We submitted about 20 questions via email. Hospital CEO and President Nancy Agee answered some of those questions alongside Dr. Paul Skolnik.
We began by asking Carilion if they could be more specific about the health districts their COVID-10 patients come from. We asked why the media could only get confirmations from the Virginia Department of Health.
Carilion responded in a statement that the regulatory requirement for reporting is that VDH must officially confirm the case.
"Our reported cases are captured and confirmed as part of VDH's state tracker," the statement went on to say. "Moreover, VDH follows up through their contact tracing directly with parties who potentially came into contact with a patient. We share our numbers to give an accurate depiction of what we’re seeing as a system, and VDH confirms those numbers and leads contact tracing."
We also asked Carilion who they are testing and why. We wondered whether asymptomatic people were being tested, even if they had come into close contact with positive patients.
Dr. Skolnik said they are only testing symptomatic patients right now. This, they say, to conserve supplies and reduce over flow in the hospital.
“We are prioritizing symptomatic patients to know if they have COVID or if they have another viral illness such as influenza or another respiratory pathogen for which we have treatments, so we have to know that for those patients who are symptomatic," he said. "We’re also prioritizing healthcare workers who may be asked to self isolate if they have exposures so we can get them back into the workforce quickly so they can care for sick patients.”
We asked about a drive-through testing site. They don't have one yet, but say it's under consideration if needed. But for about a week, Skolnik said they have been using a referral testing site.
“We have test kits to use there and people come through we obtain the test in a very safe manner," he said. "We are using this for those patients who are symptomatic. This is not for people who are asymptomatic. They need a referral from either the ED or our primary care sites.”
Earlier this week, during his briefing, President Trump said he hoped the country would be "back open" by Easter.
We asked doctors if this would be feasible for southwest Virginia.
“It’s gonna take more time than that," Skolnik said. "And all the things we’re talking about, social distancing, hand washing, and other methods are gonna just take longer than that to flatten the curve as it’s said so we can decrease the numbers and care for people. So I think that's overly optimistic."
We also wanted to know what Carilion could do if they start running out of room for patients.
CEO and president Nancy Agee said they have been planning for that scenario.
"We do know that we could fairly easily open up about 60 additional beds. The Governor has given us permission to open beds as necessary above our allotted beds license numbers," she said. "...Most likely we would move some of our less ill patients to capacity and then add ICU capacity at a different place.”
Nancy Agee was also asked about the hospital's financial position.
She said they are in a reasonably good place right now and will be if this lasts several months. If this goes on for much longer than that, she said, it could be a different story.
Dr. Skolnik was asked about how susceptible pregnant women are to catching the coronavirus. He said they don't appear to be any more susceptible than the average person without prexisting conditions, and the virus cannot pass through the placenta.
“Pregnant women probably are not any more apt to get severe disease, however, if they do get severe disease they’re not only putting themselves at risk but the unborn child because the main effect of this virus is to decrease the amount of oxygen in the blood and if the unborn child gets less oxygen, that’s less risky," he said.
Dr. Skolnik also said it is hard to determine how long someone might be contagious. He said that was something doctors still don't know for sure. Some places are making that determination based on the disappearance of symptoms, others require 2 negative tests of the virus. He said the methods in use by Carilion were done out of an abundance of caution.
Many restaurants in our hometowns, and nationwide, are resorting to curbside and delivery service only to provide people with food. We asked Dr. Skolnik how those restaurants might work to be even more diligent about preventing the spread of the virus. He said cooked food will be fine. The only risk might be the containers of the food themselves. He recommended either wiping down those containers with a disinfectant, or putting the food onto a plate, throwing the container away and washing your hands immediately.
Dr. Skolnik was asked about reports or "new" symptoms associated with the virus, including digestive issues and the loss of smell. He said they appeared to be true, noting digestive issues could appear early on in the disease including a change in bowel movement or loose stool. The inability to smell might be a symptom that would occur late during the disease and perhaps only in the more severe cases.
We also wanted to know what protocols the hospital was taking when someone arrived with symptoms of COVID-19. Dr. Skolnik said those patients are immediately placed into isolation on a special floor with negative pressure rooms. This prevents the virus from being passed from room to room.
He said the hospital is following procedure to move people from the emergency room to those specialized rooms. He also said staff is taking extra precautions with Personal Protective Equipment, like face masks and gowns.
We wanted to know how Carilion was handing its PPE supply. Dr. Skolnik said the hospital does have enough supplies right now. That said, WDBJ7 reported earlier this week Carilion is seeking PPE donations from the community. Dr. Skolnik and Agee said the materials management team at Carilion is working to make sure they continue to have enough. They are also reusing some equipment if they are able, using UV technology to disinfect them. They are, he said, trying to be conscious not to burn through precious supplies.
Many members of the community have donated homemade face masks for health care workers. Right now, Carilion is not accepting them, but says it is looking for ways to be able to use them in the future. Dr. Skolnik noted that some hospitals in other parts of the country currently overloaded with COVID19 cases might be using alternative methods for protection, methods he said are appropriate for their stage.
Agee noted Carilion had many donations of high-grade PPE from several local colleges and universities, dental offices, non-profits like Habitat for Humanity and businesses like Norfolk Southern.
We also asked Dr. Skolnik what Agee called "the million dollar question." How will we know when this pandemic is over?
They, of course, can't provide a specific date or time. But Skolnik told us we will eventually see numbers of infections go down, likely around summertime. He anticipates COVID19 will make a return, but that we'll be much better equipped to handle it.
"We'll have preexisting immunity from people who have encountered this virus now, we'll have a vaccine available," he said. "We'll likely have treatments that we know work. And so when it comes back, as it most probably will, it will no longer be a pandemic, it'll be another seasonal virus that we have to deal with."
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