we are experiencing a prolonged fluctuating plateau

Today I thought I would take a minute to share a snapshot of the COVID-19 situation in my area.  To start, I am now off the COVID positive palliative care team. I recognized the need for a break from this very difficult work and the 6 advanced practice nurses on our team are all taking turns rotating through it. This makes sense for lots of reasons. 

Lets start with the numbers:
In the hospital this morning we had 25 COVID positive patients hospitalized and in isolation.  We also had 27 patients who are considered to be recovered (no longer in isolation) but still sick enough to be in the hospital. More about that in a minute. 

In Kansas we are experiencing a prolonged fluctuating plateau but have moved from low to high numbers. It is anticipated that we will have a slower, more prolonged downward trend, and may have more “peaks” in the future.  As of today, in the state of Kansas we have had 40,968 cases and 446 deaths. In Douglas county, where I live, we are seeing an influx of college students and a BIG increase in numbers related to this. Specifically among the fraternity/sorority population where there is a 10% positive rate and quarantining is supposed to be going on in an effort to decrease these numbers.  

At the hospital were I work, we are seeing more new admissions per day than we have previously seen at any point in this pandemic. We are not “overwhelmed” but it would be appropriate to say the system is “stressed”.

Above I mentioned patients who are considered to be “recovered”. Let me take a second to explain what that means.  In the hospital a patient can come out of isolation if the following criteria are met:

1. COVID + patients who have confirmatory lab results who have gone 24 hours without a fever of 100.5 or higher (without use of fever reducing meds), AND improvement in respiratory symptoms (cough, shortness of breath), AND it has been 10 days since the first diagnostic test.
2. Patient with high suspicion of having COVID 19 without confirmatory lab test who have gone 24 hours without a fever of 100.5 or higher (without use of fever reducing meds), AND improvement in respiratory symptoms (cough, shortness of breath), AND it has been 10 days since the first symptom appeared. 
3. For the ICU level patient with severe to critical illness at least 20 days have passed since first diagnostic test, AND at least 24 hours without a fever of 100.5 or greater (without use of fever reducing meds), AND improvement in respiratory symptoms (cough, shortness of breath).  

The above is based on available data that persons with mild to moderate COVID 19 remain infectious no longer than 10 days after onset of symptoms, and those persons with severe illness likely remain infectious no longer than 20 days after onset of symptoms.  Recovered people can continue to shed detectable virus in upper respiratory specimens for up to 3 months after onset of illness but in lower concentrations and infectiousness is unlikely.  Because of this we are relying on symptom-based rather than test-based strategies to determine who can come out of isolation. This is really important for families because once a patient is out of isolation, they can have one visitor per day. The importance of this can not be overstated. 

I will share more about a vaccine in my next COVID-19 post. For today, I have already exceeded my usual word limit. But not before I remind you all one more time of the vitally important trifecta of continuing to mask, maintain social distancing, and wash those hands.  In general, masks are not needed outside, unless there are 15 other people milling around looking at the same glorious view you are. If that's the case, mask up. 

You may already know this, but if you don't, let me share a few thoughts on masks - cloth masks should have 2 layers of washable, breathable fabric. Masks should completely cover the nose and mouth and fit snugly against the side of your face. Gators are not considered to be effective (I am seeing lots of these around). Masks with vents are not effective. Masks should be removed using ear loops, wash your hands after removing a mask and before you touch your face. Wash masks regularly and iron them after they dry. 

These are my perspectives on what is happening in my area, as a palliative care nurse, not an infectious disease specialist.  I believe they are applicable everywhere. Take what you need, leave the rest for later.

P.S.  Happy Friday everyone. 

P.S.S. Thank you Marilyn Parker for our masks which were the best looking, in all of Estes Park. 

Comments

[Janet G]

I have a question about ironing masks--why is this necessary-I've washed ours and while they don't look nearly as nice, it seems they still fit okay---Also just a comment we have seen a dramatic jump in cases since U of MO opened a couple of weeks ago. Columbia had a mask order for most of the summer and the virus was "manageable" and was declining but the University opened and our numbers are soaring! Large gatherings of partying students who think they are invincible!

[carol]

Janet: I don't know that it's necessary, but a nice hot iron = extra germ killing, in my mind. Sounds like Columbia is having the same experience as Lawrence with the return of students to campus. The other problem is that contact tracing is so difficult with big groups of people, who really don't even know each other.

[jeanette sclar]

A host of blessing be heaped upon you! I am so glad to hear that your hospital provides "relief" for those working in such stressful situations. Your advice is welcome!

[Christine]

Thank you for your posts on COVID. A sane prospective. When I stood in the check out line the other day a woman in front of me said, "The virus is all a big hype against Trump." If only the virus knew that.

[carol]

Thanks Jeanette!

[carol]

Christine: I am torn between wishing that everyone who thinks the virus is a "hoax" will get it, and hoping that they don't. I hate to admit that, but it's true.