A college basketball arena in Burlington could house 100 Covid-19 patients. The Champlain Valley Expo now holds 400 hospital cots. Rutland Regional Medical Center is eyeing its conference center to add dozens of new beds.
Hospitals around the state are transforming and expanding to prepare for a potential surge of Covid-19 patients. But they’re preparing without knowing exactly when that surge might hit — or how severe it could be.
“It’s a sort of waiting game,” said Elliott Bent, communications director for Central Vermont Medical Center, standing in a hallway lined with isolation rooms for suspected and confirmed Covid-19 patients. While state projections show the growth of cases peaking in the next 2-4 weeks, it’s unclear when the Berlin hospital will see its facilities fill up.
CVMC has rerouted traffic around its emergency department to help ambulances reach its doors more quickly. It’s turned an ambulance bay into a corridor of isolation rooms for possible Covid-19 patients. Staff are “constantly” being trained on how to use personal respirators, a reusable form of protective equipment that allows the hospital to conserve its limited supply of N95 face masks.
In the meantime, the hospital has limited visitors and cut back on routine care, leaving some hallways virtually empty. “There’s a certain anxiety that comes with waiting,” Bent said. “I would describe it as the quiet before the storm.”
On this week’s podcast, Bent and others describe the efforts underway to prepare hospitals for the peak of coronavirus cases. Plus, VTDigger’s Katie Jickling discusses how worst-case scenario planning poses difficult questions for health care institutions.
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This week: hospitals across Vermont are transforming their facilities to get ready for a potential surge of Covid-19 patients. But they’re preparing without knowing exactly when that surge might hit – or how severe it could be.
On Tuesday, our health care reporter Katie Jickling and I visited the Patrick Gymnasium in Burlington, which until recently was the basketball arena for the University of Vermont.
Katie Jickling: So everybody who enters and exits the Patrick Gym has to be screened, meaning a nurse measures your temperature…
Intake nurse: Any cough today?
Katie Jickling: And everybody who comes in and comes out needs to be wearing a mask.
Intake nurse: Do you have a mask?
Katie Jickling: Inside they’ve basically transported a whole hospital into what was very recently a basketball court for college athletes.
Erik Anderson (Medical Director): Our unit here is really focused on being another wing of the hospital. So patients will go through the emergency department or the urgent care, and then they will be transferred here if we feel it’s appropriate for them to be here, if their care needs match what we can do and if the medical treatment plan seems appropriate.
Katie Jickling: There are 50 very simple beds, cots really, set up across the room, each with a single pillow and a blanket that really, to me, evoked a World War II hospital from the movies.
Erik Anderson: You’ll notice that there are green tanks supplied throughout the building. One of the needs of patients that we expect to see is oxygen, and we wanted to make sure we can deliver that…
Katie Jickling: There’s a set of computers where nurses and doctors are typing away on a variety of types of plans for staffing. They’re thinking about how to transport patients to and from the facility. They’re thinking about what to do when a patient there needs to go to the bathroom — every kind of eventuality.
Erik Anderson: We’ve been working hard for a couple weeks now, getting all this set up, trying to think of everything we can plan for, and developing as many contingency plans as we can.
Katie Jickling: They really had everything they could possibly imagine needing. They had wheelchairs and stretchers. They had fridges for staff to keep their food. They had shelves of linens and towels and scrubs for the nurses and places for staff to change. They had their own little pharmacy for medications, and all the power and oxygen and and even food as well that they might need in the coming weeks. And that’s all juxtaposed with these soccer nets that are pushed to the side and lacrosse goals and championship banners.
When the UVM Medical Center overflows, this is the place where patients will go.
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How likely do the people who are in charge of this facility think that scenario might be?
Katie Jickling: We really don’t know. Hospital officials and state officials have put out models in which there’s a worst case scenario, a best case scenario, and a most likely. If we do hit the worst case scenario, if more people do get sick due to coronavirus, then we’ll definitely need that type of facility. So far Vermont has fewer coronavirus patients than even the most likely scenario. So at this point, it’s not looking imminent. But we don’t know yet. The number of patients with coronavirus hasn’t peaked, and likely won’t peak until mid to late April.
Dawn LeBaron (Vice President of Hospital Services, UVM Health Network): We call it the tyranny of the now. You know, we’re in the middle of a pandemic situation here. So that means that everybody drops what they’re doing and focuses on the one priority and the one mission. And that is to respond to this event.
We look around the country and around the rest of the world, you can see the impact of what this pandemic is having on people. And we think that Vermonters can do the best of anybody in responding. And I think I have a good feeling about how we’ll land at the end. But there’s impact. We certainly know it’s here. So we have to respond.
We probably don’t take the amount of time in planning that we would like. There’s no question about that. But you can see what our team put up here in a matter of 10 days or so. It’s pretty amazing.
Katie Jickling: It was very much reminiscent of this whole moment that we’re in, where we’re fearful of and preparing for something that might come, and it may not come. We’re in this moment of ‘hurry up and wait’ — to prepare as much as possible, but we really don’t know what the next steps are going to look like. And I really saw that at play at Patrick Gym.
Last month, you wrote a story that posed this question of: ‘are Vermont hospitals ready?’ And I do want to talk about what you found in the course of that. But I also am just curious, in a situation like this where there’s so many unknowns, what does ‘ready’ even mean?
Katie Jickling: Hospitals in Vermont and around the country are looking at these disaster scenarios like we’ve been seeing in New York City, and in Wuhan, China, where hospitals were just completely overwhelmed. That’s the worst case scenario that we have in mind. Where doctors are choosing who lives and who dies, and who gets a ventilator. In New York, we saw these pictures of people just piling up bodies in refrigerator trucks.
The state has put out models of how much personal protective gear we might need, how many ventilators we might need, and how many workers and rooms and beds might be required for this virus. But that’s not really something that hospitals can prepare for, in some ways. It’s just a number that’s so big, in the worst case scenario. So hospital CEOs are really just saying, ‘here’s the space I have, here’s the resources I have, and I’m going to do everything I can to be ready for that.’ What I heard from hospital workers and from administrators is they’re just going to prepare the best that they possibly can. And they’re not really basing those preparations on the modeling as much as just their own capacity.
Just doing as much as they possibly can with their resources.
Katie Jickling: Right. And given that they have limited staff, and limited money, and the supplies for the coronavirus that are coming in from across the country are limited.
So what might that entail for a hospital that maybe is not building the type of surge facility that we were talking about at UVM Medical Center, but that is kind of working within the confines of their existing campus? What kinds of changes would people expect to see?
Katie Jickling: At some of Vermont’s smaller hospitals, they’re rearranging some of their staff as they cancel some of their primary care or physical therapy appointments. They are moving the people they can over to the emergency room, over to the intensive care unit if they have them.
In some cases, like at Gifford Medical Center in Randolph, they don’t have an intensive care unit. And so they’re preparing a few beds to adapt them to essentially be an intensive care unit if they need them. They say they’re buying as much equipment as possible. They’re putting in orders for ventilators and gloves and masks. And it’s really just, ‘give us as much as you can possibly get, and we’re just gonna sock it away in case we need it.’ They’re also doing trainings with staff to prepare for coronavirus patients, to teach them how to protect themselves, and adapting new policies to make sure that staff know how to care for patients and know how to take care of themselves and keep themselves safe.
When we come back: what those internal changes look like at one Vermont hospital.
Barbara Qualey: Welcome to Command Central.
Later this week, I visited Central Vermont Medical Center to see how they’re preparing for a potential surge. CVMC is part of the UVM Health Network, but it’s a much smaller hospital than the Burlington campus. And the first thing they’ve been doing is managing how patients who think they’re sick are getting into the system in the first place.
Call center staffer: Okay, so we’re going to get you in at 1:30 this afternoon at a mobile testing site…
A few weeks ago, the hospital turned this administrative building into a call center for their coronavirus hotline.
Barbara Qualey: At this point we have four or five nurses. We’re here seven days a week, and they’re taking calls from the public, from providers, from staff at the hospital.
These nurses all sit six feet apart talking on headsets under oversized post-it notes with answers to some of the most frequently asked questions. Barbara Qualey runs the show.
I’m curious, what’s the most common thing that you hear when someone picks up the phone here?
Right now, because the state has announced expanded guidelines for testing, right now there are a lot of clinical symptoms that patients present. Is that allergies? Is that a new cough? ‘I heard my neighbor say that maybe someone had it.’ So there’s rumors, there’s a lot of anxiety. I’d say about half the time our nurses are helping with that education and emotional support. But right now we’re probably testing 50% of those that call.
I asked Barbara what she was expecting for the next few weeks.
A lot of prayers. A lot of teamwork. We are expecting the volume of calls to increase. We’re expecting the volume of tests to increase.
We’re expecting a lot of anxiety in the community. So just being able to talk to patients, to offer them that emotional support. We’ve also partnered with some of the community agencies. We’ve met some fabulous people. We have patients who call to say, I have no food in my house, what should I do? I can’t get my medicines, what should I do? So there are the local food supports, you know, pharmacies that deliver. So that is one of the other connections that we’ve had to build on the fly. And it’s just been, I think, a wonderful experience for all of the nurses to recognize what we have in our own community.
If someone calls the hotline and gets referred to a testing site, they may eventually get referred to the hospital. And things look a little different there too.
Elliott Bent: So this is one of the rooms that you can see. It’s a negative pressure room that’s been modified…
In the emergency department, and in a few other locations, the hospital built negative pressure rooms with specialized air handling systems. These rooms are modified to keep any airborne particles from leaking into the hall. Over the existing door, there’s a synthetic curtain with a zippered opening, kinda like a camping tent. There’s actually two for each doorway, to create sort of a buffer zone between the hallway and the room itself.
Elliott Bent: This is what we call an anteroom. So folks, as they enter, are donning and doffing and doing their sanitization process here, and then they unzip and enter. It’s basically an airlock, right?
This is Elliott Bent. He’s the hospital’s communications director. He also pointed out a couple stands of personal respirators, called PAPRs – these army green bodysuits with hoses and motorized fans attached. The hospital is using them more because they have a limited supply of N95 face masks.
Elliott Bent: This is just a reusable system so that we’re not burning through disposable supplies.
Sarah Mazur: This is the reusable N95.
Down the hall, Sarah Mazur, who normally works as a physical therapist, was training the hospital’s Rehab Director on how to use the respirator.
Sarah Mazur: You’re gonna get the gray strap on your forehead, the gray stuff. So I’m just going in going in…and I’m going to come to the back. I’m gonna hook you…There’s the air.
Elliott said the hospital’s already seen an uptick in what they call rule-outs: patients who get hospitalized while they’re waiting on their test results. But between those cases and the positives, there’s now an entire section of one floor dedicated to Covid-19 isolation rooms.
Elliott Bent: This is Two North, and it’s where we’ve tried to cohort those Covid ruleouts and Covid positive patients.
The strange thing about all this is that right now, at CVMC, it’s pretty quiet. There’s no one there for routine care. Elective procedures have been canceled for weeks. And a lot of these isolation rooms aren’t being used yet.
Elliott Bent: It’s a sort of waiting game, right? And so, there’s a certain level of anxiety that comes with waiting. But it’s an anxiety around sort of, when this is going to hit, you know, what the severity is going to be like. That type of thing. I would describe it as the quiet before the storm.
Katie Jickling: It’s a sort of contradiction and the juxtaposition as hospitals across the state are losing money. In fact, they’re losing a lot of money. Because they don’t have enough patients to fill their rooms, because they’re canceling routine procedures. They’re postponing primary care visits and non-urgent surgeries. And at the same time, they’re investing a ton of money to prepare for this potential flood of patients that may come through their doors at any moment.
But that also may not.
Katie Jickling: That also may never enter, in fact, and in which case all this preparation would be for naught. And honestly, that’s really what everybody’s hoping for. But we still need to put in this massive amount of work to create the infrastructure just in case.
What’s the sense among the hospital officials that you’ve talked to? Are they optimistic that those things will be enough that will get them through without ending up in these sort of disaster scenes like you were talking about in other locations?
Katie Jickling: Across the board, hospital leaders say the best way to prepare is to not get sick in the first place. So they’re really advising Vermonters to stay home, and to continue to self isolate and social distance, and don’t go to work, and wear a mask when you go to the grocery store.
By keeping the number of patients low, that’s the best way to prepare and to be ready for this. Because if the numbers do grow, it’s just going to be impossible to prepare. Jeff Tieman, the president and CEO of the Vermont Association of Hospitals and Health Systems, said, “It’s literally not possible to be ready for something at the level we’re facing right now.” So in a worst case scenario, that’s really the attitude that people have.
But in the meantime, they’re just kind of doing everything in their power to try to build capacity, then wait to see what happens next.
Katie Jickling: Yes. And at the same time, the state is also trying to invest in basically building hospitals as well. So they’ve set up the Barre Civic Center and the Champlain Valley Expo as “surge sites,” they call them — with beds and with the gear that they might need in case hospitals are overflowing and they need to move patients to those sites.
Do we have a sense of the overall number or percentage of how much Vermont’s patient capacity has expanded? Like, do we have a sense of the scale of how big this change is?
Katie Jickling: Before this crisis, we had just over 900 staffed beds across the state. Now, the state has added roughly 600 additional surge site beds.
Katie Jickling: So that’s a more than 50% addition. Keep in mind, though, that this is not a typical hospital. While it has a lot of the equipment that hospitals have, these are very basic cots. Hospitals — UVM Medical Center is saying, for instance — that they only want patients staying here for 24 to 48 hours. So while the capacity has expanded significantly, it’s not the kind of place that you want to just rest comfortably for a few days.
As someone who watches this sector really closely, I have to ask, have you come across criticism about how the state and the hospitals are going about this?
Well, I guess there are two points that I think are questions worth raising. First is that we see a lot of additional beds in Chittenden County. The University of Vermont Medical Center is the largest hospital in the state. They also have this new 100 bed search site at Patrick Gym that we’ve been discussing. And the Champlain Valley Expo has 400 additional beds. But elsewhere around the state, if there are a lot of sick patients, they may have to travel a long way for additional beds. There are other surge sites, but they’re much fewer and farther between.
The other thing is that some people are raising the question: is Vermont creating too many beds? Officials say they want to be prepared for the worst, and to be ready for every possible bad thing that can happen. But this is costing a lot of money. And right now we don’t have that many sick patients. So some people are saying the cost to the state and to hospitals and businesses around Vermont is really high. And maybe we should just make sure we’re not being paranoid before we build hundreds of new beds and new medical facilities that might not be needed at all.
How do you go about tackling that question? I mean, it seems like there’s both the sort of economic considerations, but also the ethical ones — that if we didn’t do that, wouldn’t people be questioning things on a more grave kind of level?
Katie Jickling: Most public health officials would say, prepare for the worst case scenario: the highest number of patients and a lot of really sick ones. And then if we don’t reach that number, then the better for us. But speaking with epidemiologists, they say that the best way to do this would have been to test more on the front end — that really, we could have mitigated a lot of this if we had tested a large number of people very early, and if we had done contact tracing for all those people, and then tested all the people that came in contact with.
That just wasn’t possible, because we didn’t have enough tests. We still don’t have enough tests to test everybody. We might want to, sure. But at this point, the virus has spread enough that we can’t quarantine a small number of people very aggressively the way that we could have if we knew exactly who was sick, and when they got sick, early on.
And so our only option now, really, is to make these preparations and then wait and see.
Katie Jickling: Yes, the only option right now is to know what the worst case scenario is and prepare for it. And at the same time, tell everybody to stay home, to not go out if at all possible, and don’t go hang out with your friends and go to the grocery store if you don’t need to.
Record your podcast remotely.
Katie Jickling: And record your podcasts remotely, exactly.
Okay. Thanks, Katie for the rundown. I appreciate it.
Katie Jickling: Thanks, Mike.
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