New Haven Register (New Haven, CT)
When COVID became real for CT doctor
For Dr. Rob Fogerty, the pandemic became real at 11:47 p.m. on March 16, 2020.
Fogerty is director of bed resources for Yale New Haven Hospital. He’s the guy who keeps track of how many of which kinds of beds are available in the largest hospital in the state, and one of the largest
in the nation.
“It’s a weird job,” he said. “A lot of people even here don’t really know what I do. And I’m OK with that. If I’m invisible, that means that they were able to provide the care that they wanted to provide for their patient.”
By mid-March last year, physicians and administrators at Yale New Haven Hospital had been talking about the coronavirus for a while, and Fogerty is used to late-night phone calls. He usually wouldn’t bat an eye if his phone rang at midnight.
“As a doctor, you’re used to getting woken up in the middle of night,” he said.
But when Fogerty’s phone rang and he saw that it was Steve Choi, Yale’s chief quality officer, he woke up and took notice.
“A call from him is weird,” he said. “I sat bolt upright, like an ice cube went down my spine.”
Doctors in Connecticut all have friends in New York, and Choi had just gotten off the phone with some colleagues. Choi told Fogerty: “They’re about to be totally overrun.”
“That was when COVID really started for me,” he said.
A year later, and Fogerty is still in the weeds. Yes, hospitalizations have declined considerably since then (and then up, and then down again), but he can’t seem to let go.
“The boundary between personal and professional is gone,” he said. “I was hiking the other day, there was this beautiful bluff. It looks out, and I saw some houses and it was beautiful. I was there with my kids and I looked out and I said, ‘Someone’s waking up in one of those houses with a cough and we have to provide care for that.’”
“The real weight of how much our community depends on us is a privilege,” he said. “But, boy, it got scary sometimes.”
Fogerty sees the white coat he wears as a “solemn responsibility.” He is a cancer survivor, and he knows firsthand what it means to be a patient.
“I was a patient before I was a doctor. I very much appreciate those folks for saving my life. And this is how I pay it forward,” he said. “I’m very proud of what we’ve done and what we do. There’s a lot of grief in the world. If I can play a part in just preventing a little bit of that, it’s all worth it.”
Preparing for a pandemic
When the COVID pandemic was at its peak in Connecticut, Fogerty said there were 451 people in his hospital suffering from the disease. That sheer number wasn’t the problem. What gave Fogerty pause, he said, was not knowing how high it would go.
“Even over the summer, when it was relatively quiet, there was still a sword of Damocles, it was still there,” he said. “In my professional circle at work, we knew it was going to come back. This wasn’t over because nothing had changed the equation. And then it came back and it was living the same thing except this time, everybody was sicker from the care that got delayed over the summer.”
The hospital was, Fogerty said, as prepared as they could have been before the pandemic struck.
“Surge planning” is a big part of his job, as is working with the various teams within the hospital. Fogerty routinely works with the bed management group about how to move patients into and out of isolation. He often works with the hospital’s infection prevention team.
A few years ago, Fogerty helped build a data-driven bed management technique that he said allows administrators to know what resources are available in real time.
With that software in place, Fogerty established what he called the hospital’s capacity coordination center.
“We built it where we put the bed managers and the nursing staffing office and patient transport and the ambulance company, we’re all in the same room,” he said. “We’re all talking about how to move patients through their hospital stay.”
When two record flu seasons hit, they used that information and practiced coordination to their advantage. It had been a useful education, Fogerty said.
“We published a paper on how to turn a conference room into an inpatient unit,” he said.
All of that was years before COVID. When the pandemic struck, Fogerty said they were prepared for the complications inherent in managing hundreds of patients with an unknown disease.
For example, the initial guidance from the CDC suggested that all COVID patients needed to be segregated. That presents a set of challenges all its own.
“It’s one of those things that operationally is much more challenging than it sounds,” he said. “You need to get the housekeepers involved, environmental services, food and nutrition. The nurses need to have the right PPE, which means you need to have materials and remember, PPE was hard to come by.”
But because all that work had been done in the years prior to the pandemic, when that call came in from Choi near midnight one day after the ides of March, Fogerty had plans and processes already in place.
“The next day was when I called the director of nursing for oncology and I said, ‘We need your floor. It’s time to move all your inpatients to St. Raphael’s,” he said. “They emptied three 28-bed units in about two days. And they could do it because we had the ambulance company in the room and everybody had worked with each other, and they knew that this was coming.”
Mistakes and lessons
That doesn’t mean they didn’t learn anything in the ensuing year. Quite the opposite, Fogerty said the hospital’s ability to manage COVID patients has improved considerably as they learned about the disease.
“We know a lot more about this disease than we did this time last year,” he said. “Initially, in the first wave of the pandemic, we spent a lot of time and effort on air circulation patterns and what level the filtration is. I learned more about HVAC than I ever thought I would.”
Now they know that every breath of air does not need to be siphoned through a HIPAA filter. They have better cohorting strategies for patients and staff. They know how to keep staff safe when they move between COVID patients and non-COVID patients.
“Now we realize that some things are safe that we did not even consider this time last year,” he said. “The fundamental fear around airborne transmission of an unknown disease, it’s been an interesting sociological experiment. Someone’s going to write a book on that someday, it’s gonna be fascinating.”
When asked what mistakes he made during the pandemic, Fogerty replied, “a lot,” with a self-effacing laugh.
The mistake that came first to his mind was how he managed the capacity of staff, particularly during the “summer lull period,” when COVID cases went down before what would be a postholiday peak.
“We probably could have reallocated things in a way that could have given more units a break,” he said. “There are particular nursing units that had COVID patients every day for a year . ... I think if I were going to go back and do it again, I would probably figure out a way to give those staff a break.”