Preparing for a coronavirus surge
Danbury, New Milford hospitals refine COVID-19 plan
DANBURY — Local hospitals are stocking up on personal protective equipment and refining treatment and other plans as the number of patients hospitalized for the coronavirus rises across the state.
“We have continued to learn not only a great deal about the virus itself, how to treat it, but how to prepare for an uptick in the number of cases coming into the hospital,” said Dr. John Murphy, president and CEO of Nuvance Health, which includes Danbury, Norwalk, Sharon and New Milford hospitals.
There were 134 patients hospitalized in the state on
Friday, but numbers remain low in Nuvance Health’s seven individual hospitals. Each hospital had nine or fewer COVID-19 patients early this week, Murphy said. New Milford Hospital had none.
“I wouldn’t call this yet a surge of any kind,” Murphy said. “We’re very carefully monitoring it.”
But he does not expect numbers to stay that way as activities like dining move indoors and people gather for Halloween, Thanksgiving and Christmas.
“We’re prepared to see it (a surge) with the onset of cold weather,” Murphy said. “I hope I’m wrong, but it could be November.”
Fatigue with precautions like mask wearing and students returning to school are other factors that could contribute to a surge, he said.
This comes as Nuvance eyes its largest drop in revenue yet, with Murphy estimating at least a $50 million loss this year. Typically, the system earns tens of millions in profit.
Hospital staff have demanded hazard pay — something Murphy said he would support if the federal government would cover it.
“We have a serious financial challenge in front of us,” he said.
The hospitals have relied on donors to pay for equipment, he said.
‘Playbook’ for future surge
Nuvance has created an extensive “playbook” reflecting on what has gone well and what needs to be improved, Murphy said.
Officials meet weekly to review the plan and are working on pieces, such as getting physicians credentialed to work in multiple hospitals, already. That would be helpful in case of staff illnesses or to bring in more people with particular specialties, Murphy said.
The hospitals are identifying space that could be used for coronavirus patients, while still keep
ing open procedural rooms for surgeries. Some hospitals could be kept COVID-free for a period of time.
Some non-COVID-19 patients were worried about going to the doctor’s office, so physicians are creating a list of at-risk patients.
“We can proactively reach out to them to keep tabs on how they are doing,” Murphy said.
Nuvance is creating a ranking system for surges, with level one being “modest,” level two “moderate” and level three “marked.” The peak in April would have been considered a “marked” surge at some of the hospitals, Murphy said.
The exact numbers for what is considered a “modest” or “marked” surge are still being worked out, but the difference between each of the levels is about 30 to 40 patients, roughly equivalent to an entire ward, he said.
Additional equipment has been ordered to ramp up testing and improve turnaround time, Murphy said.
If a surge comes with the cold weather, it will be challenging to offer outdoor testing at the Danbury Hospital garage, which was
available in the beginning of the pandemic, Murphy said. The hospital has identified potential indoor sites.
But if saliva testing becomes more readily available, then office-based testing is more practical, he said.
With the cold weather, it is also unlikely that the hospitals would set up outdoor tents again, Murphy said. Bringing additional beds into an indoor facility — as Danbury did at Western Connecticut State University in the spring — is possible, he said.
“If there were an overflow of patients — let’s say who were already treated, not yet ready to go back home or to their nursing home — that’s where we might house them,” Murphy said.
Improved treatment methods
Murphy estimates it won’t be until mid- to late 2021 at the earliest that a safe and effective vaccine is widely accessible.
“Until that happens, we’re going to have to get used to and get better at treating COVID patients,” he said.
One of the biggest changes in treatment is that patients are not put on a ventilator until their case
is more severe, Murphy said. Instead, health care workers put patients face down or deliver a high-flow of oxygen through a type of hood, he said.
The medication Remdesivir is also used.
“We’re not sure it saves lives, but we’re convinced it shortens the amount of time someone spends in a hospital,” Murphy said.
There has been a debate about steroids, but the hospital has found dexamethasone — a steroid given last week to President Donald Trump — works best with patients that are “quite ill,” he said.
The benefits of plasma from people who have recovered is still unclear, but the treatment is used, Murphy said.
“The science shows it is safe and it will be effective,” he said. “We’re using that more frequently.”
Preventing blood clots and kidney damage have become key issues, he said.
Being ‘resourceful’
Many hospital staff members — from the doctors and nurses to those that cleaned the rooms —
were scared of getting the virus and bringing it home to their families, Murphy said.
“The thing that I’m proudest of is how resourceful everybody was, how brave they were,” he said.
Hotels were available for staff and will be again during a surge.
Staff have grown accustomed to the environment and understand PPE and sanitation protocols, Murphy said.
Patients are tested for the virus when they arrive and are retested if results come back negative, but symptoms remain.
“Just by the virtue of having gone through this for six to seven months, people are less anxious than they were,” he said.
Nuvance has a 90-day supply of personal protective equipment based on current usage rates, Murphy said. Hospitals are prepared to have masked professionally re-processed if necessary, he said.
“If we were to have to care for say 10 times as many patients, then we don’t have a 90-day supply and neither does anyone else,” Murphy said. “The supply chain is still not back the way it once was.”