ST. PAUL — When M Health Fairview needed to designate a hospital for the sickest of patients infected with the coronavirus, administrators at Bethesda Rehabilitation Hospital in St. Paul stepped up.
So did nurses, physicians and even research doctors throughout the health care system, many of whom have volunteered to convert the long-term acute care facility into a 90-bed COVID-19 crisis hospital, almost overnight.
On Thursday, March 26, they expected to transfer in their first seriously ill coronavirus patient from another M Health Fairview hospital.
Hospital administrators say they have few illusions about the arc of the pandemic — this will be their world for the next three or four months.
This room is ready for the most ill patients — today. pic.twitter.com/xfTMaGqiKD— Frederick Melo, Reporter (@FrederickMelo) March 26, 2020
Remodeling for virus patients
The last Bethesda rehabilitation patient was transferred out a week ago, and even before he was gone, crews began ripping out carpeting throughout future patient areas. Cloth fibers absorb and retain water, which isn’t ideal for avoiding virus particles.
New linoleum was laid over the bare concrete. Oversized therapy balls were removed from a basement physical rehab gym that, years earlier, had served as an interventional radiology unit. The walls are still lined with lead, and the radiologists — who diagnose and treat illnesses — are back, as is their equipment.
Airflow units were added to dozens of patient rooms, bringing the hospitals three “negative airflow” rooms up to a total of 35. What’s a negative airflow room? When a patient coughs, the goal is to get those particles out the window as quickly as possible, instead of circulating in place, onto staff or into the hall.
Bethesda Hospital had only recently downsized from 90 beds down to 50 beds as a cost-cutting measure. It’s now back up to 90 in light of the pandemic.
As of Thursday, 14 of its 35 intensive care beds are ready for the critically ill. Another 22 of 45 medical beds are ready to receive patients from hospitals from throughout the M Health Fairview system.
Inside an ICU room, registered nurse Lindsay Stewart demonstrated for a group of reporters how medical staff carefully “don and doff” protective gloves, gowns, surgical masks and face shields according to a protocol.
Sanitize hands before you put on gloves. Then sanitize hands after. Throw gown away after use. Take off gloves. Foam again. Take face shield off. Foam again. Take face mask off. Foam. That’s 7 foams, minimum, even if you don’t touch patient. More if you do. Lindsay Stewart, RN. pic.twitter.com/1S6Tn9VRY4— Frederick Melo, Reporter (@FrederickMelo) March 26, 2020
Sanitize hands at least 7 times
Hands will be sanitized with foam at least seven times, or more if they come into contact with a patient.
They foam up before gloves are put on, and then again when they’re on. They foam up again after throwing a gown away and taking gloves off. Then after the face shield is removed, they foam up. When they take a surgical mask off, they foam up. When in doubt, another foam.
In intensive care unit, nurses would don an N95 mask — a touch more sophisticated than the typical surgical mask or painter-style masks — when they perform aerosol-producing procedures, such as nebulizer work or deep suctioning.
The layers of protection can create both a physical and emotional barrier between patient and caregiver and they can make communication difficult. But no one should breathe in more particles than necessary.
For now, M Health Fairview will transport severely ill patients from its own health network. And in the future? That could change. Gov. Walz has acknowledged the day may come when alternative care sites such as stadiums, hotels or nursing homes will have to be activated.
Trying to avoid being overwhelmed
Administrators are well aware that doctors in Italy — which has reported more than 7,500 coronavirus deaths — have had to throw decorum and protocol aside, even making heartbreaking ethical choices over which patients should be taken off ventilators to make room for one with a better chance of survival.
The goal is to avoid the point where the medical system — and ICU beds in particular — are overwhelmed.
Elsewhere throughout the M Health Fairview system — including St. Joseph’s Hospital in downtown St. Paul — hospitals and clinics are postponing elective surgeries and asking family and friends not to visit patients on-site.
On Friday, M Health Fairview clinics in Roseville, Minneapolis-Lake Street, Pine City and Milaca plan to transition existing patient care visits to virtual care through OnCare.org, by phone or through video where possible. Patients will be advised by their clinic and provider for instructions on receiving in-person care, if necessary.
Patients can be screened for upper respiratory illnesses via OnCare.org at no out-of-pocket cost.
Several M Health Fairview clinics, however, will remain staffed as hubs for patients who require in-person care.