Two weeks is often described as an eternity in politics or sport, but rarely in the emergency room of a hospital.
In the COVID-19 era, though, all is possible.
It was only two weeks ago that Dr. Melisa Lai-Becker, Emergency Department chief at CHA Everett, said they were preparing for a surge, with great hopes that there would be no surge of sick patients with COVID-19.
Preparations have now turned to practice.
“What a world of difference here in just two weeks,” said Dr. Lai-Becker on Monday night after finishing her shift in the ER. “Everything we were preparing for is coming to bear and now we are experiencing the surges I had hoped wouldn’t come. Our volume had actually gone down by one-third, but to counter the lower volumes was the fact that the acuity level is greater. I would say three-quarters, about 80 percent, of our patients are coming in sick. With that many presenting sick we have begun suspecting they are COVID-positive. The ICU has been full for over one week, including with continued admissions and transfers out.”
Just on Monday afternoon, Dr. Lai-Becker counted 10 new admissions on her chart that they are taking care of in the department. While they would have about five patients on a ventilator in the ICU during normal times, she said they have a dozen or more now that need ICU and ventilation care – a treatment that is the highest level of treatment for most hospitals. Most of that treatment is demanding a ratio of two patients to every nurse as a result of the overall surge to the ICU.
Dr. Lai-Becker said, in response to that, the hospital has expanded their ICU beds, using the post-anesthesia care unit as a makeshift ICU – a place where normally patients recover from surgery. Right now, they have the appropriate space, but have been transferring patients to other places using ambulances when need be.
“When we don’t have a bed available here, we get people moved to our sister campus in Cambridge,” she said. “If those beds are full, we send them to a location that has a bed available…We have been lucky to be able to partner with the tertiary hospitals like MGH, BMC, Beth Israel, the Brigham and Tufts. They understand the challenges we face and understand why we are calling them for help; it’s because our ICU is full. They are wonderful and do what they can to help us out. Talk about a large, statewide and regional effort – that’s what that is.”
Pausing, Dr. Lai-Becker did confirm they have had several patients die from COVID-19 while in their care, but it was a painful topic for her and her staff as they don’t know how much more of that lies ahead. What they do know is that the patients they are seeing are not exclusively the old and infirm that were talked about last month.
“About half of our patients seem to be in their 40s and 50s,” she said. “We are getting quite a number of patients in their 20s and 30s – not as many in their 20s. It is now not surprising to see someone here in their 30s. They come in and we know we’ll send the test and it will be positive. It’s been surprising that regardless of age, it’s very stark.”
She said they have been fortunate in that many of those patients can be treated and then sent home with home oxygen kits to help them breath, and they can recover outside of the hospital setting and make way for sicker patients. That is a good reason for social distancing, and for people to stay in the home as much as possible. There is a direct correlation with not heeding those warnings, and the hospital being inundated with new and more critical cases. It is one of the few protections the public can provide for health care workers like Lai-Becker and her staff.
“It’s definitely the real world playing out,” she said. “It’s important to social distance and the better we do with that, the better we can have these resources around for everyone. Getting a large rush of patients right now might get us to a point where there isn’t enough ventilators or hospital beds. It’s something everyone is watching so closely in Massachusetts.”
Another way to help is by donating or making Personal Protective Equipment (PPE) for the health care workers. Dr. Lai-Becker said they were able to secure a large amount of N95 masks from the New England Patriots humanitarian mission that used the team plane to go to China and get more than 1 million masks for the state. However, as a community hospital sitting beside many large medical centers, they may not get all the supplies they need ahead of those larger hospitals. That is why she said they welcome and appreciate the community donations.
“We know there are a lot of makers out there and we welcome cloth masks, we welcome cloth gowns, and the welcome the tech savvy folks who are using 3-D printers…to make sure we have the respirators needed to protect us,” she said. “We’re really grateful for every glove, mask and gown and disinfectant we get. Every little bit makes a difference and as a community hospital, it’s wonderful…We’re not a big juggernaut. We’re not MGH.”
It is, in fact, the support of the community that has kept the staff going in the surges from the area communities like Everett, Chelsea and Revere – where their patient base mostly resides.
Small things, she said, like Everett Police Chief Steve Mazzie dropping by on Monday with several baskets of “treats” for the ER staff keep the morale up in what has become a challenging day most every day.
“I have to give a shout out to Chief Mazzie for bringing that by,” she said, “and for everyone else in the community who has thought of us in so many ways and supported their community hospital. Those things mean so much; we were so encouraged when he came in with those treats for us. It means so much to have that support.”
Two weeks ago was all about preparations, and this week has been about treating and hoping that the next two weeks don’t see any further surge – as the hospital is pretty much full already. It is a remarkable change in a short period of time, and scary in that no one in the ER is certain what next week will bring.
“It is a distinctly different place than where we were only a short time ago,” she said.
“It is an all hands on deck effort for sure,” she continued. “We’re fortunate to be here in Boston and to be serving this community and to be as well-resourced as we can be given that at the end of the day, we’re a community hospital that’s working with what we have.”