Heroes of Healthcare
Heroes of Healthcare

Episode · 8 months ago

Cycle of Patient Care During a COVID Surge (Part 1)

ABOUT THIS EPISODE

On an average day, there are usually 1,400 beds in operation across the Memorial Healthcare System in Hollywood, Florida. During the first wave of COVID last summer, the hospital exceeded that capacity with 1,600 patients.

Florida is now in the midst of another COVID wave. This time patients are younger, and they are almost entirely unvaccinated — and at the peak of the wave, there were 1,700 patients in the hospital system. 

In part 1 of this 2-part series, we’re joined by six distinguished physicians from Memorial Healthcare System to discuss what the treatment cycle of a COVID patient looks like today. 

Our panel includes:

To hear this interview and more like it, subscribe to Heroes of Healthcare on Apple Podcasts, Spotify , or wherever you listen to podcasts.

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Since proxing. Ninety percent of the people in the hospital did not get vaccinated. If every one of those people had gotten vaccinated, this would be an on issue. We wouldn't be talking about covid anymore because so few people would be in the hospital for it. You're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Welcome to this special two part edition of the heroes of healthcare podcast. I'm your host, Ted Wayne. Today I'm joined by six very distinguished healthcare professionals from the memorial health care system in Hollywood, Florida. Like many areas in the United States, memorial is going through the latest and what sum are referring to as the fourth surge of the coronavirus that is once again greatly impacting and stressing many healthcare systems in the US, and especially in the southeast. It was our privilege to be able to speak with the heads of memorials covid response team to get their perspective not only on the current surge but how this has been, in some ways the same and in some ways very different than what they experienced last summer. To give this some perspective, one thus fourteen hundred bed facility surge to thosixteen hundred patients last summer and at current counts, is exceeding seventeen hundred. Currently, in this episode will attempt to take our listeners through the cycle of care for covid patients entering memorials emergency room. Joining me is chief medical officer, Dr Mark Knapp. For our regular listeners, you may recall Dr Nap from our second episode back in December of last year, as he led the efforts to combat covid at Mount scionize health system in New York City. Also joining us is Dr Randy Kat's, head of Emergency Medicine, Dr Jose Fernandez, head of hospital and medicine, Dr Ari Sarelli, head of critical care, Dr Paula Eckert, head of infectious disease, and Dr Tammy Tucker, had of behavioral health, all with the memorial health system. Thank you for joining us during what we're sure is a very busy time for you all. We're privilege to have you, so let's jump right into it. Joined by six very distinguished physicians from Memorial Health Systems in Hollywood Florida, and very excited to have everybody on this unique or first time podcast for us with so many great speakers on there. But let's get you right into it. Dr Nap, if you don't mind, could you mind telling the listeners, let's start a lawf a little bit with what's the current state down a memorial? What do you guys experiencing our things going well. Thanks, but for asking, Ted and it's good to speak with you. This is an opportunity for the caregivers a memorial to share a bit of their story. For those of your listeners who don't or not familiar with our health system, where a six hospital system in that's a anchored in Hollywood Florida, to public system takes care of any and all patients to come our way. We care for a full range of conditions. We have a children's hospital that's one of the best in the country. We've got a robust transplant program trauma center, etc. It's we really have the full the full package here and with us today are a number of my colleagues who have been on the front lines of managing the COVID pandemic and they'll speak much more eloquently about what's been happening than I can, but I'll tell you a little bit from a high level what's been happening at Memorial. We have roughly on a typical day, about fourteen hundred beds in operation across the health system. What's happened during Covid last summer in July is we got up to about sixteen hundred patients in the hospital and the overwhelming majority of those patients last summer were covid patients. Unlike what happened in the Northeast and out in California and a few other places, that the peak for for Florida was in the summer. It was July and August and sort of trailed off in September and then we had a smoldering sort of lower level peak for our period of about four months through the winter months. And then comes June of this year and things are pretty quiet and you know, significant portion of the populations gotten vaccinated, although far to certainly is behind many of the other states in the country, and people started to really enjoy themselves getting out there on July fourth weekend and really not taking any precautions about masking and we started to see a rise in cases in late July. The numbers of cases continue to escalate into our hospitals. At our peak, which occurred about a little over a week ago, we had over seventeen hundred patients in our hospitals. Remember, we typically run around fourteen hundred. So one seventeen hundred patients means three hundred extra patients in the hospital and a hundred over the peak last summer. Correct. And this major difference, I would say, between this peak and last, because this peak was steeper and it also was not mirrored by a decline...

...in noncovid patients. So does everybody probably remembers when the pandemic first hit last year, hospitals became a place that nobody wanted to go, unless, of course, you had covid. So the numbers of patients with other conditions dropped way down. That did not happen this year. So our hospitals are full of regular medical patients requiring medical care, as well as an unprecedented number of covid patients on top of that, and that's been a real significant difference in this in this time around. Another significant difference, which you'll hear about later is that the population that was sick and that is sick is younger than the earlier wave of a year ago and almost entirely unvaccinated. Vaccination in Florida is a very contentious subject. It's very politically heated, as is wearing. That asks and and self protection and self and personal rights, and the healthcare system is sort of the barometer as to what impact that has on society and I'm I feel fortunate to have an opportunity to work with you today to have some of my colleagues just speak about that impact and what it's meant. Well, we're delighted to have you all and so with that summary, let's let's jump in and for the listeners, are just want to let you know we're going to take you through a cycle of a covid patient today. So we're going to we're going to start with emergency medicine, move into hospital medicine, critical care. Hopefully, if you talk a little bit more about the behavioral health challenges and then also talk about infectious disease and talk more about the Delta variant the different things going on in that world. So hopefully this will help the listeners kind of understand how a hospital approaches the normal stages of a a covid patient entering the door. So Dr Kats, who oversees emergency medicine at Memorial, will start with you and I guess a covid patient walks through the emergency room doors and says, I don't feel good and they've now entered into your department. Can you walk us through a little bit of what that experience is like and and any differences or changes that you've seen over the last twelve day team? Short thanks to Ted and thanks for having me on this podcast. You know, I look at the emergency departments as really the Canary in the coal mine when it comes to Covid we tend to be at the tip of the spear with these surges and really in the emergency department tend to kind of get a feel for what's going on in the community before everybody else. Our Emergency Department then typically sees somewhere between two hundred and fifty and three hundred patients a day, so it is a good barometer of what's going on out in the community. With respect to spread of the viruns, as mentioned in June, you know, things were actually looking really good. People were getting comfortable going on vacation and, you know, going out to restaurants. And typically when we start to see these surges, they patients show up an emergency department requesting testing or sick with pneumonia, and we we typically ask a lot of questions at triage. You know, we try and segregate patients. So when a patient arrives and comes to that to the hospital, into the emergency department, we screen for Covid type symptoms and we have designated areas to put these patients and, depending on where we are in these surges, sometimes those areas require large square footage, you know, a tent outside. Many times we've had in place. We have one now where we have to house twenty to thirty patients with Covid type symptoms. So when these patients come in there, they're seen at at triage by a nurse question about their symptoms and typically move to either a clean area if they're here for something that does not seem to be covid related, or they're moved towards a covid holding area where they can be, you know, housed with other covid patients so that there's no cross contamination or cross infection of other patients and staff members. At that point, you know, patients are seen by a physician. We when we go to see a covid patient, it requires Ppe it requires, you know, a different set of infection control standards then we would typically use with a regular patient. So it it is labor intensive, you know, to go see a patient that that has come with type symptoms or work in one of those units. And typically that's that's the way the front and works, you know, to patients come in, sometimes with very mild symptoms and sometimes patients come in by fire rescue or even dropped off by family and distress and require a median intervention. So I hope that answers the question. And and that's really the beginning phase of a patient coming into the hospital. Yeah, so that's great and I question I have is at what point do you what are some of the indicators for you, Dr Kats, in your team that says we need to admit or we can, we think this person can go home. So...

...it's a difficult question that we have a little more clarity on now compared to a year and a half ago. I will tell you when the the pandemics started, that was a really tough question for us. You know, when we typically see a patient who comes into the hospital with respiratory symptoms, you know, prior to the pandemic, with bilateral pneumonia on an x ray, there's no question whether or not we would keep a patient like that in the hospital. Atypical Pneumonia, Ninety nine percent of the time is going to be admitted to the hospital. When this pandemic started, what we saw, and it was an interesting the physiology in that patients would show up without any apparent to dress but oxygen levels extremely depressed and very abnormal looking x rays that we've never seen before. However, the patient clinically, you know, look pretty comfortable, can speak full sentences, and so you're we're faced with a question of what do you do with a patient who you suspect has covid who has an admirable x Ray, who has very low objective clinical findings like a low oxygen level, and then they're sitting there talking to you comfortably and you're not sure you know why we're admitting this patient to the hospital. So a lot of those patients early on we're admitted state in the hospital for many days. Some of them receive some experimental treatment. We were doing a lot of convalescent plasma at the time and things that we now know are not that effective. But these days were a little more educated and experienced, and so we send a lot of these patients home that do have admirabal x rays. It really depends on their oxygen level their co Morbidities such as age and kidney issues. You know, diabetes, hypertension, overweight. Those are all risk factors and so we tend to combine objective findings like oxygen saturation levels and x Ray findings with COO moorbidities that we now know lead towards poor outcomes. We do have other treatments available, like monoclonal anybodies, which we're now doing here in the emergency department for specific subsets of patients that meet criteria, but really the treatment hasn't changed a lot. So putting somebody in the hospital is really a way to provide supportive care at this point. You know oxygen supplementation. There's other ways to give oxygen at very high volumes to patients, now through Nasal Canyal as, where we can give forty to sixty leaders an hour or a minute of oxygen to patients and eventually, if a patient is really sick, you know, requires a mechanical ventilator, which which really leads to a very poor outcome. So the medications we give these patients don't do a lot. It's really supportive care. And so what we know is that if a patient does not have a lot of risk factors and although they may have an adimbal x ray now and we look at it, we realize they have pneumonia. Sometimes we can treat some of these patients with Monopoli, anybody in fusions and send them home. Sometimes we give them a pulse oximeter and just you ask them to monitor themselves and we do, you know, monitor them at home some degree with our population health department. But the overwhelming majority of patients we see these days do go home. It's really when you know your past that threshold of really being able to survive at home without oxygen that you require the hospital. Well, yeah, so and I, and you know my own personal situations. Find Father, and that was the same thing. They admitted him for a few days. When you know what they noticed? His his oxygen levels would go down but he would rally back really fast, you know. So he might get, you know, down into the lower numbers, but you know, once he rested for a couple of minutes he would come right back up. So I know that that was what made him, in their eyes, a little borderline. Do we admit him or don't readmit him? I think they end they ended up admitting him, but I also think that's because he's in his s. But you know, but that was it is, it was the things they were trying to figure out. And this was back in in January this year. So so so, Dr Cats, your team says we're going to admit him or her, they get they get admitted to the hospital and and that's when Dr Fernandez Duarte, your team kicks into gears. That correct? Yes, that will be correct. So do you mind walking the listeners through a little bit of what your team is looking at, a little bit different than Dr Kats, and how you're monitoring, how you're deciding discharge, how you're deciding maybe potentially critical care? Absolutely so, once there's being a decision to admit by the emergency position and they would generate a coal to the hospital steam and they will proceed. I go ablewait the patient in the emergency department. So we will perform ATS, call that history and physical which is essentially unaccessmentble how the patient is doing. Specifically for a covid patients, most of the Pasi to will of course be on oxygen and we most likely quovin pneumonia. So we told we're all COB patients. They usually have three outcomes from the hospital is medicine side. Number One, they...

...will get better and eventually get death chart from the hospital medicine service. Number two, they will ad deteriorate, sometimes practically unaffortunate with some of them, we would ultimately lose. For three, they will progressively get worser, extent requirements will increase and then at that point will communicate with doctor Surelian steam for them to be placed in the ICEU. So you know this. The evolution of the patient is variable based on the age, older commorabilities that they be. This hypertension, any cardiac, his history. You know patients that are in the in the advanced age state, you know they have, you know, sixty five yearoldso older can definitely have our worst outcomes. And you know and Doug requiring that doctor's early services more often than not patients are on the younger side. Are have a higher probability be in this church. Now there has been a change from the origins of the pandemic to today. As you're aware, in Florida the hospital steam has been fighting cobby prober eighteen months. At the beginning of the pandemic we tended to see patient that are admitted where you know, s or older. Now, as a vaccine nation, without in the vaccination, and now we have patients that are are actually younger because it's the younger population for we have some are reluctant or getting vaccinated, so to that's actually a scary finding. It does have an effect on our hospital, as you know. Once when there's sixty five older, they have a different mindset. When you're seeing forty years old people extremely tail there really affects the mindset of the hospitalist and that he can makes it even more personal, so to speak. So that's overall the process. Once a decision to admit has been placed, with that quid decasional roombeesseper steroids and oxygen. If we see the oxygen a requirement increase in statewise manner from Nass or Canula to wrest of our mask. Then, you know, we tend to use high blow and then by PAP and we maxter settings. Then at that's when we require or I see you or I see you as system. Now a Caucation is essentially getting this charge. What we do is we will see the UXIMI requirements continue to decline, which is always a good sign, and then at that point, if the oxygen requirements either stabilize or their hot oxygen, we do a preparation for this church and the patients either go home, then we go home with home oxygen and home health, or if they really have a need of supervision or some sort of Rehab, they will go to run nursing home. Hi said, it's mark, Mark Navigan. I think it might be helpful to your list centers to understand what a hospitalist is, because that's a concept that's going to be familiar to many people, but not necessarily all people, and I think it's particularly important in the context of Covid probably over twenty years ago now, the idea of physicians who specialized in hospital care, meaning in patient care of patients, started to evolve and started to become a thing in terms of their presence in hospitals. At our health system, the vast majority of patients with on the general medical floors are cared for by somebody who is called a hospitalist or or a hospital medicine specialist. It it. Initially it was a debatable whether or not that was appropriate. Some patients would prefer to have their family, you know, their family physician, follow them into the hospital with somebody who they may know for years. But the reality is that the pressures on a physician to take care of patients in the outpatient setting and in the inpatient setting nowadays really makes it untenable for a physician to be able to do both, and so we strongly recommend, particularly for for really sick patients, that a hospitalist take care of them. And that's that's how it works in our system. In terms of Covid I think it's especially important. This disease is is much worse than many of the conditions that patients are typically were in the hospital for in the past. Takes very specialized care with real, real understanding of just, you know, what interventions are necessary and when you compound that by the fact that there are no visitors in the hospital and therefore communication with the caregivers is so critical and we aren't having people coming and going in the hospital. It really is important to have a dedicated hospital based team to take care of these positions. So Dr Fernandez, always just speaking, is the head of all of hospital services for our health system and I think that's you know, that's a particularly important thing to understand. Now. I'm glad you pointed that out and one of the things we get feedback on the show that people like is we that's is that I'm so ignorant about medical terms. I'll stop the person and ask them to explain that. And...

...and that's it is a term I'm a little more familiar with, but it's not a common term. I don't think people, you know, understand what is a hospitalist. So thank you for pointing that out. And Yeah, I know it's an and it's obviously a it's a critical part of the care and I love the point about you bring up about, you know, in today's Day and age, with the Covid the communication part, you don't have family members in the room with you anymore to ask the questions or to be there. So getting that communication from the hospital is team, you know, is an important conduit between the patient and the and the outside world, and Ted to that point. This is Dr Fernandez. That's probably one of the biggest thing or team dogs, and for that we have leverage technology. You know, you know something's now we're using webbics and IPADS who have family conferences spatially eleven time. We cannot be there either because, you know, they have commorbidities or in any other issues like that. So looking over hospital is now our very at that that have a time of meetings over Telec Conference, and so, you know, we obate, or patients at least, can't be other day or finmily members every other day. Great, I think, the progress of their patients and you know, sometimes we even have to have end up life conversations. You see the Tele Conference and wherever, if it's think any's extremely hard. But I also speak to the bi live the hospitals to relate critical information using technology. Yeah, yeah, in a sense your team is that. You had to also become, in the midst of all this communication, special absolutely right that a you learn how to use all that technology in order to help connect those people. So important, important role. There's another sorry to it's more navigant. There's another aspect of this that I think is particularly important and for people to understand. As our knowledge about COVID has evolved over the past eighteen months, it's very important to be able to communicate with the frontline caregivers as to what the latest developments are. You may recall that at one point hydrox of chloroquin was something I was touted to be effective. Now there's this the drug called I remect, and that's that's you know people are talking about. At one point drinking bleach was a recommendation, believe it or not. My point is it's a lot easier and a lot better for our patients to know that we can communicate through Doctor Fernandez, who will immediately to reach every one of those caregivers and give them the latest information about what is appropriate treatment. We get recommendations from Dr Eckert, who you'll hear from later, about the best in vectorous disease treatment. You'll hear from Dr Cereli about the best way to manage their pulmonary complications, etc. It's the hospital of service can do that in a way that individual private physicians coming from their offices. There's just no way for them to keep up. So it's definitely a clinical advantage to be using a team like this. Yeah, well, everybody's in the same house, so to speak, right so that it makes it makes it easier. But the now, I bousally, technology has taken us a long way and some of the technology wasn't even there where we weren't looking at it, but unfortunately these crisis he's throw us into it. They make it where we have to do it. You know, we see the advances when we talk to some of our our guests about tell a medicine and how fast that's gone because of covid and, especially in the behavioral health area, how it's been such a it's been such a critical piece to push in. So thank you for that, Dr Nap. Let's keep going through the cycle. Now. So, Dr Sorelli, unfortunately somebody under Doctor Fernandez's care is not doing so well. It's getting into a crisis mode and they have to be, I assume, trans transported to your one. Are Your floors? What is kind of the course of action for your team and what are you guys handling? Great High Tailed, thanks for having me on your podcast. You know, I think it's important for the listeners trying to stand that at one of the biggest challengers with covid nineteen, with as virus is the variable impact that it has on people. It's very tough for the public to understand how some people can get covid nineteen and have the sniffles at home and feel good after a few days to some people come to the R but Dr Cat sends them home with supportive care. Some people end up in the hospital, require oxygen and treatment and go home. But some people, despite all the treatment that they're getting in the hospital, will fail those treatments, require more and more oxygen, require more oxygen delivered under pressure through a bypath mask or through a high flow nasal canula and ultimately land up in the ICU. And it's important to understand that if you fail all those supportive care measures and you land up in the ICU for a reason that we don't completely understand, in two thousand and twenty one it will probably land up being a combination of genetic predisposition or acquired immune disposition to become so severely affected. Once a patient lands up in the ICU with me on a mechanical ventilator, it...

...is now a completely different ball game. It's an appeal battle, even with the best care that we have to provide in two thousand and twenty one, with top of the line care, once we've selected those patients that are so susceptible to covid that des by treatment land up in the ICU, we're looking at maybe one in three of those patients leaving the ICU and the in two thirds of those patients dying, and I think that is a real you know, it's a real hard fact. It's a very difficult reality for the teams on the front lines to face and unfortunately, what makes it even tougher for patients families who are suffering the emotional burden of this to understand is that death does not occur quickly. Patients can get supported in the ICU for weeks, sometimes even months, and what happens is that we can get them through the acute phase of illness. And the way that I explain it to families is initially the virus multiplies, it makes copies of itself and it causes massive inflammation in the lands. It's during that period that if we can't support a patient, they go onto a mechanical ventilator with very high concentrations of oxygen to be kept alive. But after the land starts healing, it does not heal in a normal pattern. It heals with a pattern of scarring. Patients require high oxygen and high pressures through the ventilators, which by themselves are toxic to the Lens and do injury. And while patients can survive the acute phase of illness, we can get them through their ICU stay in states of induced comas, paralyzing their muscles treating their infections, they come out on the other side as respiratory cripples with destroyed lines who will never be able to come off mechanical ventilation. And the longer patients spending the ice you, the longer there at risk for developing non covid related infections like renal failure, blood clots, bleeding episodes, infections, and that's that's the reason that the outcomes for covid patients are so bad. I think that's been one of the hardest challengers for our care teams, are nurses, are physicians, anyone who's being involved with the care of covid nineteen patients, because it's very long appeal battles with a death rate and mortality rate unlike that which we've seen for any other disease in the history of modern medicine and despite all the benefits of modern technology, despite the team's giving one hundred percent plass to try and save patients, at the end two thirds of our patients died despite our efforts, and I think that's that's probably being the biggest emotional burden. It's not only the exhaustion and the difficulty in emotionally dealing with with patients with covid nineteen, but it's at the end of it that, despite the efforts of the team, that our patients still succumbed to their succombting their illness. Yes, thanks Ted and and Dr Sarelie. That was that was a very clear explanation of some of the concerns that the people should have. Some members of your podcast might know that I used to work in New York. In New York City there's a roadway called the FDR drive, basically goes up the east side of Manhattan, and spray painted on the entrance to the FDR drive, where I typically got on the highway, is some graffiti that says covid is a hoax and I would see it every day as I was driving to work at at the mount side of health system when I was working there, and that really concerns me in that people do not have a feeling for just how real this is. I'm very hopeful and I do not know how you can basically emphasize, with Dr Sarelli was just sharing with the group that basically, due to some unknown factors, and you meant he said it was genetic predisposition or some other factors we haven't uncovered yet, it's basically a crap shoot as to whether or not somebody who gets exposed to the COVID virus ends up having essentially no symptoms whatsoever or ending up on a ventilator in the ICEU. And once you get on that ventilator in the ICEU there's a two out of three chance you're never leaving or you're leaving in a box. If somehow that message could get through to people, maybe they would have a little more respect for the virus and a little more respect for what can happen, what can go wrong. Yeah, it is a perplexing situation how people can disregard it. And to your point to your graffiti artist that it's a hoax and when you were seeing these numbers coming out, it...

...is it is a little unfathomable that that does happen. Dr Sarelli, you at yeah, I wanted to speak a little bit more about that because I think that's really so important. As healthcare providers, one of the hardest things for us to see is such a preventable loss of life. And we have a very effective way to prevent getting sick with covid in the first place. The data all across the country, including our healthcare system, speaks to itself. When we look at our patient population in the hospital, ninety percent and vaccinated covid. Only ten percent of vaccinated people are admitted. In My icee you, it's the same thing. Ninety three percent of the patients in the ice you are and vaccinated and seven percent of vaccinated and and the tragedy is that that loss of life could be prevented. And one of the concepts it's so important for us to get out there is that you can make the wrong decision and get lucky, but that is very different from making the right decision, and the right decision is to get vaccinated, not to take a risk with your life, because when you don't get vaccinated and you land up with mild symptoms. That's the wrong decision and getting lucky. But unfortunately, so many of those people and to the misinformation out there and to be like what a great decision. Didn't get the vaccine, didn't get sick, and essentially, you know, it creates the situation where the only people there are truly impacted and understand the magnitude of their bad decisions, of those people for whom it's too late. Those are the people that land up in the ice you and are dying, and then it's too late for them. It's so hard for us as healthcare workers to see those people dying, to speak with their families day in, day out, day in, day out, and then, at the end of it, to fail to Save Them. But always at the back of our minds were is, you know, we get you to know them, we get to know their kids, we get to know their brothers and sisters and we hear the desperation in their voices and always at the back of our minds we are thinking this was a preventable tragedy if only this person who had got in vaccinated right. We've heard that that that's the frustration out of the medical community. Last year over this year. Last year it was a tragedy that you couldn't be prevented. Now, this year it's something that could have been prevented. Dr Cats, I'll come back to you in a second. DCOR Fernandez, you wanted to come here. You know, some of the hardest thing we have to do is have that transition conversation where we're telling the patient that their relative is going to get intovated. sometings they don't understand the getting into theated in the setting of covid can be very, very final, and that's when I'm going to have sometimes have that end of life conversation that we have to have over and over again. And you know, I just want to remind everybody with the told that takes on the healthcare providers. I was rounding in one of my sites to the you know, one of my younger physicians, and she didn't complain about the volume to theirn't complain about how seek the patients where, you know, she just con solicited start talking about how how it is for her to have these conversations when basically the relatives are asking, you know, doctor, are you going to save him or doctor is going to be okay and they know that the patient is not going to be okay and they have to have those really crucial conversations. And sometimes, you know, it's not only the family members, the family, the kids, you know, in the other side of the screen. So having those conversations, they in and they out, will wear when healthcare professionals and also again, we've been at this for eighteen months, so it's it's additional, you know, mental stress that keeps going on and on. So I think it's important to get it out to the public or health providers are also feeling it in that sense, and also physical fatigue. There's some degree of also mental strain. Yeah, for sure. There's a bit of a boomerang right. We think it's gone and it's going out and then year it does, it comes back again. We're in what I guess we're now deeming the fourth surge. So it I can't imagine the toll it will take him. We'll come back to Dr Tucker Pretty soon here and start to talk a little bit about on the behavioral stress. But Dr Kats, you had else on the same conversation. You know, there's a reason why ninety five percent of physicians and the United States are vaccinated, and Dr Slowe had alluded to it, that we understand that the only way to prevent this disease is to get vaccinated. And I find it always very difficult to have conversations with people outside of the hospital, whether it's you know, friends or family you know who do not want to get vaccinated for whatever reason, and it's always a very passionate discussion and it's back and forth with view points. But...

I think the problem right now in our society is there's so much misinformation, particularly on social media and the news and disinformation and it's really hard for the average lay person to understand numbers and statistics, and they're not scientists, you know, and I'll share one statistic with you, and it was actually published today, as a matter of fact, out of La County and they followed vaccinated and partially vaccinated and unvaccinated patients over time from the time they started doing vaccinations and what they found was that there's a five times likelihood of acquiring covid in an unvaccinated individual, but a thirty time for thirtyfold increased chance of landing in the hospital if you do not receive the vaccine and acquire covid and what that means is essentially, you know, people can still get covid will we can still, you know, acquire the disease even with the vaccine, which is one of the arguments that a lot of the people that do not want to get vaccinated make. But the likelihood of landing in the hospital and getting sick and winding up with Dr Serell and having to have these conversations and watching people die, the likelihood if your vaccinate is extremely low. But if you're not vaccinated once you get into the hospital, there's a there's a ten percent chancer not going to make it out. Yeah, you know, and I'm glad we're taking some time to emphasize this. I saw over the weekend Piedmont healthcare out of Atlanta, where we are, Atria Health, big national provider, and Navant at a North Carolina, all published their statistics around their covid patients and they're, you know, the covid patients unvaccinated just admitted. We're ninety s around the ninety six percent and and and I'm not giving each of the data numbers, but in that area, the ones who are going into. So ninety six percent and we're coming in are unvaccinated. Are Coming in, ninety seven percent who are being admitted are unvaccinated, and ninety seven and ninety eight percent who are going on intubation or into icee. You, are unvaccinated. Oh and the ones who are coming in hostile I think it was. The number was around three or four percent, excuse me, were vaccinated. So what we're seeing in summary, is consistency cross the country, from different hell systems that were in the high s of people who are unvaccinated getting it again. We're in the higher s of those who are going into critical care and even higher those who are going into intubation. And I see you. So I like that you guys are supporting all that, but we are. You guys are right, you said out of La we're seeing this country wide. So we have to continue to push the message out. As Dr Sarelli said so well, is you're really rolling the dice with your life if you just think you're going to be you going to take a chance of getting it and being okay. Dr Sure, Ellie. Anything more to add before we go to Dr Tucker? Yeah, thank you. I just wanted to address one other misconception, and that is that this time we're absolutely seeing a much higher number of younger people getting admitted to the hospital. Those are unvaccinated individuals, and then subsequently we are getting a higher percentage of younger patients in our intensive care units dying of covid pregnant MOMS, young patients, patients in their S, S and S. and it is a total misconception to think that once you get into the icee you, because those patients are younger, the prognosis is better for those patients. What happens is that those young patients are so susceptible to the virus that again, if they land up on a ventilatoring, I see you, the death rates are horrifyingly high. Again, it is not protective. So the young person who's sitting in the community, who's thinking, even if I get sick and then I get critically ill, I'm still going to make it if I end up in icee you, that is that is absolutely not true. The young patients that we are seeing now have unfortunately got a shockingly high mortality. It's right up there with more than half of them succumbing to their illness and if I may just make one additional point, and and that is, you know, someone had asked me. Doesn't make it better for us that when our patients die, that we know that they made a choice to not to get vaccinated? and that's absolute nonsense. I mean, a life is a life. It makes it not one. Iowte a better for me that people have landed up making the wrong choice directly as a result of band information, misinformation out there. We have an intimate relationship with their families. I hear their kids in the background when I speak with him and it's every bit as terrible to watch any single person in the ice you die, whether they're vaccinated or unvaccinated. So that is a notion that I sometimes here out there, that people have bought it onto themselves board it about themselves. It really does not make it better for any physician...

...to see, to see that happen. Yeah, no, I wouldn't think that. Somebody says, who now has it? Who's going into this critical nature? Who says, well, I guess I deserved yeah, that that me. They're saying, why did why didn't I do it? They're they're probably angry with themselfs but they're they probably don't accept the fact that there was. Okay, it was my choice, so you're right. I was going to say one thing, you know, one comment which which really people should hear, is that I've seen zero patients admitted to the hospital for vaccine side effects. Not One. Wow, that says that's that says a lot. Yeah, hi, it's aricesarily again. I was going to say I've seen zero in the ICEE you, but we've seen zero in the hospital. So this thought stuff about the side effects of the vaccine and during that same time period where we have seen zero patients admitted for Covid side effects to the hospital, we've seen more than one thousand deaths from covid. I think it's close to fifteen hundred deaths now, and we've seen almost fourteen thousand admissions for covid in our healthcare system. Only threezero in this loss waves since July, with three hundred being admitted to the intensive care units, but zero covid side effects, zero VAX stories, zero a covid vaccine side effects. Thank you. Sorry, I thought it was important. You know, part of the reason for this podcast, or maybe the reason for this kind of test, was what's different this time around, and I think I just want to highlight that because you've heard a lot. So it's different about this time around is well, now we have a vaccine. We didn't before. So last time, as are said, last time it was just very unfortunate. There was no nothing we could do about it. Now choice is involved and since proxy ninety percent of the people in the hospital did not get vaccinated. If every one of those people had gotten vaccinated, this would be an onn issue. We wouldn't be talking about covid anymore because so few people would be in the hospital for it. So one is the fact that we have a vaccine, and choices is a factor because we have vaccine. Choices of factor. All the things that play into how people make their choices is obviously important. The politics of the choice, the politics of the behaviors, the economics of shutting down a community's wealth, communities sort of activity in favor of public safety, all those are issues that are different this time around. Basically every state shutdown last spring. This time around almost no states of shutdown, and now we see very protracted surges and you know, we'll have to wait and see just how many people do die this time around. Another factor is that the virus now, Delta, is a much more efficient virus, meaning that it replicates itself in much greater numbers of viral particles, making it much more infectious. So a single individual who was infectious a year ago, who might have infected one or two people, now can infect five to seven or eight people, and Dr Reckord may touch on that. It's it's a much more efficient virus for getting people infected and even though somebody's been vaccinated, if they get a breakthrough infection, and we haven't gotten to that at all, but if they get a breakthrough infection, they are just as infectious as somebody who never got vaccinated. And so that's the importance of everybody protecting themselves and wearing a mask, because you can have a symptomatic breakthrough infections that are now infecting large numbers of the population that are completely unwitting. So those are key differences and get bring us back to the the rational for the podcast. Sorry, let me, let me hit it back over you and I think we probably can move on now. I'm glad, Hey, talker, you're being so patient. But Dr Eckert. So Dr Eckert, is just a reminder of the listeners, Dr Echored, is over infectious disease at memorial. So what I wanted to say, and I wanted to say it after what Dr Knob just said, is that people don't realize how much stress it has been placed in our healthcare systems. And I'm going to give you an example. I'm going to an infectious disease doctor. I work in the hospital but I also work in the outpatient setting. So I have a big clinic where we take care of patients with HIV and other issues, and at some point at the beginning of the pandemic, we shut down, like all the services, we move all the personnel to the inpatient side where we're going to take care of this patients. But right now, you know, without preventible backs seen where you can use a vaccine to prevent the disease. Were again stressing the system in the sense that the services that I provide to my patients and as an outpatient has to be a little bit restricted because I have to be in the hospital to take care of all the patients that are now in there. So it's it's the infectious disease part not only, you know, taking care of the inpatient but...

...taking care of the outpatients that we already have, US our patients. So that's one part that I think it's very important, because people don't realize that, you know, by not taking the vaccine you're also challenging the care of all the patients that don't have covid but do need very close care in the end and you know, in our healthcare system and other systems. So that's one part. I wanted to touch base and I have all the things that I want to say. I don't know if you want me to say it and now. Yeah, so I like your point because before Covid, what I hear part of you saying is you guys weren't not busy, right, you had patients coming in and you had a lot of workload coming in already, and now covid is, just as you said, just adding an unbelievable dish burden to it and people who are being irresponsive. So, just to put that any perspective, we are the busiest healthcare system in the region. So, Dr Record, I'm going to come back to you because I do want to spend more time talking about Delta and some of the and the things that might be misconceptions about about covid and let's continue to use this, this platform him to educate. But if I can, let me shift to Dr Tucker. and Dr Tucker, can you just share with us a little bit about what your team is doing and seeing, not only within the patient care from a behavioral health standpoint the families, but also on the physician and the clinician side as well? Absolutely ted. As you heard with Dr Sorelli and his comments. Just listening to him was difficult. You know, the emotions and the passion and how frustrating and difficult treating these this patient population. I think drs really and all our physicians that are participating today have done a great job articulating just how difficult and challenging it is, and they represent many health care providers and certainly the nurses are struggling just as equally because we've had this protracted surge not just within our own region but our entire state or throughout our nation. I'm sure you've been hearing about the shortages of staff to be able to take care of the patients. So this adds to the stress for our staff. Our nurses, are respiratory therapist, our pharmacist even our food service workers. Not only are they struggling with taking care of the patients, oftentimes maybe not having enough staff to cover the care, but also at risk of getting exposed as well and having to take additional precautions to reduce their exposure. If they've been exposed in advertently, perhaps having to quarantine, which adds to the shortages. So there's no question our staff have been stressed. We focus a lot in our healthcare system on trying to provide support figuring out ways to address resiliency. We've been promoting our EAP services, we've rolled out an APP that staff can access on their phone. We've tried to provide some in person's services within the hospital to try to support them. But with all that said, it just feels like it's not enough. It's extremely difficult to support and combat the challenges that covid presents for our healthcare providers. They truly are heroes. You know, your podcast is called heroes and healthcare. They really are. In terms of our patients, you know, like Dr Eckard said, that you know life goes on and patients continue to have behavioral health problems or, you know, people with chronic mental illnesses because of the covid surge and having to do things to try to reduce the spread of the infection. Some of the traditional therapies that patients have relied on that have been very helpful to them, social, social emotional programs, group therapies, seeing therapists or their psychiatrist in person. Many of those providers have shifted to tell a health and although that's very helpful for some patients, some of the patients really do need the benefit of direct in person contact and they haven't been able to have access to that. So Dr Cats gets to see them in the emergency department when they come in in crisis, and so we've had to provide additional support to try to help those patients and they end up coming to the emergency department and we end up, you know, they're extremely anxious, depressed, suicidal and we end up we've seen a increase with our inpatient admissions and unfortunately it's particularly impacted the pediatric population. We've seen an a tremendous increase with children needing behavioral health in Patient Crisis Services. Yeah, I'll just add to what what Dr Tucker said. You know, the impact, the collateral damage, the pandemic...

...has had over the past year is so profound and we see it so much in the emergency department. We've seen a thirty percent increase in drug overdoses. We have a tough time with the homeless population. We've seen our psychiatric population explode. You know, just the number of patients coming in for treatment for stress and suicidal thoughts. We've had a number of patients, you know, that have come to the Emergency Department for Psychiatric treatment that have committed suicide after leaving this year more than I've ever seen. So there is a tremendous, tremendous amount of collateral damage that's been done to the population and most of many, many of the problems with your psychiatric and nature or social and not just medical. It's a big problem. I wanted to talk about the challenges of bringing physicians to meet the demand. They Know Paula talk about this volume has come over where we're ready seeing right. It's not like the hospital empty that we have at thirty percent more volume that we usually see. And just to put that in perspective, that's almost thirty physicians more worth of help that we had to basically fly from all over the country to the system in a matter of weeks. So the complexities of doing that, it's incredible. You know, you have to find doctors for all over the place, make sure they're credential that appropriate. We, you know, work with the credentially team at the system level and then deployed those physicians conmergently, you know, and the strain that that puts on you know, getting new doctors, getting new doctors train. It's hard. However, I can say with certainty that at this point we have been able to meet the demand without any issues. But the strain is there and we had to have we do that with every single search. We have a search of twenty five percent of our volume, then we bring twenty five percent more doctors, then the volume goes down, we send the doctors back. So it does requires that a high degree of coordination to be able to meet the demand. Yeah, for sure. And the balance that burn out in the balance the ability to keep keep the level of care up there, and that's so Dr Tucker, going back to that, that's a word we've heard use in the in the past and I'd love your thoughts on the word resiliency. Right, it's is how do we keep up the level of resiliency in your staff and in your team. What are some of the methods, in the methodologies and things that you guys are doing or trying to implement to keep that resiliency at a high level? Well, our leaders are working with our staff to try to check in with them, reminding staff to try to engage in some balance, for example when they're you know, when they're off work, to try to maybe get outdoors, exercise, spend time with their family, do things that are that are meaningful. You know, I think one of the challenges with this current surge it's stressful. It's been stressful from the very beginning, but it continues to be stressful as a different level of stress, as was indicated because, like was said, this was some of what's going on has the potential to be prevented. But reminding staff that they might not be able to control the stress, but they can control their response to it, and reinforcing strategies, you know, to try to contextualize. For example, you know, unfortunately misinformation is just as much of part of this pandemic as the actual virus, maybe in some ways more so. And you know, I read a great article and I wish I could attribute it the physician that wrote it talked about the misinformation was actually part of the problem, you know, part of the symptom of the disease of Covid and trying to understand it that way and really trying to work with patients and their families to do the best that we can to educate them and not, you know, to cope with the frustration that comes with it. Yeah, I think that, you know, the part of the you know, the the connecting with the things outside of work and making sure that those pieces, you know, are there in our lives is, you know, obviously as critical. There needs to be a level of normalcy brought to these folks lives and otherwise it can be overwhelming and consuming and you, I'm sure, at times feel like the level of it there's not going to be an end in sight. Right right. Thank you for listening to part one of our conversation with the heads of memorial healthcare system in Hollywood, Florida. Please join us in our next episode, when we will start to delve into areas surrounding the Delta variant vaccines and learn more from this esteem team of medical professionals as they continue to battle through the latest covid surge. We look forward to listening to part two of our episode cycle of patient care during a covid surge. We'll see you then. You've been listening the heroes of healthcare for more, subscribe to the show in your favorite podcastt player or visit us at heroes of...

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