Staff at Columbia Memorial Hospital have seen a spike of people coming to the emergency room in Astoria and its urgent and primary care clinics with upper respiratory infections, as the fear of coronavirus grows.
Clatsop County had not reported any cases of COVID-19 by Monday afternoon, but public health officials and hospital administrators are preparing for a potential outbreak.
With a tenuous supply of coronavirus tests and hospitals around the U.S. and the world increasingly overwhelmed, local doctors are trying to prevent a similar run on their limited resources.
“Of course, we are concerned about being overwhelmed,” Dr. Kevin Baxter, the chief medical officer at Columbia Memorial, said in a statement from the hospital. “But we are calm and prepared. That is why we are asking people to self-quarantine and follow the directions put forth by the” federal Centers for Disease Control and Prevention.
The CDC advises people who think they have been exposed to COVID-19 to call a health care provider for medical advice, rather than showing up unannounced and potentially infecting others.
Symptoms of coronavirus include fever, cough and shortness of breath. Emergency warning signs include shortness of breath, persistent pressure or pain in the chest and blueish lips or face.
The hospital, required by law to assess the health of every person coming into the emergency room, has been examining and sending home patients to recuperate.
“This is no different from any other flu season in that if you are not feeling well, you should stay away from others,” Baxter said.
As of Monday afternoon, Columbia Memorial had only tested 10 people for COVID-19. On Friday, the hospital only had about 350 testing kits in reserve, with no guarantee of how quickly they’ll be replenished if used, CEO Erik Thorsen said.
“We are still maintaining that for a commercial lab test like that, that there will still be screening criteria,” he said. “We’re going to focus on the moderate to high-risk patients until the tests become more available to us.”
“All we have heard is … whoever makes the kits is ramping up production. But there has not been a definitive ETA on the ‘when’ for those kits.”
Before testing someone, the hospital has to rule out other illnesses such as the flu, the rate of which is increasing locally, said Judy Geiger, Columbia Memorial’s vice president of patient services, in a statement from the hospital.
“Only (the) very sick will be tested,” she said of COVID-19.
People healthy enough will be sent home to heal, leaving hospital beds for those who require more care, Geiger said. A two-week quarantine has become the recommended standard for people with coronavirus.
Columbia Memorial has 25 beds. But the hospital has other annex spaces, tents and an emergency plan that could include expanding to Astoria Middle School if necessary, Thorsen said.
“We have other areas on our campus where we could potentially triage patients or set up screening stations on this campus without having to go to an off-site location,” he said. “We would hope to exhaust all of those places first.”
Emergency room doctors are some of the most vulnerable to the coronavirus, a point reinforced by physicians in Washington state and New Jersey in critical condition with the virus.
Columbia Memorial opened an emergency operations center, where staff meets twice a day to monitor the volume of patients and the supply of protective equipment, along with how to keep operations in line with state and federal recommendations, Thorsen said.
“We want to convey that we are very well-prepared,” he said. “We’re ready. We know how to safely care for a potential COVID-19 patient and an actual COVID-19 patient.”
Gov. Kate Brown told reporters in a conference call that a White House testing czar said private labs will have the capacity to do 1 million tests this week, 2 million next week and 5 million the week after for COVID-19, The Associated Press reported.
“That’s good news,” Brown said.
The death toll from coronavirus will depend largely on the capacity of hospitals to treat the highest-risk patients. Numerous states have been promoting social distancing and barring large gatherings to limit the spread and avoid overwhelming the medical system.
Becky Hultberg, the president and CEO of the Oregon Association of Hospitals and Health Systems, said hospitals can defer elective surgeries to focus on the response to the virus.
“While hospitals are doing all they can to prepare, there is only so much physical capacity these facilities can create. Supplies and workforce are also limited,” she said in a statement. “The only way to ensure that hospitals can respond effectively to a surge in patients is to flatten the pandemic curve by enacting more stringent social distancing measures immediately.
“We understand the dramatic social and economic consequences of these decisions, but the time to act is now and we applaud the governor for making these hard choices. We also recognize that stronger measures may be required.”
Around 360 medical professionals signed an open letter to Vice President Mike Pence calling for a more coordinated national response to the crisis, including expanded testing and production of protective equipment. Among other recommendations, they called for closing all schools, passing a stimulus package, barring foreclosures and evictions, tracking all quarantines and creating a national policy on social distancing.
“No one should leave their homes in impacted regions except for medical care, essential supplies, essential work services and compelling other reasons that are clearly defined,” the letter states. “Virtual work options should be encouraged for all businesses, whenever possible.”