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Q&A with Dr. Jim Kravec | Covid fatigue and the end game

By Jess Hardin

November 6, 2020 4:11 AM

YOUNGSTOWN — The Ohio Department of Health Thursday reported a record single-day increase in COVID-19 cases — nearly 5,000.

At the end of September, the state was consistently reporting less than 1,000 new cases per day.

All of Ohio's 88 counties are considered high incidence for virus transmission. Counties considered "high incidence" have seen more than 100 cases per 100,000 residents in the past two weeks.

During a Thursday press briefing, Gov. Mike DeWine said Ohioans should be scared.

We caught up with Mercy Health Chief Clinical Officer Dr. Jim Kravec to discuss the status of the pandemic in the Mahoning Valley and charting a way forward.

MM: What are you seeing in terms of COVID-19 spread in the Mahoning Valley?

JK: I think we are seeing continued increase in hospitalizations here in the Mahoning Valley and increased number of outpatient cases. The increased amount of outpatient cases is really indicative of both more testing, but also there is more illness in the community, so it's a combination of both. As we continue looking at the fall and folks coming indoors, we need to continue to stress social distancing, mask-wearing, people staying home when they're sick and limiting the size of gatherings. Those are still relevant and by doing that we've noticed last time in the spring when we did push for that, we really did see a reduction in spread.

MM: How can we change behavior if we all know what to do? This message isn't unfamiliar to people.

JK: People have heard the message, and I think some people are complying and other people are not complying with what I think most people have already heard. I can't stress that enough, the importance of that, it's unfortunate that some people continue to not follow that.

Every time I speak to someone it's the same message I give. Really nothing has changed since we started talking about this in the spring. Maybe the message is, we realized that we're going on the ninth month of this and with that comes fatigue and the desire to get back to normal. It's a long-term problem. It's very frustrating. I get the question all the time, what is the end game? You don't hear [discussion about] the end game.

I think as we hear more and more about vaccines coming out, which we think will be coming out at some point soon, I think we're getting to the end game. Because If more people can get the vaccine, if it's effective, then we will have, at least hopefully, an end in sight.

MM: At the state and national levels, leaders seem to be pivoting from focusing on containing the virus to focusing on a vaccine. Do you find that shift concerning?

JK: I think it's both. We need to prepare for the vaccine but we still need to contain. That doesn't stop the need for social distancing, mask-wearing, staying home when you're sick. All those things don't go away. It's not one of the other, it's both of them

MM: Do you think something should be done to increase compliance of things like the statewide mask mandate? In some cities around the country, people get a fine for not wearing a mask, almost like a parking ticket.

JK: I'm not sure what the capabilities of law enforcement would be. I know the health department is very limited in being able to enforce. That's the problem. It's just such a big task because it's hard to enforce. When there's not enforcement, people may not be following ... I realize the limitations from the health department and from law enforcement, it's challenging, but I do think the more compliance to that mandate the better the public is as far as safety.

MM: What is the current status of hospital capacity in the Mahoning Valley?

JK: I continue to watch every day along with the leaders of the health department as well as leaders of Mercy Health, and we keep an eye on our hospital capacity, our ICU capacity and our ventilator capacity. We're seeing stable numbers over the past few weeks, so it's an encouraging sign.

MM: Are local hospitals at a point where they'd consider postponing non-essential surgery to focus on COVID-19 capacity?

JK: Not right now. We're still seeing all patients ... We always plan ahead, but right now we're still moving forward with all normal patient care.

MM: Death rates aren't surging like cases and hospitalizations. What's going on there?

JK: Death rates are interesting because it's a couple of factors, I believe. One is we do have better recognition. Two is we have better treatments now than we had before. Number three is that the more positive tests you have, patients that are not severely ill, the death rate will go down, just from a pure statistical number. If you have the same deaths, divided by the total number of cases and you have more cases out there the death rate declines. We're diagnosing more cases. We're seeing a death rate drop. That's part of it, and part of it is there might be a mutation that's making it less virulent, and it might be that we have better treatment, too. I think it's a combination of the three.

Another thing that's important to talk about, because people commonly will say well yes we're testing, therefore we have more cases, the death rate is not as severe as it is so just a cold, why are we worried about this? What we're seeing now is called post-COVID syndrome, COVID long-hauler. These are patients that have had covid, and they have months of symptoms: fatigue, liver problems, heart problems, hair loss, depression, anxiety.

It's not a cold, for some patients. It is for most patients, but for some patients, there's long term consequences ... That's only one of the concerns we have with saying let's everyone just get it, because the death rate's going down. That's the concern I have, with the impact on patients that did have it.

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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:

This story was originally published November 6, 2020 at 4:11 AM with the headline "Q&A with Dr. Jim Kravec | Covid fatigue and the end game."