Two vaccines from manufacturers Pfizer and Moderna may be approved for use in the U.S. in the next few weeks. That fact, combined with discussion about the rising number of cases of the COVID-19 …
Two vaccines from manufacturers Pfizer and Moderna may be approved for use in the U.S. in the next few weeks. That fact, combined with discussion about the rising number of cases of the COVID-19 disease the vaccines are intended to fight raise questions after a stressful year of work-safe-stay-home orders, a sickness that has struck family and/or friends and a heavily impacted economy has many asking questions.
Joe Freudenberger, CEO of OakBend Medical Center offered answers to several questions about the COVID-19 pandemic and its continued impact. A month before the interview on Dec. 4, OakBend had only four hospitalized COVID-19 patients, but had 18 as of that morning and cases were not limited to a subsegment of the population the hospital serves with patients of all ages and backgrounds impacted, he said.
Freudenberger said he is concerned about a rise in case numbers. While he does not believe Greater Houston is headed towards the crisis level El Paso has seen, cases across the Houston region are increasing.
“For the last four weeks, the count has been rising steadily – as opposed to the way the count rose in the June-July time frame – where it’s going up three, four additional people a day (at OakBend) and sometimes up to half a dozen.”
Freudenberger said he expected similar numbers at Memorial Hermann and Houston Methodist West and data from the Texas Medical Center supports that. The lowest number of COVID-19 hospitalizations since the summer spike in June and July is reported at 76 the week of Sept. 21. That number has steadily risen and for the week of Nov. 30, 174 patients were hospitalized at the TMC. The number of newly diagnosed cases diagnosed regionally is similar with 373 new cases the week of Sept. 14 and a jump to 2,373 the week of Nov. 30.
“So, inside the hospital – recognizing the increasing threat level – we’ve taken additional precautions to protect our patients and our staff,” Freudenberger said. “And so, as other county hospitals have done, we’ve gone back to a zero-visitor policy, except with certain exemptions – end of life, things like that.”
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Still, improvements have been made, though more are needed, Freudenberger said.
“At the peak (of the pandemic in the summer) we had positivity rates of 20% or higher,” Freudenberger said. “Presently in Fort Bend County, our positivity rate is at 11%.”
Regionally, TMC data shows a positivity rate of 6.7% as of Dec. 8 with an ideal rate being 5% or less.
Treatment and vaccines
While he was firm in expressing concern regarding case numbers, Freudenberger did offer pieces of hope regarding the pandemic.
Treatment and mitigation of the spread of the virus have come a long way since the pandemic began, he said. From a mitigation standpoint in hospitals and nursing homes operated by OakBend, things are better due to testing and stronger use of protective equipment and procedures. Nursing home care providers are tested for COVID-19 twice weekly and that has mitigated spread in those facilities. Freudenberger said OakBend had zero cases among patients and workers in those facilities at the time of the interview.
Health professionals have learned how to utilize antibiotics, oxygen therapies and other tactics to fight cases of COVID-19 and prevent the cases from becoming severe, Freudenberger said. Applying some of those treatments earlier has helped, as have some experimental treatments such as convalescent plasma have helped as well as monoclonal antibodies – proteins that mimic the immune system’s ability to fight off antigens such as viruses. Making sure patients move around more has also been therapeutic, he said.
Freudenberger said reinfection appears to be a nonissue. Nationwide, there are only three cases of reported reinfection with the novel coronavirus that causes COVID-19. However, after review, it is likely those cases were actually individuals that had a false negative test, were not in fact fully recovered and something caused a resurgence of the disease.
The success and quality of the two vaccines being considered in the U.S. are promising as well, Freudenberger said. Both have been tested on at least 30,000 patients domestically and zero patients reported any side effects to the vaccine.
“These are not vaccines that have, you know, a few hundred doses administered and nobody’s come up with anything. That’s 30,000 people have had (each) vaccine and they have no documented examples yet where somebody has been harmed,” Freudenberger said.
“It is remarkable how much we have learned about this disease in a short period of time, we’ve been finding,” Freudenberger said. “The good news is it’s a worldwide thing, so there are a lot of people that are working to address this.”
From a local and operational perspective, Freudenberger said, while the medical community would rather the pandemic not have happened, it has allowed them to come together to better coordinate patient care. Because COVID-19 attacks a variety of body systems, physicians of different specialties have had to consult with one another more in order to treat patients successfully. Such practices help provide better care and outcomes for patients and can reduce the cost of care, he said. Prior to the pandemic, hospital departments often worked in silos without consulting one another as often.
Freudenberger said, like many health professionals, he is concerned about the misinformation and politicization of the pandemic. Debates about mask usage, death rates and other issues have distracted from the need for people to work together to keep one another safe, he said.
Freudenberger is frustrated with some members of the public thinking COVID-19 is no big deal. While the death rate is low as a precentage and has become lower since the pandemic began, it is still dangerous, he said. The long-term impact on patient health is also a serious concern, he said, especially when comorbidities such as diabetes, obesity, heart conditions, asthma and similar issues already affect the patient. Some “long-haulers” will see lifelong impacts, he said. The thing hospitals are trying to do is take out the politics of the situation and get area residents to take it seriously to mitigate the impact the pandemic has on the community. While the death rate may be low, the higher the number of people infected, the more people die, he said.
Freudenberger said he has no doubts face coverings work to mitigate the spread of the virus. They prevent spittle – the most common contaminate – from contaminating others and keep people from breathing in the virus when used properly over the nose and mouth.
Another myth that frustrates Freudenberger is the notion that hospitals have inflated case numbers to make more money from treating the disease. He said the only payor that increases payment for COVID-19 cases is Medicare and the associated patient must have tested positive for COVID-19 prior to an extra 20% being paid. However, that 20% makes little difference because the average COVID-19 patient remains in the hospital 30% longer than a similarly-ill non-COVID-19 patient, thus making for a losing financial stake from an operational perspective.
“We’re not making a boatload off COVID,” Freudenberger said. “In fact, it’s hurting us (financially) because all the elective procedures where we make our money are down. Our elective cases are down 20% across the (hospital) system.”
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