Coronavirus: About half of the patients at Kaiser's San Jose hospital are infected or suspected of being infected, hospital vice president says
An intensive care unit just for COVID patients “Essentially we have filled one entire ICU just with COVID patients, which means that we have had to repurpose another unit to take care of the regular ICU patients as well,” Parodi said.
Of Kaiser’s two hospitals in Santa Clara County — San Jose and Santa Clara — “about a quarter of the patients are in the ICU relative to the others that are not,” Parodi said.Once in the ICU, patients typically need somewhere between 10 to 14 days of mechanical ventilation, Parodi said. “So this is a long-term proposition, in terms of vent days, ICU days and personnel days,” he said. “And I am concerned about planning for having enough ventilators — I’m talking about across the country — to be able to have this level of response.”There can be a sudden increase in intensive care patients. “This thing can come on very quickly. So when you go from zero to having 10 patients — that happened for us ... in the ICU within one week,” Parodi said. “So you’ve got to be prepared for that level of surge.”That means planning for an unthinkable situation, where the hospital may have to choose who gets a ventilator and who doesn’t. The experience in Italy suggests that the hospital would have to do mass triage, and determine “who are the best patients that need mechanical ventilation, who are the patients that may not benefit from it.”Some of those who end up in the intensive care unit actually come in as outpatients a week earlier before they need ICU care, Parodi said. “They were relatively doing well,” Parodi said. “They had a cold and cough. And then they rapidly deteriorated the second week.”The deterioration can be rapid — within hours. And patients suffering from difficulty breathing can suddenly need a breathing tube inserted into their throat and need to be hooked up to a mechanical ventilator to push oxygen into their lungs.Current testing is a slow. Most areas across the country are still limited by manual testing, Parodi said. Depending on the state you’re in, it can take one to two days before a test for an in-patient test result to come back, and five days or longer for an outpatient.To deal with the national shortage of tightly fitting N95 masks, also known as respirators, that are designed to filter out 95% of airborne particles, Kaiser is moving toward reusing them, and getting some from a national strategic stockpile, some of which have expired. N95 masks are particularly important when healthcare workers do procedures that aerosolize a patient’s saliva into tiny airborne particles that can float in the air, which happens when a breathing tube is inserted down a throat to hook up the patient to a mechanical ventilator to help them breathe when they can no longer do so. Kaiser’s cancellation of elective surgeries earlier in March is also helping preserve masks and other personal protective equipment. Doing so has reduced the number of patients in the hospital by 15%, Parodi said, and instead of having just five to 10 days on hand of personal protective equipment, that’s increased to more than 30 days of supply. Kaiser is also resorting to unorthodox measures — “literally going to hardware stores” to pick up personal protective equipment and finding “different vendors local to us to be able to provide masks and literally surgical masks, sewing them together, [and] getting the face shields made from hardware store material.”
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