Kaweah Health Chief Executive Officer answers community's COVID-19 questions

VISALIA – As the number of cases rise in Tulare County, many people have questions about COVID-19. In a virtual video-conference call this week, Gary Herbst, Kaweah Health's Chief Executive Officer, answered questions from Tulare County residents.

Question: What are the most current numbers of COVID-19 in Tulare County?

Answer: As of Thursday, April 23, there were 453 confirmed positive cases in Tulare County with 25 COVID-19-related deaths and 69 recovered. California has 37, 369 positive cases with 1,469 deaths. Kaweah Health currently has 27 positive inpatients, and 17 total deaths since the beginning of March, 10 of which were residents of Redwood Springs nursing home.

Question: Any updates on when Tulare County will reach its peak?

Answer: On a very positive note, Qventus, the predictive analytical tool being used by many hospitals across the country to help predict the patient demands Kaweah Health will likely experience over the next 45 days, is now indicating that Tulare and Kern counties have actually reached their apex. The model indicates that these counties will experience a plateau over the next week or so and then start coming down the slope.

Question: Now that Kaweah Health has Abbott testing, which takes minutes instead of hours, do people get tested at the specimen collection tents and Emergency Department or is that still only for inpatients?

Answer: Due to an initial limited supply of Abbott testing materials (chemical reagents and test cartridges), Kaweah Health limited the ID Now testing to only KD inpatients, and to symptomatic employees, physicians, and residents. As shipments and test kits increased in supply, Kaweah Health extended the Abbott testing to all patients coming through the ED that were to be admitted. We would also allow the ED to test non-inpatients (those to be discharged home from the ED) for rule-out. Kaweah Health expanded this testing capability to our Urgent Care Center located on Court Street where it now has one or two Abbott analyzers to perform specimen collection and testing for patients who arrive to the urgent care center for normal urgent care services, but may be exhibiting COVID-19 symptoms. Kaweah Health decided this week that it will no longer use any commercial labs to perform testing as results are not being returned for 7-10 days, but will instead only use the County’s lab or its in-house lab.

Question: Do we know why Tulare County’s per capita number is so much higher than Fresno County’s?

Answer: With Fresno County’s population of almost 1 million people, compared to Tulare County’s population of approximately 500,000, it is hard to understand why they have 384 positive cases and seven deaths (132 recovered) and Tulare County has 441 positive cases and 25 deaths. “I don’t believe they have practiced better social distancing or have sheltered-in-place or practiced hand hygiene any differently than us. I do believe that we have had earlier and better testing capability and capacity at our County level and now, within Kaweah Health,” Herbst said. “However, I believe the single distinguishing factor is the Redwood Springs nursing home outbreak. I have not read of a single nursing home outbreak in Fresno County.” Kaweah Health's 54-bed skilled nursing facility has had 0 positive cases among patients and staff. Without these nursing home outbreaks, Tulare County would have had only 224 positive cases (160 fewer than Fresno County) and only 10 deaths (still slightly higher than Fresno’s seven).

Question: What is the leadership directive regarding personal protective equipment (PPE) for staff?

Answer: Over the past two weeks, the availability of PPE has significantly improved, through Kaweah Health's conservation efforts and the stabilization of supply channels. Kaweah Health has continuously adjusted its PPE protocol to reflect this changing supply condition. Most recently, on Wednesday, April 23, Kaweah Health began issuing new surgical masks to the 3,000 of its 5,000 employees who do not work in the high-risk clinical areas, but Kaweah Health wants to protect from contracting the virus or giving it to someone else in the event they are infected but asymptomatic. These employees will now receive a new mask every Wednesday, unless one of these masks becomes soiled, damp or otherwise unusable, in which case it is replaced immediately.

On April 17, Kaweah Health also began issuing three N95 masks to over 2,000 employees and providers who work in the higher-risk areas, including those ancillary staff (e.g., phlebotomists, imaging techs, respiratory therapists, housekeepers, etc.) who work on the units with our nurses and physicians. These masks are now changed out every day allowing for the first mask worn to be re-worn on the 4^th day, free of any virus cells that would have died off.

During the initial pandemic outbreak in Tulare County, Kaweah Health was forced to implement pretty restrictive PPE conservation measures, although in line with Center for Disease Control & Prevention Guidelines, as normal supply chain distribution channels were being greatly disrupted and our inventories were being depleted. Understand that under normal, non-COVID conditions, our staff rarely ever wear an N95 mask, only when taking care of patients with tuberculosis or active measles; not even during flu season. Not knowing yet whether the coronavirus should be handled as an airborne or droplet virus, Kaweah Health had to be careful not to burn through PPE before the surge hit. As such, Kaweah Health instituted a protocol where physicians and staff were asked to reuse and practice extended use of masks and gowns. This is the same practice that was instituted across the country. Kaweah Health would always, and without hesitation, replace an employee or physician’s mask if it became soiled, damp or otherwise unusable.

Question: What is the current census at the hospital? Are employees being asked to stay home due to low census because of cancelled elective surgeries, etc. during these challenging times?

Answer: On April 23, Kaweah Health's adult acute inpatient census in the downtown Kaweah Health Medical Center was 223 patients across all medical/surgical units, Intermediate Critical Care Units and Intensive Care Units. Kaweah Health had 109 empty adult acute beds and 12 empty pediatric beds (closed for possible surge). Due to the very low inpatient census, caused largely by the cancellation of elective surgeries, coupled with a significant decline in Emergency Department, urgent care, and outpatient visits, Kaweah Health has been “docking” employees (cancelling their shifts), reducing hours and furloughing (temporary layoff). “It’s awful, but we have no other option as, like so many businesses and industries out there, our revenue has plummeted. We are helping these employees as much as possible to secure federal and state unemployment insurance benefits and evaluating other options to potentially use sick banks or other sources to cover lost wages,” Herbst said.