really good at figuring out those schedules and that'd be the WIAA. And, you know, they have to go through the same things we do. We have to be patient with the organizing bodies and be flexible when they change regulations or dates of start dates and things like that. And number two, I think we should always stay up to date. Um, make sure you read, read the news articles out there. And I think if there's any failing on our part as physicians is we haven't done the greatest job communicating the facts as they come up and updating the community.

I think we could do better. So if you haven't already just feel free to email any one of us on the panel, um, and ask questions, feel free to ask questions. The our, our River Valley School District finally, you know, they, they've been really great about communicating and asking great questions. We want to help. So feel free to contact us. Um, so if there, as a closing remark, you guys, if sports can be done and it can be done safely. Man, have you guys watch baseball lately? I mean, it is. I love it. I mean, it's funny to see the cardboard cutouts, but sports can really bring that energy back because we can do it and we can do it safely. Um, so it, I mean, it, there's this great clip where I saw, um, this Angels, um, uh, Japanese player hit a home run and I saw him coming around.

He, he crushed that ball. He ran, ran around the bases and he came down third base and I saw him stick his hands out around third base. I'm like, what is he doing? And then he comes into home and he just puts his hands up in high fives. And there's another guy, like 10 feet away, high fiving. I'm like, Oh, they're air fives. And then he goes in and high fives in the air. And, and once he gets a dugout, they're all in masks. So I thought, you know, it can be done. It truly can. So I just wanted to close with that.

Awesome back to, you know, absolutely sports and other things uplift us. And as Dr. Furukawa shared, you know, we want to be that resource and help. Um, but I will stress. These panelists are absolutely incredibly read and up to date on this very evolving pandemic. And they will be the first though to state, we don't know everything, but we are committed to providing information on what we know today and continuing to push out what is happening. Uh, we do want to be seen as that source for our business partners. And that's, you know, part of why we're here today and because there's so much out there that's conflicting. So there will be that portion on the web page that we talked about. COVID we not me that, and we'll push that out there, but you can ask those questions and we'll make sure to get you what we know as of today.

So with that, uh, we're at the end of our session, I appreciate everybody sticking around a little extra. I want to thank our panelists for participating, for providing some very important guidance on strategies to keep our communities healthy and our businesses open and our economy strong. I truly appreciate each of you taking the time today to learn more and really demonstrates your desire and how we can incorporate these methods to keep our businesses vibrant. I do hope you found today's session meaningful. I look forward to continuing our collaboration and efforts designed to truly stop the spread of COVID. I absolutely wish everybody a wonderful and safe evening, but I'm going to reinforce remember to mask, distance, and I am hand hygiene. So with that, I wish you all a wonderful day, everybody mascot. Right? Thank you.

Okay, good evening everybody. I'm Shawn Lerch, the CEO for Sauk Prairie Healthcare, and I'll be the moderator for tonight's session. First, thank you for joining us in our first virtual COVID-19 townhall. The townhall's, purpose and format is designed to help answer questions from our business partners and to be a trusted resource as we collaboratively really navigate this pandemic. I want to stress Sauk Prairie Healthcare is committed to keeping our communities healthy and safe with vibrant and strong economies. Our partnership and support with the regional businesses is vital to supporting this mission. First, a few housekeeping items, all mics were muted during this townhall because of the large audience, but participants are encouraged to use the question section within the control box and submit questions throughout today's session. We will do our best to provide pertinent information on questions. Many of you have previously submitted along with additional questions raised today.

This includes time we will reserve at the end to address any of those submitted questions that we can get to. Also, Sauk Prairie Healthcare has created a business and community resource webpage, where all of the questions and answers will be posted and additional links to resources that are meaningful to our business community. This link will be sent out after today's session. Once the question section is updated.

Now, I am truly grateful to the esteemed panelists who are part of today's townhall session. COVID-19 is a novel virus that has impacted every part of our lives and will continue to present challenges for the foreseeable future. Fortunately, we are learning so much new information every day on how this virus is transmitted, affects our health and how to stop it from spreading. I am proud of the Sauk Prairie Healthcare team and our community health partners for being truly at the forefront and keeping abreast of the latest scientific research in our unified fight against COVID. This focus on science was a primary reason our early adoption and promotion of public masking and adherence with our other infection prevention strategies to keep our patients, our team members and our communities vibrant. You are part of that vibrant community.

I know our panelists are excited to share their insights with you today. So with that, let's open it up and we're going to start with Dr. John McAuliffe who provide his perspective on the impact of COVID-19 on our communities and our businesses. Dr. McAuliffe, please share a little bit about your background and role in community health and your perspectives.

Thank you, Shawn. Uh, and thank you for getting all of the, uh, members together and basically beginning trying to get the silos, talking to each other. Um, I've been a family practice doctor in the community for 42 years, and I've never quite honestly seen anything quite like this. And I've never seen the kind of reaction within the community that's actually more escalating as we go along and the tremendous amount of anxiety and the fear, uh, all because of there's a lot of uncertainty with this whole virus. And then the messaging keeps changing. And so again, uh, that's one of our main goals here is to how do we make that messaging consistent and based upon the best science. That's how you really start to address the fears, because as fear and anxiety escalate its very paralyzing and people that I see in the clinic day in and day out, they just have thrown up their hands and say, "I don't want to deal with this anymore."

I think they were fine for the first two to three months, but when it starts to be four and five months of no end in sight, they start to decompensate and just start to say, "I don't want to be bothered by this." And that's what we can't have. We've got to constantly try to reach out and connect with those people and to see how we can get them engaged because there's, there's numerous studies that, that show and Dr. Osterholm, uh, he's the world renowned epidemiologist from University of Minnesota, uh, says the virus is going to be around quite a while yet. And then when you look at communities, the incidence of this virus in the community will vary anywhere from five to 15%. And he says, it's going to be around until that gets up to about 60 to 70%. And we know how much pain and suffering has gone to get us to the five to 15%, but we're not even a quarter of the way there yet.

So we've got a long ways to go and everybody's got to be on the same page and everybody's got to be plugged in. And before anybody really makes any change there first has to be in an acknowledgement of the issue. And that's where I think a lot of people get hung up is that they haven't had training really in how a virus or how a bacteria are even worse. In other words, their reality is really dependent upon what they see, what they feel, what they touch, that's their reality. And if they can't see it and feel it and touch it or smell it, they don't necessarily believe in that. And we have to, as professionals, we have to engage them somehow some way. We can't turn them off. We have to try to understand their perspective if we're going to get them involved. And after, after there's some awareness, then before we can make any change, we have to accept that this is the reality.

And we also have to accept the belief that we can make a difference. And that's what will then empower us as we go forward. And there's lots of data now, largely from the World Health Organization. They've, they're not, uh, any random controlled studies, that will probably never happen, but they're observational studies over 172 of them have shown if we can, but get 90% of people to wear masks and to have some distancing that will bend that curve within two weeks. We'll notice a tremendous difference. And I think that that's what really needs to be our goal as we, as we go forward. And then there has to be the action that has to be the action, but it has to be internalized. And it has to become, by that I mean it has to become a habit. We just can't be thinking about it because of it's not habituated, we constantly go to the negative. And nobody likes wearing a mask --- there's irritation, there's shortness of breath, there's all these other things. But once it becomes habituated, we start to take it on and that's where we need to get, get to be as a community. Uh, and if we can do that to get these certain habits that we'll talk even more about, uh, then we'll make progress with deterring the, the rate of progression of this virus. And then I think our really our, our, our weakness now will become our strength and that's just, we have to become more educated. We have to become more unified in our approach to this whole problem.

Well said, Dr. McAuliffe. I couldn't agree with you more. What I would like then to move into Dr. Nathan Grunewald. He is a urologist with Saukk Prairie Healthcare. Dr. Grunewald leads our research effort, and he's going to provide some of the current state, what we've learned about COVID-19 and why is there that unified need to fight and have that urgency? So, Dr. Grunewald, if you could share just a little bit about yourself and then role within the community health in this fight against COVID.

You bet. Thank you, Shawn. Dr. McAuliffe you're a tough act to follow, so I'll do my best. Um, I, as Shawn said, I'm proud to say I'm a Sauk Prairie native. I grew up here and graduated from high school here, and I'm glad to have returned back to my roots. Uh, this is a great community and I'm happy to be here. Uh, I do, I am a urologic surgeon and I also serve as our innovation officer at Sauk Prairie Healthcare, uh, very much, uh, enjoy my time there. Uh, it's a great place to be. Uh, first I'd really like to thank all those participants who are on the webinar today, uh, for joining us. Uh, it shows real commitment to learning more about COVID-19. And I can't say enough that we in healthcare are very appreciative of the support. Uh, you are providing us today. In the long run your participation will be instrumental in minimizing the impact COVID-19 has on our communities. And quite honestly, your business. I've been asked to share a little bit about how this has evolved over time and why it matters to our communities. Uh, you know, in some ways it feels as though COVID-19 is not really a problem around here. We don't see it, uh, as, as in feel it as much as those folks in New York and the South have noticed. And I think, uh, why we feel that way is because much of our barometer was really set by the New York experience. We all saw it on the news. We saw the suffering, um, and we don't quite see that here in Southern Wisconsin, uh, not to the same degree, it's more hidden. I, and the reality is that we see and feel COVID differently in rural America. It's going to be more of a constant drip with the potential for a pretty big flood.

And that's mainly because we have limited resources and capacity to absorb those influx of cases. So with that though, why is COVID-19 such a big deal? After all that's why we're here. Um, and we have infectious diseases all the time --- , colds, flu, HIV --- those are all infectious diseases, just like COVID-19. Why is this so different? And it's because COVID-19 is a new disease. We've never seen COVID-19 before caused by a Coronavirus that mutated and the human population has never experienced this particular strain. And when it was first reported in late 2019, there was a lot we did not know about the virus. And what we learned and what we did early on for this brand new, highly contagious respiratory virus that, uh, as a terrible stroke of, uh, of life, it actually causes death. And in medicine, that group of characteristics is one of our biggest fears.

It's very difficult to control, and it takes a monumental feat amongst human to get this under control. As that virus spread, we saw the massive impact in Asia and Europe, from afar. We, uh, early prevention and treatment focused on using known information from other respiratory illnesses, particularly the flu.Our experience with the flu drove a lot of our early, uh, treatment and recommendations. However, what we've learned so far COVID-19 does not behave exactly like the flu. And over the spring and summer enormous effort has been mobilized in the medical and research community to sort out the very basic details on the behavior of this virus, its risk. And most importantly, how to prevent the spread and treat those who actually contract the virus. This is has included updating guidance and treatments as we learn more. Uh, and most of you remember that early on the focus was on social distancing and handwashing. We now know that face coverings are very much a very important step to preventing and stopping the spread. That took time to sort out, and there is still much more to do and look.

So if we kind of step back and really look at this at a high level, uh, I'll give you some numbers that, uh, to, to put it in perspective. For those of you who watch these, you know, the United States today has reported over 5 million cases, 163,000 deaths. Wisconsin has seen 62,000 cases and a thousand deaths. And note that of those 62,000 cases, 15% of those are in children. In Sauk County alone we've seen almost 450 cases. We've had three deaths related directly to COVID-19. It's important to note though, that this is the confirmed case counts. Uh, this comes from testing folks with active infection. Based on estimates from blood samples, we suspect that the actual number of US cases are closer to 40 million. That's a lot of people. And compared to the flu, which this oftentimes gets, uh, uh, compared to, depending on the particular flu season we have between 20 and 40 million infections in 20,000 to 60,000 deaths.Just looking at those US numbers for COVID-19, it's much worse.

It's not the flu. Uh, we don't know the longterm effects of COVID-19. And even if you use death as the barometer, it's still bad. However, what does COVID-19 really look like for us in our communities? Like I said, rural feels different. Well, it's clear we have some work to do to improve our situation. We don't see the same high numbers, like what we see in New York, LA or Chicago, simply because we don't have the same size population. So instead it's helpful to look at the case rates. This is the percentage of the population that's affected, uh, and the trends more importantly within that. And as we review the data, we look at our 14-day running stretch of time, and that's really to smooth out the individual variances that you experienced on a particular day. And when you drill down to Sauk County for the period ending, uh, August 6th, 4.4% of all tests were positive for COVID-19.

And in that short period of time, that's 164 new cases. And realize that cases are unique individuals--- there's no double counting there --- once you test positive for COVID-19, even if you get multiple tests and they're all positive case, counts represent one. It's you. Okay. Um, since the end of July, there's been a steady increase in the overall number of cases in Sauk County. However, for me, the most worrisome number of all of the stuff that's reported is the number of new cases that cannot be traced or linked to a known source. So when someone tests positive for COVID-19, we do our best to figure out where do they get it? And who did they expose? And, uh, and, and it's called contact tracing. In Sauk County that number is 37% of all positive tests in this past 14 day period. That means more than a third of the people who have tested positive we can't find where they contracted the illness and find a commonality to help slow or stop the spread. That is right now, our best defense against COVID-19. If we continue on this trajectory, we can expect another shutdown in the future. However, we have an opportunity right now to bend this curve as Dr. McAuliffe said, and move us back into a safer zone while we sort out the prevention and treatment options. This is where you come in. Helping us encourage the use of proven strategies to decrease the spread among your employees, your visitors, your patrons is one of the many pieces we need to build a wall between us and the virus. Doing so will allow us to return to more normal and buy time to finalize treatments, and hopefully a vaccine, when life can return to normal. Most importantly, though, we will be saving lives, possibly your own.

I thank you for joining the webinar and listening, and I know we're going to have a lot more great questions to come. Uh, thanks again, back to you, Shawn.

Thank you so very much, Dr. Grunewald. We're going to tee this one up maybe for a little bit, but there was positive news. And if you're willing to share, or, you know, at the end with New Zealand specifically where 102 days now recorded no community spread because of several measures, but they've been doing things the right way and their economies are thriving again. So I think we can talk a little bit about that as some examples would agree.

Okay, let's move on. Um, unfortunately, uh, Tywana German who's you all with us today, but just by voice, she had a little bit of an issue with her computer. But many of you recognize to Tywana who's the director for the Sauk Prairie Area Chamber of Commerce. Tywana has been extremely proactive in supporting our regional businesses as we reopen the economy and providing strategies, how we can keep it open. Tywanna is going to share some information, because she's worked a lot with businesses on different surveys and studies and specifically a QTI study, and really understanding some of those complexities facing our regional businesses. Tywana, please share a little bit about your background and your impact here on our community.

You should be live Tywana. Tywana are you there? All right. I think she's struggling and again, a little bit with the technology and you do have to, uh, give us a little bit of a break as we go into the new virtual world. Right? Well, with that, we will come back to Tywana, but we do want to move on and shift the focus a little bit again, back to our businesses and how we're supporting. Just like Sauk Prairie Healthcare, we're dealing with a lot of issues around our workforce, our team and Dr. Trevor Bus and Robbi Bos with our Vice President for Human Resources are going to help us better understand navigating workforce issues from teleworking to testing and really how we can keep our team members healthy in this COVID era. This includes an interest, like I said, on testing protocols, sick policies, safely returning to the workplace. In addition, as you know, addressing the stress and anxiety Dr. McAuliffe spoke to earlier. And first I would ask Robbi, share a little bit about yourself and then Dr. Buss. Okay.

Thank you, Shawn. And thank you everyone for taking the time to hear what words of wisdom I can offer as a, as you navigate through this difficult time that we're going through. Um, I think I would like to just start out by, um, letting you know that I've been in human resources for over 30 years. The last almost 15 of them have been here with Sauk Prairie Healthcare. Um, going through a pandemic in a healthcare organization, um, had its pluses and minuses. Its pluses, because I was blessed to be able to work with physicians like those you see here who could keep us abreast of the most, um, up to date knowledge, uh, that could be had, uh, as we tried to figure out how we were going to move forward. I would like to talk a little bit about, uh, the fact that I am sharing my perspective as an HR professional. Uh, I am not a lawyer. I do have some background working with, um, compliance areas and I'm going to talk a little bit about those. Um, I also want to acknowledge, uh, that if you are on this call, then you are an employer who is very concerned about providing a safe workplace while still remaining compliant with legal requirements that we all deal with. And to remain open and retain your workforce, we need to be able to make it easy for employees to trust that their jobs are not in jeopardy if they comply with public health requirements. Uh, we need to be able to communicate with them early and often. One thing I learned as we were moving through the pandemic is that even if you've shared something with employees, once it needs to be shared again and again, uh, to make sure that, that it remains fresh and it remains front of mind. Um, and it helps, uh, with becoming, um, creating that habit that Dr. McAuliffe talked about.

Uh, I would like to mention a few areas, uh, that I think all employers need to stay abreast of. And these may be things that you don't normally, um, connect with in your day to day business. But the first thing that I watched for as we went through the pandemic was what was the federal government going to do? What laws, what regulations were going to come down the pike that we needed to be ready to act on quickly? And the first of those was the cares act. It was made a little more confusing by the fact that the cares act applied to businesses with employees under 500. And so businesses like Sauk Prairie Healthcare who have more than 500 employees, uh, were not covered by it yet. Our employees were going to be aware of the provisions of that act changes to the family and medical leave act, um, requirements for paid sick time.

Those sorts of things were going to be front of mind for our employees. And so it was still important for us to remain connected to it. And one that I think didn't get as much play as it might have was the Americans with Disabilities Act, because we soon learned that there were going to be requests for accommodations from our employees. We also needed to be as up tp date as possible on unemployment insurance and any requirements that would change there as well as OSHA requirements. And I found that bookmarking all of those federal sites were, and state sites were, uh, critical for me to be able to go back and see how they were changing them from day to day. A couple of the questions that have come forward and that I've seen a lot and I'll go through them relatively quickly, um, is one, can require an employee to get tested?

And that was one of the first things that the Equal Employment Opportunity Commission gave guidance on. And the answer to that one was yes. Uh, any, any mandatory medical test must be job related and COVID-19 was, was definitely, uh, uh, consistent with business necessity. The next was can I require an employee to wear a mask? And, uh, especially during the statewide mandate, you definitely can. And employers do have the right to institute reasonable safety precautions to be taken within their workplaces. Um, another question that has come up is, do I have to tell other employees, if one of the staff have tested positive? And this is where it gets tricky. And, and again, I re I reiterate, I am not an attorney, uh, but there's, there are so many laws that come into play. OSHA, for example, does not require employees to note or employers to notify other employees if, uh, one of their employees gets COVID. But they must take appropriate steps to protect other workers from exposure to the virus.

And so these steps might be listen, we had an employee who tested positive. You may need to engage in additional cleaning and disinfecting of the work environment, notify your employees to monitor themselves for signs and symptoms of COVID. Um, the CDC, however, recommends that employers do determine which employees may have been exposed to the virus and inform them of their possible exposure in the workplace. You should do your best to maintain confidentiality of the employee who tested positive as much as possible. Uh, keeping in mind that employees may choose to be open about their diagnosis uh themselves. Um, the ADA also, uh, uh, requires confidentiality of the person's name, uh, but the method of disclosure, uh, would need to comply with applicable federal state and local laws. Um, policies to have in place during the pandemic...We learned quickly that policies that we did have were in need of updating and changing, and we needed to implement new ones.

The biggest one that we struggled with, uh, uh, defining was your attendance policy. If you are covered by the Cares Act, there are requirements for paid leave that you must follow, and this act is amended. It also amended the family and medical leave act. So there's lots of provisions in there that may apply to you if you have less than 500 employees. Uh, all of the professional organizations, including WSHRM recommend that employers be as flexible as possible with attendance. And that may mean having that, that very strict attendance policy of five absences and then the employee is, is let go is no longer going to be a program. Teleworking. If you have not got a teleworking policy, you should really put one together. Determine whether or not you will allow it if it's possible in your organization. And if so for how long will you allow it?

Are there certain employee groups that it makes sense to allow it for? Will you provide the equipment, the hardware, the software that employees might need to make teleworking successful? Will you allow them to telework from anywhere, uh, uh, uh, from their home within the state, from another state? Consider payroll implications of situations where the work is being performed out of state. What tax laws will apply if you allow that? Um, obligations to accommodate an individual who has an underlying health condition. If an employee asks you for an accommodation, you need to remember that the ADA, the Americans with Disabilities Act still applies. You'll want to consider each case on its own merits, and you'll make different determinations based on what you learn. Leave of absence can be an accommodation; consider implementing a mechanism for employees to utilize. We did this online at Sauk Prairie Healthcare and found that it was a much cleaner way for employees to make their requests.

And then lastly, what about employees who are just afraid to return to work for fear of exposure? Um, many employees are frightened that their returned to the workplace may put them or their loved ones at risk. Take the time to listen to those employees, listen to their reasons. Sometimes it's because the employee is themselves immunocompromised and may need an accommodation. Maybe they live with an elderly or at-risk relative, or maybe they're anxious that you haven't done enough to create a safe workplace. Listening to them and talking to them on a case by case basis will go a long way to reducing the anxiety that Dr. McAuliffe referenced earlier. Make decisions and determinations on how you're going to proceed keeping those, those laws. I discussed the ADA, the Cares Act, OSHA in mind, look for that telework option, granting leaves and adjusting duties, as much as you can.

Again, I want to reiterate that one of the most important things that you can do during this pandemic is to talk to your employees as frequently and as often as you can to reduce that anxiety. One of the things that Sauk Prairie Healthcare did was the CEO held a weekly, um, town hall meeting with all staff so that they could do a virtual meeting so that staff could connect with the CEO and hear directly from him how the organization was doing. Were they're going to be layoffs? It goes so far, uh, toward reducing rumors that create and raise anxiety that I highly recommend it. And we may even continue doing, uh, uh, town hall meetings on a frequent basis, even once the pandemic has passed. So that's what I wanted to share with you. I hope I've kept within my time. Uh, and I think I'm turning it over to you, Dr. Buss.

Real quick, Robbi, uh, we're going to keep you on just a few questions. Follow up, came through, I think absolutely pertinent to what you talked about and thank you. And specifically about you, you spoke to teleworking. Now, one of the questions came in, you know, we have team members who are teleworking. However, how long do you anticipate that going? What are some of the challenges you faced and how did you deal with that?

Well, that question has come up for us repeatedly and we struggled to try and figure out, you know, should we be bringing people back? Things seems to be settling down a bit. Um, how is the work being impacted, uh, by the employees working from home? And what we chose to do was to put employee safety as the number one, the number one issue to consider. And if the infection rate continued to increase, if we continue to see signs of community spread, then we decided that we were going to maintain teleworking for as long as, as it takes to get through those, those, uh, that situation. That said, um, not all employees can work from home indefinitely. And so we did gather a group of people together to talk through, um, what tools could we provide these employees that would make their jobs easier. This could be things like a dual monitor, uh, an additional phone line, uh, restructuring work, reassigning work, a redeployment of your staff to a different area if there's not enough work for them to do from home. A staffing pool for us in the beginning of the pandemic, when we had insufficient work, um, as a result of having to cancel our elective surgeries, created opportunities for employees to assist in other ways that were meaningful to the organization and allowed employees to maintain a connection with the employer that they truly valued in the long run.

Thank you very much, Robbi, uh, you know, Dr. Buss, we're going to put you on the spot a little bit, because there's a lot of questions as you saw, come in around testing, return to work, um, and those things along with, as we look at the schools. So if you could take us through that process,.

Hey thanks a lot Shawn.

Yeah. Thanks for thanks for having me on, I have testing and interpretation of the rules regarding testing and, um, quarantine or isolation are probably the majority of what I talk about every day these days. It can be a little bit confusing and hopefully I'll be able to make this a little easier for people. Obviously the goals related to testing involve, uh, really keeping everybody safe in our community. Um, as was alluded to earlier, the way that you stop the spread of a virus is you, um, make it so that anybody who's infected can't infect anybody else. So you stop one chain or path of infection. Um, uh, if you have very few cases, you can track all those cases, nip it in the bud and it's gone, okay. Or you can at least manage a few small brush fires that come up from time to time. However, if you can no longer keep track of where everybody got their virus from, it gets a lot harder. That relates to a Dr. Grunewald was talking about, uh, something we call community spread rather than an identifiable an identifiable source. So, um, I like to break down the reasons to treat there's three main reasons that people come to get tested for coronavirus. All right. One of those is "I have one of the symptoms of coronavirus" okay of the COVID-19. The second one is "I've been told, I've been exposed to somebody who has been diagnosed with coronavirus." And the third scenario is "I'm just curious. They keep talking on TV that we need more people to get tested so I'm going to sign up, I'm going to do my part. Or, you know, I've had a sniffly nose maybe it is, maybe it isn't. I don't I have allergies. I don't know. You know, just some curiosity." Um, I will tell you that one of the things that makes the strategy of, um, tracing, uh, is related to the availability and turnaround time of our tests.

Um, and, um, another big challenge to getting this under control is the fact that there are asymptomatic people who have the virus and can spread it to other people. Asymptomatic of course means "I feel fine; I got no symptoms whatsoever." Okay. So first I want to we'll, we'll get a little bit more medical here. Um, I'm going to describe the symptoms of COVID. So you dial, if we go all the way back to February, March, and you go out to the CDC website and looked at what are the symptoms of coronavirus of COVID-19, it would have said fever or chills, cough, and shortness of breath or difficulty breathing. That was it. Okay. Um, as Dr. Grunewald alluded to over the, and, and actually so did Dr. McAuliffe, over the last five months, we've learned so much more about this virus that's never been seen on the planet before.

And as a result, we've learned, oh, there's more symptoms. And by the way, they don't have to be severe and you don't have to get real sick. You don't have to end up in the hospital. And maybe there's a difference based on other medical conditions, maybe age, uh, wait a second, nope young people get it too. So all of this has evolved over time because we started to look at it. We started to study it. So in addition to fevers or chills, cough, shortness of breath or difficulty breathing, we now include fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea. So that's the most recent list of all the different symptoms for which you should consider COVID-19 as a cause. Okay.

So remember those three reasons to test: 1) I have symptoms. So any of those symptoms. 2) I've been told I've been exposed or 3) I'm just curious. So let's talk a little bit about the, I have symptoms course and the value of testing and most important, I think to a lot of those watching, um, what do I do when I wait for the test result and how long does the employee have to be off? Okay. So if you have symptoms and you come in and get a test, when, while we're waiting for the results of the test, we assume the person is positive. All right. We don't know so they could be, therefore they should isolate or quarantine until we have that test result back. Okay. If the result comes back negative, we can say, okay, good. It's not coronavirus. As long as you are feeling better, especially if you don't have a fever, then you're allowed to go back to work, go back to school.

It's okay. All right. So that's somebody who has symptoms, who then tests negative. Let's say you have symptoms and you go in and you test positive. All right, so you've been off for the amount of time it took for the test result to come back. Now it's positive. Assuming, so healthcare needs aside, whether you need more advanced treatment, or you can weather it out at home, um, the amount of time that somebody has to isolate or not go to school or work is 10 days from the first day of symptoms. Okay. So if we look at the timeline day zero, I got symptoms. Day two, I went and got tested. Day four I got the results of my test. I still have six more days to be out until it's been 10 days since the first day of symptoms. All right. So if it's been 10 days out and you have not had a fever in the last 24 hours, and you are not taking medicines that would be the reason that your temperature is down and you're getting better, then the CDC says it's okay to go back to work again. All right. So remember this: infected people 10 days. This is the most common question I get.

Because we're next going to compare that to someone who's been exposed, alright? So somebody gets a phone call from a coworker. The coworker says, dude, I just tested positive for coronavirus. Um, I was told that you need to isolate. You need to separate. And if I were, you I'd go get tested. Okay? Maybe it was the health department that called them. Maybe it was their employer that told them you've been exposed as Robbi would encourage you to do. Um, um, uh, you need to leave and go get tested. Alright. And almost everybody thinks they just need to go get tested. Here's a big, big, important warning. It's not just go get tested. It's we've noted you've had a true exposure, so you need to be out for 14 days, no matter what your own personal test result shows positive or negative. It does not matter. It's 14 days. All right. So to make this a little more clear, let's define what an exposure is in the eyes of the CDC and based on the guidance that we're following, a true exposure means you've spent 15 minutes or more within six feet of a known positive patient. Okay. So remember, 15 minutes within six feet. Alright. Back to the example. So the patient employee is notified, hey, they've had an exposure. So they leave. If they choose to get tested, it could be positive or negative. If it's negative, they stay out until 14 days after the last exposure to the one who tested positive. Okay. So if it was at work and they worked with the person the day before, they have to wait 14 days, and then as long as they never develop any symptoms of COVID, they can go back to work.

All right. Um, now here's an interesting thing. Let's say the coworker gets tested and is positive day zero. The patient that we're now saying, oh, you were exposed go home, goes home on day one. And then day two, they start getting symptoms. They get fatigue, fever, achiness. They go in and get tested and miraculously, they get their test result back the same day. Don't hold your breath. That's very rare. But they get their tests back that very same day. They are one day past the day they were last exposed to the person known to be positive. Okay. They're no longer an exposed person. They're an infected person. They have symptoms. So this person needs to stay out of work for 10 days, not 14 but from the first day of their symptoms. Okay. So theoretically, and this is what's so weird and why it's so darn confusing. The one who's infected comes to work sooner than the one that was exposed.

Okay. One more scenario. The one that was exposed goes home. Doesn't develop symptoms until day six. Now they have symptoms. They get tested. They're positive. Now it's 10 days from the day they first started symptoms. All right. Just like I said, well, now that means they're out 16 days. Okay. So I hope I can't see nonverbal anything because I can only see the other panelists through this, but I, I hope that that kind of explains some of the timeline challenges that we face with all of this. All right.

Um, interrupt for a minute because it absolutely, and it's very complex. I want to remind all the audience, we will be posting those I'll say algorithms out on a webpage and releasing that. Because you know, as the physicians, absolutely they know this by heart and they follow the CDC and all of those updates. But for our business partners, it gets very confusing and we want, you know, invite any questions to reach out to us.

But this will be posted on our webpage, because this is one of the number one questions. So go ahead, Dr. Buss, thank you. And I'll clarify, I do not expect a single one of you to memorize anything that I just said. I just want people to understand that some days your employees are going to come back and say, I was told I have to be out 10 days. Somebody else is going to say, I was told I have to be out 14 days. Those are the two most common numbers you're going to hear. Okay. But there might be times when they have to be out at a different amount of time and this is why it's so complex. Okay. Um, I did get a list of a couple of questions from beforehand that I can go into and they're of course, more complicated scenarios that could play out as well.

I'm sure you guys are kind of thinking through those in your minds already. Um, the question specifically here, when should I consider sending an employee home from work? Um, uh, I think, uh, anytime a patient or one of your employees, complains of any of those symptoms, I think it's worth saying you should go, you should go home. I don't want you to exposing any of my other employees here. Go get tested, figure out if you have it or not. Okay. Um, I know that a lot of people say, but I always have a stuffy nose. Do I really need to go get tested? Um, for clarification, generally speaking, we are asking if somebody has had any of those symptoms and are they new or worsening in the last 14 days. So hopefully that helps you guys a little bit so that we're not feeling like everybody has to leave work and be tested.

Okay. So new or worse in the last 14 days. But remember that's a long list of symptoms. Um, uh, so you should request, hey, leave, work, go get tested, go get checked out if they have symptoms. Um, if you know that they have been exposed to somebody who has tested positive, um, and then obviously if you hear that one of your employees has tested positive, don't let them work, uh, unless it's been at least 10 days, they're fever free for 24 hours and they've not been taking medicines to lower their temperature. Um, another one, and this is a very common scenario here. My employee lives with somebody who was exposed to somebody else who tested positive. What do we do? Alright. Hugely important. Okay. So you can play that game forever. Right? I was exposed to somebody who was exposed to somebody who was exposed to somebody who's exposed to somebody else.

Right? Try not to go crazy thinking through all of those scenarios. Okay. What matters is, if the employee was exposed to somebody who knowingly tested positive or is unable to avoid being around somebody whose test is pending. They've got symptoms, they might have the infection, they've been tested and we're waiting for those results to come back. So, um, it's a unique, the specific scenario, my employee lives with somebody who was exposed to somebody else. As long as the one they live with has no symptoms, they do not have to stay home. They can go to work. Okay. But if that person who they live with has a fever, has a cough, that person they live with should go get tested. And until the results are back, your employee should not come back to work. Only after we know the results, do we determine, okay, false alarm it wasn't COVID then you can go back to work again. Okay.

Thank you. And a real quick tie in on that question because it's coming in a lot, uh, is really about timeliness because we keep talking about testing and, and the difference between the time you're tested and those results. Have we seen that calmed down? Because initially there were some reports, people are waiting up to two weeks for that test. What have you experienced or other clinicians?

Yeah, that was one of the points I made at the very beginning. Right? How long it takes to get a test result back really makes it a challenge to nip this thing in the bud. Um, for the most part most, so the time it takes to get them back has been variable. Alright. And it's been based on how many people in our entire country are trying to, or getting tested at any one time. Um, as well as the capacity for labs. The capacity for labs has just gone up and up and up. People are adding new labs, adding more machines to each lab. And so our ability to test has gone up. As that capacity goes up, the wait time goes down. So, um, uh, there's a variety of scenarios here, but I would say that the majority of tests are, um, come back within two to seven days, um, for people tested in Sauk Prairie. Uh, thankfully it's now been a long time since it took seven days to get a result back, we are much closer to the two to five day range right now. And at least in the last week we've been getting most of ours in two to three days. So, um, what it is today doesn't guarantee that that's what it's going to be next week, or if suddenly we're inundated by people with symptoms. So it certainly can vary. And in fact, um, as we come into a season where we tend to see a lot more people who have cough and runny noses and et cetera, this fall, um, it wouldn't surprise me if some of our wait times goes up as way more people get tested. Okay. Um, so let's see. I keep hearing about that quarantine is for 14 days. 14 days from when? All right.

So this is a really important question too. Um, quarantine for 14 days. What does 14 days mean? That's in the scenario where you were exposed to a known positive. So the time zero starts the moment you left that person that you were exposed to the last time. Okay. So if it's somebody, if it's a coworker the coworker has left now, so, uh, or the, the, whatever, the last day they were around that coworker is you start that is day zero. So you've got to wait 14 days after that last exposure. Here's the unique scenario, um, and it's not a fun one to consider. What if somebody lives in your, um, house is the one who's positive, you're doing your best to not get infected. You're separating yourself from that person, but you do live with them. And ah, yeah, probably we had 15 minutes within six feet of each other over the entire duration of their 10 days of illness.

Well then, um, 14, uh, 14 days comes from the last date of your exposure to that person while they could be infectious. Since that positive test could have been after that your own child, your own spouse had those symptoms only for three or four days, you got to wait until they're done with their 10 days. And then now your 14 days starts, okay. Um, 14 days from the last exposure to a known positive case. So that might be in the past. It might be in the future. Okay. Very, very valid question.

Uh, there was one final question that's related to traveling to a hotspot. Um, we talk about hotspots, um, like there's what the media calls a hotspot and then there's what the CDC considers a hotspot. Um, for purposes of our deciding whether somebody is at an elevated risk or not, um, we actually think more about is there community spread or is there not community spread? Okay. It turns out in the Sauk Prairie area, we have community spread as Dr. Grunewald said 37% of our positives we can't trace. Um, so since we already have community spread here, we treat you living in this town as being just as risky as flying to LA or Wuhan or wherever. Okay. Um, so that's testing in a nutshell, at least as far as it pertains to time off, uh, and isolation.

Perfect, Dr. Buss. And I appreciate that. That was, I mean, a tremendous amount of information. I really want to stress with the audience, we will have that out there on the webpage and we will have a follow-up link and email sent to all of the audience participants. So you can easily access that not only, you know, over the next couple of weeks, but to be that resource. Um, so more to come on that. So as we come back and I see Tywana's face, hi, Tywana welcome. Oh, again, many of you know Tywana. Uh, we're going to jump back a little bit. So Tywana, I know you've done a lot of work in working with our business partners, doing different surveys and helping strategies. Can you talk a little bit about that and some of the, um, surveys you've done?

Sure Shawn, thank you so much. And I do apologize to the panelists and the attendees for my technical difficulties. We rehearsed it, it went off without a hook, and leave it to me to bring the issue. So, um, thank you for Sauk Prairie Healthcare and our esteemed panel members for taking time to educate the business community. Um, as you've just heard from the various explanations, there are so many ways to manage this. And from an employer standpoint, there's really more questions I think, than there are answers at times. So I appreciate everyone, um, following along this evening, asking the questions. Let me just share with you that since March, uh, the Sauk County chamber directors have worked with leaders within Sauk County to develop surveys, to get a sense of what is the community feeling in terms of this pandemic and what are their preferences in terms of where they shop, uh, choices that they make for their family.

And so since about mid-April, when the first results came in, it was very apparent that Sauk Prairie residents really have a higher level of concern than our counterparts in Baraboo, Reedsburg, um, Spring Green. And some may say that's because of our closer proximity to Dane County. We do have a lot of influx of people driving into work, as well as residents who drive outside into Dane County and coming back. But one thing for sure has shown through the survey results and that's, we are more concerned. And just to put some data behind that in April's results, late May's results, mid-July's results, we were tracking consistently seven to eight points higher than those communities in a lot of the questions that we asked around concern and preferences. Um, over the last two weeks, the most recent results have come in and that spread has jumped from about 7% to 10 and 11%, depending on the question.

So what does that mean for you as an area employer? First impressions mean everything to the buyer, to those customers who are coming into your workplace. Make sure that your signage is clear, that you expect people masking, abiding by proper social distancing. I believe everyone now in Sauk Prairie to my knowledge is abiding by and respecting the state mandate of wearing masks, um, requiring your employees. But you as an employer need to be spot checking that situation. We have lots of employees that throughout the day, they may know your preferences, your tendencies. When you tend to stop by, do a walk and talk session, make sure that you're surprising them with spot check visits throughout the day. Make sure if you have cameras, that you are looking at different parts of the community to make sure that they are wearing the mask properly. And I say this to you, one I'm tired of technology and zoom calls, so I want to get back to normal, but your customers that are supporting your business, they're really afraid of this spreading further and causing additional mandates to stay at home. None of us want that. So, um, thank you for the work that you've done, make sure that the mask situation is being communicated. A great example of that is Piggly wiggly, right when you go in a huge sign showing their commitment. The other area that is very consistent for people is your cleaning practices. And that is something that I have not stressed as much. Um, I would encourage you the same way you're communicating how you mask and your requirements on that, that you communicate right next to that mask poster, the additional cleaning that you're doing within your workplace. And then finally, um, for any restaurants, uh, retailers that may be on the call, people are saying in their comments to us, they are making choices to only visit places who are offering outdoor seating, open air markets, really still a lot of reservation about going into enclosed spaces.

And so based on the way the numbers are tracking, tracking, and the way that people are reporting their feelings on this, as we do transition into the fall where typical allergies and cold season, there's going to be more people being tested. We anticipate those numbers may increase. And so I think anything you can do now to prepare, be proactive instead of having to be reactive, would be much appreciated by both the consumer and our medical community as well. So I'm happy to share any of these results with you. There are more recommendations. The second part to our kind of, um, training around this topic will take place on a Wednesday, September 24th. It too will be a virtual training with the presenters being the staff of the QTI group. And the topic is HR trends that we're seeing in this new world of work. And so a lot of it is going to be impacted by COVID. Uh, Robbi did a wonderful, wonderful job of talking about what you as the employer can do in terms of job sharing and, um, being flexible in your workspace and the requirements there. But we'll expand on that on September 24th, and we'll be communicating that view, uh, via all of our social media platforms and our electronic communications with members. So thank you again for coming. Thank you for the time, Shawn, and thank you to our esteemed guests today.

Excellent, excellent information to Tywana. And I guess I'll reinforce it all again, Sauk Prairie Healthcare, we are here obviously to keep people healthy and well, but coming, you know, many of our patients did not want to return to the hospital or to our clinics because of that fear. And it was almost felt that hospitals and clinics were the most contagious or most, most unsafe. So we really put a lot of investment to build the trust and confidence and just what Tywana spoke to from really demonstrating not only the masking, the distancing, hand hygiene, of course, but really diligent about cleaning and demonstrating that. And absolutely I'd be very open to sharing, you know, different strategies from what we did around disinfecting, including UVC lighting and others, that's really helped. And now what I am proud of and we're hearing healthcare and specificly, I'll say Sauk Prairie Healthcare that we are committed to quality and safety.

We are seen as one of the safest places in our community. So more to come on that, and we're more than willing to share because we want your customers to truly feel very confident and trust that they feel safe in your businesses. So again, thank you Tywana and look forward to that upcoming session and know Robbi will be very tuned into that too. Well, let's move on. We're going to turn a little bit with Dr. Janelle Hupp and Paul Fiscus. Uh, Paul is the administrator with Maplewood Skilled Nursing and Rehab Center. And Dr. Janelle Hupp is our medical director for infection prevention. Many of the submitted questions really centered around how to protect much what we're talking about, customers and better understanding those at-risk populations. This does include the strategies how to not only protect those at-risk populations in the communities, but also group home settings. So Dr. Hupp I'll first turn to you. Share a little bit about your background and then Paul.

Thank you, Shawn. And thanks for everyone who's joining the webinar today. I think this really shows the investment that our community has, and I'm so happy to hear Tywana talk about, uh, Sauk Prairie's investment in trying to make a difference in, um, tackling this virus. Um, I, uh, have worked with Sauk Prairie Healthcare for 15 years. I'm a flat lander, uh, but don't hold that against me. Um, we moved here to God's country 15 years ago and, uh, uh, I've been with Sauk Prairie Healthcare since. Um, I'm a family medicine doctor. Uh, our clinic is at, uh, in Mazo, a Wisconsin Heights Clinic, and I am the chair of infection control and also the medical director for employee health. So in those rules, uh, I've, it's been a huge learning curve this year. Um, but I am so fortunate to be surrounded by wonderful, um, hospital staff members and, uh, great, uh, employee health, um, nurse and infection control nurse.

So, um, we've all learned together. And one of the, probably one of the biggest things we've learned is that COVID-19 is really, uh, has really caused people to make lots and lots of difficult decisions. Um, and we've been forced to do some of that within our own work environment, but I know businesses have, um, been really taxed with making those difficult decisions. And I can't work with employee health without also sort of working with the community because our employees are part of the community. So, um, we have learned about the many ripple effects of, of COVID-19 and how one exposure sort of opens a black box, uh, for many other people to be affected and to miss work. And, um, it's, it's really, um, kind of mind boggling to, um, when you think about that ripple effect. So, uh, one of the areas or the area, I guess, that I've been asked to talk about are our vulnerable populations.

Um, we all remember early on in this pandemic, seeing the awful pictures from Washington state and the nursing home populations there that were affected and the many, many, many deaths that occurred in those settings. Um, that of course is the first population of people we think about when we think about vulnerable patients. Um, but that list goes on and I'm happy to say that the nursing homes in our service area have done a really excellent job at trying to mitigate and, uh, infection and protect the both their residents and their staff from, uh, infection and, uh, from, and really, um, it's involved in many difficult decisions. As you know, that nursing home population, uh, is that's one of the saddest things about this pandemic. They have faced great isolation, um, without having visitors and even physicians not being able to go into those facilities in some cases. Um, we're doing a lot of physicians are doing a lot of those visits via telehealth.

Um, and it's, uh, it's taxing nursing staff because they have to, uh, be the facilitators of those telehealth visits. Um, but that population of people is, um, probably is the most vulnerable population. Um, we know that the people in, uh, who are 65 and older are at high risk, but those who are 80 and over are at, uh, like 600 times greater risk of dying than the, than the younger 20 to 29 year olds. Um, so it's, it is, um, a population that we want to be certain that we are paying close attention to. Um, nursing homes in our communities have, uh, gone to, um, periodic testing of their employees. And, um, there's good reason for that. Um, their employees, many of them are contracted, so they are working not only at say Maplewood, but they might be, um, working at other facilities. So they, uh, are in and out of and interacting with many of those vulnerable folks.

So testing is important in those situations and the issue of lag time, uh, to get those test results is an issue, and we hope that that improves with time. Um, but that population of people, uh, is the most important to protect because they are at the greatest risk. Other vulnerable populations though include our people who have chronic illnesses. So, um, a patient who, or an individual with high blood pressure for example, is three times higher risk, uh, than someone who doesn't have a chronic medical condition to be hospitalized if they get infected with coronavirus. Um, a person, uh, who struggles with obesity three times higher risk of getting hospitalized. Um, if they get infected. Someone who has two chronic medical conditions, for instance, somebody who has hypertension and diabetes, they're four times or sometimes four and a half times at greater risk for being hospitalized with coronavirus.

And we have these people in our midst. I can tell you that in a day in my office, uh, 75% of the patients that I see have more than one chronic medical condition. Um, it's very common for people to have heart disease and diabetes or hypertension and kidney disease. So, um, and those people are working in our businesses. They are our coworkers. They are management. Um, so how do we protect those people? Um, well I think that really the improvement that I've seen in our community with masking is so huge, and we can't emphasize that enough. Masking and really emphasizing that in the workplace is going to go a long way in helping us pass this pandemic. Um, but the other things that, um, we need to think about in the work setting to protect those vulnerable people are, you know, trying to limit interaction with others.

And again, this has been about painful decisions. Um, maybe not allowing congregating in break rooms, um, not allowing potlucks and people bringing food in, um, making sure that people aren't sharing headsets and phones and, um, things that are near their face. Um, looking at ways to maybe improve air quality in workplaces. If you have, uh, individuals who are, you know, have risk factors, um, Robbi talked about, you know, offering options for work at home, or maybe separate office space to get them out of the mix, because it's really about limiting contact. Um, as Dr. Buss said, 15 minutes, uh, is considered a close contact. So you can imagine in a workplace with employees sitting across the table from each other in a break room, eating lunch, where they can't be masked, those risks are great. So, um, those are some simple things that we can do in our work environments to, um, help the cause.

Um, I know people are getting tired of virtual meetings, but it's important to continue with those. And, um, it's, it's, I know it's drawing on all of our patience. Uh, we, we are tired of it, but, um, limiting that, um, large group gathering is, um, so important and we need to be vigilant and, and put the fatigue aside. And if we can just do this for eight weeks, eight weeks, if we can be really, um, concentrating on keeping the masks on, limiting our, um, exposures outside of workplaces and places we have to be, and, um, washing our hands and, um, keeping our distance, uh, we will come a long way in getting past this. Um, there are a lot of, uh, people who look at COVID-19 and feel like, well, you know, only a small percentage of people ever goes to the hospital. Um, most people who get this, you know, feel crummy for a few days and then they get past it.

And isn't this just kind of like a bad flu? Well, the difference is that, um, we know that people can transmit this virus days before they actually become symptomatic. And it is much easier to transmit this virus than it is even the, the influenza. Um, so there is a difference in the transmissibility and there is a tremendous difference in how it affects that vulnerable population of people that I talked about, um, and their risk of hospitalization and their risk of death. So it is different than a bad flu. Um, it is much more serious and, um, again, protecting our vulnerable, uh, the, the vulnerable people in our midst, um, is important. Um, I, um, I have to say that, um, my, uh, patients who are, um, older, who come into the office are, um, they are concerned and most of them, yes, they'll admit that they're tired of being at home.

They're tired of, you know, being alone or talking to family members on the phone. They're also scared and concerned, and they understand the ramifications of, you know, if they were to get infected, what that could mean. Um, so we worry about them, but in my experience, many of them are doing better than my 20 and 21 year old daughters in dealing with this. Um, so, but, but we need to encourage each other. We need to encourage each other to just be patient, to stay the course. If we do this for eight or 12 weeks, we will be in a much better place. And, um, we will be in a position where we can take a breath. And, um, eventually we're going to get to the point where we can give a hug, shake a hand, um, it'll happen, but we have to be vigilant and diligent about what we're doing now.

Thank you so very much Dr. Hupp. Absolutely, you know, well said, and those tactics. Paul, I was hoping you could share a little bit also your perspective. We talk about, you know, I would see the geriatric population at risk, but also with your teams and the approach and the business to improve that trust amongst the community.
 
Sure Shawn, I'd be happy to, first of all, I'd like to apologize for the technological difficulties. Is the audio clear? Yes, we can hear you clearly. Good, glad to know. Um, as Dr. Hupp said, obviously um dealing with a population at probably one of, if not, the highest risk, uh, has been a challenge at our facility. Um, I think, you know, from our perspective, we just sat down in the beginning and said, look, let's, let's focus on safety for everyone. Uh, the residents, uh, obviously our staff and the families. Um, we, we took this extremely seriously from day one and I believe in my heart that that has really propelled us to the place that we're at now. Um, we focused on adhering to guidance, which as most of the other providers on, um, the town hall would probably agree, um, has zigged and zagged a little, uh, from time to time, but we've, we've adhered to guidance because, um, we believe that the experts are the folks that, uh, that have the most information and the most knowledge.

Um, we created habits early on and we remained diligent with those habits. And we've to this day, stuck with a process that was repetitive. Um, Robbi talked about communication being important. Um, not only once, not only twice, but ongoing, continuous as, um, things evolve and things have evolved in this environment. It's very difficult when we've had to sort of close the doors, um, to not only family members, but friends in the community, medical providers, vendors. Um, it's been very difficult sometimes for folks to understand, um, what's happening at Maplewood at this point, you know. And we appreciate so much, um, the folks who have helped us during this, this time. Obviously we've been what I call stubbornly cautious throughout the process, especially with things like quarantines and the admissions that we were, uh, basically severely restricting at one time and have slowly begun to take on a more regular basis.

And multiple of the folks on the panel have talked about disinfection and cleaning. We've been extremely diligent and we've learned a ton of things. Um, as I've worked with, uh, your material management person on a regular basis here over the last four months, Shawn, um, we've learned all kinds of things about, uh, personal protective equipment that we never knew before and cleaning products that, uh, uh, do things that we never knew they would. And I think that that's been extremely important. And as I mentioned, uh, restricting access, um, there was guidance about those things and we've been very, uh, forthright to folks. And I think we communicated very well. We've been extremely fortunate with the families and the partners here in the community, um, just meeting some of the daily challenges that, that face our population when they can no longer receive a visit from a loved one.

I was used to seeing them three or four or five or six times a week face to face. This is a very, very difficult thing. Um, and I just appreciate all the creativity from some of our staff members. Uh, we've probably done two or 3000 Skype visits or FaceTime visits. Uh, we're beginning to do, um, limited outdoor visits now with, uh, um, some very strict protocols regarding, uh, screening and distancing and masking. Um, these things are obviously bringing people back together on some level. Um, now, you know, we're kind of focusing now, I think one of the panelists mentioned earlier, you know, I think it's time to go focus on sustaining the energy. I think Dr. McAuliffe talked about it a little bit in the beginning. We can't stress enough how tired, um, and mentally, emotionally, and physically overwhelmed some of this team is, um, from what we've gone through. But, you know, we're, we're focused also on addressing the psychosocial needs of our residents, and, you know, there's been a lot of moving parts throughout this. And, um, these are things that they sap your energy at at a, at a period of five months or getting close to it. You know, we're, we're trying to create new communications and, you know, family interactions and focused on the wellbeing of the residents, especially our long term care folks, um, who have called this home. And there's some strict protocols that we're, you know, we're following to remain open for admissions. Our short term rehab is beginning to get going a little bit again. We're happy to serve the community as always. Um, we grouped those folks, uh, whether they are coming in, uh, new for the first time or whether they've had to be hospitalized for a short time and return. Uh, we group those folks in one particular area and there's a fairly strict quarantine process there. Again, um, most of this following CMS and then CDC guidelines. Um, as I mentioned, the outdoor family visits are are beginning again. And if any of our family members happen to be listening, um, we would love for you to schedule a visit. If you didn't hear about that, we've only been doing that for about 10 days now.

I just want to make sure I mentioned the staff, Shawn real quick. Our staff has been absolutely outstanding. I want to thank them through this process. Um, there has been a level of sticktuitiveness and diligence that is hard to describe. Um, and we just appreciate that extremely, uh, on our end. Um, and I think going forward, the, you know, some of the risk factors, um, are going to, are going to drive our industry as we move into the fall and winter time. Um, we're going to have to monitor the effect that this isolation has had on our residents going forward and ongoing. Um, you know, how long are the staff going to be able to hold up? Uh, you know, we're doing our best to continue to recognize, appreciate and support them. And, uh, you know, when will the testing process standardize in our world? Uh, as Dr. Hupp I believe mentioned, you know, our staff are being tested on a periodic basis. That will be, uh, uh, in concrete soon as how often we will be tested. We think that that's important. We think it's appropriate. Um, and I could talk about all the other challenges all day, but we're focused on being thankful and hopeful for our residents and our family and our staff. And, uh, I'd like to thank all the panelists that have been here, uh, this evening and everyone that's been working with us in the community, appreciate the opportunity.

Absolutely Paul and thank you. You hit a key thing. And it all, again, I'll remind everyone we're going to wrap up here. Unfortunately, we're running out of time, but please put in any questions, you know, that you have, and we will follow up on those on our webpage. As Paul really pointed out, we have the privilege I'll say to be in healthcare, and it's truly inspirational every day to see how we're affecting people's health and wellness. But we are going to be putting out there tips and tricks, how to keep morale up. People, and as Paul said, truly appreciate it because that's so important as we've talked about once what we're going through. All right, we're going to move into, um, I know Jeff and Dr. Furukawa, who I know our audience will stick with us because you've got a lot of important information. Dr. Furukawa, I'll let you introduce yourself first and why you're wearing a mask and then Jeff, Wright.

Okay.

Thanks for having me. I'm very happy to be here. My name's Masaru Furukawa. Um, I've been with Sauk Prairie Healthcare for seven years now. It has gone by fast. I'm the medical director, uh, for the sports medicine group here. Um, I'm also the physician advisor for the River Valley School District. So I wear two hats. I do primary care. So I've had a few patients with COVID ranging from zero symptoms to unfortunately passing away. Uh, and some, some people who were very high risk who got very, very ill and they made it through. Um, and I, I have a sports medicine practice here, uh, at Orthopedic Associates. I'm wearing a mask because I don't have an office here and I'm using a patient room. And I think it's important for us to demonstrate that we're trying to even protect the environments that we work in, that that is shared.

And that's why I'm still wearing a mask. Um, but I also have a primary care clinic and sports medicine clinic in Spring Green. Um, so, uh, in terms of my background, um, I do primary care, but I also have fellowship training in sports medicine. Uh, I did my fellowship training at the UW where I took care of the UW athletes. Um, I took care of the UW football team when I was there. It was a privilege, it was wonderful. I also took care of wrestling. Um, women's soccer, um, women's hockey and track and field. So, uh, it's, it's a passion of mine, uh, to work with these athletes and keep them on the track or the field whenever I can. And that's why I was invited here to talk.

Jeff, what this segment is, obviously, employers are really looking to the school districts overall and Jeff has been an instrumental part, trying to coordinate a unified approach as we look at the fall and understanding the impact on businesses. So, Jeff. Well, thank you for just a few quick minutes. Uh, the Sauk County Health Department has put together a matrix for decision making and how many students should be in a school. And it's very similar to what Dr. Grunewald Dr. Grunewald spoke about at the very beginning of the session. It looks at the 14 day active case rates, the rate of community spread, the COVID-like symptoms in our emergency departments and the percentage of positive tests in the community. We now are able to use that, to determine what the capacity should be in our buildings. And in Sauk Prairie, we announced last night that we're going to open in a reduced capacity or hybrid model.

I'll wrap up saying that you can always reach out to talk to us or look at our website. SaukPrairieSchools.org to see our plans and our communication with our families. But I want to wrap up by echoing what Dr. Hupp and Tywana talked about and the importance of sending the message of masking, social distancing, and that the only way we get our kids back into school full time is if we kick COVID out of town and we need to do that as a full community and make that happen. So we can have students back in every school. It's 6:30. Well, we don't want to rush to the end and again, I know our audience will stick with us. Um, and we've had such great information come out, Dr. Furukawa, you know on the sports, I know several questions were coming through. As student athletes return, how can we make sure we're keeping people safe and even as they're coming back into the household?

Absolutely. Um, Jeff, you're absolutely right. Number one, I wrote right here, number one, control the disease in the community. That is how we're going to keep our athletes safe. Um, that, and specifically, since we're talking to the business community, um, you guys are truly seen as leaders in the community. Uh, if you're out there in the community, at the athletic fields or in your business, at a social function, if you're wearing a mask, people will see it. There's, you know, all of us here, we, we obsessively look at the curves. We look at the numbers, we look at the publications, but there's this human thing called observer bias, where we won't really make changes in something like putting a mask on in public until we see other people wearing it. So that's where businesses can really help the athletic community is, is, is helping out with the disease control in our community.

So other things about sports, again, all centers around controlling the disease in the community. So if you're a parent and you're out there watching a sport, don't be sitting together in the, in the, the bleachers, you know, practice social distancing, wear masks. If you can't sit far away from people, um, that's really important that allows our athletes to do what they love. Um, number three, if you, you know, your kids are going out outside of sports, you know, ask them questions or there going to be large groups, is it going to be indoors or outdoors? You know, it's just like driving, review the safety rules with your kids when you let them out. So again, number one is really controlling the disease in the community because when you look at sports, most sports, you're going to be outside. The transmissions are more going to be outside of sports.

And I've been talking to the UW team physicians, and we feel in the sports community, pretty good about the protocols. It's what people do outside of sports that we worry about. And that's where we have to focus a lot of our energy. So I think those are, those are the really big things. Um, so I had some questions specifically about how do I keep my kids safe in sports? Um, yes, you want to let your kids play sports. Oh, and before I go into to this, we think of sports as something we turn on, on TV, something to entertain us, it's a pastime. But the athletes in our communities, sports is sometimes more than entertainment. It's actually a lot more than entertainment. The UW our, our UW has already done research on the impacts of, uh, depression and anxiety on our student athletes. And they looked at those numbers and they found that before May of 2020, uh, only 30% of athletes ever described any kind of depression symptoms.

Now that is up to 68% in our student athlete population, right after the cancellation. So in addition to that, athletes reporting moderate to severe clinical depression went up by three and a half times. So it has had a profound impact on our athletes and our community. So certainly we want to do, we want to get athletes back on the field, but we also want to do it safely. And there's, there's tremendous positive benefits for these athletes to get back on the field. So I think aside from the community control of disease, I think before you let it lit up, let, uh, let let an athlete go back and make sure they feel safe because, you know, everybody sees this very differently. And this is true about your customers, your employees, when they see the news outside, we don't all perceive the risk the same. So make sure if, if you do have an athlete in your home to make sure they feel safe before they go out.

So I'm not going to go up too much longer, but couple things, couple big picture things, I guess, for everyone is one be flexible. Our athletics is, um, a lot of, how would you say conference level schedule level things. We're relying on the people who are really good at figuring out those schedules and that'd be the WIAA. And, you know, they have to go through the same things we do. We have to be patient with the organizing bodies and be flexible when they change regulations or dates of start dates and things like that. And number two, I think we should always stay up to date. Um, make sure you read, read the news articles out there. And I think if there's any failing on our part as physicians is we haven't done the greatest job communicating the facts as they come up and updating the community.

I think we could do better. So if you haven't already just feel free to email any one of us on the panel, um, and ask questions, feel free to ask questions. The our, our River Valley School District finally, you know, they, they've been really great about communicating and asking great questions. We want to help. So feel free to contact us. Um, so if there, as a closing remark, you guys, if sports can be done and it can be done safely. Man, have you guys watch baseball lately? I mean, it is. I love it. I mean, it's funny to see the cardboard cutouts, but sports can really bring that energy back because we can do it and we can do it safely. Um, so it, I mean, it, there's this great clip where I saw, um, this Angels, um, uh, Japanese player hit a home run and I saw him coming around.

He, he crushed that ball. He ran, ran around the bases and he came down third base and I saw him stick his hands out around third base. I'm like, what is he doing? And then he comes into home and he just puts his hands up in high fives. And there's another guy, like 10 feet away, high fiving. I'm like, Oh, they're air fives. And then he goes in and high fives in the air. And, and once he gets a dugout, they're all in masks. So I thought, you know, it can be done. It truly can. So I just wanted to close with that.

Awesome back to, you know, absolutely sports and other things uplift us. And as Dr. Furukawa shared, you know, we want to be that resource and help. Um, but I will stress. These panelists are absolutely incredibly read and up to date on this very evolving pandemic. And they will be the first though to state, we don't know everything, but we are committed to providing information on what we know today and continuing to push out what is happening. Uh, we do want to be seen as that source for our business partners. And that's, you know, part of why we're here today and because there's so much out there that's conflicting. So there will be that portion on the web page that we talked about. COVID we not me that, and we'll push that out there, but you can ask those questions and we'll make sure to get you what we know as of today.

So with that, uh, we're at the end of our session, I appreciate everybody sticking around a little extra. I want to thank our panelists for participating, for providing some very important guidance on strategies to keep our communities healthy and our businesses open and our economy strong. I truly appreciate each of you taking the time today to learn more and really demonstrates your desire and how we can incorporate these methods to keep our businesses vibrant. I do hope you found today's session meaningful. I look forward to continuing our collaboration and efforts designed to truly stop the spread of COVID. I absolutely wish everybody a wonderful and safe evening, but I'm going to reinforce remember to mask, distance, and I am hand hygiene. So with that, I wish you all a wonderful day, everybody mascot. Right? Thank you.

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