♪♪ Scott: What's it really like in our hospital, emergency rooms, and ICUs, and where are we going from here?

Joining us today to tell us what's happening on the front lines are Sutter Health'’s Dr. Peter Hull, UC Davis Health'’s Dr. Nate Kuppermann, Kaiser Permanente Senior Vice President, Trish Rodriguez, and Dignity Health'’s Dr. Todd Strumwasser.

Dr. Strumwasser, what is it like for a patient entering into the ER with COVID-19 today?

Dr. Strumwasser: Well, thank you very much for the question, Scott.

And thank you for asking me to be on this panel.

Um, we are living in very unique times right now.

We are now seeing, uh, it's January 13 of 2021, we're seeing a rather significant surge in pretty much all the California hospitals.

Um, so coming into the ER right now, um, I think, um, for the most part in California, and specifically in Sacramento, you're going to see a fair number of either COVID patients or patients who suspect they have COVID.

Uh, um, there- unfortunately, um, we have more patients in our hospitals, inpatients with that diagnosis than we've ever had before of the six hospitals in the Sacramento area, we are over 200 positive COVID patients.

So, people will be wearing PPE.

They'll be protecting themselves, they'll put a mask on the patient themselves, but nonetheless, these are rare times that we're living in, um, I just want to say that we are going to get through this.

We are taking good care of our patients, but more importantly, what we're doing right now, that's most- that's very significant is we are trying to vaccinate as many people as possible because quite honestly, vaccination is the only way out of this pandemic.

We've got vaccines we just need to get the bodies to give the shots in the arms.

And I'm very hopeful that we will be, uh, getting through this within the next few months.

Scott: And we're going to be talking about that in a... in a few moments, but Trisha, I w-— I would like to know, uh, in the Kaiser system, you... you take care of so many patients throughout the region.

How burdened are your ERs and ICUs at the moment?

Ms. Rodriguez: Thanks Scott, um, and happy new year, everyone.

And, you know, first I want to express my gratitude to all of our employees, our physicians, clinicians, for what they're doing and how they're dealing with this impact, Scott, um, and it's significant.

Uh, we are not under normal operating conditions.

We have surge areas open and our goal is, and always has been, is to, uh, provide a high-quality safe patient care, and we're doing that.

Um, but it is not, uh, it's not normal operating conditions.

And, um, so especially grateful for how our teams are responding and, you know, they're ready for this.

Um, uh, Kaiser South Sacramento, uh, is a, uh, certified CDC Ebola treatment center so, we understand infectious disease.

And this is, um, this is, um, what we do, but not normal conditions.

And so, I, again, just gratitude for all of our staff.

Scott: Uh, Peter.

I...

I am curious, when I drive past, uh, your facilities, you know, it looks like business-as-usual outside.

What is it that we as patients are not seeing, um, from the outside in that you and the rest of your colleagues, uh, have to deal with every single day?

Dr.

Hull: Thank you, Scott.

And I appreciate the opportunity to be able to be on this, uh, panel and be able to speak today to, uh, you regarding, uh, the state of healthcare today, um, in January in 2021.

Um, we feel very fortunate that oftentimes for patients, they may not feel a huge difference in the care that's being delivered.

If you walk into the emergency department and you're having symptoms of, uh, stroke or, uh, chest pain, you... you may not realize that this pandemic is ongoing because we've... we've accommodated, um, and learned over the last several months, how to be able to deliver care, um, across the... the Sutter Health footprint in Northern California.

We've been able to, um, share our resources and be able to allow ourselves to, uh, continue to provide care for all the patients that are arriving.

That doesn't mean that it isn't, uh, challenging as, um, as Trish and Todd, uh, referred.

We are, um, taking care of patients in places where we haven't always taken care of patients, but we continue to be able to deliver that care safely and effectively in a way that benefits our patients and makes sure that our... our staff and physicians are kept safe.

Scott: Mhm.

Dr. Kuppermann, what part of our regional health care system, from your perspective, is the most fragile at this moment and-— because of the utilization that has been a consequence of the pandemic?

Dr. Kuppermann: Yeah.

So, uh, thanks, uh, Scott, and again, I also am very happy to participate on this panel on the show.

So, there are a couple of issues that I think, um, are fragile.

Now, in Northern California, we certainly have had a surge but not like our sisters and brothers in Southern California.

Uh, but two things that I would say that are relatively fragile, first of all, is the capacity for intensive care unit beds.

So, if you walk into our emergency department right now, the total volume of patients is less than it was a year ago.

But, um, the number of sick patients that are waiting for... for beds who have COVID disease is much greater than it was before.

So, our capacity to care for intensive care patients in the region is challenged.

Fortunately, at UC Davis, like other systems, we have great accordion capacity so that even though we don't have very many ICU beds free right now, we can accordion our capacity to accommodate much more.

So, that is the one challenge that I think our region has, is in terms of ICU beds.

The second is the distribution of the vaccine.

And to echo what one of, uh, I think, uh... uh, Peter had said is that this is a race.

It's a race between getting the vaccine into the arms of the population and the spread of this really, you know, dastardly virus.

And I think one of the challenges we have is in distribution.

The vaccine has been an incredible piece of science that we came up with, these incredible vaccines, over, uh, over a 1-year time period.

But the distribution has lagged behind, for a number of reasons, and we, like other regions, are challenged by that.

I will just comment that one of the things that I'’m feel very fortunate at UC Davis, not only do we care for, uh, a disproportionate number of the underserved, uh, and the very sick in our, uh, in our regional population, but we're actually involved in the discoveries that are helping sort of mitigate the disease.

So, we've been involved with the randomized trials of, uh, vaccines.

We're in the- involved with the randomized trial of what's called convalescent plasma-— that is plasma from patients who have recovered from the illness to see if that helps outpatients prevent worsening.

But those are the two big- biggest challenges in my mind, ICU capacity in the region and distribution of the vaccine.

Scott: Hmm.

Trish, you work on so many issues, uh, not just on behalf of Kaiser Permanente, but throughout the region.

How is it that, uh, from your perspective, the health systems are best working together in order, not only to address the acute treatment issues, but also, uh, to Dr. Kuppermann'’s point related to the issue of the distribution of vaccines.

Ms. Rodriguez: Well, uh, good question, Scott.

You know, um, one of the... the great things that we have here in the Sacramento area is the cooperation between our healthcare facilities and health plans.

You know, almost on a weekly basis, the, um, CEOs and the leaders from the hospitals and health systems are working together on many fronts, whether it's, um, you know, understanding how we're all affected in the system, to just recently having a discussion with Dr. Kasirye and other leaders on how we get vaccinations done and really a call to action if I-— if you will.

And how do we collaborate since we already all have systems in place for vaccinations, how do we collaborate and create good in the community.

Um, and especially for that, the next level of vaccinations.

So, I am so grateful for our partnership, um, and the understanding that we have about helping each other out, um, which is a benefit to our community.

Scott: Uh, Dr.

Hull, as a healthcare leader, I'm curious, um, I'm sure that you read the papers and watch the news.

And, uh, most recently, there was, uh, a party at Eddie Murphy's old mansion in Granite Bay that was seen or reported on as a super spreader event.

When you look at what it is that you and your colleagues are dealing with over at Sutter on a daily basis and trying to care for people who have been afflicted by the pandemic and you see events like that, how does that personally impact, uh, your feeling about the work that you're doing and... and what you're trying to solve?

Dr.

Hull: Um, yes, Scott.

It certainly is impactful.

Um, we, um, I-— I've heard of that... that event and others that are similar and people in the community who, uh, quite frankly, just don't embrace, um, how challenging this disease can truly be.

Um, we know that these events are, um, often born out of people not feeling like they... they... they see a risk anymore and unfortunately that just is not true.

I mean, I work in the emergency department at Sutter Roseville and so that is my community.

And the people that attend a party like that, and then end up coming to the emergency department in dire need of... of care for their infections, um, are placing our staff at risk, and unnecessarily so.

So, it's really challenging.

We... we work very closely with the county and state to make sure that we're adhering to the guidelines.

And as, uh, others have said, we're working, uh, as quickly as possible to make sure we can vaccinate as many people as... as we can.

But we're still left with a public that seems at times to not fully understand the... the significance of this infection and what each individual can do on a daily basis to, um, reduce that risk, which are very basic: wash your hands, wear a mask and, um, social distance.

Which obviously, um, you can't do in a... in a large party indoors.

So... Scott: Dr. Strumwasser when... when, uh, I hear Dr.

Hull's comments and I think about, um, the professionals that are working to take care of all of us, I not only think about one, the reaction to seeing superspreader events, like the one that we were just talking about, but I also wonder about, uh, the resiliency and the emotional wellbeing of, uh, the... the healthcare professionals in our ERs and ICUs and health... health systems.

How does... how does seeing those things affect them when they're dealing with so much?

Dr. Strumwasser: No, that's a great question, Scott, I'm glad you asked.

Uh, you know, I...

I...

I finished medical school in 1981 and the closest thing I ever had in my career to dealing with this kind of thing was the AIDS epidemic.

But you know, when I was dealing with HIV positive patients, I didn't have the kind of fear that the caregivers have now of actually contracting the disease by caring for these patients.

So, I want to just say right up front, you know, all of our caregivers, our physicians, our nurses, respiratory therapists, environmental service workers, all of them are putting themselves in a very precarious position by caring for these patients who did ...they're being heroes.

Um, now with PPE, they're... they're safe, but nonetheless, there's a constant fear of... of potential exposure that going to work and worrying about whether or not you're going to bring back the disease to your family and your friends is a very stressful experience that our caregivers have.

It's a contributor to the burnout, it's a term being used of the moral injury our patient- our... our caregivers have in these periods of high stress when they're pulling extra shifts, they're taking care of patients in extreme situations, watching patients come in very sick, some of whom are not making it.

Um, this adds up, it takes a toll on the wellbeing of our caregivers.

We're really encouraging all of them to take time for self-care, to use the resources that we have in our organization, uh, to seek the help of qualified others, social workers, psychologists, so that we can all get through this and be, um, intact emotionally at the end of it.

I think that's a really important thing.

And, um, Scott, before I...

I...

I... end, and I do want to, um, loop back to something that, um, uh, Nate was talking about, about the vaccine as well.

I think it's important that we use this particular moment in time to debunk the myths that are out there about this vaccine.

These vaccines, particularly the Moderna and the Pfizer are proven, they've gone through phase three, they're safe, they're 90 to 95% effective.

There is really almost no reason why everyone shouldn't get a vaccine.

So, there's a lot of worries about - out there about, you know, 5G, whatever, whatever.

Please be assured, these have gone through clinical trials.

They're not only safe, they're efficacious.

And this is the only way out, is to have as many people vaccinated as possible.

So, I just think that we need to all get that message out.

Scott: Hmm, it... it's interesting you raise that.

Dr. Kuppermann, I'm curious from your perspective, one of the-— you know, there are a number of things being talked about related to the vaccines, as recently, uh, as this morning.

Uh, it seems that there's been a change in strategy at the federal level.

And, uh... uh, the talk is well, let's democratize access to vaccines, let's maybe give everybody one shot.

Maybe we base vaccine delivery on, uh, impacting the geography where the hotspots are.

Do you have any thoughts on, um, vaccine distribution and how we get from where we're at today, not just locally, but nationally and where we need to be?

Dr. Kuppermann: Yeah, I certainly do Scott, but I would love to piggyback on something that Todd said.

And I promise I'll get back to that question, but there's two, um, uh, messages and I... and I would hate to lose the opportunity because I do think this is, uh, a moment, uh, as Peter, Todd, and Trish have said to really educate, uh, the public.

Um, and I'll come back to that question about vaccine strategy.

First, masking.

It is so fundamentally critical, and people think like now, you know, the restrictions are being let up a bit in Sacramento, but we still need to mask because if you look nationally at the differences in settings where there have been high prevalence of disease, that is high frequency of disease and low, the greatest difference is whether they are populations that are masking.

And if you look internationally, why is there a very little disease in Japan and Korea and Vietnam?

Because masking is just what they do.

So, I just, you know, we just cannot- mask is the best vaccine that we have.

The second comment I want to make about vaccines, and then I'll talk about strategies, is that I completely agree with Todd that this vaccine is just- they'’re miracle vaccines.

They'’re- with technology that's, it's not brand new, it started 10 years ago.

They're safe.

They're very effective.

You know, typically, on the second vaccine, people might have local reactions.

Uh, my wife is a physician, she had just had her second vaccine.

She didn't feel well for a day.

For me, all I felt after the second dose was euphoria.

I got them both in and that was it.

Uh, so I really want to emphasize that because, uh, the public, they don't see what happens in the hospital unless they've had a loved one or a friend affected by the disease.

It's not just the mortality of the disease, as we see we're losing now up to 4,000 Americans a day on this.

But besides the mortality, people that are infected, some cannot smell and taste for six and nine months.

That has a tremendous impact to your quality of life.

We're seeing young people, I'm- I- my specialty is in pediatric emergency medicine, they're getting inflammation of their hearts and we don't know what the long-term consequences are.

So, I don't want anybody in the public to fool themselves that this is a nothing disease.

This is a really big disease, and it goes beyond the mortality.

So, with that, I'll talk about the distribution and this-— these are the two, um, tensions, the two strategies.

Uh, the Moderna and Pfizer vaccines were tested scientifically in two seq - two doses.

Uh, the Pfizer one separated by, uh, three weeks and Moderna by four weeks.

And that was the science proving its efficacy.

The problem is, is that we're on a race with a virus that there are variant forms as you know, that are more infectious.

So, we want to get as much vaccine out there as possible.

So, some would argue we should get the first vaccine to as many people possible and not worry about the second vaccine right now because we have this virus we're racing against and we want to get the vulnerable population, but it does break the science a little bit.

The science is that the second dose was either supposed to be three or four weeks later.

And those that are advocating for a dose now for everyone would say, well, we'll wait for vaccine of production to catch up and maybe we get the second dose a couple of months or three months later.

And there are certainly arguments to be made for that strategy because one dose gives you some protection.

Uh, but then of course, the argument on the other side is what was tested really was the 2-dose strategy, um, the problem with that... that would only get half as many people until we have enough production of vaccine.

And I-— I'm not going to say which one, which strategy is right, but I think they're both legitimate, uh, they're legitimate to debate.

Scott: Peter, uh... uh, Dr.

Hull, do you have a point of view on this, um, at... at all, whether we go broad or we go deep or just business as usual?

Dr.

Hull: Well, I... I-—it... Scott, I think it's a great question.

And I think it's as... as Dr. Kuppermann very clearly elucidated, it's one that has a bit of a known.

Um, I think though, um, what we struggle with as much is that, um, the people we're talking to so far, some... some people are eligible are re - are... are asking to... to not get the vaccine yet.

And that's a real, uh, concern to us because those... those, uh, staff members and people are being exposed to this... this virus.

And, um, sometimes it's easy for people to believe that if I do nothing it's less risky than if I... then if I...

I do something, which is true if you're skydiving or something like that, it's easier to not skydive than to skydive.

But, um, th- the science behind this vaccine is very clear and, uh, very compelling that it's safe.

And so, I think however we can get the most people vaccinated possible is what I- w- is what I'm absolutely, uh, in favor of, because I think we have to help break down some of the barriers people may have and, um, ask people to really rely on science and not rely on, um, on, uh, conjecture and hearsay that's unfounded because that... that actually has real danger to it.

Uh, because as we know from... from, you know, almost a year of this... this virus is that not everybody gets really sick.

But some people do get really sick and some of those people may die and some may not die, but they may have prolonged recovery times that will be very impactful for their lives.

So, I think we have to continue to make sure that, um, everyone sees this as... as really, um, a requirement in our society to be... to be vaccinated.

Scott: Trish when... when we talk about vaccines and, uh, balancing that against, uh, the pressure that have been on the ERs and ICUs now there's a third element that's come in.

Uh, we just, uh, got the... the stay-at-home order lifted here within this region.

And I wonder whether or not the public is going to get mixed messages out of all of this, in that it seems like, uh, we're recovering because now we're... we're lifting that very stringent order.

But at the same time, this conversation is about, uh, the seriousness of what we're confronting on the way forward.

How do we make some sense of this?

Ms. Rodriguez: Yeah.

Well, certainly when I heard the announcement yesterday, I thought, hmm, it doesn't feel like that's the right thing to do.

I understand that it's based on 4 -week projections and I think that, um, as Dr.

Hull and Dr. Strumwasser, everyone said that all of our facilities have the ability to accordion and to flex to meet the demands.

Um, I...

I think what's most important, Scott is, uh, really four key strategies is vaccinate, vaccinate as many people as soon as possible.

Um, we're really-— we're so proud to have been involved in both trials, both the Moderna and the Pfizer trials.

And as my colleagues have said, this vaccine is safe, um, scientifically proven, and that's a key strategy.

But we can't let down our guard in our community, um, while it... it, you know, the... the- it's technically lifted and more businesses can open.

And I feel for our business owners, Scott, I mean, I- you know, we... we see that businesses are in desperate conditions, but we still have to maintain social distancing, masking, good hand hygiene.

If we let our guard down, uh, we're going to see more surges and it's not going to come to an end.

So, I think, you know, technically the order has lifted, but, um, I'm saying to all my friends and family stay home, maintain the 3 Ws, and get vaccinated when it's your time to get vaccinated.

Scott: Dr. Strumwasser, as we look out into the future for what's next over the coming weeks and months, uh, what is going to be top of mind for you and your colleagues at Dignity as, uh, we try to not only, uh, deal with the current crisis, but also move towards solution with the vaccines?

Dr. Strumwasser: Yeah, that's a great question.

Um, top of mind for me at this moment in time is get as many shots in arms as possible.

I think people have said that.

I like what Dr. Kuppermann said about masking.

If you look at the societies that use masks, they've done very well in this... in this pandemic, meaning they'’ve had fewer numbers of fatalities.

So, we're going to be masking for the foreseeable future following the, uh, rollout of these vaccines.

So please remember to... to keep your mask on.

You know, the one thing that they don't know for certain is whether or not you're able to transmit the disease after you've been vaccinated.

There's not enough data to prove that yet so keep your mask on out of respect for all of those around you.

Uh, but we are going to try to continue to roll out our operations, you know, continue to do elective surgeries as needed.

We have to take care... You know, the one thing that people aren't really talking about very much is there are-— there have been, um, fatalities related to COVID, but there's also been fatalities related to the people who have not come in for appropriate care when they needed to throughout this pandemic.

So please, if you're experiencing symptoms of chest pain, stroke, whatever other illness you have, come see us.

We'll take care of you.

We don't want that to be a by-product of this pandemic.

So, we're going to continue to care for all those patients going forward.

Scott: And... and we're going to have to leave it there.

Thanks to all of you.

And please give our best wishes to your colleagues and we appreciate your service.

Dr.

Hull: Thank you, Scott.

Dr. Kuppermann: Thanks so much.

Nice chatting with all of you.

Scott: And that's our show.

Thanks to our guests and thanks to you for watching Studio Sacramento.

I'm Scott Syphax.

See you next time right here on KVIE.

♪♪ ♪♪ Scott Syphax: All episodes of Studio Sacramento, along with other KVIE programs, are available to watch online at kvie.org/video.