By Genoa Barrow | OBSERVER Senior Staff Writer

A local doctor says an ounce of prevention can go a long way to help end the coronavirus pandemic. 

Dr. Neal Kohatsu, a fellow with the American College of Preventive Medicine (ACPM) is lending his expertise to the organization’s Vaccine Confident campaign and offering real talk about vaccines and variants. The discussion is critical, he says, as COVID-19 numbers rise again, primarily because of the Omicron variant, which followed its Delta predecessor.

Dr. Kohatsu, who works at UC Davis Medical Center (UCDMC), said that despite Omicron’s apparent lesser severity, case spikes nationally and locally are dramatic enough that UCDMC is preparing for its hospital and intensive care units to be “fully stressed.”

According to Sacramento County Public Health, as of Tuesday, 623 people were hospitalized and 110 being treated in ICUs for COVID-19. Overall, the percentage of positive tests has also risen from 5.9% last year to 42.6%, said Dr. Olivia Kasirye, Sacramento County public health officer.

Before the pandemic, many African Americans without regular health coverage relied on the emergency room as essentially their primary care provider. While some continue to go in for non-emergencies, others visit the ER worried about whether possible cold or flu symptoms are in fact COVID. On the flipside, many are avoiding the ER and hospitals for fear of getting sick while there. The ACPM says more than 26 million people nationwide have skipped out on regularly scheduled, non-COVID vaccines. Health providers are concerned about the looming threat of adverse health outcomes from missed checkups and regular vaccinations.

Dr. Kohatsu said data show hospitalization rates and risk, as well as mortality risk, have risen sharply among African Americans. He added that Sacramento hospitals have prepared for an expected surge at ERs, which still will be equipped to safely care for routine emergencies.

Last week, Dr. Kasirye advised residents not to flood ERs for things that can be addressed elsewhere.

“We — sadly over the last two years — have seen people avoid the emergency department for fear of COVID,” Dr. Kohatsu said. “It’s important to go if you need to.”

Dr. Kohatsu said Omicron hasn’t yet peaked in Sacramento, but he’s hopeful it starts to decline by early February. Vaccination remains the best defense, he said, but preventative measures also include new recommendations for masks. Public health experts now recommend the N95, KN95 or KF94 masks, the design of which tends to block particulates. Dr. Kohatsu added that such masks also feature an electrostatic charge, which works to “trap the virus in particles.”

Some people are choosing to return to wearing disposable gloves as they did early in the pandemic, a move not endorsed by public health experts.

“By far the main transmission route is respiratory or through air particles,” Dr. Kohatsu said. Vaccination, hand washing, social distancing and masking “are the real preventive measures.”

Many have taken to the Internet to suggest everyone should deliberately expose themselves to the Omicron variant because of its milder nature and just be done with it. “There are several things wrong with that recommendation,” Dr. Kohatsu said. “One, even with protection, there’s a lower chance, but still a chance of getting very serious COVID. Omicron is not to be messed with. Second, the risk of getting ‘long COVID’ is something we all want to avoid.”

“Long COVID” refers to people having COVID symptoms for months instead of weeks. The virus’ long-term symptoms can include more than just the loss of taste and smell. Other serious conditions associated with long COVID include heart, neurological and digestive problems, and what people are calling “brain fog” — not being able to think clearly, sometimes for months.

“Not to take away from the fact it’s good that we are better at treating (COVID), because there are breakthrough infections,” Dr. Kohatsu said, “but from a doctor’s individual perspective, it’s best to work on prevention — and certainly from a population standpoint, we want to work on prevention.”

Lessons Learned

Studies and first-hand experience have taught medical professionals many lessons about the coronavirus over the last two years, Dr. Kohatsu said. These include how to manage it, how much oxygen to give patients, and whether to situate them on their back or their side.

“Through two years of experience, there’s a lot better and effective management for those who need hospitalization or intensive care unit management,” Dr. Kohatsu said.

Medical professionals are still dealing with vaccine hesitancy. Anti-vaxxers and the gun shy have expressed concern about the number of people who have gotten the virus despite being fully vaccinated. Dr. Kohatsu said he believes time has given doctors and public health officials better understanding of people’s wide-ranging reservations about vaccinations, and that it’s important to understand and respect those fears.

“We need to start where people are and address what those individual concerns are and see if we can answer them,” he said. “I think if one has a doctor, or nurse practitioner, or physician assistant — someone who is your primary care provider — that would be a good place to start.”

Many are without a primary care doctor; a local effort to move clinics into the community has sought to bridge that gap. Dr. Kohatsu’s wife, a registered nurse, has participated in pop-up clinics spearheaded by local Black neurosurgeon Dr. Kawanaa Carter to ensure the vaccine reaches the city’s most vulnerable people.

“She, on her own, said, ‘I have to go out into the community.’ Most of the clinics have been in North Sacramento where my wife has gone out to where people live, to answer their questions,” Dr. Kohatsu said. “Dr. Carter has recruited a lot of her former nurse colleagues and doctor colleagues from UC Davis. I know it’s been very well received.”

Then there’s misinformation.

“I’m not sure anyone anticipated this level of misinformation,” he said.

According to Dr. Kohatsu, the best way to fight that is with reliable information from scientists and doctors. That, he said, is the point of the Vaccine Confident campaign: getting accurate information directly to patients and community members “so that they can make the best decisions.”

Medical professionals have had to make decisions on the fly with limited information that has constantly changed. It took time for scientists to understand the virus’ genetics, biology and epidemiology, and the threat posed to public health.

“A lot of people don’t understand, unfortunately, how science works,” Dr. Kohatsu said. “This [COVID-19] is brand new. No one saw this before about two years ago. … So we didn’t know what was the best way to treat it.”

It’s understandable that people are frustrated, he said.

“The rules keep changing, the guidance keeps changing and that is really watching science in real time,” he said. “We usually don’t see that, but that’s how medical science works.”

But the public can’t afford to be complacent. Without better rates of vaccination, virologists predict more variants. Nationally, Dr Kohatsu said, about four in 10 Americans remain unvaccinated and Sacramento County is “more or less in that ballpark.”

Subsequent variants’ characteristics are tough to forecast, he added, but public health officials are on the lookout. 

“I know everybody is tired,” he said. “Doctors, public health workers, people in the community — we’re tired of fighting COVID-19. But we are going to get through this if we can just pull together at this very divisive time.”