With over 1 million total confirmed COVID-19 cases and surging, California is pumping the brakes on reopening. We checked in with Dr. Allen Radner for the fourth time since the beginning of the pandemic. He’s Chief Medical Officer of Salinas Valley Memorial Healthcare System and an infectious disease specialist. Last weekend (November 14-15, 2020), Monterey County hospitals had 51 patients hospitalized with COVID-19, an all time high.
Erika Mahoney (EM): What’s the situation in Monterey County?
Dr. Allen Radner (AR): Our understanding is that right now the rate of growth in California is exceeding what it did in the first wave, so to speak, in the summer in July and August, and we’re seeing that in Monterey County. Over the last week, there's been a dramatic explosion in the number of cases. In total the hospitals are becoming filled up again with patients. This weekend we had the all time number of patients that are hospitalized, the all time number of patients that are on ventilators. And one of the things that seems to be different, we're still trying to analyze the data, but it seems like it's much more widely distributed geographically throughout the county, not just concentrated in Salinas. So initially it was predominantly in the seasonal agricultural workers. We're seeing it in families, throughout different occupations throughout the county, and we're seeing different age distribution.
Monterey County occupational demographic information regarding COVID-19 case numbers.
EM: That’s interesting and speaking about families, we have been living with the coronavirus for about nine months now. What is your advice to those who are tired and want to celebrate the holidays with family and friends?
AR: Yeah, I think this is a challenge we're all experiencing. We're seeing family after family coming to the hospital. In many cases, we've had three or four family members very ill in our hospital with multiple people on ventilators and multiple deaths within families. So it's unfortunately a problem as we're getting to that time of the year where people are moving indoors, there's family gatherings. We think the virus is transmitted better in cold weather. Everybody's fatigued, as you mentioned, with respect to distancing and isolation and not being with people. It's the most likely explanation why throughout the nation, and certainly we believe the same thing in Monterey County, why we're seeing a dramatic increase.
EM: So what’s your advice to families who want to gather for the holidays?
AR: You know, unfortunately, I think they have to understand that whenever we're encountering anybody that's not in our immediate circle and even within our immediate circle, unfortunately, there's a significant risk that they have this disease and people can spread this asymptomatically. There's this notion that if you get everyone tested, that you can have large gatherings or family gatherings and it's just not assured. We've seen lots of people who have had negative tests that spread the disease. There's a lot of complexity in that and it's really some false security. So we're asking people to be as safe as they can. And again, it's an individual decision at some level. But, you know, it's one of those things where you really have to evaluate whether having a family gathering this year is worth the idea of not being able to do that any time in the future if somebody becomes seriously ill or dies.
EM: This week, Governor Gavin Newsom pulled the emergency brake, in his words, on reopening and we're seeing most of the state back in the Purple Tier, the widespread tier, which is the most restrictive one. What is your reaction to that move?
AR: I think that, as we've already said, the only way to really put the brakes on this at this point is to aggressively do what we know that works. Unfortunately, the thing that works the best is shelter-in-place and profound distancing measures. Nobody wants that, there's huge economic consequences, there's huge social, educational consequences. I think the only way around that, frankly, is to really do aggressive management of identification of patients and do contact tracing and do selective but appropriate quarantine. Given the totality of where we're at now, really putting the brakes on what we can control is really the only option. I think that's what we're seeing throughout the country and I think we're forced to do that within our community.
EM: We’re in flu season now. Do you see our practices of mask wearing, hand washing and social distancing helping out?
AR: We're pretty optimistic that this isn't going to be a terrible flu season. Flu usually starts circulating in the Southern Hemisphere before it comes to the Northern Hemisphere. This year, most of the Southern Hemisphere have the lowest incidence of flu they've had in almost recorded history. And we believe it's because of this social distancing and masking and school, frankly, not having kids in school. These are all areas where influenza is kind of widely distributed. So far nationally there's been very little flu; we haven't had a case in Monterey County. I should also mention it looks like the flu vaccine that's being widely administered is a good match to at least the influenza that circulated in the Southern Hemisphere this year. So there's a lot of optimism that this isn't going to be a bad flu year. But we talk about it continually. We continue to monitor it.
EM: Nationally, we’re hearing about extreme healthcare worker fatigue. How’s the staff doing?
AR: There's always been this concern about the number of ICU beds and the number of ventilators and the amount of hospital equipment. In reality, we've experienced from the beginning, [it] has been maintaining adequate staff. And we've had nurses and other health care providers here who've been taking care of these patients for seven or eight months on these wards where it's very depressing and they're fatigued and they have their own individual concerns for themselves and their family. And it's very, very difficult. So we're working with our staff and they've done an absolutely phenomenal job and I'm speaking for all of the hospitals in the county. It's definitely something that we discuss every day at all the hospitals and trying to get through again what we think is, we hope is, a relatively limited period of time before we'll get on the other side of this tunnel.
EM: Yes, how encouraged are you about reports of successful vaccine trials?
AR: I think we're all very, very encouraged. The first two trials looked very positive. There's a lot of very complex operational issues with respect to how the vaccine is going to be stored and distributed and administered. But, the trials, the information we've seen to date is incredibly positive. And we're very optimistic that if not by the end of the year, the first part of next year there's going to be a much more widely available vaccine that seems to be very effective.
EM: Is SVMHS involved in planning for a distribution of a vaccine once it is developed?
AR: All of the hospitals are working together. We have a weekly meeting that's coordinated by the Monterey County Health Department that all of the hospitals, CHOMP, Salinas Valley Memorial Hospital, Natividad Medical Center, Mee Memorial Hospital, are all working together to discuss coordination and distribution of the vaccine. We need a lot more information, but we're all working on understanding how we're going to do it, to whom we're going to give the vaccine both in the short-term and the long-term as we hope to spread this out to the general community as well.
Salinas Valley Memorial Healthcare System is one of the many organizations that supports KAZU.