Aiding the Fight Against Covid in Overflow Facilities

Stu News: Local Dr. Anita Wang serves on emergency staff at COVID-19 overflow facility in Costa Mesa

By DIANNE RUSSELL

As of this morning, Friday, Dec 18, ICU bed availability in Southern California is at zero percent. In response to the increasing shortage of beds, on Monday, Dec 14, Fairview Developmental Center in Costa Mesa opened as an 80-bed overflow facility for COVID-19 patients who have been stabilized.

On December 21, Dr. Anita Wang, an emergency room physician who has operated Wellness, Longevity and Aesthetics in Laguna for six years, will join their staff. 

Patients who are stabilized – but not well enough to be completely discharged from a hospital and go home – would be transferred to the overflow facility where they might still need emergency doctors if they take a turn for the worse.

Field hospital experience

Dr. Wang has 35 years of experience as an emergency physician – previously at UCLA Medical Center, Eisenhower Medical Center, and St. Mary’s Medical Center – and has an extensive background as a team leader with Doctors Without Borders. She was in China from 2002-2005, serving as the team lead in Beijing during the 2003 SARS outbreak. 

“I’m not naïve to this field hospital type of treatment. When I flew into Beijing, I noticed it was very quiet. I could hear the birds sing. Then I read an article about the SARS coronavirus,” she says. “That was the area where there was the highest instance. Everyone was locked in, and then everyone started to leave the area, which was the worst thing to do. So we went in and set up a field hospital.”

Fast forward to December 2020. Dr. Wang says, “Here in Orange County, we’re seeing a peak after the Thanksgiving holiday. During the first peak, it was individuals, but sadly, because of the holiday gatherings, we’re now seeing whole families infected. It’s more difficult and more stressful, because parents and grandparents are dying.”

Dr. Wang also explains how the demographics of the virus have changed. 

“In the ICU, the numbers are up for younger people who have been out in the workplace. In the beginning, it was the elderly people, now it’s 20, 30, and 40-year-olds. Hospital beds are overrun. The field hospitals in the communities are taking the overflow.”

Blood clotting disorder

“COVID-19 is a blood clotting disorder, and we’re seeing it in all the organs – brain, lungs, kidneys. We’re seeing patients who get mild symptoms and also long-haulers. I have one patient who has had COVID-19 since March, and still has a fever, heart palpitations, and can’t walk. It’s a devastating disease. Six months later [after being infected], another patient celebrated a victory because of the ability to get up out of bed and back into bed without assistance.”

 Dr. Wang emphasizes that we need to be diligent in adhering to public health policies – wearing masks, washing hands, and staying distanced.

Public health tool

“We need federal leadership for an additional public health tool,” she says. “With the saliva test, we would know results within 5-8 minutes.” 

“It will be a game-changer, I think, to help people quickly identify if their symptoms are due to COVID,” says Dr. Michael Mina, an infectious disease specialist at the Harvard T.H. Chan School of Public Health. “But from the perspective of truly stopping or massively slowing this pandemic, this test isn’t designed for that.”

The technology the test uses detects proteins from the virus called antigens. The most commonly used tests, known as PCR tests, detect genetic material from the virus.

In an interview with KX FM, Dr. Wang said, “Mina has been advocating for the FDA to approve much simpler, less expensive antigen tests that could be produced in the tens of millions per day. The FDA currently requires tests to detect at a Ct value of 40 and below – so a person may be diagnosed with COVID-19 but not infectious. Scientists and public health experts now believe that a less sensitive test, detecting at a Ct 35 (higher viral load) would only identify infectious individuals as COVID-19 positive.

“A cheaper, less sensitive test like the $1-3 at-home saliva paper strip test 

could be performed daily and could be used more widely by more individuals. Even if missing a positive result on day one for someone with COVID-19, the person testing themselves on subsequent days would provide the positive result and allow the person to begin quarantining and notifying others who may have also been exposed. 

“Just imagine: individuals could check themselves often, and given a positive result, self-quarantine and notify their doctor to confirm the result with a standard swab test. Taken a step further, the government could affordably provide these tests to all citizens. Businesses, schools, and restaurants could more definitively know how to act if each participant took the test and showed their negative result before entering. The public could move about more freely with confidence if these tests were employed as required for certain establishments like offices, classrooms, and restaurants.”

Build a better host 

Dr. Wang poses the question, “Why does an 80-year-old get a mild case and a 20-year-old a severe case? The 80-year-old may watch their diet, eat no processed food, and limit sugar, and the younger patient may not. It’s what’s going on in the host. It’s health, not age. It’s 25 percent genetics, 75 percent lifestyle. Western medicine looks for disease, is based on disease and early detection, not prevention or prediction. 

“Our bodies are constantly battling infections and viruses all the time. This virus is a whole-body system. There are 8 to 10 nutrients such as and Vitamin D, zinc, and selenium that are really the most important for fighting infections.”

Dr. Wang feels that we need to build a better host to fight off the virus. In addition to all the public health measures, she wants to help people before they get COVID-19 by building up their immune systems. 

She further explains that inflammation is a root cause, and we need to get our systems balanced in the gut (90 percent of the inflammation is from the gut) and detox. 

To this end, she is transitioning into more time in her office (90 percent).

“I now practice the philosophy of medicine I have held for myself, which is a combination of Eastern medicine, that is good for prevention and chronic disease, and Western medicine, for acute care and advance life-saving technology. There is a growing trend of integrative medicine specialists that are trained in functional medicine, anti-aging, regenerative medicine, and holistic medicine, etc.”

This article first appeared in Stu News Laguna.

Laguna Beach physicians confront the COVID-19 surge

By Justine Amodeo on December 17, 2020

Emergency Medicine physician Dr. Anita Wang of Laguna Beach said “the surge is here.” Wang, who has a functional medicine practice in Laguna Beach when she’s not being called to county field hospitals to help with an influx of stabilized COVID-19 patients, said that since the Thanksgiving holiday, entire families are contracting the virus, which has killed over 1,718 people in Orange County.

The vaccine, which is being distributed to frontline workers and other high-risk individuals first and should reach the general population by March, “will help eradicate the virus,” said Wang, who worked to combat infectious diseases like SARS in China when it broke out years ago. “But it’s not a silver bullet. Respiratory etiquette – handwashing, not touching your face – wearing a mask and staying home if you are infectious,” is crucial, she said. “We have this machismo, ‘I went to work and powered through it.’ During this pandemic, 35 percent of people with COVID went to work sick.”

Last weekend, while many county residents continue to protest the regional stay at home order that went into effect last Sunday, the Orange County Health Care Agency reported more than 5,200 cases, with 3,250 more cases reported Monday. Some 1,486 county residents are in hospitals with the region’s ICU capacity for virus patients dropping to 0.5 percent.

In Laguna Beach, of the 407 cases reported since March, half of them were in the first two weeks of December according to Dr. Gregg DeNicola, chief medical officer and primary care physician at Caduceus Medical Group, where in the group’s three locations, 40 percent of the staff has come down with the virus since March.

“[Our staff] are around patients all day, and while N95 masks are 95 percent effective, 5 percent [of cases of the virus] get past the mask. We send them home and wait until they test negative before they come back,” DeNicola said.

The problem, he said, is that once patients test positive, the Orange County Health Care Agency will call them and inquire about symptoms.

“Far too many patients went back to work, went to gatherings, and went out with friends despite not confirming a negative test after a positive one, or after a close contact,” DeNicola said. “If you’ve gone seven days with no symptoms, they tell you to leave the house, go back to work. I tell my patients to ignore what the health department is telling you. If you’ll allow someone [back to work] who was positive a week ago to cough in your face without a mask… I wouldn’t let them without a negative test.”

In Laguna Beach, he said the recent “surge and spike in cases is terrible. I think it’s because of Thanksgiving and we are expecting another one in early to mid January because of Christmas. People are just not quarantining.”

DiNicola said that as the virus has mutated, symptoms have changed. “The vast majority have diarrhea, headaches and now a dry cough and stuffy nose. While they are getting better quickly, we put six people in the hospital last week, 10 this month.”

Field hospitals like the one built at Fairview Developmental Center in Costa Mesa—where Wang will work starting Dec. 21—can ease the burden of emergency rooms throughout the county, taking in the overflow of stabilized, non-critical COVID patients. Wang said that the difference between now and last spring “is that doctors have a much better sense of how to treat the virus, what therapeutics actually help.” She added that patients catching the virus who are deficient in vitamin D and zinc “have a bigger chance of going into the ICU. It’s important to make sure these vitamin levels are normal to keep people from getting sick. My goal is to make sure my patients have resilient immune systems.”

Wang said that one of the areas of COVID-19 being overlooked is the treatment of “long haulers [those who still have symptoms months after being infected.] I have a woman who after six months, considered it a victory to walk to the bathroom and back. Athletes that were running marathons can’t walk around the block. These college kids having COVID parties [to catch the virus] are scary. It’s not something you just want to catch and get it over with.”

The Pfizer messenger RNA vaccine, said DeNicola, will help, with the first doses going to frontline workers at hospitals, large government facilities, high-risk seniors, nursing homes and assisted living facilities and jails. “We have been inundated with phone calls from people wanting the vaccine. Caduceus will get vaccines in March. We will start with staff and then begin with patients. We will prioritize patients with health issues. I have a long list of seniors, those with immune deficiencies, cancer, COPD, asthma. I don’t envision running out, but if so, we will prioritize high-risk patients.”

Found to be 95% effective, side effects from the Pfizer vaccine, which does nothing once the virus infects you, were uncommon, DeNicola said, naming the usual site pain, fatigue, headache, and chills. “These were more common after the second dose that is required with the Pfizer vaccine. More traditional antibody vaccines are also asking for approval, and may become available through the spring. Patients could then pick their personal choice,” he said, adding that the duration of the immunity from the vaccine is unknown and an annual vaccine, much like the flu shot, is likely.

“For many of us, the coronavirus has been the most challenging experience of our careers, wrote Dr. Rod Hochman, President and CEO at Providence, which includes Mission Hospital in Laguna Beach, in a letter to the community, “and we still have a few more hard months to go. But the vaccine marks a turning point and will be an important way that we change the trajectory of the pandemic.”

This article originally appeared on the Laguna Beach Independent.

Costa Mesa’s Fairview Developmental Center Ready for Coronavirus Patient Overflow

By  SPENCER CUSTODIO December 9, 2020

Soaring coronavirus hospitalizations and case rates are leading to the opening of the Fairview Developmental Center in Costa Mesa to help ease the strain Orange County hospitals are facing. 

The county is quickly approaching 1,000 people hospitalized as the case increases and trends keep breaking OC records. 

As of Wednesday, 974 OC residents were in hospitals, including 239 people in intensive care units, according to state data.

Dr. Anita Wang was recently hired to help staff the Fairview Developmental Center, which has turned into a field hospital for stabilized virus patients in an effort to keep hospital beds open. 

“After Thanksgiving, the numbers have gone up and my phone has been ringing off the hook to go and work at these places,” Wang said in a Tuesday phone interview. 

Wang, who’s treated patients in emergency rooms and intensive care units for 35 years, said she starts at Fairview next week to help stabilize patients if their conditions worsen. 

“We’ll be doing a lot of treatment there and I’ll be there to respond to anyone who’s spiraling down the tubes and doing procedures,” Wang said. “We have this overflow field hospital to ease the burden.” 

Headhunters are also searching around the state for recently retired doctors and nurses who can help the already burned out hospital workers. 

“These are individuals that recently retired, their health care licenses for whatever reason have expired. People with particular expertise across the spectrum in this state,” said Gov. Gavin Newsom at a Monday news conference. 

The group, known as the Health Corps, goes to the hardest hit hospitals in the state to help staff beds. 

Newsom also said officials have readied places like Fairview, which can be up and running in a matter of a few days. 

The virus presents a significant public health challenge as for many people who are infected, there’s no symptoms. But for others, the virus threatens their health in myriad ways. 

Dr. Todd Newton, an emergency care physician and area director and chief of staff for Kaiser Permanente Orange County, said he’s never seen anything like the pandemic.  

“It’s absolutely different. We have never seen anything close to it and anybody who says they have, I don’t believe them,” Newton said in a Wednesday phone interview. “I have been doing this for 20 years — I’ve been through H1N1 (Swine Flu in 2009) and really bad flu seasons … it wasn’t even close to what we’re experiencing now.” 

He said the Kaiser system should be able to handle the spike in cases and hospitalizations and likely won’t need assistance from the state. 

Like other doctors interviewed by Voice of OC over the past few weeks as hospitalizations skyrocketed, Newton and Wang said they’ve seen lingering aftereffects from the virus. 

“It’s devastating. That’s the problem with this. This virus is a whole body system, it attacks everything and it’s a clotting disease … it gets into the blood vessels,” Wang said. “Six months later, a patient had a victory because they were able to get up out of bed and back into bed without assistance.” 

Newton said, who oversees roughly 1,200 doctors, said they’re still discovering new aftereffects from the virus every day. 

“There’s been some reports of cognitive decline in people, having trouble remembering or thinking clearly. Certainly you’d expect to see some lung effects,” Newton said. “Blood clots are a feature of this disease process and you can certainly see that. It affects really every organ … it’s unique in this case that some of the effects are more severe than other viruses.” 

Local epidemiologists and public health experts warn the situation will continue worsening. 

“Even if right now the measures are in place are adhered to strictly and people are not gathering, masking 100%, staying outdoors when they get together with people — even if we do those best practices, I don’t think we’re going to see a decline coming for at least another few weeks,” UC Irvine epidemiologist Sanghyuk Shin said. 

He said the virus is spreading at an exponential rate in Orange County because the reproductive rate has reached two before Thanksgiving. 

“So one person who’s becoming ill with COVID-19, then two additional people will get sick,” Shin said. “That’s pretty alarming.” 

Doctors, public health experts and epidemiologists all fear a potential Thanksgiving spike in cases and hospitalizations. 

Shin is convinced it will hit. 

“It’s definitely coming. There’s no way around it.” 

The county Health Care Agency reported 2,613 new cases on Wednesday — the highest number of daily new cases ever reported, so far.  

That bumped the average daily cases up to nearly 1,800 a day for the past week. 

State public health officials estimate 12 to 13% of new cases end up in the hospitals. 

Since the pandemic began in March, the virus has killed 1,633 county residents out of 93,126 confirmed cases. 

Shin said UCI researchers found roughly 5% of OC residents could have the virus right now. 

“So the best estimate right now is from Dr. Vladimir Minin (a biostatician) and his modeling suggests that it’s possible about 5% of Orange County residents today may be infected and infectious at this time. So this again, an exponential increase from a few days ago,” Shin said. “He estimates about 150,000 people in Orange County right now have COVID.” 

The virus has already killed nearly three times as many people in Orange County as the flu does on an average yearly basis. 

For context, Orange County has averaged around 20,000 deaths a year since 2016, including 543 annual flu deaths, according to state health data. 

According to those state death statistics, cancer kills over 4,600 people, heart disease kills over 2,800, more than 1,400 die from Alzheimer’s disease and strokes kill over 1,300 people.

The county is on track to surpass its average yearly deaths with over 19,000 people dead as of October, the latest available state health data.

Newton said the exploding hospitalizations could force hospitals to cut back on some non vital surgeries that aren’t outpatient procedures, meaning people go home the same day.  

“I believe most systems are going to have to do some cutting back. For instance we’re still going to do things that need to be done now, like cancer surgeries,” Newton said. “Surgeries that can wait — I think every system is going to have to look at whether or not they wait on those.” 

This article originally appeared on the Voice of OC.