Unknowns Make Surge Prep Challenging for Region's Hospitals

Apr 8, 2020

Hospitals across Ohio are grouped geographically into zones to respond to public health emergencies. Summit County is part of the 13-county Northeast Central Ohio Region, referred to as the NECO region.

Those involved with leading the region’s planning for the expected surge of COVID-19 cases include Grace Wakulchik, President and CEO of Akron Children’s Hospital and the hospital's associate medical director Dr. John Crow, who's heading up a NECO subgroup that's working to prepare for the surge. 

They talked about where things stand and what sites might be used in the Akron area to care for more patients. 

GRACE: We're still evaluating all sites. We don't have one positively identified yet. Mainly because we're very confident about the numbers that we have identified with our existing systems but we are working very closely with the governor's office, the National Guard to evaluate potentially different sites to see what bed capacity there may be, what supplies there may be staffing, etc.

JOHN: The one thing, not only have the acute care beds [availability] gone up from around 2,400 to over 6,000, almost 6,500 in the region, every institution of the 30-some hospitals in our region have tried to find other spaces to help take care of these patients in the convalescent phase.

SARAH: So you're confident that you will have adequate hospital space for the surge in this area?

JOHN: Right now, I think we're looking at alternate sites. The challenge of all of them is not only supplies but staffing. I think a lot of the hospitals feel that by opening up buildings that are on their campus, it's a lot easier to staff those as well as the fact that some of the patients, if they do get worse, they have an easy trip right back into acute care.  

SARAH: You have set up a tent right outside of your facility. What will that be used for?

GRACE: We'd originally set this tent up to help us manage triage coming into the emergency department with the ability to try and separate COVID from non COVID patients. But and the reality is, that this is not an inpatient disease of pediatric, of kids. So basically, what I'm saying is that the surge in these kind of patients is largely in adults. So we've set this up, but we have not had to use it yet at all. So and in fact, if you look at our emergency room visits, I've never seen them this low in my entire career. Yesterday, we had 73 patients at our Akron emergency department. Normally around this time, it would be 150 to 180.

SARAH: What do you attribute that to?

GRACE: It’s probably multi causal. One of the things that we have done is our physicians and providers in Akron, and I know the other hospitals as well, have really stepped up their telehealth programs. So they're able to have quick care online visits or telehealth visits with their specialists. That's one thing. John, you wanted to add something?

JOHN: No, I just think that our trauma system, our orthopedic department, we are seeing much less kids with injury. So I think that's just really because everybody's hunkered down and, exactly what Grace said, we’re trying to do more and more telehealth. I think people are just really afraid to come in unless somebody’s really sick. I think the adult facilities are also having, at least we have a chart through the NECO region, either low or normal ER activity. So, you know, the surge hasn't really happened. We had a little bit of an event in the prison system, the federal prison system in Columbiana County so that was kind of a mini-surge, but everybody’s just kind of preparing for the worst and hoping for the best.

GRACE: Youngstown area is seeing probably the most significant number of patients in our region right now.

SARAH: Is there a reason why? 

JOHN: I don't know that anybody really knows why. They're  probably one of the bigger hot spots in the state of Ohio at this point. The numbers are still not anything that the healthcare system can't take. So I don't know that there's a good answer for that. There's so much predictive analytics going on now. So some, you know, we're using the state of Ohio, the curves that they use for surge. I mean, we're talking anywhere from in an eight week period, nine to 14,000 unique patients who come down with COVID disease just in our region. And so, but then,  other modeling that's done for some of the bigger institutions say, you know, say the surge will be much less and much longer drawn out. It’s a little bit of weather forecasting without all the information here.

SARAH: Do you guys use your own modeling or are you relying on what the state is showing you?

JOHN: You know, the curves that the state presented through the data analysis through OSU, Ohio State, were quite good and they were good because they were regional as well as by county. And so I think that was really the first of the good modeling. And we have communicated with other large institutions who have differing opinions. I mean, I've had one communication that says that the surge is not going to be very, very, very bad at all. And it will be, you know, not till towards the end of May. I've had other people tell me that, you know, virtually all the patients are going to have to go to rehab after admission to the hospital and someone else is showing the data, saying, that almost nobody goes to rehab. We’re doing the best we can with the data we have, and we’re just watching the trends day to day.

SARAH: What's your best guess as to when the surge will occur, John?

JOHN: I think that we're going to know a lot more in the next two to three weeks. I think we're already I think seeing the benefits of what Governor DeWine and [Ohio Department of Health Director] Amy Acton have done here. So I think it'll be probably in May. And I don't think it'll be as bad, but as Grace said, we're preparing for 11 to 14,000 new admissions to the hospital for COVID disease because that’s probably the best statistical model we have.

SARAH: That’s in the NECO region.

JOHN: That’s the NECO region and so that may require 1 to 2,000 beds after discharge which is what we’re working on now through the surge.

SARAH: What does your supply situation look like at Children's and are you able, since you're not seeing necessarily as many cases maybe as other facilities, are you able to share your supply with others?

GRACE: We evaluate our supply every day, and we've just started moving towards universal masking, so we're trying to manage our supply so that we will have it when the surge happens. If we need to, we will absolutely be sharing our supplies with others. Right now we've planned for what our staff may be according to what we think the surge may require for our PPE. But we have gone to universal masking and honestly we've had zero COVID patients and the staff who have been diagnosed with COVID we believe have acquired that in the community, not from anyone at the hospital.

Wakulchik says six staff members have been diagnosed with COVID-19 at Akron Children’s Hospital.