What does the future of COVID care look like in CT?
As of Friday, Connecticut hospitals had 309 COVID-19 patients. While that number is expected to continue to steadily decline, hospitals expect to be treating COVID patients for the foreseeable future.
But care of COVID patients may start to look quite different.
“Every day that goes on, we learn a little bit more about this disease and how to manage it,” said Rob Fogerty, director of bed resources for Yale New Haven Hospital. “What we've done is, we've taken what we've known, and started to push, flex, change the shape of the play-dough.”
Emblematic of that shift is a transition from COVID-specific wards to hybrid units, according to Rick Martinello, director of infection prevention at Yale New Haven Health.
“What we've developed a lot of confidence in is that it is safe for us to care for patients in a mixed unit,” he said.
Kim Metcalf, associate vice president of phar
macy and ancillary services for UConn Health, said they have been creating sections of the hospital specifically for COVID patients “when the census reaches a higher level such that it's better to segregate or close off that unit.”
“So that the clinicians who are working with those patients stay in that unit and work with those patients,” she said.
Martinello said they try to have a group of staff dedicated to COVID patients, though some hospitals in the Yale system have been using a hybrid model all along.
“At our other hospitals, we have been doing this for a long time where we have patients with COVID intermixed with our non-COVID patients,” he said. “Here in New Haven, we are now making that transition. We do have one unit right now that is following that hybrid model.”
That hybrid approach may be the future of hospital-based COVID care.
“If we see the numbers continue to decrease, we'll be following that model more and more,” he said.
As the pandemic progresses and changes, Fogerty said the future of COVID care in hospitals is dependent on many factors. That means hospitals need to stay nimble in how they manage patients.
“We just try to be flexible and play the game of limbo,” he said.
Mutations matter
How patients are cared for depends on the number of people in need of care, which Fogerty called “volume,” and the restrictions the disease requires.
Hospitals are heading toward a low-volume, lowrestriction situation. The number of COVID patients in need of inpatient care is trending down, and infection prevention units know when a patient can be moved out of isolation and into a hybrid unit without
putting others in danger.
“They're far enough into their illness where we're confident that they're not contagious any longer,” Martinello said. “So we can move them from their isolation bed to their non-isolation bed.”
But if, for example, a variant emerges that is more infectious, more virulent and evades immunity granted by vaccines, Fogerty said the hospital would be forced to manage higher volume and more restrictions.
Those restrictions vary based on the needs of the patient and the progress of a pandemic.
“What are the air filtration requirements? What are the roommate requirements? How long do they have to be with the door closed after a given procedure, labor, all of that stuff,” he said. “So, if you came into the hospital with a broken leg, you have no restrictions. If you come in with infective diarrhea, you have a lot of restrictions. If you come in with Ebola,
you have super-crazy restrictions. So where are we going to fit on that?”
Therapies and volume
Metcalf said she does not expect COVID-19 to go away. “It's going to be a part of our lives,” she said, but she believes it will be better managed and treated.
“I hope it'll be more in line with what we see with flu,” she said.
Metcalf said the flu has an at-home therapy prescribed that mitigates the need for hospitalization. She said reports a similar treatment is being developed for COVID.
Pfizer, for example, announced it was in phase one of an antiviral pill to treat COVID, what the company said was “a potential oral therapy that could be prescribed at the first sign of infection,” similar to Tamiflu, prescribed at the onset of a flu infection.
“My hope is we are going to evolve into having pharmaceutical drugs that will be able to help minimize or prevent the advancement of disease with COVID,” Metcalf said. “My hope is that it's part of our lives in a minor way, one that we have an arsenal to treat it and keep it at bay, to reduce severity of illness, eliminate death from it, and improve our ability to manage it going forward.”
For Fogerty, who said flexibility is key when managing resources during a pandemic, therapies are a way to ensure that volume stays low.
“The pill, also the monoclonal antibodies and then on top of that, also the vaccinations, that has pressure that pushes it into the low-volume category,” he said. “If you move this way, COVID could very well be something that we never have to even think about at a system level. We know how to treat it, we have enough rooms, we know what the rooms are.”
Echoes of the 1980s
Fogerty is hopeful. Therapies are being developed, hospitals have learned flexibility, vaccinations are driving down transmission and it’s possible the virus could mutate into a more manageable form.
“Eventually, this could just become another respiratory virus, if it mutates that way,” he said.
That shift, from the start of the pandemic when so little was known about how to treat a novel pathogen, echoes what hospitals experienced at the start of the AIDS crisis.
“Early in the ’80s, they used to have wards set aside for HIV patients, because that was before we knew it was transmitted by blood and by other body fluids,” Martinello said.
Fogerty also drew a comparison to how hospitals learned to treat and manage the spread of HIV.
“With HIV-AIDS, there was a lot of the same concern. Am I going to get sick? Am I going to get my family sick? Am I going to bring it home to my kids?” he said. “That turned out not to be an airborne disease. But we didn't really know that at the time.”