Before the first confirmed U.S. case of the new coronavirus infection showed up at a hospital in late January, the patient did exactly what hospital officials in Washington state had hoped for: He gave them a heads-up he was coming.
"What we really want patients to do is call and click through virtual ways, so when they come in, we're ready for them," said Dr. Amy Compton-Phillips, executive vice president and chief clinical officer of Providence St. Joseph Health, the health care system that includes the hospital in Everett to which the patient went.
Preparation is key, she said, and if health care workers can activate so-called disaster readiness plans before patients arrive, the likelihood of containing and properly treating the illness goes up. It's a lesson learned from previous outbreaks, such as Ebola, and other coronavirus epidemics, including severe acute respiratory syndrome, or SARS, and Middle East respiratory syndrome, or MERS.
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"For the whole country, this is not our first rodeo with new germs," Compton-Phillips said. "Ebola was our wake-up call that we needed to be ready for the next pandemic. So we, as well as other hospitals, put in place the 'just-in-case' scenario planning."
That scenario is something that hospitals across the country have been rehearsing for weeks as cases of the new coronavirus, which causes a disease called COVID-19, rise around the world. And while not every U.S. hospital will get notice that a possible coronavirus case is coming through its doors, many say they have been bracing in other ways: They are holding daily briefings with state and local health departments, stocking up on personal protective equipment for health care workers and working with engineers to control air flow in their hospitals to make sure they are best positioned to stop the virus from spreading.
"We're already acting as if it's here."
"We're already acting as if it's here," said Dr. Michael Phillips, chief epidemiologist at the NYU Langone Health System in New York City, which has yet to see a confirmed case. "We're already thinking about what we should be doing, how we make sure our health care workers are safe. Are we messaging them enough, but not over-messaging them?"
So far, more than 81,000 people around the world have been diagnosed with the infection, the majority of them in China. The U.S. has seen just 59 cases, but in recent weeks, as the virus has proliferated around Europe and spread as far as Latin America, top U.S. health officials have warned that more cases are inevitable.
"It's not so much of a question of if this will happen in this country anymore but a question of when this will happen," Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said Tuesday.
While the risk to the general public remains fairly low, hospitals are not taking chances.
At Denver Health in Colorado, hospital officials have been stocking up on protective equipment for health care workers, including gowns, eye protection and masks. Masks in particular are expected to run out because of high demand and the supply chain interruption from China, where N95 masks, among the most protective, are manufactured.
"Everybody is trained on how to use the personal protective equipment, but we are doing additional what we call 'just in time' training for front-line staff, so they can practice again how to put on the masks, make sure they have the right fit and really feel confident with the personal protective equipment that they're putting on," said Dr. Heather Young, an infectious diseases physician and medical director of infection prevention at Denver Health.
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At Scripps Health in San Diego, officials are also preparing for a mask shortage — and are putting protocols in place to train staff on when they can reuse N95 masks.
"Tuberculosis is a great example," said Scripps Health's chief medical officer, Dr. Ghazala Sharieff. "There are certain conditions that are purely respiratory viruses. Because we don't know enough about coronavirus, if we have suspected coronavirus patients, we would not reuse the masks in those situations."
Scripps Health is also looking to limit the number of health care workers who deal directly with sick patients, including exploring expansion of its use of telemedicine.
"We don't all have to go into the room. The person registering them, certain staff members, not everyone has to interact face to face with the patient," Sharieff said.
The hospitals are relying on basic CDC guidelines to prepare for the coronavirus, such as training health care personnel for signs and symptoms of infection and posting signs in triage areas, like emergency department entrances, that advise patients with fevers or respiratory symptoms who have recently traveled to China to notify triage personnel.
Many said they are also mapping out how they would handle the first patient in their hospital, how they would handle a handful of patients and how they would handle a worst-case scenario of a flood of patients.
"We think about this with regular influenza. Part of our key preparations was going to the plan that we have and our processes that we have, but we're using that framework as we approach COVID," said Phillips, of NYU Langone. "There's some sort of comfort with that, that we know what to do with each stage."
That means having airborne infection isolation rooms ready that would prevent the virus from being transmitted through the air in the hospital, Phillips said. If there were to be a large number of patients, the hospital would designate a "surge unit" where all confirmed cases would be placed together, either in an in-patient unit or in spaces outside and adjacent to emergency departments, he said.
The hospital also plans to minimize the number of people who enter the room of a patient with a coronavirus infection, Phillips said.
"You're a doctor and you go in and assess a patient and the garbage can is full, you empty it so a building serviceman doesn't have to go do it," he said. "These are methods we learned through Ebola. Personal protective equipment is important, but it's part of a whole systemic approach that we used during measles and are refining through COVID."
Meanwhile, state health departments have been in close contact with hospitals. Young, of Denver Health, said she was in touch with the Colorado Health Department on a daily basis. The Illinois Health Department said it was "currently conducting hospital assessments to determine all available capacity in the event more people need medical care."
While the hospitals are doing drills for worst-case scenarios, Compton-Phillips, of Providence St. Joseph Health, said health care workers are not panicking.
"We want to hope for the best and plan for the worst," she said.
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