Hospitals’ timeline followed spikes and concerns — then hope
EAST NORRITON >> “It’s only been a year but it feels like 20 years,” noted Einstein Medical Center Montgomery COO Beth Duffy when reflecting on the coronavirus timeline at the East Norriton facility.
“We remember back in January of 2020 we first started hearing about this ‘epidemic’ when the first death was reported by the Chinese government on Jan. 11.
Then it started to ramp up when the World Health Organization declared a global emergency on Jan. 30, 2020. The first case was reported in the United States on Feb. 1, and then the first death from COVID was reported on Feb. 28 in a nursing home in Seattle. It seemed so far away when it was in China, and while we were keeping an eye on it we really didn’t think that anything was going to come of it, but we were very concerned when we started to see cases in the U.S., and then of course the
first death.”
Over the course of the next several weeks, starting in March, Einstein Montgomery put an Incident Command Center in place, Duffy recalled.
“We developed a surge plan, as we referred to it, and on March 12 we implemented reduced visitation because that was the recommendation.”
On March 14 the first COVID-19 patient was admitted to Einstein Montgomery.
“I believe it was the first patient admitted in Montgomery County,” Duffy said. “From there, things quickly ramped up. On March 19 the Department of Health mandated that we stop all elective surgical procedures and we converted our physician practices to be Telehealth only. On March 29 there were 404 cases reported in Montgomery County, which at that time was really considered to be a hotspot. We were actually ahead of Philadelphia.”
Throughout March and April the number of patients continued to increase.
“The surge plan we had developed back in early March unfortunately became a reality. We were dealing with issues like not having enough personal protective equipment, test results were taking seven to 10 days to come back, a number of employees were furloughed and we allowed employees to work from home. It was very humbling for us to get such great community support. We had a lot of people who dropped off items for our staff to use. We started to see the first impact of this pandemic on our staff and the emotional toll it was taking on them and tried to put some support systems in place. In mid-April the volume spiked, and then things started to come down and we saw that curve start to flatten and we started to look at how can we now safely bring our patients back to services that people were afraid to come into the hospital for.”
From June to September, the volume remained pretty flat, Duffy remembered.
“As the weather started to turn and with the holidays and people doing more things indoors, we saw a rapid increase in cases which we referred to as a second surge. We were much better prepared to deal with that from what we learned with the first peak. We were able to see some light at the end of the tunnel in December when we were able to start vaccinating our employees. Now we’re seeing the second spike decline and we’re hoping that the new variants don’t cause a third spike. We’re much better prepared to deal with COVID patients with so many more tools available to care for them.
At Einstein Montgomery more than 4,000 patients with COVID-19 have been treated, Duffy noted.
“Not all of them were admitted. About a quarter of them have had to be admitted,” she said. “And we’re prepared to deal with it for the long run because obviously it’s not going to go away completely. Hopefully it will become something that occurs far less frequently in our community. As many more get vaccinated, the number will continue to drop.”
Gerard Cleary, DO, Senior Vice President, Chief of Staff and Chief Medical Officer, Abington–Jefferson Health, recalled working to set up a similar Command Center at Abington-Jefferson around the same time.
“It’s been just about a year. I remember pretty distinctly that March 5, Central Bucks put the kids out of school because of potential exposure and the same day we had actually set up our Incident Command Center both at Abington and Jefferson for us to be prepared for what was coming in the next few weeks,” he said.
“That Command Center was integral to being sure that we had good communications and we focused on areas that were critical to managing the pandemic. We focused on our staff, that they were safe, and that we had the right personal protective equipment, the right staffing, the right protocols and guidelines, that we were responsive to changes in the virus, changes in the patterns of infection, and over time, improving our treatments and improving our outcomes.”
The work had begun long before the formal structure was in place, Cleary allowed.
“The CDC had alerted us in early January about the viral outbreak. China had reported its first death in early January and we started a multidisciplinary task force to begin holding meetings to prepare. In February we doubled down on our infrastructure for Telehealth, recognizing that we had a good foundation for Telehealth but it had not been deployed or utilized at the rates that we need to use during a pandemic, when we had to shut down offices and elective work at the hospital but still needed to communicate with patients. We began that work in February, 2020 to understand what we could do to accelerate Telehealth through our network and our hospitals.”
The local Command Center and the Jefferson Hospital Command Center all worked in tandem, Cleary pointed out.
“Our first patient in Montgomery County was March 7. We were the first to open a COVID testing site, which opened on the Abington campus on March 12. So we really moved very quickly with the capacity to test, which became integral to maintaining our understanding of how the virus and pandemic was progressing. On March 15 we cancelled any of our elective procedures at the hospital and moved all appointments to Telehealth. Our patients were able to be cared for without coming to the office. That protected the patients and protected the staff.”
Visitors to the hospital were under new restrictions as well.
“We went to universal masking on March 20, one of the first in the region to universally mask our staff,” Cleary said.
“We received so many community donations … food donations that went to our nutrition department, personal protective equipment, things like lab googles, other types of masks, hand-made caps. Schools emptied out their science labs. There was really unbelievable support from the community.”
The surge of coronavirus cases peaked on April 22, he recalled.
“About 45 percent of the work in the hospital was COVID related. We were able to meet the community demands because we cut back on elective services. At our peak we had over 200 COVID cases in the hospital. We came back down to a baseline of 30 or 35 patients over the summer, and the surge began in October and took us to a peak in November, early December where we had about the same number of patients at our peak. Things that we didn’t have in the spring — treatments that we could test with the scientific rigor that we would have liked,” he added.
“We started with a few treatments that didn’t pan out, but we did learn over time how to better manage the COVID patient and when to administer certain medications, like the antivirals, when they were most effective, and the anti-inflammatories. Because the medical and scientific communities really worked together to understand that, that was explosive in terms of the amount of information and understanding we were able to obtain about the virus that we could then direct for better care of the patients. In December, we started administering monoclonal antibody treatment in the outpatient area, which is indicated for patients who have COVID and fit certain criteria with regard to underlying conditions. We are now over 100 patients that we’ve treated with monoclonal antibodies and that had helped that group of patients to avoid hospitalization and worsening disease. So we had all that for the fall surge and our mortality rate has significantly decreased.”
At the outset of the pandemic, there was a high risk of mortality, Cleary noted.
“But as we have been able to understand how the virus responds to different treatments, employing those treatments, having the supply chain for the medication secure, we’ve really been able to drive down the mortality rate from COVID, which is a real accomplishment for the medical and scientific community. The beginning of what we hope will be the end of COVID suffering is our vaccination program,” Cleary added. “We began vaccinations here at Abington on Dec. 18 and have vaccinated all of our staff who have opted in for the vaccination. We rolled out vaccinations for patients at Lansdale Hospital on Feb. 1 and on Feb. 8 at the Abington Warminster campus. We continue to work our community partners and affiliates in Montgomery County and we’re hoping to vaccinate as many as we can, depending on the supply chain.”