This week marks a big change for CHA Everett hospital as it turns a corner from the past few months of COVID-19 treatments – shutting down the hospital’s crisis command center this week that was formed in March at the outset of the outbreak.
Dr. Melisa Lai-Becker, chief of the Emergency Department at CHA Everett, said the crisis center put in place came down last week, which was a major step out of the COVID-19 world for the hospital – but also, hopefully, a step into a new way of doing medicine that was learned during the last few months.
“We have at last born out and cleared the incident command center that had been up and operating since the first week of April or the last week of March,” she said on Monday. “That officially means we are technically back to normal operations as far as all the higher level administration items. Basically, all of our operations have gone back to non-crisis and non-incident operations.”
That change is almost hard to believe for those in the hospital that went through the darkest days of COVID-19 in March, April and May – when things were very close to their tipping points. Now, however, numbers have gone down consistently and new cases are down to a trickle.
Several weeks ago, they took down the comfort care station – which was a place where patients with COVID-19 who did not wish to be intubated could go to be comfortable and to die.
There has also been relief as the hospital has not seen any surge of patients related to the many outdoor protests that occurred in the early weeks of June. Many physicians and hospital officials had been concerned in Greater Boston that there would be a surge of patients due to the protests – which attracted thousands of people to small spaces like the Boston Common.
That, she said, has not happened in the Everett hospital.
“We’re not seeing anything that’s crazy in regards to that,” Lai-Becker said. “There’s been no big spike. People are wearing masks and washing their hands. We’re following the examples of Hong Kong, Singapore and Taiwan. There is really something to be said for just wearing a mask. Props to everyone for that and for buying us time and helping us preserve the PPE supply chain.”
Now, as those threats in regards to COVID-19 subside for a time – hopefully forever – many in the medical community are hoping that lessons learned over the last four months will not be lost.
Some of those key lessons at CHA Everett are the expanded use of tele-medicine and ambulance care units. Tele-medicine was talked about for years, but insurance companies never made the jump to cover such visits, and hospitals never pushed the envelope. In COVID-19, tele-medicine came on as a necessity for many patients, and insurance companies covered it. It has been a great victory for delivering health care in the 21st Century. The same is said for the ambulance care units, whereby ambulances overseen by physicians can deliver care in a person’s home – and get paid for that service without transporting the patient. Prior to COVID-19, ambulance companies had to transport a patient to get paid.
Both of these innovations have been great changes for both physician and patient, and Lai-Becker said the hope is that they are permanent changes.
“It really just showed how the cost-price-reimbursement and insurance models in our country are really messed up,” she said. “To think tele-health was not covered until this pandemic is hard to imagine. Hopefully it will continue to be covered. It’s a big and important model we’ve just developed.”
•Looking on in Horror
Dr. Lai-Becker said as things wind down at CHA Everett, talking to colleagues in other parts of the country where the virus is surging has been tragic.
“We’re definitely looking at the rest of the country and looking at the new hot spots of Florida, Texas and Arizona; collectively, we look there in horror,” she said. “It is horrendous and incredibly disheartening to see colleagues are dealing with what we tried to keep at bay here, in New York and in Seattle. It’s really too bad. I mean, really? No one believed us? I do think this will show having everyone wear a mask and having good hand hygiene and having that message come from the top down will have made a difference.”
She said it is as simple as wearing a mask, being very careful and considering others who may be more compromised. These were messages that were routinely conveyed in Massachusetts, and it was a great help.
She said many might not realize how close hospitals were to having to ration ventilators and other medical equipment to treat COVID-19.
Lai-Becker said at one point in early April, when the surge was in full bloom, they were treating a 90-year-old and a 40-year-old in the Emergency Department. Both were in respiratory distress and likely needed a ventilator. However, there was apparently only one ventilator available at that time.
“We received information that we had one ventilator in the hospital at that time,” she said. “My PA looked at me and said, ‘Well?’ I was going to have to decide. She said I should probably intubate the 40-year-old and make the 90-year-old comfortable. I thought, ‘Yea, that’s what I have to do.’”
As it turned out, however, another ventilator became available at the last minute, and then the family of the older man chose not to use a machine. It turned out that rationing wasn’t necessary, but it became close. “We were very close to that happening,” she said.