The CHA Everett hospital has seen an uptick in cases and patients coming in with COVID-19 cases, but caregivers there are more confident and experienced to deal with it this time around – and better resources as well, compared to the surges of April and May that were touch-and-go on a daily basis.
Dr. Melissa Lai-Becker, chief of the Emergency Department at CHA Everett, said observers are right to be concerned about the uptick in cases at the hospital, but that the good news is the hospital is better-equipped to treat the illness, and the numbers are nowhere near the surges last spring.
“It’s really getting that balance between maintaining good preparedness and practices and taking care of patients we have – COVID-19 or not,” she said. “It’s really remaining vigilant without getting fatigued or feeling run down by the last six months here. We want to stay prepared as we look ahead. The numbers reported are accurate and while they represent a gentle uprising, the good news is ultimately…having 10 cases and three or four in the ICU is concerning but nowhere near where they were in April and May. We are thankful for that.”
In March, as the hospital ramped up operations related to COVID care, and shut down other operations to make room for what they expected to come – the disadvantage is doctors and caregivers had no idea what to expect. There were more patients than they expected, they had to develop a network on the fly to transfer patients to open beds throughout Greater Boston, and the disease was new with many of its symptoms and characteristics was unknown.
Even some of the treatments now known to help – such as the potential of using the Tylenol poisoning antidote to help COVID-19 patients that was developed at CHA Everett – were not yet known.
Those deficits are no longer the case, Lai-Becker said, and any new uptick in cases is something she said they feel like they are more prepared to handle.
“It’s good to be in a place where six months in – even if there aren’t multiple breakthroughs or relatively few treatments – there is enough experience with patients that clinicians have a much better understanding of the direction of the disease and its course,” she said. “It’s a lot less of a cognitive barrier trying to figure out where on the spectrum of sickness the patient is at. We have a much better idea of how to gently treat patients and ease them through their sickness.”
That also comes with more supplies and better preparedness. During the recent uptick, Lai-Becker said they went to get a ventilator to use, and found that there were three extras waiting in the storage room. That was something that was not common during the surge, when there were sometimes one or none in waiting.
“We’re going to be grateful for the bounty we have,” she said.
Right now, however, the fight is to make sure everyone gets the flu shot, she said. She recommended people get it as soon as it becomes available. Most clinicians are worried about a double hit in the late fall and winter – that if COVID-19 increases, it could be complicated by the traditional flu and potentially overwhelm caregivers again.
“If your primary care is getting it in or your doctor has it, or if the CVS has it when you happen to be walking by – by all means get it,” she said. “We are awaiting our shipments right now and we want to at least have everyone vaccinated for the flu.”
Right now, she said hospitals like CHA Everett are monitoring the shipments and the production of vaccine, as most orders were put in back in the fall of 2019 – long before COVID-19 came on the scene and prior to the extra push to vaccinate all children going to school and adults in the workplace. So far, she said she isn’t worried about supply, but they are monitoring it.
Lai-Becker said one clear change is that the urgency of her job in monitoring available beds in the region and supplies in the Department has slowed.
“In the last two months, my job has moved back to having many meetings where we might not have but a few mentions about COVID or COVID patients, but we are spending time on preparing for these larger picture issues,” she said.
•THE NEW BALANCING ACT
One of the biggest balancing acts right now is still trying to get the hospital back to normal volumes, but what exactly is normal? That is something that is constantly evolving, she said.
Right now, the Emergency Department and in the overall hospital operations, they are at about 85 percent of their typical pre-COVID volumes. However, she said the Somerville Urgent Care facility is seeing record numbers and tele-health visits are booming as well. Adding that all up, it could mean that lasting change is on the way – something many in the health care field are watching very closely.
“Putting all of these things together, I’m wondering if we’re starting to see the right-sizing of the health care system,” she said. “Maybe we’re starting to see patient care in the right place at the most appropriate time. That could be a silver lining of this pandemic.”
•TESTING IS AMPLE
Another major difference this fall is that testing is in place – both in ample supply and in testing systems that are proven to work. There is no more guesswork on the best systems, whether they are actually working, and figuring out how to get them to a lab (at times in April and May they had to run tests via a courier to an outside lab).
There were times during the surge when they had to ration their tests, and figure out who needed to be tested and who did not.
“We were tracking test kits daily,” she said. “It made a difference on who we tested and how we tested them and if we could test them on site…We had to use our best judgment…Now, we have the testing and with the lower volumes, we don’t expect an issue.”
She said Massachusetts has some of the lowest rates right now in the country, and credits that to a slow and methodical approach, a public willing to follow the rules for the most part, and a plethora of medical facilities in the region.
“It’s like the tortoise and the hare,” she said. “We’re the tortoise and slowly, methodically and thoughtfully moving forward. We do benefit in Boston and in Massachusetts by a lot of medical expertise. It is also helpful in general to have communities that are all and for the most part are trying to follow the rules.”
She said it is right to sound the alarm, even if the hospital is more prepared right now. She said people need to understand things can get worse fast and care needs to be taken to move forward on re-opening.
“(Everett) Mayor (Carlo) DeMaria expressed concerns about the gatherings,” she said. “I, too, express the same concerns, but I too have to trust the people because we have to get our kids back in school.”