Tenet Health Central Coast Emergency Physician Answers Questions About COVID-19

Tenet Health Central Coast’s Dr. Brad Knox spoke to numerous media outlets in late March and early April 2020 to help provide answers to address public questions and concerns about COVID-19. Dr. Knox is Vice Chief of Staff and the Chair of the Emergency Department at Sierra Vista Regional Medical Center (the San Luis Obispo County’s only Trauma Center) and an emergency physician at Twin Cities Community Hospital (the county’s busiest Emergency Department). The post below combines elements of the interviews, and links to the media stories are available at the bottom of this post.

Topic: Surge Preparedness

Dr. Knox: Every day that this doesn't hit, we're becoming even more ready. It's kind of like you've done all the training, you've done the practicing. Now, you are just waiting for that Friday night game and ready to get out on the field and do it. We are doing everything possible, and I feel, as a member of the community, very safe and very prepared.

The message to get out right now is that we're prepared. We have appropriate equipment right now and protective equipment – and we are obviously planning for the weeks down the line. Right now, speaking as one of the people that is helping to guide the preparations, I feel like we are as prepared as we can be at the moment with the resources we have. Short of building another hospital or suddenly having just a wealth of additional equipment and manpower show up, I think we're ready.

Topic: More Cases in North County Compared to South County 

Dr. Knox: I think the reason [County of San Luis Obispo Public Health Director] Dr. Borenstein said that [Paso Robles is going to be a hot spot in the county for coronavirus] is because that is where a majority of the cases in the county have been thus far. But I would not take a false sense of security from that if you happen to live in South County. On the Johns Hopkins map, you can see how much this is spreading all over. You have to assume that this is going to hit all of [our communities]. Thankfully, we are a very small community, so there's a chance that we're not going to be hit as hard as some of our neighbors are. I think ultimately, when you look at a virus like this, probably half of our population will get infected. Thankfully, again, most of these people are going to be just fine.

Topic: Attitude of Frontline Health Workers Before the Anticipated Surge

Dr. Knox: I think the general attitude is one of anticipation. We have a wonderful team. And I'm thankful I'm not living anywhere else right now.

We have actually increased our equipment drastically [at both hospitals] as we were watching what's happening worldwide and the predictions. Thankfully, we have taken it very seriously from the get-go.

Topic: Coordination With County Officials and Other Health Providers

Dr. Knox: We are in touch with the county daily, multiple calls a day, and with our compatriots over at Dignity Health and Cal Poly. I believe that our neighbors in the community, the county Public Health Department – everyone – is on the same page. Then there is a weekly roundup between all facilities and physicians. This is an all-hands-on-deck, community-first effort.

No one alive, pretty much, has seen anything like this before. So there's really no guidebook for this. You [have to] look at the last pandemic, like the Spanish Flu in 1918. We don't know yet how prevalent it is in our community. For right now, if it sounds like someone may have it, we are treating them as if they do. For our [health] providers, most of them are going to have a mask on just to try and give a little bit of protection to themselves in the event that some patient who's coming in with acute appendicitis may happen to have it. So make sure [we have] gloves on, protecting skin, and any kind of exposures. You know, that's the tricky part, where patients have this illness and aren't necessarily symptomatic from it. So we're just kind of being overly cautious.

But that being said, we train on infectious disease in emergency medicine. Just like we trained for bioterrorism or bombings. It's all part of what we do.

Topic: The Treatment Process for COVID-19

Dr. Knox: When you come to the emergency room, we will be screening you looking at the oxygenation of the blood. And that's going to be a big branch point for us. That is where your more intensive treatments start is simply with supportive oxygen.

From there, we may do breathing treatments. From there, if the respiratory status becomes compromised further, that's when ventilators come into play. There is different positioning as far as putting patients on a ventilator on their stomach to try to minimize some of the inflammation that happens in the lungs. And a lot of it is giving the patient's body time to get better. We may put antibiotics on board because it is hard to tell if this is truly COVID-19 while we are waiting for test results and bacterial pneumonia is something we can clearly treat – and aggressive respiratory therapies.

Estimates are that about 80 percent of people who get this disease will have no symptoms or they are going to have very mild symptoms: a sore throat, a runny nose, a cough, against maybe some body aches, some fevers. Symptoms are well managed with rest, fluids, acetaminophen (such as Tylenol), as well as the usual over-the-counter cold medications. Patients that are more ill, or have shortness of breath, or feel they can’t catch their breath, will need to go to the hospital. They may need oxygen therapies, lung therapies, or if they’re really ill and going into respiratory failure, to be on a ventilator in the (intensive care unit). The goal is to buy them time and help their bodies beat this virus with its own immune system.

Topic: Whether People Have Had Undiagnosed COVID-19

Dr. Knox: We do not have the testing ability worldwide to [check if you had already had COVID-19 and recovered]. It is quite possible. In Spain, they were testing people in the morgue and they found COVID-19 dating back to February. So it is quite possible it has already been through our community. And the “bad flu” you may have had a month or two ago may have been it.

Topic: Positive Tests vs. Virus Spreading

Dr. Knox: It is hard to know if the increase in numbers represents purely an increase in testing or a true increase in incidents of this disease in our community. Right now, as the testing ramps up, we are clearly going to see more patients. I will say we have not seen a lot of critical patients [as of early April 2020]. Most of the patients are “the walking well.” But as these tests become more available, we are going to see an increase in numbers. And again, I would say most of the time it is going to be purely because we're looking for it more.

The other thing that must be taken into consideration is the limits of testing. Whether it is for the flu or COVID-19, the tests are not perfect. If it is positive, it's positive – you can trust the patient has the illness. But, if it is negative, there is still a chance they could still have the disease and it was just a poor sample or something wrong with the equipment. So we have to keep it in context.

Topic: Social Distancing

Dr. Knox: I think we can say social distancing is working when we start to see our infectious rates slow down. If we see our rates double only every two or three weeks, that's when we'll know our social distancing is really having an effect. Please stay home if you can. Limit your contact with others. I know it is frustrating. But try and minimize the social gatherings because we really want to just try and stamp this thing down. If we can do that, we can go back to our regular lifestyle.

I think the worst thing we could do right now is break this shelter idea. People saying it has been 11, 12 days and asking when can we get back to our daily lives. I want to emphasize the reason we're doing this is really trying to slow this down and buy us time to better prepare for it.

Media Links:

San Luis Obispo Tribune:

“Coronavirus Questions? SLO County CA doctor has answers…”

https://www.sanluisobispo.com/news/health-and-medicine/article241576891.html

New Times:

“New Times speaks with a local emergency physician about COVID-19”

https://www.newtimesslo.com/sanluisobispo/new-times-speaks-with-a-local-emergency-physician-about-covid-19/Content?oid=9562027

KSBY-TV (NBC):

“San Luis Obispo doctor answers viewers' questions on COVID-19”