How Do Hospitals Prepare for Coronavirus Patients?

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On Friday evening, 57 Americans arrived on a flight in Omaha, Nebraska, roughly 35 hours after leaving China.

American evacuees from the coronavirus outbreak in China board a bus after arriving by flight to Eppley Airfield in Omaha, Neb., Friday, Feb. 7, 2020. The evacuees are to be quarantined at Camp Ashland, a nearby Nebraska National Guard training base.

They are among the hundreds of Americans who have been evacuated from China in the wake of a novel coronavirus outbreak that has infected more than 40,000 people and killed more than 900, mostly in mainland China. Other flights carrying U.S. evacuees were sent to locations such as San Antonio, San Diego and the Sacramento, California, area, and the passengers will be quarantined for up to 14 days from the time they left China.

In the Omaha area, the evacuees are being confined to the Camp Ashland military base and will be regularly monitored for symptoms of the new virus, which can include fever, cough and other respiratory issues. There are 12 confirmed cases in the U.S. – as well as one U.S. citizen who died of the virus in China – and while health officials expect additional cases to surface, they say the risk of person-to-person spread in the U.S. remains low.

Nebraska Medical Center, about 30 miles from the military base, may be uniquely positioned to care for any eventual coronavirus patients. It was one of 10 regional hospitals in the U.S. specially designated in 2017 to manage serious infectious diseases – it treated three Ebola patients in its biocontainment unit in 2014 – and recently opened a nearby quarantine unit.

Shelly Schwedhelm, Nebraska Medicine’s executive director of emergency management and biopreparedness, spoke with U.S. News about how the hospital has prepared for potential cases of a virus that first surfaced in December. The interview has been edited for length and clarity.

Tell me how the hospital has been preparing for the folks at Camp Ashland and potential coronavirus cases more broadly.

For those folks, the federal government is the lead, and we are simply providing them wraparound support services. We have worked to make sure that food, linen, cleaning services, information technology, those sorts of things are available and supported out there. In addition, we were able to get an ambulance that 24/7 will be based out there, so if anybody did become symptomatic, or have some sort of a medical emergency, there would be prompt care for them to get them brought to our organization.

In more global terms, we’re always in a ready state with our quarantine or biocontainment unit here. We have no idea whether this virus could become a pandemic-type event. We’ve done quite an extensive amount of planning over the last several years and recently refreshed our pandemic plan assumptions, and have done quite a bit of stockpiling of personal protective equipment over time.

At what point would you consider activating the biocontainment unit, and in what situation would the quarantine unit come in to play?

We’ve got a few scenarios. With general day-to-day in our health system, we’ve always had a robust symptom- and travel-screening strategy. That really helps alert the team to quickly isolate the patient, mask the patient – which we do for influenza-like symptoms. Of course, this new novel virus just evolved a few weeks ago, so that’s when we actually began the screening for China.

But it really depends on the person – for example, here in our local environment, and even with the folks at Camp Ashland, if they have minimal symptoms that need to be tested, we’ll work hard to really help them self-isolate, because if this were somebody from the Omaha community, we would likely encourage them to self-isolate at home. They really probably wouldn’t need admission to the hospital for minor symptoms.

Then if we have people that are exhibiting symptoms and definitely need care in a hospital setting, we’re going to go with these folks to the biocontainment unit – not necessarily because they absolutely need to be in the biocontainment unit, but we really believe strongly that risk assessment and containment is the ultimate priority, initially.

If case counts would exponentially increase anywhere, then obviously a biocontainment unit wouldn’t have enough beds. That’s why we would refer back to all the pandemic planning and surge strategy work that we’ve done.

I know you worked very closely on the hospital’s response during the Ebola outbreak. As you’ve developed this response plan, are you drawing on any lessons from that, or H1N1, or anything else?

Absolutely. We’ve got a very robust process here, and actually, our federal partners are totally engaged with that process. That was one learning we had from back in 2014, and it’s working really well right now in the response.

I think the other is just simply making sure that we’re mindful of our inventory numbers, especially when it comes to personal protective equipment, and then having a planned approach – if case counts would exponentially increase, just having that plan of surge, and where we would go, what we would do, what would the care look like.

Can you describe that surge plan a bit more?

For example, during regular influenza season – even this year, which was a really rough influenza season – we had clinics that we allocated to focus on influenza and then really did a lot of communication to really try to guide people to those locations, so that the emergency rooms weren’t being overwhelmed. Obviously, if people present at the ER, we care for them, but we really tried to get people with minor symptoms to go to those dedicated clinic areas or urgent care areas. We have an ambulatory strategy that we would flip the switch on if we needed to do that. It makes sense to have the right level of care.

What’s the coordination with other providers and health departments been like?

We actually are part of our Omaha metro coalition, so we actually have done quite a bit of coordination already among our coalition members, and that includes public health, health care, emergency management and EMS.

We meet routinely, and then we also have an incident management system that we share. We’re sharing a daily briefing, not about the repatriated Americans, but just about planning in general for surge. I just pushed out our personal protective equipment donning and doffing protocol with visuals. We’re doing our best to really push things that we think could be helpful to others.

What are you expecting to see over the next few weeks?

I think it really is going to depend on how well containment occurs. The challenge with this virus is there is no vaccine. Usually with influenza year to year, there’s a vaccine. Nothing’s ever 100%, so you’re still going to have cases. But for a novel coronavirus situation like this, from start to stop, typically vaccine production takes six months. Just like with H1N1, we were well into having lots and lots of cases before we got a vaccine. I think that’s what people are worried about.

In Omaha, we’ll continue to do coordination within our coalition, and then as a leader in our region we will continue to push things out and coordinate (with) the states that surround us.

We also have a very significant national role because of our work in 2014 – we also support the National Ebola Training and Education Center. We are partnering with several professional organizations to do a webinar coming on all things coronavirus, and key guidance and things like that.

Is there anything else that you want people to keep in mind about all this, or any misconceptions that you want to correct?

I think it’s important for people to make sure they go to trusted sources for information. There’s a lot of bogus things out there. And then I think it’s important to do all the usual and customary things we do during influenza season – handwashing, distance, if you’re sick, stay home – all those sorts of things.

Copyright 2020 U.S. News & World Report

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