BENNINGTON, Vt. — Southwestern Vermont Medical Center had Vermont's first patient to test positive for COVID-19.
But hospital officials knew it would be far from the last.
Since then, the facility has been gearing up for the surge that public health officials nationwide are predicting.
"We actually had plans in place, like most hospitals, prior to the pandemic as to how we would tackle a surge need, whether from a disaster or an infectious outbreak," said Dr. Trey Dobson, an emergency department physician and SVMC's chief medical officer.
"We secured additional actual beds — some we shifted from other locations and some we rented. Then we got staffing levels up to accommodate a number of patients two to three times our normal census.
That census normally is between 35 and 40 patients, Dobson said. Right now, SVMC has plans in place to treat about 100 patients inside the hospital.
After that, it would look to transfer patients to other facilities. And if the surge hit hospitals throughout the region simultaneously and transfers are not an option?
"If it came to it that we were full and had nowhere to transfer, we would have to start putting patients in the hallway as you would in a disaster," Dobson said. "Right now, … lower acuity patients would be treated outside the hospital."
Southwestern Vermont already has set up a Respiratory Evaluation Center adjacent to its emergency room for patients who have respiratory symptoms but stable vital signs.
"They are evaluated, treated and most likely discharged home," Dobson said.
Not all will receive a blood test to detect the novel coronavirus.
Although the early shortage of testing resources has improved over time, Dobson said the facility still has to be selective about who does and does not receive tests.
Generally speaking, tests are reserved for patients who are symptomatic and meet certain criteria: over age 65; have risk factors like diabetes, heart disease or lung disease; on immuno-suppression therapy; and health-care workers.
For now, testing of asymptomatic people is not advisable, Dobson said.
"We recognize that the sensitivity of testing in asymptomatic patients is not as high," he said. "There are many more false negatives, and that gives false reassurance. Second, there are still not likely to be the resources to test all the asymptomatic patients who want it. And third, when you test, you have to wear specific [personal protective equipment]. We want to save that for treatment, first of all, and second for testing of symptomatic patients."
"So for a young, healthy, minimally symptomatic patient right now, we don't have the resources to test and feel comfortable that those patients can be safely returned home for home isolation."
In the near future, Dobson said there likely will be more sensitive tests and the ability to test more of the population, "not for a medical reason but for epidemiological and societal reasons to determine who has been exposed and who has not."
Besides ordering beds, SVMC is making improvements to its infrastructure to handle a likely wave of patients who need treatment for COVID-19.
"We had to do some actual facility improvements to make sure those locations are capable of handling patients overnight, making sure enough oxygen is available, making sure there's enough storage," Dobson said. "We expanded our negative pressure rooms up to 44 rooms, which is a lot more than we normally have. We normally have around 10."
Negative pressure rooms use ventilation systems to allow clean air to flow into an isolation room but not out, thereby reducing cross contamination between patients.
Another change to SVMC's operations because of the pandemic: Like most hospitals, it has eliminated all non-urgent and elective procedures in order to free up space for COVID-19 patients.
But, at the same time, the hospital is reaching out to patients to make sure that their critical, non-coronavirus needs are being met and that people are not avoiding treatment out of fear of coming into contact with the virus.
"I am concerned about that, and I would not be transparent if I said I wasn't," Dobson said. "We try continually to find ways to communicate with individuals. We're doing a lot of telemedicine and telephone medicine.
"When I said we're not doing urgent procedures … we try to convert many patients to telemedicine and then reassess. What may not be urgent today may become urgent in two weeks when we don't talk to them now.
"We know that patients who forego treatment because they're scared or have misconceptions about our desire to see patients get very sick and end up in the Emergency Department. It's a balancing act, a lot of it is."
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