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May 29, 2020
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June 5, 2020

CPNHS COVID-19 pandemic update

By Dr. Adam Vascellaro, D.O., CPN Chief Medical Officer

Hello all,

I would like to share an update regarding the coronavirus/SARS-CoV-2/COVID-19 pandemic. This crisis is real and has dominoed its way to Oklahoma, including Oklahoma City, Pottawatomie County and finally to Citizen Potawatomi Nation Health Services. We have been serving a few COVID-19 patients since March of 2020. Most were evaluated and diagnosed in mid-to-late March, but their symptoms had started in early March, meaning COVID-19 was in Oklahoma even as CPN and CPNHS began their proactive preparations.

Again, CPNHS was well prepared to handle COVID-19 patients in the safest way possible. Our safety protocols for patients, employees and coworkers have proven highly successful and are still in place. This includes COVID-19 pressurized tents, requiring all that enter our clinics wear a surgical/cloth-type mask, continued telehealth, drive-thru pharmacy pickup, screening and temperature checks at the doors, restrictions on visitors, multi-layered social distancing, increased cleaning and disinfecting protocols, drive-thru Title VI meal pickup and many other measures.

CPNHS has a relatively small sampling of COVID-19 patients, around two per 1,000, but it has been enough to make it palpable, educational and eye opening. I have personally talked and continue dialoge with all our COVID-19 patients that I’m aware of. It has impacted mainly CPN tribal members and their families. One early observation that is clear is when one member of a family or household gets infected, most members of the household get infected as well. Due to this and federally encouraged “contact tracing,” CPNHS has started offering lab testing to not only patients but also their first-degree contacts in the household, usually family, who are eligible. This includes initial and follow-up COVID-19 nasopharyngeal polymerase chain reaction testing combined with COVID-19 IgG antibody testing. An algorithm using the two tests is applied to get a reasonable determination of susceptibility, early infection, late infection and immunity. It’s not perfect. There are too many unknowns still, but it is the best we have at present.

Typically, COVID-19 patients I’ve spoken with share the history of flu-like illness: fever, cough, shortness of breath, loss of taste or smell, scratchy throat, bad headache and chills. A few get gastrointestinal symptoms, including vomiting and diarrhea. Some just get a mild cold or allergy symptoms. Loss of smell and taste has become a hallmark symptom of this disease. If you are a CPNHS patient with the previously mentioned COVID-19 symptoms, current or previous COVID-19 infection or exposure, please call your medical provider/clinic first and notify them of the situation. You then will be given appropriate guidance.

Most patients have been treated symptomatically at home, but we have had a handful hospitalized and a couple need ventilator assistance. We have had a couple develop pulmonary emboli (blood clots in their lungs) after infection. Due to this increase risk of blood clots, CT imaging studies with contrast are now indicated sooner if you develop shortness of breath in the recovery phase of the disease. Many have residual shortness of breath, fatigue, shakiness and mental confusion even after entering recovery from a lab perspective. Any diagnosed patients that develop worsening shortness of breath must go to the hospital for probable admission, close observation, and/or symptomatic treatment including oxygen and breathing assist devices. CPNHS has not yet had a confirmed primary COVID-19 patient death.

Although things have been constantly changing, progressing and dimming since February, recently the Light has started to shine through, and needed hope is growing.

Symptomatic, primarily respiratory, support is working for most patients and local hospitals, and ICUs and their ventilators have not been saturated with coronavirus patients. COVID-19 nasopharyngeal PCR testing has improved to the point of real time, in-house results if symptomatic and two to three days for those non-symptomatic. COVID-19 IgG antibody testing has been a valuable addition, but it is best used in combination with PCR testing. Gilead released the promising intravenous medication Remdesivir, which is not in Oklahoma yet, but it will soon make its way to regional hospitals for use on the sickest patients. Convalescent plasma transfusion is gaining traction for early use after hospitalization. Vaccine development and clinical trials are happening at a breakneck pace with a huge positive announcement by Moderna on May 19, 2020, indicating the probability of an effective, safe and mass-deployable COVID-19 vaccine by the first of next year.

CPNHS has formulated its “Gating Criteria and Phased Comeback” plan under the leadership of Dr. Kassi Roselius, medical professional director and public health coordinator. These are the plans to taper off COVID-19 safety and get to a “new normal” currently estimated for Aug. 1, 2020. Once we get there, things will stay that way until herd immunity to COVID-19 is reached either by 80 percent of people becoming infected or getting immunized. The latter is much preferred and the probable route. My estimation for herd immunity to this coronavirus and getting back to a true normal is January of 2021.

I’ll end with how proud I am of over 200+ dedicated CPNHS employees who are taking real risks at work but still working hard and safely during this crisis. Most are still working on the front lines in the clinics and the rest are supporting via telework from home. Thus far, no CPNHS employees have contracted COVID-19 while performing their health care related duties at CPNHS.

My initial fear of the coronavirus pandemic has turned more to a healthy concern. I’ve prayed more than usual these past few months. Many of our patients have let us know they are praying for us. We are very thankful, and I ask you to please continue to do so.