March 4, 2020

What these 2 American hospitals learned from treating coronavirus

Daily Briefing

    As hospitals across the country prepare for an expected influx of coronavirus patients, officials at Providence Sacred Heart Medical Center (PSHMC) and University of Nebraska Medical Center (UNMC)—two hospitals that treated some of the nation's first coronavirus patients—share their lessons learned, Patti Neighmond reports for NPR's "Shots."

    Our analysis: The 'recurring themes' of disease outbreaks

    About the coronavirus epidemic

    Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China. According to the World Health Organization (WHO), the main symptoms of the virus are fever and lesions in both lungs. Some patients also have reported difficulty breathing, WHO said.

    In the United States, state and federal officials as of Wednesday reported a total of 129 confirmed or presumed positive cases of COVID-19 and nine deaths linked to the virus, the Times reports. CDC as of Wednesday said 49 of the cases involved Americans who contracted the virus elsewhere and then repatriated to the United States, 24 cases involved patients who had contracted the virus while traveling abroad and were diagnosed after returning to the United States, and 16 cases involved patients who contracted the virus via human-to-human transmission in the United States. CDC said 40 cases were under investigation.

    Globally, officials have reported more than 94,300 cases of the virus as of Wednesday, with most of those cases occurring in mainland China, the New York Times reports. Officials said as of Wednesday there had been at least 3,210 deaths linked to the virus, and all but 229 of the deaths occurred in mainland China.

    Lessons from PSHMC

    PSHMC is treating four patients who were infected with the new coronavirus on the Diamond Princess cruise ship.

    Amy Compton-Phillips—EVP and CCO at Providence St. Joseph Health, the hospital network that oversees PSHMC—said each of the patients are stable, but she noted that "their level of symptomatology is pretty variable."

    The patients are being treated in the hospital's special isolation rooms, which are designed to keep the virus from spreading.

    "All the air is sanitized before being exhausted out," Compton-Phillips said, "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."

    Compton-Phillips said the patients are being treated at the hospital instead of at home as an extra level of precaution.

    "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," she said.

    Lessons from UNMC

    Meanwhile, UNMC has treated 14 patients. According to the hospital, four patients have been cleared and discharged, two patients tested negative for the virus and are still being monitored, and two patients initially tested positive but are now symptom-free and have recently tested negative for the virus.

    Like PSHMC, UNMC is treating the patients in special isolation rooms designed to keep the virus from spreading. Shelly Schwedhelm, executive director of emergency management and bio-preparedness at UNMC, said most of the patients have exhibited "minimal symptoms and are stable."

    Schwedhelm likened caring for coronavirus patients to caring for severe cases of the flu or other infectious diseases.

    "Putting them in a private room, no matter what that looks like is best," Schwedhelm said. "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."

    In a webinar advising hospitals on how to prepare for the new coronavirus, Schwedhelm and a physician colleague told attendees 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."

    Resources a concern if cases spike

    Both Compton-Phillips and Schwedhelm noted that resources, including hospital beds and protective gear, could become a problem if the new coronavirus reaches pandemic levels, and cases in the United States surge.

    For instance, Compton-Phillips said many hospitals are already strained from treating flu patients. "And so, if we have another (big epidemic of respiratory illness around the same time), it could wreak havoc," she said.

    In addition, Schwedhelm said UNMC's 41 isolation beds won't be enough to treat all of the severely ill patients if the case count rises quickly. PSHMC has 10 isolation rooms, Neighmond reports.

    "If this virus becomes a virus of pandemic potential, every health system, every organization is going to need to be all in," Schwedhelm said.

    Another potential problem for providers is a shortage of protective gear, including gloves, gowns, and masks, Neighmond reports. Compton-Phillips said this is a common problem in a large outbreak because the gear has to be thrown away after it's used.

    "The first [coronavirus] 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 said. "And then, as he started getting sicker, it got to 22 changes per shift."

    Since much of the protective gear is made in China, "suppliers are triaging to where the need is highest," Compton-Phillips said. She added PSHMC is working hard to be "creative, conservative, and judicious" in its use of protective gear.

    That said, Schwedhelm said hospitals and health care organizations across the United States are taking the right steps. They're "doing a lot with education and communication, sharing resources, sharing information," Schwedhelm said, "starting to prepare for that scenario, should it evolve" (Neighmond, "Shots," NPR, 3/2; Lai et al., New York Times, 3/4; CDC website, 3/4).

    X
    Cookies help us improve your website experience. By using our website, you agree to our use of cookies.