President of the American Society of Anesthesiologists, Dr Mary Dale Peterson, explains how healthcare sector is dealing with the COVID-19 coronavirus outbreak and what challenges and priorities there are.
What effect has COVID-19 had on
your work?
As
President of the American Society of Anesthesiologists, I have been working
with our Committee on Occupational Health to publish specific guidance for anaesthesiologists
to help them take care of patients that might be affected as well as protecting
themselves and other patients from possible transmission of this
virus. Many times, anaesthesiologists are the critical care physicians who
are intubating patients in severe respiratory failure. These are
challenging procedures in an unstable patient and also where transmission of
viruses is more likely. We did see this in the SARS outbreak. It is very
important that all steps of donning and taking off personal protective
equipment are followed, even in an emergency situation. We also offer specific
guidance in how to keep our special equipment from being contaminated as well
as cleaning procedures.
As an
association, we are now dealing with some hospitals or academic departments not
allowing staff to travel, even domestically. We do have the technology to
convert many of our committee meetings to virtual meetings, although we all
miss the social functions of getting together. We have also provided
encouragement to our colleagues around the world, especially in China, who have
been hit the hardest so far. They have also offered some lessons learned for us
to incorporate in our guidance to our members.
What are the priorities in
dealing with the COVID-19 emergency from a hospital management perspective?
In my other
job as Chief Operating Officer of a hospital system, our teams have been very
busy working on the following:
- Reinforcing and retraining
all of our staff on when and how to use personal protective equipment
(PPE). The Centers for Disease Control and Prevention (CDC) has
recommended airborne precautions, which is more challenging – it requires
special masks or self-contained systems and face shields or goggles.
- Educating all greeters
(volunteers, security guards) at our entrances to direct patients and
families to our check-in areas and, if they have cold symptoms, to don
masks. We have also posted signage. This is done year round, but
especially in the cold and flu season. What is different is that when the
patient is triaged by medical personnel, they are asked specific travel
history to affected areas of COVID-19 and symptom history. If these are
positive, the patient and family are given masks to wear (if they don’t
already have) and are escorted to a private room, preferably with negative
pressure ventilation. Staff are required to don full PPE, and we limit the
staff going into these rooms.
- Education to all community
physicians and working closely with our local and state health
departments. As of this writing, we still have no local ability for
COVID-19 testing. Any tests are sent to the CDC, although later this
week, it is expected that our state health department can begin to process
a limited number of samples (15 per day).
- I am also working with our
public relations team and the local media, along with our infectious
disease expert to calm the public so that we don’t have inappropriate use
of our emergency departments.
- An additional area of concern for us is the supply chain. Many items are produced in China and now we have also had a tornado in Nashville that has disrupted another major supplier. We are asking our staff to be mindful of the situation, conserve where we can, and be satisfied with the supplies we do get in, even though it might not be their favourite brand. We are on allocation from all of our suppliers and hope that production ramps up before we have critical shortages.
How can we protect providers and patients in health care settings?
As I have
stated above, reinforcing good infection control practices is the key. We have
contingency plans in place now to open up an entire floor of the hospital
solely devoted to patients with COVID-19, if needed.
Patients
should also be judicious in using our emergency departments (ED) – they should
call their doctor of advice if they have mild symptoms and only use the EDs for
significant symptoms like severe fever, shortness of breath, inability to keep
down fluids, etc. This will keep their potential exposure to other sick people
to a minimum. Of course, reinforcing good hand washing and cough etiquette and
staying home if ill are also always good practices.