Assistant Professor of Infectious Disease at UCI School of Medicine Saahir Khan, MD, and Gastroenterologist and Chief Medical Officer for St. Jude Hospital in Fullerton Dr. Sajen Matthews, participated in a COVID-19 town hall call hosted by State Senator Ling Ling Chang on April 29. Each answered constituents’ questions read by Senator Chang.
Dr. Kahn explained that hospitals were able to handle the number of patients at or near the peak without being overwhelmed or needing to make any difficult triaging decisions.
Some hospital staff across the county have tested positive despite wearing eye protection and surgical masks or N95 masks while performing high-risk procedures with infected patients. They believe the infections were contracted from the community or from other staff. More strict social distancing, temperature checks, and universal mask-wearing throughout the hospital are the rule now.
Dr. Kahn differentiated between two kinds of tests for COVID-19. One test is administered using a swab to take a sample from the nose or throat and sample tested to detect genetic material of the virus. The other is a serological test using a blood sample to detect antibodies to the coronavirus in late stages of infection. The first is most appropriate to test people with symptoms or to screen high-risk staff and healthcare workers. The second determines whether a person has been infected in the past and may not have been tested by the PCR method because they had mild or no symptoms.
Dr. Kahn said there will be community testing in Orange County by UCI, the same as USC in LA County is doing. But he recommended against paying $75 to $100 at what he called “pop-up clinics.” There are over 100 antibody tests offered that are not yet validated none are FDA approved. He warned, “A single test does not tell you that you have immunity from the virus.” No test tells you that you have immunity, and it is not yet known whether having had COVID-19 confers immunity.
A vaccine will not be ready until at least late 2021.
Unfortunately, there might be only clinical trials, not yet FDA approved, in time for the expected surge in the fall, he said.
The amount of molecular diagnostic testing (PCR) will have to “dramatically increase” in order to effectively track the virus. Community testing can help determine the extent of the spread, but is not as good as individual contact tracing, he said.
He closed by saying, “You have done a really good job of social distancing” and “we need to stick to that.” We are still at risk, particularly as other states reopen and people travel here. We should “maintain vigilance in California.”
Dr. Matthews answered questions related to St. Jude’s capacity to provide care for COVID-19 patients and their current capacity to begin scheduling elective surgeries.
On March 9 the hospital had its first COVID-19 patient. Since then, there have been 97 treated for the virus in total. At most, there have been 25 patients at one time. Currently, there are about 17, according to Matthews.
Typically, patients have been in the hospital for 2 weeks. Thirty of 100 ventilators were used, with at most 10 being used simultaneously. Their capacity exceeded demand, as the hospital was “well prepared.”
Surge planning increased the hospital’s capacity to 100 patients with nurses, physicians, anesthesiologists, and other staff ready if needed, but he said, “The surge was not as bad as we expected,” as evidenced by the removal of the tent in the parking lot last week.
Dr. Matthews feels the hospital will be able to handle the second wave, “much, much better than the first time” as St. Jude is maintaining capacity and has systems in place for a second wave. The plans they worked hard to pull together in March—contact tracing, testing, and treatment—are now processes set in place.
Matthews said the hospital participated in clinical trials, had pronation teams to reduce the time patients were on ventilators, and their outcomes “have been very good.” Matthews did not provide a recovery rate, stating that it was “hard to find,” but said the mortality rate was much less than in New York.
When there was a lack of testing and personal protective equipment (PPE), they had to use and dispose of PPE for all patients (as a precaution) while waiting days for test results. They now have an N95 mask disinfection system using vaporized hydrogen peroxide that allows the wearer to use a mask for 3 to 5 times. They are still “nervously watching their stock of PPE,” but it is sufficient for now.
The hospital is currently at 30 to 40% of capacity. They are scheduling elective surgeries, testing all inpatients, and sectioning off the COVID patients. Staff are screened daily and wear PPE. (Matthews clarified that St. Jude has testing only for inpatient care and recommends contacting one’s own physician to be directed to a testing center.)
He lamented the debate between opening the economy and protecting our own health as “kind of sad.” He expects measures such as reduced capacity in restaurants, social distancing, and wearing masks will be “the new normal unless we want to experience another surge.”
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