Prepare_Hospital_For_Pandemic

I’m in Charge of Preparing My Small-Town Hospital for the Coronavirus Pandemic

We’re 100 miles outside of Chicago. We’re doing everything we can to ready ourselves for the slow, creeping assault of COVID-19

Three years ago, Grant Reed and his family moved back to the area where he grew up, Peru, Illinois (pop. 10,257 and about 100 miles southwest of Chicago), to practice family medicine. For the last few years, he built his practice — seeing 15 to 25 patients a day in his office — while doing rounds at the local hospital. With the coronavirus spreading, however, his job has completely changed. As part of the “Incident Command” team, his responsibility now is to prepare the small-town hospital for anything and everything the pandemic could possibly throw at it. 

Because while most of Illinois’ growing coronavirus infections are contained to Chicago, the virus will undoubtedly make its way downstate, where rural hospitals are already under financial duress. Here, in his own words, is what it’s like to attempt to keep such a fragile ecosystem from being overwhelmed by a global behemoth.

* * * * *

A few weeks ago, every day was filled with very serious conversations about if and when disaster hits, what do we do? It’s a frightening thought process, especially because there are so many things to consider. We all have disaster-preparedness plans in place, but you can talk in generalities all you want. When it’s actually being put into place, every day is different.

Taking PPE into account has been a driving factor in planning our surge response. Until earlier this week, we didn’t know if we had enough stock to last us more than a month at peak capacity time, so we didn’t want to start using up supplies 24/7 before we absolutely needed them. Every hospital in America has concerns about possible PPE shortages — be it masks, gowns, gloves, goggles or cleaning supplies — and we’re all searching for more, which means there’s definitely some bidding going on and we’re all paying higher prices than average.

We were especially worried about PPE because for a rural hospital system like ours, protecting our staff is extremely important. If one of our doctors or nurses is sick or suspected of having COVID, it’s a huge loss. We don’t have the backup that bigger hospital systems have, and it’s not like we can reach out and ask for help from the hospitals we typically transfer patients to, because they’re going to be the first ones that are going to be inundated. 

That means there’s going to be a lot of people on staff who might potentially do work they’re not used to doing. Again, though, at least we were able to confirm that we have enough PPE to last through the expected peak of cases, even in a worst-case scenario. So as of now, we’re all wearing masks and goggles at all times during patient contact.

Regardless, there’s still a lot of work to do in gearing up the staff and individual clinics. It’s prime time to make sure everyone is as calm and collected as they can be. They all have a million and one questions going through their minds — from how we’re going to deal with this on site, to their health, to their jobs and financial well-being, to their children and any sick people at home they might need to consider. Personally speaking, one of my biggest fears is how financially stressed the organization is going to be months from now. 

It’s been a lot to manage, and at times, taxing on everybody’s mental health. Overall, though, staff sentiment has settled down — at least currently. But the way things are progressing, it’s looking like in two weeks there will be a burden on the system. And we’re just praying that it’s not going to be as bad locally as we’re seeing in the news in bigger cities. 

We’re insulated from Chicago, but they have a lot of cases and it’s doubling every three to four days. So the fear is that they’ll peak, and then we’ll peak out here a week or two after that, especially considering that there will be a bounce in cases once the self-isolation order is lifted.

A couple of weeks ago, a nursing home up in the suburbs accounted for 15 percent of all COVID cases in the entire state. As such, we’ve focused efforts to monitor the local nursing homes and the hundreds of residents who live there. If some cases were to flourish through a facility or two, that would be a death sentence for a lot of those people. We’ve placed a dedicated provider to each facility who visits a few days per week. They also serve as our eyes and ears to pick up on any suspected cases so we can shut down any spread.

Thus far, there’s been one positive COVID patient that our organization has found, but there are a lot of people out there who we’re monitoring. However, we only have a limited number of tests. Which raises another question: Do we start getting more liberal with our testing and exhaust our supplies so that we can find these pockets of cases and isolate them? Or do we follow these black-and-white guidelines and try to conserve the tests as best we can for fear that more people are going to come in?

Let’s say that we tested all of the people calling in with symptoms. We could very easily run out of test kits within one to two weeks. Plus, it’s going to take maybe a week to get the results. By that time, they’ll likely be better and would have quarantined the entire time anyway, so what did we do there? In an ideal world, we’d have the ability to test everyone who needed it and get immediate results. Unfortunately, we’re not there yet. 

I spend hours every day, usually after my family has gone to bed, combing through all the latest news and publications to think through the best data-driven decisions that we could be making. The problem is, the studies that are being published right now, for the most part, aren’t actively going through the process of being peer-reviewed and vetted, which leaves it up to individual doctors to interpret information in their own way. That’s why over-prescription of hydroxychloroquine was so rampant recently in Ohio that the state’s pharmacy board had to add new restrictions on prescriptions

In that same vein, individual hospitals are left to decide how much or how little they feel they need to prepare. Unless guidance is state-directed or comes straight from the CDC (or some other major health organization), it’s up to us to decide what’s best. In our specific case, we have our feelers out there, monitoring suspected cases, and I think we’ll be able to identify a situation at least several days in advance. 

I love my job, I really do. But the past couple of weeks, reading about and watching other doctors on the front lines painted a grim picture. It made me dread coming into work. I don’t know when I hit the stage of acceptance to all of this, but I’m in a better place mentally knowing we’ve completed a lot of the major prep work already. We’ve made more isolation rooms. We should have enough PPE. And we’re not seeing a lot of cases requiring hospital care right now. 

Fingers crossed, it stays that way.

This Is Life Under Quarantine