In preparation for a potential surge of COVID-19 patients, hospitals in southeastern Wisconsin have halted non-emergency surgeries, repurposed hospital beds, reopened shuttered wings and coordinated across health systems to create more capacity for the region’s sickest patients.
With no proven medication or vaccine available for the coronavirus, the extent to which hospitals use that capacity has been predicated on the effectiveness of social distancing measures.
Early this month, Medical College of Wisconsin president and chief executive officer Dr. John Raymond ominously drew comparisons between a runaway train and COVID-19’s projected impact on the state’s health care system.
“The train is going too fast to stop before it crashes into the station,” Raymond said. “We’re pulling the brakes to slow it down but it’s going to crash into the station no matter what we do. We see that now all we can do is work harder to minimize the damage.”
But the bleakest projections have not yet been realized. Despite the mounting number of new confirmed cases each day, public health officials say social distancing, so far, has flattened what might have otherwise been a sharp peak.
Hospitals across the region have not exceeded their ICU bed or ventilator capacity to date. As of press time, health systems in southeastern Wisconsin had a total of 194 available ICU beds, and 1,134 available non-ICU beds, according to Wisconsin Hospital Association data. The region has 511 ventilators available across health systems, with 207 currently in use.
“People are feeling better … about new cases and the ability to have beds and ventilators than we were feeling two or three weeks ago,” said Dr. Mark Kaufman, chief medical officer at the Wisconsin Hospital Association. “That’s really the good news. (But) we’re certainly not out of the woods.”
As the state prepares for a phased reopening of business and normal social activity, public health leaders urge for continued vigilance.
A model from the Medical College of Wisconsin projects that, if all social distancing measures ended as soon as Gov. Tony Evers’ “Safer at Home” order lifts on May 26, Milwaukee County would see a spike in COVID-19 hospitalizations and exceed capacity by late June.
If some physical distancing practices remain – including continued bans on mass gatherings and limitations for non-essential businesses and restaurants – the model shows a long, flattened peak of hospitalizations occurring from early August to late October, with cases never exceeding hospital capacity. ICU hospitalization would also remain under capacity, according to the model.
Health systems take financial hit
The region’s major health systems have worked quickly to create more capacity and set up systems of communication with one another, Kaufman said.
“(The Milwaukee area) has done a really terrific job of developing sort of a command center of the five systems where they look at data daily,” he said. “They have homegrown some metrics. … They have doctors on call to monitor the surge in their region and they have a way to quickly communicate among systems and be sort of air traffic control.”
But preparing for a surge has come at a significant cost to those systems. Wisconsin hospitals are projected to be losing about $170 million weekly in revenue because of the suspension of nonemergency procedures, according to WHA. Those suspensions have been in place for over a month. The measure was recommended by the Centers for Disease Control and Prevention to reserve beds for critically ill COVID-19 patients, preserve the supply of personal protective equipment for health care workers and mitigate further spread of the virus.
“It’s the clinically appropriate thing to do,” Kaufman said. “(But) it’s a huge financial hit to the bottom line. Some systems can handle that better, but the smaller hospitals and independents tend to be living more on the edge financially. And that may be a really challenging set of circumstances for them, depending on how long there is a need to prepare for surge.”
For outpatient health care providers, the suspension has halted their normal operations altogether. Greenfield-based Advanced Pain Management, which performs procedures that are considered elective under the CDC directive, has temporarily closed its clinics. It recently warned the state Department of Workforce Development that it will have to permanently lay off 50 employees and close clinics if it doesn’t secure financing by the end of the month.
The $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act stimulus package is expected to offer some relief, with $100 billion (new legislation would add another $75 billion) set aside to reimburse health care providers for lost revenue due to COVID-19. In the short-term, health systems have paused construction on several capital projects to cut costs.
Treatment
As providers wait for a COVID-19 vaccine – with some projections saying that will take another 12 months – area health systems are performing an experimental COVID-19 treatment method to provide immediate relief to sick patients.
As of April 20, Froedtert Hospital had treated four COVID-19 patients with an investigational convalescent plasma treatment, supplied by Wauwatosa-based Versiti Inc. plasma donations. MCW is researching the effectiveness of the novel treatment, which involves taking the antibodies from the bloodstream of a person who has recovered from the virus and giving them to ill patients. The method has been used to treat viruses since the late 1800s, in situations when new diseases or infections develop quickly, and no other options are available.
“Froedtert & MCW have achieved positive results in the past using convalescent plasma to battle other viruses, including Ebola and H1N1,” said Parameswaran Hari, chief in the division of hematology and oncology at MCW and a medical oncologist at the Froedtert & MCW Clinical Cancer Center. “This work is critical to helping push both individuals and the region as a whole into the recovery phase of the battle against COVID-19.”
The availability of plasma from patients who were both confirmed to have COVID-19 and to have recovered from it has been a limiting factor in administering the treatment, however.
Dr. Ajay Sahajpal, director of Advocate Aurora’s transplant program, said he anticipates plasma donations will be more plentiful in the coming weeks, as testing capacity in the state ramps up and more people recover from the virus.
“I expect in the next four to six weeks, there will be more and more plasma,” Sahajpal said. “And by summer there will probably be a large supply.”
Dr. Dave Lal, a pediatric surgeon at Children’s Wisconsin, sees it as his duty to donate plasma. Lal tested positive in March for COVID-19, prompting the health system to request tests for the more than 100 patients, family members and Children’s employees he had come into contact with. All returned negative for the virus.
After quarantining for two weeks while he recovered from what remained mild symptoms, Lal was the first recovered patient to donate plasma through Versiti Blood Center of Wisconsin.
He said it’s a small contribution to the fight against the virus, which has required an extraordinary effort from health care providers.
“It’s a time like no other I’ve experienced,” he said, noting many health care workers fear inadvertently spreading the virus to patients and their families. “Doctors who work these long shifts, or PAs (physician assistants) or NPs (nurse practitioners), are scared to come home. They’re exhausted emotionally, and physically drained. Some are going to hotels, staying in their garages, showering in the hospital, eating a quick meal before having to come back.”
The crisis has also put the region’s health infrastructure to the test, prompting high levels of collaboration among health systems that ordinarily compete.
“There aren’t many good things about these types of crises, but perhaps one of the very, very, very, very few positives is that systems … understand the need to come together and make this work and coordinate,” Kaufman said. “This likely won’t be the last pandemic our country will see, so if we can maintain those relationships and infrastructure, that will be very positive.”
