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Getting ready: St. Louis hospital systems and health departments prepare for COVID-19

Getting ready: St. Louis hospital systems and health departments prepare for COVID-19

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CREVE COEUR — Three large whiteboards at SSM Health’s corporate headquarters help keep track of the rapidly changing details of COVID-19, the disease caused by the newest strain of coronavirus. The boards list who is in charge of key areas such as supplies and infection prevention, staff questions that need answers, and updates and guidance from federal health officials.

Scribbled in a red dry-erase marker are the numbers of patients who have gone to each SSM hospital — the system has 23 hospitals, including eight in the St. Louis area — concerned that they’ve been infected by the virus.

Then there are the even smaller numbers of patients who met enough risk factors to merit referral to local and state health departments. To date, only six SSM patient cases have reached the state level, where they are considered for testing by the U.S. Centers for Disease Control and Prevention. None have met the requirements for federal testing.

“That’s the ‘Hey, let’s not get too excited about this,’ but …,” said Dr. Alexander Garza, SSM’s chief medical officer. It’s a matter of preparing for when the number of infected patients rises, not if, he says.

Efforts to contain the virus by identifying travelers who may have been exposed are proving increasingly futile. “The odds of it escaping those protective measures are growing every day,” Garza said.

That reality prompted the CDC to warn this week that the spread of COVID-19 is inevitable in the U.S., and area hospitals and local public health officials say they are stepping up preparations to be ready for any scenario.

On Thursday, Missouri joined the growing list of states with a laboratory approved by the CDC to test patients for the virus. The test can provide same-day results rather than the previous two- or three-day wait.

Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, said having immediate results improves efforts to contain the virus.

Health officials are working “to provide timely and accurate information for the possibility of a future positive case,” Williams said in a statement. “The risk for infection still remains low, and we will continue to strategically align with all of our partners under our operating principle of hoping for the best and preparing for the worst.”

Experts at area hospital systems are constantly monitoring the latest guidance from the CDC, disseminating updates quickly to staff and making sure enough protective gear is on hand. Public health officials are also working to educate the public on how to keep themselves healthy and quickly respond to questions from legislators, schools and businesses.

“There will be cases in our region and our area, and people should be thinking about how to protect themselves,” said Dr. Hilary Babcock, who directs infection prevention efforts at BJC HealthCare facilities, which includes more than a dozen hospitals in Missouri and Illinois.

When the Post-Dispatch talked to Babcock on Tuesday, none of the BJC facilities had seen any patients requiring testing for the virus. “Not yet,” she said then.

Two days later, BJC’s Belleville Memorial Hospital revealed it cared for a patient that the Illinois Department of Public Health was testing for the virus. Results are expected in the next few days, BJC said.

Across Missouri, more than 60 people have been evaluated and monitored for the virus because of their travel history or possible exposure. Williams declined to be more specific when asked by the Post-Dispatch, but said a “much smaller number” met the criteria for testing. None have tested positive, and no test results are pending, he said.

At BJC and other area hospital systems, signs at the entrances of hospitals and clinics warn visitors to immediately alert a staff member if they have flu-like symptoms and have traveled to China, so staff can immediately isolate them for further screening.

Those signs are in the process of being updated to include other international travel, Babcock said. Screening questions also changed this week to include broader questions about recent travel, not just to China.

If people suspect they may be sickened with the virus, they should first call the urgent care center, doctor’s office or clinic they plan to visit, Babcock explained. If they are considered at risk, patients can be directed where to go for screening. Health care providers can meet them at the door, put a mask on them and take them to an isolation room.

“The short message is, call your provider first,” Babcock said.

Fine-tuning earlier plans

Hospital systems began dusting off their emergency plans soon after the new coronavirus was first identified in Wuhan, China, in December. Having prepared for the threats of SARS, MERS, H1N1 and Ebola in the past, it’s just a matter of fine-tuning those plans to what they learn about the newest virus, officials say.

“Though it is a lot of work,” Babcock said, “a lot of policies and procedures are already in place that make this easier if we had not thought about this before.”

Researchers are still learning about the virus. While it has similar symptoms to the flu, it appears to spread quicker and be twice as deadly.

While people can get a vaccine or possess some antibodies that provide protection against the flu, there is no vaccine to provide immunity against the new coronavirus.

“There’s no innate immunity within the population to this virus,” Garza said, “and so potentially everybody is at risk for acquiring the infection.”

Area hospital system officials say they have ordered extra protective gear such as masks and gowns, reminded staff how to properly wear and remove gear and what to do if they themselves feel sick.

“We also update them on the work we are doing so they feel confident they will be able to work safely,” Babcock said.

While hospital officials are quickly responding to constant updates, they say they are also beginning to think about what they will need if large numbers of people get sick.

A command team might have to work full-time on virus response. Patients may need to be separated on wings if isolation rooms are overwhelmed. Drive-through screening clinics could be needed. Employees might have to be paid to stay home to take care of children. Others may have to work more.

“It’s serious enough that we all need to be thinking about this,” Garza said. “And even if it doesn’t play out, you would rather over-prepare and have it be underwhelming than the other way around. Because the other way around is disastrous.”

In addition to frequent hand-washing and staying home if sick, officials warned that people need to prepare for scenarios that might require school closures, working from home, canceling large gatherings and having prescriptions filled.

Emergency rule

In another sign of how Missouri is ramping up its response to COVID-19, the state health department issued an emergency rule this week adding the virus to a list of infectious diseases, such as anthrax and ricin.

The move, which goes into effect on Monday, is designed to boost the response rate in times of a potential health emergency.

“It ensures that should a case be confirmed in Missouri, the authorities of the department are specifically stated and clarified so as to expedite any necessary public health response,” said Lisa Cox, DHSS spokeswoman.

Williams said state and local health department officials have the authority to force school closures or cancel large gatherings such as concerts if they feel it’s necessary to protect the public’s health.

One of the big questions for health officials, Williams said, is if families should cancel their summer travel plans.

“The answer is,” he said, “stay tuned.”

Kurt Erickson of the Post-Dispatch contributed to this report.

 

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