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Bloomington-Normal Hospitals Brace For Potential Surge In COVID-19 Cases

A tent next to a hospital.
Ryan Denham
Advocate BroMenn is preparing for a surge in COVID-19 cases with a tent next to the Emergency Department for overflow of suspected coronavirus patients.

Bloomington-Normal hospital officials said Thursday they have planned for surges in COVID-19 cases that could demand "desperate action."

Advocate BroMenn Medical Director Dr. James Nevin said one of those precautions is for people with COVID-19 symptoms who are directed to the emergency room.

"We have erected an overflow tent outside the emergency department. This has air handlers and is pretty sophisticated. We expect to have it up and running any day now," said Nevin.

OSF HealthCare St. Joseph Medical Center Medical Director Dr. Paul Pedersen said his hospital has contingency plans too.

"To manage those patients as best we can, to cohort them into areas where we can manage them best within the hospital and allow for the safest places for them to be, both for themselves and for our mission partners," said Pedersen.

"I would love to test every single person. I would love to have 10 million tests done so that we really know how significant this is. But that's not going to happen just because that's my dream."

Both BroMenn and OSF St. Joseph said their overall occupancy is low because they have stopped elective surgeries. As of Wednesday, Pedersen said St. Joseph had 90 patients and St. Joseph is licensed at 149, for about 60% occupancy.

Pedersen said people with risk factors such as chronic respiratory conditions appear to be staying home and not getting sick because St. Joseph is seeing fewer of that kind of patient than usual.

"Oh gosh, we've probably got half our population in the hospital with respiratory illness, but only one is confirmed with COVID-19 right now," said Pedersen. Nevin said it's lower at BroMenn, 25% at most. BroMenn has two COVID-19 patients in ICU.

It's difficult to get a clear picture or to make inferences about hospital patient populations. For example, Pedersen said there are several patients with upper respiratory illness that have tested negative for flu, RSV, and for COVID-19.

"If somebody comes in to our emergency department with fever, cough, shortness of breath and they have a normal chest x-ray, we're not testing those folks because the CDC says don't test them yet. If they have an abnormal chest x-ray we're testing them (for COVID-19)," said Nevin.

 James Nevin
Credit Advocate Health Care
Advocate BroMenn Medical Director Dr. James Nevin.

Nevin said you have to be admitted to the hospital with a suspicion of COVID-19 to be tested. He said there have been several who were likely COVID-19 cases who were not admitted and not tested. BroMenn and many other hospitals worldwide have stopped wide testing for the flu, Nevin said, because that test also consumes scarce resources. Sufficient testing is simply not available.

People who have symptoms and are not being tested, but want to be tested, "should stay at home and monitor their symptoms. Fever and chills and myalgias (muscle pains) can come with mild cases. 80% of COVID cases are mild and do not need treatment and the last place they need to be is in a hospital where that risk could be higher," said Nevin.

He said higher risk people should also watch their symptoms. 

"I would love to test every single person. I would love to have 10 million tests done so that we really know how significant this is. But that's not going to happen just because that's my dream," said Nevin.

"The biggest concern is saving PPE for when these surges occur. Italy, Spain, China all lost a huge amount of (medical) personnel because the worried-well were consuming them, said Nevin.

It's clear there is a lot of fear that is causing some people in Bloomington-Normal to act badly.

"We had to remove our surgical masks from the kiosk in an area at the front of the hospital because quite frankly the public was coming in and stealing them in masses. Those are controlled by our nursing staff," said Nevin. "We even had some steal rolls of toilet paper."

For those who want to talk to someone about their symptoms, Nevin said there is a 24-hour hotline, (866) 4HEALTH (or 866-442-2584).

Determining Use Of Critical Care Resources

Ventilator use is currently low at both Twin City hospitals. A national report put Bloomington-Normal far below average in ventilator capacity among cities. The Dartmouth University study noted Bloomington-Normal has 31 ICU beds. In contrast, Champaign-Urbana has 110. ICU beds have ventilators available. Operating rooms have a few more that could be used for critical care. 

The Dartmouth study indicates Bloomington-Normal ranked 277th of 304 metro areas in the study with 15 ICU beds per 100,000 population. Champaign-Urbana ranked 198th with 24 ICU beds per 100,000 people

Paul Pedersen portrait
Credit OSF Healthcare
OSF HealthCare St. Joseph Medical Center Medical Director Dr. Paul Pedersen.

In areas where COVID-19 cases have overwhelmed available resources, doctors have sometimes been forced to make choices on how to use scarce equipment to save the critically ill. This can result in tradeoffs such as gauging how the age of a patient might affect the potential for eventual recovery. Conversations about the ethical framework of those difficult decisions have begun in Bloomington-Normal hospitals as well, though policy is not firmed up in either.

"Each of our (OSF) hospitals has an ethics committee that can help those physicians in making some of those decisions and give them advice about that," said Pedersen. "We had a call about that Tuesday as a matter of fact for our ministry ethics committee to talk exactly about that and how we would go about developing some of those criteria."

"We have an incident command team that meets twice a day by phone and once a day on weekends to discuss all issues," said Nevin.

The State of New York has developed criteria for ventilator allocation.

"We're looking at that and that's fairly objective. And that identifies and stratifies people into likelihoods of survival and therefore benefit from ventilation," said Pedersen. "We, of course, hope that we never ever get to that situation."

Some hospitals overun with COVID-19 cases have cycled ventilator use, hopping between patients for periods of time in the hope the method can tide two or more patients through a crisis. Pedersen noted medical opinion is mixed whether that is effective. He also said there are YouTube videos on how to split ventilator air feeds for two patients so both can use one machine at the same time. Federal authorities Thursday approved that technique for use.

"We're looking at all of those opportunities and options should we get to that occurence," said Pedersen.

"We're not there yet. Those are going to be difficult decisions and I'm sure that in Italy and New York City they had to address that and we'll probably be learning from them since the landscape is changing," said Nevin.

Neither OSF St. Joseph nor Advocate BroMenn should be viewed as islands without recourse. Both are part of larger systems. Nevin said the Advocate Aurora Health system has regular conversations about resources and is prepared to shift equipment and even personnel to whichever hospital is the hottest.

And both medical directors said if society is successful in sheltering in and social distancing and washing hands and coughing into elbows, we might not have to force doctors to make those choices.

We’re living in unprecedented times when information changes by the minute. WGLT will continue to be here for you, keeping you up-to-date with the live, local and trusted news you need. Help ensure WGLT can continue with its in-depth and comprehensive COVID-19 coverage as the situation evolves by making a contribution.

WGLT Senior Reporter Charlie Schlenker has spent more than three award-winning decades in radio. He lives in Normal with his family.