Doctor outlines holiday fears and future hopes

The current wave of coronavirus spread is more ominous than the first in Washington for reasons that give doctors cause to fear the near future, including those at Coulee Medical Center, where “we’ve been pretty lucky thus far,” says Dr. Jacob Chaffee at CMC, but they’re also feeling upbeat about coming vaccines.

“Hospitals across the state are becoming saturated both on their medical floors as well as their ICUs, and so our biggest fear is that if we see our rates climb significantly, we’re not going to be able to transfer patients who need to be transferred,” Chaffee said in a phone interview Nov. 19.

CMC currently has two rooms set up to care for patients with COVID-19 and is prepared to set up more if necessary, but the local 25-bed hospital has no intensive care unit, and it has neither the equipment nor personnel to handle people who need long-term intubation.

Covid patients needing that kind of care have been sent to a large hospital in Spokane, Wenatchee, the Tri-Cities or the west side of the state, but it’s very possible that, following a post-Thanksgiving surge after people have joined others in traditional gatherings, those beds won’t be available.

Chaffee primarily works in CMC’s emergency room and as a hospitalist, as well as doing obstetrics work and more. He also attends weekly online meetings with the infectious disease experts at the University of Washington.

With COVID-19 cases surging around the nation, including in rural areas mostly spared in last spring’s surge, this state is in a more perilous state than before. With hospitals on the west side seeing the spread at the same time as eastern Washington, the worry is that if it gets bad there could be no place to send patients from small hospitals like CMC that are not equipped to handle the most serious cases.

It’s a scenario playing out in other states that Washington has so far avoided by following recommended masking and distancing guidelines.

In Oklahoma, a state from which several CMC healthcare providers come, new daily cases have shot up 600 percent since October. A family physician and friend to Drs. Adam McConnel and Marilyn Holman, died from COVID-19 last Wednesday, Chaffee said. “That hits home.”

And in Texas, hundreds of health care workers are being transferred from city to city to meet the surge, Chaffee said.

A big surge endangers other types of patients, too, as beds and ICUs they need aren’t available, either because the physical space is taken, or just because hospitals don’t have enough health care workers to staff those units because they’ve gotten sick.

Chaffee said data makes it clear that risk of catching the virus is low at hospital because of use of protective equipment and enforced use of masks and distancing, but hospital workers can and do pick up the infection in the community, and it’s spreading through small, personal gatherings.

Such gatherings have been happening in the local community. Chaffee said he knows of people who have had to quarantine because of them.

“Our biggest plea,” Chaffee said is to follow the guidelines to wear a mask in public and stay home for Thanksgiving, as recommended by the Centers for Disease Control and Prevention and the state’s Department of Health.

“We think it’s exceedingly important that people wear masks … and that people avoid indoor gatherings with people outside of their immediate family,” he said. “It just is not a safe thing to do at this point, as has been demonstrated across the country.”

Thanksgiving is an awful time of year to have to follow that kind of recommendation, Chaffee acknowledged.

“We are social animals, and it sucks to be isolated and to be trying to do things via phone and video,” Chaffee said. “We’re all dying to hug our loved ones.”

CMC has also made plans for the worst, hoping to never use them. The staff there have “gone down the rabbit hole” to lay plans for turning the whole place into a Covid ward in the unlikely event that became necessary.

On the hopeful side, Chaffee said infectious disease professionals at UW are feeling good about the lack of what some had feared would be a capitulation to election-year political pressures at the Food and Drug Administration, which approves new vaccines. That didn’t happen, and two vaccines announced so far are more than 90% effective, an “amazing” result, Chaffee said, noting the influenza vaccine is about 50% effective.

Separate from the FDA, Washington, Oregon and California have also set up a review process for the data on vaccines once it’s available.

But until those vaccines are widely available, we’ll still need to stay safe by wearing masks, keeping our distance and, for now, not traveling or spending holidays with people who don’t live in our households.