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Castle’s Response to COVID-19



On March 20, 2020, Dr. Robert Smitson, hospitalist at Adventist Health Castle, sat down with Cailyn Whyte to discuss the coronavirus pandemic and how Castle is responding to it. Listen to the premiere podcast episode of “Health Wholeness Hope” above or read the transcript below.

Caitlin Whyte (Host): It seems as though the only topic on the news these days is the Coronavirus and rightly so as it spreads around the globe at an alarming rate with information changing daily, even hourly. How can you stay up to date and how do you know what is correct? That's why the doctors of Adventist Health Castle are going to help you out with this podcast about all things Coronavirus. Joining us for that conversation today is Dr. Robert Smitson. He's a Hospitalist at Adventist Health Castle. This is the Health Wholeness Hope Podcast. I'm your host, Caitlin Whyte. Dr. Smitson. I'm sure you're all very busy right now. Let's start with a simple question. What exactly is the Coronavirus? Break it down for us.

Dr. Smitson: So the Coronavirus, it's kind of difficult because there are multiple Coronaviruses, so Coronavirus is actually our account for 20% I believe, of the common colds and they circulate every year, but this is a different Coronavirus. This is, it's called SARS 2 Cove or, and the disease is called COVID-19. SARS, if you remember in 2003 was also a Coronavirus. So this is, this is just a new form of the Coronavirus that started in China and unfortunately has started to spread around the world. In some people it's like the Coronaviruses that has circulated, you know, for a long time. And in some people you can become much sicker. So that's why we're talking about it today.

Host: So we're hearing about this in the news, you know, every minute, every time we're on our phones, I still know people who are split, some who think this isn't that big a deal and some who are on the other end hoarding supplies. Where do you fall on this? Is it being blown out of proportion?

Dr. Smitson: I guess the way I look at it is I hope it's being blown out of proportion. I hope we look back in three months and everybody's doing very well and we did blow it out of proportion, but I don't believe that to be the case. There's a reason that a city's had shut down over the, you know, the whole world. And some of the data we have from anything from the World Health Organization to, you know, Korea, is that the fatality rate for this COVID-19 is anywhere between 0.6 to 3%. Just to give you a comparison, the flu in a bad year is about 0.1%, so if you're looking just at fatality rate, this could be anywhere from six to 30 times as bad as the flu. And that's what's so scary about this disease. The other scary part about this is that we don't have a vaccine for it. We don't know much about it and we don't have a treatment for it. And there's one other scary thing is that some people get it and then they don't have a lot of symptoms. So they become spreaders of the disease and the disease can spread very quickly. And because up to 20% of people even need hospitalization. So if you look at the China data, moderate to severe disease, which is defined as hospitalization, is about 20%. So if 20% of people need hospitalization, our healthcare system could be overrun. So that's what you're seeing in places like Italy and now Spain. And what you saw in Wuhan China is that their healthcare systems were overrun. And the reason that we need to blow it out of proportion in some ways is so people stay home and the healthy people, and stop spreading the disease to unhealthy people that will need hospitalization.

Host: So you mentioned the flu and that's something we've been hearing a lot about. Can you talk about why we're hearing this comparison and some of the similarities between this Coronavirus and the flu?

Dr. Smitson: Well, I think the illness is similar to the flu. If you look at some of the statistics on what's called the are not, or how many people you spread the disease to, on average it's, it's somewhere similar to the flu. A lot of the symptoms are very similar to the flu where you get fevers and body aches. So I think in some ways it's a lot like the flu. The only issue is, is that it can be much more severe and in a higher percentage of the population. So it's, you know, as a hospital we all know that flu season the hospital gets very, very busy and if this truly is six to 30 times as bad as the flu, then you know, we'll have to use all of our resources to take care of patients with this virus. So that's why I believe, you know, the CDC is right in encouraging people to stay home and to do the social distancing that we're doing.

Host: That leads me into my next question. Social distancing. How strict should we be isolating ourselves?

Dr. Smitson: I think we should be very strict about it. We don't know a lot about this disease and how it's spread. And you know, even if you're young and healthy and you might do fine if you catch this COVID or Coronavirus, you could be spreading it to other people who aren't healthy or aren't able to handle it. So even if you are healthy, you probably know someone that's not and you wouldn't want them to get the disease and you wouldn't want the hospital to be overwhelmed if you infect other people. And let's say you get in a car accident and you need help at the hospital. So I think everybody needs to stay home whether they're young and healthy or not because we need to get control of this disease.

Host: I mean, we hear from the Federal Government, you know, no groups over 10 some States are making that even smaller. I mean, can I really not go see a friend of mine? I know I can't be in groups, but really what is the numbers that we should be abiding by?

Dr. Smitson: Right. I mean, yeah, the government says stay six feet away from everybody. Right? But I tell people that, you know, outdoors isn't a hundred percent safe, but it's probably safer if you're going to see a small group of people that haven't traveled recently, that haven't been on any cruise ships, or been in contact with anybody else that's had the virus that, you know, maintain your distance. You can have some conversation. But again, they recommend six feet, you know? And the reason for that is just like the flu, it can spread via droplets and you don't, the droplets can go about six feet. So I think you can be with a group of a small party as long as you continue to wash your hands, if you touch anything, if you stay six feet away from them.

Host: So how has this Coronavirus been affecting Adventist Health Castle? How are you guys preparing for it?

Dr. Smitson: Well, it's been a really active situation. There's been a lot of meetings, but we are making quite a bit of progress. So just this week we started a drive through testing. People can come and get, I'm sure you saw on, you know the videos in Korea and they're starting them all over the US now where people can stay in their car and get tested by somebody. You do need just so everybody knows, you can't just show up. You do need a physician order, but that's one thing we're doing. We've also restricted patient visitors except in our labor and delivery department, so we have chaplains that are coming and meeting with patients for their spiritual needs. We have all of our outpatient services are remaining open for the time being, but all of our elective surgeries are being canceled. We've been relearning and relearning again on how to wear protective devices and going through that drill quite often to make sure that all of us are wearing the correct protective gear.

When we see patients that we are at least screening for the COVID-19. As physicians, we are updating the families daily for patients that are in the hospital that aren't allowed visitors. We are also encouraging our families and patients to use video chats with each other while the patient's in the hospital. As you know, this is a fluid and quick fluid situation and it seems like guidelines change daily, weekly, and we are monitoring all of that closely and having many meetings every day trying to figure it out. Like the social distancing thing. Right. Didn't even exist, I mean two weeks ago. And now it seems like the world's changed quite a bit in two weeks, but with healthcare it's changed too, so we're trying to follow those guidelines as quickly and as strictly as possible to make the changes that we need to do.

Host: Some people have been talking, you know, once summer comes around, maybe the heat will kill off this virus. Being in Hawaii, the heat and humidity there, does that help it at all?

Dr. Smitson: Well, that's actually a really good question. I wish I had a good answer for you, but the fact is we don't know a lot about the virus right now and we don't know if it's going to live in the summer or not. A lot of Coronaviruses do go away in the summer, but as you know, if we get the flu in Hawaii too, so I would not count on the protection of heat or humidity from this virus, especially because so many people spend time indoors anyway. And I think, you know, countries in the Southern hemisphere are getting it right now too, and it's their summer. So while I'm hopeful, you know, there's New Zealand and Australia and I saw Brazil is also having issues, so I wouldn't count on the summer to get rid of the virus just because one, we just don't know enough about it.

Host: So here's a conversation I was actually having today with my boss at another job. He was kind of throwing it out there like, what if we all just got the virus, let it run its course and then we'll be done with it. I know that's probably not the best idea, but tell us why, you know, we're flattening the curve as they say?

Dr. Smitson: So your boss sounds like my wife, no offense, I'm just kidding. I mean from personal standpoint, that sounds great, right? Like from a purely selfish standpoint, I'm young and healthy and I can get over this thing, but the problem is you can infect other people. And if everybody thinks that way, you know, if 20% of the people need hospitalization, we will overwhelm our hospitals and we will not be able to take care of those patients that need hospitalization. And that's what flattening the curve is all about. We need to flatten this curve if we want to be able to take care of everybody that has COVID, you know, I see what I see what your boss is saying. But I, you know, we're health infrastructure could not handle if everybody in the country got infected with it at the same time.

Host: So let's get into some of the symptoms. Can you talk a little bit about specifics and then when is the time to actually call your Doctor?

Dr. Smitson: Really, you need to talk to your doctor. I think your doctor knows, knows your, who you are, what's your co-morbidities are, meaning what other medical problems do you have, how old you are. And they need to take a good history on where you've been, who you've been in contact with. So it's, you know, it's difficult. Does everybody that has the sniffles need to go get a test? No, probably not. But especially if tests are limited. But I think that question would have to be answered by your doctor. Now the symptoms, you know, they could be as mild as a sore throat and a low fever, but typically it seems like patients are getting sore throats and then fevers and then a cough. And you know, the patients that need hospitalization typically need hospitalization around day five to seven after having those symptoms. And that's what I read from all the reports in China and more's coming out of Italy as well. But I'm learning from them. That's what happens. Now, the cough and the fever, if you have a cough and a fever, you definitely should call your doctor and see if the test is right for you.

Host: So what would you say for people like me who even before this pandemic spent a lot of time maybe on Web MD Googling symptoms of random viruses or illnesses? I mean, how do we kind of stay logical and calm through all this?

Dr. Smitson: So again, if you're young and healthy, you're probably, you know, most, you're going to be fine from this. Again, it's the elderly and the people with a lot of other medical problems and smokers as well that are the ones that are having the biggest problem. It doesn't mean if you're healthy, you're going to be fine. But I think the main thing to focus on now is, well if you have a cough and a fever, you need to call your doctor. But the main thing to focus on now is not spreading this disease and not the only way you can spread it is to catch it. So stick with social distancing, wash your hands as much as you can before touching anything outside of your home. And I mean, unfortunately we're going to have to hunker down for awhile and I think people just need to stay up to date on what the CDC is saying. And Dr. Fowchee, I watch him every day and I trust everything that he says.

Host: As much as we want to social distance. I mean there are some things we have to do, right? We have to go to the grocery store, we have to get gas. What do we do when we get ourselves into those situations?

Dr. Smitson: Well, I mean you have to do what you have to do. I mean, it's not like every time you go out you're going to get the virus, but you want to limit the number of chances, you have to get it right. So we have to eat, we have to get food. Personally, I had food delivered to me from Instacart the other day for me and my family. You know what's really cool, actually, this is kind of not your question, but some of the grocery stores and there's one in particular in Hawaii I know of. They are having elderly only shopping times.

Host: I have seen that. Yeah. It's so cool.

Dr. Smitson: Which is I think is a fantastic idea. So they don't have, they're the ones that are staying home, but when they go out you don't want to be around, you know, an asymptomatic or mild disease spreader of someone that's 20 and healthy. And I think that's a great idea. But no, there is a chance of getting it when you do that. But I think if you're getting gas or you're pumping gas, wash your hands right after, you know, let's say you're going for a jog outside and someone becomes within three feet of you one time I wouldn't, you know, panic, but you just got to limit the number of times that you have that risk of getting the virus. So important things are important and you've got to take care of yourself and your family and your life. But I wouldn't be going to, you know, bars and hanging out or going to restaurants when they're crowded with lots of people or anything like that.

Host: Tell us a bit more about the drive through testing services at Castle.

Dr. Smitson: I'm so glad we're doing that, just because we got to take care of ourselves. If we're going to take care of our patients and we don't want to all get it, you know, we don't want our healthcare providers to get infected. But you know, any patients listening to this do need to know that they do need to order from their doctors. Call your doctor, they can send a fax to Castle and then an appointment needs to be made for the patient to show up to get tested. So you can't just show up and ask for a test.

Host: So if my doctor does recommend that I do go get a test, what should I expect at the drive through?

Dr. Smitson: So when you drive up, I think they hold up the order in their window and then there's the station where they put up the order and then they move them on and then they go to the next station where one of our nurses swabs, does the swab. And I don’t know if you've ever had a swab, but it is kind of like a big Q-tip that goes way in the back of your nose and it can be quite painful. But definitely worth doing if your doctor thinks you need the test. And it's great because you're not exposing anybody else if you have it. So it's a great idea.

Host: Well, Dr. Smitson and I'll let you get back to it and thank you so much for everything you do over at Adventist Health Castle. That was Dr. Robert Smitson, a Hospitalist at Adventist Health Castle. You can find out more about our hospital and how they are responding to Coronavirus at You can also reach out to our COVID-19 advice line at (844) 542-8840. Find more podcasts like this one in our podcast library. And if you enjoyed it, please share it on your social channels. This has been the Health Wholeness Hope Podcast from Adventist Health Castle. I'm your host, Caitlin Whyte. Stay safe.