Modesto hospital sees patients with COVID breakthrough cases

COVID-19 is again surging in the Northern San Joaquin Valley, sending patients to hospitals in Stanislaus County with symptoms of fever and trouble breathing.

In contrast to previous surges, more young adults are being admitted. Most are people with no vaccine protection against the coronavirus, but some are “breakthrough” cases in people who are vaccinated, a hospital medical director said.

Dr. Eric Ramos, chief medical officer of Tenet Healthcare’s Northern California Group, said Thursday that Doctors Medical Center has more than 40 patients suffering from COVID-19, and the numbers are growing.

Stanislaus County reported an additional 159 cases of coronavirus Friday, for a two-day total of 447, as cases recorded during the 16-month epidemic surpassed 60,000. COVID admissions at the county’s five hospitals grew to 136, quadruple the number six weeks ago.

County health officials said the highly infectious delta variant has spurred the upsurge in cases that began in July. The variant is responsible for 80 to 90 percent of new cases in different parts of California.

With the new surge, Ramos said, it’s not uncommon for the hospital to admit COVID-positive patients in their early 20s to early 30s and 40s. That’s different from last year when the hospital mostly took in older people who had underlying health conditions, he said.

Ramos said most of the younger patients are not vaccinated against COVID-19, but the hospital is also seeing breakthrough illness in people who are vaccinated.

The breakthrough cases are seen with all three vaccines — Johnson & Johnson, Moderna and Pfizer, Ramos said.

The vaccinated people need to be admitted for hospital care, but they are less likely to need intensive care than unvaccinated patients, the medical officer said. He cited a figure that risk of death is far higher for unvaccinated people, who are vulnerable to a Delta variant that replicates faster and may cause more serious disease.

Ramos did not disclose the number of vaccinated and unvaccinated hospital patients or deaths since the surge erupted last month. While the COVID vaccines never promised full protection against illness, they are considered up to 95 percent effective in preventing serious illness and death, but a few experts have dialed back the estimate for the delta strain.

The California Department of Public Health has identified 41,279 breakthrough cases, between Jan. 1 and Aug. 1, out of 21.3 million state residents fully vaccinated. The state has tallied 1,379 vaccinated people hospitalized for COVID illness and 119 deaths, which have not been vetted.

The state health department has recorded a daily case rate of 33 per 100,000 for unvaccinated residents and 7 per 100,000 for the fully vaccinated.

Professor Bob Wachter, chairman of the department of medicine at UCSF, said in a Twitter thread the delta variant makes the mRNA vaccines like Pfizer and Moderna about 85 percent effective. Since it would take months for a vaccine campaign to stop the delta variant, Wachter recommended masks for the public, even for those vaccinated.

“Until then, anything other than universal masking is simply bonkers,” Wachter tweeted.

With the delta variant, Ramos said, the COVID-19 illness takes a strong hold on younger adults at the Modesto hospital.

The staff members are seeing blood-clotting in those patients soon after arrival. The microvascular clotting was an effect of COVID-19 in the previous waves but came later in the course of illness, Ramos said.

Today, the hospital staff knows more about treating COVID patients and getting positive outcomes. Doctors wait longer before putting a patient on a ventilator, if possible, Ramos said. Patients in respiratory distress may be placed on their stomachs in bed for easier breathing.

Maintaining staff morale in hospital

After the late fall and winter surge, Doctors Medical Center did not end its visitation restrictions and protocols for masks, hand-washing and keeping COVID patients in isolated areas of the emergency department and hospital. It remained on alert for the next battle.

It is challenging to maintain staff morale as another coronavirus wave hits the county and may not peak until the end of August, but “we are still in good spirits,” Ramos said.

“After our wave in January, we were hoping it would continue to decrease,” Ramos said. “I think everyone in the county and surrounding area is going — oh no, not another surge.”

Ramos said the statewide reopening in June was an experiment in getting back to normal but has not gone well. “We need to get back to some kind of (infectious disease) protections, so we can stop this surge if we can,” he said.

The director said a short-handed staff of intensive care nurses is assigned to care for the growing number of COVID patients, which eventually will mean patients who need heart procedures or neurosurgery may be delayed due to lack of beds and staff.

How to protect children?

There’s concern for delta’s affect on children 12 and under, who are too young for coronavirus vaccine, and on teenagers who have low vaccination rates, especially as schools prepare to open.

Valley Children’s Healthcare near Fresno has seen a recent increase in positive tests, hospitalizations and emergency department visits for COVID-19. The nonprofit network with a hospital and specialty clinics serves children in the Central Valley from Modesto to Bakersfield.

Of the 3,440 tests administered last month, 133 were positive for COVID, up from 61 in May and 37 in June. Valley Children’s Healthcare said the 30 children hospitalized for COVID in July was double the number in June.

Since the pandemic began last year, the children’s hospital admitted 208 patients for a COVID-19 diagnosis, and 93 children were treated for multisystem inflammatory syndrome, a rare condition linked to COVID-19.

Valley Children’s Healthcare said it will require full vaccination against COVID-19 for all staff, physicians, vendors, students and volunteers, effective Sept. 21, as a way to assure families their children are safe in the hospital and outpatient clinics.

Todd Suntrapak, president and CEO of Valley Children’s Healthcare, said in a briefing that adults who are around young children can protect the kids by getting vaccinated.

“As children under the age of 12 are not yet eligible to receive the vaccine, we all must take the recommended safety measures to protect them and keep them as safe as we can,” Suntrapak said.