Emergency room doctors share best COVID-19 practices

SAN FRANCISCO - UCSF health officials said as of Wednesday there were 52 COVID-19 patients in the hospital, 33 of them in acute care and 19 in critical care.

Hospitals have not seen the surge in coronavirus cases that was first predicted when the city first implemented a stay-at-home order March 17.

"What we've found over the past month is those volumes have actually stayed quite low. I think that's largely in part due to social distancing," said Dr. Rajesh Daftary, medical director of pediatric emergency medicine at Zuckerberg San Francisco General Hospital.

Daftary said he's encouraged by community members' efforts to follow the stay-at-home orders and reduce the virus transmission, which he says has helped ease the burden and buy time for healthcare workers on the front lines.

The novel coronavirus has been a challenge for doctors who are learning what works and what doesn't, as they try to develop effective protocols, emergency responses, and find the most effective treatments for patients for the new COVID-19 disease.

Nearly all of the UCSF cases have been adults.

Daftary says about a dozen children have tested positive at UCSF for the new coronavirus SARS-CoV2 but have been treated without need for hospitalization. He says one of the many unexpected areas they are researching is why other children appear not to have the coronavirus, even though their parents test positive for COVID-19.

"When we test these patients who also have respiratory symptoms, also have fevers, they're testing negative," Daftary says. "I think our tests might not be giving us the entire picture."

He added that there is a need for more data, "I suspect there's a lot more infections out there."

Supplies of masks, gloves and other personal protective equipment remain a concern as doctors look to the future.

"Personal protective equipment is something we continually think about. How many days do we have left? How many weeks do we have left of supply? That is going to be ongoing," said  Daftary. "We really need policy makers to prioritize that. That really makes a difference in our capacity and ability to serve the community."

Doctors nationwide right now are using all tools available to share knowledge about the disease.

"We're using peer-reviewed articles, we're using email list-serves, we are using conference calls, any way that we can spread word, get the word out about a finding and new development," said Dr. Daftary.

Treatment strategies have evolved over the past month, with a focus on preventing lung damage.

"Tempering an aggressive approach and instead allowing the patients to have lower oxygen levels for a longer period of time," said Dr. Daftary, "Holding off on intubation or putting a tube in their throat to help them breathe, trying to delay that as much as possible. And then even using lower pressure settings on our ventilators. All of those are things are things we can do to preserve lung functions....things we can do to also potentially avoid the need for ventilator use."

"COVID-19 has really provided a situation where we are flying a plane as we're building it," says Dr. Nicolaus Glomb, an assistant professor at UCSF Benioff Children's Hospital Mission Bay.

Glomb says San Francisco has been able to develop surge plans to prepare if stay-at-home orders are lifted in coming months and the virus begins to spread again.

"We've essentially reworked our triage and screening process," said  Glomb. "We are prepared for the possibility of a surge, the possibility of a rebound in the number of cases that we're seeing."

Glomb also says UCSF is part of a federally funded consortium just launched last fall called the Western Regional Alliance for Pediatric Emergency Medicine or WRAP-EM. The consortium has been able to work together to identify gaps in care and emergency response.

"We have five states in the northwest region and we have health care professionals that are collaborating not just for future disasters," said Glomb.  "We're also coordinating and communicating between states right now to make sure we are providing the best care possible."

That regional approach that could be critical as communities and health workers throughout the region try to find a way to a new normal.

 Daftary says it's important for community members to continue helping others through food banks that distribute nutritious food to keep people healthy, maintaining social distancing, and helping ease the economic burdens being felt during the stay-at-home orders.

"Everything that we're doing to support each other is going to make a difference in the long run. I really think this is going to be a long fight," said Daftary, "This isn't something that's going to go away in a month or two. We're going to be seeing the effects of this well past a year."

Jana Katsuyama is a reporter forKTVU.  Email Jana at jana.katsuyama@foxtv.com and follow her on Twitter@JanaKTVU