Coronavirus is the biggest challenge our healthcare system has faced. Is Kentucky prepared?
In January, I concluded an OpEd with an alarmist statement: “The epidemic of antibiotic resistant organisms may be the final solution to global warming.” We are currently on the precipice of a massive pandemic from the coronavirus (COVID-19). Initial data from China has documented massive economic disruption with a 25 percent drop in carbon emissions. A sobering observation, but of even more concern when one considers the United States does not have the authoritarian structure and a culture of population control which exists in the Chinese government. According to the CDC, the unknown is when, not if, the epidemic will hit the United States and “severe disruption” of everyday life may occur.
On Thursday, Gov. Andy Beshear said Kentucky does not yet have any cases. That said, it is of paramount importance that we prepare to treat patients and slow the spread of this virus. A large portion of our population will become infected and supportive care is key to lowering mortality. Not only the provision of fluids, nutrition and in severe cases oxygen, but also the treatment of bacterial co-infections which have been commonly associated with deaths from viral pneumonia.
It is imperative that a statewide survey is performed regarding the availability of personal protective equipment (PPE) and negative airflow rooms. PPE such as N-95 masks will become more valuable than gold. All PPE (masks, gowns, eye protection) need to be locked down, since theft becomes a problem. If protective equipment runs out, patients may stop coming into a hospital and healthcare workers may become reluctant to treat patients.
Patients will need to be screened at the time appointments are made, and if positive, directed into safe areas. Visitors should be limited and screened for infection. Hospitals will need to address their physical plant, setting triage areas at their facility’s entrances and construction of separate waiting rooms with separate airflows. Many facilities have shells of unfinished rooms which are used to block the provision of State Certificate of Needs being awarded to other facilities. These areas need to be finished with negative airflow rooms for patients.
Attention to drug resistant bacteria needs to take place. The protracted course of COVID-19 causes concern regarding bacterial coinfections and patient deaths. Common pathogens are H. Influenza, S. pneumonia and Staph aureus. Coinfections have been noted to occur in 29 percent to 55 percent of deaths in the 2009 Swine flu epidemic and in 95 percent of the 1918 Spanish flu epidemic.
Thus, if there is a high rate of community methicillin-resistant staphylococcus aureus (MRSA), screening of all patient admissions and healthcare workers should take place. And, if you have not had a S. pneumonia vaccination, this is just another reason to obtain one.
We may need to also change the way we do business. Grocery stores may have to set up call in and pick up food service. Businesses need to switch to working from home. And teleconference services will need to be prioritized based on community need.
Nursing homes will pose significant challenges; besides the above strategies, plans should be made for a reduction in visitors and to enact reverse isolation strategies, which were common in the 2018 Spanish Flu epidemic.
Finally, community education is crucial. The public needs to be educated on hand hygiene and not to touch their eyes, nose or mouth; along with given advisories regarding public gatherings and travel.
There is no doubt that this is the largest challenge our healthcare system has ever faced. In order to save lives, massive resources will have to be advocated without the concern of payment. No one will have enough resources, but we need to help as many as possible. This is what medicine should be about.
Kevin Kavanagh of Somerset is a retired physician and board chairman of Health Watch USA.
This story was originally published February 27, 2020 at 10:03 PM.