SALEM – For Dr. Omer Khan, the treatment of patients with severe cases of COVID-19 has not become more predictable since the hospital first in March.
But the Salem Health hospital doctor, who cares for people admitted to the hospital but not sick enough for the intensive care unit, said he has become more comfortable treating patients with coronavirus because he has learned to be prepared for anything.
Marion County had a grim pandemic earlier this month – 100 people in the county have already died of COVID-19, killing 600 people in Oregon so far. To date, the county has registered 5,223 cases of COVID-19, with a mortality rate of 1.9%.
A total of 418 residents of the county have been hospitalized with the virus, with Salem Hospital treating at least 350 of them. One in four has spent some time in intensive care while in hospital, said Salem Health spokeswoman Elijah Penner.
County data show that deaths with COVID-19 are concentrated in nursing homes and long-term care in the county. Almost all are older residents of the Salem area with other health conditions, according to a new report from the district health department on October 3rd, which investigated 98 of the deaths.
Sixty-three of the dead became infected with the virus during outbreaks in long-term care facilities. The next most common source of infection is sporadic, with 18 of the dead reported. This means that health investigators do not know where they became ill. Eleven were related to the spread of households, and two fell ill in prison or in food processing establishments.
Half of the dead are over 80, and the youngest death in the county is a 45-year-old man who died on April 18. All had at least one other health condition such as heart disease, diabetes, asthma or a history of smoking. Most of those who die from the disease report two or three health conditions.
The deaths in the county follow patterns around the United States, where older Americans and those with health are most likely to die from the virus. More than half of people who die of COVID-19 in the United States are 75 or older, according to the latest data from the Centers for Disease Control and Prevention.
But Khan and county health officials said the data did not mean younger and healthier people could ignore the risks.
First, older Salemites often become infected with the virus through contact with younger people. Katrina Rotenberger, the county’s director of public health, said the virus usually enters nursing homes through younger employees or visitors and then spreads to vulnerable residents with often fatal outcomes.
“It’s really a tragedy for our community to have so many people who have died,” Rothenberger said in an interview last week.
Second, they both said that the phrase “basic health condition” is often misunderstood by people who are not aware of the wide range of conditions it covers, or how common these conditions are, such as asthma, high blood pressure, and obesity.
A 2019 community health report found that half of adults in Marion County have at least one chronic illness. About 10% of adults had asthma and 6% had chronic obstructive pulmonary disease, a chronic lung condition common in smokers.
Khan said the county’s data on who died of COVID-19 reflected his experience at Salem Hospital. He said that obesity, diabetes and old age are the three factors he sees most often in seriously ill people.
COVID-19 deaths are most often due to respiratory failure, Hahn said, often after the patient develops pneumonia due to damage caused by the lung virus.
The virus can also cause blood clots, which lead to strokes or heart problems in some patients, Han said, something he has personally observed three or four times. As a result, doctors closely monitor the patient’s blood for clotting proteins, cholesterol levels, and more.
While those who die with COVID-19 are usually adults, Hahn said patients who stay in the hospital the longest are younger.
The average time a Covid patient stays at Salem Hospital is about a week, Penner said.
But Khan has seen much longer stays of three to four weeks, often with middle-aged people who are obese or have asthma or diabetes. While older patients who are seriously ill can die quickly after hospitalization with the virus, he said younger people with serious illnesses stay in the hospital longer than because their bodies will continue to fight the virus.
“It’s going to take weeks and months for this man to get back to where he was before it all started, and that’s the scary part of getting sick,” Khan said.
After seven months of caring for patients with COVID-19, Hahn said he and other doctors still could not reliably predict who would become seriously ill, as the disease is often unpredictable. Testing is more affordable now, so it’s common for hospital patients to get tested for COVID-19, even if they’re there for unrelated disease.
He has seen elderly people with many serious health conditions that are positive but show little or no symptoms. He recently cared for a COVID-19 patient in his 50s with a history of asthma who was admitted to the hospital because he felt tired and ill, but was not struggling with respiratory problems. She was receiving minimal oxygen when Khan left the hospital that evening. The next day, when he showed up for work, the woman was in the intensive care unit on a ventilator, he said.
“Who will this man be?” We don’t know, ‘he said.
What has changed, Hahn said, is that health professionals have seen the basic precautions they take to prevent the disease from spreading – such as wearing masks and dresses around patients and washing their hands regularly – work well to stop coronavirus. Many feared becoming infected at the start of the pandemic, when protective equipment was in short supply and less was known to effectively stop the spread.
Khan said he and other doctors he works with have tested negative for coronavirus antibodies, even though they care for dozens of patients with COVID-19 in the immediate vicinity.
“It’s best to defend ourselves,” he said.