The Morning Call (Sunday)
Officials: ‘We know what works’
Lehigh Valley hospitals say they’re ready for second surge
As coronavirus cases appeared, crept up and eventually surged in the spring, Pennsylvania hospitals quickly went from anticipating patients to being overrun with them. With daily case counts now much higher than in the spring, you
may be wondering if that nightmarish scenario will return.
So far, the rising numbers have been manageable, say infectious disease specialists at Lehigh Valley Health Network and St. Luke’s University Health Network. Even as the state shattered daily case numbers nearly every day last week, surpassing 5,500 on Friday, about 150 COVID-19 patients were hospitalized at LVHN that day — 100 fewer than April’s peak, when daily cases exceeded 2,000 statewide. In part, that is because infections are occurring more in younger people, who aren’t at high risk for the virus’ sometimes deadly complications. And when complications do arise, doctors are better equipped to address them. In March and April, health professionals were considering hydroxychloroquine and steroids as potential treatments. They were participating in clinical trials to learn about other therapies. And they were putting patients on ventilators early, overwhelming intensive care units, said Dr. Alex Benjamin, LVHN’s chief of infection control and hospital epidemiology.
As the counts dropped in late spring and summer, hospitals had time to prepare for the inevitable second wave, addressing issues with the supply chain, pharmaceuticals and staffing, buying ventilators and personal protective equipment and finding more effective noninvasive treatments as well as drugs such as corticosteroid dexamethasone and remdesivir.
“When a patient does become critically ill, we know better about the strategies on how to manage a patient to try to prevent intubation, prevent mortality, obviously, and also decrease length of stay and try to fend off the need for ventilation,” Benjamin said.
In her daily briefings, Pennsylvania Health Secretary Dr. Rachel Levine has urged people to wear masks and not congregate with those outside of their households. She even has implored Pennsylvanians to reconsider family gatherings over Thanksgiving. All to mitigate the scourge. But Levine noted Thursday, when 5,488 cases were reported, that only 9% of COVID-19 patients were on ventilators, compared to 30% at times last spring.
“Our health systems are not overwhelmed by any means at this point,” she said.
Still, cases keep climbing and health officials say we are in the early stages of the second wave.
People should be cautious and respect the disease, said Dr. Jeffrey Jahre, infectious disease specialist at St. Luke’s. That means wearing masks, washing hands, practicing social distancing, and considering if it’s prudent to gather at the holidays.
For those who get seriously ill, the Lehigh Valley’s large hospital networks say they are prepared and equipped, unlike hospitals in some Midwestern states, which are experiencing their first surge in virus cases and are becoming overrun the way New York City hospitals were last spring.
“What I want to stress is, there’s no shortage of beds,” Jahre said. “There’s no shortage of ventilators, there’s no shortage of ICU beds, and last but not least, — and this was true in the dark days of April — we were never in the position like New York City was, because we have what we often refer to as the power of network.”
For example, Jahre said St. Luke’s recently has been seeing 80 to 90 patients per day across its 12 campuses, which have 1,400 beds.WhenSt. Luke’s-Monroe campus saw a sharp rise in COVID-19 cases in late March, Jahre said personnel and equipment were transferred to the
Poconos from other parts of the network. And, he said, St. Luke’s could have moved patients to other hospitals, if necessary.
“Whenyouhave 12 campuses,” he said, “it is very unlikely that all of the campuses are going to be hit at the same time.”
At LVHN, Benjamin said none of the network’s eight hospitals was nearing capacity last week, but units were “definitely filling up.” Each hospital has a daily leadership call, he added, to discuss how many beds and ventilators are available.
What has health officials concerned is that the virus is spreading more among young people now than in the spring. Many college campuses are dealing with spikes, some of which have been tied to Halloween parties. The University of Pittsburgh has ordered students to shelter in place for two weeks and most other colleges are urging students to take COVID19 tests before venturing home for Thanksgiving. Because people can be infected and contagious without showing symptoms, public health officials worry about active young people spreading the disease unwittingly.
“We’re seeing a lot more community spread in a younger age bracket,” Benjamin said. “And while they’re still having the same challenges when they have severe disease, you can imagine that age group is much more mobile and much more involved in doing things in the community.”
With the virus more prevalent, LVHN also has seen an increase in cases among staff. Benjamin said in many such instances, workers were exposed to the coronavirus in a community setting. To monitor staff, LVHN is doing daily temperature screenings and symptom checks. At Lehigh Valley Hospital-Schuylkill, visitors have been limited since early October to tamp down any spread among staff and patients. And restrictions may crop up at other facilities in the network, he said.
What Benjamin doesn’t see happening is LVHN limiting elective surgeries, as it did in the spring to focus resources on the first surge. Suspending elective surgeries and other lucrative procedures put a huge dent in the finances of many health networks.
While LVHN in May forecast it would likely lose about $306 million in its fiscal year that ended June 30, spokesperson Brian Downs said it finished in good financial condition, putting it in good shape clinically as well as financially to face this new COVID-19 wave. While Downs didn’t provide a specific number — LVHN will disclose its yearly finances during its annual meeting next month — he said getting elective surgeries and other key services reopened sooner than expected and $118 million from the Coronavirus Aid, Relief, and Economic Security Act allowed for improved performance.
While the local networks are handling the increased load, they know they will continue to have their efforts tested, as the virus’ spread is projected to only increase in the coming weeks, even as seasonal flu takes hold.
Mitigation measures have helped, Jahre noted, and it’s important that the public keep adhering to them.
“This is not the kind of thing you can be defiant about and just will it away,” he said.
“We know what works.”