How Utah hospitals and health departments are getting ready for coronavirus
Utah hospitals, health officials and others are teaming up to make sure they’re ready when coronavirus reaches Utah, which officials view as inevitable. They’re confident they know what to do.
SALT LAKE CITY — With coronavirus COVID-19 expected to spread illness throughout the United States, health care providers, public health officials and others are teaming up to be ready.
Any rivalry between service providers falls away during an outbreak, a fact made clear at a news conference Thursday at the Utah Department of Health outlining plans to tackle COVID-19 in the state — echoing global, national and local collaboration specific to the virus since the respiratory illness was announced in China in January.
In Utah’s health care system, coronavirus-specific efforts build on drills and teamwork that go back years. The foundation has been developed through preparations for earthquakes, mass casualty accidents, H1N1 influenza, Zika virus, even Ebola.
“Utah has been planning for pandemic since 2002, since really the initiation of the Public Health Emergency Preparedness program. The partnerships and plans are in place. We practice. We are in a good position to actively ensure we do the absolute best we can,” said Kevin McCulley, director of preparedness and response for the Utah Department of Health.
Utah experts are confident that cooperation can help to manage this health crisis, though the exact details won’t be known until it hits. Right now, COVID-19 is not circulating through communities, though a single case has been diagnosed in California with no clear origin. Other cases on U.S. soil are directly linked either to travel or to close contact with someone who traveled somewhere the virus was active.
The story has been very different internationally. The virus is waning some in China but has now been diagnosed in at least 40 countries, with a minimum of 81,000 diagnosed and nearly 2,800 dead. The numbers change daily.
Still, experts caution against panic.
“We know how to deal with it,” Dr. Andrew Pavia, chief of pediatric infectious diseases at University of Utah Health and an adviser to the Centers for Disease Control and Prevention, told the Deseret News. “Even though we don’t know all the details about this particular virus, we have lots of experience dealing with epidemics and pandemics and that playbook is what we’re using to respond to this.”
The CDC has taken the lead nationally, while involving state and local health departments in sharing information and best practices and coordinating in their area.
Epidemiologists are working on public messaging and providing guidance to clinicians on identifying cases and managing care, McCulley said.
Preparedness planners are counting hospital beds likely to be available and preparing surge capacity. Doctors are learning how to care for those with COVID-19 without getting it themselves. And everyone involved is discussing how to tackle any shortages, from drugs to medical devices like ventilators.
By next week, Utah’s state lab will be able to test for the virus, now possible only through the CDC.
The public health incident command system is ON.
Utah, ready or not
Utah has no cases of coronavirus yet, though Utahns have been diagnosed, because cases are attributed to the place where they were identified, said Dr. Joseph Miner, executive director of the Utah Department of Health.
A Utah couple who will soon be coming home from their COVID-19 quarantine on a cruise ship after testing negative twice post-exposure pose no risk, said Dr. Angela Dunn, state epidemiologist.
There’s no risk they will spread the illness; they’ve recovered well, she said. “Which is fantastic.”
What does cause some concern is a diagnosis of COVID-19 in California with no known exposure, she said. “It’s possible that is the first community spread” that could be a “turning point in the outbreak” for the United States.
Utah works hard to be prepared on many fronts and is in some ways ahead of others, Pavia said. “We’ve developed a very elaborate plan for dealing with health care when the system is overwhelmed.”
Representatives of Utah’s major health care systems — including the U., Intermountain Healthcare, MountainStar and Steward — spoke at the news conference, noting their internal preparations, their broad cooperation and pointing out that they each have ways for patients to connect with their health care providers without having to go into hospitals and waiting rooms.
They each also said they have robust supplies on hand at this point to handle what’s coming and noted their care providers are actively watching for symptoms and recent travel to areas that have been impacted.
Utah’s hospitals have a long history of working together when the health of residents is at risk, said Greg Bell, Utah Hospital Association president. Since the 2002 Olympics, the health care community has shared information and worked to understand shortages and challenges, trying to keep the community safe, he said.
“We know each other, We have each other’s cell numbers,” Bell said.
The state has also drafted crisis standards of care to help prioritize treatment and allocate resources if there’s not enough to go around. “Those standards of care are well agreed on,” Bell said.
Besides health policymakers and government agencies and health care providers, the Utah Disaster Advisory Council and Utah Hospital Association, to name just a couple examples, are tasked with helping the state ride out this type of public health storm.
Crisis care planners track how many hospital beds are available and what share of those are in intensive care. They have carefully considered issues like how emergency medical services will be dispatched. Utah is home to a “pretty advanced telehealth system that we can put into place so people can have their doctor visits online” instead of exposing sick people to others in waiting rooms, said Pavia.
There’s also a lot of internal facility-specific preparation, said Alison Flynn Gaffney, executive director for service lines, ancillary and support services at University of Utah Health. “We have daily huddles internally. We’ve been focused on educating our internal community and patients. We have a weekly systemwide meeting that can ramp up to daily.” And different health networks also have subcommittees that look at everything from employee safety to supply chains.
Gaffney said the supply chain provides her “a bit more concern personally” than some issues. “It’s not a secret that products coming from China have constrained our supply chain channel as it relates to protective equipment we use, the commodity items we use every day. We are at full inventory now and working on securing inventory on a daily basis, as is every hospital around the country.”
Travel restrictions that might slow person-to-person spread could make supply chain issues worse.
Despite what Pavia calls good preparedness infrastructure and great teamwork, there are worries.
Utah hospitals typically operate at high capacity, so there’s not too much room to expand. Officials hope the flu will go away before COVID-19 arrives to free up beds. And it’s important that health care workers remain healthy, because beds won’t matter if no one is there to provide care for those in them.
McCulley said much of the upfront work is built on the knowledge that the number of patients who need care may exceed the capacity of the health care system in the community. States have “started to consider an orderly and rational allocation of resources because at some point there may not be enough resources for all who need them.”
The goal is to manage resources to meet the challenges COVID-19 will pose.
While experts have likened this coronavirus to a heavy influenza season and point to natural disaster planning as a preparedness framework, they acknowledge differences.
In a natural disaster, areas nearby that aren’t affected can pitch in. If coronavirus burns through the area, it may be doing the same in those other, usually helpful locations. Other states and communities may not have the capacity to meet needs outside their own boundaries.
“We have to do all we can to extend our available resources for the population of Utah and to continue to leverage the guidance and resources that might be provided by our federal partners to work through this,” said McCulley.
In the case of Ebola, they planned for a small number of patients. With COVID-19, the planning is for a mass event. It could require more than quarantine and isolation. Measures could extend to canceling group gatherings, including schools.
China, South Korea and Italy are among countries that have taken steps to limit crowds as a tool to decrease COVID-19 spread.
Mark Fotheringham, spokesman for the Utah Medical Association, said physicians are watching and waiting and doing what they can to prepare. One goal is education because if COVID-19 hits the state hard, it could overwhelm resources, he said, so prevention matters.
Pavia noted that, too. Seeing 200,000 cases over a long period of time is more manageable than trying to handle such a caseload all at once. So what people can do to avoid getting or spreading an illness counts.
“Our aim is to find the least restrictive interventions and encourage people to do their part: Stay home if you’re sick,” said McCulley.
That is, in fact, key to handling the crisis.
Among other steps people can take to stay safe and well:
- Stop touching your face, the entry point for respiratory illness.
- Wash your hands often.
- If you’re sick, put on a mask and stay away from others as much as possible. Self-isolate.
- Have a cushion of groceries and medications so you can stay in for a while if the illness is raging in your community or, worse, in your household.
- Employers should let workers telecommute if possible.
“Utahns tend to be pretty level-headed,” said Pavia, “often brought up in a Western self-sufficiency culture. They don’t melt down in the face of a crisis. But communicating with the public is one of the huge challenges in this sort of health crisis and I don’t think we are better than anyone else. Yes, this is real. Yes, you need to take precautions. But ignore fake news. Don’t panic. Be a careful consumer of good information resources.”