How Hospitals & Clinics Can Prepare for COVID-19, Global Cases Surge (Lecture 38)
Welcome to another MedCram covid-19 update. Here, we see 182,000 confirmed; total death 7100; total recovered 79,000. The map is turning into basically a red blob.
I want to go over to the WorldOmeter website and show you some interesting trends. We see here the total cases starting to accelerate once again because we’re reaching an epidemic phase outside of China. If we look here at total deaths, they are also being mirrored. If we looked at active cases, we can see here that there was a plateauing, even a dropping off as China was containing what was going on. Then outside of China here in Italy, South Korea and now United States, we’re starting to see an increasing number of those active cases.
But here’s something that’s very interesting. In the close cases, when we show the graph for that, we’re actually starting to see that there is an upturn here in the death rate where they’ve either gotten better or they’ve passed now. There are only two reasons that I could see for the death rate to be increasing; either number one: the virus is mutating and becoming more deadly; or number two: there is a lot less testing and the number of active cases is going up much more. So I suspect given the fact that the death rate is going up, there are a lot more cases that are just not being picked up out there because of lack of testing.
We can see here that in China, where there was a rip-roaring infection, of course at the beginning, the total cases per million population was 56. We’re seeing a much higher number here in Iran and Spain and even in South Korea, in Italy. We don’t have that number here, but we can see that those numbers are quite high and would probably be very large. In terms of the United States, we’re seeing very small numbers. The question is whether or not that’s because of lack of testing.
If we look again at the active cases list, we see here by far the most amount of active cases going on right now is in Italy, and that is the tragedy right now. What is going on in Italy? Because there are so many active cases happening so quickly that their healthcare system is being overwhelmed.
I want to go back to this notion of ‘flattening the curve’. I think there are some other things that we need to talk about. So if this represents the number of patients over time, and this dashed line represents the capacity of the health system, then clearly what is going on right now in Italy is something that looks like this, and we can only hope that it starts to come down quickly.
What we are trying to do here in the United States is slow down the rise of this so that we’re able to take care of these patients that are coming into the hospital. So the question here is “is this going to be the United States?” And the question here is ‘is this Italy”? I think it has already proven itself to be in this kind of situation, and what we are trying to do in this country is to make sure that we stay below that capacity of our healthcare system. Because if we have something that looks like this, then this is going to represent the excess deaths, and the reason why this would happen is because of no isolation.
So if you’re wondering why we are doing isolation is that we go on a trajectory of this rather than this. In my clinical practice, and in my administrative practice, in the medical group that I work for, we have spent a lot of time trying to come up with a surge plan and a plan to put into place both in the clinic and in the hospital to actually modify this dotted line for us locally.
I like to about that because obviously we’re smart enough to be able to work on two things at the same time: to get this surge down and to flatten the curve. But are there ways that we can raise this bar so that we’re ready to meet this in the middle? So the question is what have we been doing and what are some suggestions that we can give?
let’s talk about some of the support that we’re doing. The purpose of this talk is not only to let healthcare providers, clinics, hospitals, out there know what it is that can be done. But it’s also to let all of you know that yes, your healthcare infrastructure is full of people working very hard right now to come up with solutions so that we don’t have to deal with this if we get a surge that we can’t normally deal with.
I’m going to divide this into two categories: what we would do at the hospital and what we would do to personnel. These are people and bricks and mortar. The first thing is setting up the emergency room so that there is a pre triage outside, and that usually involves a tent.
Sometimes you have to get clearance from your county to be able to treat patients outside of a licensed building. Usually, that can probably happen by this point. If you haven’t already gotten that kind of approval. This tent also allows you to triage people and to put masks on people who may have covid-19 and could spread it to other patients in the emergency room, proper or healthcare providers nurses Etc.
inside the hospital you can set up whole wings that have negative pressure and we’ve talked about this before the other thing you need to think about is just setting up more rooms these rooms can be other negative pressure Wings whole wings of the hospital, but you have to have engineering look at the situation look at the structure and see how they can configure it so that you’re dealing with a negative pressure room as opposed to a positive pressure room.
You have in the operating rooms.
The other thing that you have to look at is the possibility that some of your providers might be quarantined because they were exposed to somebody with covid-19. And so for that you need to think about robots. So robots are basically computers on mechanical wheels that you can wheel around and they have very powerful microphones speakers and they also have very powerful cameras so that you can see close up and they use these in hospitals where they need in a row.
It’s just 24 hours a day, but they don’t have one. This is the way that they do it for stroke centers, but this could also be very helpful. If you have a physician who’s quarantine at home and can’t come into the hospital but you still need their expertise the last thing that I want to talk about our ventilators so a couple of things on ventilators number one, there are disposable ventilators that you can get fairly cheap and number two is this idea of hooking up multiple patients to ventilators this
It is an off-label use but it’s something that has been done before in an acute surge situation.
So here’s a really cool video that I want you to see and I’m going to put a link to in the description where dr. Babcock and emergency room physician describes in detail how you can take a regular ventilator and actually hook up numerous people to this ventilator and looks as though there are companies that are responding to this video that are actually putting together kits that allow you to readily put ventilators into rooms that allow you to ventilate multiple patients. So I think every hospital in the country should be looking at this.
The as a quick way of temporarily if you need to ventilate patients when you don’t have enough ventilators until you do have enough ventilators.
So let’s talk about Personnel. What do we do? If we don’t have enough doctors primary care doctors typically working in the clinic are seeing well patients. That’s not a priority during a surge. We can take primary care physicians and get them into the hospital many years ago before hospitalist. This is what primary care physicians did they worked in the hospital and in the clinic and even though they might be a little bit Rusty. Some of them are probably well suited to work in the hospital and those
Are the ones that we could select you would have to waive privileges in an acute situation and usually hospital by laws allow for that sort of thing. Especially if it is approved by the chief of staff. What about primary care doctors or clinic patients in general? A lot of those things can be dealt with over the phone. So should you be having elderly patients coming to your office sitting in Waiting rooms? If it is something that can be dealt with over the phone call them up.
And deal with it over the phone. There are some insurance companies that will actually even pay for that kind of a visit if that’s what you’re doing. And obviously they’re going to be visits that you just have to see so these are patients that are being worked up for cancer timely application of tests and reviewing of those tests can be done very quickly. But again, there are still a lot of things that can be done over the phone and if that is the case then that’s what should be done.
What about in the Intensive Care Unit? Well, there are hospitalists people that work in the hospital but not necessarily in the Intensive Care Unit that can help out in the ICU. If it becomes very crowded so hospitalists into the Intensive Care Unit to help out the intensivists who are there. So again, you’re working a little bit out of your area of expertise, but the risks associated with that are far outweighed by the benefits of taking care of people during the surge. What about students?
So this is what happens on a daily basis in teaching hospitals. You have students you have residents. There are able to meet The Surge demand not so much if you have a private hospital where there are no students or residents, but is it possible for students to come into those hospitals to help that has to do with laws that has to do with credentialing and you have to see if those things can be waived to help out in a specific case or cases where you have a surge and you need help what?
Bringing in other doctors, so that’s exactly what’s going on right now here in the United States usually a doctor is licensed to practice medicine in a specific State what has happened is some of those state requirements have been waived. So doctors can travel to other states to help out in Surge situations right now in the United States, not every state is impacted the same as other states are and so it’s possible that doctors from states that are not being impacted could come to those states that are being impacted.
Did so that they can help that’s kind of what’s going on actually right now in Italy but to a much larger extent because you can see the doctors and Italy are having a very difficult time handling this Surge and help is coming from a very unlikely Source. It’s actually coming from China China has had an immense amount of experience in dealing with this coronavirus. You can see here in this article which will put a link to in the description below. So this article goes on to talk about
All of the help and the resources that’s coming from China to help out in Italy which has the most active cases in the world right now the Italian Minister Luigi. Di maio told Rai television. Our doctors don’t need anyone to teach them in their job. But the Chinese doctors were the first to treat the virus and they can bring their experience and this folks is what it’s going to be about when we’re talking about a world pandemic of a deadly virus. We’re going to have to help each other out if we’re going to be able to
to get through this together.
The recipe for Success if we’re going to be able to fight effectively covid-19 is going to come from two different parties. Number one the doctors the nurses the respiratory therapist the hospital’s they are going to have to increase the bar in terms of what we are able to do in terms of our health care abilities, but it’s not just there. Also. We’re going to need help from the public at large to continue ice.
Isolation to make sure that we’re able to flatten that curve. So that’s at the end of the day. We can take care of everybody that we need to take care of. Thanks for joining us.