By Lauren Koffman DO, MS
Months ago, I had plans for a weekend trip with a friend, and despite my multiple reassurances, she cancelled. She had family and friends in China and had deep concerns about the COVID-19 situation evolving. She would tell me about the horrific scenes unfolding as hospitals were overwhelmed and under prepared.
Thinking back two or three months ago, the virus and its casualties on another continent felt like an isolated health crisis. Now, not much time has passed, and COVID-19 is here.
While we as intensivists are used to a world of critically ill patients, this feels different. It could be the uncertainty of waiting for the exponential growth of patients, the helplessness of not having a definitive treatment, or the fear of exposure and subsequent illness for ourselves and our families. We will be caring for patients that will not be able to see their loves ones due to visitor restrictions during a time of fear and anxiety. We are facing limited resources and may have to decide who is worthy of treatment. We are versed in end-of-life discussions, but what if these discussions are not an option?
Despite all of the above, I know that Rush University Health System (RUMC) is prepared. RUMC in Chicago was built for disaster management and is one of 35 hospitals in the United States recognized as a leader in disease treatment by the Centers for Disease Control and Prevention (CDC). Weeks ago, before states were enacting “shelter in place” recommendations, a Hospital Incident Command Center was formed with the objective of having an organized system for coordination of personnel, faculty, equipment, etc. in preparation for the surge of patients to come. Soon after, triage tents were established for testing, and Rush has tested 2,406 people in the community, with 202 confirmed cases and 45 patients admitted, at the time I write this. Communications have been consistent at a department and university-wide level.
The infrastructure has markedly expanded to accommodate the influx of patients. The hospital typically has 40 negative pressure rooms, and now has 72 total. There are four intensive care units with a total of 111 critical care beds. As surge preparation continues, there will be an additional 175 ICU beds available. Beyond the physical changes, processes are rapidly evolving; a multi-disciplinary group of intensivists, pharmacists and respiratory therapists have created unified protocols for airway management, codes, treatment of acute respiratory distress syndrome and proning.
Within a short period of time staff have become accustomed to appropriate donning and doffing procedures. We are investigating use of technology and devices to minimize provider exposure. There is a sense of security as residents and fellows not only accept the extra work and calls but welcome the challenge. Our neurocritical care group is a source of strength, and we know we will get through this with the support of one another.
The pandemic has taken over the media, and it is hard to refrain from the constant images of overworked healthcare providers and collapsing healthcare systems around the world.
I am on service this week and awaiting the surge of patients that is anticipated in the next few days. It is an eerie feeling of calmness before the storm. COVID-19 is here, and we are ready.