by Elizabeth Hofheinz, M.P.H., M.Ed., April 21, 2020
New Orleanians are seasonal beings, and at this time of the year, we are typically revving up for crawfish boils and music festivals. Forced to switch gears and put on our all-too-familiar disaster hats, we are staring down another round of destruction—and another round of clawing our way towards rebirth.
One M.D. and hospital administrator in New Orleans who lived through Hurricane Katrina has a few things to say about the Covid-19 crisis.
“I remember that for about two years after Katrina, my colleagues and I were helping to put people back together again after they had lost loved ones and their worlds had been radically altered. With Katrina, people didn’t always lose their jobs and insurance as is happening now. And typically, most disasters are local…now, we can’t help our neighbors and neighboring states can’t help us. Add to that the physical challenges of contagion, the financial disruption at the national level and you have a perfect storm.”
To find, indeed put, calm in the storm, this hospital system and his colleagues have engaged in unprecedented 24×7 planning. “We have developed decision trees to find our way through these rapidly-occurring disruptions. From deciding what and who is essential to caring for our patients, we have made years of learning in just weeks.”
“Hospitals and caregivers are trying to figure out how to stay connected with our patients, while maintaining the required distance.”
“Our providers have established a system of incoming and outgoing calls so as to maintain consistent communication with patients. Nurses are available to field questions from the community and make outgoing calls to patients who are in need. We have drawn up a list of all patients who have been tested for Covid-19 (regardless of whether they tested positive) and are reaching out to those with COPD and asthma.”
Reflecting on the Covid situation, he states, “An image comes to mind…a tale of two cities, one where some patients are in critical care and another where everyone else is physically unaffected. Those working in the ‘critical care city’ are focused on doing their important work while the other ‘city’ prepares for the aftermath. We are preparing for all the fallout of this social disruption.”
“We are now seeing a steady admission of Covid patients, although luckily we are still within capacity. We are learning new ways of caring for patients while dealing with the risk of infection. We are dealing with families who remain separated from their ailing loved ones. They become the second victims of the virus. Struggles around getting supplies leave the caregivers, and the community feeling very vulnerable.”
“This has all happened so fast…to have to immediately begin a series of new protective procedures that are not familiar. There is quite a learning curve. We have also done a lot of staff redeployment. Nurses who normally do GI procedures all of a sudden are managing ICU patients…and sometimes having to do it in ways that are non-traditional. Maintaining professional standards requires a large team effort.”
“We have also set up a new unit filled with convalescent beds for those Covid patients who weren’t ill enough to land in the ICU. From there most people can go home on oxygen and be closely monitored. The state has created a hospital in the Convention Center which helps patients transition back home. All of this might have been unimaginable just a month ago.”
And this M.D./administrator’s biggest concern?
“We will be exploring how to redefine our care processes so that safety can be maintained, and make patients comfortable in getting the care they need at medical facilities.”
“I went to a store the other day and people were standing in line outside…six feet apart and on blue circles. They were only allowing 50 people in the store at a time. And when you did reach the checkout line there was ‘no contact payment.’ Hospitals need to be engineering social distancing in the same way. If we can adjust the way patients get the care they need in a setting where social distancing can be maintained, it’s a win-win…patients don’t want any more exposure to infectious risk than is needed.”
Looking forward, he states, “We will be working to get patients back on track—people with chronic illnesses still need monitoring and adjustments of their medication. We also learned from Katrina that emotional needs after a large disruption become very significant. Providing that kind of support will be equally important in our planning.”
“New Orleans has faced disaster and disruption before, and we know the value of coordinated care. In addition to the medical services we will ramp up efforts to engage social workers and pharmacy assistants and behavioral health professionals. Physicians here will likely have to do what we did after Katrina…spend part of our sessions in a supportive mode to help patients who are hurting emotionally and financially.”
“Now is the time to decide what we want the future of healthcare to look like. Healthcare has been challenged even before Covid. This crisis is giving us a chance to see what is truly needed. The use of non-traditional methods like video and audio visits has helped us connect with patients in novel ways. This experience will help us learn to use these channels for years to come.”
Touting another positive aspect of this crisis, he notes, “Virtual visits has gone well overall. The video piece is very focused and tends to result in more effective visits. They also bring a lot of flexibility. With video visits we can say, ‘I’ll check in with you tomorrow, Mr. Jones.’”
But that video visit will get some patients only so far.
“We worry about the effects of unemployment and loss of insurance coverage…about those patients dealing with chronic conditions who have lost their incomes. They may very well not be able to afford the necessary medications. Some commonly used diabetes medications, for example, can cost $400 a month. How does a health system respond to community needs when the basic platform has been disrupted so deeply?”
“The American health system will be facing unprecedented changes in the weeks and months to come. But in New Orleans, we have our shared history and community for support. Katrina made us stronger and more resilient; we will find a way to get through this together. And that is reassuring.”