COVID-19 update from a future frontline
It's been just over 3 weeks since Governor Abbott declared a state of disaster for Texas. By that time we had 39 cases and no death in our state. Today we are at 7,276 cases and 140 fatalities. I live in a small rural community somewhere halfway between San Antonio and Corpus Christi. My county issues a stay-at-home on the 28th of March. I am the director of the ED and ICU of a small 70 bed hospital and we are part of a larger hospital system. So, decisions are usually made by the corporate office and then trickle down to the individual hospitals. As of today, we have not had a confirmed case of Covid-19 at our facility or our community, yet all counties around us have confirmed a few cases. It is estimated that we are going to see a vast increase in numbers during the next few weeks. So, where do we stand in all of this? We are having the same problems as anybody else. A broken supply chain! No N-95 masks available, no face shields, not enough gowns! Not yet an issue for us since we have only had 3 or 4 dozen of PUI's, but once the real thing happens we'll be up to our armpits in alligators’. Company policies that clearly not always in line with what Experts recommending. CDC recommendations change daily and are just another frikkin joke, just like during the Ebola crisis. They seem to change their ideas daily and habitually downgrade the risks since they know our healthcare system is not going to win the fight against this enemy. All we are going to do is to minimize the damage and ride it out. Winning it would be eradication and inoculation. Can anybody tell me what some states are going to do with 30-40,000 vents? Just in case you do not know, there has been a shortage of nurses and qualified personnel for years. Who do the politicians and news media think is going to operate those vents? The patient’s families? There ARE NO QUALIFIED PEOPLE! There never have been. Profit-before-People in the healthcare INDUSTRY made sure off that. I listen to the news and no matter if it is left, right or center; it's all a bunch of BS. Smoke and mirrors and ignorance are what got us in this situation. For as long as healthcare is a business driven by profit and traded on the stock exchange we will never be ready. We have to stand up and say enough of the BS and start looking after our sick and hurt. The wealthiest nation in the world and we can't buy thermometers, masks, gowns etc.
So, instead of answering question for those that are looking for help in Answers I have been busy for the last 4 weeks preparing my staff and my units for whatever lies ahead. My goal is to minimize any chance of contamination to anybody. As for our patients and community the only thing we can do for Covid-19 victims is to identify and isolate. All of our treatments will be supportive in nature only since there are no curative interventions yet. Everything we hear on TV or read on social media, is nothing but experimental.
I am in a very fortunate position. I have a President and a CNO that are in total support of protecting our staff and patients. This is our only goal. Our facility has had an empty wing with 12 private rooms and 2 negative pressure rooms. It was closed years ago due to a decrease in one of our service lines. In the past we’ve used that wing for storage, as well as overflow area for the Emergency Department and ultimately we had it set up for the Ebola crisis which now seems decades ago. I was granted permission to use it as an isolation area for any possible COVID-19 patients.
We also utilized our Decon tent which we will be using for the mild cases, those that can be send home under self quarantine. We erected a larger tent to utilize as an overflow area just in case our county gets hit hard and we can’t keep up. Those will be for moderate cases. At least both tents have AC and the larger one utilize HEPA filtration. All vented patients etc. will be distributed between the ED and ICU in the main building. From a logistical point we got it figured out. Here are the challenges. Not enough beds/cots available. Not enough PPE available and only very limited hardware available for any kind of Telemedicine. Remember, we are a small hospital, we got one Doc working. We will need to utilize technology to our best advantage to make the most of our limited staffing and limited PPE.
We are not NYC or LA so we will never get the help we will need. Anything over 8 vented patients would be a major disaster for us, while others would be happy to only have that many. Nice that Apple now decided to make face-shields and everybody is going to build vents and donate masks etc., but rest assured those will never go to places like ours. No PR value in that for greed driven America. Our staff is prepared to face whatever challenge may come our way and we will prevail. We always do and we always manage.
We were also instrumental in establishing a drive through COVID-19 testing site for our County and if I find some time I ‘ll tell you more about that. We also designed and build a UV sterilization cabinet as outlined and tested on here. There are also two videos that I yet have to convert so I can post on here. They will explain the patient flow a bit better. I know, you all must think it looks like some sort of refugee camp. It’s totally crazy but trust me, it’ll work and we will continue to provide safe patient care as we always do
Outside triage area. This way nobody gets to enter without being checked
This is south Texas. Installing shade cloth is important to our well being.
This will be setup with rapid triage equipment to identify and isolate
Ready for a privacy fence to keep onlookers away.
Not bad for one days work. It’ll do the trick
Decon tent for assessment of mild cases
Here is our overflow for moderate victims.
Am I concerned about things to come? !&&* yeah but I do believe “That which does not kill us makes us stronger.” We will prevail!
Here is a quick update about what has been going on in my little hospital/community. If we consider COVID-19 the unseen enemy, let me tell you that I have met the enemy. It is just as frightening as anyone could imagine. You just do not know who has it and it is the people that you least expect it who will hand you a surprise. We've had mild as well as severe cases of it and managed to get through this. For now, all off our patients survived. Thankfully my staff is on point and always vigilant. We managed to identify and isolate the patients appropriately without the possibility of us getting infected as well as protected the other patients in my departments by separating them to the right areas. It is scary. We still do have N-95 not because of some amazing corporate healthcare thing but by my staff being prudent and careful with the use as well as reuse on those. We are having critical levels with proper gowns now. No, we are not going to use trash bags but have managed to use our "home built" sterilizer. We manage to sterilize gowns,masks,face shields etc.
As for the efficacy of the sterilizer lights "cabinets", I purchased a photometer to measure the output of the UVC lights in this cabinet. I got an average of 500uW/cm^2 With those numbers we can re-sterilize about 15 masks in 20 minutes. Not bad for us since that is currently the daily max of masks we are using. I built an additional light that we can place in front of the cabinet so as to also do inside/backsides of gowns and masks at the same time.
What really helps us as a small facility is the willingness of Universities/ teaching facilities to share their information as well as experiences. It enabled us to learn from those and to implement processes that are helping us. Also, iFixit's initiative to get as many people involved in providing service manuals etc. for Ventilators that are commonly used makes a big difference. Even so we have not had to refer to those just yet, it provides us with a huge security blanket. We know that repair information is available and we know that there are people/organizations out there that actually do care about us. This just reiterates what we have been saying for decades on iFixit’s Answers as well as the Right to Repair. Being transparent and the sharing of information will always have a positive impact on human lives and our Planet. It makes a difference. Unlike companies like Apple, (of course not the only major corporation that does not care for small town USA) that never followed up/through with any request for assistance. No, free was never asked for. The staff in our hospital ended up providing plenty of old/older iPad's to us that we could then use to connect to our network. We use those to practice tele-medicine which does save us plenty of PPE. Again, it is not corporate America or corporate Healthcare that takes care of patients. It is the frontline staff that makes things happening. Patients do not survive because of corporate policies that are re-written daily on how to reuse masks over and over again. They survive because of the ingenuity that nurses and other staff are using to make sure that people are okay. COVID-19 has not broken the healthcare system, it only showed the general public how broken our system really is. Profit -before-People is the common factor in all of this. Let's squeeze every dime out of this and let's not worry about providers. We can always hire new ones. Let's not fool ourselves. Healthcare is no different than any other industry. Dealing with human lives is treated no different than dealing with any other commodity. As long as it makes money we will continue with this practice.
Best part of this crisis was that corporations, Governments (state and federal) as well as individuals within an organization, got called out. We found the ones that have integrity and ethics as well as those who lack those qualities. We now know who we can trust and rely on. Like my " 'Rona Team"!
These individuals have been doing the public testing in our community Drive-Thru test site since its creation. They are there. Day in, day out no matter how busy, how slow, how hot or how rainy; they are always volunteering their time. Nobody gets paid or reimbursed but everybody is there. That is the integrity, loyalty and devotion that we as human beings and healthcare providers should posses.
Anyhow, this is just an update of the ONGOING pandemic. It is NOT over yet, no matter what our "leaders" are telling us. Please continue to play it smart. WEAR YOUR MASKS, WASH YOUR HANDS AND PRACTICE SOCIAL DISTANCING.
Opinions expressed are solely my own and do not express the views or opinions of my employer
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