Indiana hospitals use drills, telehealth to get ready for possible large COVID-19 outbreak

At Indiana University Health hospitals, nurses are getting refresher lessons in “donning and doffing” protective gear. One tip: make sure the gown fully covers the torso, neck to knees, and gloves are pulled up to cover the wrists of the gown.

At Riverview Health in Noblesville, officials have removed most of the self-serve food options from the cafeteria to prevent the spread of germs, and restricted patients’ visitors to immediate family.

At Eskenazi Health, any patient who walks into the hospital sniffling or sneezing is immediately given a mask and escorted into an isolation room.

Around Indiana, hospital officials say they have stepped up safety precautions in the wake of the COVID-19 outbreak, the disease being spread by the novel coronavirus, which so far has claimed the lives of 22 Americans and more than 4,000 people worldwide.

Hospital officials say they regularly do drills on possible disasters, from floods and earthquakes to mass shootings and highway crashes.

But even as they have planned in recent months for a potential outbreak of COVID-19, some acknowledge that if the disease spreads quickly, as it has in some other countries, it could test their facilities.

“I think it’s going to depend on how widespread it is, and then how sick the population gets,” said Dr. Christopher Doehring, vice president of medical affairs at Franciscan Health Indianapolis.

He quickly stressed, however, that his hospital has a wide array of isolation rooms, ventilators, critical care unit beds and other features designed to handle a large outbreak.

So far, Indiana has only six positive cases of COVID-19, and health officials say they are keeping on top of things. Still, on Friday, Gov. Eric Holcomb declared a state of emergency, the first step in applying for federal money to assist local officials.

State Health Commissioner Kris Box said the state needs more epidemiologists to investigate cases, do follow-up and track who came into contact with other people, who in turn would need to be investigated.

The disease has a track record of spreading quickly and overwhelming health professionals in some places where it has had an early start.

In South Korea, where the death toll was 54 on Tuesday and the number of total cases hit 7,513, sick people are waiting days for hospital beds.

In Italy, where 463 people have died and the total number of coronavirus cases rose to more than 9,000 on Monday, hospitals are running short of beds and dozens of doctors have contracted the virus.

In the United Kingdom, the health minister disclosed on Tuesday she had tested positive for COVID-19. Doctors in that country are warning that routine appointments at surgeries may have to stop as the number of coronavirus cases rise.

Dr. Aaron Carroll, a researcher at the Indiana University School of Medicine, said what is happening in Europe should be a lesson for the United States.

“Our (hospital) capacity just isn’t as great as many assume,” he tweeted on Tuesday. “It’s not like hospitals work by keeping tons of ICU beds and ventilators open and doing nothing. It won’t take that much to completely saturate our capacity to provide care for these patients. Look what’s happening in Italy right now. That’s the cautionary tale.”

In Indiana, meanwhile, hospitals are dealing with high volumes of patients suffering from fevers, body aches and fatigue and other symptoms of the winter flu.

“Overall patient volumes at hospitals have been strong and steady over the last few weeks, mostly as a result of the annual flu season,” said Dixie Platt, vice president of the Indiana Hospital Association. “Flu activity remains high in Indiana.”

The step-up in hospital readiness comes at a challenging time. Hospitals in Indiana and elsewhere have been shrinking the number of inpatient beds in recent years as insurers have demanded that they move care to lower-cost settings, such as urgent care centers and ambulatory surgical centers.

Any serious outbreak of serious disease requiring lengthy hospital treatment and quarantine could test health systems just as they have moved sharply away from the traditional hospital-centric model of patient care.

So health systems are coming up with innovative ways to keep would-be patients from overwhelming their facilities as the disease gets more attention.

Beginning Friday, when the state declared an emergency, officials at IU Health began to think how to approach the problem with new technology.

“When this started to hit in Indiana, we recognized very quickly that we needed to look at a pathway to provide information, guidance and assurance to the population,” said Ian McDaniel, executive director of telehealth and retail operations.

More than 50 people—including IT specialists, physicians and lawyers—huddled to develop a brand-new app for people to use on their phones or computer that would give them free virtual screenings for COVID-19 with an IU Health doctor or nurse.

IU Health quickly staffed its telehealth center around the clock with clinical specialists to take calls from people wondering if they had contracted the illness and to ask them questions about their symptoms, their recent travel history and whether they came into contact with anyone who tested positive for the virus. By Tuesday, more than 500 people had called the telehealth center.

“The majority of them, we have been able to keep them at home, even if they have had a potential exposure or travel because they may not have symptoms,” said Dr. Michele Saysana, IU Health’s vice president of quality and safety. “And I see that as a huge win because we didn’t send them to the emergency department or urgent care or a primary care doctor’s office unnecessarily.”

So far, IU Health has determined that just one person that came in for testing, a Hendricks County resident, was positive for COVID-19

Some hospitals are also exploring whether to set up drive-thru-style screenings and testing, the Indiana Hospital Association said.

There is no treatment available for the virus yet, although several laboratories and pharmaceutical companies are racing to develop a vaccine. To contain the spread of the virus, hospitals and health officials are asking people who test positive or might have come into contact with the illness to isolate themselves for two weeks.

In the meantime, one critical issue is that none of the hospitals have testing kits on hand. All they can do is collect specimens from patients with symptoms and send the swabs and fluids to the Indiana State Department of Health for testing.

The state health department has said it will conduct tests only on “approved patients”—or those deemed to be the sickest or at highest risk of contracting the virus. As of Tuesday, the health department had tested only 36 people—up from 12 on Friday.

The state declined to say how many test kits it had on hand. Each kit contains chemical reagents that are used to process the specimens. The number of tests that can be done with each kit varies, because some tests require the use of up to 15 reagents, said Jennifer O’Malley, health department spokeswoman.

“We have requested additional reagent kits but don’t have a delivery date,” she said.

Some states, including Oregon, have said they could run out of the test within days without an infusion of new kits.

Many health systems in Indiana have declined to say how many people they have treated or who have tested positive. Many also say they have been ordering extra supplies to deal with a possible large outbreak, from protective gear to diagnostic tools.

“Our supplies have been evaluated and we are well-stocked, even have extra supplies stocked due to influenza season, including masks,” said Jeff Dutton, a spokesman at Johnson Memorial Hospital in Franklin.

Ascension St. Vincent said it has infection-control specialists at hospitals who are working closely with federal and state officials to detect and respond to an outbreak.

Hancock Health said it is practicing conservative techniques to keep supplies on hand as long as possible, such as prioritizing the use of disposable face respirators, and substituting other methods, such as air-purifying respirators for example, when possible.

Community Health Network, which handled the first positive case last week, said it has a sufficient number of isolation rooms, equipped with negative airflow, to house patients and keep the virus from spreading. But it declined to predict how much space the hospitals could require if the outbreak continues to spread.

“At some point, we may reach a capacity,” said Dr. Ram Yeleti, chief physician executive at Community Health. “So we are actually doing disaster planning, where we may isolate specific wings of a hospital or find other potential ways of increasing capacity.”