Patients go to Dr. Melissa Marshall’s community clinics in Northern California with the revealing symptoms. They have trouble breathing. It can even hurt to inhale. They have coughs and sore throats are definitely there.
A straight case with COVID-19? Not so fast. This is a fireplace.
Up and down the west coast, hospitals and health facilities are reporting an influx of patients with problems likely related to smoke inhalation. As fires rage largely uncontrollably in the midst of dry heat and strong winds, smoke and ash settle over towns and cities up to hundreds of miles away, making the sky orange or gray and making ordinary breathing difficult.
But that, Marshall said, is only part of the challenge. Facilities already strained for testing supplies and personal protective equipment should first rule out COVID-19 in these patients because many of the symptoms they have are the same as those caused by the virus.
“There is an obvious overlap in the symptoms,” said Marshall, CEO of CommuniCare, a collection of six clinics in Yolo County that mainly treat patients with underinsurance and non-insurance. “Every time someone comes in with some of these symptoms, we ask ourselves, ‘Is it COVID?’ At the end of the day, I will clinically still rule out the virus. ”
The protocol is to treat the symptoms, whatever the cause, while recommending that the patient be quarantined until the test results for the virus return, she said.
It’s a scene that plays out in many hospitals. Administrators and physicians, fine-tuned COVID-19’s ability to spread rapidly and create chaos, simply do not take a chance when they recognize symptoms that may be caused by the virus.
“We have seen an increase in patients presenting to the emergency department with difficulty breathing,” said Dr. Nanette Mickiewicz, President and CEO of Dominican Hospital Santa Cruz. “As this may also be a symptom of COVID-19, we treat these patients as we would with any person tested for coronavirus until we can rule them out through our screening process.” During reprocessing, symptoms more specific to COVID-19, such as fever, would become apparent.
For the workers in the Dominicans, the question quickly moved to the top of the list. Santa Cruz and San Mateo counties have borne the brunt of CZU Lightning Complex fires that have burned more than 86,000 acres. Several tents erected outside the building serve as an extension of the ER waiting room. They are also used to perform what has been understood as an essential role: to separate those with symptoms of COVID-19 from those without.
New patients have arrived at NorthBay Healthcare’s two hospitals in Solano County with COVID-19-like symptoms that may actually be from smoke inhalation.
NorthBay’s ingestion process “requires that everyone with COVID properties be treated as [a] patient under investigation for COVID, which means they are separated, screened and managed by staff in special personal protection, ”said spokesman Steve Huddleston. At the two hospitals that have so far treated almost 200 COVID-19 cases, the protocol is well established.
Although the west coast is now at the most dangerous time of the year for forest fires – generally September to December – another complication for healthcare providers is on the horizon: the flu season.
The southern hemisphere, whose flu trends in our summer months typically predict what is coming for the United States, has had very little of the disease this year, presumably due to limited travel, social distance, and face masks. But it is too early to know for sure what the US flu season will bring.
“You may start to see some cases of flu in late October,” Marshall said, “and the reality is that it will carry a number of characteristics that may also be symptomatic of COVID. And nothing changes: you have to rule it out just to eliminate the risk. ”
Mark Kreidler writes for Kaiser Health News, a nonprofit news service that covers health issues. It is an editorially independent program of the Kaiser Family Foundation and is not affiliated with the Kaiser Permanente.