Texas County Memorial Hospital’s coronavirus (COVID-19) task force is working diligently to prepare for potential surge in inpatient volumes in the coming weeks as a result of the nationwide pandemic, hospital board members heard at their monthly meeting Tuesday.
Texas County had not reported a positive COVID-19 case when the board met, but officials from the hospital’s task force anticipate that status to change any day due to the rapid evolvement in the number of positive cases throughout Missouri.
Matthew Brown, MD, and task force physician leader, presented information.
“COVID-19 is a mutated version of the common cold that developed in Wuhan, China, around Dec. 8 last year,” Matthew Brown, MD, said. “The danger of the virus is that it is about 2X as contagious as the flu and without interventions, the fatality rate is about 10-20X higher.”
“The initial all mortality rate is 3-4 percent, which is huge,” Brown said. “The problem is that we do not have any specific treatment available for those patients, it is supportive only. Most people have mild to moderate symptoms and recover, but 15-30 percent have to be admitted into the hospital with several of those having to be treated in the ICU (intensive care unit) on ventilators.”
“The fatality rates we are seeing are due to hospital system limitations,” Brown explained. “There are not enough hospital beds or ventilators anywhere in the world to take care of this on a widespread scale.”
“As a hospital we began anticipating this from a public health crisis standpoint several weeks ago,” Brown said. “We started making emergency plans both in terms of doing things like patient screenings, so we can identify and isolate those cases early. We also began putting plans into place for emergency operations on a sustained scale.”
Brown explained that the only reason why they fully anticipate that they will see cases of it here, and the only reason the hospital has not been in a disaster so far, is because of what has been learned globally.
“We saw what happened in Wuhan and the lockdown that was implemented by the Chinese authorities,” Brown said. “We saw how bad it was in South Korea, Iran, and Italy and that it was not going to go away.”
“As a result social distancing and transportation lockdowns have taken place in the United States over the past couple of weeks, and has helped slow the spread,” Brown explained.
“Realistically there are only two options going forward,” Brown said. “We do not have a vaccine for this and as long as there is a reservoir to reintroduce it into a population, it will come back.”
“If you do nothing, no social lockdown, no isolation — nothing, it will burn itself out in about three months, which is what they have seen in China,” Brown said. “The problem is that it will overwhelm the health system’s capacity and result in a significant amount of lives lost.”
Brown explained that the second option has negative impacts also.
“To try to flatten the curve and do interventions from a public health standpoint like the country has done over the past two weeks, presents a huge economic impact and it extends the duration of the crisis for at least 18-20 weeks, possibly even 18 months,” Brown said. “By that time, we may have enough herd immunity to prevent sustained transmission or hopefully, we may have a vaccine in place.”
“What we’re dealing with now isn’t just the COVID-19 standpoint, but all of those secondary effects as well,” Brown said.
“It is a huge economic impact; it is a huge logistical impact. We can’t even order surgical gloves now and common medications are an allocation that we need daily to take care of the patients that we have now,” Brown explained.
“This is something that is going to be extensive and widespread. That is why we appreciate the responsiveness of everybody to get things done because it is something that really, no one has ever faced in 100 years,” Brown said.
Brown added that there are some very difficult decisions being made at higher levels of both government and public health to try to find a balance.
“This has the potential to be really, really bad for pretty much everybody,” Brown said.
Brown explained that the hospital has made progress with emergency planning.
ADDITIONAL VENTILATORS REQUIRED
“We have secured additional ventilators should they be required,” Brown said. “We are looking into resource conservation and utilization changes so we can conserve what we have.”
“We have also been looking at disaster mode contingencies,” Brown explained. “It is really sobering to look at what this has the potential to be.”
Brown added that because of the public health interventions that have been implemented so far, he does not think this area is going to get quite as bad as some locations.
Bill Bridges, TCMH emergency medical services director, said the plans the hospital has prepared to enact as soon as they become necessary.
“We have 11 ventilators now and can go up to 14 if we need to,” Bridges said.
“We have been preparing the east wing for COVID-19 patients in the event that our ICU exceeds its four-bed capacity,” Bridges said. “Although the CDC is no longer requiring negative pressure rooms, we do have the hallway set up so that it can be locked down and provide negative pressure to help protect the rest of the hospital’s patients.”
EAST WING WOULD BE USED
Jenny Sawyer, TCMH infection control director, said that the east wing can be fully functional in a matter of 15-20 minutes when it is needed for patients.
“It is estimated that 50 percent of staff will not show up for work in a crisis,” Bridges said. “We will need to utilize all of our staff, not just our clinical staff to help if we become overwhelmed.”
“This is a scary time for everyone, but I have walked through our halls the last two weeks and I have had the most incredible amount of people come up to me from dietary, housekeeping and from different departments across the hospital to offer help for anything else that we need to keep our hospital going,” Sawyer said.
“While 50 percent may be the average rate for other places, I think that you all will be pleasantly surprised if this hits here, because TCMH is different,” Sawyer said. “I think we will have much more than half of our staff show up for work.”
MURRAY PRAISES TAX FORCE
“I think that this group exemplifies what we are talking about as well,” Wes Murray, TCMH chief executive officer, said. “Not every rural hospital group has a Dr. Brown, Bill and Jenny heading their task force up and I promise you, they are on top of things.”
Omanez Fockler, TCMH board of trustee’s vice chair mentioned how proud she is of the task force team.
“I just want to applaud you guys,” Fockler said. “I’m an old infection control nurse and I am reading and watching all of this and I know what it is. “
“I started nursing in 1955, I know what is going on here,” Fockler said. “I am so impressed with the good work you have going on here and I call it a miracle!”
Fockler added that she believes what was said about the people at TCMH as she applauded the task force team that presented the update.
During his closing statements, Brown mentioned that from a crisis standard, the hospital is as prepared as it can be and in a better position than many other locations.
“Moving forward as an institution, what we do and the way we do it are going to be different for a while,” Brown said. “That will mean doing things such as canceling screening procedures, keeping the cafeteria closed or doing telemedicine out of our clinics to keep patients from having to come in.”
“This is an opportunity to innovate and modernize a lot of our processes,” Brown said. “We just ask for the community’s continued support so that we can be responsive as this situation remains.”
Murray noted that the clinics do have the capability to provide audio telehealth services, but that currently they are just waiting on a final approval to use it.