When the surge keeps coming: Views from the COVID whirlpool

When the surge keeps coming: Views from the COVID whirlpool


Dr. Rais Vohra’s timing was impeccable. Just a few months before the start of the OVID-19 pandemic, he served as the Interim Health Officer of Fresno County. Almost immediately, he found himself dealing with the dangerous tension between public health information and the skeptical population at the Industrialized Agriculture Center, which is also one of the most politically conservative areas in California.

The first is the anti-mask protest, magnified by the oath from County sheriff Her deputy will refuse to enforce the state’s mask authorization. Next comes a strong dissatisfaction with business restrictions related to COVID. End the distrust of the new COVID vaccine and the large number of migrant workers who have long-term challenges in accessing health care. Not surprisingly, as of December 3, About 55% Of Fresno County residents have been fully vaccinated, nearly 10 percentage points below the statewide average. In some rural areas of the county, Less than 40% Of residents have been fully vaccinated.

For the past two years, Vohra and other health care systems in the county have struggled to keep up with a series of relentless COVID surges.Current wave Overwhelmed regional hospital, The emergency room was overcrowded, and ambulances waited for hours to unload patients. Nearly 160,000 COVID cases It has been recorded that more than 2,200 residents have died.

Fresno County stretches for more than 6,000 square miles and includes Fresno, the urban core of the Central Valley, and large tracts of farmland. The county has approximately 1 million residents, and a little over half of them are Latino.

Vohra is also a professor of clinical emergency medicine at the University of California, San Francisco-Fresno. He talked with Jenny Gold of KHN about the “reasons” of the continued surge and the loss of the Fresno healthcare system. The dialogue has been edited for length and clarity.

Q: Fresno County COVID hospitalization rate Four times as much as seen in Los Angeles County and eight times as much as San Francisco. Why?

The entire state experienced a surge in the fall. When the surge in other parts of the state was resolved, unfortunately, our numbers did not decline. We stand still. We may see another surge this winter, so the inability to restore our resources and give people time to report and consider how to prepare for the next time is obviously very worrying.

Our vaccination rate is not up to the level we need. The number of masks we have is certainly small, and we cannot obtain authorization for masks. We also have many essential workers. The remote workers who can “zoom in” are very different from those who work at Foster Farms, who must show up without any breaks. Every little thing is connected with every other little thing.

Q: Why does the county’s vaccination rate continue to lag behind the vaccination rate in most parts of the state?

Some people are still struggling to visit, and we are definitely working hard to solve this problem. Then there are other people who just don’t accept science, and I don’t know how to make these people accept it. I think there is emotion first, and reasoning later.

Is it disappointing? Yes, yes. Are we trying to do the right thing and increase the ratio? Of course we are.

But when you see everything we hear, sometimes I feel pleasantly surprised. One million doses of vaccine have been vaccinated. If you told me a year ago that we would complete this work in less than a year, I would not believe it.

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Q: Fresno’s hospital network is working hard to absorb the burden of COVID patients and begging other counties to accept patients. Did you get help?

We only have seven acute care hospitals in Fresno County. We may need twice as much to serve the population. They always run at very high capacity, sometimes exceeding 100% of the licensed capacity. Therefore, this COVID surge is indeed very challenging.

You would think that, given all our information technology, we will have a way to share the burden and transfer personnel. But this is not how the system is designed. We had good conversations with our state partners and all other hospitals on this matter, and I hope it can become a reality. But these questions are not easy to answer.

In addition to the logistics of finding open beds and EMS [emergency medical services] A properly staffed transportation vehicle can manage critically ill patients hundreds of miles away, and you must also obtain the patient’s consent. And, it turns out that if you tell patients and their families, “Your family will be well taken care of, but it will be 100 or 200 miles away”, they will actually refuse.

Q: When you say that Fresno needs twice as many hospitals, do you mean in the COVID era or the normal era?

The non-COVID era. We lack clinicians and nurses, so that it is difficult to meet the needs of patients. The population growth is much faster than that of hospitals.

Rural hospitals are actually restricting their services rather than adding new ones, and this is just part of a larger and more tragic story in the healthcare sector.

Q: As a health official in Fresno County, you are in a state of natural tension in your opposition to wearing a mask and opposing vaccination. How do you navigate?

It’s very interesting, very humble, and very enlightening. This actually makes us very sure of our recommendations, because we know they will be reviewed.

Sometimes we are disappointed. For example, when we saw that the autumn peak was coming, we really worked hard to obtain the authorization of masks. And, unfortunately, our county just doesn’t want to accept this. People are just getting ready to complete the work and can’t even restore it.

Q: I think public health personnel and healthcare providers are exhausted. What are you looking at?

When the pandemic came, I had never seen a feeling of exhaustion and tiredness in my colleagues. In the early days, we were all talking about medical heroes, even though it was scary and surreal, we had a lot of adrenaline. But it ran out a long time ago. Now, people just manage as best they can.

In the hospital, many people are really tired of this anti-vaccination mood. Because they are responsible for caring for people who are sick. It is very sad to see it with my own eyes and get through it. What it does, however, is to connect people together in a way that only severe trauma can do. At this point, if you still go to work every day, even though you are exhausted, it is because you really like the team you work with. I certainly saw this in our health department.

Q: Your wife, Dr. Stacy Sawtelle Vohra, is an emergency doctor at the Fresno Community Regional Medical Center and also works on the frontline of COVID. What is the loss of your family?

Whenever there is high transmission in our community, it also affects us personally, and people have to take time off to take care of relatives or conduct inspections. We gave our children a test because they had a runny nose. And you must let your child leave school while taking the test. After going through this, you will understand that if I can’t have a meeting at home, it will become impossible. We have not yet created a good solution for our community, especially for parents who have to work and do not have good childcare options.

We are all lucky that we have understanding and flexible employers.We have two 4 year old and 7 year old kids, their first task is to make sure Elf on the shelf Appeared today. For better or worse, we are good dividers, we just leave everything in the office or emergency room. When we go home, we are a family. We just hope to give them a normal childhood as possible in this challenging period.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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