Surge or No Surge, the Midwest Readies for COVID-19

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As in the rest of the country, the healthcare system in Iowa was quickly beset by worries about PPE levels. Even before the Iowa Department of Health implemented a PPE shortage order on April 10, the hospital was conserving masks and other gear. All employees are now wearing reusable plastic face shields with a visor-like brim, with added PPE if individual responsibilities require it, Brennan said.

“When you walk the halls, it’s a little Star Wars-y,” Brennan mused.

“When we heard about people elsewhere wearing a mask for a week and not having appropriate N95 masks, that really hit home for us,” she told Medscape Medical News. “We’re clearly not in a surge like other areas have been, but we’ve begun reprocessing our N95 masks [to sterilize them for reuse] because we don’t know what the future will hold.”

The Iowa team has also watched how hospitals in virus hotspots in other states have dealt with treatment challenges presented by COVID patients, so as to make the best use of what little medical evidence exists.

“Because COVID-19 is new, there’s not much published evidence,” Van Beek said. “We need to be constantly reminded to go back to what’s biologically plausible,” she added, and to use evidence “as the best mitigation against hysteria.”

Surge or no surge, the hospital’s approach seems to be working. One component of its influenza-like illnesses clinic program is a home treatment team for COVID-positive patients, which includes the delivery of a blood pressure cuff and pulse oximeter to each. Nurses call to counsel patients on how to take their vital signs and hospitalists check on high-risk patients each day by telephone or video chat.

Results of the initiative are impressive, Brennan said. Of the 200-plus patients managed in this manner, only nine have required eventual hospitalization. None have died.

“I think we’ve bent the curve in treating our patients,” she said. “The model has proven effective in keeping patients out of the hospital and improving outcomes.”

For her part, Van Beek is keeping close tabs on her staff’s mental state as the crisis continues. As she does during Mohs surgery, she stands ready to pivot in response to ever-changing data and circumstances.

“Everyone has their own degree of angst,” she said. “Worrying about faculty and staff, making sure people feel safe, that in itself weighs heavily on me. I do feel blessed to have a team.”

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