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‘Unspeakable challenges’: COVID-19 forced St. Louis-area hospitals to adapt quickly
A year of COVID-19

‘Unspeakable challenges’: COVID-19 forced St. Louis-area hospitals to adapt quickly

From the A year of the pandemic, and its impacts on hospitals, government, nursing homes and residents, and health departments series
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ST. LOUIS — Changing how things are done in large hospital systems with thousands of employees and doctors stuck in their ways has been likened to turning a massive ship. It’s usually done slowly.

The new and deadly coronavirus, however, was like an iceberg in a ship’s path: hospitals were forced to adapt quickly and work with each other in ways that greatly changed in just one year how health care is provided.

St. Louis-area hospital systems created command centers within days of seeing their first patients, with small groups of key leaders meeting daily to address immediate and changing needs.

They monitored the constantly changing safety updates and research — some 80,000 papers published in just one year — and quickly adopted new policies to protect staff and patients.

They scrambled to find testing supplies and protective gear. They monitored spread in the community to predict its impact. They created and staffed intensive care units. They developed systems to vaccinate thousands of people a week.

Mercy officials provide information about the new drive-through test site including the procedure and how much it might cost on Friday, March 13, 2020 in the Mercy Virtual parking lot in Chesterfield. The site, located at 15740 South Outer Forty Road in Chesterfield, will open Saturday, March 14, 2020 at the earliest, it is expected to be open from 8 A.M. to 4 P.M. every day until it is no longer needed. Mercy is requiring anyone interested in being tested to call the Mercy COVID-19 Clinical Support Line at (314)251-0500 before arriving. Video by Colter Peterson, cpeterson@post-dispatch.com

It was a steep learning curve, said Dave Dillon, spokesman for the Missouri Hospital Association.

“COVID-19 required hospitals to rethink everything,” Dillon said. “From supply chains to visitor policies, the pandemic required flexibility and innovation.”

To work in lockstep, the area’s four major hospital systems — SSM Health, Mercy, BJC HealthCare and St. Luke’s Hospital — partnered to create the St. Louis Metropolitan Pandemic Task Force and appointed Dr. Alex Garza as its head.

Garza, the chief medical officer for SSM Health with experience in the military and fighting the H1N1 pandemic as a key figure in the Obama administration, routinely updated the public with live video and helped residents and government officials understand the importance of prevention efforts.

Dr. Jeff Ciaramita, president of Mercy’s physician practices in the St. Louis region, said decision-making accelerated to a speed they never thought was possible.

“Our command-center approach has been used for COVID, but today, it is used for just as much outside of COVID,” Ciaramita said. “Our ability as an organization … to make decisions instantaneously, whereas before it could take one month, two months or more. COVID has changed the way we look at all operations in general. I don’t think we’ll ever go back.”

Lasting changes

Newfound agility is one of the biggest and lasting changes caused by the pandemic, said Dr. Clay Dunagan, chief clinical officer for BJC HealthCare. “It has raised awareness that big health care systems can move more nimbly than we may have thought.”

Telemedicine, which many providers had been slow to embrace, was suddenly the only option in getting people the care they needed. Providers and patients quickly saw the benefits.

When hospitals reached capacity in November and December, Mercy’s area hospitals provided round-the-clock virtual care at home to 36,000 COVID patients, said Mercy St. Louis President Stephen Mackin. It taught them a lot.

Dr. Hilary Babcock, infectious disease expert with BJC HealthCare & Washington University School of Medicine, discusses how health care systems have been forced to change in response to the pandemic.  

Gone are the days of not calling doctors on weekends, nights or even over the lunch hour. Patients can fill out a digital assessment and be instantaneously referred to a virtual visit or urgent care clinic.

During a recent snow storm, Mercy was able to quickly switch 1,500 of its doctor appointments to virtual appointments. “That capability did not exist one year ago today,” Ciaramita said. “That team-based approach of, ‘How are we offering to take care of patients 24 hours a day, seven days a week?’ That will never go away.”

Other changes include a hyper-focus on infection control, and reduced waiting times to avoid lines and congregating, Mackin said.

“I think it translates to an even safer, better and more effective care for patients inside hospitals,” he said. “We are more efficient in a lot of areas today than we ever were.”

Dr. Clay Dunagan, BJC chief clinical officer and infectious disease specialist at Washington University, announces suspension of elective procedures at BJC HealthCare. Video provided by BJC and Washington University

Financially, the hospital systems took a huge hit in the first wave of the pandemic when together they agreed to shut down elective surgeries — allowing them to get caught up on scarce protective gear and testing supplies. Little was known about the extent of spread, and watching hospitals in Italy and New York get overwhelmed and ration ventilators put everyone on edge.

At Garza’s first news conference on April 5, area hospitals had 468 COVID-19 patients. Two weeks later, that number had jumped to 757. Shelter-in-place orders in the St. Louis area kept the average number below 700, and the next month, hospitalizations declined to the lowest levels in the summer.

Dr. Alex Garza, while introducing a group of people who talked about their experiences with coronavirus, said: "If we continue down the path we're on right now ... things could potentially get much worse." He choked up when discussing the losses that the hospitalization numbers represent.

The pause on electives, however, led to layoffs within Mercy and furloughs across the board. Relief came in various federal emergency funding and stimulus packages, but Dillon says the qualifying rules are complex and variable.

“It has yet to be determined how this will play out,” he said. “Federal guidance on loans, grants and other payment mechanisms introduced early in the response to stabilize the system has shifted over the duration of the response.”

Hospitals were better prepared to respond to the second, larger wave of patients in the fall, when the average number of COVID-19 patients in hospitals hovered over 900 for weeks. Some elective surgeries were postponed, but overall, hospital leaders say they have caught up on procedures, returned to pre-COVID staffing levels and are getting back on solid financial ground.

Focusing on success

Harder to measure was the emotional burden on providers as they dealt with initial uncertainty about their own safety, relentless weeks of caring for critically sick patients, enormous loss of life and the strain of being by bedsides instead of patients’ family members.

That burden can’t be emphasized enough, Dunagan said. People refusing to follow prevention measures added another layer of frustration, he added. “It was very hard to be drained from taking care of a population with a high risk of dying, and then to hear those efforts undermined by people who didn’t believe coronavirus was a serious threat.”

To fuel their efforts, health care providers focused on the success stories — the approximately 20,000 COVID-19 patients who recovered and left their hospitals — and support from the community.

“This year has been so different. It created unspeakable challenges,” Ciaramita said. “Yet the rewards and the appreciation from the community … I can’t stress enough of how much that has consistently recharged the batteries.”

Garza said he’s not sure what is next for the pandemic task force, but the members have talked about using their collective power to influence other health outcomes.

Dr. Alex Garza, Incident Commander of the St. Louis Metropolitan Pandemic Task Force, asked for a state-wide mask mandate, among other things, to slow the spiking cases of Covid that is severely taxing our local and regional healthcare systems.

“We all recognize that this is a really good thing that we’ve pulled together, and we should use this kind of construct to identify other issues that we could work on together,” Garza said. “People want to continue this partnership once this pandemic is over, because we’ve seen how much we were able to pull together and focus on something that was good for the community.”

Michele Munz • 314-340-8263 @michelemunz on Twitter mmunz@post-dispatch.com

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