COVID-19: A Year of Reflection, Part 1

Media Contact: Karina Rusk
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The last 12 months have been a difficult and traumatic time for everyone, but the frontline heroes have witnessed more than they could have ever imagined. In part one of a two-part series, Dr. Mario Cole, pulmonary disease and critical care specialist at Salinas Valley Health, reflects on his experiences.

To listen to an in-depth conversation on this topic with Dr. Mario Cole, pulmonary disease and critical care specialist at Salinas Valley Health, click here.

Fighting the Unknown

One of the most difficult challenges at the outset of COVID-19’s arrival in the United States was that so much was still unknown about the virus and its effects. “We weren't really sure if the measures we were putting into place were adequate to protect the nursing staff and the other workers involved in caring for these patients. We also weren't aware or quite sure as to how quickly this would spread among the population and whether we were going to be overwhelmed,” shares Dr. Cole.

However, the Salinas Valley Health physicians, nurses, and other staff soon learned how important it was to quickly pivot to meet those unknowns. Dr. Cole recalls one patient who was alert, and even feeling better than the day before. Just 30 minutes later, that same patient required life support. “We later learned that the patient's own immune response to the virus is very valuable, but it can progress very quickly and so we had to change how we approached things.”

Challenges Specific to Monterey County

An important revelation about how the virus affected different individuals arose from patterns among patients suffering with obesity. While non-obese patients largely avoided hospitalization, obese individuals proceeded to worsen—and quickly. Dr. Cole and his staff realized these patients needed to be monitored in a unique way, based on their weight and any weight-related conditions (heart disease, diabetes).

Unfortunately, the prevalence of obesity in Monterey County is quite high. And, that’s not the only challenge that emerged specific to the area. Individuals residing in the county often reside in multigenerational homes, some of them very small homes, resulting in higher rates of transmission. A language barrier also stymied communication between health officials and community members.

“There were public service announcements and other efforts to get information out in other languages, but that wasn't always effective. Some patients really didn't understand what they were supposed to do to protect themselves,” notes Dr. Cole.

ICU Logistics

Early on in the pandemic, it became apparent it would be critical to isolate COVID-19 patients from the rest of the patient population. The hospital split its ICU into two, moving the COVID-19 portion to Tower 5. Eventually, Towers 3 and 4 would also become COVID-dedicated units.

“At one point, we were running three COVID units in addition to the regular ICU and regular floor patients,” recalls Dr. Cole. “And, at the height of the pandemic, I believe we had 77 or 78 patients in total in the hospital at the same time. There was one particular week where I started off with 15 isolated and intubated COVID patients in the ICU. Fifteen of them on ventilators, all critically ill and potentially at risk of dying.”

Fortunately, fewer people were arriving at the ER and outpatient clinic volume also decreased. This freed up crucial staff members to assist in the COVID ICUs.

Leadership in Care: Being the Voice of Reason

Throughout the pandemic, there has been a lot of good information disseminated—but there has also been misinformation. Seeing death tolls rise across the globe and just knowing someone who unfortunately succumbed to the virus was incredibly frightening for many in the community. Dr. Cole and his colleagues always attempted to be a voice of reason.

“When you're dealing with life and death situations, you always try to paint an accurate, but as positive, a picture as you can. Not everyone with COVID dies. Sometimes, people fixate on that because they know someone who died. And they say, ‘Well, if it happened to them, it can happen to me.’”

In truth, a majority of the patients that tested positive in Salinas Valley Health Medical Center’s drive-through COVID-19 testing unit survived and never ended up requiring hospitalization.

“So, when you're talking to a patient sitting in front of you and who's suffering from COVID, and you're explaining to her what it is that we're trying to do and what we can offer, you always say, ‘Most people survive COVID.’ It gives them a ray of hope and it gives them the strength to fight.”