In an interview this week with Palomar Health’s Chief Medical Doctor Omar Khawaja he called on the public to “follow health mandates” because the system is not “overwhelmed” but “if we continue on the path we are on, we are going to stretch hospital resources.”
Dr. Khawaja is responsible for Palomar Medical Center in Escondido and Palomar Medical Center Poway (formerly Pomerado Hospital.) This is a follow-up to an interview we did with him at the beginning of the pandemic.
Dr. Khawaja told the newspaper, “What we are seeing is a large uptick in numbers [of positive COVID infections]. As someone who works in the health system, I look at hospitalizations. We have seen an dramatic increase in hospitalizations. We are up to over four hundred patients consistently, a twenty-five to thirty percent increase. We are not overwhelmed but if we continue on the path we are going to stretch hospital resources.”
Note: That 400 patient figure is for the two hospitals and represents about 75% of capacity. According to Khawaja it is normal for the numbers to increase as the winter progresses, often up to 90% of capacity, but that’s usually for flu. This is the first winter of the COVID pandemic.
So far COVID patients represent a small percentage of that total number. “We have gone from the low twenties to as high as forty between the two hospitals, he said.
Asked how the health system has prepared for a second surge of COVID-19, Dr. Khawaja said, “All of the health systems in the county get in a conference call twice a week to strategize on how to prepare. The major thing is to have the proper equipment for staff, including test equipment, beds and PPE’s [personal protective equipment]. We have been working together to share our resources. We have been building stocks of supplies.”
How much are they stockpiling? “We are looking to have 60 days of PPE and a cache of testing supplies and we are looking to hire more staff and bring in temporary staff for any kind of surge.” The includes the normal seasonal surge of the flu. “We are getting ready for that and we have done a good job of making sure we have all of that ready,” he said.
But one of the most important missions of the health system is “to get out the message to our community that it’s important to not do large gatherings this Thanksgiving to slow the spread,” said Dr. Khawaja.
He explained, “I think we are seeing people accepting the idea of masking and being distant. But from multiple reports, we see that the spread of the disease is happening in smaller gatherings, families coming together. That’s what concerns people.”
People are fatigued from COVID, he said. “People are letting their guards down. I personally see it from my patients. We know that COVID is spreading in smaller gatherings and we are worried that people are letting their guard down. They are going to have bigger gatherings. Although we are learning how to control it, it is a fast spreading disease in that kind of atmosphere. Our concern is we will see a much faster rise than we are even seeing now.”
Note: the statistics from this week indicate that in California the second wave of COVID-19 is actually larger than the first wave in March of 2020, with identified cases three times more numerous than last month. According to the San Diego County Health and Human Services Agency, there were a record high number of coronavirus cases last week.
We asked Dr. Khawaja how many beds are available for COVID patients. “Essentially any bed can be a COVID bed,” he said. “At this point on a daily basis we have from forty to sixty beds available. Of the special rooms [dedicated to COVID cases] with negative air pressure, on any given day we have or twenty or thirty available.” Those beds are held in reserve.
Another question of interest is do the local hospitals have enough doctors and nurses, i.e. are there many medical people out sick? “Right now we don’t [have many out sick],” said Dr. Khawaja. “It’s another concern that our internal staff might get sick over the holidays. We are doing multiple warnings and town hall meetings to make sure that our caregivers are being as careful as they can because we are going to need them.”
He added, “We have been very conservative in terms of our use of protective equipment and testing. “We are doing everything to keep our staff safe and we have had very little spread. I’m much more concerned of contracting the disease outside of the hospital than I am inside the hospital.”
Is the second surge worse than the first? “The numbers are rising very quickly,” said Dr. Khawaja. “The speed that it is rising is worse than the first, but how sick people get and the number deaths is not as bad.”
He said these figures could possibly be attributed to masking and physical distancing and the better level of treatment compared to the early weeks of the pandemic. “A good number of those who are getting sick are in the younger years, although we do see deaths and symptoms. Right now we hopeful that our changes will make the acuity less but we are seeing a rapid increase in numbers—which is very worrisome.”
As worrisome as that is, doctors have arrows in their quivers they didn’t have at the beginning of the pandemic. “We have learned a few things,” said Khawaja. “One is the idea of ‘proning,’ changing positions throughout the days—and in testing. We have better access to testing and faster results. We’ve learned that the distancing the masking is working and we’ve learned that when someone comes in with a stroke, the presentation can actually be COVID in a different kind of presentation. We do have a few treatments like steroids and Remdesivir.”
Several months ago, when the newspaper inquired about President Trump’s favorite COVID treatment, Hydroxychloroquine, we were told the hospitals were using it in some cases. Now, apparently that is no longer true. “We’ve found better drugs and moved on from that,” said Dr. Khawaja.
Dr. Khawaja said Palomar Health gets inquiries about the 202-bed Federal Medical Station loaned to the county in April and occupying two formerly vacant floors of Palomar Medical Center Escondido.
“The Federal Medical Station they set up, upstairs, we still have those available but we haven’t had to use them,” he said. “It’s another asset available. There is a lot of ability to flex up and down. I don’t think we’ll need it but you always think worst case scenario to be ready for that.”
One common complaint about the response to the COVID pandemic is that patients are not allowed to have elective surgery because the health system must concentrate on the rising number of cases.
Dr. Khawaja said that in the hospital system there isn’t much that is truly elective. “We do have some things we cut back on, but the idea that someone doesn’t get surgery who needs surgery is wrong. Right now the hospitals are doing about 75% of their normal number of surgeries. As the numbers of COVID cases rise, they would look at curtailing elective surgeries: “But right now we are not at that point,” he said.