Turning NHTI into a field hospital will be worth it, even if it’s never used

  • New Hampshire Governor Chris Sununu walks through NHTI’s Sweeney Hall on Friday morning. GEOFF FORESTER / Monitor staff

  • New Hampshire Governor Chris Sununu during the tour of the NHTI's Sweeney Hall on Friday morning, April 10, 2020. GEOFF FORESTER—Monitor staff

  • Concord Hospital medical personnel wave to passing emergency vehicles in front of the hospital on Friday afternoon. GEOFF FORESTER / Monitor staff

Monitor staff
Published: 4/10/2020 4:07:48 PM

The spread of COVID-19 has transformed pretty much everything around us, but few places in Concord have seen as big a change as NHTI.

“They have transformed a college campus .. into a field hospital, in very little time.”

That’s how Dr. Christopher Fore, chief quality officer for Concord Hospital, describes the situation at the community college, where Sweeney Hall has been transformed from a building full of classrooms, bursar’s offices and a bistro into the site of 125 long-term single-occupancy rooms that could handle patients in a pinch. The community college’s gymnasium is full of cots, electrical connections and other material that could handle another 115 patients. This space would be needed if local hospitals fill up with COVID-19 patients, leaving others with no safe place to be treated.

With any luck – which means if New Hampshire residents keep doing what we’ve been doing and stay separated, and businesses stay shut, and the shortage of medical supplies doesn’t worsen – they may not even get used.

“If we continue to self-isolate … I think by the time we get to the end of April we will be in a good place,” Dr. Fore said.

But even if the state’s cases do decline sharply in May, that doesn’t mean the field hospital would be put away and NHTI returned to normal, because the future behavior of the novel coronavirus is uncertain.

Uncertainty about disease future

Officials don’t have enough experience with COVID-19 to know how the coronavirus will react to warmer weather and then the return of cool weather. Other infectious coronavirus diseases such as MERS and SARS have faded in summer but strengthened again in autumn.

“We don’t know if COVID-19 will play by these rules and return next fall,” Dr. Fore said. He pointed to the Spanish Flu epidemic of a century ago. That disease hit the U.S. hard in the winter of 1918 but then faded away only to return in force in the fall of 1919, when things got so bad that at least one building on Concord’s Main Street had to be turned into an emergency hospital.

If the NHTI field hospital stays in place even into mid-summer, that would raise questions about whether Concord’s community college could return to in-person classes and dormitory housing for the fall semester, which starts around Labor Day.

“It’s far too early to tell whether or when the medical flex site may be needed. We’re planning for summer and fall semesters as we always do, understanding that continued adjustments may be necessary,” said College President Gretchen Mullin-Sawicki. “NHTI is fortunate that we already had considerable expertise in online learning and in blending online with on-site course delivery, so we are well-positioned either way.”

Dr. Fore gave an online briefing Friday about the field hospital at NHTI, sponsored in part by the Greater Concord Chamber of Commerce. He noted that while Concord Hospital has overseen creation of the field facility at NHTI it has involved many groups, including its sister hospitals in Franklin and Laconia, local public networks, NHTI staff, and even the Army National Guard.

It comes as Concord Hospital has transformed itself, changing staffing patterns, eliminating elective medical and surgical work, and expanding the number of negative-pressure rooms, which keep airborne diseases like COVID-19 from escaping, from 20 to 80. This sort of change is being done by many hospitals and is taking a financial toll – “the loss of revenue across the state is a quarter billion dollars a month,” Dr. Fore said.

In recognition of this work, the New Hampshire Department of Safety put on a parade of ambulances, fire trucks and police cruisers at Concord Hospital on Friday “to thank the employees for their hard work during these challenging times.”

If hospitals fill up

The trigger for moving patients into the NHTI site will be hospital admissions. If there’s a surge in patients to the point that 75% of rooms that can safely hold COVID-19 patients in Concord, Franklin and Lakes Region hospitals are occupied, which means roughly 80 patients, “we will turn this on.”

“It will take 48 hours to staff up, turn on infrastructure, start to take transfers,” he said of the NHTI site.

It would ramp down when “that trigger was met in reverse, when we’re below 75%” in COVID-19 room occupancy, at which point patients could be transferred elsewhere. Those transfers won’t take place quickly, however.

“The operational length of this project could be three months or longer as we place patents back into hospitals, back home, back into long-term care facilities,” said Dr. Fore.

As currently envisioned, the NHTI site would be used to separate out different categories of patients who don’t require acute hospitalization. Separation is important, he said, because mixing patients that are COVID-positive, COVID-negative and presumed but not proven positive would be difficult logistically and could spread the disease.

Three categories of patients

Official envision placing three categories of patients at NHTI: those who can’t safely or independently self-isolate for social reasons; people from long-term care facilities – Dr. Fore noted that the Concord area has the state’s highest proportion of these facilities, which are particularly vulnerable to infectious disease – and people in hospice or end-of-life status that don’t have safe place to go.

It would not take sick prisoners from the state Department of Corrections or area jails, for security reasons.

The facility would be heavily staffed during daylight hours and less so overnight to ease the burden on health-care workers who would also be dealing with full hospital rooms. “Staffing will be a significant restraint,” he said.

As for the long-term status of coping with COVID-19, Dr. Fore said the key will be widespread and frequent testing. Especially important would be the development of antibody tests, which can determine not just if a person is exposed right now but has ever been exposed and thus has developed immunity.

In answer to questions, he said he thought this experience would help us prepare for the next pandemic.

“I think it is highly unlike we come out … without a renewed emphasis on a PPE (personal protection equipment) supply chain that is statewide. We need to increase our ability to supply those critical things,” he said.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)



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