This article was originally published in the Calaveras Enterprise.
Mark Twain Medical Center—Dignity Health, the only hospital serving Calaveras County, sits in wait of a surge of COVID-19 patients on Tuesday.
COVID-19 cases are spiking everywhere and the Mother Lode is no exception.
With winter descending over the nation, cold weather will bring more risky indoor interactions and, inevitably, the flu, pushing some jurisdictions to mull future lockdowns. And although hopes are high over multiple candidates for a vaccine, how soon will it be distributed? And are there risks to counter its lauded effectiveness?
“Most of the medical community is pretty excited and encouraged,” Dr. Randy Smart,
internist and CEO at the Valley Springs Health and Wellness Center, said about initial reports
on the Pfizer vaccine, which have claimed a 90% effective rate.
Yet the promising data should be approached with caution, he said. The new vaccine and its Moderna competitor are the first in history to utilize synthetic mRNA (messenger ribonucleic acids) – a potentially revolutionary method which scientists have been attempting for decades.
An mRNA-based vaccine wards off a virus by encoding proteins of the virus, which are injected into a cell to trigger an immune response and create antibodies. Beyond its potential to beat the pandemic, mRNA technology could speed up the manufacturing process of new and existing vaccines, according to “Nature.”
“This can be a very good thing. Maybe the most effective (type) of vaccine. But there may be issues we don’t know about yet,” Smart said. “The FDA (U.S. Food and Drug Administration) needs to approve it. I don’t think it will be too much of an issue, because of the urgency. This is a high-priority item.”
Even if the vaccine continues to prove itself in expedited trials, Smart estimates it won’t be available to the public until at least March 2021.
Which leaves Americans to endure what many physicians have feared: winter with COVID-19.
What will the coming months look like? It’s hard to say, though spikes in cases locally and worldwide foreshadow astronomical rates of infection on the horizon. According to Smart, brimming hospitals like those now reported in Europe where the weather cools earlier are “absolutely coming our way.”
The next surge
On Friday, Calaveras County’s Public Health Department warned of a surge in cases after weeks of relatively low positivity rates.
Following less than a month spent in the least restrictive tier of the state’s COVID-19 monitoring system, the county – along with many others – moved into a more restrictive tier this week due to an “unprecedented surge” statewide. With 42 California counties now gone purple, reporting “widespread” transmission, Gov. Gavin Newsom announced on Monday that he is considering a statewide curfew to curb the spread.
In neighboring Tuolumne County, which has been purple since Monday, some businesses including bars and indoor restaurants must close again as a steep incline in cases has yielded an 8% positivity rate, 223 active cases and six currently hospitalized. Adventist Health Sonora – the only hospital serving the county – has 152 staffed beds, according to the American Hospital Directory.
Although the numbers are unnerving, Smart says medical professionals are now better prepared to treat COVID-19 than they were during its onset. Progress has been made in prescribing drugs like Remdesivir and preventing complications associated with the disease such as blood clots.
“I think we’ve had a chance to settle down a little bit. Things aren’t as crazy as they were back in March and April. I don’t think any community can be fully prepared for a surge, but I think we are in a better place than we were in the early summer. We have a plan,” Smart said. “In terms of what things you can do in an ICU to have better outcomes, to have better survival, we’ve learned a lot about ventilator management and what complications to expect.”
However, the medical community will soon face another novel challenge: COVID-19 during flu season.
COVID-19 and the flu
The in-hospital death rate of COVID-19 patients is two times higher than that of flu patients, according to a recent study published in the Annals of the American Thoracic Society. But the risk of simultaneous outbreaks should not be underestimated.
Experts say it’s too soon to tell whether the two viruses will be a deadly double-threat, or if preventative practices adopted to reduce the spread of COVID-19 – handwashing, social distancing and mask-wearing – will effectively stave off the flu season.
It is unlikely that a person will contract both viruses at the same time or that, in such a case, the double infection would increase morbidity. Rather, Smart’s concerns lie with doctors and their ability to accurately discern between the two viruses, which produce similar symptoms but are treated differently.
“I honestly think the winter viral pandemic will be harder for doctors than patients,” Smart said. “If you just look at COVID alone, it’s a little bit daunting. And then you throw influenza into the equation and, as a doctor, it kind of makes my hair stand up.”
The potential for false-positive results in COVID-19 testing, as the FDA recently warned, will make the situation even harder.
In preparation, local hospitals are requiring all staff members to receive a flu shot and are evaluating some patients remotely.
“In March MTMC (Dignity Health Mark Twain Medical Center) implemented a very robust care model that enhances our ability to screen patients over the phone, identify those with flu like symptoms and direct them to (designated) medical evaluation and treatment areas thereby limiting exposure of possible active flu and other infectious diseases to other public and healthcare providers,” Nicki Stevens, spokesperson for MTMC – Calaveras County’s only hospital – stated on Nov. 6. “In anticipation of a potential influx of patients we continue to review and update our medical surge plan to maximize our treatment and bed capacity to continue providing effective and timely care to our community. MTMC will continue to manage the care of any suspected or confirmed COVID-19 patients and has increased its capacity to quickly test and differentiate COVID-19 from the seasonal flu.”
So what can people do to protect themselves and ease the burden on the medical community? Get a flu shot – ASAP, Smart said. All it takes is a visit to a healthcare provider or most pharmacies, where the vaccine is usually covered by insurance.
And there’s an added bonus: some studies have suggested that getting vaccinated for the flu might provide some protection against COVID-19 and/or its severity. While there may be less-intriguing reasons for these findings, such as those who get vaccinated are more health-conscious and therefore less likely to contract COVID-19, a recent “Scientific American” article explains, the known benefits are still worth a shot this winter.
Safe for the holidays
On Nov. 11, the California Department of Public Health (CDPH) released updated guidance warning against multi-household holiday celebrations and recommending outdoor or virtual gatherings.
The new rules prohibit gatherings of more than three households and also require outdoor-only gatherings for those living in counties in the most severe purple tier of the state’s monitoring system.
Other preventative measures were also required including wearing a mask at all times (except when eating and drinking), physical distancing and limiting “singing, chanting, shouting, cheering, physical exertion and similar activities (that) significantly increase the risk of COVID-19 transmission.”
Though they may be stringent, Smart believes the rules are good advice.
“It’s tough. You know, Thanksgiving and Christmas, people want to see family. It’s tough, but I think people really need to be smart about this,” he said. “The people that get hurt are not the young 20 or 30-year-olds – they survive. They do fine. But then they go home to parents and grandparents, even young children. We shouldn’t be thinking about ourselves. We should be thinking about the people we’ll see afterwards. This is really about caring about other people.”