Tuesday evening Palomar Health hosted a “Community Briefing: Palomar Health in 2021” led by Palomar Health President and CEO Diane Hansen. She discussed the healthcare system’s strategy and growth plans for 2021.
Perhaps of more immediate interest to those awaiting vaccinations for COVID-19, Dr. Sandeep Soni, Palomar’s medical director of infectious diseases, spoke about the district’s COVID response, which he is in charge of. He also spoke of the vaccine, its effectiveness, and when it might be available to wider public.
The vaccine Palomar has been dispensing to its medical staff is Pfizer’s vaccine, which, he said, “helps trick the body into creating an immune response.”
The mRNA vaccines (which includes Pfizer and Moderna) tell cells how to make a piece of “spike protein” found on the surfaces of the SARS CoV-2 virus. Since only part of the protein is made, it doesn’t harm the vaccine recipient but does stimulate the immune system into making antibodies.
The Pfizer vaccine requires two doses, 25 days apart and after the second dose is 95% effective. “It requires a special freezer, which Palomar Health does have,” said Soni. Note: The vaccine must be stored at Antarctic cold—minus 70 degrees Celsius (minus 94 F.)
The district has more than 5,000 vaccines on hand. “It is now being provided to everyone on staff including volunteers and work is in progress to get it to Arch Health and Graybill as second sites to vaccinate doctors, employees and staff,” said Dr. Soni.
Currently, the Escondido site [Downtown Campus, aka the old hospital] is the only registered site for vaccination. CEO Hansen added, “We are working on spinning up that vaccination center at the Downtown Campus. As soon as we get that off the ground we will get that word to you. We are working as fast as we can to make that a reality.”
As most people know by now, the vaccine is being rolled out in phases, with Phase 1A having three Tiers and including health care providers, EMTs, paramedics, people in nursing facilities etc. In San Diego County this is about 500,000 people.
Phase 1B Tier 1 will include people 75 and older and workers at high risk of exposure in Education & Childcare, Emergency Services; and Food & Agriculture.
Phase 1C, said Dr. Soni, “will be trickier in how they roll it out.” It will include people with conditions making them more vulnerable. Such people may need a doctor’s note, he said.
The vaccine for that will probably be the Moderna vaccine, because it doesn’t have low temperature storage issues, he said. “By the time we to get this we will be several millions into giving the vaccines,” he said.
Dr. Soni answered questions about vaccine side effects: “The first dose was pretty well-tolerated. The second dose you see reactions; that’s when your immune system wakes up to it.” He describe how his wife had high grade fevers for 48 hours. “After that she was back to work.” He added, “You see chills, itchiness and myalgia, like a bad tetanus shot. Most people have tolerated it pretty well. If you have had COVID before, your first shot will be like your second shot.” Anyone getting the vaccine will be monitored for 15 minutes to assess a possible allergic reaction.
Right now you can’t interchange the shots. You either get both shots from the Pfizer or Moderna vaccines. Both are expected to have a lasting immunity of at least one year. “Moderna says it will last a year,” Soni said. “They don’t say how they know that since the pandemic has only been going on for year. It’s anyone’s guess until they release their data.”
Those vaccinated should wait 14 days after having COVID and 14 days between vaccines. This is true of any vaccines, such as flu and shingles. Patients should complete their CDC defined quarantine period before seeking either their first or second dose of the vaccine.
Regarding allergies, Soni said, “Only one staff member had an allergy.” The vaccine ingredients in the COVID vaccine include sugar, salt, fat and mRNA itself.
He noted that no vaccine is “officially approved” by the FDA. “It was an emergency authorization,” he said. “The official approval process takes quite a bit of time and so in the interim, the FDA has allowed emergency use under the parameters that it has deemed safe and effective.”
As of Tuesday in the United States, “about four to five million doses have been given with 13 reactions, and no hospitalizations.” It is safe for people who had COVID to be vaccinated, although they should wait up until 90 days. “The chance of getting COVID twice is almost nil,” he said.
Is it safe for pregnant or breastfeeding women? “The risk is low, he said. “It’s still being studied,” although observational data, animal studies and the understanding of the mechanism suggest the risk is low.
Can it make you sterile? “There is no evidence of that,” he said. “That’s online being online.” He added, “We are waiting on data on whether it is safe for children. As a parent of two children I am waiting eagerly for that.”
Data is limited on the effects of the vaccine on those with compromised autoimmune systems.
CEO Hansen talked about measures the district took to keep staff and patients safe last year and how the Federal Medical Station was readied for deployment over the holidays before being activated December 31. Its 202 beds are on the 10th and 11th floors of Palomar Medical Center. One hundred beds on the 10th floor are currently available—with 21 in use.
“They [staff] gave up holidays and vacation time during the holidays through New Year’s Eve to make this a reality.” She added, “We’re safer than ever and if a family member needs care we are absolutely there for them.”
Hansen discussed COVID’s impact on Palomar Health during 2020. It initially stopped non-COVID treatments and lost $45 million in those four months. After June they started readmitting non-COVID patients. “Since November we have had a stronger performance than last year,” she said. It helped when the federal government paid it $25 million.
“We have continued to move this organization forward to the best of our ability,” said Hansen.
All Fiscal Year 2020 projects were funded without additional debt and capital was distributed across both the Escondido and Poway campuses. More than 20 projects were completed and more than 30 are in progress.
The Employee and Corporate Health facility and the Radiation Oncology facilities are now open. Projects in progress include: Internal Medicine, Infusion, Perinatology, Pulmonology, Rady Children’s Urgent Care and Physicians Offices and Palomar Health Urgent Care. Other projects are the corporate offices for administration and the healthcare foundation.
Hansen spokes of completing several projects at the Poway campus, such as the imaging room, recovery center and outpatient rehabilitation center.
In Escondido the Crisis Stabilization Unit will help offload volume from mental health. By April they will open the 47-room Rehabilitation Institute. They are also working on the Outpatient Center II in Escondido, which will be a mirror image of the first.
Future projects will include expanding the neonatal intensive care unit (NICU), the 9th floor buildout, the hospital parking lot—which will have 1907 spaces—and the 120 bed Behavioral Health Hospital, which will probably be in Escondido. “We have significant needs in behavioral health in North County,” said Hansen.
“Our strategic vision for the next 12-36 months is to use our geographic advantage to become the preeminent integrated delivery system in in North County and expand services to decrease the need for patients to seek care outside of our district. When you think of Palomar Health I hope you will think of ‘preeminent.’ ”
She praised her coworkers: “This team has done things and make improvements to this organization that I didn’t know was possible.”
The strategy for the next three years will focus on “growth and market share,” she said. She noted that the district successfully acquired the physicians group Graybill. “Instead of Graybill and Arch Health competing with each other, they are strategizing together how to provide the highest quality of care at the lowest cost. If we can improve quality and provide it at a more efficient manner, we will do that.”
Hansen continued, “We haven’t had pediatrics in North County since the closure of the Downtown Campus [the old hospital.] Bringing that back is a goal.” The focus in 2021, she said, will be on three areas; Patient Satisfaction Scores, Employment Engagement and Physician Engagement. “We do want to be your system of choice.”
The action plan is to develop and expand “key service lines and make sure what partnerships work best. We have to look at the right partnerships.” And to complete development of the Escondido campus. “You will see that there is a whole lot going on there. Our employees will be very excited when we complete that parking lot!”
She concluded by saying, “We have some of the best doctors in the world right here.”
Wayne Herron, vice president of philanthropy & chief philanthropy officer, discussed the Physician Quarters and Conference Center of the Future that will have 14 on-call rooms for doctors to use when they are resting.
“We are adding public meeting space, including a conference hospital. This will help replace the auditorium that is going away at the Downtown Campus [the old hospital,]” said Herron.
To help raise funds for this, the Health Foundation has launched the Commemorative Brick, Campaign, offering 3,000 bricks that will be placed in the Jacobs and McCann courtyard.
Bricks cost $500 and $250, and may be inscribed as purchasers choose.
In February there will another community briefing on vaccinations.
Questions go to firstname.lastname@example.org
Readers can find a recording of the State of Your Healthcare program at attendee.gotowebinar.com/recording/7617386183349751558