How US hospitals are preparing for novel coronavirus

(NEW YORK) — As the number of novel coronavirus cases continues to grow, doctors on the front lines are describing how they are preparing.

Hospitals are mobilizing resources and modifying protocols as new information about the virus emerges.

“When preparing for an outbreak the main priorities are to identify, isolate, and inform,” said Dr. Theresa Madaline, epedimiologist at Montefiore Hospital, in an interview with ABC News.

Dr. Michael Phillips, chief epidemiologist at NYU Langone Hospital said, “Hospitals are focused but should not be panicked.”

The protocols for COVID-19 are modified preparedness plans, designed for previous pandemics.

“We are utilizing or modifying plans that have been in place for pandemic influenza and SARS. We are prioritizing the travel questions but this is not much different than we were doing during the Ebola outbreaks,” said Dr. David Cennimo, assistant professor of Medicine-Pediatrics Infectious Disease at Rutgers New Jersey Medical School.

Phillips said that at NYU Langone they are adopting previous preparadness protocols for the flu with some changes.

“The basic principles are the same but we are placing more preventative emphasis on airborne transmission,” he said, which means patients with flu or penumonia-like symptoms that test negative for these illnesses and other common respiratory illnesses are immediately placed under isolation for caution. Anyone coming in contact with these patients is required to wear a surgical mask and eye protection. He describes this change as a “big shift.”

Across the U.S., hospitals are also modifying screening and triage protocols to detect COVID-19 patients as early as possible. Dr. Mark Jarrett, the chief quality officer for Northwell Health, says that across all 23 sites they are “working on screening, triage and identification so that any places of entry are included and addressed.”

We are conducting drills on the identification, transport, rooming and safe care of patients,” said a Brigham Young Hospital spokesperson, on how they are optimizing efficiency and responsiveness to a potential COVID-19 patient.

Currently, there is one confirmed case of COVID-19 in New York City. If the number of cases in New York City were to significantly increase and NYU Langone were to receive a large number of COVID-19 patients, Phillips said they would escalate precautions to what he called a “Level 3.” In this situation, “we would open our surge units, which are designated respiratory isolation units, where we cohort patients with the same respiratory infections,” he said.

Montefiore Hospital has a similar facility, ready to be used if necessary.

“Our emerging infectious disease unit is an additional space that could be utilized if needed for this virus. We have taken extra steps to prepare this unit should we need to use it,” said Madaline.

At Rutgers, the negative pressure rooms for airborne isolation have been checked and stand ready for use.

“If there is a large surge of patients, we may have to consider cohorting on separate wards,” said Cenmino.

Among these changes, doctors report rationing medical masks and protective person equipment (PPE), like gowns, as concerns over potential shortages grow.

“We are concerned about the amount of PPE we have. We certainly are not panicked but we are focused on how much we have on hand,” said Phillips.

Last Wednesday, Department of Health and Human Services Secretary Alex Azar told members of the House Appropriation Committee, “We have 30 million surgical masks. We have 12 million N95 NIOSH-certified masks in the stockpile.”

The stockpile is not enough. Azar estimated that the U.S. would need at least 300 million N95 masks for healthcare workers in the case of a larger outbreak.

The Centers for Disease Control and Prevention currently does not recommend any healthy person wear face masks.

There are two types of masks. According to the CDC, surgical masks are more loose fitting, fluid resistant, and provide the wearer protection against larger droplets. They should be worn by people who are sick with a respiratory virus in order to prevent the spread of their own germs.

N95 masks or respirators, are more tight fitting, can protect against smaller particles, and must be especially adjusted for the user. N95 respirators should only be used by healthcare workers in clinical settings. Nevertheless, many among the general healthy public still continue to hoard and misuse masks.

“Every medical supplier has put hospitals on allotment,” said Phillips.

“We should expect shortages of supply possibly by early March and we should start planning for that. Though these companies have factories outside of Asia, we don’t know when they will start production,” said Dr. Robyn Livingston, an infectious disease doctor at Children’s Mercy Kansas City. “I can say we have to be cautiously optimistic but prepare for the worst.”

NYU Langone has already implemented conservation plans, which includes taking N95 respirators from units where utilization is historically low, and instructing doctors on how to safely reuse their respirators.

“With a bit of care you can reuse that respirator for the rest of your shift,” said Phillips. “It takes a while for people to change their practice and we are building up our stock in case we see a situation where we need to use a whole lot more.”

Some health systems are also voicing concerns that regular surgical masks are taken from public spaces.

“As a result, we are now providing masks on an as-needed basis to our patients and visitors,” said a Brigham and Women’s Hospital spokesperson.

Jarrett says at Northwell Health, “We decreased the supplies in the hospital and put them in a store where they cannot be easily accessed. We restricted access and we are tracking the amount of N95 masks used so we will notice if someone hordes the supplies.”

Other hospitals say it’s “business as usual.”

“We are still in influenza season. We want our patients and visitors protecting others from respiratory illnesses. As of today, you are still far more likely to be exposed to influenza in a U.S. hospital lobby than COVID-19,” said Dr. Oluyemi Odugbesan, an attending anesthesiologist a Denver area hospital.

Odugbesan says that the hospital administration has also encouraged them reuse their mask the entire day.

“PPE is paramount in preventing spread between those of us on the frontlines in healthcare and so it is concerning from that standpoint,” said Odugbesan.

States and hospitals are working together to ensure that healthcare workers’ protection is not compromised. The New York State Department of Health, for example, “has already supplied hospitals across the state with N-95 respirators and other PPE to help mitigate any supply shortages currently being realized due to COVID-19,” according to Jill Montag, New York State Department of Health spokesperson.

The department has creates a stockpile of medical equipment over a decade ago and is monitoring all hospital capacities to ensure continuity of health care services.

Dr. Ashwin Jathavedam, chief of Infectious Disease at New Jersey- Englewood Health, says vigilance is key: “This isn’t the first pandemic and won’t be the last and everyone is working to be ready.”

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