Crisis control: A hospital responds to a pandemic
BY AMBER SMITH
It felt like the world turned upside down.
So many changes, so suddenly, so surreal.
Medical classes moved online. Research laboratories shut down. Fever checks. Face masks. Toilet paper shortages. Rationing of pasta and butter and sugar. Elective surgeries postponed. Almost no hospital visitors allowed. Daily briefings by the governor and an order that all but essential businesses must close. Employees who could work from home began to do so. Upstate University Hospital’s daily operations were turned over to an “incident command” structure reserved for major disasters.
While the coronavirus tore through civilization, many in health care continued caring for the sick, feeling more like they were reporting for duty in a war against a microscopic villain. Others were isolated at home, watching grimly as the Johns Hopkins University global coronavirus map turned redder as more cases of COVID-19 were reported on every continent except Antarctica, and as federal health officials predicted maybe 200,000 Americans could die. Just like in the movie “Contagion,” this virus got its start in a bustling Asian city some 7,500 miles from Syracuse.
Infectious disease experts at Upstate were aware of the novel coronavirus and the respiratory syndrome it causes. It was similar in some ways to the SARS outbreak in 2002, and the MERS outbreak in 2012, both respiratory illnesses caused by other types of coronaviruses. After the first case of COVID-19 was diagnosed in the United States in January, Stephen Thomas, MD, Upstate’s chief of infectious disease, said what’s still true today: “We don’t know more than we do know. It’s an evolving story.”
Common symptoms of fever, cough and achiness are well-known, but there is no proven treatment. This disease is more infectious than seasonal influenza, and deadlier. Scientists, including some at Upstate, are developing tests for the virus and for the antibodies that would indicate a person had recovered. Others are working on a vaccine. And others are involved in ventilator research and efforts to treat those infected.
At Upstate, some 75 hospital leaders gather twice a day – virtually – in “incident command” meetings so that everyone is aware of issues related to the coronavirus pandemic: how many beds are available, the supply of masks and other personal protective equipment (PPE), staffing issues, requests from county or state emergency management officials and more. With incident command in place, the meetings launched March 16, the same day the first case of COVID-19 was confirmed in a patient in Onondaga County.
“Decisions are made, data is updated. We execute,” explains Robert Corona, DO, chief executive officer. “It’s pivoting, and making impactful decisions hour by hour.”
Someone during each meeting summarizes important information from the World Health Organization, the Centers for Disease Control and Prevention, the state Department of Health, scientific literature and other health organizations. “We put all of that in context,” Thomas says. “Our policies are first to protect Upstate staff and second to conserve PPE. Protecting our staff is our priority. Period. Full stop.”
The leaders explore how best to care for infected patients. Dean of Upstate’s College of Medicine Lawrence Chin, MD, coordinated a 90-minute conference call between Upstate experts and Chinese doctors in Wuhan — the first COVID-19 battlefield — to learn from their experiences.
“We thought it would be really helpful to have the perspective and experience of doctors that have been dealing with this the longest,” Chin explained to Syracuse.com.
They discussed a variety of topics, including early identification of patients, chest imaging, drug use, hormone therapy, immune adjustment, plasma exchange and treatment using a machine called ECMO, extracorporeal membrane oxygenation, which adds oxygen, removes carbon dioxide and recirculates a patient’s blood.
Mental health concerns have also been addressed. Upstate interim President Mantosh Dewan, MD, asked the chief of psychiatry to talk in a webinar to all
Upstate employees about healthy ways to cope.
When Governor Andrew Cuomo ordered all hospitals in New York state to be ready to expand capacity by 50 percent, Corona says his team came up with a plan to obtain beds and staffing to increase by 77 percent. Some private rooms would be doubled up, and some other rooms in the hospital would be converted for patient care. He said nearby hotels were prepared to help as well, providing lodging for health care workers or patients.
The incident command team also works through ways to minimize the hospital services that are nonessential, for the time being, and how to keep essential services operating. Because, even as the crisis unfolds, heart attack patients are still revived, people injured
in car crashes are still put back together, babies are still born.