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Across the world, stories have emerged of doctors in the midst of the coronavirus pandemic who have to decide: Who gets the ventilator that will help keep them alive—and who doesn’t?
While there are only 17 confirmed cases of coronavirus in Jefferson County, healthcare officials are already preparing for this worst-case scenario.
Twenty percent of people who contract COVID-19 will need hospital care, according to Public Health Officer Tom Locke. About 6% will need intensive care and mechanical ventilation from a machine that helps people breathe when they are unable to.
“What keeps me up at night is ventilators,” said Tracie Harris, chief of medicine for Jefferson Healthcare. “When the sickest of the sick come, specifically with COVID-19 symptoms, what we’re faced with is folks whose lungs can’t support their breathing without the help of a machine.”
Right now, Jefferson Healthcare has only four ventilators, according to Amy Yaley, the hospital’s public relations director. Jefferson County has a population of more than 32,000.
But with the hope of meeting the challenge of a global pandemic head-on, Jefferson Healthcare has spent the last few months transforming the hospital on Sheridan Street in Port Townsend into a facility equipped to handle the “surge” of coronavirus patients that could come in the future.
In an online panel, Jefferson Healthcare doctors spoke with Locke about how they are increasing the number of beds in the hospital and working to organize their responses to both coronavirus-related patients and for those who need the hospital to perform its normal emergency functions.
“While the picture was still forming, there was enough science to tell us that we would be facing something that would potentially stretch our capacity to its very limits,” said Joe Mattern, chief medical officer at Jefferson Healthcare. “We began preparing in early February. Within one month, we were talking about the potential and the reality of cases in Jefferson County.”
Early on, the hospital developed an isolated respiratory evaluation station. This clinic, with a separate waiting room and providers who specialize in evaluating respiratory illnesses, allowed people to be tested without the risk of infecting other patients.
The hospital also began testing early in March, and has now run more than 500 tests.
“If we could have it our way, we would be testing many more people,” Mattern said. “The first day we had our drive-through testing open, we did 70 tests and probably could have done more, but the fact of the matter is, we do have a shortage of testing supplies both here and across the state.”
For now, doctors will evaluate patients with life-threatening COVID-19 symptoms to decide whether they need to be airlifted to a facility that can better handle their needs. But if hospitals such as Harborview Medical Center become overrun with COVID-19 cases from across the state, Jefferson Healthcare plans to be ready to treat as many patients as they can.
“We normally have 25 inpatient beds,” Harris said. “Task one was to increase that capacity.”
The hospital will look a little different in the coming weeks, she said, with the hopes of doubling its capacity.
There will be a big tent outside where hospital officials can funnel patients into the proper care. Through a triage assessment, doctors will determine which patients have coronavirus symptoms and should be quarantined, which need regular emergency services and which might have coronavirus symptoms but do not need hospital care.
“The singular goal is to do the greatest amount of good for the greatest number of people that we can,” Harris said. “We will certainly have hospitalized patients with COVID-19. The hope with flattening the curve is that you all don’t come at the same time.”
Right now, the hospital has stopped all elective surgeries and is dividing these areas, as well as the Post Anesthesia Care Unit into more ICU space to accommodate COVID-19 patients.
There will be a discharge lounge, where patients who no longer need to be hospitalized can wait for family to bring them home. That way, beds can be cleared as quickly as possible to accommodate new patients.
There might also be a space dedicated to the comfort of patients who aren’t going to survive the illness, or a post-acute care for those who no longer need intensive care but aren’t quite ready to go home yet.
“There will be lives we are unable to save,” Harris said, noting the lack of ventilators in the healthcare facility.
“We have very few of those machines,” she said. “I can count on two hands how many exist in this community.”
Not only that, but healthcare workers lack personal protective equipment.
“We see pictures in the media, we hear stories all around,” she said. “We see folks operating without the kind of gear that is needed.”
To help address those needs, Jefferson County’s Department of Emergency Management is working with the state’s Emergency Operation Center to request more supplies.
The department sends resource requests to the state and other vendors. Requests for resources are prioritized based on population and the number of positive cases.
“We are getting two additional ventilators in the county,” said Willie Bence, the county’s emergency management director. “One for patient transport and one into the ICU in the hospital.”
Local Emergency Operation Center officials are working to create an isolation and quarantine facility for the homeless community in Jefferson County. They are also working with Olympic Community Action Programs to create a “step-down” care facility for those who no longer need hospitalization but still need observation.
“This will ease the strain on Jefferson Healthcare and enable them to get people out of the hospital as soon as they can,” Bence said.
The department is also working on increasing the county’s morgue capacity, should there be an increase in deaths. A facility has been located, and county officials are working to make some alterations to accommodate the potential need for a morgue.
On top of that, the EOC is organizing volunteers to help when the time comes. They are searching for volunteers with medical backgrounds (doctors, nurses, EMTs, etc.), backgrounds in security (military, law enforcement), other emergency response (firefighters, Incident Command System) or other specialized skills. They have also organized a community face-mask program and are offering sewing patterns and advice. To learn more about how to volunteer, go to www.co.jefferson.wa.us/1450/VolunteerHow-to-Help.
Health care workers and first responders are prepared to take on this pandemic, Harris said.
“What gives me peace in this whole situation is the individuals who make up the care team in this community,” she said. “The doctors, nurses, technicians, cleaners, all rising to the calling of serving this community.”
Even with a lack of supplies and the uncertainty of how hard this will hit local resources, the hospital staff and employees say they are ready for the challenge.
“At the end of the day, when anybody is faced with the kind of challenge that this community is facing we have to acknowledge that there’s anxiety and fear, and we’re stepping into this challenge anyway,” Harris said. “Courage in times like this isn’t defined by the absence of fear, it’s by stepping up and doing what needs to be done despite the fear.”
The most important thing the community can do to help the healthcare workers on the front lines is to stay home.
“We will prepare to face this and get through this,” Mattern added. “I would also ask the community to do what you can from a standpoint of spacing and social distancing and staying healthy. I would love this to be the greatest intellectual exercise that any of us have taken in our careers.”