SALEM – For Dr. Omer Khan, treatment of patients with severe cases of COVID-19 has not become more predictable since the hospital first saw it in March.
But the Salem Health hospitalist, who takes care of people who are hospitalized but not sick enough for the intensive care unit, said he has become more comfortable treating coronavirus patients because he has learned to be prepared for something.
Marion County passed a deep milestone in the pandemic earlier this month – 100 county residents have now died of COVID-19 with 600 total deaths in Oregon to date. The county has so far registered 5,223 cases of COVID-19 with a mortality rate of 1.9%.
A total of 418 county residents have been hospitalized with the virus, with Salem Hospital treating at least 350 of them. One in four has spent some time in intensive care at the hospital, Salem Health spokeswoman Elijah Penner said.
County data show that those who die with COVID-19 are concentrated in the county’s nursing homes and long-term care facilities. Nearly all are elderly residents of the Salem area with other health conditions, according to a new county health report from Oct. 3, which examined 98 of the deaths.
63 of the dead got the virus during outbreaks on long-term care. The next most common source of infection was sporadic, reported for 18 of the dead. This means that health researchers do not know where they got sick. Eleven were related to the proliferation of the household, and two both fell ill in prison or in a food processing facility.
Half of the dead were over 80 years old, and the county’s youngest death was a 45-year-old man who died on April 18. Everyone had at least one other health condition such as heart disease, diabetes, asthma or a history of smoking. Most of those who died from the disease reported two or three health conditions.
County deaths follow patterns around the United States, where older Americans and those with underlying health conditions have been most likely to die from the virus. Over half of people who have died with COVID-19 in the United States are 75 years or older, according to the latest figures from the Center for Disease Control and Prevention.
But Khan and county health officials said the data does not mean younger and healthier people can ignore the risks.
First, older salemites often get the virus through contact with younger people. Katrina Rothenberger, the county’s public health director, said the virus typically enters nursing homes through younger staff or visitors and then spreads among vulnerable residents with often deadly results.
“It’s really a tragedy for our society to have so many people dead,” Rothenberger said in an interview last week.
Second, both said that the term “underlying health conditions” is often misunderstood by people who are not aware of the wide range of conditions it covers, or how common these conditions, such as asthma, high blood pressure and obesity, are.
A health report from the community in 2019 showed that half of Marion County adults have at least one chronic illness. Approx. 10% of adults had asthma and 6% had chronic obstructive pulmonary disease, a chronic lung disease common among smokers.
Khan said the county’s data on who dies of COVID-19 reflects his experience at Salem Hospital. He said obesity, diabetes and the elderly are the three factors he often sees in people who are seriously ill.
Deaths from COVID-19 are most often due to respiratory failure, Khan said, often after a patient develops pneumonia due to the damage the virus has done to the lungs.
The virus can also cause blood clots that lead to strokes or heart problems in some patients, Khan said, something he has personally observed three or four times. As a result, doctors carefully monitor the patient’s blood for proteins related to coagulation, cholesterol levels and more.
While those who die with COVID-19 are usually older, Khan said the patients who stay the longest in the hospital are younger.
The average time a Covid patient stays at Salem Hospital is about a week, Penner said.
But Khan has seen many longer stays of three to four weeks, often in middle-aged people who are overweight or have asthma or diabetes. While older patients who are seriously ill may die soon after hospitalization with the virus, he said younger people with serious illness stay longer in the hospital than because their bodies continue to fight the virus.
“That person will take weeks and months to get back to where he was before all this started, and that’s the scary part of getting sick,” Khan said.
After seven months of caring for COVID-19 patients, Khan said he and other doctors still cannot reliably guess who will become seriously ill because the disease is often unpredictable. Testing is more available now, so it is common for hospital patients to get a COVID-19 test even if they are there for an unrelated disease.
He has seen elderly people with several serious health conditions test positive but show few or no symptoms. Recently, he took care of a COVID-19 patient in his 50s with an asthma story who came into the hospital because she felt tired and uncomfortable but was not struggling with breathing problems. She received minimal oxygen when Khan left the hospital in the evening. The next day, when he reported for work, the woman in the ICU was on a ventilator, he said.
“Who will that person be? We do not know, ”he said.
What has changed, Khan said, is that healthcare professionals have seen the basic precautions they take to prevent the spread of the disease – such as wearing masks and dresses around patients and washing hands regularly – work well to stop coronavirus. Many feared becoming infected early in the pandemic, as protective equipment was in short supply and less was known to effectively stop the spread.
Khan said he and other doctors he works with have all tested negative for coronavirus antibodies despite taking care of dozens of COVID-19 patients in close proximity.
“Our best chance is to protect ourselves,” he said.