Maryland hospitals are ramping up for an expected surge in COVID-19 cases.
While patient levels are low as of now, hospital administrators across the state are working with the Maryland Department of Health and the Maryland Emergency Management Agency to expand capacity.
They are also taking steps to protect their workers from illness and exhaustion — and they are battling financial issues and a global shortage of protective gear.
Maryland Matters reporter Bruce DePuyt spoke with Maryland Hospitals Association CEO Bob Atlas on Thursday. This account of their conversation has been lightly edited for clarity and length.
Maryland Matters: Gov. Hogan and others describe this as the calm before the storm. Is that how it feels to you?
Bob Atlas: Very active preparations are ongoing. It really heated up on Saturday, March 14, and we’ve been working without a break ever since, at our association and at all of our hospitals, to get ready.
MM: Your hospitals range greatly in size and need, but can you describe some of the steps that are being taken?
Atlas: There are things that we never thought we would be involved in. For example, one of the first things we realized when the schools closed, is that hospital workers who depend on the schools to cover their children during the day might need child care, so we got involved with the state Education and Health departments and worked on a plan for getting child care available — with priority for the essential health workers.
The plan that the state school superintendent announced [on Wednesday] was something that we had been working on for more than 10 days, with the state folks.
Likewise, we’ve had to work with transit agencies so that our workers have the ability to get to work. We’ve had hospitals report that the curtailment of service has been a problem for people on their dietary staffs and their security staffs. So we’re working with those agencies.
Obviously we’re also working on surge planning for getting all the beds that are expected to be needed, and getting all the supplies. Getting the testing kits has been a problem. Unfortunately, that’s a supply chain issue, not something that’s been within the control of the hospitals.
That’s something our state leaders have been working on aggressively. But this is a national problem. We’re working as hard as everybody else to fill the demand there.
MM: Given the shortage, you’re obviously having to prioritize.
Atlas: If we could get everybody tested who needs to be tested — and we definitely don’t need everybody to be tested — then people who are suspect can be ruled out, so that means there are fewer people who are sidelined who are waiting to find out if they are actually ill with the disease.
That includes health care workers who may have had an exposure or might be showing tentative symptoms.
Even something as simple as being able to re-use the personal protective equipment that’s used when you do a test. If you do a test, you have to set aside the equipment on the theory that the person that you tested was exposed or ill, and they can’t re-use the equipment. But once you get a rule-out, you can re-use the equipment.
The problem is sometimes test results are taking four or five days to come back and that’s been a real challenge. And it’s not something we can control within the state.
MM: Your hospitals have been postponing elective surgeries to free up space, correct?
Atlas: Yes. Initially that wasn’t to free up space, because the space wasn’t needed right away, but to conserve the PPE, because it’s been in short supply.
Hospital volumes are actually dropping. That’s true across the country. I’m in contact steadily with all my 50 state counterparts and what we’re seeing here in Maryland is not unique.
The federal stimulus bill has $100 billion in it for health care providers, and a lot of those dollars are going to cover lost revenue for all the services not being performed.
MM: Is there a goal in terms of the numbers of beds you’d like to have?
Atlas: The governor has announced that he thinks the state should have 6,000 more available than we have today. Our hospitals are looking at how they can expand their capacities — starting with freeing up space that’s currently occupied.
Some of our hospitals have patients who are medically ready for discharge but they’re having challenges placing them. This might be somebody who needs a guardian for legal reasons, but the courts are closed, so we can’t get judges to sign off on guardianships.
Some might need dialysis.
These sound like narrow issues but they actually add up to a lot of need.
Hospitals are buying more beds. They might convert private rooms into double rooms, at such time as would be needed and take more people fit in. But all of this is going to be done with great care so that all COVID-19 patients will be co-horted in one area of a hospital, with other patients completely segregated. You don’t want to be transmitting any infections needlessly.
MM: How do your member hospitals track staff exhaustion and illness?
Atlas: Staffing is probably a bigger issue than beds. We can buy beds and roll them into non-standard spaces. But finding the people to staff those beds is one of the challenges.
We’ve very concerned that staff do not get exhausted, that they don’t get ill. Hospitals are all taking extraordinary measures to make sure that staff are protected as fully as possible. And if anybody does become ill that they are not only taken care of but segregated so that they don’t transmit infection to other health care workers or other patients.
MM: How many of your hospitals — if I was to drive by right now — have a new tent or pop-up unit out front?
Atlas: Many hospitals have set up tents to do intake on people who might be suspected of having COVID-19, so they don’t enter the hospital premises. The state is in the process of acquiring modular units. We’re told they might get as many as 100 of those, and we’re actively asking our members — today, even — who might benefit from having one of these units.
Those are being acquired. They’re not sitting in Maryland today. But we’re figuring out what hospitals think they need so that the state can put in the right order and those things can be delivered within a few weeks, in time for the expected surge.
MM: A lot of people are frustrated that there aren’t more tests. This includes people who don’t feel well but can’t get a test.
Atlas: What we need people to do — because this disease is so contagious — we need them, if they have symptoms, they need to start by staying home and call their doctor, not go to the doctor’s office.
Most medical practices are offering virtual visits, where they might Skype or FaceTime with the patient. They will discuss the symptoms and recommend measures to do self-care at home while isolated. And then if the systems become more severe and more indicative of the likelihood of the disease, then the doctor might order a test.
And what we really need is for the tests to be more limited to people who appear to be most at-risk. It starts, frankly, with hospitalized patients and health care workers to prevent spread in health care settings.
People who are currently at home should not just rush out to a hospital to get a test. I think people are understanding that pretty well. We’re not seeing people flooding hospital emergency departments right now.
MM: There’s been a lot of cooperation with stay-at-home orders, but some have been slow to get the message. What thoughts do you have about that?
Atlas: People who are not believing that this is real and think that we are over-reacting with the social distancing measures, I just have to differ. This is serious. The infection can be spread very easily.
People need to maintain social distancing for real, practice the hygiene, and that will reduce the spread and reduce the severity, and enable the health care system to do what it’s good at doing without being overwhelmed with too many cases at once.
The disease is getting here later than some other places, like New York and some parts of California and Washington state. So we have more time to prepare for the surge. Everybody’s doing everything they can.
Our hospitals are on the front lines of care and they’re doing everything possible to be ready and make sure they are really able to support their communities.
There are so many folks volunteering. I just learned about some supplies of N-95 masks that came from the national stockpile. The elastic bands on them have dried out with age and so people are being enlisted to sew new elastic on the masks. And I think that the people of Maryland will rally and we’ll beat this thing.