ER Docs, Major Hospitals Preparing for Potential Surge of Patients

Numerous public gatherings, meetings and conferences were abruptly cancelled over the last 10 days, and at the same time, major hospitals in the area were preparing for a potential surge of Coronavirus (COVID-19) cases – all this while financial markets in the United States and abroad show instability and unprecedented travel restrictions took effect last weekend.

At Boston Medical Center (BMC), numerous precautions were implemented in the past week to prepare for a surge of patients from Greater Boston neighborhoods and elsewhere – it being one of the few Trauma 1 medical facilities in New England.

Outside the emergency room at BMC on Albany Street, a temporary medical tent was been set up in preparation for triage – if need be.

“BMC is planning for a surge in patients, as the COVID-19 pandemic continues to evolve rapidly,” said David Kibbe, a spokesman for BMC. “BMC has set up a tent outside the hospital to prepare for potential scenarios related to COVID-19. While the tent is currently only being used for drills, it could be used as a testing location or additional Emergency Department space should we get a large number of patients requiring screening and testing for COVID-19.”

While those preparations are playing out, there is also concern in the medical community for adequate supplies at hospitals like BMC.

“We have adequate personal protective equipment supplies on hand for our staff,” said Kibbe. “Given the worldwide impact of this outbreak, we share the concern across health care about potential shortages of medical supplies, including N95 respirators. To ensure that we are able to protect our staff and provide safe care for patients, BMC has taken steps to conserve personal protective equipment, including N95 respirators, surgical masks and precaution gowns.”

Already, two weeks ago, the hospital had restricted employee travel.

Patients at BMC or its health centers, under federal guidelines, are being asked if they have had a fever or cough or having traveled in the last 30 days. They are also asked if they have had any close contact with a confirmed COVID-19 case. These questions are asked during a phone call or during an appointment.

“For any patient considered at risk for COVID-19, clinicians will undertake actions to protect the patient, hospital staff, and other hospital patients,” read their website. “This includes putting the patient in a private room and providing masks for both the patient and care team. Staff has undergone training for possible cases of COVID-19, and BMC regularly conducts staff drills and training for infectious diseases.”

State Rep. (and doctor) Jon Santiago works in the BMC emergency room (ER) and also serves in the legislature representing the South End and Lower Roxbury.

He worked in the ER last weekend, and will continue to work shifts every weekend in March. Uniquely, he will be treating patients on the frontlines in the ER, and also thinking about legislation to address the emerging, multiple challenges associated with what is now a medical pandemic.

“As an ER doctor and an elected official, my oaths to protect the public is no more important than now,” he said.

“I do know it’s going to get significantly worse before it gets better,” he said. “We’ve had a sluggish federal response. Medically, right now we really have to summon out the best in each of us and empower our neighbors and communities and let them know there are things you can do to protect yourself. It can be things like washing your hands. If you’re sick, please stay home. If you’re an older person with chronic diseases like diabetes or lung problems, you should be particularly cautious. Likewise, if you are a young, healthy person and have especially mild symptoms or no symptoms, it would behoove you to take precautions also because it will be those folks who will be transmitting the disease, maybe in a careless fashion.”

From a public policy perspective, Santiago said he and others are working on several measures. One is how to legislate in a safe fashion so that the virus isn’t transmitted during lawmaking sessions.

“I am sitting on an internal working group right now,” he said. “We are looking at our approach to legislating in these trying times.”

He noted the State Legislature approved a $15 million bill to provide more emergency funding for coronavirus responses statewide late last week.

The federal government announced a second round of emergency funding by the Centers for Disease Control (CDC) on March 11. While Massachusetts already received $500,000 in federal funding, the state will also receive an additional $11.46 million in federal funds from the CDC. The CDC has instructed state health officers to move forward with distributing that money immediately to those on the frontlines.

“Our state, local, tribal and territorial public health partners are on the front lines of the COVID-19 response. The action we are taking today will continue to support their efforts to increase public health capacity where it’s needed most,” said CDC Director Robert R. Redfield, M.D. “These funds will allow public health leaders to implement critical steps necessary to contain and mitigate spread of the virus in communities across the country.”

Like that, seemingly, everything was on hold or in a holding pattern.

For those looking to stay healthy, BMC indicated a few simple things everyone can do:

•Cover your sneezes and coughs with your sleeve, not your hand.

•Wash your hands frequently to reduce the spread of germs. Wash with soap and water for at least 20 seconds. If soap and water are not available, you can use an alcohol-based hand sanitizer.

•If you feel sick, stay home, and avoid travel.

•Avoid close contact with people with flu-like symptoms whenever possible.

Vulnerable populations need to be considered as outbreak spreads

While many are thinking about schools, public gathers and civic meetings when it comes to the spread of the coronavirus, some medical professionals are beginning to be concerned about precautions in the homeless community, the jails and homeless shelters.

Emergency Room doctor and State Rep. Jon Santiago said he is concerned about how hospitals like Boston Medical Center (BMC) might be able to help those populations if there is an outbreak.

“BMC Emergency Room is the largest ER in town,” he said. “We see a number of disproportionately impacted communities and homeless folks. As a physician, we need to be extremely cognizant of how we educate these patients and making sure they have safe places to go. I would like to know what our homeless shelters are doing. What about the jails? I wonder if undocumented immigrants feel safe enough to seek care, or if they might be scared ICE will pick them up.”

Right now, the response is very new, and what is happening with vulnerable populations is not necessarily being discussed yet.

“These are people that live in close quarters,” said Santiago. “They are also people who are already suffering from a whole host of diseases. It’s going to be challenging for sure. I do have faith in our doctors and nurses and public health officials.”

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