This Fresno lung doctor describes what he’s seeing in COVID-19 patients and hospitals
A Fresno pulmonary disease and critical care doctor for Community Medical Centers said COVID-19 patients are facing pneumonia, low oxygen levels, neurological symptoms such as confusion and clotting as hospital staff work under stressful conditions and scramble to keep medications stocked.
Dr. Mohamed Fayed, who also is a faculty member at UCSF Fresno, spoke Friday during Fresno County Public Health Department’s media briefing over Zoom and Facebook Live.
Fayed said as many as 10-15 coronavirus patients are admitted to the hospital each day, and some go straight to intensive care units or are intubated immediately, meaning they’re hooked up to a ventilator. Others require traditional oxygen therapy.
Those who need a ventilator or BiPAP to help their lungs tend to require longer hospital stays and take longer to recover. Patients who are newly ill and get traditional oxygen therapy earlier on recover and go home more quickly, he said.
Other symptoms Fayed described included neurological symptoms such as confusion or clotting, which also becomes a problem when people are hospitalized for a long time.
But mostly the virus is attacking patients’ lungs, he said.
“I think for the majority of cases, this disease affects the lungs directly and causes a lot of inflammation, and people really struggle with that,” he said.
Medications
As cases in Fresno and the central San Joaquin Valley spike and hospitalizations surge, doctors are learning more and more about the disease and how to treat it, Fayed said. Plus, doctors and UCSF staffers are staying in touch and following up with patients who recover for future medical studies.
Over the last three or four months doctors have learned about medications that have shown benefits in some patients, such as Dexamethasone — which helps reduce lung inflammation — and the antiviral medication Remdesivir. But this week, there was a 24-hour window where the hospitals ran out of Remdesivir until more was delivered Friday, he said.
“Now we have two medications that can really alter the course of the disease and make people feel better,” Fayed said.
“When you combine both together, I think you have a good chance to improve the outcome and reduce the admission to the ICU,” he said. “And remember that ICU admissions really correlate very well with mortality. So if you prevent going to the ICU, I think you’re going to be in much better shape.”
Staffing
As for staffing, last week was particularly difficult, he said. He and his colleagues are paying close attention to each other to look for signs of burnout or psychological stress.
“It certainly has been tough. I felt the stress very much last week,” he said Friday. “I think we’re doing much better this week. I think I have a very wonderful team that’s really looking (out for) each other and helping each other.”
Fresno County officials have sought help to staff its hospitals and skilled nursing facilities, particularly registered nurses and certified nursing assistants.
While staffing remains a struggle and changes every day, county officials have not yet opened the alternative care site at the Fresno Convention Center, said Dan Lynch, the county’s EMS director. But the time is near, he said.
“I can tell you we’re getting closer,” Lynch said. “I would expect that we’re going to open up that alternate care site probably within the next week or two, maybe the end of next week to maybe the following week. We are very seriously moving in that direction.”
While the FEMA team has been a big help and the county already is eyeing a staffing supply line for the alternative care site, staffing will remain a challenge, Lynch said.
Specialized ICU staff will be the most needed, and they’ll be the hardest to find, he said.
Message to the public
Fayed urged the public to be careful, wear a mask and refrain from attending social gatherings.
“Remember that you may have very mild symptoms or no symptoms, but you might give the infection to an elderly or someone that’s vulnerable and make them very sick,” he said.
Dr. Stephanie Koch-Kumar, Fresno County’s top epidemiologist, echoed those remarks, noting close contact interactions have driven the spike in infections.
Dr. Rais Vohra, Fresno County’s interim health officer, warned people not to let down their guard.
“Too often and too tragically, it’s really people that were doing the right thing for most of the time, and really being very mindful about safety and patient safety, but in the end, this caught up to them just when they let down their guard,” Vohra said.
This story was originally published July 24, 2020 at 5:33 PM.