A Deep Plunge Into The Virus, Treatments And Our Hospitals

by Mitchell Kriegman

Let’s get real – what do you need to know now? Talking COVID-19, the pandemic, local life, and help. We had the opportunity to talk with Dr. Lynn Fitzgibbons, the Infectious Diseases and Internal Medicine specialist at Cottage Hospital, whose Cottage Grand Rounds Doctor to Doctor video has gone viral locally. Dr. Fitzgibbons and the video are remarkable. Watch it and you’ll come away with a greater understanding of the mechanisms of the disease and the situation we find ourselves from a highly respected local expert at our own Cottage Hospital that cuts through the clutter of the news and social media. The video is available at the Cottage Hospital Website: https://www.cottagehealth.org/covid-19-video/

Dr. Fitzgibbons’ video is an up-to-the-minute analysis that covers everything from the biology of the coronavirus micro-organism to China’s protocols for diagnosis and how the Ebola Crisis informs our current situation, as well as the crucial role hospitals will play. Most importantly she’s in the very thick of what we are likely to see in Santa Barbara, all while somehow managing to keep her sense of optimism, humor, and remarkable calm.

Q: Where are we now?

Dr. Fitzgibbons: We’re seeing an encouraging increase in testing locally, particularly over the last five to seven days. We now know that there are at least one to two patients with this infection in Santa Barbara County. We, the infectious disease physicians, really feel that it’s likely circulating in our community. We are reassured that there has been an increase in testing, although not to the point we would desire. The most reassuring aspect of the local situation today is that inside the hospital we are not yet seeing an explosion or even much of an increase in patients admitted with unusual pneumonia, respiratory failure, or other severe viral syndromes.

Unfortunately, with the pandemic and its evolution elsewhere, we have seen significant public concern, which is very understandable, but this has led to a stress on our emergency services. Our emergency room is working incredibly hard to take care of as many patients as they possibly can, but they’re encouraging people who are not in need of urgent emergency care to start with their primary care provider. 

We’ve all heard there are no tests. So where are these testing options coming from?

Our regional public health labs have been very helpful in getting tests for our highest priority cases. However, the volume needed to really test the community at large has led to the use of commercial labs whereby samples are sent to different parts of the state or even different parts of the country with a turnaround time of perhaps four to six days. Even the commercial labs are struggling with huge volumes from around the country so turnaround could increase or stay stable. Many local clinics, including Sansum Clinic and the Neighborhood Clinics have partnered to improve outpatient testing options just this week as well.


So it sounds like, it’s not good enough, but better, in terms of testing and the log jam may be starting to break?

I would very much want to reassure our community that inside the hospital, testing is not a problem. We are getting tests for the patients who need tests. The biggest testing challenge is really for patients who are unwell and at home and understandably very much want an answer. One week ago, we had far more scarcity of testing for our community. Today we have far more tests. I’m optimistic that if we reevaluate this in one week or two weeks the story will be very different again. 

Is there a message you want the community at large to know?

I most passionately want people to understand that the dramatic measures we’re taking with social distancing, with closures, postponements and turning people’s lives upside down, are being made to try to “flatten the curve” and to slow down the epidemic. When people hear that schools are closing it strikes fear in the heart of many parents. My feeling is actually the opposite. This is not a disease that we think significantly affects children, but we know that closing schools is a great way to decrease the spread of a disease. It’s not about the kids, it’s about the community’s health.

You had a line in the Cottage video: “We’ve only tested the snowflake on the tip of the iceberg.” The iceberg metaphor and visual was brilliant. Is there another analogy that’s helpful? We’ve heard people say it’s like World War II except we’re on the front lines. Do you have any other analogies, that help everyday people think about this? 

The other one I’ve heard is that “it’s hard to address the infestation of the rats in the basement if you don’t turn the lights on in the basement and go downstairs.” I prefer to think of the snowflake on the top of the iceberg.

Is that because a big piece of that iceberg, the part we can’t see, is really people who are asymptomatic?

That’s exactly right and that’s probably because of the younger population and those who are less medically complex. If we’re only testing the snowflake or perhaps this week, we’re now testing the snowball on the tip of the iceberg, we don’t yet know the size of the epidemic. The vast majority of our population are going to get through this. Maybe half of all people who carry this virus don’t have symptoms. Eighty percent or more of people who fall ill have a mild upper respiratory infection. You have to remember that the reason we’re doing these efforts that upend our lives is for the good of our public health and that of our community.

How’s it going in terms of in the hospital infection, the nurses, the staff, and the doctors?

Hospital workers are perhaps our most precious resource in all of this. Cottage is working around the clock to improve our systems, to prepare in anticipation that this is going to affect our communities. In Santa Barbara we’re fortunate that at this point we’re not yet seeing a big increase in respiratory illness for our admitted patients. That said it changes every day. Every hour. There is some fear amongst healthcare workers about potentially being exposed, but we’re in a far better position than the core physicians and healthcare workers in China or in Italy. We have had time to plan and to get our systems in place to protect our healthcare workers. I think, some degree of anxiety is understandable.

During this really unprecedented set of events that we’re living through, I think pausing and asking our neighbors, asking our nursing friends, what do you need?

There’s a lot of negative and even euphoric news in the social media world that seems unrealistic. What do you think about the future? Will things go back to normal. Does it run its course?

Well, one of the challenges of the concept of “flattening the curve” is thinking ahead to how long we are talking. We know that our healthcare systems are going to be better off if we see a trickle of patients, as opposed to a surge of patients. But one of the interesting questions I was asked this week was, is there a point at which, this really takes too long to come through in a way that doesn’t disrupt our lives for months and months or longer? What we don’t know about the virus itself is how it’s going to behave in our human population in the long term. Is it going to be an epidemic that comes through and moves on, that we developed some immunity to as a population? Or is there some seasonality to this? Is it going to mutate and change in such a way that we’re at risk down the road? These are unanswered questions.

One big takeaway watching your video the importance of hospitals. Why are hospitals so important? Why are hospitals a line of defense?

Well unfortunately some percentage of patients are falling so sick so quickly that they would not survive outside of the hospital, that they need care that can only be delivered in a hospital and often only in an ICU to save their life. While the percentage may not be very high, the number of patients may be very high.

So, because there is no cure, no vaccine, and limited therapeutic options, it seems funny and obvious to say that comes down to that good old four-letter word, “care.”

I’ve spoken about Ebola in the video. That was another viral epidemic for which there was no known treatment. In the Democratic Republic of the Congo, the mortality rate was 90%. Nine out of every 10 people died. While in Western Europe and the United States, we had a total of 27 patients during that epidemic and only 18% of the patients who fell ill died. Now that’s still a tragedy. That’s still horrendous but the difference there between 18% in our healthcare system compared to 90% in the developing world is almost entirely because these patients had access to excellent hospital clinical care.

Which means they’re in a bed, in a controlled environment?

They’re getting IV fluids. If they need oxygen, they get oxygen. If they can’t breathe there’s a machine to help support their lungs. If they go into shock, they get medicines to help. If they get another infection on top, like a bacterial infection, they get antibiotics. These life saving measures make all the difference. This is all of the care that we provide in our healthcare system. That’s why hospitals are so important.

Then how do we support our hospitals and our healthcare workers?

Great question. We start by asking, what do people need? During this really unprecedented set of events that we’re living through, I think pausing and asking our neighbors, asking our nursing friends, what do you need? I think being thoughtful and careful, but really asking, asking around the community, where is the need this week? And being ready for that to change next week because this is a very, very fluid situation.

What about literally donating to hospitals? Contributions, masks, or these other items that we’ve heard nurses and doctors don’t have?

There’s certainly a need everywhere for PPE, personal protective equipment, but I think reaching out to organizations for what their needs are is definitely the place to start.

For Cottage Hospital there is a weblink https://www.cottagehealth.org/donate/.

That’s right, but there’s another thing I think will help. You know the Montecito Journal may have a readership with some large percentage older than the age of 65. And we’re asking people to do this social kind of isolation and self-quarantine. This can be very, very hard on people. The younger population has grown up with electronics and devices and really have a very different type of social connection from those who are over 65. So, I think there’s a really big opportunity for our seniors to lean in with their electronics and stay better connected to friends and loved ones. Simple things like FaceTiming, but there’s so many platforms that people can be connected to one another.

Perhaps it’s even about time that younger people help older people figure out how to use those devices and stay socially connected. Hopefully some youth organization might organize that. Well I hope we can stay in touch for updates as the situation changes. 

Well, thanks. I’m glad we did this.

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