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March 17, 2022 - Community Engagement Virtual Meeting


    1. Positive COVID-19 cases currently in Kaweah Health:
      As of this morning, we had 22 COVID-positive patients in inpatient beds.
    2. How many are in ICU and do we have empty beds in our ICU?
      Two of the admitted COVID inpatients were in the ICU (none on vents). As of this morning, 11 of our 41 ICU beds were available for admission or transfer.
    3. Hospital Census:
      As of this morning, 311 of our 344 adult inpatient beds were occupied, representing an occupancy rate of 90.4%; in addition, we had another 15 patients waiting in the Emergency Department for an inpatient bed to open up (what we call an “admit hold” patient); including these admit hold patients, our real adjusted occupancy rate was 94.8%.
    4. Vaccinated employee percentage:
      81% of our 5,100 employees have received their initial vaccinations from Pfizer, Moderna or Johnson & Johnson; 69% of these 81% are boosted but that number will rise as more vaccinated employees become eligible for their booster shot; 19%, or 974, employees have received no vaccine. As of Monday, we have 34 employees out on a COVID leave of absence.
  1. It has been on the news that a 4th vaccination is going to be required. Is Kaweah going to make it mandatory for your employees?
    Pfizer has submitted an application to the FDA seeking authorization to offer seniors, age 60 and older, a second booster shot which would make for a 4th vaccination. In its application, Pfizer cited two studies from Israel where second booster shots were already being offered to adults 60 and older. In one of the studies, 1.1 million health records of seniors in Israel were analyzed and researchers determined that COVID-19 infection rates were two times lower and rates of severe COVID were four times lower among those who received a second booster compared with those who received just one.

    With respect to Kaweah, we have never made COVID vaccination mandatory for our providers and employees but the State did and we have to enforce the State’s requirement or lose our license. The State also made a booster shot mandatory for healthcare workers but it hasn’t yet spoke about a mandatory second booster shot. This said, Kaweah has fully supported a provider’s or employee’s request for exemption from any COVID vaccination on the grounds of a physician-supported medical reason or a religious belief objection.

  1. Has there been an update on the COVID B2 variant that is in New York?
    Today the New York Times reported that cases have increased recently and are high but the number of hospitalized patients and deaths have fallen; their positivity rate is relatively low but their number of daily new cases has risen by 27% from two weeks ago; the article didn’t speak specifically about the BA.2 variant but almost half of the countries in Europe have reported COVID-19 case increases over the past week and the predominant virus strain is the BA.2 variant. Several countries have seen double-digit percentage increases in their weekly COVID-19 case numbers like Finland which saw an 84% increase and the United Kingdom with a 31% increase. Switzerland, France, Germany and Italy also saw significant increases in case volume. COVID-19 hospitalizations have also been increasing in Ireland, the UK and the Netherlands. Several reasons have been cited for the increases including relaxed or lifted masking and “gathering” restrictions, the highly-contagious nature of the “stealth” BA.2 variant, and waning vaccine protection.
  1. The paper on Tuesday said there were 53 deaths in the latest week. That sounds high. What are your thoughts?
    There were not 53 actual COVID deaths that occurred last week. There are several factors that delay the reporting of a suspected COVID death and many of these deaths could have happened weeks ago or even months ago but a conclusive determination was just finalized by the County Health Department last week. Sometimes the reported death count can be higher than normal because of these delays and backlogs. I don’t have March’s number but for all of February, we had 37 deaths in our hospital where the patient had a primary or secondary diagnosis of COVID infection.
  2. It was mentioned in a community meeting that Kaweah is ready to start taking down the COVID Incident Command Center. What does that entail and when will that take place?
    Given the steady decline in our COVID inpatient admissions and census and the County-wide positivity rate, we too believe we are moving out of the pandemic state into an endemic condition. Like the endemic flu virus, we will now start treating COVID as one of the many viruses we confront throughout the year and incorporate testing and treatment into our normal operations. The COVID Command Center that had been located in our Acequia Wing Conference Room for more than a year moved to a virtual platform some months ago and has steadily declined to only one Section Chief meeting per week. Taking down the Command Center will essentially mean we will disband the Section Chief assignments and no longer hold the weekly meetings. But, we will always stand ready to relaunch should conditions change.
  1. Can you share the current visitation policy? Are we going to require testing or vaccination proof for our visitors indefinitely?
    Effective March 7th, non-COVID/isolation patients can have up to two visitors at the bedside throughout the entire span of visiting hours; they must be the same two visitors throughout the day but the visitors can change each day of the patient’s stay. Patients in the ICU or ICCU with confirmed COVID, can also have two visitors at the patient’s bedside for the two one-hour visitation blocks in the morning and evening; must be the same for that day’s visitation but can be different each day; COVID-positive patients outside the ICU or ICCU cannot have visitors until they are out of isolation. Patients who are at end-of-life are allowed up to four visitors at the bedside and they can change each day.
    For the Emergency Department, visitors are not allowed in the lobby or waiting area but are permitted to be at the patient’s bedside once they are brought back into an exam room; patients are allowed two visitors at the bedside but they have to remain the same throughout the patient’s stay in the ED. Procedural areas, like surgery, allow for two visitors to be with the patient and they can stay in the waiting room during the patient’s procedure.

    Regarding indefinite COVID testing of visitors, my answer is “I sure hope not” but that will be up to the Governor and the California Department of Public Health. Effective yesterday (March 16th), here is the latest on testing of visitors:
  • Visitor-provided at-home kits can be used but must be proctored by a Kaweah Health staff member; results are good for 24 hours;
  • Other antigen tests performed by authorized entities are good for 24 hours; must show proof of negative test;
  • PCR tests performed by authorized entities are good for 48 hours; must show proof of negative test;
  • Those with emergent situations (i.e., end of life or imminent death (critical condition), labor & delivery, surgery, pediatric/NICU population, disability/cognitively impaired patients) are allowed a 72-hour exemption from proof of vaccination or testing; after that they have to comply.
  1. COVID Brain Health Study – a representative of Kaweah’s Research department came to a community meeting and encouraged us to join the brain study. Can you give more information about that?
    The purpose of this study (which is a collaboration with Cleveland Clinic) is to determine the effects of COVID-19 on brain health (cognitive ability). We are very excited to be doing this study, the first of its kind and one of our six current neuroscience research projects.
    We intend to recruit 350 adult participants (we are halfway there) to enter the two-year study. A group of 175 persons will have recovered from COVID, and a control group of 175 persons will have never had COVID. We expect that the COVID group will show a negative effect on cognitive ability, and that younger and older persons will also show differences in cognition. Each participant will have four scheduled (30 minute) visits over the two-year study period, and will undergo three standard medical cognitive assessments at each visit. These cognitive assessments will be administered by our psychiatry residents. There is no cost to the participant, all tests are noninvasive and confidential. Each participant may have access to their own results, and the study has been approved by our research ethics board (IRB).
  2. Now that the pandemic seems to be waning – what are you anxious to focus your attention on? Are there any new projects on the horizon that you can share with us?
    There are so many projects and initiatives that are currently underway but I think our priority for 2022 will be to help our organization recover from COVID—physically, emotionally, spiritually, mentally and financially. Our healthcare workforce is exhausted and depleted and needs to be rebuilt and reinforced. We are excited about a new relationship with Unitek, a private healthcare university that focuses largely on the education and training of registered nurses. With our financial support, we will begin working with Unitek in the Fall of 2022 to enroll our first cohort of 20 Kaweah Health students who will spend two to three years obtaining their Bachelor of Science in Nursing degree. 20 new students will be enrolled every Fall and Spring. The program is year-round with classes and training provided at night and on weekends to allow students to continue working part-time at Kaweah Health. All didactic learning will be on-line and clinical rotations and hands-on training will take place in Kaweah Health’s simulation lab and in our facilities. Students who have already completed general education requirements going into the program will spend two years earning their degree while those just starting their education will spend three years in the program.