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Q&A with Dr. Kravec | 'My request to anyone listening would be: Wear a mask when you're out'

"Everything we're talking about as far as policies and protocols and the testing and all the stuff we've talked about before will change over time, be it in a month or a week or tomorrow," said Kravec.
James Kravec 032020
James Kravec

YOUNGSTOWN — Per the state's Responsible Restart Ohio plan, hospitals will begin to perform elective surgeries again today. 

Mahoning Matters caught up with Mercy Health Youngstown's Chief Clinical Officer Dr. Jim Kravec to discuss how Mercy will manage this roll-out.

MM: Which procedures will be prioritized as the Mercy Health begins to do elective surgeries again?

JK: As we went through the process of winding down the cases, we had many cases on the list. We absolutely did continue doing the urgent, the emergent and the time-sensitive cases during the last few weeks, because many of these could not wait at all. But, we did postpone the elective cases. So now as we ramp up, what we've done is have a list of anything that was canceled or postponed. Now we are reaching back out to those patients and their physicians to see what the best time to reschedule these cases would be, working with the physician and the patient. So it's really an individual discussion between the physician and the patient, as we ramp these back up. 

MM: So you aren't saying, "OK, first we'll do heart surgeries" or something like that?

JK: No. It's a conversation with the physician. The term "elective surgery" is really misleading in my opinion. "Elective" sounds like you're choosing to do it, but you really don't need it. That's rarely true about surgery. It's a matter of how much you need it. So I think, if we wait too long on some of these, they go from not really needed to needed more urgently, because the condition worsened. So, we're not going by category of case, more on what type of underlying illness the person has or underlying cause for surgery the person has, and then we make a decision based on bring them back.

MM: Are you concerned there's going to be a huge influx of procedures?

JK: I think it's manageable in the sense that, we've kept a list, and we're calling them back and scheduling them as we go. So I think we're doing this in a very organized fashion.

MM: How will Mercy Health continue to protect people in the hospital as you ramp up these procedures?

JK: We're doing three things to assure the safest hospital environment we can. My focus is on creating the safest hospital environment we can. First, would be on what we're doing for all patients. That is, making sure that the environment is safe with a screening questionnaire. So when patients come in for any sort of procedures or test, they are screened with a series of questions — fever, shortness of breath, been exposed to anyone with COVID — and that risk stratifies the patient. Next ... for patients having invasive procedures — those in the operating room, OB/GYN, interventional radiology, cardiology — we are testing them 72 hours prior to surgery to make sure they don't have COVID. Now if they do have COVID, it just turns into a risk stratification discussion with their physician, because some of these cases still need to happen and some of them can be delayed, depending on the type of surgery and the severity of the condition or the need for surgery. The last is to continue safety measures the staff continues to perform — wearing masks, continued safety with PPE and having a very clean environment in the hospital. So those three areas are very important as we think about what we're going to do to welcome patients back to our facilities. 

MM: What are the intake procedures for elective surgeries? Will patients be required to wear masks?

JK: Anyone would be required to wear masks. We have not changed our visitor policy. But for surgery, everyone going in for a procedure must have someone with them, because of the sedation. If anyone is with a patient, they will be asked those screening questions as well, and they will wear a mask as well. Anyone in the building for whatever reason will have the screening questions asked and [will] wear a mask. We will have masks available, but if patients can bring their own mask, only because we continue to be cautious [about] supplies. If they have them at home, please bring those as well. 

Mercy Health spokesperson Jonathon Fauvie clarified that the person accompanying the patient can wait in the waiting areas, which will be modified to ensure proper distancing.

MM: Say someone has a really serious condition but tests positive for the coronavirus. What would happen to them?

JK: Then they would have surgery, and we would know they're positive. We would perform surgery on them. It's going to be on a case-by-case basis, based on a decision between the patient and the surgeon.  

MM: What does a surgery with a coronavirus positive patient look like?

JK: It's just a matter of the type of filters and ventilators and the type of cleaning in the rooms. It doesn't change too much, it's just more of an awareness. We really do use universal precautions for all patients. We treat everyone the same when it comes to care of these patients. We wear the masks, wear the gowns, so it's a very safe environment. 

MM: Will there be enough personal protective equipment to handle these additional procedures?

JK: We have the supplies for [additional surgeries]. We still are using appropriate measures to conserve PPE, just to be judicious with our use. we are conserving and reusing PPE according to [Centers for Disease Control and Prevention] and Ohio Department of Health regulations. But, that said, we do have enough to take care of the patients in need for surgery.

MM: A lot of Ohioans are confused about mask requirements after Gov. Mike DeWine has changed his mind about whether a mask will be required. What is your view on the mask debate?

JK: I think if someone is able to wear a mask, they should wear a mask. It protects other people from that individual person potentially spreading COVID-19. My recommendation is to wear a mask when they're out in public. Social distancing is still important. Washing your hands. Using hand sanitizer. Covering your cough. Staying home when you're sick. Those are all important things that we must remember, but masks should be worn, in my opinion. I realize there are some questions on that, but it makes sense to me from a medical standpoint. It's not so much that a mask prevents the person who is wearing it from catching other germs. It's to prevent that person from spreading.

MM: Are you worried that without a state requirement, people won't take the mask recommendation seriously?

JK: I mean, I think they should be. I think people should wear masks, is my statement on that. I understand there are some other reasons why it's more of a recommendation than a mandate. But my request to anyone listening would be: wear a mask when you're out. It just seems like it makes good sense from a public health standpoint. 

MM: Is there anything else people should know about the roll-out of elective surgeries?

JK: I think it's very important to know that it is a safe environment in the hospital. We do a lot of work to make sure the hospital environment is safe for patients and welcome for patients to come in. We will continue to update that as we go. I think, one thing I would also say is, everything we're talking about today — I run into this time and time again with coronavirus — it will change. Everything we're talking about as far as policies and protocols and the testing and all the stuff we've talked about before will change over time, be it in a month or a week or tomorrow. And so I appreciate the flexibility that [the] public and the press has with that. We know the science is changing. We know that this is new and data changes. The way we capture data and the way we interpret data and the way we change our treatment protocol will change regularly based on new information. That's probably one of my most important points as well. 

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To learn more about virus response in Mahoning County and at Mercy Health, check out Mahoning Matters' previous Q&As with Dr. Kravec: 




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