March 13, 2020

Staff at EvergreenHealth in Kirkland, Washington, have treated dozens of cases of COVID-19, the disease caused by the new coronavirus, offering a look at what may be in store for the rest of nation as case counts rise, Mike Baker reports for the New York Times.

Our analysis: The 'recurring themes' of disease outbreaks

Background

Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China.

The United States didn't see its first case of COVID-19, the disease caused by the new coronavirus, until late January, but cases have spiked since then. As of Friday morning, state and federal officials reported 1,663 confirmed or presumed positive cases of COVID-19. So far, 41 U.S. deaths have been linked to the new coronavirus.

First COVID-19 cases take EvergreenHealth by surprise

While the first U.S. COVID-19 case was detected in the Seattle area in late January, by February, EvergeenHealth had not diagnosed a single case. It wasn't until late February when federal officials expanded guidelines for who could get tested for the disease that the hospital opted to test two patients who were critically ill with pneumonia.

Francis Riedo, medical director for infectious disease at Evergreen, thought it was extremely unlikely either patient would come back positive, Baker reports. "I felt like I was dropping a line into the middle of the Pacific Ocean and thinking maybe I'll come up with something," Riedo said.  

But when the tests came back, both pneumonia patients had tested positive for the disease.

According to Evergreen CEO Jeff Tomlin, upon hearing the news, "everybody knew that our work lives were going to be dramatically changed, as well as a lot of our lives in general."

Staff moved to isolate the two patients immediately, and then launched the process of identifying others who might have been exposed. Hospital officials also began testing other patients with respiratory symptoms. Many of those tests came back positive, Baker reports.

A few days later, more patients started flowing into Evergreen from Life Care Center, a nursing home near Seattle, with COVID-19 symptoms.

What it's like inside EvergreenHealth

Over the last few weeks, medical staff at EvergreenHealth have been "operating at the very edges of their capabilities," Baker writes.

According to Baker, 65 people at the hospital have tested positive for COVID-19.

The moment patients with suspected or confirmed cases come in, doctors, nurses, technicians, and respiratory therapists rush to throw on protective gear like gloves, gowns, and helmets filled with clean air. New patients are then directed to a special wing of the ED that is reserved for suspected and confirmed COVID-19 patients.

But this type of coordination and response required the hospital to take action. Before the disease's arrival, Evergreen had 15 negative-airflow rooms, or spaces that direct airflow inward so contaminants don't escape and infect other people. Since then, engineers have made enough space in the negative-airflow rooms for 58 patients, Baker reports.

In addition, supplies are running low at the hospital, Baker reports. The most recent count of supplies shows the hospital has 42,000 surgical masks left, with about 6,000 being used per day. Concerned that the supply could be depleted just as the outbreak becomes worse, the hospital put in place conservation methods.

Now, rather than replacing the face shields in their helmets, staff wash the shields with bleach wipes after each use. The hospital is also storing goggles and masks in Tupperware containers in the hopes the products will last longer. Some nurses are even using sanitary pads as extra padding in their helmets.

According to Mary Shepler, the chief nursing officer, managers are in talks with vendors, other hospitals, and the federal government to get more products. A recent shipment gave the hospital supplies to address the nurses' helmets.

Shepler said EvergreenHealth will not be the only hospital to experience these challenges. "There's just another community waiting for this to happen," she said. "This is our new normal in some ways" (Baker, New York Times, 3/11; New York Times, 3/13; Smith et al., New York Times, 3/13).

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