Lovelace medical chief is at war with yet another virus
FACE TO FACE
Editor’s note: Dr. Vesta Sandoval has dealt with AIDS research and hantavirus in her medical career. Now, she is in the midst of the COVID-19 fight. She took time out of her hectic schedule for an interview — over Zoom.
Vesta Sandoval has spent a lot of her adult life doing battle with tough opponents. As a college basketball player, she was a hard-nosed defender often tasked with shutting down the other team’s top scorer. She has worked in a virology lab dealing with the AIDS virus. As a medical resident at the University of New Mexico, she cared for some of the first
hantavirus patients in the ICU.
Now, as chief medical officer of the Lovelace Health System, Sandoval is a key player in the Lovelace system’s response to COVID-19, a viral pandemic that has shaken the world, while still working to meet the critical medical needs of non-COVID patients.
Sandoval, who grew up on a farm in Tomé, is a pulmonologist with a background in critical care. She took the chief medical officer job for the Lovelace system — which includes seven acute care hospitals, 50 medical specialties, 200 providers and five emergency rooms — about 18 months ago.
Before that, she served as medical director and chief of staff at the Lovelace Medical Center.
She said she applied for the CMO position because “I looked at it as a way I could have an impact across the entire system and improve patient care and quality in all our facilities.” The job involves coordinating with physicians and finding ways to improve and standardize processes to make things better for the patients.
“It is a challenge, but it’s a great team. Everybody has a lot of input, and we are able to pull everybody together working on these processes.”
That was all true even before the novel coronavirus reared its ugly (but invisible) head in March.
While many who get the virus never show symptoms, about 10% to 15% get really sick.
As a result, the ICU at Lovelace in recent days has been close to capacity — although Lovelace and other hospitals have the ability to ramp up many more beds if needed.
Albuquerque hospitals have been hit with a flood of patients from McKinley and San Juan counties in northwestern New Mexico, where the virus has been rampant among the Native American population.
Sandoval, 57, said there are unique challenges in treating COVID patients.
“Our lack of true understanding of the physiology that occurs with the infection and the rapidity with which this process moves have made it very challenging.”
“Over time, we have found that some of the early strategies were not working as well as we thought. For instance, early intubation (ventilator) was leading to higher mortality. Now, the consensus is moving more toward trying to maintain them on high flow oxygen and without intubation for as long as we possibly can. It’s when intubated that COVID patients seem to go into cytokine storm (an immune system reaction) that leads to multi-organ dysfunction and failure.” Another example: “We didn’t really understand other organ involvement. Myocarditis is another way this virus can present, and it can look almost like a heart attack: chest pain, elevation of EKG. We now understand that could be related to viral infection.”
Sandoval said that in the beginning, “We thought children weren’t really involved. Now we know children are showing as Kawasaki disease, an inflammatory condition of blood vessels of the heart.
“We are having to learn on our feet. Having to run with it and learn as we go, trying to look at studies and objective evidence from around the U.S. and other countries.”
Although the virus has been especially deadly for older people with underlying medical conditions, causing many deaths in long-term care facilities, Sandoval said, “We have had very severe disease in younger patients as well. It’s important for people to understand that younger people can become quite sick with this disease.”
Hantavirus
After earning her medical degree at Texas Tech, Sandoval did her internship, residency and fellowship in pulmonary and critical care medicine at UNM.
“I was a resident when hantavirus was first discovered and was working in the ICU. That certainly had a very large impact on me.”
The outbreak of the mysterious pulmonary virus with a fatality rate of 50% hit the Four Corners area in the spring of 1993, generating national news coverage. It was determined to be caused by the droppings of deer mice.
“Pulmonologists, in general, are exposed to infectious diseases, whether it’s tuberculosis or chickenpox,” she said. “We are exposed to these diseases all the time. Here in New Mexico, there was also H1N1 (also known as the swine flu and the first major influenza outbreak of the 21st century).”
“With COVID, it’s much more intense and the numbers are higher, but you have these experiences and they shape the way pulmonary doctors think. It gives you that sort of structure that helps you work on this type of patient.”
COVID strategies
In addition to highflow oxygen and intense monitoring, Sandoval said, physicians are using some standard protocols on blood thinning medication for infected patients — who can develop severe clotting — as well as administering plasma from previously affected patients.
She also said the state received word last week that New Mexico would get an allotment of remdesivir, an antiviral drug.
“That’s very good news for us,” she said.
Meanwhile, Lovelace has set up separate emergency rooms. One is a respiratory ER that ambulances can take suspected COVID patients directly to.
“Everyone in that ER is expecting patients to be COVID-positive. They are in PPE, and it’s negative pressure.”
“We have a separate ER for patients coming in for other problems, and we have the Heart Hospital ER. And women are still having babies. We have all these other things people do normally that we have to continue.”
Inside the main medical center, there are separate floors and separate intensive care units for COVID patients.
“It’s almost like building a hospital within a hospital to take care of COVID patients while still being able to address medical needs people have on a daily basis.”
Ditch-bank rider
Sandoval was born in Socorro and grew up on a “little farm with horses and cows” in Tomé. After graduating from Los Lunas High School in 1980, she went to the University of Texas at Arlington on a basketball scholarship and played three years.
“Growing up on a farm, you had a lot of responsibility. Feeding and caring for the animals. I did show steers in 4H, and back when I was playing basketball, I couldn’t imagine myself without a basketball in my hand.”
Why come back to New
Mexico?
“I grew up riding horses on the ditch banks. I couldn’t stay away.”
She and husband, Rodney, a retired respiratory therapist from Cuba, New Mexico, have four adult children, all of whom receive degrees this spring but don’t get ceremonies. Matt, 34, teaches autistic children at APS and finished his Ph.D.; Kristin, 28, earned a master’s in speech; Xena, 23, earned a master’s in genetics and is starting a Ph.D. program in Switzerland; and Sierra, 22, earned her undergraduate degree in biology and public health and is applying to physician assistant school.
“They are wonderful,” Sandoval said.
The family has a small ranch in Cuba, “so the kids got to grow up with cows and horses, the way I did.”
There is no more shooting baskets for Sandoval, thanks to two torn Achilles tendons. But she loved her playing days.
“I was really a defensive player when I got to college. They would put me on their top scorer. I was an ‘in your face’ defensive player … a little like Dennis Rodman (famed Chicago Bulls and Detroit Pistons bad boy),” she says jokingly.
Now, her default for R&R is the ranch. That means a big garden, hiking and chores.
“But my most relaxing thing is driving the tractor,” she said. “Now we’re irrigating and getting the field ready.”
Opening up
Sandoval hopes surgical procedures open up quickly — and carefully. They have mostly been on hold by order of the governor for the past six weeks due to the pandemic.
“Our different facilities give us capacity. We have plenty of PPE (personal protective equipment). We have done a lot of work to figure out how to make the operating room a safe place to be. I do anticipate we are going to be able to follow the governor’s needs as we are able to expand.”
How long will other changes, such as no visitors in hospitals, be in effect?
“It’s difficult to say. There are regional differences, and it will depend on the degree of testing.
“Knowing how much presence the virus has within our population is very important. So is contact tracing, especially if we find a hot spot. Test, isolate and prevent further spread is the best-case scenario.”
Other changes, such as masks and other precautions, are likely to stay for a while.
“We did it to protect staff and make patients safe. We have to be smart, stay a step ahead of this and really be able to use all of our resources. Part of that is thinking about this in a new way.”
Health crisis
Sandoval, who continued to see pulmonary patients weekly until the crisis hit, is especially worried about non-COVID patients not getting the care they need.
Many procedures have been postponed because of the governor’s order banning most nonemergency surgeries.
But public fear is a major factor.
“We’ve seen people come in who have put off medical care they desperately needed. They have come in with late stages of heart attack because they waited. Part of our mission is we have to find ways to continue to take care of people who are sick with other medical problems. We have to assure everyone that we can do that safely,” and without fear of cross contamination of being exposed to a COVID patient.
She said people need to get on the phone and talk to their primary care doctors.
“They need to make sure they are getting all the diabetic care they need. That their blood pressure is under control. Whatever it might be, we need to get them reconnected with their doctors.”
“We know this is something we are going to be facing for a period of time,” she said. “COVID is going to be here, so we are going to have to find ways to do our mission and take care of patients safely.”