Covid numbers are on the rise in our area, and the staff at Gothenburg Health is finding themselves in a position they hoped they would never again be in. Due to positivity rate increases in the community, Gothenburg Health Clinic has once again instituted a respiratory clinic - meaning patients who come to the clinic exhibiting potential Covid-related symptoms are separated from the rest of the population. It’s all about reducing risk, explained Dr. Carol Shackleton, Chief Medical Officer at Gothenburg Health.
“We’ve been seeing a lot of increase lately. For a long time over the summer we were getting a spattering of tests, and those started to pick up at the end of August,” Dr. Shackleton said. “We were down to maybe 40 or 50 tests a week with about a 10% positivity rate over the summer, and sometimes less. We had a few weeks where we had no positives. Now we are running over 100 tests a week and we have about a 25% positivity rate. This is not that dissimilar to what we were seeing last November when at one point we were nearly 40% in our community. This is a real surge.”
Dr. Shackleton said at this point it is unclear whether the strain of Covid they are seeing at Gothenburg Health is the Delta variant or not. She said the most recent report she has seen from the State shows that of the positive cases seen in Nebraska about 50% are Delta and the other 50% are the Alpha variant.
“The plain old regular Covid that we saw last year isn’t as prevalent as it used to be, so yes - these are the variants,” she added.
Because viruses mutate over time they become difficult to prevent and sometimes to treat. However, Dr. Shackleton did note that the original vaccine seems to be helping prevent patients from getting sick enough to require hospitalization, or worse. “Just like with the flu we are seeing a certain percentage of people who get the vaccine still test positive for Covid. But the percentage of those people who are hospitalized is much lower for those who are vaccinated,” said Shackleton. “The last statistics I saw were that two-thirds of the Covid-related deaths in Nebraska were unvaccinated individuals and only one percent of the deaths were from fully vaccinated people.”
Dr. Shackleton did say they are seeing more cases in children this time around. If a child gets sick the decision of whether to have them tested for Covid, Shackleton explained, depends on the exposure. “If you know they have been exposed to somebody positive then you treat them as though they are probably positive and they don’t necessarily need to be tested. If you have absolutely no clue where they could have gotten it, for example, if the child is homeschooled, then it is important for the parent to know if the child has it.”
The Covid vaccine is currently available for everyone over the age of 12. Dr. Shackleton said one of the things healthcare providers are seeing among children, including here in Gothenburg, is something called multisystem inflammatory disease. She said this can show up early or even weeks after the child has been sick, with symptoms other than respiratory such as GI symptoms, heart palpitations, fever, chest pains and a host of other problems believed to be related to the after effects of Covid.
“We have had to ship three kids out and we have had kids who have had to have cardiac evaluations prior to returning to sports because of some of their symptoms,” Shackleton said. “It’s hard because so many people don’t get that sick and they do well and get over it. So people tend to become apathetic.”
Dr. Shackleton did admit that for those who have been fully vaccinated, and perhaps had Covid as well, having to go back to taking preventive measures such as wearing masks can be a hard pill to swallow. However, she said studies do show that over time those antibodies that were created either from getting the virus naturally or having the vaccine, begin to drop. That is where a booster comes in.
“At this point we are not certain we need a booster every year. The CDC is constantly getting new information and evaluating that based on the information they have,” she said.
On Friday, Sept. 17, the FDA gave approval to Pfizer for a Covid booster for people aged 65 and older, as well as other vulnerable Americans, so we are expecting that release to come soon. There are still a lot of unknowns about who may need a booster, and when a booster may become available for the general population is still unclear.
The increase in positivity rates is not just being seen here in Gothenburg. Aaron Salomon, PA-C at Gothenburg Health, said he has personally experienced some very troublesome circumstances in trying to treat patients. “My biggest concern right now is that we have no ICU beds across the state, primarily related to Covid cases as well as nursing shortages. I’ve had to sit on critical patients who are needing to be in ICU, but without beds there’s nowhere to send them,” Salomon said.
Salomon also echoed Dr. Shackleton’s concerns about the younger patients he has been seeing. “With this new Delta variant we are seeing younger healthier patients having worse outcomes. I’ve sent two children with multi system inflammation to Children’s Hospital in the past several months, both having heart related issues.”
Dr. Shackleton acknowledges that Coronavirus is here to stay, and we will undoubtedly continue to see surges from time to time with Covid just like we do with influenza and the common cold. She thoroughly believes our best protection is through vaccination, and blames misinformation found mostly on the Internet - and “political views that have nothing to do with the vaccine but have been associated erroneously with it” - for so many people choosing to not get vaccinated.
“Many people don’t understand the process of the scientific method in terms of evolving treatments and evolving protocols. We get new drugs, new protocols and new treatment methods all the time,” Dr. Shackleton explained.
As for the model of the Covid vaccine, the mRNA model, Dr. Shackleton said researchers have been working on that since 1986. So while the vaccine seems like it was really quick - which she admits it was - the basic model has been around for a very long time, and has been used selectively for treatment of certain cancers.
The bottom line is, said Dr. Shackleton, that many people - including healthcare workers - are getting very burned out. “This week we were full, and we still had surgical patients scheduled. We had more Covid admissions in the past week than we have had previously and hospitals across the state are seeing the same thing,” said Shackleton. “That has put a drain on everybody. This is much worse than last fall - then we could juggle stuff around with other hospitals. But that ability is not here anymore. The surge last year was about six or seven weeks, and we are about two weeks into it now. We have real concerns that we may have people die here waiting to be transferred.”
Ann Scott, APRN at Gothenburg Health, is another provider on the front lines of the Covid fight who admits she is getting tired. “The current reality is very different from the community’s perception. When people are not completely surrounded by Covid every day they don’t realize the situation we’re in,” said Scott. “Hospitals don’t have the staff to fill all of the hospital beds so some states are truly having to decide who gets further treatment and who doesn’t. Unfortunately, we’re facing this issue in central Nebraska as well. The larger hospitals in Nebraska and our surrounding states are unable to accept any more critically ill patients which leaves patients in small rural hospitals without some life-saving resources. The truth is that people are dying and healthcare workers are wearing out.
“Gothenburg is not exempt from this and we are dealing with all of these issues right here,” Scott continued. “There are still other issues that need to be treated including heart attacks, traumas and general illness but these patients may not get care because there are no more available beds. Our best chance at turning this around and freeing up critical resources is by getting the vaccine. This is a very difficult time and we understand the frustrations. We’re all tired and facing extreme Covid fatigue so please be kind and respectful to each other.”
If you have not yet received the Covid vaccine and would like to, you may call the Gothenburg Health Clinic at 537-4066. There is no charge for the vaccine.