You’ve probably seen them in a feverish haze as you’ve lumbered toward your doctor’s waiting room — little boxes of face masks, set out to help you shield your coughing.
The boxes are there to make it easy for sick patients to practice what medical folks call “respiratory etiquette.” But, in an age of coronavirus fears — though there is, not yet, a confirmed case in Colorado — those little boxes have become something else in hospitals across the state. They’re basically vending machines for our anxieties.
“We’re seeing members of the public just coming in and taking masks,” said Lyle Moore, the director of emergency preparedness for the Colorado Hospital Association. “They’re not really there for treatment. They’re just there to take the free mask.”
So, Moore said, the boxes of masks have now moved behind the reception counter. That may be the most visible sign of how hospitals are preparing for an influx of patients with COVID-19, the formal name of the strain of coronavirus that is spreading worry across the globe.
But Moore and others in charge of planning for a pandemic say hospitals have been preparing for this moment basically every day. All hospitals are required to have an emergency-response plan, to do trainings every year and to produce after-action reports detailing how things can be improved.
Some of the drills are as simple as gathering people around a table to talk out how an epidemic response might work. Others involve volunteers playing the roles of sick patients. And some aren’t even announced.
Dr. Michelle Barron, the medical director of infection control and prevention at UCHealth University of Colorado Hospital, tells a story of an unannounced drill a couple years ago for responding to the Ebola virus. A member of Barron’s team talked of recent travel to Africa, then collapsed to the floor. Just as her alarmed colleagues were about to stick an IV in her arm, the woman fessed up that it was a drill.
“That’s the way hospitals operate,” Barron said. “We’ve got to plan for these things. There’s nothing special for (coronavirus) we needed to do in that regard because we do it on a daily basis.”
But the new coronavirus is presenting some unique challenges.
The first is that it will potentially arrive in the midst of what has been a fairly difficult flu season. Colorado has already seen nearly 2,800 hospitalizations related to the flu, and hospitals have at times been clogged with people seeking treatment.
The second is that much of the manufacturing for the medical supplies needed to respond to a respiratory virus — masks, gowns, gloves, etc. — is overseas, and especially in China (though, Vice President Mike Pence has said the federal government will work with U.S. manufacturer 3M to produce millions of more masks per month).
In early December, before the current coronavirus outbreak had been identified, U.S. Rep. Diana DeGette, D-Denver, chaired a House subcommittee meeting on preparedness for the flu season. In his written testimony, Robert Kadlec, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, had this ominous warning:
“The U.S. lacks sufficient domestic manufacturing capacity and/or raw materials for almost all pandemic influenza medical countermeasures, including vaccines and therapeutics, the needles and syringes needed to administer them, and personal protective equipment, including masks, needles, and syringes. Further, in a pandemic, global manufacturing capacity will likely not be sufficient to meet demand, resulting in an inability to import adequate quantities of medical countermeasures.”
Hence the need to put the courtesy boxes of face masks behind the counter.
Across Colorado, hospitals have begun to take modest steps to conserve masks and other supplies. UCHealth hospitals, for instance, have stopped doing mask fit re-tests that thousands of its workers take every year just to make sure they are still using the correct size of mask.
Moore said many hospitals have been put on “allocation” by their suppliers — meaning they are getting their usual shipments of supplies in their usual quantities but are unable to order more.
Some hospitals say the double whammy of flu and coronavirus may work to their benefit. They were already stocked up on supplies, and they are optimistic they have enough to treat an influx of new patients.
“We try to stay stocked up,” said Dan Weaver, a UCHealth spokesman. “It’s not something you stock up for in the height of the event.”
“The way that things are looking right now, we feel we are prepared to take care of patients,” said Dr. Gaby Frank, a physician at Denver Health.
If any hospital begins to run low, that’s when a dizzying array of behind-the-scenes mechanisms whir into gear. Both the state and federal governments maintain stockpiles of supplies, Moore said. But hospitals in Colorado also have collaborative groups and a statewide memorandum of understanding to help them work together better in a crisis and share supplies and capacity.
Large hospital systems, like UCHealth, maintain their own supply warehouses and can also move patients between hospitals within their systems. But rural hospitals have their own networks, said Jessica Garcia, a nurse and infection prevention practitioner with San Luis Valley Health in Alamosa.
Though isolated from urban areas, Garcia says the San Luis Valley every year sees the same kind of flu activity as everywhere else — in part because the valley typically sees a lot of travelers passing through. There’s no reason to think coronavirus would be any different, she said.
So, Garcia said health care providers in the valley will lean on a local coalition to share supplies and other resources as needed to respond to an epidemic. That’s why she and other medical professionals are urging calm. Doomsday prepping is not needed, she said.
“A lot of people get nervous about these things, so we’re just trying to make sure people know how to protect themselves,” she said.
Frank, the Denver Health doctor, echoed that thought. Frank is the medical director of Denver Health’s biocontainment unit — one of only a handful of such facilities in the country designed to treat patients infected with some of the most fearsome bugs known, such as Ebola. The hospital has no plans to treat coronavirus patients in the unit.
Instead, coronavirus patients may be sent to a “negative pressure room” — a specially engineered room where air does not flow out when the door is opened. Or, they could be sent home. Frank said the experience of other countries shows that many coronavirus patients could recover without needing hospitalization. Whatever happens, she’s confident her hospitals can handle it.
“We’re working very hard to be ready,” Frank said. “And I think we are.”
The do’s and don’ts of coronavirus preparation
DO Wash your hands.
DON’T Wear a mask, unless you’re sick.
“They really are not going to help you,” University of Colorado Hospital Dr. Michelle Barron said of face masks. The reason?
“The basic principle of respiratory viruses is that they are spread by your hands,” she said.
People touch infected surfaces, then touch their eyes, nose or mouth. Barron said she’s seen people wearing precautionary masks who lift them up to drink or eat — totally defeating the protection they theoretically offer.
So, just wash your hands or use hand sanitizers that are at least 60% alcohol. Wipe down surfaces. Avoid touching your face. And only wear a mask if you are coughing or sneezing, to keep your germs from getting on others. Wearing a mask while you’re healthy only makes the supply shortage worse for the people who really need them.
DO Stay home if you’re sick.
DON’T Freak out.
Barron said every feared epidemic — including this one — brings out the “worried well,” people who show up at the hospital concerned they have the disease everyone’s talking about.
COVID-19 symptoms resemble those of a lot of other illnesses — fever, cough, shortness of breath.
But, despite a number of concerning cases popping up across the country, Barron said it’s still unlikely in Colorado that your cough is COVID-19, unless you’ve recently traveled to an area with an outbreak or had contact with someone who had the disease. If you have, call your doctor and let them know what’s going on; they may get you tested for the disease, something that only the state Health Department can do right now, Barron said.
But it’s much more likely you have the flu or a less-serious illness. So stay home from work, seek medical treatment when you need it and give your body — and your fears — a much-needed rest.