Jon Massey, the director of acute care services at Castle Rock Adventist Hospital, has worked within the Centura Health network for 22 years. Watching the COVID-19 pandemic unfold is unlike anything healthcare professionals have seen, he said, and it's putting many health-care professionals under heightened pressures at work.
“We're tired already,” Massey said with a chuckle. “The preparation and planning for any potential surge is a lot of work.”
On March 24, the hospital's chief medical officer, Devin Bateman, said although Castle Rock Adventist is well-stocked on supplies and had not yet faced a large local outbreak to date, the 55-bed facility, like most hospitals, is preparing for the pandemic to ramp up.
“As a general rule, I think hospitals are expecting that up to 50% of beds will be used for patients with coronavirus, anticipating that entire intensive care units can be filled with these patients as well,” Bateman said. “I think that's a general guideline that many hospitals are using to at least prepare for a worst-case scenario.”
As of March 26, the United States led the world in the number of confirmed coronavirus cases, with more than 82,000 cases and 1,000 deaths. Gov. Jared Polis on March 25 announced a controversial stay-at-home order for Colorado after several counties and health departments in the Denver metro area declared local versions.
Officials at the Tri-County Health Department, which represents more than 1.5 million people in Adams, Arapahoe and Douglas counties, said a rapid rise in positive cases led to the agency's stay-at-home order, which was rescinded and replaced by the state's order.
Polis in a March 22 press conference had shied away from a formal stay-at-home order, stating that such orders were difficult to enforce, but he urged Coloradans to stay at home. At the time, there were 591 confirmed cases, 58 hospitalizations and six deaths, although the governor said the state believes the true number of cases is in the thousands.
At the outbreak's peak, he said, Colorado hospitals could need 7,000 more ventilators than what was available that day.
“I have another ask for you today, to keep our health-care workforce, those on the front lines, from getting sick. Because we've received so little from the national stockpile, we need Coloradans to donate any personal protective equipment — masks, gowns, gloves — to this effort,” Polis said.
Donations could be made to the state or local health departments. The state health department announced March 23 it would begin distributing what Colorado had received from the Strategic National Stockpile, the nation's largest supply of medical supplies.
That included nearly 50,000 N95 masks, 117,500 surgical masks, 21,312 face shields, 20,820 surgical gowns and 108,000 gloves — which is enough for approximately one full day of statewide operations, the Colorado Department of Public Health and Environment said in its release.
As of March 26, Colorado had recorded 1,430 COVID-19 cases, 184 hospitalizations and 24 deaths.
Douglas County had 67 confirmed cases as of March 26, according to the state. At least 14 were in Castle Rock, according to the Tri-County Health Department. Castle Rock was the site of Colorado's second confirmed case.
“We have seen COVID-19 patients,” Bateman said of Castle Rock Adventist. “I think every hospital probably has at this point.”
Bateman declined to offer hard numbers about how many COVID-19 patients were treated at Castle Rock Adventist. Most patients are not undergoing COVID-19 testing, and with the outbreak now growing through community spread, hospitals should act as though everyone coming in has the potential to be infected, he said.
“One of the challenges that we face as a community is not knowing what the true incidence or prevalence of the disease is, and that's because of the restrictions and testing guidelines to preserve testing for the patients who really need it,” Bateman said. “I wish I could give you a definitive number.”
Massey said health-care workers on the pandemic's front lines are constantly trying to balance the desire to be with patients and care for them with the need to protect their own families and loves ones. The risk of taking the virus home creates added anxiety for medical professionals. The risk of catching the virus themselves means fewer staff available to fight the pandemic.
“We've been following all the CDC and World Health Organization guidelines from day one,” Massey said, noting how rapidly guidelines can change. “You have to trust that the information we have is up to date and accurate.”
As the hospital continues preparations, Massey said how the virus unfolds at the local level remains uncertain. Bateman said that depends on the community's efforts to “flatten the curve,” which refers to slowing the virus' spread so it won't overwhelm the healthcare system.
“We're definitely trying to stay ahead of the influx of patients, which we think will come. We don't know exactly when but if we follow Italy, and we follow Seattle, we do expect that we're going to see an influx of patients within the next week or so, or two weeks,” he said.
Massey urged the community to follow guidelines from elected officials and public health departments. People who don't take the pandemic seriously are “really contributing to the problem,” he said.
“This isn't a joke, and this is not going to go away,” he said. “It's nothing to panic about but if we all do our part, we'll have a better effect on the overall outcome.”
To ensure capacity for COVID-19 patients, Castle Rock Adventist has plans to bring on additional physicians if needed, and to expand the number of beds. Staff have examined how to convert some units to accommodate patients not being treated for COVID-19.
Bateman said the hospital has enough resources— staffing, ventilators, personal protective equipment (PPE) — as of March 24 and believed the facility could handle an uptick in cases. Still, staff are making every effort to conserve supplies like PPE. Hard-hit areas go through those supplies faster than they are produced, he said.
“I think PPE is probably one of the greatest concerns that health-care providers in general have. I think that crosses all hospitals and all systems,” he said.
Centura, the largest hospital network in Colorado, is an asset to the Castle Rock campus, Bateman said. If supplies dwindle, staffing run shorts, or a large surge of patients stresses the facility, Castle Rock Adventist can lean on the Centura system and its sister hospitals for backup.
“Being part of Centura and having the strength of the system and the expertise as well as a resource,” he said, “I think, the system is a tremendous benefit to Castle Rock Adventist.”
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