Rome Memorial Hospital has reopened its COVID-19 ward as the number of cases of the coronavirus disease steadily increase, but this time it is with eight months of experience and more medical tools to fight the disease, and with a notice to the community: It’s safe to come to the hospital when you need to.
Gurinder Kaur, medical director of the St. Joseph’s Health Hospitalist Program at Rome Memorial, recalled in an interview with the Daily Sentinel this week that when the COVID situation eased off in mid-summer and people without the disease began again coming to the hospital after a spring of wariness, she and other doctors noticed many patients were worse off for having put off seeking care. Patients who came in with heart disease turned out to have had heart attacks at home or had trouble breathing but were too afraid to come to the hospital for fear of contracting COVID-19.
“Those patients are now going to have long-lasting damage to their organs that had nothing to do with COVID,” Kaur said. “If they had come to the hospital in timely fashion they would have been completely fine.”
Now, though, the COVID-19 unit is open again after this past weekend. Patients who test positive for the condition are treated there by nurses dedicated to the unit in a ward with negative air pressure to keep any traces of the coronavirus inside. Visitors are not permitted in the hospital, with some exceptions.
“We’re very careful with our personal protective equipment, trying to not expose our patients, and patients should feel safe to come in any time they feel something’s wrong.”
The other major lesson from several months of dealing with COVID-19 is how to treat it, Kaur said.
There is no flat-out cure for COVID-19, but doctors have learned much about how to reduce the damage the disease can do and to help the body’s natural defenses and healing.
Not everyone with COVID-19 needs to be admitted. Under guidelines of the National Institutes of Health, critical classification requiring hospitalizations generally comes when a person’s blood oxygen level is 94% on normal room air, when breathing more than 30 times a minute, if X-rays indicate severe pneumonia, or there is multiple organ failure or respiratory failure.
One nuance, however, is that because of a chronic condition, some people may have lower baseline blood oxygen levels, and falling a bit below 94% without other indicators of distress would not necessarily require hospitalization.
“If their normal levels are around 90 percent we’re not going to automatically admit them or assume that they’re really really sick. We have to look at the whole picture and see if they really need criteria to be admitted to thee hospital.”
In other cases, a person may have a cough, shortness of breath and other now well-known symptoms but oxygen levels are sound, and can be managed at home, though in close contact with a primary-care physician.
Once hospitalized, COVID patients are started on intravenous Remdesevir, and if needed, the steroid dexamethasone.
Kaur likened Remdesevir to the anti-flu drug Tamiflu in that while it is not a cure by itself it can shorten the duration and severity of the illness, and is usually most effective if given early. The general recommendation is to limit use to five days or perhaps 10 if a physician believes there may be some benefit.
“The steroids are also for only for five days because ultimately the body has to fight off the infection. These drugs are there to kind of support and help you do that without becoming vehemently ill.”
Similarly, patients may need antibiotics because their weakened immune systems leave them vulnerable to other infections. Many patients are also given a blood thinner to guard against clots. Full-dose thinners may be given to patients at higher risk for clots or already experiencing them. It’s part of the insidious nature of COVID-19.
“When your body is really inflamed from this virus, everything starts to go a little bit nuts, then your body thinks it’s attacking something and your blood gets thicker and you’re at high risk for blood clots. The anticoagulation is not a treatment, but it’s a supportive care to prevent that.”
Rome Memorial has iPads for patients to help patients connect to loved ones, and physicians try to keep families updated, Kaur said.
As for when to discharge, generally doctors look for improvement in symptoms, breathing function, oxygen levels in the blood and signs of inflammation, which may be assessed through a certain blood test.
More younger patients are coming in, Kaur said. Some experience anxiety and depression, while others experience last of taste and similar quality-of-life issues. Some patients fully recover, but many, particularly older patients, are at risk for deconditioning and fatigue and require physical therapy in a rehabilitation center after hospital discharge.
“You’re at risk of getting those blood clots up to 90 days after so it’s really not over when you leave the hospital. We still need to make sure that the patients that are going home are able to walk around and ambulate and are not going to be just sitting around in bed because they will get a blood clot.”
As of Tuesday, Rome Memorial was treating seven patients with COVID-19. At times from late summer until late October, the hospital had none. But capacity is not a concern at this point, Kaur said. There is ample room in the hospital itself, and regional hospitals have plans to distribute patients if needed, she added.
“We are also being extremely cautious in who we admit and trying not to admit patients who really don’t need to be here, and offering them services at home. If they need oxygen at home we can do those kinds of things too to get them home faster.”