About half of Kaiser Permanente’s hospital in San Jose has been filled with patients who have been confirmed or suspected of having the new coronavirus, says a vice president of the hospital in an interview with a medical journal.
There have been so many patients that Kaiser San Jose has had to increase its staffing, Dr. Stephen Parody, a Deputy CEO of Kaiser, expert on infectious diseases and incident commander of the COVID-19 response nationally to the health system, told Journal of the American Medical Assn.
“Our San Jose facility in California actually has nearly half of the hospital filled with either COVID-confirmed or people under investigation,” Parodi told JAMA. “So we literally had to renovate the hospital to make sure we got enough capacity from a staff perspective. To provide patients with care requires resource-intensive staff. “
Silicon Valley has been one of the areas most affected by COVID-19. As of Tuesday, Santa Clara County had the largest number of deaths in any county in California, with 16 fatalities. The county reported 375 cases, others to Los Angeles County, which has 662 cases.
Based in Oakland, Kaiser handles 12 million patients, operating 39 hospitals and 706 medical offices across the country, with facilities in Oregon, Washington, Hawaii, Colorado, Georgia, Washington, D.C., Virginia and Maryland.
Parody was not available for a follow-up interview earlier this week. Here are the key points of what he told JAMA on Friday:
Younger adults cannot breathe on their own
Parody said not only the elderly who have deteriorated clinically. there are also younger adults who cannot breathe on their own and require that they be placed in a mechanical ventilator, where a tube is placed in a patient’s throat so that the machine can press oxygen directly into the lungs.
“I think the jury is still out on who will actually be the year-end that ends up in hospitals. We have people who are as young as the 30s and 40s who have clinically deteriorated and required mechanical ventilation, ”Parodi said.
“Of course, there is the second cohort, the older cohort, in the 80s and 70s that is also found in our ICUs,” Parodi said.
Large increases in positive tests in coronavirus in NorCal and Washington
Kaiser has seen significant increases in the number of patients who have been positively confirmed in their hospitals, especially in the state of Washington and Northern California. “They seem to be the current hotspot,” Parodi said.
The number of calls Kaiser receives from patients who complain of cold-like symptoms has increased dramatically. Usually at this time of year, Kaiser receives about 4,000 calls daily and complains of coughing and colds; on Friday they received 14,000 to 15,000 calls per day.
And this is because positive influenza tests have decreased significantly.
“It says we have COVID circulated. I cannot tell you what percentage of these calls are actually COVID positive. But I can tell you that these are the most calls we have ever received, period, written large, in recent times the ten years I’ve been following the tasks, “Parodi said.
An intensive care unit only for COVID patients
“Essentially, we have filled an entire ICU only with COVID patients, which means we have to repurpose another unit to take care of the usual ICU patients as well,” Parodi said.
Of Kaiser’s two Santa Clara County hospitals – San Jose and Santa Clara – “about a quarter of patients are in the ICU relative to the others who are not,” Parodi said.
A two-week stay at the ICU
Once at the ICU, patients usually need somewhere between 10 and 14 days of mechanical ventilation, Parodi said.
“So this is a long-term proposal, in terms of venting days, ICU days and staff days,” he said. “And I’m worried about planning to have enough fans – I’m talking all over the country – to be able to get that level of response.”
Preparing for a sudden sharp increase in ICU patients
It can suddenly increase intensive care patients. “This thing can come up very quickly. So when you go from zero to have 10 patients – that’s what happened to us … at the ICU within a week, “Parodi said. “So you have to be prepared for that wave level.”
Plan to run out of fans
This means that you are planning for an unthinkable situation where the hospital may have to choose who should get a ventilator and who will not.
Experience in Italy suggests that the hospital would need to do mass testing and determine “who are the best patients who need mechanical ventilation, which are those patients who may not benefit.”
A sudden deterioration after a week of mild illness
Some of those who end up in intensive care actually come in as outpatients a week earlier before needing ICU care, Parodi said.
“They went relatively well,” Parodi said. “They had a cold and a cough. And then they quickly deteriorated the second week. “
The deterioration can be rapid – within hours. And patients suffering from breathing difficulties may suddenly need a breathing tube that is inserted into the throat and must be connected to a mechanical ventilator to push oxygen into the lungs.
Slow coronavirus testing
Current testing is slow. Most areas across the country are still limited by manual testing, Parodi said. Depending on the condition you are in, it may take one to two days for a test for a patient test result to come back and five days or longer for an outpatient care.
How to deal with N95 worm deficiency
To deal with the national shortage of tightly tailored N95 masks, also known as respirators, designed to filter out 95% of airborne particles, Kaiser goes against recycling them and gets some from a national strategic warehouse, some of which have went out .
N95 masks are especially important when healthcare workers perform procedures that aerosolize a patient’s saliva into small airborne particles that can float in the air, which happens when a respiratory tube is inserted into the throat to connect the patient to a mechanical ventilator to help them breathe as they can no longer do it.
Kaiser’s cancellation of selectable operations earlier in March also helps preserve masks and other personal protective equipment. By doing so, the number of patients in the hospital has decreased by 15%, Parodi said, and instead of having only five to ten days at hand of personal protective equipment, it has increased to more than 30 days of delivery.
Kaiser also takes unorthodox measures – “literally going to hardware stores” to retrieve personal protective equipment and finding “various suppliers who are local to us to provide masks and literally surgical masks, sew them together, [and] few face shields made of hardware merchandise. ”
Source -> https://www.latimes.com/california/story/2020-03-25/suspected-or-confirmed-coronavirus-patients-fill-up