SVMHS Chief Medical Officer Gives Update On COVID-19
It's been just over a month since KAZU’s Erika Mahoney interviewed Dr. Allen Radner, Chief Medical Officer of Salinas Valley Memorial Healthcare System. Dr. Radner is also an infectious disease specialist and has connections to all of the hospitals in Monterey County. This week, Dr. Radner discussed updates on COVID-19 testing, what it’s like inside the hospital and lessons learned.
Here are highlights from the full conversation.
Dr. Allen Radner (AR): One of the most profound things that we've learned is that people definitely shed the virus before they develop symptoms. So there's a fair number of people who are contagious that spread the virus that are asymptomatic. We're also learning every day about different clinical manifestations of the virus causing things besides just lung injury. It causes brain injury and kidney injuries and clotting abnormalities and skin manifestations. So every day, there's additional scientific information that we're using to try to take care of patients.
Erika Mahoney (EM): What is it like inside Salinas Valley Memorial Hospital compared to when the outbreak first hit?
AR: Fortunately, while there continues to be patients being diagnosed in our community, there hasn't been a significant increase in our hospitalizations. At the moment, we have two patients in the hospital. One's on a ventilator, one isn't. Early on, we were taking care of older patients and we had what we would kind of call a small surge initially, where there were a number of sick people. At the moment, we've been pretty stable with a small number of patients. We think that's one of the reasons why our patients generally, not just at Salinas Valley Memorial, all the hospitals are doing relatively well in getting people better because we haven't had huge surges and we're able to concentrate on the small number of patients who are sick that require hospitalization.
EM: Monterey County officials have been working to set up an alternative care site (at the Marina Airport in conjunction with Joby Aviation), has that been needed?
AR: We've been participating in that dialogue and the idea with the alternate care site is that it, at least the hope is that it would... first of all, the initial hope is that we never use it. The second hope is that it wouldn't be an ancillary intensive care unit facility, it would be a facility where as patients are recovering, but they're not ready to go home... that that would be a place where we could send our patients so that we would expand our ability to take care of critically ill patients in the hospital.
EM: The Monterey County Health Department is now offering zip code information about local cases. East Salinas has the most cases, a predominantly Latino community. We've seen the coronavirus disproportionately affect people of color. What's your take on this?
AR: We're not doing the county epidemiology. We do interview our patients and understand something about their background. And our experience is it's been overwhelmingly in seasonal agricultural workers, which are predominately Hispanic. The good news is that they are younger individuals and even though we're getting more positive tests, our hospitalizations haven't been concurrent with that. So again, we aren't doing a detailed epidemiologic evaluation. That's not the job of the hospital, that's Monterey County Health Department. But our belief is that, our observation is that it's disproportionately seasonal ag workers.
EM: Monterey County has opened two new testing sites, one in Salinas and one in Greenfield. How will these testing sites help in the fight against the virus?
AR: We certainly need more testing. We would like to test for, as we’ve already talked about, asymptomatic or pre-symptomatic individuals. We'd love the opportunity as a community to do more epidemiologic understanding of where there are hotspots and how many people are infected and we just haven't had that capacity. We'd like to make the hospitals safer by testing every patient hospitalized, if at all possible. So any additional testing is going to help.
EM: Los Angeles is now testing all of its residents. How close are local hospitals to allowing anyone who wants a test to be tested?
AR: So I think that the hope is that in the next few weeks, people who want to be tested will be able to use those alternative test sites that are being set up by the state. The two that you mentioned, one in Greenfield and one is Salinas. Clearly, there are limitations. I mean, they don't have the ability… my understanding is they'll be able to do about 130 to 180 tests a day with about a two to five day turnaround. Clearly they can't do 450,000 tests. But I do think that people who are minimally symptomatic or worried should in the next few weeks, to some degree, have the ability to be tested at one of these two sites.
EM: Salinas Valley Memorial Hospital was the first local hospital to receive rapid testing equipment from the state. What difference did that make?
AR: When patients come to the hospital, historically, we would send their tests to the Monterey County Health Department and that had a 12 to 24 hour turnaround. So when we hospitalized patients, we initially assumed that they were infected with the coronavirus. So that was a lot of work and a lot of utilization of PPE and a lot of operational inefficiencies. By having the ability to do rapid testing now, when people show up in the emergency room, when we're going to hospitalize them and knowing within a very short period of time whether they're positive or negative, it really changes our ability to manage patients in the hospital. So if they're COVID negative, we can take care of them in the right location immediately and not worry about all of these operational inefficiencies. You know, all of the hospitals now have that capacity to do a rapid test. So it really allows us to take care of patients in a much more efficient and timely manner rather than having to wait 12 to 24 hours to know if they're infected.
EM: Now that scheduled surgeries can happen again, how do you reassure people it's safe to visit the hospital?
AR: We are going through a very deliberate process, as are most hospitals and health care systems, about resuming more scheduled cases. We have always tried to provide emergency care and what we call time dependent surgery. If someone has cancer, it may not be an absolute emergency, but we can't wait months and months. Fortunately, they've had very good care, very good outcomes. We haven't seen any perpetuation of the virus in those patients or other people in the hospital. So we're doing everything we possibly can and we're hopeful that we will continue to protect the patients and do the surgeries. Additionally, we're trying to expand diagnostic services like what we consider pretty essential diagnostic services, like mammography that have been curtailed dramatically. And we think those are really important screening procedures.
EM: And what do those visits mean financially for the hospital?
AR: There's no question that all health care systems have taken significant financial hits over the last few months. The significant part of our revenue is doing elective surgeries or doing time dependent surgeries… doing those types of cases and we've been built to do that. We have fixed costs that our staff is here to do and it's really a significant driver. I can't tell you exactly what percent of our margin is related to doing these scheduled surgeries, but there's no question that when we shut those down, it has a dramatic impact on the hospital's bottom line.
EM: If there's a second wave of this pandemic, are local hospitals prepared?
AR: We're preparing for a wave right at this moment that really hasn't hit and whether it's a second wave or a first wave, however you want to define it, we're as prepared as we think we can be. Again, there's things we would like to have, like additional testing and additional PPE and have some, you know, therapeutic alternatives, some medications which aren't available at the moment. But I think we're as prepared as we can possibly be and a second wave isn't really any different in my mind than a first wave.
EM: How are personal protective supplies holding up?
AR: The personal protective equipment is holding up. I mean, unfortunately, we're now in May and we'd hope to have an indefinite supply here. We hope the supply chain will continue to increase and we'll be okay for the indefinite future. But with all of these things, with diagnostic testing, with personal protective equipment, it's always, for us, been kind of a month to month concern. So right now, we feel fine. I can't tell you that I'm going to be able to say that in a month from now. I'm hopeful that, again, we're going to have a lot more equipment in the next month and things will be a lot better.
EM: As Monterey County opens up, what do you want people to keep in mind?
AR: There's absolutely no question that one of the reasons we haven't had a huge surge in our community is that we had this relatively early shelter-in-place. And generally speaking, we don't have an extraordinarily high population density for most of Monterey County. As that opens up, that risk increases, that we will see more cases. So I think, you know, we would really encourage people to follow the guidelines that are put forward by the state and by the county to continue social distancing as appropriate with hand-washing and masking and not, you know... trying to avoid large congregations of individuals. And try to do this very deliberately and very slowly, or we certainly risk an increased number of cases in our community.
That was Dr. Radner, Chief Medical Officer of Salinas Valley Memorial Healthcare System. We’d like to note the organization supports KAZU. I’m Erika Mahoney, this is KAZU News.