JOHNSON CITY, Tenn. (WJHL) – If your loved one contracts COVID-19, becomes severely ill enough to be hospitalized, and is placed on a ventilator to help them to breathe, what are their chances of survival? A local health leader said it is lower than expected.
Dr. Amit Vashist, Ballad Health’s Chief Clinician, explained that, as a healthcare worker assigned to both the Intensive Care Unit (ICU) and the medical-surgical ward, working with COVID-19 patients, Vashist has compared notes with others in his shoes.
“The data – anecdotal as it may be – suggests that close to 50% and in certain scenarios, even more than that of the patients who are on ventilators or who end up on ventilators, do not make it alive out of the intensive care units,” he said.
Ballad Health provided data to News Channel 11 regarding some of its intubated patients.
Since July 1, the hospital system reported having 229 intubated patients, including the 83 reported Thursday alone.
Since the beginning of the pandemic, Ballad reports 1,015 intubated COVID patients.
The current, more aggressive Delta surge of COVID-19 continues to sweep through the Tri-Cities region. Vashist explained that the best treatment for the virus, is to not contract it at all, and to achieve that goal, the region will have to increase vaccination rates.
“As a frontline physician, as a healthcare executive, I’ll tell you, those deaths that happen, the things that we see are no longer statistics, those are the lives of people being played out in front of us and that’s very painful,” Vashist said.
Vashist explained Ballad Health’s process for researching treatment modalities and how the decision is made to introduce certain treatments versus others.
He said Ballad Health deployed a COVID-19 Treatment Panel comprised of subject matter experts from various departments in the hospital system, including pharmacists, emergency department physicians, intensive care physicians, and more.
The panel meets on a weekly basis to peruse all evidence-based medicine papers that come out, suggestions and recommendations that come from the Food and Drug Administration (FDA), and the National Institutes of Health.
“After having looked at all those recommendations, we keep on tweaking and changing our clinical care pathways, clinical care protocols, if there is a new treatment we incorporate that,” Vashist said. “What we also do is we try to make our, the jobs of our physicians as well as advanced practice providers and nursing as easy as can be under the current circumstances so they, when they go into the electronic medical records, putting in recommendations, clinical recommendations for these patients, they are assured that these are backed up by the best science, the best evidence that can be.”
“As far as the actual treatments available for patients with the novel coronavirus,” Vashist said. “There have not been many earth-shattering breakthroughs.”
The tried and tested modalities are that a patient shows up in an emergency room. Vashist explained that staff then determine how much oxygen if at all, the patient needs if they need to be admitted to the hospital.
Then, if the patient is in a fairly serious medical condition, one of the things that Ballad can do for an ICU patient – and Vashist urged that science has shown that it works – is making those patients “prone,” which is making them right on their belly facedown, that enables a better airway exchange for these ventilated patients.
“After that, we put these patients on steroids, some anti-inflammatory agents medications that you may have heard about before – Remdesivir – which has shown to reduce the length of stay for patients who are admitted to our hospitals, antibiotics in our patients need for superimposed infections. Intensive care unit patients typically require sedatives and all those medications to keep them less anxious,” he said.
When addressing the anxiety levels constantly palpable in the ICUs across the Ballad system, Vashist said that it was difficult to explain.
“It’s very hard to explain in words what are the feelings that our patients, their loved ones, that the caregivers who are battling COVID-19 on the front lines, what we go through during the heat of the moment,” Vashist said.
He said for those patients in the ICU who have a COVID diagnosis, especially those on a ventilator or about to be intubated, it can be very scary.
“Our patients understandably are very afraid, very anxious. They have seen the news, they have read a few things, “Vashist said. “Nobody obviously wants to be in that stage, but at some point of time for some of our very seriously ill patients, they realize that it’s too little and too late.”
He explained that the Delta wave is different from the previous surge the region witnessed in the winter, and it’s impacting the frontline healthcare workers differently due to who the Delta variant seems to attack the most – people who are in that “prime of life” age group.
“A lot of our patients are younger, they are almost in the same age groups as our frontline caregivers,” Vashist said. “Many of us know each other, the communities that we live in – our kids go to school together. So I think the reality is hitting home much much harder. Also, the fact that we have been in this pandemic for about 18 months, we are compassionate, we like to provide care to our patients who like to serve our communities, but that does not mean that we are robots and we can keep on going. So I think our frontline caregivers are battling anxiety, they’re battling fatigue, they’re battling stress, and I would not be surprised if a few of our health caregivers suffered from post-traumatic stress in the months and years to come.”
Though the daily COVID-19 infections remain at a peak high, Vashist said the data indicates the numbers are plateauing in the area, as the hospital system for the first time in over a week reported a COVID patient total of less than the 400 range.
The system Thursday reported 353 COVID-19 patients in its hospitals, 107 of which were in the ICU, and 84 were utilizing ventilators to breathe. Three pediatric COVID patients received treatment at Niswonger Children’s Hospital.
Some of those patients are discharged, but Vashist explained that the dip in hospitalized cases cannot be attributed to discharges.
“Obviously, it’s a great moment for our caregivers, obviously for our patients and their families, their loved ones when patients get the walk out of the hospital. But the unfortunate reality that is coming forth with the Delta variant is, we are seeing a whole lot of deaths,” he said.
Ballad continued to report that about one in three deaths in the health system is from patients dying of COVID-19.
“That is a very very high statistic that is an unfortunate statistic. And many times, the only way we get ICU beds vacant for our other patients is when a patient with COVID-19 passes away, which is heartbreaking and which is unfortunate,” Vashist added.
The area’s largest hospital system reports hospitalized COVID-19 cases may be declining, but it’s due to an unfortunate reason – death.
With limited treatment options, health care providers working in intensive care units are urging those who remain unvaccinated to get the shot because it could literally mean the difference between life and death.
“I think all across the system, we are seeing some heart-wrenching stories that are coming out from our intensive care units,” said Vashist.
Vashist added that Ballad hospitals in both Tennessee and Virginia are reporting tragedy due to COVID.
“You have to factor in the fact that in our part of the world, we have significantly higher rates of obesity, heart disease, kidney disease, lung disease, and a population that is unhealthier compared to the rest of the United States. And on top of that, you add the fact that most of our population hasn’t been vaccinated so far, so when they present to our emergency departments, they’re already in a terrible shape, which warrants higher levels of oxygen use and at times being put on a ventilator, and as such they end up in the intensive care units of the world,” he explained.
The hospital system reported Wednesday that a mobile morgue had to be utilized at its Johnson City Medical Center after 20 COVID-related deaths were reported last weekend at that facility alone.
Vashist urged the region to learn from the previous surge that occurred last winter.
“I think we are seeing the numbers that are starting to plateau or decline a little bit, or but any meaningful decreases will not happen for many more weeks. From the lessons of last year around Halloween and after Thanksgiving, we had a big wave of COVID-19 upon us and we ended up in a very unfortunate position. All of us who remember the lessons from January of this year, we don’t want to be in that position again. So please get vaccinated.”