Reaching the Peak – Covid-19

Reaching the Peak

Georgia Hospitals are Climbing Mountains

Last week I had the chance to hear from leaders of WellStar, one of the largest healthcare systems in Georgia. Here’s what they, and other state leaders, had to say.

Expanding Capacity: Expansion of ICU beds by converting and upgrading other units has been the hospital system’s focus. The creation of a non-ICU hospital at the Georgia World Congress Center helps make this possible. Redeployment of doctors and staff freed up from their usual jobs is helping to staff ICU rooms. There are contingency plans to double ventilator capacity — shifting equipment around to different hospitals, purchasing vents, and converting anesthesia equipment. Also, since COVID is hard on kidneys, more CRRT machines have been ordered (continuous renal replacement therapy).

How Staying at Home has Helped: Every single hospital administrator on the conference call said having people stay at home has helped. They sent you their thanks, and said keep it up! Dr. Carlos del Rio, chair of the Hubert Department of Global Health at Emory University’s Rollins School of Public Health, has the data to back this up. In the AJC, he states, “Instead of seeing one day 10 patients, and the next day 20, and the next day 40, and the next day 80, we are seeing one day 10, the next 12, and the next 14, and the next day 16. That makes a huge difference.”

Amazing things: Hospitals, including Grady, are reporting that access to PPE (personal protection equipment) is better now for healthcare workers. This has helped to achieve lower virus transmission rates among healthcare workers. Since many healthcare workers work 7am – 7pm they can’t get to the grocery stores. So, hospitals have created mini-convenience stores within the hospitals for healthcare workers, stocked with things like PBJs, paper towels and, of course, toilet paper! They have a constant supply of donated meals. They have organized small groups to care for other people’s children. Last but not least, healthcare workers are uplifted by the success stories of COVID survivors, and really appreciate all the thank you notes from family members.

Current Bed Availability: Brand New Data!

“We are constantly comparing hospital capacity with surge numbers. Looking at models is good guidance but not foolproof. When it comes to looking at the median numbers, we are in good shape by more than 1000 beds. But if you look at the high numbers, we are not in good shape. The World Congress Center is our relief valve should we run north of our surge capacity. Pray we don’t need it. But it will be there.” 
–Major General Tom Carden, Adjutant General, Georgia Department of Defense

Testing: According to Dr. Kathleen Toomey, testing is still inadequate, and the status quo is not acceptable. We are 45th out of the 50 states in terms of numbers tested. Though many hospitals report they are beginning to do their own testing, Dr. Toomey says don’t show up at an ER for a test — call your health department instead. “We made it too hard to get tested because it required a referral from a physician. That was too hard a barrier. Now you can call your health department directly.” There are 34 testing sites in the state, including the new GA Tech site. In addition, there is a new lab in Sandy Springs, and Georgia Universities are processing 1000 tests a day. Expansion of testing criteria is beginning to open up. Dr. Toomey says that asymptomatic people who have had direct contact with a COVID positive person can now get tested.

What Goes Up, Must Come Down

The following are answers to questions submitted by legislators and answered by the Governor during the April 8th conference call:

After the “Peak” how will opening the economy back up be approached? Is diagnostic testing being expanded? Will an antibody test be used? How available is antibody testing? 1) IHME now estimates the peak in Georgia to occur on or around May 1st, when current projections show the state will have a deficit of 218 ICU beds. More capacity is coming on-line. 2) Two companies have released rapid tests nationally. Hospitals across the state that have partnerships with these companies now have machines and are actively testing. 3) IgG antibody testing is currently entering the market and once available will be deployed by the State.4) Antibody response indicates exposure, but does not imply immunity. There are other factors of immunity including cellular immunity and no one knows about immunity to SARSCoV-2, yet.

What Metrics will be used to trigger reopening the economy? Dr. Toomey, Commissioner of Public Health, says we will look at the numbers. “Right now we continue to see widespread community transmission. It is still too early to see the impact of the Governor’s Stay at Home Order — this takes several weeks. Hopefully we will see a flattening of the curve. If we open everything up too soon we will get a rebound with a second peak — we need to keep outbreaks from occurring even after we open things back up.”

A Roof over One’s Head

Will there be a statewide freeze on evictions and foreclosures during the Emergency? No. No specific action.

What is being done to support unsheltered homeless people? We have established the Displaced Individuals Sub-Committee, which is chaired by Mayor Bottoms. Look to her and her sub-committee. We are now working with a local hotel which will open today for 200 people who test positive but require no hospitalization. This will be monitored by public health.

Long Term Care (LTC) Facilities:  There are currently 80 LTC facilities statewide with positive COVID cases. Every LTC facility is a high risk place. Dr. Toomey stated the need to get ahead of the issue and work with ALL facilities, not just those reporting a positive case. Infection control work should be part of routine care. Training on infection control should be a priority, not just testing and reporting. Sixty Georgia National Guard Infection Control Teams have sanitized 249 facilities.

Miscellaneous Questions from Legislators:

Funeral Home viewings continue to occur. Will the Governor issue additional Orders to limit these to 10 people or immediate family? The Governor’s Order prohibits gatherings of more than 10 people if the 6-ft social distancing cannot be achieved.

Will the Governor continue to allow beaches and State Parks to be open? Georgians are obeying the Order and the Order is being enforced. The closing of State Parks and beaches is not necessary. St. Simon’s last weekend had only just over 100 people on the entire beach. That’s some of the best social distancing in the state. Neighborhood block parties are a bigger problem.

What will the budget impact be? How will Federal funds help? Tax revenues were actually up for March, but we expect the rest of the months in the 2019/20 fiscal year to be down. We have established a Sub-Committee on Economic Impact, chaired by the State Economist. It is premature yet to guess. We are keeping key people updated.

Will there be direction from the Board of Education to local school systems regarding virtual learning, at-home work for students and food distribution? Superintendent Woods will partner with the Governor’s office to launch working groups and guidelines for best practices for these areas plus facilities, equipment, mental health and professional learning.

Why is DPH keeping vital information from local elected officials to include the disposition of infected persons within their community (i.e., whether the cases are located in nursing homes/prisons and/or are hospitalized)? This is inaccurate – DPH is reporting long-term care facilities with positive cases and total hospitalizations – and the Department of Corrections is putting out information regularly on confirmed cases in their facilities. As we discussed yesterday, the DPH data is the “final authority” so there may be a lag in what you read on a press release, social media, or a post from a hospital – before DPH has the ability to confirm the data as valid.

Updates from Homer Bryson, Director, GEMA

Are first responders getting the supplies they need? Yes, we are in much better shape now than we were last week. The warehouse operation is impressive. We have streamlined the process to match the large scale needed. We order one day, pull the next, then ship the third day. Hospitals, nursing homes and first responders order every other day. Sunday is inventory day, when we assess where we are. We continue to deliver urgent orders every day when we get reports of shortages. We have shipped out 86 ventilators, 871,000 N95 masks, 1.2 million surgical masks, 201,000 face shields, and 3 million gloves.

Updates from General Tom Carden, Georgia National Guard:

The Georgia National Guard has deployed 2000 soldiers and personnel.

Infection Control Teams: The GA National Guard now has 60 active Infection Control Teams (The first team was organized and put to work on March 31st). These teams are made up of 913 personnel. They have cleaned 249 Long Term Care facilities.

Medical Support Teams: The Georgia National Guard now has 17 active  Medical Support Teams (The first team was deployed to Grady on March 25th). 200 personnel are deployed to 17 hospitals. These teams are made up of doctors, PAs and nurses, doing medical care and administrative support.

Hospital Entry Control Teams: 72 GA National Guard members are at hospitals doing patient screening. This frees up healthcare workers to tend to other needs.

Food Bank Support: GA National Guard has 180 personnel assigned to nine food banks.

Public Health: GA National Guard is assisting Public Health as drivers and couriers.

Updates from Dr. Kathleen Toomey, Commissioner of Public Health

Demographics on Public Health Website: Public Health is continuing to collect data that is not posted on the website because with some of the data there are so many variables that are still missing. For example, providers doing lab tests do not always provide all the demographic information. Public Health is working proactively to correct this. For right now, 65% of positive test results lack race/ethnicity data. This is a problem because we know that the cases in Albany are disproportionately affecting African Americans.

Anti-Malarials. The National Stockpile is providing anti-malarials to the states. The window for who gets this drug, and when, is very narrow. Dr. Toomey expressed grave concerns about how physicians are prescribing these drugs across the state, and how this is leaving people without their medication who continually need this drug to live. She has sent out a letter to doctors.

The Bird’s Eye View

 “This virus will change how we function now and in the future. We are a culture that embraces and shakes hands. This will change. Things that were routine will need to be modified because of the virus and how it transmits so easily. We will look for trends, but until we see that, I cannot give a prediction as to a date or how that decision (to open the economy back up) will be made. First we must see what community spread looks like and how our hospitals are doing.”
–Dr. Kathleen Toomey, Commissioner, Dept. of Public Health

Governor Kemp, in his 4/13 press conference said, “I don’t want to speculate yet. The peak day keeps moving. … We are seeing some good signs. Keep hunkering down. Keep doing what you are doing. … We must be very nimble in dealing with what comes after … On the back side of this, we can focus on opening up but not yet.”