KAWEAH DELTA ONLINE TOWN HALL

Kaweah Delta’s Online Town Hall - Thursday, October 1

At Kaweah Delta, the greatest lesson we have learned is the importance of listening carefully to our community. We are launching a live webinar, to further involve the community in our efforts to gather feedback. Your feedback will help us continually improve and make sure we are best meeting the needs of our region.

Guest Speakers:

• Gary Herbst, Kaweah Delta’s Chief Executive Officer
• Hosted by Nevin House, Kaweah Delta Health Care District Board President

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Questions and Answers

The following questions were asked via social media for our virtual town hall on October 1, 2020

1. Can you go over the different types of masks? Are some better? Should we use disposable masks?

• Any mask is better than no mask. Even a scarf or other piece of clothing covering your mouth and nose is better than nothing. That said, an N95 mask provides the greatest level of protection but really should be reserved for healthcare workers and those people who are at greater risk of being in close contact with COVID-infected people. Medical grade surgical masks provide the next best level of protection, again generally reserved for healthcare workers and other essential workers at greater risk of exposure. General, non-medical grade masks do provide excellent general protection and are generally layered to create a mesh against viral molecules entering through the mask, and do provide ample ability to breathe. Lastly, washable, cloth masks also work quite nicely and are comfortable but don’t have the same layering protection and can sometimes be more difficult to breathe through.

2. A community member went to the Imaging Center at 4949 Cypress and noticed the signs about distancing but most of the chairs did not have a sign on them to sit apart. The patients were sitting right next to each other. Please make sure your signs are up to date and there is appropriate spacing between chairs.

• We had these sectioned off and then patients removed the signs.We have heavy duty tape on the chairs now and are having our staff at the front desk do visual assessments each morning to ensure our patients don’t move these barriers.

3. Why are the results of antigen tests not included in California's testing data? Couldn't that impact our test positivity and case numbers? Active case test positivity seems crucial to include.

• You are absolutely correct about the impact on our positivity rate and case numbers. If you go to the California CDPH website, they will tell you that for purpose of measuring a county’s positive rate, and their daily new case rate per hundred thousand population, the only test they will count in that measurement are PSR molecular based tests.They will not count antigen based test, which is very disappointing and confusing because it’s the state that deployed hundreds of thousands antigen based kits to all the nursing homes up and down the state.They have also implemented orders where we are to more frequently test our patients and test our staff.We do this, however, those results do not count towards the tiering to open up businesses and society.We run three different molecular based platforms, BD Max, Abbot ID Now, and BioFire, and soon will be adding a fourth, high-throughput molecular platform made by Perkin Elmer.This is coming at a time we have secured. 20 Quidel Sofia 2 analyzers and we now have 25,000 kits, with the goals of getting to 75,000.We have deployed these in Exeter and Dinuba and have gone live in those clinics.Soon to go live in Lindsay and our two urgent care centers.

4. Can you compare how many deaths resulted from the flu vs COVID? I would like the numbers and comparison.

• As of yesterday, September 30^th, Tulare County has reported 263 COVID-19-related deaths; based on a countywide population of 480,000 people, that translates into 54 deaths per 100,000 people; our County’s COVID death rate has held pretty constant at 1.6% meaning 1.6% of those who contract COVID pass away from it.By contrast, the CDC estimates that 24,000 to 62,000 people died of the flu in the U.S. between October 1, 2019 and April 4, 2020; with a U.S. population of 331 million people, that would translate into a flu-related death rate of 7.25 to 18.7 deaths per 100,000 people; in terms of what percentage of those who contract the flu actually die of it, the U.S. percentage ranges from 0.04% to 0.16%.In 2018, Tulare County reported 83 “influenza-like illness” deaths, or 17.8 deaths per 100,000 people; COVID-19 related deaths are 3.13 times greater than flu-related deaths in Tulare County.

5. Can you share any info on keeping healthy other than masks, hand washing, and not touching your face? Do you have any info on the effects of exercise, vitamin D, zinc, etc.? Any official opinion from you guys?

• Besides all of the great “anti-COVID behavioral habits” you referenced, our physicians and nurses advise everyone to try and eat healthy and consume foods that keep your immune system “supercharged” and elevated; do exercise, stay properly hydrated and get adequate sleep so you don’t get run down and make yourself more vulnerable to viruses and other illnesses.

6. Was overall testing lower in August due to shortages? And if so, has this been resolved?

• July was far and away our busiest testing month throughout the entire pandemic where we performed approximately 9,000 tests; that probably coincides with the greatest number of COVID-19 hospitalizations and ED visits that came on the heels of the July 4^th holiday; August testing did fall to a little over 6,000 tests due in some part to fewer COVID-positive or suspected-COVID visits to the hospital but not really because of availability of testing supplies.We have always had enough reagents to test all symptomatic patients who present to KD along with all asymptomatic patients who are going to have elective surgery at KD.With the arrival of our Quidel Sofia 2 antigen platform, we now have the ability to greatly expand our testing capability throughout the entire County.We are constantly updating our testing supplies.As recently as Monday night, we were confirmed to begin receiving higher volumes of molecular tests this week and thereafter.

7. If not due to shortages, is the reduction in testing due to less folks presenting, people being scared, wanting to get the positivity rate down, etc.?

• The reduction in specimen collection and COVID testing did fall even further in September to less than 5,000 tests; again, not due to lack of testing supplies but possibly because people are losing interest in being tested (less of the “worried well”) or they could be afraid of being tested because it means they have to quarantine and be off work or separated from family.If our local population does not submit to testing, it will be very difficult to correctly assess the true positivity rate of our area.Only through comprehensive testing programs that include as much of our population as possible will we be able to truly know what our infection levels are.

8. If someone does not have symptoms they do not need swab testing unless they work in a medical industry that demands it. I wish all hospitals in the valley would report number of COVID Only numbers and not the 15 symptoms that are related to COVID.

• If we only swab those people who are exhibiting symptoms, we are likely to always have a positivity rate that is above the Governor’s thresholds for moving into less severe COVID tiers that would allow our businesses and society to open up more.We have to prove to the Governor and State Health officials that fewer and fewer people in Tulare County have the virus and that our behaviors are having a real impact.On our public website and social media platforms, Kaweah Delta only reports the number and percentage of patients that were actually swabbed and tested positive; we do not report people that had other COVID-type symptoms.

9. Can asymptomatic people be tested at any Kaweah Delta facility?

• Yes. Beginning Monday, September 14^th, Kaweah Delta began COVID-19 testing at our Exeter Health Clinic on the recently-deployed Quidel Sofia 2 antigen-based testing platform. Anyone can make an appointment at the Clinic by calling our COVID-19 hotline at 624-4110. You can also simply show up to the Clinic and ask to be tested. While this test will return results in as little as 15 minutes, we are generally trying to batch them and run them in groups throughout the day and call people with results that evening or the next morning. This testing capability also went live at our Dinuba Clinic this past Monday and soon will be deployed to our Lindsay Clinic, and our two urgent care centers located on Court Street and Demaree; it is also available at Visalia Medical Clinic through the Kaweah Delta Medical Foundation.

10. If you do not receive a rapid test, how long does it take to get results?

• If you are symptomatic, we recommend you see your physician and have them order a test to be collected by Kaweah Delta at our specimen collection site on Court Street, or call our COVID-19 hotline at 624-4110.We will likely test it that same day and have results for you that same day or the next day.We may run your specimen on a molecular platform, if supplies are available, or on the Quidel platform, which is a rapid test platform.If you have your specimen collected by your personal physician or a non-Kaweah Delta clinic or specimen collection center offered by the State, they likely are going to send it to a commercial lab such as Quest, and the results may take anywhere from 2-4 days, or longer, to be available.

11. Do you think the uptick in positive staff has to do with the newly relaxed standards for testing patients being admitted?

• I don’t think so.With all of the PPE and precautions standards we continue to refine, not relax those stands. I think very few, if any, of our employees are contracting the virus while in the hospital; there has been an uptick in the number of infected employees but I believe they were infected outside of the hospital in other settings, similar to the slight uptick we have seen at the County, State and National levels over the past week or so.The medical team has not changed its process in testing patients being admitted to the hospital.They continue to test symptomatic patients and screen patients for symptoms every shift in their assessments.We have continued to follow the CDC guidelines on retesting after someone has been positive.Once someone is positive the CDC does not recommend testing them again for 90 days due to the length of time the virus may be present in the patient.We have implemented the CDC Transmission Based guidelines for isolation of the patients.

12. Are the healthcare workers regularly tested? An employee who’s currently working there says it’s only done if asked for. Seems it should be mandatory since working at the hospital is high risk.

• Any employee who exhibits COVID-like symptoms or believes they have been exposed to someone who has tested positive for COVID should be tested as arranged through our Employee Health Department.We currently have 30 employees who have tested positive for the virus and are on a COVID-related leave of absence as well as 6 other employees who have not tested positive for the virus but have been asked to quarantine for 14 days because they live with someone who has.Also, under a new State law, we must now perform frequent COVID testing on all KD employees who work in our skilled nursing units located on Court Street and on our West Campus; we will be using the “nares-based” swab test on them using our new Quidel Sofia 2 antigen analyzers.We also screen all 5,000 of our employees, organization-wide, every time they start their shift based on temperature and signs and symptoms.

13. What is the financial health of Kaweah Delta? Have all of the previously laid off staff returned? Are you anticipating more lay-offs?

• The coronavirus pandemic has certainly had a devastating financial impact on all hospitals across the nation, including Kaweah Delta. Fortunately, some of that devastation has been mitigated by CARES Act funding relief provided to hospitals by Congress. Kaweah Delta would have sustained a $32 million operating loss for its fiscal year ended June 30, 2020 if not for $14 million in federal stimulus funds we received in April and May; with these funds, our operating loss was reduced to $17.6 million; still the first time in our history that we incurred an operating loss for a fiscal year. July and August were still financially challenging with a $2.6 million operating loss in July followed by a $4.6 million loss in August; but, again because of federal stimulus monies we received in July, our two-month “bottom line” actually ended at a positive $194,000. We have one more month of stimulus funds for September but then it runs out.
• With respect to staff, we have not brought back any staff that were permanently laid off over the course of the pandemic. Where we have had to temporarily furlough staff, like those of the Lifestyle Center, we have tried to find other temporary positions for them in our organization using our Labor Pool program. As for future layoffs, we will do everything we can to avoid them but we really don’t know what lies ahead. With our Board’s approval, we have budgeted to only “break-even” this year; a zero operating margin, something that has never been done in the history of Kaweah Delta but was the right thing to do in this unprecedented time.

14. Can you please include a chart on your daily COVID reports that includes daily cases/100k, COVID patients, and the positivity rate to match the state’s new tier 4 requirements?

• Our daily COVID Dashboard only reports information about Kaweah Delta patients, including number of positive cases, positivity rate, hospitalizations, etc.The information you are looking for comes from the County Health Department and speaks to the entire County population which is what the State uses when applying their tier system.If you go to the County website at:covid19.tularecounty.ca.gov you will find the County’s dashboard that displays its Positive Test Rate over the past seven days (7.7% as of 5:00 P.M. on September 21^st) and New Cases per Day per 100,000 people (reported as 9 as of Tuesday, September 29, 2020).

15. Do you have information on whether the people hospitalized with COVID-19 at KDDH have preexisting conditions? The CDC changed their guidelines and separated deaths from only COVID vs death from COVID with a comorbidity? Is there a report that shows the co-morbidities in patients tested, patients hospitalized, patients sent home, or patients who passed away?

• Most everyone who has died of COVID-19 at Kaweah Delta had one or more underlying chronic health conditions referred to as co-morbidities.Those most common were uncontrolled diabetes or hypertension, obesity, COPD, congestive heart failure, asthma or some other chronic respiratory condition.We are currently developing a new slide for our daily dashboard that will display the most common co-morbidities that we see in hospitalized COVID patients, by prevalence.Often times, those patients that die of COVID have more than just one chronic disease.

16. There are so many misconceptions about what you get "paid for COVID diagnoses and deaths". Can you please explain this again to help clear those misconceptions up? (Keith G. Rafferty)

• Since inception of the coronavirus pandemic, Kaweah Delta has admitted 904 patients where COVID-19 was their primary diagnosis and the primary reason for their hospitalization.As of August 31^st, we have fully coded and billed for 676 of these inpatient cases.Of these 676 cases, 52% were Medicare, 28% were Medi-Cal, 18% were covered by commercial insurance or workers’ compensation and only 2% were uninsured.These patients stayed in the hospital 10.3 days, on average, roughly twice as long as a non-COVID patient with acute respiratory failure.The total cost of caring for these COVID patients was $20.1 million, or $29,800 per case.We were reimbursed on average by the various payers at $21,000 per case, resulting in a total net loss of $5.9 million on these 676 COVID-19 cases.On April 1, 2020, the Medicare program increased the reimbursement rate for a patient who is admitted for acute respiratory failure and is positive for COVID-19 by 20%, increasing the per-case reimbursement rate from $16,000 to $19,200; we get paid this same exact rate whether the patient is successfully discharged from the hospital or dies in the hospital because of the virus; unfortunately, it costs, on average, $29,800 to take care of these patients due to their much longer length of stay, more intense physician and nursing care, medications and other treatments.No other payer besides Medicare has increased the payment rate they make to hospitals for taking care of COVID patients.

17. Are you able to let the community know how many successful COVID 19 extubations the hospital has had? (Jeanette Rodriguez)

• Of the 904 COVID-19 inpatients admitted to Kaweah Delta throughout this entire pandemic, 103 of them had to be intubated of which 30, or 29.1%, were successfully weaned off the ventilator.

18. What is the number of COVID-19 deaths at Kaweah Delta?

• Since the beginning of the pandemic, there have been 263 COVID-19 related deaths reported by the Tulare County Health & Human Services Agency.Of those, 146 have died at Kaweah Delta.119, or 45%, of all County COVID-19 deaths were associated with patients of nursing homes.

19. Why are doctors telling people who have had COVID-19 that they are immune for four months, even if it isn’t true? Why aren’t the “second-rounders” being reported that get COVID not long after recovering the first time?

• I’m not personally aware of any physician telling their patients that they have immunity for four months after they have recovered from COVID-19 as there is no scientific evidence to support this statement. I would certainly be disappointed if a Kaweah Delta physician was making these statements. It is true that some scientists do believe that there is possibly a period of immunity after recovering from the virus but nobody knows for how long or how effective that immunity would be. We have had employees who tested very strongly for the COVID infection but then a few months later took an antibody test which turned up negative for COVID antibodies. This would suggest that some people may not develop antibodies after contracting the virus or the antibodies may only stay around for a short period of time. As for “second-rounders”, we don’t believe that we have seen any patients, employees or physicians who have contracted the virus more than once.

20. Kaweah Delta was struggling to find nurses before the pandemic, what does its workforce look like now?

• Staffing has greatly improved from what it was just a few months ago.For one thing, of the 369 employees that were on a COVID-19 leave of absence, only 30 of them remain out on leave.We, and they, are so delighted to have all of our recovered employees back to work.We also have had tremendous success over the last several months hiring and onboarding many, many new nurses.
• Since March 1^st, we have hired 206 new, bedside nurses (170 experienced, external hires and 36 new grads) and have 19 more that have a pending start date; for comparison, we hired 218 new nurses in all of 2019); we’ve also hired 53 nursing students to gain bedside experience, support our hospital operations and build our future RN bench; we also have 29 contract “traveler” RNs and 4 travelers working in imaging and lab; and have just recently hired 6 new nurses to support our specimen collection center now located on Court Street.

21. What is the timeline for a COVID-19 vaccine to reach hospitals?

• The $64 million question.While we must first begin with a proven-effective and safe vaccine, there are something like 21 different logistical steps that much be accomplished to move the vaccine from the scientist’s laboratory, into mass production, distribution, and inoculation into a person’s arm.Will it be a one-step vaccination or two-step?We still don’t know that.Which vaccine should people take as it appears there will be many on the market?Where will all the hospitals purchase freezer’s that can maintain vaccines at minus 70 degrees?

22. Have we learned anything new about COVID-19 that will help us combat the disease going forward?

• I can’t begin to adequately describe how much we have learned about combatting the coronavirus over these past seven months.Definitely the need for plentiful and effective Personal Protective Equipment, particularly N95 masks that were so rarely used before this pandemic; the creation of many more negative pressure and isolation patient rooms (we just purchased 30 brand-new HEPA filters); the proning of intubated patients (gently rolling them onto their stomachs); the early use of relatively-effective medications like Remdesivir and Dexamethasone; the greater application of non-ventilator breathing support for patients; how to better communicate with family members through formally-scheduled telephone calls and “Facetiming” when strict visitation rules are in place; clearer communication with our staff around constantly-changing and confusing information coming out of the CDC and State; and many other things.We also have seen the benefit of the community wearing masks and limiting social gathering sizes to decrease outbreaks.This has also shown that we can keep the spread in check and protect ourselves.

23. Will Kaweah Delta be allowing visitors soon? Are the visitor’s policy rules the same for the ED, inpatient rooms, and the Rehabilitation Hospital?

• Ever since Kaweah Delta, along with almost every hospital across the Country, implemented a strict “no visitor” policy to protect patients, the public and staff, we have continuously evaluated when could we loosen up our visitation policy as we know visits by friends and loved ones can greatly improve healing, recovery and communication between patients and caregivers. We have relaxed our visitation restrictions in our ICU and are currently considering allowing every patient at least one unique visitor per day during certain hours. With COVID numbers staying down over the past several weeks, this loosening of the policy feels more and more safe.
• With respect to our current visitor policy, we have always made exceptions for end of life patients, patients with special needs (i.e., developmentally disabled or patient unable to communicate), patients who are going to undergo critical surgery (e.g., open heart, neurosurgery, etc.), the birth of a child, a pediatric patient, etc.—this is the same for the ED and KD Medical Center patient units.With respect to our acute rehab hospital, we allow only approved visitors which does include family members who are coming in for family training or interpretation assistance.In addition, the ER will allow 1 visitor back into the exam and treatment areas at the discretion of the charge nurse and provider.As previously mentioned, we will likely begin to loosen our visitor restrictions within the next 2 weeks or so.

24. Are you close to finishing construction on the Emergency Department?

• Conservatively speaking, we are anticipating being done with construction around April 1, 2021 and ready for occupancy and patients by June 1, 2021.This will fully complete the three-phase expansion of the ED, essentially doubling the number of exam rooms and the waiting room.

25. Do you have an update on the Lifestyle Center? Some gyms are already open in Tulare County. Why isn’t the Lifestyle Center open?

• According to the Governor’s tiered approach to reopening businesses, gyms can only open when a county moves into the red, Tier 2, “Substantial”, not “Widespread”, after having fewer than 7 new COVID cases per day per 100,000 people and a positivity rate of less than 8%.CDPH releases every county’s Tier rating every Tuesday; a county must remain in the same Tier at least for 3 weeks before it can further advance; Tulare County has been in Tier 1 for the three-week period and would be eligible to advance.To advance to the next Tier, you must have achieved and held both thresholds for at least two weeks prior to moving into the next Tier.While Tulare County is still in Tier 1 and not eligible to advance into Tier 2, certain gyms in Tulare County are knowingly violating the Governor’s Executive Order.Kaweah Delta has chosen not to do this but is doing everything we can as an organization to help our County meet the COVID criteria that would allow the Lifestyle Center to open back up.In the meantime, we are operating a daily “day camp” for the children of our doctors, nurses and other healthcare heroes to allow them to be at work while their children are in “virtual school”.

26. Does Kaweah Delta have rapid testing availability?

• Yes. The Quidel Sofia 2 antigen-based platform uses immunofluorescence lateral flow technology, along with ultraviolet light, to detect the presence of the COVID-19 protein. Through a simple swab of the nostril (“nares”), the analyzer produces test results within 15 minutes. We have deployed these devices to VMC and our Exeter and Dinuba Clinics and will soon deploy them to our Lindsay Clinic and our two urgent care centers. We generally will batch specimen collected throughout the day and run them at the end of the day, giving results to patients that evening or the next morning.

27. Are testing supplies getting easier to aquire?

• Yes, and no. We now have close to 25,000 Quidel antigen-based test kits and see an increase on the horizon for more plentiful Abbot ID Now molecular-based test kits but supplies for our BD Max PCR molecular platform tightened up. That said, in about five weeks, we will stand up our new Perkin Elmer PCR molecular platform that appears to have an unlimited amount of testing supplies available to us.

28. Should more “healthy” people get tested to drive our numbers down?

• I hope I don’t get in trouble for saying this but I think the short answer is “yes”; at least for people that don’t have any symptoms but think they might have been exposed. This is the population that we worry about the most: those that are infected and contagious but don’t know it. At the same time, we do want to better understand the broader exposure and infection in our population and that can’t happen without more widespread testing. Two weeks ago we tested many of the teachers and staff at the schools that applied for waivers to reopen on-site schooling; they were all healthy but are now included in test results. We would also like to test first-responders and other essential workers as well as the general population.

29. What effect will the flu and cold season have? Any prediction on how bad the flu season is going to be this year?

• Hard to say but if we stay vigilant in our hand-washing, masking and social distancing, I think it is highly likely that we will have a mild cold and flu season. The southern hemisphere of the word, like Australia and New Zealand, just finished their cold and flu season and reported a very light one, in large part to social behavior. That said, the winter months drive us indoors where COVID and the flu are more productive and it will be hard for us to resist social gatherings for the holidays. No matter what happens, Kaweah Delta will be ready to care for our community.

30. Should we use face shields in place of masks?

• No. In the hospital setting where our staff are knowingly taking care of a COVID-positive patient and are going to perform an aerosolizing procedure, like intubation or a breathing treatment, we have them wear both an N95 mask and a face shield because of the much-greater risk of exposure. While a face shield alone will protect your eyes and face from a straight-on sneeze or cough by another person, the coronavirus is carried by micro-droplets that would fall from your mouth or nose and could be inhaled or touched by someone near you or visa-versa. A mask keeps your droplets contained within your mask, the primary reason we wear masks in public, but also protects you from inhaling the virus. That said a mask doesn’t protect your eyes and micro-droplets could land within your eyes which may cause some people to want to wear both. Remember that you rarely would contract the virus by simply walking by someone who was infected; you generally have to spend some time in close contact with them.

31. Where are we seeing most new positive cases (age bracket, location, type of transmission)

• Over the past 14 days, our age distribution has been as follows for percent of patients testing positive and patients admitted to Kaweah Delta Medical Center:

	COVID+ Tests	COVID+ Inpatients
Age	Percent	Percent
0-9	7.8%	0.0%
10-19	10.9%	6.7%
20-29	18.1%	6.7%
30-39	15.0%	9.3%
40-49	14.0%	5.3%
50-59	13.5%	16.0%
60-69	7.8%	24.0%
70-79	7.3%	13.3%
80+	5.7%	18.7%

• Recent case distribution: Tulare (198); Porterville (177); Dinuba (95); Visalia (93); Farmersville (29); Lindsay (25); Orosi (23); Strathmore (22); Cutler (18); Exeter (15); everyone else below 11.
• Tulare County ranks 14^th out of 58 counties in terms of number of cumulative confirmed cases and deaths but ranks 4^th in confirmed cases per 100,000 people and 5^th in deaths per 100,000 people. Over the past seven days, Tulare County ranks 14^th in percentage increase in new cases and 17^th in percentage increase in deaths.
• Overall the state continues to head in a good direction, exemplified by 6 of the Top 23 counties (those 23 counties with the most cumulative total cases) advancing to less restrictive stages Tuesday. Fresno, Sacramento, San Joaquin, Contra Costa, and San Bernardino moved from purple to red, and San Francisco moved from red to orange. While Tulare County did not advance this week, she did make progress as the positivity rate went from 7.7% to 6.0%, and the adjusted daily case rate went from 11.7 to 9.2 per 100,000 people. The state’s overall positivity rate is at 2.9% this week, up very slightly from last week’s 2.8%.

32. How will we know when things are safe again?

• The word “safe” is a relative term. We are “safe” right now if we, and others, consistently and constantly practice good behaviors of masking, hand-washing and social distancing. But if we want to stop doing these things, then we will only be safe in that kind of environment if we have widespread immunity created by an effective and safe vaccine or natural immunity through exposure.

33. Are some hand sanitizers better than others? What are the tricks health care workers use to avoid having their skin raw from cleaning?

• First, remember that while hand sanitizer kills germs, only soap and water actually kills and removes the germs from your hands. In the absence of soap and water, any hand sanitizer with alcohol content above 60% is good; brand does not make a difference in quality. Hand lotion is helpful for dry hands, but also using soap and water in lieu of sanitizer during the day can be helpful – the alcohol content in sanitizer causes the skin to dry with repeated use.

34. What is the status of elective surgeries at Kaweah Delta? Are those happening more frequently?

• We officially resumed elective, non-emergent inpatient and outpatient surgery back on May 18^th. At that time, we started off allowing only a limited number of elective inpatient surgeries each day in order to preserve inpatient bed capacity in the event of a major surge. Throughout 2019, we averaged 893 surgery cases per month; for the first three months of 2020, that number fell slightly to 887, primarily as we started shutting down elective surgeries in mid-March; for April 2020, that number fell to only 506 but then crept up to 769 in May as we started to “re-open” surgery. In June, we performed 995 surgeries, perhaps our highest number in history as we tried to catch up the backlogged surgical schedule; July tapered off to 918 as we began to experience a resurgence in the virus, and it stayed down through the intense month of August as surgical volume fell to just 782. However, as the virus has again began to subside, we continue to add more and more elective surgeries each and every day. I also want folks to know that it is extremely safe to come to Kaweah Delta and have surgery. We COVID test all elective surgery patients 48-72 hours prior to surgery, only perform elective surgery on non-infected patients, adhere to very strict universal precautions with constant disinfection and sterilization, and wear full PPE before, during, and after surgery. Deb Volosin said I could share with you that she had recent gallbladder surgery here at Kaweah Delta five weeks ago and experienced nothing but safe, compassionate and wonderful care. Thank you Deb for sharing.
• Lastly, while I wouldn’t consider this to be an “elective” procedure, although the “planning” for it might have been, we excitedly and happily delivered 2,575 babies over the course of this pandemic. Great job moms!!!

35. Can you explain exactly how herd immunity works and if a vaccine is needed before herd immunity can even be considered?

• Herd immunity occurs when enough people become immune to a disease to make its spread unlikely. As a result, the entire community is protected, even those who are not themselves immune—called “indirect protection” or “herd protection”. Herd immunity is usually achieved through vaccination, but it can also occur through natural infection. Depending on how contagious an infection is, usually 50% to 90% of a population needs immunity to achieve herd immunity.
• Chickenpox is a disease that parents use to intentionally expose their children to before the varicella vaccine was developed; this was a way of creating herd immunity through “natural infection”. But the consequences of contracting chickenpox are relatively mild and rarely result in death. Viruses like COVID-19 carry a much higher risk of severe health consequences and death. Trying to create “natural infection” herd immunity for COVID-19 would overwhelm hospitals and cause many deaths before we ever reached the 50% to 90% immunity we would need to have “herd immunity”. In the case of COVID-19, we really need to depend on an effective vaccine to create herd immunity

36. When this all first started, COVID 19 was being talked about solely as a respiratory virus. In more recent months, that thinking seems to have changed somewhat. Has it changed, and, if it has, does that mean the virus has mutated?

• COVID-19, which stands for “Coronavirus Disease 2019”, is scientifically called SARS-CoV-2, which stands for Severe Acute Respiratory Syndrome Coronavirus 2. It is first and foremost a bad respiratory virus. If your immune system doesn’t defeat it at its landing site in your nose or throat, it will advance down your windpipe, infiltrating the cells lining your lungs’ branching air tubes. At the tubes’ ends, tiny air sacs called alveoli pass oxygen to your blood. As the virus multiplies, the alveoli may fill with fluid, shutting down this critical gas exchange. Your blood-oxygen level may drop and, typically, about six days into an infection, you may start feeling short of breath.
• Interestingly, unlike the flu, COVID-19 isn’t an aggressive killer of human cells but it does often times trigger an immune attack within minutes of entering the body. Scientists and doctors believe that this extraordinary and complex attack by our immune systems is often times what leads to intubation and death.
• But, to your question, scientists and doctors are also seeing that COVID-19 can cause muscle weakness of the heart, inflammation, arrhythmias, and even heart attacks. Neurologists worry about COVID-19 caused headaches, “brain fog”, dizziness, delirium and even strokes. Nephrologists worry about kidney stress and failure. Whenever organs are robbed of oxygen-rich blood, they are at risk of failure. We have seen a number of COVID-19 patients who have died of sepsis where multiple organ systems fail and lead to death.

37. Is there any definitive research or have there been any definitive studies that prove wearing masks prevents the spread of COVID-19?

• In March 2020, Mass General Brigham (MGB), the largest health care system in Massachusetts, with 12 hospitals and more than 75,000 employees, implemented a multipronged infection reduction strategy involving systematic testing of symptomatic employees and universal masking. MGB was experiencing a positivity rate of 21.3% before it instituted its universal masking requirement; after implementation, they saw their positivity rate drop to 11.46%. They attribute the majority of the decline to wearing of masks but also acknowledge that not all masks are the same and that some are more effective than others in protecting each other from infection.

38. How much did the hand-wash monitors that have been implemented at different stations cost to install?

• We rolled this out slowly, starting with a couple units first as pilot units to evaluate the effectiveness. couple units as pilot unit.They were so effective though and our hand hygiene compliance rate went from around 60% to almost 99%.It was pretty convincing since we know that hand hygiene is the most important thing we can do to avoid a patient acquiring an infection.The final cost was $250,000 to roll out to our whole medical center.We are going to hardwire the technology in the acute medical center and look to roll it out at other area across the organization.

39. A community member attended the virtual Board meeting and was surprised that none of the board members or staff were wearing masks. Can Mr. Herbst and Mr. House explain to the public why, as elected officials and high level civic leaders and staff in charge of our most critical health care, they are so cavalier with their own adherence to necessary public health care behavior when they should be setting the highest standards at all times?”

• Every meeting room that we have throughout the organization, including the LifeStyle Center’s meeting room where we held the board meeting, there is a stated legal capacity. The State and County have set the maximum capacity at 25% of that stipulated legal capacity amount. If that large meeting area had a normal capacity of 100 people, the most we could have in there is 25 and so on. We strictly adhere to that requirement of the County and of the State. If you saw, we were all spread out. Everyone comes into the meeting wearing a masks and sits down at their assigned seating area with their mask on. When you get up to leave the room, use the restroom, etc. you put your mask back on as you leave. Even when we have guests come in for recognition, we require that they wear masks and when we stood by them, we stood six feet apart. Everyone is distanced at least 6 feet apart. I know it is difficult to gauge distance virtually, but we are very spread apart and adhering to all the CDC’s recommendations and the County and the State.

40. We have high obesity number which causes complications with COVID-19. Why isn’t Kaweah Delta more focused on healthy lifestyle and changes.

• We are.We are moving more towards population health management, preventative care, and health and well-being. We are a designated medical-based fitness center.Our clinics are focused on preventative care and working with our patients on lifestyle and eating. There are certainly more we can do.

41. What is the cost of the quick turnaround testing at the Visalia Medical Center and the site in Dinuba. Some information say it is free, other information says there is a charge.

• If you’re having it done on the rapid results platform, there is no cost.Through a partnership with Tulare County who received CARES act funds, the county is paying for the cost.There is no fee to a patient to have the test done. However, it is best for your physicians or healthcare provider to check you out if you’re feeling unwell, especially if you are displaying symptoms.

42. Why isn’t there more antibody testing to determine how much spread we have already had in the community?

• There is. In fact, anyone that wants to get tested for the antibodies, please call our hotline or call your physician and they will submit orders to get you tested.

43. What is the rapid COVID test detecting? The virus itself?

• The PCR tests, in general, look for the actual virus genetic material like viral RNA.

44. Can schools work with Kaweah Delta to set up testing for their teachers and staff?

• Yes, please contact Deborah Volosin in Community Engagement and she will make sure you are connected to the appropriate department. Her number is (559) 624-2529.

45. What is Sweden doing differently that they are at near zero deaths per day?

• We are not familiar with Sweden’s practices, but according to an article in The New York Times, Sweden’s initial choice to not close their country caused them to have the same death rates, especially in nursing homes, as the United States. Some experts are wondering if they are in-between their peak surges or if they have truly suppressed the virus in the country by “getting the masses sick early on”.