KAWEAH DELTA VIRTUAL TOWN HALL

How many people are currently in hospital with COVID?

We currently have 30 COVID positive patients in the hospital. Of those 30; 6 are in the Intensive Care Unit, 6 are in the Intermediate Intensive Care Unit and 18 are in the 2South COVID Unit.

How many deaths in Tulare County attributed to COVID were Nursing Home Patients?

As of this morning, there have been 71 deaths across Tulare County. 51 of the 71 were nursing home residents, which is 72% of the total deaths. The largest number were from Redwood Springs. Of the 71 deaths, 33 died at Kaweah Delta.

How many deaths in Tulare County attributed to COVID that weren't in a Nursing Home, had underlying conditions?

In respect to the 33 patients that died at Kaweah Delta, most of them had a serious underlying chronic condition. The common chronic diseases range from chronic renal failure, congestive heart failure, end stage renal disease, coronary artery disease chronic obstructive pulmonary disease, and diabetes.

Are we seeing more cases because of more testing? Isn’t it more helpful for the community to know the number of hospitalizations and ventilators available?

Yes, testing has become increasingly more available. Kaweah Delta has its own testing capabilities. The County of Tulare, Sierra View, and the State of California (Dinuba and Porterville) are all testing as well. Of course, the more testing that is done; the number of positive cases will increase. We should be focusing more on the positivity rate, meaning what percentage of those we test are testing positive. Kaweah Delta has tested approximately 5,500 specimens, with 560 testing positive. This gives us a positivity rate of 10%.

One of the criteria still in place for the 2^nd phase of reopening is a positivity rate of less than 8% for 7 days in a row.

Why is the county not disclosing the age range of the people who have passed away?

The ages were being disclosed early on, I am not sure why the county has not continued that practice. They are reported at the State level daily. Of the 3,436 deaths in the State of California, 80% were 65 or older.

How many people in our county died last year during this same timeframe from the flue, pneumonia, or other respiratory illnesses?

These numbers are available at the national level, but not so available at the County level. In the 2017-2018 flu season (September to April) there were 79,000 deaths nationally, 89 in Tulare County. This was a severe flu season. In the 2018/2019 flu season, it fell to 34,000 deaths nationally. We do not have the data for the 2019/2020 flu season yet.

What is our current capacity in Tulare County is to treat COVID patients?

Kaweah Delta and Sierra View Hospital in Porterville are the only two hospitals in the county treating COVID patient and I can only speak to the capacity of our medical center.

Kaweah Delta has 344 beds, excluding mother/baby, labor & deliver, and nursery. As of right now, we have 83 beds open, by design. The 11 bed Broderick Pavilion and our 12 bed Pediatric Unit have been made available for COVID patients should there be a resurgence of the virus.

We have 96 ventilators at Kaweah Delta with 27 in use. This leaves us 69 available if needed.

Where can the public receive information as to the exact number of patients admitted to the hospital for COVID-19 from March until now. It seems as though the majority of local “infected people” have been able to fight this off at home. They would like to try to figure out what the actual recovery rate has been. It seems as though the majority of COVID-19 related deaths are mainly due to deaths from senior nursing and rehab facilities. Where does the hospital report all of this and is there a website to view it?

Tulare County reports this information at Covid19.tularecounty.ca.gov. Kaweah Delta submits our information to them on a daily basis. There is a graph on the website that shows the daily occupancy of patients at Kaweah Delta and Sierra View, plotted back to the beginning of the pandemic. The numbers ramped up in March and April. Today there are 35 people in the hospitals, and 30 of them are at Kaweah Delta. The number seems to have stabilized to approximately 30-35 but can change with the behaviors in the community.

Is there a timeline that the hospital hopes to meet in testing for COVID?

There is no timeline set as of now. As long as we observe people with the symptoms, we will continue to test for COVID. The symptoms can be cough, fever, runny nose, respiratory issues as well as loss of taste or smell, fatigue, gastrointestinal issues, and blue toes. We had hoped with the warmer temperatures, this virus would fall off like the flu, but it does not seem to be behaving the same way. We will continue to test particularly those patients that need to be hospitalized, so we know what unit they should be placed in within the hospital.

With the start-up of our non-emergent elective surgeries and endoscopy procedures, we will test all those incoming patients as well.

Are there timelines and goals established for each of the "priority" groups?

Healthcare workers and first responders have been given priority for testing. At the beginning of the pandemic, the testing kits were very scarce. We had to be very cautious how we were using our supplies so employees, physicians and residents that were taking care of the COVID patients were prioritized first. As the testing kits and supplies have become more plentiful we have been able to test more. Kaweah Delta now has the ability to test in-house using two different platforms, the BD Max and the Abbot ID Now, both very sensitive and accurate.

If you or someone you know is exhibiting symptoms, call the county or your Primary Care Physician. They can write an order to have them tested at our collection site on Floral and we can run the test on our in-house platform.

Are people without symptoms being tested?

No, except for patients scheduled for surgery.

Can a Tulare County resident can be tested without an appointment?

No, not at this time.

Antibody Testing

We now have capability for antibody testing with 10,000 tests in stock. It is a blood test with a full test-tube of blood like a normal blood draw. We have stayed away from the blood drop test as it does not have the same sensitivity or accuracy. We will start the antibody testing next week with employees, physicians and residents. If you have a positive test, it Indicates you have had the virus at some point. We don’t know if that gives you immunity or not. Our test gives you a number of what is present in your body. If you test negative, it means you have not had the virus in your body.

What prescription drugs are being administered to COVID positive patients who are hospitalized? If the prescription drugs vary, please share the commonly administered.

Hydroxychloroquine is a drug that has been used for malaria and lupus for decades. It was showing promise for COVID use by helping relieve symptoms for patients that were very sick. For some, it even accelerated their recovery. Initially they paired that drug with Azithromycin, however the combination equaled a growing mortality rate so it was discontinued. Hydroxychloroquine is still being used.

Remdesivir is an anti-viral drug used for combatting SARS, or COVID-1, which was a virus a number of years ago that came and went. This drug was also used to treat Ebola. It has been an experimental drug not available to hospitals. The government has now classified it for hospital use. The first shipment we received contained 15 vials, which was enough to treat two patients. Today we received 180 vials that can treat 15-18 patients. If given to the patient early on, it has shown promise in accelerating recovery and reducing time on the ventilator.

What actions and steps has KD put into place to ensure patients coming in for surgery won’t get COVID-19?

We are testing all surgical patients for COVID, 24-48 hours before their surgery. If the test comes back positive, the surgery will be cancelled. We have extensive cleaning and disinfecting policies. Our staff is exercising our universal precautions such as gloves, gowns, face shields, and masks. There is no absolute guarantee a patient might not be exposed, but the hospital is probably one of the safest places to be right now due to cleaning and safety protocols we follow.

Why is Kaweah resuming some services and prioritizing money over patient and staff safety? There is concern that COVID cases in this county are continuing to increase at an alarming rate and the hospital should be more cautious about resuming operations.

I can assure you that resuming our services is not about the money. It is about the patients that have been waiting on their non-emergent surgery cases. Patients have been living in pain and have had their surgeries postponed for months. We are exercising great caution in opening these services and have been planning this opening for a month and a half.

We started doing elective surgeries this Monday, which were mainly outpatient surgeries. The patient comes in, has surgery, goes to recovery and then goes home. No visitors are allowed to come in with them. We are also doing a small amount of inpatient surgeries that require one or two days in the hospital. We are only doing eight of these surgeries per day to preserve beds. We are being mindful in our opening with a start and stop approach. We will reevaluate every day, while watching what is going on in the community. If we see a resurgence in the number of COVID patients, we are prepared to pull back on surgeries. And, if the COVID numbers do not increase, we could accelerate our surgeries.

What are your thoughts on the County Board of Supervisor’s decision to move forward with reopening our county in spite of the Tulare County Health and Human Services and Governor Newsom’s guidelines?

Kaweah Delta was not consulted or involved in the decision. The County was very disappointed with the revised Phase 2 opening plan. Out of the 58 counties in California, only five were not qualified to open, ours being one of them. The reason we have such high numbers is due to the nursing home outbreaks in contained facilities. It is not widespread in the community by our community members. If the governor had looked at that, he would have understood. People in our community are suffering. The hospital is suffering having to turn away surgeries and lay off employees. We have been allowed to stay open to treat emergent health care needs of the community. I sympathize and empathize with the members of our community.

As part of the reopening of the county, the hospital has to meet certain requirements. A letter had to be submitted stating we as a hospital are prepared to support a resurgence by having adequate PPE and adequate preparations in place.

With so many cases on the rise, why haven’t city and county leaders implemented mandatory masks when in public?

I think they are leaving it up to the individual businesses. When the CDC said everyone should be wearing masks while in public, Kaweah Delta went to a mandatory masking policy. So many people are asymptomatic, we felt this was the safest for our staff and patients.

When is the Lifestyle Center going to reopen?

As an avid fan of the Lifestyle Center, it was very hard to close it. Unfortunately, the gym will be one of the last things to open. We are already preparing for opening by moving equipment farther apart to accommodate social distancing. When we get the green light, we will be ready to open.

Do you foresee a change in our labor and delivery policy regarding visitors?

Unfortunately, the visitor policy will not be changing while the virus still exists. We can allow one person with the patient during delivery. It is too big of a risk to bring in more visitors that may be asymptomatic carriers.

What is the timeframe for evaluating the reimplementation of visitors for patients in the hospital in general?

We do not have a timeframe but we are always reevaluating the policy.

Mental health patients that cannot communicate on their own are allowed to have a visitor with them for communication purposes. Any patient that has an advocate through the agencies in town can have them with them during their hospital visit for communication purposes. A parent is allowed to stay with a child during their visit.

What is being done to contact Devin Nunes and our U.S. Senators to get them to sponsor legislation to fund KDHCD for its losses due to the pandemic?

I have had frequent conversations with Devin Nunes and Kendra with his healthcare staff. We have a federal lobbyist group, CJ Lake, and are also working closely with them. I was selected by California Hospital Association to tell our story in a media conference as well as newspapers and radio. We are hoping this information will get the attention of the Senator and State Legislature.

Why have nursing homes in our area been hit so hard with this virus?

This is one a population that has been hit hard across the nation. In general, nursing homes have been unprepared for a pandemic like this. They don’t maintain large supplies of patient protective equipment. They might have an infection prevention nurse visit once a week or once a month, while hospitals have staff dedicated to infection prevention daily. We have learned that nursing homes need to make some significant changes.

Is Kaweah Delta doing contact tracing?

No, the County is in charge of all the contact tracing.