Planning to travel this holiday season? We have one piece of advice: Don’t. Sorry to be a killjoy but having safe celebrations is the one thing we all can do to help alleviate the pressure on hospitals as they once again become overloaded with the recent spike in COVID cases.
We recently spoke with Zachary Edmonds, MD, Fogarty Innovation’s clinical advisor, about what we should know ahead of the holiday season as we all work together to stay safe and healthy. Zach is a hospitalist practicing at El Camino Health’s Mountain View hospital and is a site director for the Palo Alto Medical Foundation (PAMF) department of Hospital Medicine. He has been on the front lines for the last eight months, treating patients suffering from COVID.
Here is what Zach had to say about the current status of COVID-19 and what we need to know to stay healthy – physically and mentally.
Q: What are the current COVID trends you are seeing, locally and nationally, and the challenges/concerns healthcare workers and hospitals are facing?
There’s no doubt the much-predicted “third wave” is here, and it’s really scary in terms of sheer case volume across the country; in some areas, like in the Midwest, we are seeing almost exponential disease spread.
California recently hit a grim milestone of our millionth case, but while that number is notable, in a state of close to 40 million people, it is not nearly as high a per capita rate as some other states that are seeing much higher case volumes on a per capita basis. And, I will add that Northern California continues to do very well overall, while Southern California is seeing more spread. In Santa Clara County, we are also seeing a continued shift to younger patients, and ethnic disparities notably persist.
On the positive side, we are now much better equipped to care for COVID patients, such that when they require hospitalization the outcomes tend to be much better. Despite the uptick locally, the overwhelming majority of our local hospitals have plenty of capacity in terms of hospital beds, intensive care unit (ICU) beds and ventilators. But, as we’ve seen in other regions of the country, things really start to spiral downward when healthcare systems reach capacity: Healthcare professionals are overwhelmed; processes break down; there are gaps and potential mistakes made when using personal protective equipment (PPE); and many patients experience delays in diagnosis and treatment.
Obviously, the huge worry right now is the stress placed on dozens of healthcare systems around the country, which will only grow in the coming weeks. And unlike this spring, where resources could be shared/lent to hard hit areas (for example, New York City) we just can’t do that now.
Q: As you mentioned, some parts of California are doing relatively well at the moment, although we are also seeing an uptick. What has worked well in helping prevent the spread of the virus, and conversely, what leads to outbreaks?
The good news is that what we need to do to stop the spread is very simple: universal compliance with basic public health measures that we know are effective – washing hands and wearing a mask. In fact, thanks to strict adherence and policies, very few healthcare workers locally have become infected at work.
It’s not enough for 50% of the population to wear masks or even 60 or 70%. We need much higher compliance rates to reduce the spread. If you share a room with somebody who is infectious for an extended period of time and nobody is wearing a mask, your chance of catching COVID is up to 50% or higher. Keep in mind that infected individuals actively spread the virus for up to 48 hours prior to the onset of symptoms. So getting together with people who feel well can still be very risky.
When you boil it down, stopping the spread is as simple as following instructions about not gathering with others in indoor spaces and having appropriate face protection and hand hygiene.
Q: We are now eight months into the pandemic, and you mentioned that mental fatigue has set in for many. What are some mental health strategies that our readers should try during the holidays?
I find that going back to the basics works best, like sticking to a routine, including bedtimes and wake-up times; getting plenty of sleep; eating well; finding time to meditate and exercise; and avoiding media and social media overconsumption. I am also a big believer in focusing on gratitude and looking for the silver linings where they exist. That’s something I routinely practice with my wife and two daughters. For example, I recognize that if the pandemic had occurred 15 or even 10 years ago, we wouldn’t have had all the tools we have now like FaceTime and Zoom. It’s easy to take for granted the fact that we can just jump on and see the faces of loved ones that you can’t see in person.
On that note, you have to prioritize maintaining those connections. At first, we were good about making Zoom appointments, but as scheduling became more difficult, our family has been employing impromptu Zoom calls over the past month or so: We open the platform during dinnertime, leave it on and see who else is having dinner.
Q: We just have to ask the question that’s on everyone’s mind: What is the status of the vaccine?
Those of us in healthcare have been very encouraged by the recent reports for two vaccines that appear very promising. Both are based on mRNA technology, which is remarkable given the amount of effort that has been put into that approach over the last 30 years. The Moderna vaccine in particular included a fairly diverse patient population, including older individuals with comorbidities, and seems protective against severe COVID illness. I can only speak for myself, but I am looking forward to getting immunized at my earliest opportunity.
But it’s going to be still a while—well into next year before most of our community can be immunized. I think it still could be another six to nine months that we need to heed the other precautions.
Q: Any last holiday advice?
I can’t stress enough the importance of being super conservative and spending the holidays with those whom you live with, and thinking of creative ways to include other family members whom you want to see virtually. And as far as flying is concerned, I simply wouldn’t. While the airlines tout their air filters, it really doesn’t make a huge difference since the issue is being in a confined space with people about whom you have no information, such as whether they’re infected and asymptomatic.
If you are considering gathering with others for Thanksgiving my recommendation is to only gather in outdoor spaces and wear masks the entire time apart from when eating, during which time appropriate social distances of more than six feet should be employed among anyone not in the same household. And yes, this includes children.
Q: What are your recommendations for best COVID resources?
These are some places to get solid guidance on your holiday planning…and you can even share them with your family members who might be questioning your caution. It’s not an overstatement to say that our actions in the next several weeks will have lasting repercussions. I’m telling all my patients, do your holidays virtually this year so that we can all be around to have holidays together in person in the future!