‘How Kentucky flattens the curve.’ Stay home, conserve healthcare resources to fight COVID-19.
If your upcoming check-up was recently canceled, you probably noticed that healthcare conservation efforts are underway. Elective surgeries are being postponed and hospitalized patients are being discharged or transferred to lower-level treatment facilities so as to free up as much space as possible in critical care units. Palettes of personal protective equipment from national stockpiles are being distributed and healthcare workers are getting just-in-time training to prepare for the influx of COVID-19 patients.
The limited testing for COVID-19 has had tragic consequences: Frustrated patients are going clinic to clinic seeking answers about their health, clinicians lack the full understanding of the spectrum of disease needed to care for their patients, and epidemiologists do not have comprehensive case identification to effectively track down all the exposed and limit the spread of disease.
The issue is more complex than just the limited number of laboratory testing kits. There is an overall shortage of healthcare infrastructure to accommodate the demands for COVID-19 testing. Clinics need to be prepared to receive someone who might have COVID-19 so patients aren’t sitting in waiting areas and being exposed.
The specimen collection itself requires some clinical skill as it involves inserting a cotton swab deep into the nose, through the sinus cavity, all the way to the back of the pharynx; they’ve always seemed like “brain probes” to me as they seem to penetrate an alarming depth into the nose. These swabs and their collection tubes are not widely available in all clinics.
Most important, healthcare providers must be wearing high levels of personal protective equipment when testing and treating patients with COVID-19. This includes respirators or masks, gowns, gloves, and eye protection. Every healthcare facility in the country is concerned about not having enough of these supplies, and some offices do not have any at all. We are well aware of the run on toilet paper, and the same shortages currently exist for personal protective equipment needed to keep healthcare workers safe. We can laugh about the toilet paper crisis, but there is nothing funny about doctors and nursing placing their lives at risk.
Drive thru testing sites are being established which can be an efficient way to test patients while preserving protective equipment, but it is not like going to McDonalds. There is simply not the capacity to test everyone who wants and needs to be tested. The assertion by national leadership that “anyone who wants a test can get a test” is both wrong and dangerous. We must stop such thinking and pay attention to local leaders and healthcare experts. It is important for the public to know that there are not currently recommended treatments for COVID-19. Under current conditions in Kentucky, if a sick community member, who is not hospitalized, tests positive for COVID-19, then they are told to stay home and self-isolate. When supplies are limited and demand is anticipated to increase beyond capacity, it is incredibly important to ration protective equipment and testing supplies to the highest risk patients. Patients who are hospitalized need to be tested because healthcare workers must wear the appropriate equipment every time they enter the room if the patient has COVID-19.
Our local communities have a key role to play in healthcare rationing. The “Stay Home” campaign taking hold around social media is even more important if you are concerned that you are sick with COVID-19. Do not go into a clinic and try to get tested unless you have been told to come in; just stay at home and self-isolate from others in the household. If you are having a medical emergency or need to be evaluated by a clinician, then you should absolutely seek care, but call ahead to inform the clinic or emergency room that you might have COVID-19 so the medical personnel can be prepared.
This crisis is global, but the impact is local. These are our doctors and nurses that are being put at risk and our hospitals that are feeling overwhelmed. This puts all Kentuckians at greater risk. We each need to do our part to lessen the burden of an over-stressed healthcare system so that those among us—neighbors, friends and family—who are most in need of critical care can receive it. By taking individual actions to stay home when healthy or sick, we will help reduce the overall burden in the community. This is how Kentucky flattens the curve.
Dr. Kathleen Winter is an assistant professor in the University of Kentucky’s Department of Epidemiology in the College of Public Health and Dr. Steven Buck is an assistant professor in the University of Kentucky’s Department of Agricultural Economics in the College of Agriculture, Food, and the Environment.