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Hospitals operate under new normal due to COVID-19

Gulshan Sharma, MD, MPH 
Todd Caliva
 Stephen K. Jones, Jr.
Dan Newman
 Kelly Ochoa
Bob Mitchell
Jimmy Spence
As Texas is cautiously reopening for business, the Bay Area Houston Economic Partnership has begun a series of virtual general membership meetings designed to provide information, offered by those in leadership positions within industry sectors, on the state of institutions and businesses in the region.   
On Thursday, April 30, 2020, a panel of healthcare professionals used the power and convenience of the internet to speak to BAHEP membership of the ways in which regional hospital systems have adapted to COVID-19. They also looked to the future as everyone will be operating under this new normal for some time to come.    
The panel consisted of Todd Caliva, CEO, HCA Houston Healthcare Clear Lake; Stephen K. Jones, Jr., CEO, UTMB Health Clear Lake Campus; Dan Newman, CEO, Houston Methodist Clear Lake Hospital; Kelly Ochoa, Vice President of Operations, Memorial Hermann Southeast and Memorial Hermann Pearland;  and Gulshan Sharma, MD, MPH, Vice President, Chief Medical & Clinical Innovation Officer, UTMB. BAHEP President Bob Mitchell served as panel moderator while BAHEP Marketing Manager Jimmy Spence provided technical support.  
Panel provides overview of hospital systems
The panelists began the discussion by providing an overview of what was taking place within each hospital system. Although specific actions vary between systems, the hospitals also have much in common. The days are consumed by temperature checks and screenings of patients, visitors, and employees. Testing is also a huge priority. Additionally, there are command center conference calls that address personal protective equipment (PPE) on hand and what may be needed. There are physician calls where the medical staff is given an administrative update sharing new policy and procedures that are evolving, because things constantly change. Strategic priorities have been put in place across all systems to safeguard employees and the public.   
UTMB’s Dr. Sharma provided compelling statistics. He said, "Looking from a statistic standpoint so that everyone can put things into perspective, nationally we have done about 6 million tests, and 1 million have been positive. That gives you a test positive rate of 16-17 percent nationally. In Texas, we have done about 340,000 tests, and 27,000 have been positive. That gives you a prevalence of about 12 percent in Texas. In the local area of Harris and Galveston counties, the test positive rate is about 9 percent. Galveston County is 3-3.5 percent.    
"Regionally we have fared very well compared to what is going on in other areas, because most of the high numbers are coming from states like New York, Massachusetts, and Connecticut, as well as New Jersey. Texas with social distancing and early lockdown has really fared very well.    
"In terms of the current prevalence of this disease in our area, the number of cases has continued to decline throughout Harris County as well as Galveston County. The number of admissions to intensive care units is down. There is also plenty of ventilator capacity, ICU capacity, and med/surg capacity.    
"We have reached out to nursing homes, because that is where the largest outbreaks are regionally. We have also reached out to correctional care facilities to make sure that we do not have a large outbreak there. The mortality rate is fairly low compared to what has been projected from other regions nationally. The challenge is that the mortality rate goes up when you put somebody on a ventilator or a respirator. If they come early and we can address their needs, I think that is the best way to protect them.”  
Panelists answer questions
Members of the panel then answered questions that had been submitted by virtual attendees. It was asked if it is safe to go to the hospital. Caliva responded, "Absolutely. I think that I can speak for all of us on the panel in saying that our systems have gone through extreme measures to protect the safety and well being of all of our patients, our employees, and our physicians. We’ve all put in measures from the screening process that we previously discussed to social distancing measures. Anyone who has symptoms is being tested.”    
Another question concerned resource loading in regard to hospital staff. Jones said, "As Dr. Sharma mentioned, we’ve been fortunate here in that the numbers we’ve seen have not been as great as other parts of the country. All of the health systems went through a process of going into great detail looking at the number of doctors, the number of nurses, the number of respiratory techs, supply chain personnel, environmental services – all sorts of key frontline folks. I want to assure the community that we do have enough infrastructure, people, and supplies to effectively continue to take care of COVID-19 patients and open back up for business. All of the hospitals are putting very detailed plans in place to do both very, very safely.”    
Communities across the nation have shown tremendous support for frontline caregivers. When asked how the local community can help the medical community, Newman replied, "Take care of yourself all the time. Health isn’t just something you do when the weather is nice outside. The extent that care is delayed can result in worse outcomes than if you seek care now. That is probably the biggest thing that you can do to help the medical community.”   
An unprecedented effort is taking place internationally to develop a vaccine to combat COVID-19. A number of medications are also undergoing clinical trials to determine their efficacy. When asked about what medications look promising, "Dr. Sharma said, "There is an antiviral drug called remdesivir for which clinical trials are showing promising results as you have been seeing on all the news channels. We enrolled about 10 patients in the clinical trial.” (Editor’s note: The U.S. Food and Drug Administration – FDA - issued an emergency-use authorization on Friday, May 1, 2020, for remdesivir in hospitalized patients with severe COVID-19.)   
Regarding antibody tests, Dr. Sharma reported, "We will offer antibody tests starting May 1st. Your primary doctor can order an antibody test, which takes about four hours to get results. This is an IgG (Immunoglobulin G). As a word of caution, just because you have an antibody does not mean that you will be protected. All it means is that you have had an infection with this virus. We still don’t have enough data to see if this antibody is protective over a long period of time.”   
Now that hospitals are again allowing elective procedures, it was asked if anything has changed. Caliva said that much remains the same as before except that all patients will have to go through pre-admittance testing 48 hours in advance of elective surgery involving general anesthesia in order to give plenty of time to get results of the testing. That is the only thing that has changed. Jones added, "People have been required to put elective procedures off. If you need something, reach out to your physician. Every health system has done an amazing job keeping the hospitals and clinics safe.”   
Caliva responded to the question, "How are the protocols going to change in the future?” He said, "I think that we might be looking at a situation where this may be the new norm for a while. Everyone is a whole lot more cognizant of social distancing and hand hygiene. People may not be flowing back into super large gatherings again. Our screening processes may last longer than we had anticipated especially as we get closer to the flu season. It may be more of a combination of a new norm and everybody being a whole lot more alert to doing things to protect ourselves and those around us.” 
Recommendations made for reopening businesses
Many are concerned about the safety surrounding the reopening of businesses. Dr. Sharma was asked what recommendations he had for these businesses. He answered, "The best thing is to have a screening questionnaire for all employees. It would also be great to have a device to check for temperature. Ask about cough, shortness of breath, difficulty breathing – the symptoms that are related to COVID. Ask specifically if anyone has tested positive for COVID during the past month or two while the business was closed. Make sure that an employee hasn’t been in contact with anyone who is COVID positive.    
"If the screening questionnaires are negative, then I think it is safe for the employees to work as long as we continue social distancing and we are masking. There are still asymptomatic people who have coronavirus. These rates are very low at 1-2 percent compared to what we have seen in other areas. I don’t think it is mandatory to test all employees. A screening questionnaire should suffice. If testing is something you need, there is tremendous capability available.”   
Mitchell ended the meeting by thanking all those who took time out of their extremely busy schedules to participate. Upcoming virtual general membership meetings will focus on education, aerospace, and small business.
(The video of the meeting is shown below. To view the video on full screen, click on the white headline.)

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