COVID-19's learning curve: 'It's been a long road'
Both of southeastern Connecticut’s hospitals admitted their first COVID-19 patient on March 18, 2020 — an event their doctors, nurses and staffs knew was inevitable.
They didn't know much else about the coronavirus disease, which is not to say they were unprepared.
“One of the big challenges was our lack of knowledge about the virus and how it behaved,” Dr. Deidre Gifford, acting commissioner of the Connecticut Department of Public Health, said Friday, reflecting on the statewide response to COVID-19. “We were learning about the disease as the pandemic played out. Guidance was evolving in real time.”
At the outset, she said, there were no therapeutics, no vaccines. A lot of cases had to be managed before widespread testing was available. Personal protective equipment, or PPE, was in short supply.
“We learned rapidly,” said Donna Handley, president of Hartford HealthCare’s Backus Hospital in Norwich. “I remember our first COVID patient so well — a young gentleman from Norwich, married, with a 5-month-old baby. We knew right away he was pretty sick.”
On a critical care unit, a veteran nurse told Handley she and her co-workers had been afraid of what COVID would look like, what it would be like.
“We had to accept that this was a patient who just happened to have COVID-19. We had to demystify it,” Handley said. “We were watching what was happening in New York City and as the disease moved from west to east (across Connecticut). ... One of the first lessons we learned was that this patient had waited a real long time to come to the hospital.”
At the end of March, the patient would become the first COVID-19 fatality at Backus.
An 'aha' moment
Dr. Oliver Mayorga, chief medical officer of Lawrence + Memorial Hospital in New London, a member of Yale New Haven Health, said his staff has learned much about caring for COVID-19 patients and still has much yet to learn.
“One of the biggest things was realizing that not everyone needs to be on a ventilator. That was an ‘aha’ moment,” he said. “Just flipping patients on their bellies and not intubating (inserting a breathing tube) too quickly can save you some beds.”
High-flow oxygen therapy, monoclonal antibodies, the Regeneron antibody cocktail and greater use of steroids are now standard features of the fight against COVID-19, Mayorga said.
Out of necessity, hospital staffs have gotten better at communicating with patients. Amid restrictions on visitors, many patients were left without their fiercest advocates at the time they needed them most, Mayorga said. Doctors learned they had to be more proactive, make a more concerted effort to reach out to family members and patient advocates and have conversations about the goals of care.
Does the patient want to go on a ventilator? Have his or her chest compressed? Be kept sedated ... or allowed to pass?
“These are conversations we should be having with all our patients,” Mayorga said.
Hospitals across the state learned much about PPE, including how to acquire it, a process that illustrates one of the advantages of belonging to a health care system like Hartford HealthCare or Yale New Haven Health. In a virtual discussion with reporters last week, Jeffrey Flaks, president and chief executive officer of Hartford HealthCare, said his system had spent $50 million on PPE over the past year, and had built a new warehouse in Newington to store it.
While Hartford HealthCare used to maintain a 60-day supply of PPE, it’s now stockpiling a year’s worth, Flaks said.
Similarly, a Yale New Haven Health team works full time securing masks, gloves, gowns and other PPE, according to Mayorga, who said hospital administrators have become familiar with terms like “sourcing” and “price gouging.”
Handley recalled that in a news conference in the early days of the pandemic, none of the officials in attendance wore masks, a scene hardly imaginable today.
“In the first wave, we were spared, our numbers were low. We were able to manage really well,” Handley said. “When it hit eastern Connecticut in October, we knew what to do. We knew to wear masks and what precautions to take.”
Backus and L+M both reached their peak of COVID-19 patients months later, L+M treating 55 patients on Jan. 11 and Backus treating 60 on Jan. 17. Westerly Hospital, a Yale New Haven Health member, had reached its high of 22 COVID-19 patients on Dec. 23, 2020. As of Friday, L+M and Backus had five patients apiece and Westerly, four.
“We took it as serious as Greenwich did,” Mayorga said of L+M’s preparation for COVID-19. “Visitor restrictions, protocols ... We said let’s get going with overflow beds — and didn’t need them. We probably prepared more diligently than we would have if we hadn’t been affiliated with a health system. And we had the advantage of not being so close to New York. We did pretty well here.”
Masks, distancing here to stay
Of course, the pandemic isn’t over. Cases of COVID-19 variants have been popping up in Connecticut, though as of last week none had been reported in the eastern part of the state, and another wave of disease is possible.
What’s likely to be permanent?
“The best available prediction is that virus is going to remain among us,” said Gifford, the state public health commissioner. “There will potentially be a permanent vaccination program like we have for flu, but we don’t know that for sure. We don’t know how long immunity (from COVID-19) will last. We’re waiting for better science."
“As we deal with seasonal epidemics, we’ll need to have robust testing capacity — probably not in the form of drive-thru centers but in clinical settings, doctor’s offices,” she said.
Mask-wearing’s role in helping nearly eliminate flu and significantly reduce other respiratory illnesses this season ensures the practice is a keeper.
“It won’t surprise me if mask-wearing makes an annual return among the older, vulnerable population during flu season,” Gifford said. “It could end a lot of influenza."
Physical and social distancing also are here to stay.
“I don’t see handshaking coming back, which is sad because we’re social beings,” Mayorga said.
Embracing upon greeting one another also could disappear as the norm. L+M, no longer in need of as much waiting-room and meeting space due to visitor restrictions, could increase the area in which staff members eat.
Remote interactions between doctors and patients — telehealth — have sharply increased during the pandemic, at the same time highlighting inequities in health care.
“If you have no computer, no camera, no device, you don’t have telehealth,” Mayorga said. “We’ve seen the same thing with vaccine distribution — the inability of so many of those 75 and older to schedule online appointments without a young person helping them. So many are left out in the cold.”
Handley said Hartford HealthCare has filled a full-time position in its East Region, which includes Backus and Windham hospitals, to address equity issues. The network has sent a staffer with a laptop to a Killingly housing complex to schedule vaccination appointments for residents who have transportation and dispatched mobile units where necessary to administer vaccines in person.
Mayorga said he learned something about health care workers.
“I was surprised by their toughness,” he said. “Every single day they cared for COVID patients and then had to go home and see it — in their kids’ eyes. ... I’d be lying if I said I wasn’t tired. It’s been a long road.”