Matt Choate is in charge of preparing Central Vermont Medical Center (CVMC) in Berlin for a surge of patients with COVID-19. The disease has been spreading exponentially in Vermont, with the number of people testing positive doubling every two days. But Choate isn’t interested in talking about calculations of how fast the disease is spreading.
He said that the effectiveness of interventions like closing down bars and limiting the size of gatherings could change the speed of spreading. “What I’m sure of is there’s going to be more cases,” he said. “We’re planning as much capacity as we can get to in a timely way, and we’ve been trying to get ahead of the number of patients. So far, we’ve been successful.”
But Choate acknowledges, “There will come a point when you’ve reached your capacity. Then you look around the state and see if there are other places that have capacity.” If or when that’s not enough, options include building field hospitals or turning other buildings into hospitals.
Meanwhile, the hospital has been rapidly changing how it operates, to clear more spaces for COVID-19 patients. Elective surgeries have been postponed. People coming in for routine physicals are asked to wait. Asked about pregnant women, Choate said, “We’re caring for pregnant people as we’d normally care for them, with extra precautions.”
The hospital doesn’t want people with COVID-19 who don’t need the hospital’s facilities to come. To that end, Choate said, they set up a pop-up site in a camper, away from the hospital. It’s open every day.
“You can’t just go there if you think you need a test,” Choate said. For those who think they have COVID-19 symptoms, they can ask for a referral to the pop-site from their doctor or call the hospital and talk to someone at a special COVID-19 call center for a referral.
Other measures to keep people with COVID-19 away from the hospital include using telemedicine when possible at the hospital’s practices, according to CVMC’s communication director, Elliot Bent. On Saturday they began asking visitors and employees if they have COVID-19 symptoms and checking their temperatures before they’re allowed to enter the building.
In northern Italy, one of the international hotspots for COVID-19, hospitals have been overwhelmed by the number of patients in acute respiratory distress who need ICU care. Dr. Fabiano Di Marco works as head of the respiratory unit of the Hospital Papa Giovanni XXIII in Bergamo, near Milan. He told the New York Times they were using doctors far outside their specialty areas. “We had to teach cardiologists, dermatologists, rheumatologists how to treat this patient.”
The Medical Center has not yet begun training doctors in other specialties, Choate said, but it has been increasing available staffing in other ways. Nurses, nurse practitioners, and physicians have been coming out of retirement and receiving re-entry and refresher education. Staff in doctor’s offices have been given additional training. “We aren’t at the point of asking a dermatologist to take inpatients,” Choate said, “but we can take a nurse from their office.”
Masks, gloves, gowns, and other personal protective equipment (PPE) are in short supply in hospitals around the country. Choate said the hospital is conserving its existing supply using standards from the World Health Organization (WHO). “We have an adequate amount now, but that supply coming in behind is absent, so that’s probably the first shortage we’re going to see.”
“Labor is next,” said Choate. “On a good day, we don’t have a full complement of staff, partly because the unemployment rate in Vermont is so low. So if you’re starting from that point, and you’re suddenly stressed with more patients, staffing is going to become a problem at some point.”
Choate said that he hoped that CVMC would be okay for the foreseeable future with the extra staff pulled in from other parts of the University of Vermont Health Network, of which CVMC is part. “But if health care workers start becoming ill, that’s when we’re going to have some staffing challenges.”
CVMC President Anna Noonan issued a statement Friday saying that a provider at the hospital had tested positive for COVID-19 and may have been contagious while working at the hospital. The hospital has contacted the patients and staff who may have been exposed to the person and recommended they self-quarantine for 14 days, she said.
Drug supply may become a problem later, too, Choate said. He said there were 20 drugs they can no longer order. Their current stock is adequate, he said, but if the hospital is overloaded later, it could become a problem.
Di Marco, the Italian doctor, said they needed different guidelines on who to care for when hospitals are overwhelmed with patients. Normally, he said, an 80-year-old with a severe respiratory failure and renal failure would be admitted to the ICU. But if there aren’t enough ICU spaces, maybe a 45-year-old patient gets the ICU bed, and physicians need guidelines to help them decide. Asked about this, Choate said he didn’t know of different treatment guidelines of that type.
Asked about the cost of all these preparations for a surge of patients, Choate said the biggest financial hit to the hospital so far is the loss of revenue from reducing patients seeking other treatments such as elective surgery. “If you cut your volume by two thirds, you’ve cut your revenue by two thirds, and that’s your bigger hit.”