It's a logistics puzzle that might stump just about anyone: How should a hospital prepare to handle an unknown number of very sick people over an unknown span of time?
That's the question that El Camino Health's CEO Dan Woods is working to answer, even while COVID-19 continues to claim lives in Santa Clara County.
El Camino's Mountain View hospital was the site of the first COVID-19 related death in Santa Clara County on March 9. As of March 27, there were 574 confirmed COVID-19 cases and 20 related deaths reported countywide.
Figuring how to prepare a facility for a potentially large influx of COVID-19 patients – a scenario that other hard-hit hospitals in New York and Italy have likened to a war – without knowing how many people will be impacted, how severely ill they will become, and over what time span, is a difficult task.
The hospital has been busy looking at a number of different models and projections to see how fast the virus will spread, Woods said in an interview Friday.
One of the biggest variables in how bad the pandemic gets is how the community behaves in response to the shelter in place orders, he said.
"It all depends on the success of the shelter in place," he said. "If it's successful, we might peak out in a week, or we might have already peaked."
And if it's not?
"Then the peak might not happen for months down the road," he said. "You may end up seeing other situations with high degrees of people positive with COVID."
When there is a high rate of transmission, he said, everybody gets sick at once.
To use internet-speak, when something "goes viral," it undergoes exponential growth, he said. "The same concept of exponential growth happens in the transmission of the virus. If you're compliant with shelter in place, it breaks that chain," he said.
"If anybody saw the difference that sheltering place makes, it's absolutely amazing."
So far, the hospital's approach has been to plan for the worst and hope for the best, he said.
Planning for the worst
It was roughly two and a half weeks ago that Woods, at El Camino Hospital Board's last meeting on March 11, made a public statement calmly explaining that the hospital has negative pressure rooms that filter air many times to contain infectious diseases, and that the hospital routinely deals with highly infectious diseases such as tuberculosis. The hospital had already been preparing for weeks, he said, and the Centers for Disease Control and Prevention had interviewed an infectious disease nurse at the hospital about the hospital's policies and procedures for contagious diseases, he added.
Since then, the number of confirmed coronavirus cases has exploded to more than 100,000 across the U.S.
The hospital is using several different models to try to predict how many patients may be coming to the hospital's emergency room needing medical help, he said.
The hospital has also erected tents to prepare for a surge in COVID-19 patients, though the tents are not currently in use, according to hospital spokesperson Jennifer Thrift.
Hospital staff members have been keeping a close eye on their stock of personal protective equipment, and how fast it's being depleted, Woods said. They also have orders pending for new equipment and are also accepting donations of new and unopened containers of the following: gloves, isolation gowns, hard goggles, disposable eye shields, shoe covers, nurse caps, germicidal disinfecting surface wipes, Clorox disinfecting wipes and masks. More information here.
While the hospital has also been proactive in limiting visitors, it is allowing patients a single visitor to witness a birth or a death. The decision to continue to permit visitors under those limited circumstances was done in consultation with a number of sources, he said, but comes down to a desire to permit families to be with their loved ones at such important times.
Hospital administrators are talking frequently with county public health officials, Woods said. Local hospital CEOs have weekly calls with the county health department. El Camino has sent two nurses who have experience at field hospitals to work at the 248-bed federal medical station that is being set up at the Santa Clara Convention Center, he said.
Hoping for the best
Keeping morale up among staff members at the hospital has been another challenge, he said.
"Each health care worker is being asked to do tasks they haven't typically done before," he said.
One step the hospital took to reduce uncertainty for front-line providers was to have a Q&A session between hospital employees and an infectious disease specialist. Employees have also undergone training in how to use personal protective equipment, he said.
One thing the hospital won't do is set policies for how to handle a scenario in which there may be too many patients with COVID-19 than can be treated with ventilators. Elsewhere, such as in Italy, physicians have been faced with wrenching decisions about whom to provide with life-saving treatments.
Woods said it's not a kind of decision that should be decided through a policy.
"Those policies should never exist," he said. "That's a clinical decision. It's a medical decision."