Better Prepared

Better Prepared

South Jersey hospitals have evolved in a number of ways since the COVID-19 pandemic began and the lessons learned are helping them tackle the second wave with confidence.

Nine months. It’s been nine long, excruciating months since COVID-19 took over South Jersey and forced the health care systems to work into overdrive—taking care of as many coronavirus patients as they could who came flooding into their emergency rooms, working through personal protective equipment (PPE) shortages and putting their lives at risk every day—all while trying to figure out exactly what kind of virus COVID-19 is and how to treat it.
 
A lot has changed since, as health care officials have learned more about the coronavirus and have a better understanding with each passing day. That knowledge coupled with a master plan formulated last spring has put hospitals in a better position during this second wave to avoid being overwhelmed while also having more success treating patients.
 
“If you look at the first phase, the biggest challenge was fear of the unknown,” says Brian Sweeney, president and CEO of Jefferson Health-New Jersey. “We were learning from what was happening in Italy and on the West Coast, and [COVID-19] hit New Jersey in March and April and it was learning on the fly from a clinical perspective. What are the signs and symptoms? What treatments work and don’t work?”
 
“I think we are in a better position than the first time back in March and April,” says John Matsinger, executive vice president, chief operating officer, Virtua, and president of Virtua Medical Group. “We are much more familiar with the disease than we were in the first round. Treatments have advanced significantly in the last nine to ten months with steroids, Remdesivir and even monoclonal antibodies for people on an outpatient basis.”
 
Between different therapeutic treatments currently available and more familiarity with the coronavirus, doctors have been able to figure out what works best for each individual patient quicker. Patients are staying in the hospital half as many days as they were previously and the mortality rate is lower. According to data from the New Jersey Hospital Association (NJHA), the length of stay for a coronavirus patient after they were admitted to the hospital was 10 days. Now it’s down to five days.
 
“The mortality rate in the beginning of February or March, speaking to general data, was really high. It’s now a fifth of what it was earlier in the year,” says Sweeney. “The original fear in March and April was all of the ICU patients were on ventilators, we’d need all these ICU treatments and medications, and that has not materialized. What we find [now] is that about 10% of patients are in the ICU, with the majority of them stable. … You don’t need massive amounts of ventilators which is what we all originally feared.”
 
Testing for COVID-19 is a much different scenario now, too, with hospitals able to identify quickly if people test positive, as opposed to waiting for more than a week during the first wave.
 
“Testing was a problem in the first round when it came to getting access to the results,” Matsinger says. “We had tests in April we wouldn't get back for 10 days; now we get them back in 30 minutes.”
 
More testing sites have been created as well, which means more people getting tested and it’s a lead indicator of what might come to hospitals or physician offices, Sweeney says. This, plus state data compiled by the NJHA, gives hospitals all over New Jersey a greater sense for what’s happening.
 
“The latest trend is community-acquired COVID, which I find challenging because a lot of people are still not following basic health precautions and staying away from other people,” Sweeney says. “No doubt this is driving the spike.”
 
AtlantiCare’s senior vice president and chief medical officer Marilouise Venditti, says the health care system wasn’t hit nearly as hard as North Jersey, but they, too, are better prepared this time around for the incoming patients as guidelines and recommendations have become clearer.
 
“The recommendations from the Center for Disease Control and Prevention (CDC) and infectious disease experts changed hourly during the first wave,” she says. “Now, we clearly have guidelines for appropriate use of PPE, the proper way to treat patients, the right way to access oxygenation needs or what medication may or may not be helpful. All of that has put us in a better place.
 
“I am confident patients are getting excellent care. We are still seeing some very sick people, but also seeing the majority are getting treated and being discharged in a timely fashion.”
 
For Inspira Health, opening its new medical center in Mullica Hill in January with all private rooms and state-of-the-art technology allowed them to provide the utmost care to patients once the pandemic struck.
 
“With all of the rooms being private, patients have their own space, which helps from an infection prevention standpoint,” says Scott Wagner, chief medical officer, Inspira Medical Center Mullica Hill. “We’ve been able to do amazing things with heating and conditioning ventilation where we pull air out of the building, creating negative pressure from the environment. It’s able to turn entire wings into negative pressure.”
 
Negative pressure deals with how the air flows within each room and where the air is pulled from. Wagner says this is especially important right now because of how easily an infectious disease like COVID-19 can spread. “Air in the patients’ room is pulled out through the ventilation system and expelled out of the hospital, preventing it from going into hallways or public spaces and keeping patients safe,” he says.
 
Deborah Heart and Lung Center also saw the importance of having negative pressure rooms and took steps to be better prepared for the second wave.
 
“To be better prepared, we took a lot of rooms that weren’t negative pressure rooms and converted them,” says president and CEO, Joseph Chirichella. “We also are now sitting on a 90-day reserved PPE stockpile, which every hospital has to have, and thankfully we haven’t had to dip into yet. It’s very important.”
 
Jefferson-Health opened its new $250 million Patient Pavilion at Jefferson Cherry Hill Hospital this month which is also turning out to be completed at a crucial time because of the increased needs the pandemic has brought forth. Sweeney said it was important to stay on track to get this project completed before the end of the year.
 
“We said we have to stay focused on getting this done on time because the pandemic is going to go on for a while,” he says. “This gives us another safety net for capacity and is reassuring in the middle of a pandemic.”
 
AtlantiCare already had plans in place for a crisis situation, such as a pandemic, and was prepared for the first wave and even more so for the second wave.
 
“We have always had a robust incident command center and crisis preparedness team here at AtlantiCare,” Vendetti says. “Over the years we’ve done different kinds of drills, including pandemic drills. We had done a lot of work when Ebola was a threat, talking about how we would organize our teams and in terms of the basic infrastructure. That has been strong since before, during and will remain strong after the pandemic.
 
“After the first wave we also did what we do after every kind of crisis situation, we convened with members of the command center to do an after-action review and understand what worked well and what we would do better. We’re really being careful to communicate in many different ways with members of our workforce.”
 
Wagner says innovation has evolved at Inspira Health, specifically telemedicine and telemonitoring, which has helped its community greatly.
 
“It’s something that as a physician, we were moving forward with, but the rate of change brought on by COVID has made telemedicine explode. It’s amazing how well telemonitoring has taken off as well,” he says.
 
Examples of telemonitoring are patients monitoring their blood sugar at home and it’s transmitted to a monitoring center. Assistance is provided when levels aren’t where they should be, and this has also expanded to COVID patients monitoring their blood oxygen levels.
 
“Patients have responded well to it and we’re able to keep a close watch on them,” Wagner says. “Patients want to stay home when they can, and telemonitoring is helping them do that.
 
“When I look back nine months ago and ask, ‘What are we doing a lot more of?’ By far it’s telemedicine and telemonitoring. It’s here to stay and I see that evolving and growing even more.”
 
Another aspect of health care that Virtua has focused on has been food insecurity and helping the vulnerable population in the community.
 
“Food security is rising rapidly throughout the country,” Matsinger says. “We’ve always had fairly robust food access programs with our mobile farmers market, and we’ve worked even harder to make sure food is getting out in the community. Our latest innovation is the Eat Well Mobile Grocery Store, serving people in Burlington and Camden counties and offering fresh and healthy foods at below-market prices in places there is a need. We don’t want people suffering from hunger and morbid conditions that come from a poor diet. One of the most important things we’ve done is get food out to the areas that people need it.”
 
Matsinger previously mentioned Virtua is using monoclonal antibodies, which are man-made proteins that act like human antibodies in the immune system. This is also helping the community and keeping them safe in the comfort of their own home.
 
“That’s where a person is present with COVID symptoms and has other medical issues but doesn’t have to be admitted to the hospital. We give them monoclonal antibodies so they can fight off COVID at home,” he explains. “We’re making sure we’re getting into the city of Camden and Lourdes medical departments, and we’re also doing this at our Voorhees and Willingboro hospitals. We’re making sure we’re out in the communities we serve.”
 
“We have a strong sense of obligation to our community,” Venditti adds. “We offer explanations and education for the public on certain key COVID important messaging. It was particularly useful in the beginning because people have been so frightened and were getting input from many places with so much complex information. Now, I think the science is more consistent and clearer in the messaging.”
 
Educating the public about the vaccines—that are on the verge of getting emergency approvals from the Food and Drug Administration as we go to print—is near or at the top of every hospital’s list, as well as figuring out logistics, being in touch with NJHA and the New Jersey Department of Health, and having a plan in place so when the vaccine is in the hospitals’ hands, they are ready to distribute doses safely and efficiently.
 
“We put teams together to vaccinate the public once we get done with all our staff,” Chirichella says. “We have a whole COVID committee. A tremendous amount of effort goes into organizing all of this and educating people.”
 
“We’re excited about the vaccine,” Wagner says. “We’ve been on several calls with the NJHA recently and are prepared. We’ve had team working for several months getting equipment ready so when the vaccine is approved, we’re ready to start administering that to our staff and patients. It’s a whole different world.”
 
Even with the vaccine within reach, Venditti urges the public to listen to state health officials and to continue to practice safety guidelines.

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“Please observe the guidelines Gov. [Phil] Murphy is directing,” she says. “Wear a face mask when in public and even at home when with at-risk individuals. Wash your hands liberally. That’s how we can all contribute to one another’s health, our own health and get help this behind us.”

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Published and copyrighted in South Jersey Magazine, Volume 17, Issue 9 (December 2020).


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Author: Julie Shannon

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