For the last 2 weeks I have gotten an up-close look at how hospitals are dealing with the Covid-19 pandemic. As a member of the hospitalist leadership team at Baptist Health Lexington, I have been intimately involved in the daily preparations and execution of virus management plans. It has become evident that for these action plans to work, flexibility has to be a core value amongst providers. Coronavirus was on our radar in February, but by early March it became clear it would be something no hospital would escape.
Together with my partners in the ED, ICU, and infectious disease we developed screening and treatment protocols. We have used a variety of testing methods, public and private, with varying turnaround times. Ultimately, our goal is to have rapid in-house testing. When that occurs, it will help us create better guidance for patients regarding self-quarantine and help preserve PPE and resources in the hospital.
For right now we have designated specific floors that are completely negative pressure for rule out patients with a consistent group of nurses, staff, and physicians providing care. We have plans in place should volume increase. One of our biggest concerns is the preservation of PPE. Currently the hospital is well supplied, however we have enacted preservation strategies in preparation for any surge which may develop. This includes using telehealth options when clinically appropriate on admitted patients and a robust de-escalation of isolation as negative results come back.
From a clinical standpoint we have seen a wide range of ages, symptoms, and severity. Those who present to the emergency room with mild symptoms can be swabbed and discharged home with instructions for self-quarantine. Those who are sick enough to be in the hospital but hemodynamically stable can be admitted to a telemetry floor for close monitoring. If they show respiratory compromise they are watched in the ICU with the plan of early intubation in a controlled setting when necessary.
With delayed testing, we have found chest CTs to be very helpful with risk stratification. The pathognomonic changes of Covid-19 can develop rapidly, as seen by dramatic changes in one patient within 4 days. While the virus is most dangerous in the older population with co-morbidities, we have seen young and otherwise healthy individuals severely affected. We have also seen deaths unfortunately. It is extremely important to continue to stress social distancing and good hand hygiene to “flatten the curve” so that Covid does not overrun local and national hospital capacity.