SMHC President Nate Howell and Chief Medical Officer Dr. Michael Albaum talked about COVID-19, the impact on patients and how the hospital is coping in a recent interview. Courtesy Photo

BIDDEFORD — Even as Southern Maine Health Care heralded the arrival of the hospital’s first doses of the Pfiizer coronavirus vaccine on Tuesday morning, SMHC officials are continuing to hone an action as the current spike in COVID-19 cases continues statewide. On Tuesday, Maine officials reported 411 new cases of COVID-19 statewide, along with six new deaths.

In an online interview late last week, SMHC President Nate Howell and Chief Medical Officer Dr. Michael Albaum answered questions about patients experiencing COVID-19 illness, if the SMHC system has enough staff to cope, how staff is being deployed and more.

Last week, SMHC ‘s Biddeford campus had a couple of dozen patients with COVID-19; Howell said about one-third of COVID-19 patients are cared for in the special care unit and two-thirds are in a medical/surgical unit nearby.

The number of people on ventilators averages two to four a day, in an equal mix of COVID-19 and non-COVID patients, he said.

SMHC President Nate Howell SMHC/C.A. Smith Photography

In contrast to a surge earlier in the year in the pandemic, the condition COVID-19 patients seems less severe this time, Howell and Albaum both said.

“In the first surge, most (patients) were at the intensive level, ” said Howell. “This time, it’s different. We have a better understanding of the disease.”

“We’ve learned more,” said Albaum, also suggesting that in the earlier surge, those with less severe illness had not been diagnosed. As well, there are medicines being used now that weren’t available for use then, namely Remdesivir and Dexamethasone –  the former is an antiviral agent recommended for use in hospitalized patients who require supplemental oxygen, according to the National Institutes of Health.

Dexamethasone, a corticosteroid, has been found to improve survival in hospitalized patients who require supplemental oxygen, with the greatest effect observed in patients who require mechanical ventilation, the NIH wrote in a Dec. 3 outline of COVID-19 treatment guidelines.

SMHC Chief Medical Officer Michael Albaum SMHC/C.A. Smith Photography

Albaum said the average length of stay in hospital for coronavirus patients  is four to 4 ½ days— in contrast to the first surge, when the average hospital stay was 12 days and patients were more likely to be on a ventilator in the special care unit.

If those with COVID-19 are going to get sick, it is usually within in the first four to seven days from diagnosis, he said.

Some coronavirus patients are in the hospital solely because of COVID-19, while others have underlying conditions and also happen to have COVID-19, he said.

Decisions about whether a patient needs to be in the hospital depends on their oxygen levels, vital signs, or if there are other symptoms, like shortness of breath, vomiting or chest pains, said Albaum, noting a slight lowering of oxygen levels can be a marker of worsening of COVID-19.

As of Dec. 10, SMHC officials were completing “what if” plans if it turns out more space is required, or  which medical procedures would or could be curtailed if that need were to arise — and it hasn’t.

There is an inventory of staff across the MaineHealth system if there was a need for additional workers, but so far, any gaps have been filled informally, internally, within SMHC, which reaches from Biddeford across the river to Saco, down to Kennebunk, and inland to Waterboro and Sanford.

Some changes have been made. The Waterboro walk-in clinic, which had been temporarily closed and staff deployed elsewhere in the early part of the pandemic, is now open by appointment only for people without symptoms who need a COVID-19 test prior to a medical procedure, have been exposed, or are returning from a high-risk location. The walk-in clinics in Saco and Sanford have temporarily switched to respiratory care, including for COVID-19, and the Kennebunk walk-in is temporarily closed.

On the day of the interview, Albaum was on a floor, taking a shift as a hospitalist. Primary care physicians train with hospitalists and some are being redeployed to respiratory centers, he said.

“This is something we planned for and started implementing several years ago. It maintains our ability to care for a greater number of patients,” said Albaum.

On Friday Dec. 11, MaineHealth announced its plan for inoculating front-line caregivers.

The initial allotment of 1,900 doses will allow MaineHealth to offer vaccinations to direct care providers at the hospitals in its system that have seen the highest number of COVID-19 patients, including Southern Maine Health Care, Maine Medical Center, and Mid Coast-Parkview Health, MaineHealth said.

Within those organizations initial distribution will focus on Intensive Care Unit teams, front-line Emergency Department caregivers, those providing care in dedicated COVID-19 inpatient units and other critical and essential services not available elsewhere.

The next shipment of 15,775 doses includes delivery of an additional 975 doses of the Pfizer vaccine and 14,800 doses of the Moderna vaccine and will provide enough vaccines for all direct care providers across the MaineHealth system, the company said.

Both vaccines require a second dose.

Maine Center for Disease Control and Prevention Director Dr. Nirav Shah on Monday called the arrival of the first shipment of vaccines a milestone.

“It represents a light at the end of the tunnel. But even when you see a light at the end of a tunnel, it’s important to remember you’re still in a tunnel, and blue sky is still a while away,” said Shah, advocating for the continued use of face coverings and social distancing.

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