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Concord Hospital prepares for ‘medical surge’ of COVID-19 patients

  • Concord Hospital medical staff at one of the two undisclosed COVID-19 testing sites holds a testing kit.

  • Concord Hospital medical staff at one of the two undisclosed COVID-19 testing sites in the Concord area. The site is an evaluation and testing location for Concord Hospital Medical Group patients only. The license plate in the image was concealed to protect patient privacy. Geoff Forester—Monitor staff

Monitor staff
Published: 3/26/2020 4:14:14 PM

It’s been 11 days, and already Concord Hospital has been transformed.

Intensive care unit rooms have been upgraded and outfitted. Nurses and specialists are prepping for new roles. Unnecessary procedures have been called off. Triage facilities have been set up in nearby towns to help manage lower priorities.

Precisely when New Hampshire will see its peak of COVID-19 cases – and how high that peak becomes– is still unknown.

But the doctors and nurses at Concord Hospital have been pulling out every stop available to get ready. 

“(We’ve) essentially completely changed the character of how we deliver health care,” said Dr. Matthew Gibb, chief clinical officer at the hospital. 

New Hampshire has so far experienced one death – and more than 130 known cases – since the spread of the COVID-19 respiratory virus. But hospitals across the state are prepping for a “medical surge” – the likelihood that cases flare and more beds are needed than hospitals have space for.

At Concord Hospital that’s meant an immediate upgrade for many of its rooms.

In order to most safely treat COVID-19 patients, hospital rooms should be “negative pressure rooms,” Gibb said. That means they have special ventilation that removes air from the room and expels it outside the building. Normal heating and cooling systems simply redistribute the air, which can spread the virus. 

Two weeks ago, Concord Hospital had fewer than 20 rooms with that capacity in its intensive care unit. This week, it has more than 75.

It’s progress, but the hospital is still grappling with limitations beyond its control, like dwindling supplies. Provisions of masks, gowns and other protective equipment – not to mention ventilators – continue to cause a squeeze. 

“We’re increasing capacity to take care of ventilated patients,” Gibb said. “Right now that really means trying to acquire additional ventilators to use. That’s the limiting issue right now.”

Changing that dynamic means entering a rat race. New Hampshire is receiving its second shipment of personal protective equipment from the Federal Emergency Management Agency this week. But to actually get the supplies, hospitals must apply for it and lobby for it individually.

In the meantime, Concord Hospital is taking its own measures, including dealing with manufacturers directly. “Basically all avenues that we can pursue, we’re pursuing,” Gibb said. 

While the hospital has 75 negative pressure rooms to house COVID-19 patients, it so far has only 32 ventilators to help the most extreme cases. The hospital is planning to build up its capacity in three tiers: the first by using 24 ventilators, second with all 32, and the third with 48. Getting that far will require obtaining more machines.

For those with COVID-19 not needing respiratory assistance, the hospital still plans to treat them in beds, Gibb said. That care would include giving oxygen, providing them isolation, and monitoring in case symptoms get worse.

“That care will be delivered and certainly close monitoring, because there is a chance that these patients deteriorate fairly quickly,” Gibb said. “So we would plan to have the next level of care available to them as best as possible.”

It may not be enough. Depending on projections, New Hampshire could be hundreds of beds short of what is needed to handle an influx, according to a Harvard study last week. 

In that case, Gibb said, the hospital may need to start hosting COVID-19 patients in rooms that are not negative pressure – and it may need to designate entire wards or floors to coronavirus treatment.

The hospital is also working with the National Guard and state officials to help create a medical "flex area" – hopefully by next week – that would create bed spaces where people without COVID-19 could be treated while the hospital is repurposed.

For now, the hospital has had to innovate with what it has. The hospital has cut off the bulk of elective procedures – non-life threatening surgeries that Gibb says take up protective equipment and staff time. 

Doing so was not a light decision. Those procedures comprise a large portion of Concord’s in-patient care – as well as its revenue stream. But Gibb said the equipment needs overcame that.

Meanwhile, many of the nursing staff and physicians who normally handle those surgeries are preparing to take on COVID-19 patients. Anesthesiologists, in particular, have the skills that will help people on ventilators, Gibb said. 

Then there is the question of triaging incoming patients. The hospital is leaning on neighborhood clinics in Penacook and Epsom to direct patients who may believe they have symptoms. That includes mobile testing and telemedicine. The goal: keep patients away from the emergency room if possible.

“We’re working on a telemedicine strategy within our emergency rooms so that patients who arrive there with respiratory symptoms that are not in crisis can be triaged through a telemedicine process and reduce interpersonal contact,” Gibb said.

Testing has created its own challenge. In recent weeks, the ICU in Concord has housed and isolated 10 to 15 people at any given time who may have COVID-19 symptoms. But because the test results can take days, many of them wait in limbo.

As the COVID-19 virus continues its spread. Gibb and others are acutely aware that the most difficult conditions are likely yet to come. It’s a realization that affects everyone on staff, he says.

Hospital officials are taking lengths to be transparent to employees about evolving policies for personal protective equipment – who gets it, what it’s used for and why, Gibb said. 

“It’s rough, as you can imagine,” he said. “The anxiety over the degree of change that we have to introduce is high. The first strategy is communicate as best we can.”

Still, as capital area residents continue to hunker down, Gibb said the preparation so far could prove a silver lining. 

“We’re in a sense fortunate in New Hampshire and Concord that we are not New York and we’ve had some time to plan,” he said. 

“Our entire organization is being reconfigured to prep for COVID and the surge. I think we had one to two weeks of head start on that. Which we hope will serve us well no matter what happens.”

Correction: An earlier version misstated the location of one of the Concord Hospital’s neighborhood triage clinics. The cliis located in Penacook. 

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