As the COVID-19 crisis grows in Missouri, Columbia’s hospitals have adjusted their practices and executed plans to better manage the pandemic.
With COVID-19 cases increasing across the state, concern has risen about whether hospitals have the resources to treat the number of people who could fall seriously ill. These concerns were heightened after Missouri’s first COVID-19-related death was reported Wednesday in Boone County.
According to the Organisation for Economic Co-operation and Development, the U.S. has 2.8 hospital beds for every 1,000 residents in comparison with 3.2 in Italy, 4.3 in China and 12.3 in South Korea, countries that have all been hit with large numbers of COVID-19 cases.
MU Health Care, Boone Hospital Center and the Harry S. Truman Memorial Veterans’ Hospital have all adjusted visitor policies to try to slow or prevent disease transmission. These changes include limiting the number of visitors, screening visitors before they’re allowed in and suspending overnight visits, among other changes, according to previous Missourian coverage.
The Centers for Disease Control and Prevention outlined other guidelines for health care facilities to take to best prepare for the COVID-19 pandemic. That list includes developing or reviewing emergency plans, ensuring proper use of personal protection equipment, encouraging sick employees to stay home and separating patients with respiratory symptoms so they are not waiting among other patients seeking care.
The veterans hospital is taking these recommendations very seriously, said Jeffrey Hoelscher, public affairs officer for the hospital, because many of its patients have chronic conditions or suppressed immune systems that put them at higher risk of serious complications from the virus.
To protect patients, the veterans hospital has also added a long list of changes to its everyday routines. Hoelscher said some of these changes include screening of all veterans, visitors and staff each time they enter a VA facility, restricting access to the medical center to controlled entrances and the suspension of group meetings and chaplain services.
Hoelscher said the hospital is also in the process of suspending elective procedures to reduce the possibility of exposure to infectious diseases and to preserve resources that may be needed for COVID-19 care.
He emphasized that the hospital began preparations for COVID-19 more than a month ago, so it is not anticipating any immediate shortage in personal protective equipment, such as the masks and gloves that protect patients and staff from spreading or contracting the virus.
Eric Maze, media relations strategist for MU Health Care, said the system was “confident” it would have the materials and supplies needed to protect patients and staff. He emphasized that the supply of masks and other personal protective equipment was being monitored and the system was working closely with suppliers to ensure the safety of patients and staff.
MU Health Care has also canceled all elective surgeries that require extensive use of personal protective equipment as well as surgeries resulting in anticipated hospital stays of longer than two days, according to a news release Thursday afternoon. Elective surgeries for those over 60 or those with underlying conditions have also been canceled.
Maze said that while “proven response plans” were in place to handle infectious diseases, hospital leadership would still update response plans as necessary. He also said that the hospital system had the “ability to make adjustments to open up additional beds in certain units if needs arise.”
MU Health Care has also limited public access to hospital entrances, according to the release, and visitors will now be screened for illness upon entry. Valet services have been suspended at all MU Health Care locations.
Boone Hospital Center has also taken precautions over the last six to eight weeks to protect patients and staff in accordance with its surge plan, according to previous Missourian reporting.
At a media briefing Wednesday, the center’s chief medical officer, Robin Blount, said that the hospital wasn’t encountering a shortage of personal protective equipment or test kits and clarified that the supply of both was being monitored daily.
State and federal governments would provide extra personal protective equipment, such as gloves or gowns, to Boone Hospital Center if the hospital were to run low, Blount said. She also noted that additional test kits were on the way.
According to previous coverage, the hospital has “cataloged their staff to assess who works part-time, full-time or PRN (as needed) hours to identify how they would staff if a shortage were to occur.”
Avoiding a spike
Many experts say hospital preparedness and capacity to treat an increase in COVID-19 cases depends on the ability to “flatten the curve,” meaning to slow the rate of infection to give medical staff the ability to treat people in smaller numbers simultaneously.
In 2018, 900 of Columbia’s 1,880 hospital beds were open, according to data gathered by the Harvard Global Health Institute. At that rate, the institute projected that in a “moderate” scenario, in which 40% of the population is infected over 12 months, hospitals could currently only provide beds for an estimated 57.7% of incoming COVID-19 patients at the outbreak’s peak.
Put another way, at the moderate scenario’s peak, projected COVID-19 cases would occupy 173% of the available beds in Columbia hospitals at the 2018 rate of availability, not accounting for beds that could be made available by reducing or suspending altogether elective surgeries.
What these data indicate is that “flattening the curve” is vital to keeping hospitals from becoming overwhelmed. Health care providers will only be able to provide necessary care to infected people if the public helps slow the speed of transmission and hospitals are able to greatly increase vital resources like available hospital beds, according to the group’s analysis.
“The adequacy of services, supplies and workers will depend on the peak. If we can flatten the curve, we will be much better prepared than if not,” said Dave Dillon, vice president of public and media relations for the Missouri Hospital Association. “The emergency preparedness and response coalitions in Missouri are actively monitoring resources, and additional federal resources to manage the pandemic are expected.”
President Donald Trump declared COVID-19 a national emergency last Friday afternoon hours before Gov. Mike Parson declared a state of emergency in Missouri surrounding COVID-19 concerns. According to the Missouri Hospital Association, these are both good things in terms of improving hospital preparedness.
A statement last Friday from the association said the announcements trigger access to new tools for hospitals, better care for those who are infected, protect caregivers and help slow the spread of the virus.
“As these new resources and authority are available, hospitals will be permitted to expand capacity in both urban and rural areas and gain the flexibility needed to manage alternative care settings and patient surge,” the statement read.
In a follow-up email, Dillon clarified that the declarations at the state and national level will help expand testing capacity by potentially adding “several thousand” private labs improve testing speed.
Ventilators and separation
One organization looking to help hospitals avoid shortages is the Exercise Tiger Association, a veterans’ organization in Columbia. At a news conference Thursday, National Executive Director Susan Haines said there aren’t enough ventilators in circulation to serve the patients who could be affected in the second or third wave of the pandemic in Columbia.
The organization is now advocating for increased ventilator production.
But speakers at the news conference also emphasized the need for social distancing now to avoid the need for more ventilators in the future.
The hospital association also has highlighted the importance of alternative care settings in flattening the curve and slowing the rate of infection.
“The goal is to get individuals who are at risk or symptomatic to a location designed to provide testing service specific to COVID-19. This will remove this population from waiting rooms limiting the potential for exposure,” Dillon said.
Prime examples of alternative care settings are the drive-thru testing sites that have been set up by both Boone Hospital Center and MU Health Care. The testing sites opened Wednesday and will greatly increase the number of COVID-19 tests completed, according to previous Missourian coverage.
MU Health Care also launched $10 video visit screenings for COVID-19 on March 11. On Tuesday, it switched to providing free video screenings.
“Video visits also are good options for patients who want to avoid waiting rooms where they may be exposed to other illnesses. Conditions like cold and flu, sore throat, pink eye and abdominal pain can also be treated by a provider virtually,” said Matthew Robinson, chair for the School of Medicine’s Department of Emergency Medicine and medical director at the University Hospital Emergency Medicine Department in a news release announcing the virtual screenings.
These alternative care settings are in line with the goal outlined by the CDC of separating patients with respiratory symptoms from other patients to prevent the transmission of the virus between patients.
The veterans hospital has accomplished the same goal by designating a separate clinic area for the evaluation of patients with respiratory illnesses, Hoelscher said.
The veterans hospital uploaded photos on its Facebook page Tuesday evening of a large tent that was put up behind the hospital. The post explained that the tent was meant to be a “triage facility” in case of an increase in COVID-19 cases.
“Although we have not received any cases, as you know, we always work in advance to be prepared. And we will continue preparations to ensure our nations #Veterans get the best care possible,” the post read.
“Without knowing what COVID-19 will look like in the future, it is impossible to predict,” Hoelscher said. “An important aspect of our planning is the practice of social distancing. It provides us with the best opportunity to reduce or eliminate the potential spread of infectious diseases.”