Physicians and data experts at Santa Clara Valley Medical Center, located in one of the first COVID-19 hot spots, have developed a risk score that aims to maximize resources and direct treatment.
They devised a set of criteria that typically indicate how sick COVID-19 patients will get. If they are male, over the age of 60, have a body-mass index of at least 30 and have comorbidities like diabetes or heart conditions, they are more likely to get sick, Santa Clara Valley Medical Center experts’ analysis of nearly 7,000 emergency department visits revealed.
Patients who have fewer than three of those characteristics are extremely unlikely to require hospitalization. And 1 in 8 patients who meet at least three of the criteria will likely get very sick.
The goal is threefold: help providers best allocate resources, use the data to explain to patients why they didn’t get tested and show who is least vulnerable as the country eases social distancing, said Dr. Sanjay Kurani, medical director of inpatient medicine at the medical center in San Jose, Calif.
“We have more testing capability, but the operational components and resources involved to test people can be very challenging, so we have to be mindful,” he said. “The ultimate goal is to potentially use it as an exit strategy as we ease social distancing and use science to say who is lowest risk to come out of isolation.”
California was one of the first states to issue stay-at-home orders, thanks in part to the Santa Clara Valley Medical Center and the Santa Clara County Public Health Department. In early March, the organizations studied individuals with flu-like symptoms, finding that about 11% tested positive for COVID-19.
Internally, Santa Clara County officials made plans to allocate essential staff and equipment across its three hospitals, which would allow Santa Clara Medical Center alone to care for up to 200 ventilated patients. But the majority of its PPE—like most providers—came from China.
“Dependence on the current supply chain is one of the things that hamstrung us,” Kurani said.
They turned to community organizations and businesses who made face shields via 3D printers and stitched surgical masks. Santa Clara Medical Center also partnered with other providers including Stanford Health Care and Regional Medical Center to secure additional tests in the pandemic’s early stages.
“Fear is not going to beat this disease, collaboration in the community will,” Kurani said. “I previously never spoke to the CMOs at hospitals on the East Side—now we are speaking almost weekly. Our goal now is to continue to work as a team to balance our patients between organizations and help each other.”
Santa Clara Valley also deployed its nurses to private nursing homes and homeless shelters to mitigate staffing shortages and prevent outbreaks at some of the most vulnerable facilities, he added.
“We feel much more a part of the Silicon Valley culture of disruption now,” Kurani said. “Medicine felt like it moved at a glacial pace. Now we have been able to rapidly transform and change processes—hopefully that will continue.”
