What a year 2020 has been and continues to be. We are dealing with civil unrest, prolonged drought and a pandemic that has touched more lives for longer than anything in generations.
It is on this last topic I was invited to pen a few thoughts.
OK, that’s not entirely accurate. I’ve penned lots of thoughts, as I wanted to cover as many big points of COVID-19 as I could. Below are paragraphs on our local response, COVID-19 treatments, vaccines and masks. And this is the condensed version!
Five months have passed since we were made aware of Carroll County’s first COVID-19-positive patient. Since that time, our society has been dramatically altered. Our governor, along with governors of all 50 states, issued emergency proclamations in an effort to save lives.
While there are more eloquent and detailed ways of describing what Governor Reynolds has attempted to do with limitations on business, religious services, public gatherings and more, the simple truth is that she (and governors of other states) attempted to prevent unnecessary death.
This pandemic is real; it is not a political fiction.
It has been stated that our ICUs have not been overwhelmed. While true that we have not, as of now, had to resort to using hallways for rooms, the major medical centers in Des Moines have repurposed additional areas of the hospital into new “COVID-19 ICUs,” allowing them to care for greater numbers of critically ill COVID-19 patients.
This isn’t a critique; it’s exactly what they should be doing.
But that excellent preparation and flexibility of the medical teams should not be interpreted to mean this isn’t a life-and-death matter daily for the patients there.
The physicians, providers, nurses and other healthcare workers in Carroll and our surrounding counties have taken care of hundreds of outpatient COVID-19 patients. These patients do not all quickly self-recover.
We’ve also taken care of several COVID-19 patients ill enough to require hospitalization.
As our inpatient COVID-19 numbers decreased in June, we made the decision at St. Anthony Regional Hospital to decrease the size of our dedicated COVID-19/Infectious Disease Ward.
As the numbers rebounded in July, we increased the ward back to its previous size. Words cannot express how proud I am to work with these dedicated men and women.
We are healthcare workers; this is what we do.
But this pandemic is not something very many of us trained for extensively.
Nonetheless, these physicians, providers, nurses and other healthcare workers are our family, neighbors, fellow parishioners and friends. And we have been pulling extra shifts, going through extra training and exposing ourselves to extra risk because that is what this time calls for.
At St. Anthony Regional Hospital, we became an early participant in the Mayo Clinic organized national trial of Convalescent Plasma for the treatment of COVID-19.
One week ago, the trial primary investigators presented their initial results. The use of Convalescent Plasma in COVID-19 patients sick enough to be hospitalized appears to reduce mortality.
We at St. Anthony utilized this treatment on multiple patients over the last five months. The next step in good medical research will be the completion of randomized prospective trials — having some patients receive plasma, others not (both groups will receive all other approved COVID-19 treatments as indicated), while the physicians caring for them are unaware of which group they are in to prevent bias. These trials already have begun (not currently at St. Anthony Regional Hospital). This is the standard, validated process the scientific and medical communities use to trial new treatments.
The currently-approved treatment with the best evidence behind it is an antiviral medication, Remdesivir. The randomized, prospective trial results were published at the end of May in the New England Journal of Medicine.
This treatment also is reserved for COVID-19 patients sick enough to require hospitalization.
Because of our experience at St. Anthony treating multiple inpatients with COVID-19 over the past several months, we applied to the State of Iowa to receive some of the antiviral treatment. As this is a novel treatment, only a limited number of doses were allocated to each state. At the end of July, with the excellent work of our pharmacy team, St. Anthony was approved to receive doses of Remdesivir.
We are getting snippets of information on different vaccines originating from American, Russian and other companies. Barring a major change to the safety and efficacy testing process, it is unlikely the public at large would have access to those possible vaccines in 2020. I am so more than willing to be wrong on this!
It also will be very interesting to see what the effectiveness and duration of immunity is. Coronaviruses (COVID-19 included) are notoriously difficult to build a consistent immunity to. This is why, despite prior coronavirus pandemics, we have not had a coronavirus vaccine up to now. Of those infected with COVID-19, the immunity is minimal if the patient had little to no symptoms.
Of those infected with a more serious case of COVID-19 (significantly symptomatic or hospitalized), the immunity was much more robust, but waned over months. There certainly is going to be more research presented over 2020 and the next year on this topic.
Please read the open letter collectively penned last week by nearly all the Critical Care Medicine (ICU) physicians of MercyOne Medical Center — DSM, UnityPoint Iowa Methodist Medical Center, & Mary Greely Medical Center. In that letter, the physicians state that with our state’s reopening this summer, their ICUs began filling once again with COVID-19 patients. The difference in this summer compared with the initial COVID-19 surge this spring? Now they are seeing patients in their 30s and 40s becoming sick enough to require ICU care in a major medical center.
Quoting the letter: “We are troubled by the path that we are on and what will lie ahead for all of us. We ask all of you to look out for each other and limit social gathering. The use of masks is absolutely critical in controlling the spread of this virus.”
Also last week, McFarland Clinic, Iowa’s largest physician-owned, multi-specialty clinic, issued a press release calling for universal masking indoors at schools, businesses and gatherings. More than a hundred healthcare workers affiliated with St. Anthony Regional Hospital signed a public letter expressing our thanks to members of the public for their support, and repeated the established recommendations for how we decrease the COVID-19 infections in our communities and get our society on a stable reopening plan: practice good hand hygiene, distance yourself from others outside your household when possible, wear a face covering when in public (especially when distancing cannot be achieved).
I have been asked numerous times recently about a mask mandate or requirement.
I typically give some variation of the same answer: “I’m a physician; those decisions are made by our political leaders. But I would support efforts that result in more masking so that we can get our communities back open to stay.”
As of this writing, nearly 70 percent of states have some form of a masking mandate or requirement.
I honestly don’t know if that is the best idea for Iowa right now.
But I do know that if we as Iowans cannot limit the spread of coronavirus successfully enough for a long enough time, our cases will continue to climb (percent positives, not just raw numbers). And if that happens, we may put our governor in a position where she has to take more action.
I’ll admit that I’m not as forceful on a government mandate as some other physicians; many believe the time already has come for more action.
On July 27, representatives from the Iowa Medical Society (of which I am a member), Iowa Academy of Family Physicians, Iowa Chapter of the American Academy of Pediatrics, Iowa Chapter of the American College of Emergency Physicians, Iowa Nurse Practitioner Society and Iowa Physician Assistants Society, among others (15 in total) wrote an open letter to Governor Reynolds calling for a statewide public mask order.
They cited the 64 percent rise in cases from the end of June to the end of July. They also cited how over that same time frame, greater than 48 percent of the new cases were in patients aged 18-40.
Governor Reynolds, while not ordering a state-wide masking mandate, repeatedly has asked us to follow the established methods of limiting this pandemic: hand hygiene, distancing and wearing masks when in public (especially when distancing isn’t possible).
In briefing after briefing, she has called on Iowans to “do the right thing.”
To be clear, the Centers for Disease Control & Prevention, the National Institute of Health, the governor and numerous state and local medical officials all are asking for the same thing: that we take our responsibility as fellow citizens to hasten the end of this pandemic seriously.
I also appreciate the enforcement questions that accompany any state mandate.
I have great respect for the work Carroll Police Chief Brad Burke and Carroll County Sheriff Ken Pingrey, along with their respective law-enforcement staffs, do for our communities.
I won’t speak for either law-enforcement official, so as a citizen of the communities they serve, let’s all step up and do the right thing rather than have to focus on the enforcement side.
The Catholic Healthcare Association of the United States published a campaign related to masking that I feel gets at the heart of the issue: “#LoveThyNeighbor.” Sister Mary Haddad, RSM, stated: “Wearing a mask is about caring for your friends and neighbors and follows Christ’s simple commandment to love one another.”
I am not perfect, and I do not have all the answers.
But if wearing a mask can prevent me from unknowingly exposing others and prevent unneeded death, count me in.
If wearing a mask at work can keep my wife’s wonderful coworkers and the customers they serve from getting exposed and temporarily closing, count her in.
If having my children (I have two school-aged boys) wear masks at school can prevent them from unknowingly exposing a class and keep our kids, teachers and school staff safe and in school, count my whole family in.
I care for countless senior citizens, some of whom live in long-term care facilities.
I cannot adequately express the emotional toll that this prolonged separation from family and friends has taken on the residents and their loved ones.
Can we please respect the sacrifices of this Greatest Generation and the generations that have followed by making our sacrifices now?
For those of you who don’t believe any of what I’ve written about, or what the scientific and medical experts of Iowa have written about, I don’t know if there’s a set of facts I could ever present.
But could you decide to help your fellow citizens out anyway?
I come from a large family, and we can’t agree on which football team to support, let alone every other issue that comes along.
But what we can agree on? We love each other. And we loved our late mother. And we love our father. And if wearing a mask when we cannot adequately distance, and washing our hands like we are all pretend surgeons keeps our father with us, then count us in.
I could not be happier telling people for the past 40-plus years that I’m from Carroll (when I was in Omaha, Breda still wasn’t well-known, so I fibbed).
I have just as much pride now.
Physicians, nurses, healthcare workers, law-enforcement, business owners, teachers, students, political leaders and skeptics, we are one great community.
Let’s support each other in this incredible year of strife.
Let’s show the rest of Iowa our best.
Dr. Kyle Ulveling, a Carroll cardiologist and Breda native, is the chief medical officer at St. Anthony Regional Hospital.