CLEVELAND, Ohio — As the novel coronavirus, called COVID-19, continues to spread across the globe, Cleveland’s major hospitals are preparing for potential cases.
From screening patients for the virus to protecting medical providers, local health care systems are taking precautions to ensure that if they do get a case of COVID-19, it doesn’t spread, as it has in China.
“Part of preparedness is thinking ahead,” said Dr. Amy Ray, medical director of infection prevention at the MetroHealth System.
As of Feb. 20, there were more than 75,000 cases reported worldwide and more than 2,100 deaths, most of which are concentrated in China, the epicenter of the outbreak, according to the World Health Organization. The virus has spread to 26 countries, including the U.S., which has 15 reported cases, according to the Centers for Disease Control and Prevention.
Currently, there are no cases in Ohio of the respiratory illness, which has symptoms similar to the flu — fever, cough and shortness of breath.
Protecting patients
Early identification of patients who are at risk for COVID-19 infection is important, Ray said.
MetroHealth staff who schedule urgent appointments in doctors’ offices are trained to look for patients who are having fever and cough, or fever and shortness of breath, and have traveled in China or been in close contact with someone who traveled there, Ray said.
If a patient who may have COVID-19 walks into the MetroHealth emergency department unannounced, health care workers will ask the person to put on a mask, the same as they do with a patient who appears to have the flu, Ray said. Signs hanging in the emergency room urge patients to wear masks and cover coughs.
Transmission of COVID-19 from person to person happens after prolonged, direct contact, Ray said. The CDC considers sharing a hospital waiting room with a person who has the virus to be a low-risk situation.
At the Cleveland Clinic, the electronic medical records vendor turned on a function that automatically prompts those who are checking in patients or taking calls to ask if patients have traveled to China and are experiencing symptoms such as cough and fever, said Dr. Tom Fraser, vice chairman of infectious disease at the Clinic.
University Hospitals’ staff also screens patients entering the system. If someone is at risk for COVID-19, staff will ask the patient to put on a mask before visiting the doctor, or the patient can be met outside with a mask, said Dr. Elie Saade, medical director for infection control at UH.
“We are really taking an aggressive approach. Whenever we have a doubt, the slightest doubt, the infection control team will intervene right away to help the providers on the front line,” Saade said.
Each UH location has at least one dedicated infection preventionist, he said. The Clinic has a multidisciplinary team working on infection prevention.
At MetroHealth, patients considered at risk for COVID-19 are directed to the emergency department. There, the patient is handed a mask and immediately placed in a private isolation exam room, which has a ventilation system that pumps the room’s air to the outdoors six times an hour. The air isn’t recirculated into the hospital, Ray said.
“The goal is to isolate the [suspected COVID-19] patient from others to minimize exposure,” Ray said. There wouldn’t be any need to evacuate the emergency department, she said.
At MetroHealth’s main campus in south Tremont area, officials have set aside a two-bed unit, called the Special Diseases Care Unit, for possible COVID-19 patients.
The unit has its own blood lab and an anteroom where health care workers can put on and take off their protective gear. The Infection Prevention Team is looking for other areas of MetroHealth with negative-pressure ventilation systems that could be used to care for COVID-19 patients, Ray said.
Portable X-ray and other equipment can be brought to the isolation rooms to minimize the need to move patients through the hospital, limiting the danger of transmission to others.
The procedures at MetroHealth, the Clinic and UH are similar.
Staff also would limit how many people are entering isolation rooms, Saade said. Environmental services and food delivery would be restricted, and food would be delivered by doctors and nurses, he said.
There are requirements for hospitals to have these types of negative-pressure rooms, which typically are housed in emergency departments, Saade said, and hospitals can also use machines to purify the air in other rooms, if there’s a need for more capacity.
Protecting health care workers
At each hospital system, medical personnel wear protective gear that covers their nose, mouth and eyes to examine patients suspected of having COVID-19. That means wearing fitted respirators, a face shield or goggles, gloves and a gown.
Keeping health care workers protected and healthy is a priority because they come in contact with so many others, Saade said.
“A big problem in these big epidemics — thankfully, we’re not there yet — is that you don’t have enough health care workers to help with people care,” he said.
The hospitals have adequate supplies of personal protective equipment for medical staff, the doctors said.
“All staff dealing with patients are prepared to enter a room feeling safe that they can take care of somebody,” Fraser said.
Depending on the type of exposure a medical provider has with a COVID-19 patient, the staff member will then need to go into isolation, Saade said.
A worker who suffered high-risk exposure to the illness, such as being in contact with saliva or mucus from a COVID-19 patient while not wearing protective gear, would spend 14 days in isolation at home, doctors said.
Because the treatment for COVID-19 involves ensuring that the patient gets adequate oxygen and fluids, any physician — and not only infectious disease doctors — can treat these patients, Ray said. She doesn’t anticipate a shortage of doctors if there is an outbreak in Northeast Ohio.
Dr. David Nguyen, an infectious disease physician at University Hospitals, practices putting on the personal protective equipment that would be needed if there were a patient with the novel coronavirus. (Gus Chan, The Plain Dealer)The Plain Dealer
Testing
Hospitals cannot test for COVID-19; only the CDC can do that at this point.
Each health system is working closely with local and state health departments and the CDC.
Doctors or nurses at area hospitals take test swabs from suspected COVID-19 patients and ship them to CDC headquarters in Atlanta, using biosafety protocols for shipping, Ray said. Public health departments are responsible for following up with the patient’s family and friends and other contacts. It takes about a week to get test results back from the CDC.
Suspected COVID-19 patients who are in stable condition and don’t need hospital care are quarantined at home, Ray said. Public health workers monitor the patient via phone or Skype. The patient would need fluids and rest to recover.
If the suspected COVID-19 patient has other health conditions that make coronavirus dangerous, such as diabetes or heart disease, he or she will be admitted to the hospital, Ray said.
Saade estimates there are least 60 respirators, which are used to help patients breathe, at UH Cleveland Medical Center alone. A Clinic spokesperson didn’t give an exact number but said the system is “well supplied.” Ray declined to state the number of respirators at MetroHealth.
While it’s ideal to isolate all patients in the hospital, if there were a COVID-19 outbreak, those with lesser symptoms would need to self-quarantine at home, Saade said.
“If we have just a few people, we can isolate them,” he said. “That’s not something that can happen if it’s widespread.”
Back to the basics
Fraser said that a lot of the precautions that health systems are taking for COVID-19 are built on day-to-day infection-prevention practices.
In the end, it all comes down to the basics, he said.
“Everybody’s seen the Hazmat suits and stuff like that on TV. But if we don’t wash our hands well between patients, then you can have all kinds of fancy suits” but not be protected, Frazer said.
“Clean hands going in, and clean hands going out” is the “fail safe,” he said. “Because not everybody is going to come with a sign that says ‘I’ve got coronavirus.’ ”
The Clinic emphasizes daily basic infection-prevention practices, such as hand hygiene and proper cough etiquette.
“Those kind of basics, without those, everything else would fall apart,” Fraser said.
Because Northeast Ohio already is in flu season, a lot of extra precautions already are being taken, such as asking patients with a cough to wear a mask in waiting rooms.
“For now, influenza is still a bigger risk,” Saade said.
In Ohio, there have been 5,457 flu-related hospitalizations this season, and in Cuyahoga County, there have been 1,045 confirmed cases of the flu, health officials said.
So far this season, there have been 92 pediatric flu-related deaths reported across the United States, according to the CDC. Ohio has seen two pediatric flu deaths this season, health officials said. The CDC and ODH track only pediatric flu-related deaths.
The CDC said COVID-19 still poses a low risk to the vast majority of Americans.
Read more COVID-19 coverage:
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Ohio economy could feel impact if China’s coronavirus outbreak continues much longer
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Coronavirus death toll continues to climb in China; U.S. hospitals prepare: Updates
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