Editor’s note: In the next days and weeks ANC is reaching out to various north state health-care professionals for input and information about the Coronavirus in our community. Today please welcome Shasta Community Health Center CEO Dean Germano, who took time to share his thoughts after a particularly demanding week.
This week it’s been non-stop COVID-19 information at the Shasta Community Health Center.
Our clinical leadership team has been in constant contact with Shasta County Public Health, the Partnership Health Plan and state and federal agencies, including the Center for Disease Control.
The biggest challenge so far is the lack of adequate testing. The federal government was way too late in the game in getting the testing and test-certification process going. It did not help that our government’s administration had gutted the pandemic division of the CDC in a budget-cut move.
So, until testing becomes much more available, health practices — including SCHC’s , and certainly the hospitals’ — will use a risk-stratification process that relies upon individuals being honest about how they are feeling. Specifically, do they have any respiratory symptoms, particularly coughing, sneezing and running a fever? Certainly, if they have been traveling is a factor, depending upon when and where they have been. Many of us have (or will) have screeners at our doors for the initial screening. If someone has symptoms we will likely have a nurse or other practitioner do a more thorough screening before they enter our main facilities. This may mean a screening outside, in their car, or in a tent, or in an adjacent building. This is complicated by the fact that we are in allergy season and the normal flu/influenza also abounds.
For most people – around 80% – the most infected people will experience are mild to moderate flu symptoms. If they are at all sick, even with the basic flu, people need to stay home, and to the best of their ability, not expose others.
The challenge is for many workers who lack generous sick programs that allow them not to lose income while ill or under quarantine. But both the state and the federal government are working on systems to prevent infected people from going to work, and thus infecting others.
In the healthcare field the workforce issue is a big question. We are taking all normal precautions and increasing the frequency of cleaning. Certain protective equipment, like N-95 masks, are in short supply, so almost all practices are only using those masks when in close proximity to a known COVID carrier, or one who is highly suspected of being a carrier. Because transmission of this virus is primarily by “droplets” rather than airborne, using a surgical mask, both on people who are sick and those around them, should be effective.
The information we are getting is that the virus can live on surfaces for several hours, depending on the surfaces. Regular cleaning of hard surfaces in particular is a good idea. Right now Shasta County and much of the north state is in a “containment” mode. That is, if someone is discovered as positive, public health professionals will coordinate with those around the person to contain and isolate the infected person for about 14 days. Public health staff will track down anyone with whom the infected person may have engaged so those secondary contact people will be screened, too.
As you can imagine, that process is labor intensive and only works with smaller numbers. My feeling is that as soon as a small cluster of infected people are identified, we will then move into what is called “mitigation mode” – that is, to try to minimize the overall extent of the infection. This would include steps like social isolation, keeping gatherings to a minimum, keeping a distance of at least 3-6 feet, and restriction of the general population’s entry into nursing homes, long-term care facilities or even hospitals, as the virus is particularly hard on seniors and people with underlying health conditions. As you can see by the governor’s state declarations, we are already in mitigation mode.
With respect to the category of the workforce, some economic modeling shows that if schools close, some businesses will see 30-40% of their workforce impacted because of child-care responsibilities.
In the healthcare field, this is particularly problematic. My son is a third-year internal medicine resident in Iowa and will be heading to further training in critical care medicine this summer. He is also one of his hospital’s clinical leaders in their COVID-19 response. From what he tells me, securing enough ventilators will be a challenge if there is large wave of positive COVID cases.
Also, my son said it may be a challenge to access some medications, and that in northern Italy intensive care unit doctors are making difficult choices about who gets these interventions. He said that the morbidity from this virus is around 5-6 percent, based on the Italian data, compared to the 0.01 percent with influenza.
So the goal of mitigation is to slow the surge of cases so the healthcare system is not overwhelmed at any one point. This may take a few months. What you may also see is the use by physicians and other clinicians of the use of telephone/FaceTime or other tele-communications for high-risk people. Many payers, including the federal and state governments, are working on establishing a payment system based on the extensive use of telephonic visits.
The challenge our system faces is that we have little time to make a fairly large paradigm shift in the business model.
In any case, this is a sampling of what we know. I want to make sure people understand that if the virus should take root in our community the vast majority of us (more than 80 percent) will see little in the way of problems.
I would suggest that if you have seniors in your life, particularly those who are frail or those who have underlying health conditions, please lend a hand. Perhaps do their shopping for them. Encourage them not to go out until things settle down.
One word about testing: right now there is only a modest capacity for testing. Testing so far has been limited to those who are symptomatic, and only by a doctor’s order. While Quest and LabCorp say they have a test, you still need a physician or doctor’s office to collect the sample (a swab of the throat and nasal passage). Please do not go to the labs asking for the testing, because they cannot collect the specimen, and at the moment collection can only be done with a doctor/licensed practitioner’s order.
From my understanding, the most reliable testing are those administered at a public health facility, but their capacity to process such tests are limited. We are hearing that some of the lab companies have designed testing equipment that can process tests at a higher volume, so we have to wait to see if the CDC/FDA tests and approves them for a more broad roll-out.
That said, while we do not want to overly worry folks, we also need to take the risks seriously. Once testing becomes more mainstream and eventually an inoculation appears (probably not for year or more) things should settle down.
Dean Germano is the chief executive officer of Shasta Community Health Center in Redding.