Crisis control: A hospital responds to a pandemic

The first thing that happened at Upstate — long before the first COVID-19 patient was identified in Central New York — was the establishment of an Incident Command. This group of approximately 75 individuals has a conference call twice each day. Led by Stephen Thomas, MD, chief of infectious disease, each call covers all aspects of operations, patient care and safety, logistics, communications and materials management across the entire medical university during the crisis. Here, a screen shot shows participants as they gather online for their morning call. (photo by Kathleen Froio)

The first thing that happened at Upstate — long before the first COVID-19 patient was identified in Central New York — was the establishment of an Incident Command. This group of approximately 75 individuals has a conference call twice each day. Led by Stephen Thomas, MD, chief of infectious disease, each call covers all aspects of operations, patient care and safety, logistics, communications and materials management across the entire medical university during the crisis. Here, a screen shot shows participants as they gather online for their morning call. (photo by Kathleen Froio)

BY AMBER SMITH

It felt like the world turned upside down.

So many changes, so suddenly, so surreal.

Medical classes moved online. Research laboratories shut down. Fever checks. Face masks. Toilet paper shortages. Rationing of pasta and butter and sugar. Elective surgeries postponed. Almost no hospital visitors allowed. Daily briefings by the governor and an order that all but essential businesses must close. Employees who could work from home began to do so. Upstate University Hospital’s daily operations were turned over to an “incident command” structure reserved for major disasters.

Upstate University Hospital CEO Robert Corona, DO (center), and Stephen Thomas, MD, chief of infectious diseases  (right), share their COVID-19 expertise with Dan Cummings, NewsChannel 9 anchor. (photo courtesy of NewsChannel 9)

Upstate University Hospital CEO Robert Corona, DO (center), and Stephen Thomas, MD, chief of infectious diseases  (right), share their COVID-19 expertise with Dan Cummings, NewsChannel 9 anchor. (photo courtesy of NewsChannel 9)

While the coronavirus tore through civilization, many in health care continued caring for the sick, feeling more like they were reporting for duty in a war against a microscopic villain. Others were isolated at home, watching grimly as the Johns Hopkins University global coronavirus map turned redder as more cases of COVID-19 were reported on every continent except Antarctica, and as federal health officials predicted maybe 200,000 Americans could die. Just like in the movie “Contagion,” this virus got its start in a bustling Asian city some 7,500 miles from Syracuse.

Infectious disease experts at Upstate were aware of the novel coronavirus and the respiratory syndrome it causes. It was similar in some ways to the SARS outbreak in 2002, and the MERS outbreak in 2012, both respiratory illnesses caused by other types of coronaviruses. After the first case of COVID-19 was diagnosed in the United States in January, Stephen Thomas, MD, Upstate’s chief of infectious disease, said what’s still true today: “We don’t know more than we do know. It’s an evolving story.”

Upstate nurse Julia Burns greeted a patient at the coronavirus testing site at the Upstate Specialty Services at Harrison Center. To minimize contact, gowned and masked staff took nasal swabs in the parking lot, so patients did not have to leave their vehicles. The swabs were tested for dozens of respiratory illnesses in the pathology lab at Upstate. If those were negative, the swabs were sent to Albany for coronavirus testing. (photo by Susan Keeter)

Upstate nurse Julia Burns greeted a patient at the coronavirus testing site at the Upstate Specialty Services at Harrison Center. To minimize contact, gowned and masked staff took nasal swabs in the parking lot, so patients did not have to leave their vehicles. The swabs were tested for dozens of respiratory illnesses in the pathology lab at Upstate. If those were negative, the swabs were sent to Albany for coronavirus testing. (photo by Susan Keeter)

Common symptoms of fever, cough and achiness are well-known, but there is no proven treatment. This disease is more infectious than seasonal influenza, and deadlier. Scientists, including some at Upstate, are developing tests for the virus and for the antibodies that would indicate a person had recovered. Others are working on a vaccine. And others are involved in ventilator research and efforts to treat those infected.

At Upstate, some 75 hospital leaders gather twice a day – virtually – in “incident command” meetings so that everyone is aware of issues related to the coronavirus pandemic: how many beds are available, the supply of masks and other personal protective equipment (PPE), staffing issues, requests from county or state emergency management officials and more. With incident command in place, the meetings launched March 16, the same day the first case of COVID-19 was confirmed in a patient in Onondaga County.

“Decisions are made, data is updated. We execute,” explains Robert Corona, DO, chief executive officer. “It’s pivoting, and making impactful decisions hour by hour.”

Someone during each meeting summarizes important information from the World Health Organization, the Centers for Disease Control and Prevention, the state Department of Health, scientific literature and other health organizations. “We put all of that in context,” Thomas says. “Our policies are first to protect Upstate staff and second to conserve PPE. Protecting our staff is our priority. Period. Full stop.”

The leaders explore how best to care for infected patients. Dean of Upstate’s College of Medicine Lawrence Chin, MD, coordinated a 90-minute conference call between Upstate experts and Chinese doctors in Wuhan — the first COVID-19 battlefield — to learn from their experiences.

Immediate response: Restrictions to reduce possible exposure to COVID-19 change quickly. On March 16, Upstate University Hospital implemented a “no visitor” policy in response to the first two confirmed cases of COVID-19 in Onondaga County. By March 29, 146 confirmed cases and one death were reported in Onondaga County. (photo by Susan Kahn)

Immediate response: Restrictions to reduce possible exposure to COVID-19 change quickly. On March 16, Upstate University Hospital implemented a “no visitor” policy in response to the first two confirmed cases of COVID-19 in Onondaga County. By March 29, 146 confirmed cases and one death were reported in Onondaga County. (photo by Susan Kahn)

“We thought it would be really helpful to have the perspective and experience of doctors that have been dealing with this the longest,” Chin explained to Syracuse.com.

They discussed a variety of topics, including early identification of patients, chest imaging, drug use, hormone therapy, immune adjustment, plasma exchange and treatment using a machine called ECMO, extracorporeal membrane oxygenation, which adds oxygen, removes carbon dioxide and recirculates a patient’s blood.

Mental health concerns have also been addressed. Upstate interim President Mantosh Dewan, MD, asked the chief of psychiatry to talk in a webinar to all
Upstate employees about healthy ways to cope.

When Governor Andrew Cuomo ordered all hospitals in New York state to be ready to expand capacity by 50 percent, Corona says his team came up with a plan to obtain beds and staffing to increase by 77 percent. Some private rooms would be doubled up, and some other rooms in the hospital would be converted for patient care. He said nearby hotels were prepared to help as well, providing lodging for health care workers or patients.

The incident command team also works through ways to minimize the hospital services that are nonessential, for the time being, and how to keep essential services operating. Because, even as the crisis unfolds, heart attack patients are still revived, people injured
in car crashes are still put back together, babies are still born.

Mantosh Dewan, MD, interim president of Upstate Medical University, prepares for one of his videotaped updates about COVID-19 issues to Upstate’s more than 9,000 employees. (photo by William Mueller)

Mantosh Dewan, MD, interim president of Upstate Medical University, prepares for one of his videotaped updates about COVID-19 issues to Upstate’s more than 9,000 employees. (photo by William Mueller)

Upstate Health magazine cover for spring 2020, special coronavirus editionThis article is from the spring 2020 Upstate Health magazine, a special edition dealing with the coronavirus.

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