Lessons From U.S. Hospitals Caring For COVID-19 Patients

As Americans begin to cope with the prospect that the novel coronavirus could spread more widely in the U.S., there are questions about how prepared and sufficiently funded most hospitals are to handle severe cases in a major outbreak.

So far, several dozen people, or so, across the country have been hospitalized with the virus, and at least six people in the U.S. have died. Government health officials now say they expect significantly more cases could arise, which means that hospitals need to be ready.

NPR checked in with two of the hospitals handling the first U.S. patients with COVID-19, to get their insights and advice.

Four people who were infected on the Diamond Princess cruise ship are now being treated at Providence Sacred Heart Medical Center in Spokane, Wash.

These patients are stable for now, but "their level of symptomatology is pretty variable," according to Dr. Amy Compton-Phillips, executive vice president and chief clinical officer for Providence St. Joseph Health, a network of hospitals and clinics that includes Sacred Heart Medical Center.

She says treating these patients in the hospital, as opposed to at home, is the result of an abundance of caution.

"They aren't necessarily sick enough to be in the hospital, but because the virus is new and because it's different and nobody knows exactly how it's going to progress and we're still at the phase where we're trying to prevent the genie from getting out of the bottle — trying to prevent this from becoming the next big pandemic," this was the appropriate step for health officials to take, she says.

George Roberts, president of the National Association of County and City Health Officials, says many hospitals around the country already are at "surge capacity" treating patients who are sick with the flu.

The influenza season in the U.S. usually peaks from December to February, and this year's has been pretty typical, so far, according to surveillance by the Centers for Disease Control and Prevention. Roughly 310,000 people nationally have been hospitalized with the flu, and about 18,000 have died.

"I think hospitals are getting as prepared as they can be for coronavirus at this point in time," Roberts says.

But Compton-Phillips says the strain on U.S. hospitals could increase quickly if the coronavirus starts to circulate widely.

"The flu is terrible already, not just the sickness it causes, but how many people it kills in the U.S. each year, says Compton-Phillips. "And so, if we have another [big epidemic of respiratory illness around the same time], it could wreak havoc." That's why, she say, "we're trying really hard to prevent it from getting a toehold here in the States."

In an effort to contain the spread, patients at Sacred Heart Medical Center are in special isolation rooms designed to prevent the virus from escaping.

"All the air is sanitized before being exhausted out," says Compton-Phillips, "so that germs cannot go from being in the room, through a vent system into the rest of the hospital, or out into the air of the community."

There are 10 such rooms at her hospital to isolate patients, she says.

At the University of Nebraska Medical Center in Omaha, 14 patients have been treated. Four have since been cleared and released from the hospital. Two had tested negative, but because of close contact with infected individuals were being monitored. Two had tested positive for COVID-19, but are now symptom-free and have tested negative for the virus in three separate tests.

Eleven people are still in the hospital quarantine unit and are being monitored. Most have "minimal symptoms and are stable," according to Shelly Schwedhelm, executive director of emergency management and bio-preparedness at Nebraska Medical. These patients, too, are being cared for in isolation rooms with special ventilation systems.

UNMC has a total of 41 beds to isolate patients. That won't be enough to treat every severely ill patient if the virus spreads dramatically, Schwedhelm says.

"If this virus becomes a virus of pandemic potential, every health system, every organization is going to need to be all in," she says, adding that the health care workers at her hospital, for that reason, are working hard right now to equip their counterparts at other hospitals.

They are "doing a lot with education and communication, sharing resources, sharing information," she says — "starting to prepare for that scenario, should it evolve." The hospital has set up webinars and been in touch with many hospitals nationwide about how to prepare for a pandemic.

A recent webinar organized by UNMC and aimed at hospital staff included county, regional, and state public health officials nationwide, as well as some first responders. A total of 500 participants took part in the educational event.

Schwedhelm and a physician colleague told participants to "do the best that you can and use the resources that you have available in terms of an airborne isolation room — but, if not, do the best that you can, and that is probably going to be good enough in most cases."

Hospitals have plenty of experience in dealing with severe cases of flu or other infectious diseases. Schwedhelm told participants that dealing with this respiratory illness will be similar in some ways.

"Putting them in a private room, no matter what that looks like is best," Schwedhelm advised. "Certainly, getting them masked even before moving them from the front door or reception area is best. While we don't completely know how this virus is transmitted, like most respiratory viruses, the most important routes of transmission certainly are going to be direct contact and droplet."

One concern in treating even the relatively few patients who are hospitalized now is a possible shortage of protective gear for health care workers, including respirator masks, gowns and gloves. Such shortages would be likely in a bigger outbreak, says Compton-Phillips of Sacred Heart, since the gear has to be thrown out after use.

"The first patient we had — when he was doing well, it took about six changes a day per shift for nurses and caregivers to take on and take off, as they were caring for that person, she says. "And then, as he started getting sicker, it got up to 22 changes per shift."

That's 22 sets of protective gear thrown out in a single shift. Most of the gear is made in China. While there are other manufacturers in other countries, Compton-Phillips says the demand from China is so great right now that even with protective equipment made elsewhere, "suppliers are triaging to where the need is highest." She says her hospital is working hard to be "creative, conservative and judicious" in using the equipment.

Dealing with a large outbreak goes well beyond hospital preparedness says NACCHO's Roberts. His organization is working with local health departments to help ensure they know what to look for and how to report suspected cases. On top of all this, he says "we are working with our community partners to disseminate credible information, calm fears and dispel myths."

But public health in general is chronically underfunded, he notes.

For example, hospitals have an immediate, and ongoing, need for epidemiologists at the local level who can help with contact tracing and monitoring, he says. Much of stopping an expanding epidemic in its tracks, he says, is spending money now, in the early days, to do good epidemiology.

"We need boots on the ground — people that are ready to go and deal with these situations on a day to day basis, and not just when the emergency pops up," he says. "When the emergency pops up, many times it's kind of too late."

That level of staffing, of course costs money — more money, he says, than the federal government now allocates to public health.

There's a debate going on now in Congress about how much additional funding should be allocated to contain and stop the spread of the new coronavirus. While that debate continues, Roberts says, local hospitals and communities aren't yet getting the extra money they need. [Copyright 2020 NPR]