The break in COVID-19 cases at CHA Everett hospital has subsided, with a “gentle slope” upwards that has the hospital cautiously implementing protocols that were successful during last spring’s surge, but at the same time assuring there is not a panic at the moment.
Dr. Melisa Lai-Becker, chief of the Emergency Department at CHA Everett, reported this week that the trajectory of cases is moving gently upwards, though obviously far from the panic levels that the hospital saw last spring. That said, Lai-Becker said they are moving back to some of the precautions that were successful in the spring – things like daily coordinating phone calls, making practices developed on the fly into official policy and re-evaluating the visitor policy.
“It has been a very gentle slope upward since late September,” she said. “It is clearly not going down. There’s not any huge spike, but the trajectory and slope of cases is a very gentle upward slope. It’s not exactly what we’d like to see, but it’s not unexpected either.”
Daily hospitalizations for COVID-19 at CHA Everett have ranged from 15 to 24 over the last several days, and about two to four of those patients are in the ICU for COVID-19. The numbers have been steadily increasing over the last two weeks, when the numbers of hospitalizations were in the single digits.
Lai-Becker said they have given around 70,000 COVID-19 tests since March, and there have been 4,500 that came back positive. She said the positivity rate is another metric to look at, and that number in Everett has been pressed back up to around 9 percent.
“At the very least it shows a trend,” she said. “It does reflect what’s going on around the state.
“It’s nothing like April or May,” she continued. “Our intention is to never return to April or May. What we have now is a much more methodical and prepared and confident look at what things could help.”
One of the things the hospital has returned to is daily coordination calls with all stakeholders at CHA Everett, CHA and Beth Israel Leahy. When those twice-daily calls occurred from April to June this year, it was all about helping CHA Everett handle the numbers of cases coming into the hospital and needing treatment. Being overloaded, there needed to be a thoughtful and effective coordination effort to be able to transfer patients to available beds elsewhere when CHA Everett was full. Those calls dwindled down to once a day, and then in the summer, they stopped.
Now, out of an abundance of caution, they’ve started them up again just as a way to be prepared.
“It’s a good thing,” she said. “Right now it’s once daily for about five minutes. But it’s good to make sure those muscles don’t atrophy.”
That is a prime example of how the hospital in general feels about any second wave or gentle slope upwards in cases. When COVID-19 hit with a boom last spring, many care providers equated it with wandering around a room in the dark looking for a light switch. There were bumps to the shins, trips over furniture, and just being outright lost.
But now the light is on, and doctors like Lai-Becker and her team have gained confidence in how to treat and care for COVID-19. They now know symptoms that weren’t known, and treatments that were a mystery in April. They also have more testing, more equipment and access to supplies. Beyond that, they developed important protocols on the fly that worked but weren’t written down as policy. At the moment, Lai-Becker said the hospital has been streamlining all of the best practices to be prepared for any uptick in cases.
“Right now we’re trying to make sure we have firmed up all the ad hoc policies we created, but didn’t make into policy,” she said. “It’s good now to look at what was put in place and make it official.”
That would include how to notify people they are positive, and what they can do next. Making a phone call to those positive for COVID was a better use of time and resources during the surge, and allowed the hospital to educate and offer services to the patient on the spot. Meanwhile, those who were negative got a form letter letting them know everything was ok. That has become the standard now.
The preparation, Lai-Becker said, is something that will make all the difference, and she equated it with emergency remote learning in schools last spring versus this fall.
“It’s like the difference between how online school existed in the spring, and the fall isn’t ideal at all, but it’s 1,000 times better than it was in the spring,” she said. “It’s the small things like in the schools having a district agree to use one platform for all the classes and stay with that…That’s how I feel like where we’re at here. We can look back and know we’ve all changed. In the spring, it was every different department trying different things and using different guidelines, but now we’re streamlining that and getting them together. As they said last spring, it was like building the plane while flying it. Now it’s so good to have the plane in the hangar and to look ahead at a potential flight plan.”
• Flu Shot and a Vaccine
One step taken by the hospital is to make sure every employee is vaccinated for the flu, and there are no waivers unless someone is allergic to the shot. That is a step they have taken out of an abundance of caution, but those large flu clinics are also a trial run for any potential COVID vaccine that becomes available.
“That will be preparation for whenever a potential vaccine is available and at this point we’re looking at a minimum of six months until anything is ready for the market,” she said. “At that point we’ll deal with limited doses, but we’ll have a good, tight distribution to get people vaccinated.”
• Visitor Policy Revised
The hospital has now also reversed its policy on visitors, which had loosened up over the summer and early fall. However, three weeks ago an outbreak occurred at Brigham & Women’s Hospital – where they believe a visitor brought COVID into a non-COVID unit of the hospital. Some patients and about 50 employees got sick. That instance has caused CHA Everett to revise their policy as well.
“We talked about what happened there and that’s when we started clamping down again on our visitor policy,” she said.