‘No blueprint for this’: Hospitals prepare for possible surge

Hospitals last week were gearing up for an expected surge in coronavirus patients as Indiana continues toward its peak.

With thousands of Hoosiers infected with the virus, health officials have said for weeks they expect the number of patients to reach its peak sometime in mid- to late-April.

By Easter Sunday, 20 Johnson County residents had died, and 317 had been diagnosed with COVID-19, the disease caused by the virus. Across the state, 343 Hoosiers have died, and nearly 8,000 have been diagnosed, according to the Indiana State Department of Health.

Over the past four weeks, area hospitals developed plans to take on more patients by ramping up staffing levels and adding to its capacity.

[sc:text-divider text-divider-title=”Story continues below gallery” ]Click here to purchase photos from this gallery

Preparing for weeks

Officials at all three local hospitals said they have adequate space, staff and supplies ready for a surge, an influx of patients health officials worry could overwhelm hospitals.

At Johnson Memorial Hospital in Franklin, the leadership team has daily meetings to review its "disaster plans," said Dr. David Dunkle, president and CEO of the hospital. The hospital opened a new 24-bed COVID-19 unit last month separate from the main hospital, and so far, it has helped manage the hospital’s capacity, Dunkle said. 

"We had warning of what was coming," Dunkle said. "Like we did, all the hospitals worked hard to increase the number of available beds, of available ventilators."

That warning came weeks ago, and Johnson Memorial officials used that time to prepare by closing its outpatient units and shuffling health care workers to work in critical care. But there is still only so much a hospital can prepare for, he said.

"There’s no blueprint for this," Dunkle said. "We have empty beds, yes, we have available ventilators, but the question is, how much of a surge?"

Part of the plan for most hospitals is to transform other spaces that aren’t being used right now into additional ICU areas. By canceling elective surgeries and using health care workers from those less busy departments at the hospitals, other rooms—and some facilities—can be turned into critical care units if the need arises.

Franciscan Health and Community Hospital South have already put these plans in place to increase their capacity for COVID-19 patients.

Last week, Franciscan Health had 60 to 90 COVID-19 patients in the hospital at any given time. The hospital has the capacity for about 160 critical patients total, said Dr. Christopher Doehring, vice president of medical affairs.

"We’re constantly going over plans for how do we continue to care for the sickest patients, looking at alternative sites for care," he said.

Community Hospital South has capacity for about 200 critical care patients, said Nichole Goddard, the hospital’s vice president of operations. The hospital admitted 25 COVID-19 patients last week.

"Our lives have completely shifted," Goddard said. "It’s COVID-19 24/7, just making sure we’re ready to support the needs of our patients."

One problem Johnson Memorial ran into was finding staff to take care of those critical care patients. Special training is required because those patients need more one-on-one care, Dunkle said. They have hired three additional nurses for the hospital’s COVID-19 unit.

"We truly didn’t have enough critical care nurses as the number of patients increases. There is a certain level of care that goes into taking care of a patient on a ventilator, and that’s tough to give a crash course on," he said.

Stocking up, shifting supplies

The hospitals may have plenty of beds, but the number of ventilators is a big factor in determining how many critical patients can be cared for at a time.

Indiana has more than 1,100 ventilators, the state revealed late last week. Community Hospital South has 17 ventilators, nine of which were being used last week, said Dr. Randy Lee, physician of internal medicine and a Community Health Network executive. 

Hospital officials don’t expect to become overwhelmed with patients who need ventilators, but there are emergency plans in place that includes sharing or rationing ventilators as a last resort, Lee said. This would involve serious discussions on who should be on a ventilator and who should not, depending on their level of health, he said.

For example, the hospital would have to consider other health conditions of  critical COVID-19 patients, such as if they also have kidney problems or dementia, Lee said.

"Our caretakers would need to have serious talks with these patients and their families to tell them this may not end well," he said.

And sharing ventilators has not been proven to be effective, Lee said. 

Getting to that point is not something hospital officials expect will happen, particularly at Johnson Memorial, Dunkle said. The hospital has 13 ventilators, and three are being used by COVID-19 patients, he said.

"We have a ventilator allocation plan, but we try not to think about that," he said. "I don’t think we’ll get to that point."

There are other devices that do the same job of traditional ventilators, such as machines used for anesthesia, and hospital leaders are also planning to use those as ventilators if needed.

Franciscan has about 55 ventilators at its Indianapolis hospital on the southside, but they can increase that to 100 with ventilator-equivalent devices, Doehring said.

As for personal protective equipment at the hospitals, the staff is going through masks, gloves, gowns and face shields constantly. Still, officials at all three were confident in their supply, even with the possibility of a surge. Hospital leaders are focused on conserving those supplies the best they can, and they have also received thousands of donations from the public. 

"We’re much better off than we were two weeks ago, or even three weeks ago," Lee said.

Franciscan hospitals implemented a system to keep patients’ IV pumps and monitors outside the rooms, so nurses don’t have to go inside as much, which limits their use of the gear, Doerhing said. 

"Having to use the PPE when you’re going in and out of a room is sort of exhausting and emotionally draining," he said.

Opening the COVID-19 unit at Johnson Memorial has helped the hospital conserve its gear, Dunkle said. 

"We still have patients in other areas of the hospital where nurses don’t need to wear that extensive equipment, so that helps a lot," he said. 

Testing turnaround improving

Not just anyone can get tested. That hasn’t changed. But the time it takes to get results has improved significantly.

Franciscan Health is testing 20 to 60 patients a day for COVID-19, offering drive-thru testing at its southside campus, Doerhing said. Patients who have been evaluated by their doctor over the phone and are deemed necessary to receive a test can drive to one of Franciscan’s hospitals in Indianapolis or Mooresville to get a test without getting out of their cars.

Testers take a swab sample from both nostrils and send it to the hospital’s lab. Results come back within a day now, Doerhing said. The health network also has access to what’s called a "rapid test," which will be used for patients admitted to the hospital with severe COVID-19-like symptoms.

"Certainly, the testing turnaround time has improved significantly from the first couple weeks where we were having to wait upwards of a week or more," Doerhing said. 

Even with faster testing, there still aren’t enough tests that everyone can be tested, Lee said. Only high-risk individuals who are displaying some symptoms, or those with serious symptoms fit the criteria to be tested, he said.

"Universal testing is neither indicated at this time nor is it available," Lee said. "Obviously we’ve improved, not just in Indiana, but in the United States. But there are still people we have to explain why they don’t meet the criteria (to)."

Discussing auxiliary hospitals

The Johnson County Health Department began discussions last week, looking at possible locations for an auxiliary hospital, or a place to quarantine people, said Betsy Swearingen, director.

There is no set plan in place now, but it is something the health department is considering, along with the county’s Joint Incident Management team, to place patients if the hospitals do become overwhelmed, she said.

"We would look at probably having a location in the central part of the county," Swearingen said.

The situation is so new that she can’t say whether an auxiliary hospital is something the county will even need, she said.

Boosting morale

There is a sense of unending urgency at hospitals where staffs are dealing with patients who have the potentially deadly virus day in and day out. Still, hospital officials said staff morale has remained positive, and many are eager to help.

"We do have a lot of folks waiting in the wings to step into to help," Doerhing said. "We’re holding up well under these circumstances."

The staffs at Community Hospital South are also maintaining "good spirits," Lee said.

"We all have our guard up. We’re all being vigilant," Lee said. "I’m not experiencing fear. I’m seeing everyone coming here every night to do the best at their jobs."

For Dunkle, the staff at Johnson Memorial is doing the best they can. The new unit, separate from the rest of the hospital, has helped lessen some fears, he said.

"The new unit was fantastic … Obviously, it’s hard to stay chipper when we’re facing a global pandemic," he said. "It’s tough when you come in and do a demanding job. What are we doing? We’re taking care of COVID-19 patients.

"For a lot of our front-line workers, there’s no escape from it."

Those on the front lines are the heroes during this pandemic, Doerhing said.

"It does make a normal shift seem a lot longer," he said. "Our front line health care workers are the heroes in this. This battle continues, and we’re not toward the end yet."

[sc:pullout-title pullout-title=”By the numbers” ][sc:pullout-text-begin]

Here is a look at the latest numbers available:

Johnson County

COVID-19 deaths: 20

COVID-19 cases: 317

COVID-19 tests: 1,706

Otterbein deaths: 7

Otterbein cases: 45

Otterbein tests: 143

Indiana

COVID-19 deaths: 343

COVID-19 cases: 7,928

COVID-19 tests: 42,489

U.S.

COVID-19 deaths: 20,608

COVID-19 cases: 530,006

COVID-19 recoveries: 32,100

World

COVID-19 deaths: 110,042

COVID-19 cases: 1.8M

COVID-19 recoveries: 412,000

Sources: Johnson County Health Department, Indiana State Department of Health and Johns Hopkins University and Medicine

[sc:pullout-text-end]