Guest Editorial: My COVID Observations and a Request
by Jackie Taylor, M.D.
Chief Physician Executive, West Tennessee Healthcare
March 5, 2020 the state of Tennessee reported its first COVID-19 positive patient. With this news, pandemic medical care in West Tennessee advanced from theory to reality.
At West Tennessee Healthcare we intensified our preparation to care for COVID-19 patients. Our existing plans for emergency preparedness were updated for this pandemic as we worked with our medical staff, other hospitals in West Tennessee, and hospital systems across the state. This was a community effort with our mayors and other local leaders. The planning of a new routine for daily hospital care was initiated as well the establishment of a catastrophic ‘surge’ plan to be carried out in the scenario where the volume of patient needs could exceed our capacity to care for patients.
As April turned to May and then June, we experienced no real surge in COVID-19 cases, and we were able to provide services and accommodate the number of patients in our region.
Then came July. As we all relaxed, we began to experience a rapid increase of COVID-19 patients in West Tennessee and our healthcare system. We went from a census of less than 20 COVID-19 patients per day to 30 per day, then 40 per day and now to a steady daily increase. As I am writing this, Jackson-Madison County General Hospital has over 500 patients in the hospital, 99 of whom have tested positive for COVID-19. Thirty-seven of the COVID patients are requiring intensive care and twenty-four are on ventilators. This morning, almost 20% of all admitted patients at Jackson-Madison County General Hospital are COVID-19 positive. This is in addition to our non-COVID-19 ICU and ventilator patients. We are setting records for patients requiring ventilator assistance to breathe.
I am frequently asked by friends, “Is COVID-19 real?” The answer is yes. COVID-19 is real and it is extremely lethal in certain people-not just the elderly, not just the very sick, not just those with pre-existing conditions. We have had 30- year-old West Tennesseans die. The mortality rate accelerates at about age 60, which, as of this past March, is a much more personally meaningful age to me. It is also true that most people who become infected with COVID-19 have a mild illness and recover. We do not know why some people become deathly ill while others experience a mild illness or no symptoms at all. With this virus, the spectrum of illness is such that both concepts are true, not one or the other. However, I can assure you that you do not want the version of COVID-19 that requires hospitalization… just ask an ICU nurse.
As we make continue to make decisions and evolve patient care in our hospitals the most significant number we are referencing is the number of hospitalized COVID-19 positive patients. This number consists of the number of ICU patients and the number of ventilator patients in WTH hospitals and hospitals across the state. These numbers transcend any questions about testing and data collection, as these numbers are people who have tested positive for COVID-19 and are sick enough to require hospitalization. COVID-19 patients require extended hospital stays and experience much higher mortality rates than non-COVID-19 hospitalized patients. This intensive utilization of ventilators, personal protective equipment, and medications rapidly decreases the resources available for other patients.
Our most important and most limited resource for caring for you, our patients, is our staff. Nurses, physicians, respiratory therapists, lab technicians, environmental services personnel, dietary personnel and many others are all limited, and all part of the team to care for each and every patient that requires hospital care. At this time, our people and our resources are being severely strained. This is even more concerning because hospitals in Memphis and Nashville, along with Mississippi, Texas and Florida to name a few, are also full and competing for the same resources. A limit in resources causes delays and rescheduling outpatient procedures. I apologize to those of you who have experienced this disruption in your planned care, and I hope you understand why.
One of the first principles of Disaster Medicine (yes that is a real specialty) is that the delivery of care changes from caring for the individual patient, one at a time, to caring for a community, a group at one time. Our Ethics Committee at Jackson-Madison County General Hospital is meeting regularly to prepare for a situation when patient need exceeds hospital capacity. We are not there yet, but we are close enough that the discussions are much more real and meaningful.
I have had the great privilege to practice medicine in West Tennessee for over 30 years. I truly believe West Tennesseans are some of the finest people on earth. As a physician, my appeal to West Tennesseans is that you would choose to follow the guidelines for masking, social distancing and avoid large gatherings. I have no political agenda. I am a doctor responsible for your care, and I hope to encourage you to follow these guidelines. Many of you want the freedom to choose to follow these guidelines, rather than be mandated by the government to follow them. Now is the time to make that choice to follow the guidelines. I support and thank the elected officials who have mandated these guidelines and appreciate their leadership.
On behalf of your health care providers, we appreciate all the support you have given us over the past several months. Your yard signs, your hospital drive-bys, your prayers, and the meals you have provided are very encouraging and all greatly appreciated. We will continue to be there for you. Now, the best support for your local hospitals, doctors and nurses is to follow the health department guidelines for masking and social distancing, and in doing so, do your part to help slow the spread of COVID-19. This will also ensure the most uninterrupted healthcare services for you and your family. Six weeks ago, the virus had a low presence in West Tennessee. Now it is imperative we slow the spread of the COVID-19 virus, or we will likely be facing horrible decisions that hospitals in overrun pandemic areas have faced.
If you are ever going to choose to follow the health department guidelines, please start today. It matters greatly.