When the H1N1 flu began spreading a decade ago, U.S. hospitals were flooded with patients. The pandemic, which was declared over in 2010, left nearly 275,000 hospitalized, as health officials fretted whether they would have enough beds, enough medical supplies, or enough protective gear.
Today, with a novel coronavirus spreading, health care facilities in mainland China and Hong Kong have been overwhelmed by a flood of patients and are facing shortages of direly needed space and supplies. Hospitals in the U.S. are doing everything they can to make sure they’re prepared if local spread takes off here.
“Things sort of go hot and cold, and they’re very hot right now. We’re going back to our protocols to make sure they still work with coronavirus,” said Dr. Nathan Hatton, a critical care pulmonologist at University of Utah Health and the co-director of a hospital preparedness team.
Hospitals across the country are convening near-daily meetings to check in on their emergency preparedness plans. And they’ve called all hands on deck. Nearly everyone — from physicians and nurses to public affairs representatives and the employees responsible for ordering supplies and keeping the hospital clean — is involved in making sure a hospital’s existing emergency plans are up to date.
U.S. health officials have stressed that the risk to the American public remains low. About 99% of the more than 28,000 cases have occurred in China, where the outbreak began. There have been 12 people in the U.S. infected with the virus, 10 of whom had recently traveled to China and two of whom had been in close contact with two of the initial U.S. patients.
“But as we project outward with the potential for this to be a much longer situation, one of the things that we’re actively working on is projecting the long-term needs for our health care system,” Dr. Nancy Messonnier, director of Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, told reporters on Wednesday.
Hospitals are trying to get ahead of those potential needs, having seen how quickly an outbreak can evolve in 2009. Pulmonologists, in particular, were concerned at the the time about a potential shortage of ventilators and ECMO machines, both of which are used to care for patients with acute respiratory distress syndrome, or ARDS, a serious condition that causes fluid to collect in the lungs. Many hospitals had just a handful of ECMO machines — heart-lung machines that pump and oxygenate blood outside the body — and those were reserved for patients having heart surgeries.
“It really would have required a substantial decrease in cardiac surgery procedures being done,” said Dr. Paul Biddinger, an ER physician and the medical director of emergency preparedness at Massachusetts General Hospital.
Much has changed since that pandemic. ECMO machines are much more common. Many health departments and professional organizations have updated guidelines that govern how to allocate limited resources like ventilators during a crisis. A number of hospitals have also created new emergency plans, which detail everything from how to triage patients and when to cancel elective surgeries to how to convert hospital rooms and wings to areas dedicated to the care of infected patients.
“In many ways we’re in a better place, but there’s more work to be done as well,” said Dr. William Graham Carlos, the chief of internal medicine at Eskenazi Health, an Indianapolis health system.
Much of that work revolves around hospitals planning for what Biddinger called the “four S’s” of a surge in patients amid an outbreak: supplies, staff, space, and the system that governs all of them.
They need to review their inventory of supplies, including ventilators, oxygen tanks, and the respirator masks that health workers might need to wear to care for infected patients. They need to plan for how to protect other patients in the hospital, particularly those with weak immune systems. They need to review screening procedures and the proper way to put on protective gear. And they need to educate everyone — from the front desk employees in the ER to the workers who take out the trash in patient rooms — in those protocols.
“We often think of the doctors and the nurses that provide direct care to patients. But we need everyone for this,” said Eileen Searle, the Biothreats Clinical Operations program manager in Mass. General’s Center for Disaster Medicine.
Some hospitals are leaning on other health systems for guidance as they grapple with emergency preparations. Biddinger said hospitals around the country have reached out to his team at Mass. General for assistance. As one of 10 CDC-designated “regional Ebola and other special pathogen treatment centers,” the hospital is particularly well-equipped to dole out advice. Having an open line of communication with the preparedness teams at other hospitals would be critical during a crisis, he said.
“We all value the importance of coordinated action because we want to make sure we’re following the best science and doing the best for our patients,” Biddinger said.
That also includes educating patients — which Searle said Mass. General has been doing much more of in recent weeks.
“The biggest burden we’ve seen so far is the fear in the community, and patients reaching out for reassurance,” she said. Primary care offices and outpatient clinics affiliated with Mass. General have been receiving more phone calls than usual, she said, with patient concerns about the virus.
The hospital has trained employees to respond to those calls by reassuring patients that — unless they have recently traveled to China or been in contact with a known, confirmed case — the risk to the community remains low. The hospital continues to encourage patients to practice good respiratory hygiene habits, like washing their hands frequently and covering their mouths while coughing.
The hospital has also added a message to the text messages it sends to remind patients of an upcoming appointment, asking them to call before coming in if they have traveled in the past month.
“Our goal is to make sure our staff has the information they need to be safe and to safely provide care for patients,” Searle said.