‘The, “Oh my goodness, one more thing we have to go through” feeling’

The winter storms that swept through much of the country in mid-February caused a significant disruption in COVID-19 vaccination efforts. Texas was among the hardest hit states where millions of people were left without electricity and water. The Houston Methodist system was in the thick of it all, contending with everything from crowded emergency departments to quickly standing up a vaccination event to assist the county health department, which lost power and its ability to store vaccines. Modern Healthcare Managing Editor Matthew Weinstock spoke with Houston Methodist President and CEO Dr. Marc Boom. The following is an edited transcript.

MH: You’re used to hurricanes coming in, so managing during a crisis is not necessarily unique for you. But you’re managing during the storm and outages while rolling out the COVID-19 vaccine. What kind of challenges did that present?

Boom: Going back almost a year, probably in the April time frame as we’re dealing with COVID, we started thinking about what does the summer look like? We’re experienced with hurricanes. In fact, we had a hurricane last summer that was barreling at us. Fortunately it turned (away, but) we were getting prepared for that. We had done a lot of discussion and looked at how do you do both, because it’s very different during COVID.

I think the first and foremost challenge is fatigue. We’re all just tired. Everybody’s a little bit on edge, everybody’s a little cranky. And there was very much the, “Oh my goodness, one more thing we have to go through” feeling.

Motivating oneself, motivating a team is a lot harder in that scenario than let’s say a normal year where everybody’s had a relaxing summer and then on Monday you figure out that a hurricane is barreling down at you five, six days out and everybody rallies together.

Another thing that COVID put as a challenge is the normal ride-out and recovery that we would just call on without hesitation. We looked at two things. One is we knew everybody’s tired, so the last thing we want to do is put the ride-out and recovery in place with a bunch of exhausted people.

But the other issue being that you can’t put together a conference room with rows of cots where a bunch of staff stay. So the logistics of housing staff for ride-out and recovery are difficult. We went with a modification and it ended up working reasonably well.

What made this time particularly challenging was … the fact that the vast majority of people who worked at our hospitals in any capacity, were home without electricity. And then what ended up spiraling after that was … so many of our communities were without water. We had two hospitals without water from the city supply … (one for) 48 (and the other for) 72 hours.

MH: At one point staff were going outside to collect rainwater, right?

Boom: The day after the snow, we had some rain in the middle of the afternoon, so then there was worry about it icing back up that night. (Staff) got creative. They took the laundry carts that are on wheels … and they literally took a series of those and rigged up a little pump that would take rainwater and then pump it into those carts and they distributed those around nursing units. So they could be used for flushing (toilets).

During a disaster like this, we always talked about the nurses and the doctors, the respiratory therapists and other front-line groups. We often don’t talk about the people behind the scenes who make it all work in a disaster like this. All of those people are heroes for sure … these folks working 24/7, figuring out how to keep the systems running.

This week is kind of crazy because now we are doing way more volume than normal. And all of this (while) still having about 425 patients with COVID across our system. Our peak was 750 in the summer.

MH: You’re seeing an increase in patients for dialysis too?

Boom: This is the third major disaster where we have dealt with the dialysis issue.

Most of those dialysis centers are small, they’re in strip centers, they’re stand-alone, they don’t have generators. This time we had water access issues for the whole city, and they just shut down. And they shut

down without ride-out and recovery teams, without staff in place, without ability to get equipment to any of the hospitals or anywhere else. The hospitals all end up (filling the void). Literally 20% of our volume in the emergency rooms began to be patients who were overdue for dialysis.

We’re very frustrated because that industry has not addressed the issues that it should have in past disasters. We’ve taken a couple passes (with lawmakers) to try to address that and this time, working with the Texas Hospital Association and others, we’re going to get some answers to those solutions.

Of course we’re going to take care of those patients. But that could be avoided if we had the right disaster preparedness for many of these stand-alone sites.

MH: Looking at vaccination efforts, you also had to step in quickly for Harris County when it was about to lose a bunch of doses.

Boom: The storm hits Sunday night. Monday morning … we get a call because the county lost a generator ... and they had doses of Moderna that needed to be used.

We looked at it and said, “We really can’t put out a call to our usual schedule or accelerate the schedule or

“We often don’t talk about the people behind the scenes who make it all work in a disaster like this.”

invite because we don’t want people getting on the roads, it’s not safe right now.”

Right across the street from our main hospital is Rice University. I picked up the phone, called their president and said, “Hey, would you all like us to vaccinate some of your folks?” I mean, at this point, you can’t worry about 1A 1B, you just have to get those vaccines out.

Then (we worked) with the local neighborhoods. We ended up working with a synagogue that had some physicians and nurses right there who could manage this and they took 300 doses. In three hours we got them into people’s arms.

We went into one of our buildings, took a look and said, “OK, those tables there, those will work.” My team started doing the paper side of things because there was no time to set up our usual computers and stations and everything else that we would use. People started flowing in. I sat down and started giving vaccines. We put a call out and the physicians came out in droves. And in two-and-ahalf to three hours at that site, we vaccinated over 700 people. That was very rewarding.

We did over 12,000 first doses alone and about that many second doses from Wednesday through Monday the subsequent week, which is kind of our normal cadence. To date, we’ve done about 245,000 vaccines, all told. ●