Coronavirus Pandemic Update 38: How Hospitals & Clinics Can Prepare for COVID-19, Global Cases Surge

Coronavirus Pandemic Update 38: How Hospitals & Clinics Can Prepare for COVID-19, Global Cases Surge


welcome to another MedCram COVID-19
update here we see 180 mm confirmed total death 70 100 total recovered 79
thousand the map is turning into basically a red blob I want to go over
to the world ometer website and show you some interesting trends we see here the
total cases starting to accelerate once again because we’re reaching an epidemic
phase outside of China and if we look here at total deaths they’re also being
mirrored if we looked at active cases we can see here that there was a plateauing
even a dropping off as China was containing what was going on and then
outside of China here in Italy South Korea and now United States we’re
starting to see increasing number of those active cases but here’s something
that’s very interesting in the close cases when we show the graph for that
we’re actually starting to see that there is a upturn here in the death rate
where they’ve either gotten better or they’ve passed now there’s only two
reasons that I could see for the death rate to be increasing either number one
the virus is mutating and becoming more deadly or number two there is a lot less
testing and the number of active cases is going up much more so I suspect given
the fact that the death rate is going up that there are a lot more cases that are
just not being picked up out there because of lack of testing we can see
here that in China where there was a rip-roaring infection of course at the
beginning the total cases per million population was 56 we’re seeing a much
higher number here in Iran and Spain and even in South Korea in Italy we don’t
have that number here but we can see that those numbers are quite high and
will probably be very large in terms of the United States we’re seeing very
small numbers the question is whether or not that’s because of lack of testing if
we look again at the active cases list we see here by far the most amount of
active cases going on right now is in Italy and that is the tragedy right
now what is going on in Italy because there are so many active cases happening
so quickly that their healthcare system is being
overwhelmed I want to go back to this notion of flattening the curve I think
there’s some other things that we need to talk about so if this represents the
amount of patients over time and this dashed line represents the capacity of
the health system then clearly what is going on right now in Italy is something
that looks like this and we can only hope that it starts to come down quickly
what we are trying to do here in the United States is slow down the rise of
this so that we’re able to take care of these patients that are coming into the
hospital so the question here is is this going to be the United States and the
question here is is this Italy I think Italy has already proven itself to be in
this kind of a situation and what we are trying to do in this country is make
sure that we stay below that capacity of our healthcare system because if we have
something that looks like this then this is going to represent the excess deaths
and the reason why this would happen is because of no isolation so if you’re
wondering why we’re doing isolation is so that we go on a trajectory of this
rather than this so in my clinical practice and in my administrative
practice in the medical group that I work for we have spent a lot of time
trying to come up with a surge plan and a plan to put into place both in the
clinic and in the hospital to actually modify this dotted line for us locally
and I’d like to talk about that because obviously we’re smart enough to be able
to work on two things at the same time to get this surge down to flatten the
curve but are there ways that we can raise this bar so that we’re ready to
meet this in the middle so the question is is what have we been doing and what
are some suggestions that we can give so let’s talk about some of the support
that the purpose of this talk is not only to
let health care providers clinics hospitals out there know what it is that
can be done but it’s also to let all of you know that yes your healthcare
infrastructure is full of people working very hard right now to come up with
solutions so that we don’t have to deal with this if we get a surge that we
can’t normally deal with so I’m gonna divide this into two categories what we
would do at the hospital and what we would do to personnel so these are
people and bricks and mortar so the first thing is setting up the emergency
room so that there is a pre triage outside and that usually involves a tent
sometimes you have to get clearance from your County to be able to treat patients
outside of a licensed building usually that can probably happen by this point
if you haven’t already gotten that kind of approval so this tent also allows you
to triage people and to put masks on people who may have kovat 19 and could
spread it to other patients in the emergency room proper or healthcare
providers nurses etc inside the hospital you can set up whole wings that have
negative pressure and we’ve talked about this before the other thing you need to
think about is just setting up more rooms these rooms can be other negative
pressure wings whole wings of the hospital but you have to have
engineering look at the situation look at the structure and see how they can
configure it so that you’re dealing with a negative pressure room as opposed to a
positive pressure room like you have in the operating rooms the other thing that
you have to look at is the possibility that some of your providers might be
quarantined because they were exposed to somebody with kovat 19:00 and so for
that you need to think about robots so robots are basically computers on
mechanical wheels that you can wheel around and they have very powerful
microphones speakers and they also have very powerful cameras so that you can
see close up and they use these in hospitals where they need a neurologist
24 hours a day but they don’t have one this is the way that they do it for
joke centers but this could also be very helpful if you have a physician who’s
quarantine at home and can’t come into the hospital but you still need their
expertise the last thing that I want to talk about our ventilators so a couple
of things on ventilators number one there are disposable ventilators that
you can get fairly cheap and number two is this idea of hooking up multiple
patients to ventilators this is an off-label use but it’s something that
has been done before in an acute surge situation so here’s a really cool video
that I want you to see and I’m gonna put a link to in the description where dr.
Babcock an emergency room physician describes in detail how you can take a
regular ventilator and actually hook up numerous people to this ventilator and
it looks as though there are companies that are responding to this video that
are actually putting together kits that allow you to readily put ventilators
into rooms that allow you to ventilate multiple patients so I think every
hospital in the country should be looking at this possibility as a quick
way of temporarily if you need to ventilate patients when you don’t have
enough ventilators until you do have enough ventilators so let’s talk about
personnel what do we do if we don’t have enough doctors primary care doctors
typically working in the clinic are seeing well patients that’s not a
priority during a surge we can take primary care physicians and get them
into the hospital many years ago before hospitalist this is what primary care
physicians did they worked in the hospital and in the clinic and even
though they might be a little bit rusty some of them are probably well suited to
work in the hospital and those are the ones that we could select you would have
to waive privileges in an acute situation and usually Hospital bylaws
allow for that sort of thing especially if it is approved by the chief of staff
what about primary care doctors or clinic patients in general a lot of
those things can be dealt with over the phone so should you be having elderly
patients coming to your office sitting in waiting rooms if it is something that
can be dealt with over the phone call them up and deal with it over
the phone there are some insurance companies that will actually even pay
for that kind of a visit if that’s what you’re doing and obviously they’re gonna
be visits that you just have to see so these are patients that are being worked
out for cancer timely application of tests and reviewing of those tests can
be done very quickly but again there are still a lot of things that can be done
over the phone and if that is the case then that’s what should be done what
about in the intensive care unit well there are hospitalists people that work
in the hospital but not necessarily in the intensive care unit that can help
out in the ICU if it becomes very crowded so hospitalists into the
intensive care unit to help out the intensivists who are there so again
you’re working a little bit out of your area of expertise but the risks
associated with that are far outweighed by the benefits of taking care of people
during the surge what about students so this is what happens on a daily basis in
teaching hospitals you have students you have residents they’re able to meet the
surge demand not so much if you have a private hospital where there are no
students or residents but is it possible for students to come in to those
hospitals to help that has to do with laws that has to do with credentialing
and you have to see if those things can be waived to help out in a specific case
or cases where you have a surge and you need help what about bringing in other
doctors so that’s exactly what’s going on right now here in the United States
usually a doctor is licensed to practice medicine in a specific state what has
happened is some of those state requirements have been waived so doctors
can travel to other states to help out in surge situations right now in the
United States not every state is impacted the same as other states are
and so it’s possible that doctors from states that are not being impacted could
come to those states that are being impacted so that they can help that’s
kind of what’s going on actually right now in Italy but to a much larger extent
because you can see the doctors in Italy are having a very difficult time
handling this surge and help is coming from a very unlikely source it’s
actually coming from China try an immense amount of experience in
dealing with this coronavirus you can see here in this article which we’ll put
a link to in the description below so this article goes on to talk about all
of the help and the resources that’s coming from China to help out in Italy
which has the most active cases in the world right now
the Italian Minister Luigi de Mayo told Rai television our doctors don’t need
anyone to teach them in their job but the Chinese doctors were the first to
treat the virus and they can bring their experience and this folks is what it’s
going to be about when we’re talking about a world pandemic of a deadly virus
we’re gonna have to help each other out if we’re gonna be able to get through
this together the recipe for success if we’re going to be able to fight
effectively kovat 19 is going to come from two different parties number one
the doctors the nurses the respiratory therapists the hospitals they are going
to have to increase the bar in terms of what we are able to do in terms of our
healthcare abilities but it’s not just they’re also we’re going to need help
from the public at large to continue isolation to make sure that we’re able
to flatten that curve so that’s at the end of the day we can take care of
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