OC and Hoag surgery and vaccine information

As most of you know, I’ve been closely following the Covid-19 pandemic and the local situation in Orange County, particularly at Hoag Hospital.  Here is some of the latest information that I thought you should know about Hoag, our regional hospital. It’s easy to look outside and see the sun shining, go for a walk or bike ride, and wonder why we should be so concerned. My hope is that this factual information will put things in perspective, make it easier to see that we are in a worsening crisis that is affecting all of our medical care, and help us make informed decisions about our behavior going forward.

1 – Hoag surgeries: all Non-Emergency Surgeries cancelled

Because of an immediate need for the reallocation of clinical staff for patient care due to the increasing inpatient Covid surge, “all Priority 3 and 4 surgeries and procedures and all non- emergent Priority 2 surgeries and procedures will be cancelled effective tomorrow, December 16, 2020 and until further notice.”

This includes ALL procedural areas – the operating suites, cardiac cath lab, interventional radiology and the GI lab. All elective cases requiring post-surgery or post-procedure admissions were already cancelled last week. Here are some details of the current surgical priority groups:

1. Allowed: Inpatient requiring non-elective surgery prior to discharge.
2. Only some allowed: Outpatient to be scheduled for surgery with time-dependent medical necessity (e.g., discectomy for ruptured disc with new onset neurological symptoms, D&C for miscarriage).
3. Cancelled: Outpatients to be scheduled for elective surgery that can be delayed up to 4-6 weeks without reasonable expectation of detriment to the patient, For example:

• GI diagnostic procedures
• Upper/lower extremity soft tissue injury repair
• Cholecystectomy for non-acute symptoms, non-incarcerated hernia, hemorrhoidectomy
• Angiograms, pacemaker, battery replacement

4. Cancelled: Outpatients to be scheduled for screening procedure and elective surgery that can be delayed longer than 4-6 weeks without reasonable expectation of detriment to the patient, for example:

• GI screening procedure
  Carpel tunnel release
  Surgery for chronic musculoskeletal conditions
  Cosmetic surgery
  PFO, implantable event monitors

2- Vaccine information – it’s coming!

PRIORITIZATION:

• A limited supply of Emergency Use Authorization (EUA) Pfizer and Moderna COVID vaccines will be available very soon.
• Hoag will follow Centers for Disease Control and Prevention (CDC), California Department of Public Health (CDPH), Orange County Health Care Agency (OCHCA), and Advisory Committee on Immunization Practices (ACIP) guidelines for prioritizing healthcare providers.

SAFETY:

• Vaccine safety for EUA and full approval use the same standards, with the exception that full approval requires longer follow-up.
• Vaccine safety and efficacy is determined by scientific experts, not political appointees.
• Most negative reactions to vaccines occur within a month of vaccination.
• COVID vaccines will have independent safety reviews done at the study level, prior to the Food and Drug Administration (FDA) decision and at the state level before making it available to those in the state of California.
• All persons receiving the vaccine will be followed by the CDC for adverse reactions; that information is available to the general public.

BENEFITS:

• These vaccines will reduce your chances of developing COVID infection.
• The vaccine may lessen the severity of illness if you do get COVID.

EFFECTIVENESS:
• The vaccine has shown a greater than 94% effectiveness.

VACCINE:

• These vaccines do not contain any part of the virus, so recipients cannot become infected from the vaccine.
• Individuals may experience normal activation of their immune system including mild to moderate symptoms that should resolve within a few days:

o Soreness, redness and/or swelling at the injection site
o Headache
o Fever
o Fatigue

• Both vaccines require 2 doses: 21 days apart (Pfizer) or 28 days (Moderna).
• Individuals who have had infection should still plan to get the vaccine to augment their immunity.

3 – Orange County Covid-19

Without going into too many specifics, review of the Orange County Covid-19 Dashboard (go to https://occovid19.ochealthinfo.com/ , scroll down and click on either the desktop or mobile version, then use the arrows at the bottom to click over to the Hospital/ICU page) shows that there are currently 10.4% ICU Beds currently available (unadjusted) and 1.4% ICU beds currently available (adjusted.) I’m waiting on an answer from the county and state about how the adjusted rate formula originated and will share it with you.  But it’s easy to notice that the graph of current hospital patients is now about double the summer peak and the rate of increase is exponential (in fact, the rate of rise is steeper than it’s ever been!)

If you put together this county-wide information with today’s Hoag recommendations, you can see how dire our crisis has become. We are right now beginning to exceed our hospital capacity! The vaccine availability will continue to be extremely limited, even for Hoag medical staff and hospital personnel. So, for the next few weeks we need to all do our best to minimize the strain on our medical resources.I really miss my family of patients and want to see each and every one of you again (at least, the ones who want to see me!)  Please stay safe, wear the best masks that you can find, wash your hands frequently, social distance and avoid unnecessary socializing and travel.  Oh yes, and please get your normal flu shot if you haven’t already. I hope to see you all again when we get through this together.

Sincerely,

Dr. Weiss