How do hospitals prepare for an outbreak? The first place to look is their warehouse. - North Carolina Health News
Liora Engel-Smith and Rose Hoban
As North Carolina contends with its first case of coronavirus, some in the state have been long preparing to support health care providers should an outbreak such as COVID-19 become widespread.
One of those people is Dale Hill of WakeMed, the Raleigh-based health care system. Hill, operations manager for preparedness for the health system, is part of the Capital Regional Advisory Committee, or CapRAC, a unit that responds to disasters and hazards in Franklin, Wake, Johnston, Harnett and Lee Counties.
Hill thinks about disasters for a living, from floods and hurricanes to unlikely events such as severe earthquakes, even a volcanic eruption.
But of late, Hill has been considering another hazard, one that has been on the minds of many: a potential for widespread coronavirus infections. As of Tuesday, the Centers for Disease Control and Prevention tallied roughly 60 infections and 6 deaths across 12 states in the U.S. One of these cases, North Carolina health officials said on Tuesday afternoon, involves a person in Wake County. Health officials declined to provide detailed information but said the patient, who had been in Washington state and was exposed at a long-term care facility, is doing well in isolation at home in Wake County.
Legacy of natural disasters
On Monday, before the infection made the news, Hill said the CapRAC is ready to assist area facilities should they run out of masks, gowns and other personal protective equipment. The committee can also set up mobile emergency departments should the need arise, he added.
Hill showed reporters around the nondescript 50,000 square-foot facility that featured medical trailers, gurneys and 20-foot high shelves filled to the brim with medical supplies, everything from oxygen tanks, gauze and full-coverage Tyvek suits, to Post-it notes and coffee makers.
Supplies also included other such mundane items as folding chairs and tables, disposable pillows, linens, air mattresses and cots.
“We’ve gotta be able to feed ‘em, treat ‘em, transport ‘em and give ‘em somewhere to sleep,” said James Creech, logistics and training specialist at WakeMed.
Hill said the team is ready to respond to the need in the five-county territory it covers. Across North Carolina, seven other such teams, each covering a part of the state, operate similarly, he added.
CapRAC can turn almost any building or parking lot to a mobile medical unit, Hill said. During Hurricanes Matthew and Florence, WakeMed, as part of the State Medical Assistance Team, used this equipment to set up a care facility inside a megachurch in Clayton.
In the case of infectious diseases, such as coronavirus-induced pneumonia, which requires treating the air, CapRAC can even set up air scrubbers to create makeshift isolation rooms, Creech said.
The team also has several battery-powered ventilators and intubation equipment, he added.
Hill said the team will use the trailers to transport supplies anywhere in the five-county region.
“If we were to set up at a community college, for example, there’s plenty of rooms that we could set up cots and things like that, where we would take these different cabinets here, roll into a wing, so to speak, and that would be like your supply area for that hospital wing that we’ve set up in another building,” Hill added.
The first mobile hospitals came out of North Carolina, created in the wake of the terrorist attacks of 2001. That first “hospital on wheels,” MED-1, was created at then-Carolinas Medical Center in Charlotte and deployed to southern Mississippi in the wake of Hurricane Katrina.
Increased demand anticipated
Though there have been some reported shortages of masks and other protective equipment worldwide as coronavirus spread, Hill said WakeMed has not been affected as of yet. He said CapRAC has made projections of how many masks and gowns they’d need per patient in case they have to respond to widespread infection. CapRAC will also share its supplies with facilities in the five-county area they serve if shortages arise. In North Carolina, where some hospitals — particularly rural ones — have been under financial pressure, that support may be necessary.
Other hospitals in the state report they’re well equipped for now but will, as time goes on, rely on the state stockpile for replenishing supplies, said Catherine Passaretti, Atrium Health’s Medical Director of Infection Prevention.
This week, the federal Department of Health and Human Services loosened rules to allow health care workers to use “certain industrial respirators during the COVID-19 outbreak in health care settings.”
The FDA and Centers for Disease Control and Prevention noted that the supply chain for personal protective equipment could become stressed as demand increases, leading to shortages.
“The FDA and CDC are taking steps to address the observed and anticipated shortages by expanding the use of respirators that are NIOSH approved, but do not currently meet FDA regulatory requirements,” said a Monday press release from the agency. The move allows for health care providers to use appropriate masks and coverings that might only be currently approved for construction and other industries.
Those shortages may already be here for many. In remarks Tuesday, World Health Organization Director-General Tedros Adhanom Ghebreyesus expressed concern about “the severe and increasing disruption to the global supply of personal protective equipment – caused by rising demand, hoarding and misuse.”
Last week, in a joint letter to Congress, leaders from the American Hospital Association and the American Nurses Association asked for an additional billion dollars to cover costs of additional equipment, training and construction to provide for treating “potentially large numbers of persons” affected by COVID-19 infections.
Additional reporting in Charlotte was contributed by Yen Duong