A Kiss of Life During Pandemic
Local doc provides help on social media
Nearly a year into a global pandemic, the United States has 24 million cases and 400,000 deaths from the coronavirus. We know flattening the curve in new infection rates is critical to gaining control over the coronavirus, but frustrated people are tired of waiting. This was exemplified by the numbers of Americans that traveled to celebrate with their loved ones this past holiday season.
The reality that frontline workers experience in treating the public cannot continue. As our subject for this story noted, doctors are having to “Mickey Mouse” things in a way to help COVID patients who must endure excessive emergency room waits. Hospitals in Los
Angeles County are at capacity and cannot treat people suffering from other ailments and accidents unrelated to COVID-19. Doctors must perform triage as if the country is at war. Folks are scared. But what comes next has frontline healthcare scared.
Doctors have taken to combatting the fear and the misinformation by posting about their experiences in the hospitals as well as facts about COVID-19. Dr. Jessica Kiss is one of them.
Dr. Kiss, a mother of four, specializes in family medicine and works at Palos Verdes Medical Group. She has practiced medicine for the past five years and has
lived in the community her entire life, minus her undergraduate studies at Arizona State University.
Her social media page, Ask Dr. Mom, is a section on the blog site, South Bay Mommies and Daddies. There, Kiss gives her more than 1,500 social media followers straight forward information — not medical advice — aimed at “providing help with parenting, health, and beyond.” These days, COVID has become the subject of that “beyond” including the nuances of testing, vaccines and coping.
Kiss recently spoke about triage protocols for COVID patients, getting patients to the hospital, including discharge and follow up. Buckle in.
COVID triage protocol
When patients call her office worried they have COVID-19, the staff walks them through a series of questions about symptoms and past potential exposure. If they’re not in any distress, patients are sent to the clinic’s drive up test site. If they need a more rapid COVID swab and for the most part are symptomatic, they administer a molecular test for the rapid and symptomatic patients.
For patients in more serious need, they have protocols to safely bring them into the office.
Going to the hospital
Depending on what they need, if a patient is not very sick — either it’s not COVID symptoms they’re sick with, or they’re sick with COVID but it’s not emergent — the staff usually has them transported by private car. Kiss noted the craziness of the situation when, for instance, they had a patient with a kidney infection. The patient needed to go to the hospital, go through admission, receive antibiotics and fluids and then be checked more closely.
“Normally, a weekday in the emergency room will require a couple hours wait and you’re done,” Kiss said. “In this case we know they are going to wait 15 to 20 hours on average in LA County right now. So we have to then Mickey Mouse things where we are trying to prepare them. We’ll give them extra shots of antibiotics in the office, we tell them to go home and pick up fluids. We tell them to call us if they are sitting in the E.R. and they need something because we’re not sure that their staff will be able to accommodate them.”
When the doctor calls 911 for a patient who is in distress, maybe with acute chest pain or symptoms of appendicitis, the first question is, ‘Is this a COVID patient?’
“Well, everybody’s a COVID patient until
Dr. Jessica Kiss, poses a direct question from her Facebook page proven otherwise,” she said. “We’ve had situations where patients are sitting in our office, literally vomiting and we’re like, ‘Sorry, we have to stick this swab up your nose now.’ And we have to ‘COVID’[test] them before the team comes in because anything really can be COVID. Your abdominal pain and your appendicitis might be secondary to COVID because it set you over the edge, you were already predisposed to getting that. It becomes a nightmare situation.”
Hospital stay and discharge protocol
“Most patients now, if they are bad enough to be in the hospital, will require some level of either monoclonal antibody treatment [which are] laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses,” she said. “Either people have recovered their plasma or need secondary treatments, [because] they have COVID associated pneumonia. That’s the main reason we are hospitalizing patients right now. Sometimes they develop secondary bacterial pneumonia and have to wait till that improves which could take up to 3 to 5 days. It’s also not uncommon for these patients to get on ventilators and stay in for much longer than that.”
Discharge protocols for COVID-19 are similar to other diagnoses. Primary physicians, like Dr. Kiss, want to see COVID patients back in a couple days for a follow up. With COVID patients most screenings happen with a telemed visit. If she feels the patient is still too sick, she will have them come into the office.
“The telemed is less than ideal,” she said. “It’s hard because the burden on the hospital system is so much right now. Normally they would be good at communicating with me what potential needs my patients would have after they leave or they will send a discharge summary. Normally I’d get those in a few days and discharge them. Right now that’s not happening because turnover in the hospital is so, so high. That’s not a priority at the moment.
“I turned to my nurse practitioner the other day talking about a patient we were sending to wait in the E.R., trying to figure out what to do and MacGyvering things essentially,” said Kiss, referring to the old television show. “I stopped and said to her, ‘What is this? Why are we having this conversation? It’s 2021, not 1821.’ This shouldn’t be a thing and it’s a really unfortunate reality.”
Staff morale
Dr. Kiss’ staff is doing very well, going above and beyond, she said. The staff is well skilled in identifying patient needs. They hired extra staff to help manage their testing facility, who have been “just crushing it every day and doing more and more.”
While her staff is holding up very well, right now — everyone’s in “fight or flight mode.” She’s concerned, when all of this ends, about the mental health needs of frontline workers who have been experiencing this kind of chronic trauma.
What would help inform people about COVID-19?
The doctor said the Centers for Disease Control and Prevention and Los Angeles County Health websites are both excellent patient resources. LA County Public Health website links information on who can get a vaccination, where and when. It also links to who people can contact and provides testing information as does Dr. Kiss’s clinic.
If people think they have been in contact with someone who has COVID, they should contact a testing center and their primary care physician for testing advice. But not all testing centers are offering the same resources to patients and that’s a problem. For example, Kiss’ office requires a telehealth visit to determine what the right testing is based on the patient’s circumstance.
“We also let you know what a negative test or a positive test will implicate,” she said. “Without that information it’s really hard to know when you get a positive or negative result what that means,” she said. “Not all tests are created the same and all of the tests are used for different reasons so that’s been a key loophole that needs to close.”
What people should understand
Even when you sign up to get a test at a clinic where they don’t do that process, Dr. Kiss
encourages people to contact their primary care physician and to have that conversation, prior and after testing so that they are informed what that means.
“Because potentially you can have somebody get a negative test who was exposed five days earlier and not realize that they still have to quarantine for a full 14 days,” she said. “[They] go out spreading disease and suddenly on day 10, develop symptoms. I can’t tell you how many times where we’ve seen that happen. It’s becoming a tragedy.”
She recounted cases where young adults have had the infection, not realized it, tested because they we’re going to go see Grandma. They visited Grandma and then developed symptoms the following day. They have had COVID essentially the whole time, or at least part of the time without knowing.
“Then Grandma gets sick and in at least a few cases, Grandma has ended up hospitalized or died,” she said.
There is a need for a major public service announcement push. That’s why Kiss has been doing so much and posts daily on her Facebook and Instagram pages, talking to anyone who is willing to listen because “that’s how we end this.”
“We end this if people understand the reality of the situation, the gravity of the situation but also how they can take charge to stop it from spreading. And also, how they can be empowered to do that rather than fear it.”
Details: www.facebook.com/AskDrMom, www. publichealth.lacounty.gov/covidvaccinedistribution