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COVID-19 in the Hospital Setting

I have to really commend the Partners Healthcare System and the team members of our department, who have done really an outstanding job in terms of preparing and communicating with all the physicians and clinicians with regard to the COVID crisis. They have been on full alert for quite some time.

Joseph Schwab, MD
Chief, Orthopaedic Spine Surgery
Director, Spine Oncology & Co-Director,
Stephan L. Harris Chordoma Center
Massachusetts General Hospital
Associate Professor of Orthopaedic Surgery
Harvard Medical School
Boston, MA

How Our Daily Practice Has Changed

We’re not doing elective cases. We are still doing emergency cases on an as-needed basis, and we’re platooning our physicians. For instance, I do take spine call, and spine call is a necessary part of running a hospital. People are actively involved in clinical care that must go on, like spine call, are not necessarily going to be directly involved with COVID care. Someone who’s not necessarily taking call, for other reasons, will be pulled into the COVID care of patients. There has been an enterprise level organization of integrating clinicians. That’s really been a dramatic change.

Organizing the use of ventilators and organizing the use of personal protective equipment has been a major thrust. A facility was recently built outside of our Partners Healthcare System headquarters that allows us to recycle or reuse the N95 masks, which was a major change. I think that’s probably the most significant thing that I’ve seen, along with the high level of organization and preparation by our system.

Our system has been very stressed and we’ve gotten a huge number of patients. I think we’re up to 350 patients right now in-house, in Mass General, and over 100 patients in the ICUs. The care has been outstanding, and there’ve been some really great saves because of the care of our medical intensive care units. They’ve had patients who’ve been on ECMO, they’ve been intubated for three weeks, and we have seen them walk out of the hospital. It’s been really remarkable. It makes me proud to be at Mass General, and I think it’s just really a testimony to the organization.

How Hospital Systems Can Prepare for the Impact

Similarly, for other Systems and Hospital groups, whether in an urban or rural setting, it’s apparent that you really can’t go on as business as usual. You have to scale back your normal practices and just go to essential services. You have to make sure that you’re preparing for the worst. You have to work with your epidemiologist, to predict peak time for patients and what that will mean, so that you have enough ventilators, and staff to staff the ventilators. And, of course, PPE is obviously a national crisis, and so people are paying attention to that all around.

I think that those types of efforts are pretty well-known at this point, so I don’t think I’d be surprising any of my colleagues elsewhere. But I do think, as we read more and more, the rural hospitals are going to see some more of this, maybe at a smaller scale, but they generally have fewer resources, so they’re going to have to prepare in a very similar way.

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