Even though nobody anticipated the scope of the novel coronavirus pandemic, University of Maryland Upper Chesapeake Medical Center in Bel Air saw the writing on the wall. While doctors there did not treat their first COVID-19 patient until March, they were preparing for an influx of cases weeks ahead of time.
Since then, the hospital had to be reconfigured, families were made to watch their relatives be cared for behind glass, and some of those changes could become more permanent until a vaccine is developed.
Dr. Jason M. Birnbaum, medical director at the Bel Air hospital’s intensive care unit, said the coronavirus has profoundly changed the way the hospital does business. Formerly, patients’ families were encouraged to be part of their care ? sometimes accompanying doctors and specialists on their rounds. Now, they are scarcely allowed contact with their hospitalized families members except through a webcam or a view from an adjacent room, he said.
It is for their protection and the healthcare workers who do not have the luxury of staying home, though it is regrettable.
“Families are left completely at arm’s length,” Birnbaum said. “We all have fears and anxieties about what we are doing.”
Birnbaum said the virus has been a wake-up call for hospital systems and health care professionals everywhere. Before, medical professionals scarcely felt at risk when treating a patient, but with the virus’ ascendance, some wards need to be adapted and doctors will have to rely more on telemedicine and electronic screening until a vaccine can be developed. The hospital, he said, is budgeting for those changes in the coming fiscal year.
“Now we are retrofitting these units into areas of the hospital that were not designed for this,” he said, “This is something that is going to be a new state of normal.”
Because of the virus’s infectivity, careful guidelines need to be followed to keep medical workers safe, said Melodi Vest, a registered nurse at the hospital’s ICU. Visitation has been restricted and masks are required at all times in the building, but treatment of a COVID-19 patient requires more than that.
Teams prepare in a separate room, putting on personal protective equipment before entering a room, a step requiring two people — one to don and one to doff — and underscoring the seriousness of the situation. The doffer watches while care is given in case they spot any holes in the protective equipment or see the need to redon it, Vest said.
“We used to just jump in with a pair of gloves on and stop it,” Vest said. “Now, if we don’t protect ourselves, we cannot protect each and every patient that is in that hospital.”
While doctors and nurses get most of the credit, Birnbaum said, the facility, maintenance and other administrative workers at the hospital deserve recognition too. Those providing care would scarcely be able to do their jobs if not for the collective contributions of all the hospital’s staff.
“The doctors and nurses would be completely hamstrung if they were not there to help us,” he said.
He said the number of coronavirus cases is anticipated to rise as the state begins to reopen, and health officials are preparing for that eventuality, but he also stressed that the hospital is open to people with non-COVID health issues. Many patients, he said, have contacted him after-hours to ask medical questions. They did not, he said, want to go to the hospital for fear of contracting the virus.
“The reduction in ER visits, outpatient visits, patients calling with questions … has been dramatic,” he said. “And that is what has gotten us very anxious.”
He and the hospital’s staff know some in the community have complex health conditions. But they have not been coming to the hospital, effectively “disappearing.” He said their fears are unfounded and that the hospital is taking comprehensive steps to prevent the spread of the virus within its building.
Still, Vest said, the prospect of contracting the virus worries her. She and her daughters ? who are also nurses — leave their clothes in the garage and shower first thing upon returning home. The two hospitals she works at — Upper Chesapeake and University Hospital in Baltimore, are taking similarly cautious steps, covering personnel from head to toe in single-use PPE when caring for a COVID-19 patient.
The nurses, she said, have come to identify each other by their eyes, which is about all they can see of each other under the equipment.
“Everyone is right there to help each other,” Vest said.
Working five to six 12-hour shifts between the Baltimore and Bel Air hospitals, Vest sees patients when they are at or nearing their worst. Many are on ventilators; some have to have their blood manually oxygenated through tubing inserted into their necks and groins. It is an unpleasant procedure, she said.
The symptoms, too, are unpleasant: fevers upward of 105 degrees, muscle aches and coughing. Though the work is draining physically and emotionally, seeing patients leave the hospital with a clean bill of health is its own reward, Vest said. One elderly man, she recalled, had been in the hospital for 27 days before being released last Sunday. His family was there to support him, and all the nurses were hoping he would recover. So when he left the hospital, “there was not a dry eye in the house,” Vest said.
And patients who beat the virus are being used to combat it, Birnbaum said. Upper Chesapeake Health is experimenting with plasma from recovered COVID-19 patients to treat others. Patients who recover from the virus develop antibodies that could safeguard others who have yet to contract the virus, though that research is ongoing, Birnbaum said, and was sparked by anecdotal experience.
Though several promising remedies to the coronavirus are being tested, Birnbaum said social media is hampering some efforts. Some patients demand specific treatments — ones culled from Facebook posts or other social media sites — that could be meretricious or even harmful to them, he said. There is no substitute for solid fundamental care, he said, like using antibiotics effectively and properly using ventilators.
“Good practice is good practice,” he said.
Upper Chesapeake has also been accepting overflow patients from other areas like Prince George’s County and the Eastern Shore, Birnbaum said.
Jennifer Gardener, a registered nurse at Upper Chesapeake’s emergency department, said that the community has come out in support of medial workers in a way she has never seen before. Gifts of food, coffee and uplifting cards come streaming into the hospital — simple gestures, but appreciated ones all the same.
“I have been so amazed and just so appreciative of all of the support the community has given to us,” Gardener said. “It is kind of an uncomfortable feeling to have so much attention and so much appreciation being brought forward to healthcare workers because it is not something I have seen at this magnitude ever before.”
Gardener also said that fewer people were coming to the hospital’s emergency room. Medical issues that need treatment should not wait, she said, and patients with medical issues should not be afraid to come to the hospital.
“People are really trying to adhere to that rule, but if you are having chest pain, you are having shortness of breath, we are here for you,” she said. “We are there for everyone, even though it is a crazy time right now.”
