For the past two weeks, managers and administrators at Littleton Adventist Hospital have been meeting as many as six times a day.

Those meetings, which are part of the hospital's emergency preparedness activation, originally took place in-person but have since shifted to video chat as the hospital aims to reduce in-person contact between its employees. However, the purpose of the meetings has remained the same: to evaluate and discuss where the hospital's capacity and stock of supplies are at as the facility anticipates a possible influx of seriously ill COVID-19 patients.

It's a worrying possibility, but Dr. Mark Elliott, an emergency room physician who serves as the president of Littleton Adventist's medical staff, says he feels “very good” about Littleton Adventist's ability to respond to the challenge.

“We have been training for this kind of thing for years, and Littleton Adventist has experience with mass casualties in the past,” Elliott said. “This is not a mass casualty situation, but the same preparation that gets us ready for that gets us ready for this.”

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That preexisting preparedness has also been bolstered more recently, Elliott said, by efforts to convert underutilized space into negative airflow rooms where COVID-19 patients could be treated and to make more nurses available to treat those patients by postponing elective procedures.

Littleton Adventist Hospital is part of Centura Health, a Centennial-based network of 17 hospitals that also includes Parker Adventist Hospital, Castle Rock Adventist Hospital, St. Anthony Hospital in Lakewood and the St. Anthony North Medical Campus in Westminster. Elliott said the other Centura hospitals are similarly prepared for the outbreak. A Centura webpage with information about COVID-19 and the hospital's response can be accessed at centura.org/COVID-19.

Incident command system

A chief medical officer at HealthOne, the largest hospital operator in the Denver metro area, said the hospitals in that system, which include Sky Ridge Medical Center in Lone Tree, Swedish Medical Center in Englewood and North Suburban Medical Center in Thornton, are similarly ready to deal with a surge in COVID-19 cases.

That's in part because HealthOne is owned by HCA Healthcare and is therefore able to benefit from the sophisticated incident command that HCA employs for the 184 hospitals it owns across the United States and the United Kingdom.

“We've done a fairly sophisticated analysis of what we expect in terms of patients and the supplies we are going to need to care for those patients, and we feel pretty good that we are in this for the long haul and we are able to take care of these patients,” said Dr. Jason Kelly, the chief medical officer.

Still, the COVID crisis has presented some unique and perhaps unintuitive challenges — even if its treatment is mostly similar to treating other existing respiratory diseases. Among the recent concerns has been the closure of all schools for several weeks, a decision that could slow the spread of the disease but also have an impact on hospital staffing levels.

“One of the things that we worry about," Kelly said, "is child care in terms of — if we have moms and dads that work here but they don't have any child care, are they going to be able to come to work?”

Kaiser closes 21 clinics

The COVID-19 crisis is also having an impact on Kaiser Permanente, a managed care consortium that serves more than 600,000 members in Colorado, with many locations in the metro area. On March 18, Kaiser announced it was closing 21 of its 31 Colorado clinics and canceling all elective procedures in an effort to slow the spread of COVID-19. The separate Children's Hospital Colorado also recently announced that it is closing several of its clinics for the same reason.

But even with a reduced number of open clinics, Kaiser still has an important role to play in helping address and prevent the spread of COVID-19.

Dr. Wendoyln Gozansky, a geriatrician and vice president and chief quality officer at Kaiser, said the company is trying to take what she called “a virtual first approach” to caring for potential COVID-19 patients. That approach asks those exhibiting COVID-19 symptoms to use virtual options ranging from emailing a doctor to “e-visits” to seek initial treatment, although Gozansky emphasized those patients whose treatments cannot be managed virtually can still seek treatment at Kaiser offices.

“We really are trying to meet our members where they are during this time of unprecedented change during this pandemic,” Gozansky said.

Medical staffers under stress

Such approaches make sense not only to prevent the spread of the virus at medical facilities but also because hospitals must try to save as much space as possible for the most critical patients, given the likelihood they will receive an influx of them.

That possibility, as well as the general anxiety that comes with the unpredictability of a pandemic and treating patients who may have COVID, also takes a toll on those who do the work of treating patients.

“I think it has tremendous impact on the staff,” said Elliott. “We have staff that are coming every day knowing they may have potential exposure and taking that home, and I think that certainly adds an added stress. But we certainly have resources to help staff that feel uncomfortable.”

That impact is likely to increase as facilities have so far seen few if any COVID-19 patients. Kelly said Sky Ridge has only had a couple of confirmed patients.

“Right now you feel a little bit like the soldier on the castle wall,” Kelly said. “You're ready, your sword is sharpened, the castle has been battened down and now you're kind of waiting for the invading army to show up.”