CORONAVIRUS

Hospitals approaching COVID-19 rise for second time with more confidence

Providers have better understanding of treating patients, aren't grappling with supply challenges

UnityPoint - St Luke's Hospital employees gather for a walkthrough of the emergency department, which includes a new scr
UnityPoint - St Luke’s Hospital employees gather for a walkthrough of the emergency department, which includes a new screening shed, outside the emergency entrance at the hospital in Cedar Rapids on Tuesday, April 7, 2020. The shed will be used to screen patients with mild to moderate respiratory symptoms as part of the ER triage process. Health care workers on Tuesday walked through the new patient flow as they prepared for anticipated high patient volumes due to coronavirus. (Liz Martin/The Gazette)

A conversation with hospital officials about the novel coronavirus pandemic in early July takes on a much different tone than it did back in March.

In recent days, as the number of new COVID-19 cases continues to rise locally, local hospitals and the county public health departments have continued conversations on how to best prepare for a surge in hospitalizations and deaths.

But this time, hospital officials say they don’t have the same concerns they did before about their supply of necessary personal protective gear as well as the number of ICU beds and ventilators on hand.

That, coupled with health care providers’ expanded understanding of how the virus operates and effective treatment options for patients, means officials are confident hospitals in the Corridor “would not be overwhelmed.”

“We will have to deal with (hospitalizations), but I have unbridled confidence that we can handle whatever is thrown at us,” said UnityPoint Health-St. Luke’s Hospital’s Chief Medical Officer Dr. Dustin Arnold.

Beginning this past month, the rate of new cases rose sharply in certain parts of Iowa, making the state one of the worst in the nation for new cases per capita. A Washington Post analysis of states showed Iowa was the nation’s 17th worst rate of new COVID-19 cases per 100,000 people.

The majority of these individuals are between the ages of 18-25 and were exposed at a large social gathering, most likely at a bar or restaurant, according to local public health officials.

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State officials have said these new cases are concentrated in counties where public universities and colleges are located, as well as counties with high population densities.

Hospital officials in Cedar Rapids and Iowa City say they are — once again — watching the metrics closely and have surge plans ready to launch whenever it’s needed.

Though younger people are less likely to require inpatient care after a novel coronavirus infection, health care officials are preparing for a potential spike in the hospitalization rate in the coming weeks.

“As they interact with family members, parents, grandparents and people in an older age group, we anticipate that those hospitalizations might go up,” said Dr. Theresa Brennan, chief medical officer at the University of Iowa Hospitals and Clinics.

But this time, they are not grappling with a strain on the country’s supply of personal protective gear. The worldwide supply chain has corrected itself after weeks of shortages, and area hospitals have enough supply on hand to address needs as they arise, said Dr. Tony Myers, chief medical officer of Mercy Medical Center.

Early on in the pandemic, Myers said the hospital “could go week after week, or months on some things, with no new supplies.”

“That’s massively changed,” he said.

The lack of PPE was what prompted hospitals in Iowa, and across the nation, to suspend elective and otherwise nonemergent surgical procedures for several weeks starting in March.

For now, those cases will continue. However, Myers stated that if it gets to the point that there’s not enough supply to care for sick patients and conduct elective surgeries, officials will likely reassess.

More hospital employees testing positive

Because of the high prevalence of cases in younger members of the community, officials at the University of Iowa Hospitals and Clinics have noticed that they are seeing more employees become infected now than in March.

“That has an impact on our ability to take care of patients,” said

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As of June 30, 173 UIHC employees have tested positive for COVID-19 since the beginning of March. Brennan said UIHC had reached about 90 cases among employees for the first several weeks of the pandemic, but recently saw a resurgence in positive tests among staff that aligned with the resurgence in the community.

“In our initial surge plan we’ve taken into consideration employees who could be sick, but we really focused a lot on beds and on ventilators, those non-human resources that we needed,” Brennan said. “So in the last week we’ve also developed with our departments plans for how we would care for patients if large numbers of providers — such as nurses and respiratory therapists — became infected.”

Part of that plan includes increased cross-training among nursing staff at all levels for other departments, should another part of a hospital become short staffed.

As of May 1, the UIHC Department of Nursing coordinated cross-training for 1,420 staff nurses and 83 nursing assistants.

Infections among staff is also a huge concern for hospital officials in Cedar Rapids, Myers said, prompting both hospitals to increase internal messaging to staff about the importance of continuing social distancing, wearing masks and staying home when experiencing symptoms.

Arnold said he does not see current policies on visitors allowed into the hospitals changing anytime soon.

“It’s just too early to ease visitor restrictions,” he said. “With things opening things back up, and the protests and college starting up again in the fall, a lot of people are out and about in close proximity. It would be foolish to curtail those restrictions, at least until we know how (the virus) is going to unfold.”

Increased medical understanding

Initially, the recommendation to doctors nationwide was to place COVID-19 patients having difficulty breathing on mechanical ventilators, Myers said. The thought was that the risk for transmission to caregivers would be less, because those patients would not be coughing while in comas.

However, patients on ventilators tend to have worse outcomes and doctors have found it’s difficult to get a patient off a machine once they are placed on one.

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“As we took care of more and more (COVID-19 patients), we found that if we used different ventilation support to keep them oxygenating appropriately, but avoiding paralyzation, the patients got better sooner,” Myers said.

Sometimes there is no other option than to place a patient on a ventilator, but Arnold said doctors at St. Luke’s developed methods — thanks to advice from doctors in other parts of the country — to keep patients off life-support machines.

And as more people have recovered from a COVID-19 infection, convalescent plasma therapy — which uses antibodies to help patients fight off a virus — has become a more readily available option.

Doctors have also found other ways to help treat COVID-19 patients, including using a steroid and an antiviral medication called Remdesivir, Myers said.

“The tone is way different from it was in March,” Myers said.

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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