October 28, 2020

You’re down for the count; and it’s only round one.  Saved by the bell, you struggle to your feet and stumble to your stool.  Still dazed by the sting of the last blow, you wonder if your wobbly legs will be able to stand and remain standing for another round.  For, as we all know, round two is coming.  That’s the way many in the healthcare industry are feeling right now.  Having weathered the blows of the first round of COVID, we’re now bracing for round two.  In today’s article, we will examine the current status of the virus, as well as strategies that some hospitals are using to deal with the surge of cases in their area.

Tale of the Tape

It may be helpful to first survey the current situation as it concerns the coronavirus.  Is there a second wave, and are we in it?  That question may be answered by figures being released by some of the nation’s leading news outlets.  According to the October 25 edition of The Washington Post, the United States sustained a new record high in new COVID cases over a seven-day rolling period, coming in just shy of the 70,000 mark.  The New York Times is reporting that some 41,000 patients are being treated in hospitals nationwide, which amounts to a 40 percent increase from September numbers.

Anecdotal evidence in support of what these newspapers are reporting can be seen in diverse areas of the country.  For example:

• In Texas, there has been a nearly 400 percent increase in hospitalizations in just the last three weeks in El Paso County.
• In Utah, the Governor’s office is reporting that many hospitals are nearing 85 percent capacity, which is the maximum benchmark set to ensure hospitals have enough staff members to care for patients.
• In Michigan, hospitalizations due to COVID have surged by 80 percent in recent weeks, according to a letter issued to the public by officials representing 110 hospitals in the Wolverine State.
• From a national average perspective, the Centers for Disease Control and Prevention (CDC) is reporting, as of October 26, that there are 21.1 new COVID cases per 100,000 people over the last seven days.

All of this would seem to indicate that we are entering the predicted second wave of COVID; so, things may get worse before they get better.

Answering the Bell

Yes, round one of the pandemic was devastating in many ways to the nation’s health, economy and way of life.  The surge in the late spring was debilitating to be sure, but hospitals managed to find ways to battle through the hardships.  Now that the dreaded second round looks to be a reality in large sectors of the country, hospital officials and clinicians are being called on once more to fight the good fight in spite of all difficulties.  But how?

Not all regions are experiencing the same degree of virulency, and so state and locality responses will need to be customized to match the threat level.  In the areas mentioned in the previous section, we are seeing a different array of initial solutions/suggestions.  For example, in El Paso County, Texas, the state has implemented curfews and has plans to open a field hospital at the convention center in the next few days to deal with the large influx of coronavirus cases.  In Utah, there is talk of implementing a state rationing plan to ensure care is prioritized for younger patients and pregnant women.  The Michigan hospital clinical leaders have used their clout to issue a statewide call for universal mask usage and urging citizens to double-down on social distancing.

However, individual hospitals can only rely on state action and public compliance to a certain point.  Ultimately, each facility will have to respond to the best of their capabilities with the resources they now have in place.  Hopefully, CEOs and other decisionmakers learned from mistakes and successes that occurred during the first wave and developed plans months ago to more successfully address the predicted second wave expected this fall.  This would have included staffing strategies, unit flexibility, PPE and other supply chain management, and budgetary planning.

Something all hospitals will have to consider is the extent to which so-called “elective surgery” cases will be allowed should another full-blown COVID wave hit their area.  In an earlier article, we cited a confident optimism expressed by some hospital executives who believed that they would be able to handle a rise in both COVID and flu cases, as well as maintain a strong level of elective procedures.  Whether this optimistic assessment has any validity remains to be seen, but it at least demonstrates that some hospitals made what they believe to be adequate preparations for round two.  Of course, the best laid plans . . . well, you know the rest.

So, what are individual hospitals doing or planning to do in light of COVID’s second round?  Here is a sampling:

• At Baptist Memorial Hospital in Memphis, Tennessee, their strategies are multi-fold.  According to their director of infectious diseases, Dr. Steve Threlkeld, they have learned to “keep people safely at home on a little bit of oxygen and close follow-up and telemedicine.”  In addition, their doctors have found that administering steroids significantly helps in reducing the mortality rate in COVID patients.
• In the greater Boston area, where they are seeing the beginning of a surge in the virus, hospitals are confident that they will have capacity to care for the expected influx, and have already stockpiled what they believe will be sufficient supplies of PPE and ventilators to handle the demand.
• At Munson Medical Center in Traverse City, Michigan, leaders established a “clinical incident command team,” comprised of physicians, nurses and administrators, whose mandate is to analyze health department numbers, in-patient numbers and diagnostic testing numbers on a regional basis.  This is to allow them to get a sense of where they are in terms of the virus’ spread in their community.  The facility has already identified and readied certain rooms to be utilized for COVID-patient care.

One important thing that we’ve gleaned from reviewing the experiences of many who are on the front lines of the pandemic is that it will be critical in your round-two strategy to recognize that there is potential for COVID fatigue among your clinical team.  One first responder remarked in the last few days: “People are tired. I don’t want to say they’re cutting corners, but they’re just not as sharp as they were back in the spring when everything was fresh and the intensity was there.”  So, it may be helpful to develop strategies meant to bolster the morale of your team as they face yet another round of critically ill patients and frustrated families.  A new sense of urgency will be required in the days and weeks ahead.

We would love to hear what your hospital is doing in response to the current increase in coronavirus cases.  You can reach out to us at info@miramedgs.com.  You can also ask about our range of services while using that same link.  We’re here to make your life easier.