August 19 2021 Community Engagement Virtual Meeting

Thursday, August 19, 2021

QUESTIONS FOR 08/19/2021 COMMUNITY ENGAGEMENT MEETING

CURRENT COVID NUMBERS IN TULARE COUNTY

1. Positive Cases in Tulare County:
   Yesterday the County reported 52,342 cumulative positive cases since the beginning of the pandemic, with 853 newly-reported cases just yesterday. There have been 855 COVID-related deaths since the beginning of the pandemic and there are currently 1,617 cases under active management. The 7-day average new daily case count per 100,000 population is 21.1 and the 7-day positivity rate is 8.7%.

2. Positive Cases currently in Kaweah Health:
   As of yesterday we had 98 COVID-positive adults in the acute medical center with 16 in the ICU and 14 on ventilators. We had no COVID-positive pediatric patients in the hospital.
   
3. Positive Employees at Kaweah Delta:
   We currently have 77 COVID-positive employees out on leave of absence; 44 of them were previously vaccinated and are considered “breakthrough” cases. We have an additional 22 employees who are unvaccinated and on LOA because they are living in a home with a COVID-positiveperson. We have an additional 14 employees who are suspected of having COVID but are waiting on test results. Our employee vaccination rate now stands at 65% and our Medical Staff at 92%.
   
4. Hospital Census
   As of 7:03 this morning, we had an adult inpatient occupancy rate of 91.0% with 7 of 41 ICU beds available; 9 of 54 ICCU beds available; and 15 of 249 medical/surgical beds available.
   

The COVID-19 positive numbers aren’t as high as they were in January, and Kaweah Health did not call a Code Triage then. Why is the hospital more impacted now than when we had 170+ COVID-19 positive patients?
The Code Triage was called because we had 161 patients in the Emergency Department of which 63 needed to be admitted and we didn’t have any available beds in which to admit them. We did not see this kind of intense demand on the ED back in December and January. Our staffing shortage has also intensified over the past six months as we now have over 500 open positions waiting to be filled; approximately 140 of them are bedside nurses.

Was the Code Triage/ED overwhelmed due to a staffing shortage and, if so, was the staffing shortage due to employees leaving because of the vaccine mandate?
In this case, it was actually physical capacity that caused us to call the Code Triage. We are definitely short-staffed from a nursing standpoint throughout the entire hospital, including the ED, but we didn’t have enough staffing or physical capacity to handle 161 ED patients and 63 new admissions. While we have lost nurses over the course of the pandemic who have left the area or profession because of COVID but the vaccination mandate has not yet driven away any nurses from Kaweah Health.

Since our last meeting, the state of California has mandated the vaccine for healthcare workers. How is this mandate affecting Kaweah Health in terms of logistics and employee morale?
It has taken a Herculean effort by many, many people to put the mandatory testing in place by next Monday, August 23^rd. We are estimating that we will have to test almost 2,000 employees twice a week. We have already ordered more than 10,000 Abbot BinaxNOW home testing kits for distribution to unvaccinated employees who will test themselves every Monday and Thursday and log their test results into an online portal. As for morale, there is definitely growing friction between vaccinated and unvaccinated employees.

If employees refuse to get the vaccine will they be fired?
Employees who are required to be vaccinated (those that work in buildings where patient care is provided) but choose not to be vaccinated can be exempt from vaccination for a medical reason or sincere religious belief. If they submit a declination form for one of these two reasons, they will remain employed but will be subject to twice-per-week COVID testing. Unvaccinated employees who do not submit an approved declination form will be terminated.

Have we seen an increase in vaccinations across Tulare County since this mandate was handed down?
I’m not certain as I continue to read current reports that still reference our Countywide vaccination rate of only 37%. That said, Kaweah Health’s employee vaccination rate has increase from 55% a few weeks ago to 65% today; our Medical Staff vaccination rate has also increased from 57% to 92%.

Which vaccines are being offered at the Kaweah Health rural clinics?
Moderna and Johnson & Johnson. We are hoping to get Pfizer in the next couple of weeks.

How many of the COVID-19 positive cases in the hospital have been vaccinated?
While we can’t say with absolute certainty because some patients won’t reveal their vaccination status or are uncertain of it, I would say that approximately 90-95% of our COVID-positive cases are with unvaccinated patients.

It is difficult to get an appointment to get a COVID test. Are you going to open up additional testing sites again?
We are definitely seeing a significant increase in the demand for COVID testing. We have just recently opened up testing at our Tulare Clinic and are working to re-establish testing at our other four rural health care clinics in Exeter, Lindsay, Woodlake and Dinuba. We are also offering testing at our Kaweah Health Medical Group clinic on Hillsdale.

Patients are being asked to wait outside/in the car in 100+ degree heat. Will Urgent Care be providing tents or benches for patients having to wait?
Yes. We have tents and benches at virtually all of our outpatient clinic sites but may not have at our two urgent care centers. Our Director of Facilities and Maintenance is going to make sure today that all urgent care sites have tents and seating areas.

Update: We put awnings and chairs outside of our urgent cares to provide cooler seating for patients who were experiencing long wait times. Unfortunately, these amenities brought some unforeseen problems such as the chairs being moved, the lack of staff available to clean chairs in between patients, and non-patients using the chairs and leaving trash, etc.

Did Kaweah Health give VUSD guidance on their masking updates.
No one from Kaweah Health has spoken to VUSD officials about masking. I did answer a question at our recent video press conference about Kaweah Health’s outdoor masking policy and I subsequently shared this answer with a community member who emailed me.