The atmosphere of the emergency department at Upstate Community Hospital has become one of teamwork and support.

The health care workers check in with one another, asking how they and their families are doing. And Jay Brenner, medical director of the emergency department, tries to reassure his staff by sharing what they’re capable of handling.

The hospital was prepared recently to treat Brenner’s first patient who needed a ventilator, quickly intubating the individual and admitting them to the intensive care unit.

“So we’re ready,” Brenner said. “I think there’s a general sense that right now is the calm before the storm.”

Brenner is one of hundreds of doctors, nurses and health care workers in Onondaga County working to treat patients who have contracted the novel coronavirus. As infections rise, health care professionals told The Daily Orange that their hospitals have prepared for the virus spreading to the county.

The novel coronavirus causes COVID-19, a respiratory disease that has infected over a million people and killed at least 58,800 worldwide. Onondaga County has confirmed 322 cases of COVID-19 as of Friday. Three patients in the county have died of the virus.

“We have been anticipating this pandemic arriving here in Syracuse, and when we had our first confirmed case on March 16, it was not a surprise,” Brenner said. 

The World Health Organization declared COVID-19 a global pandemic on March 11. The day after, Upstate Community Hospital’s emergency department began placing patients who arrived with symptoms of COVID-19 in a separate, isolated area. The separation allows staff in the department to properly put on personal protective equipment, Brenner said.

SUNY Upstate Medical University started preparing weeks before seeing its first patients with COVID-19, said William Paolo, residency program director of emergency medicine. The hospital was put under incident command, and began gathering its resources in anticipation of incoming patients. 

The preparation period has been “extraordinarily beneficial” to Upstate, especially as it concerns personal protective equipment, Paolo said. 

New York Gov. Andrew Cuomo said at a media briefing Thursday that the state continues to have difficulty collecting needed medical supplies like ventilators. He has also mandated that all hospitals in the state increase bed capacity by at least 50%.

“Ventilators are a precious resource throughout the state, right now we’re not nearing capacity on ventilators by any stretch of the imagination,” Paolo said. 

Upstate Community Hospital hasn’t experienced a severe shortage of ventilators or face masks overall, Brenner said. The hospital was in short supply of small N95 face masks, but solved the issue under incident command by purchasing one-size-fits-all masks. 

The overall volume of people seeking emergency treatment has decreased at Upstate Community Hospital, Brenner said, but a large amount of patients coming to the emergency room are seeking COVID-19 testing or are exhibiting symptoms of the virus. Given the smaller volume of patients, the hospital has plenty of beds and ventilators available, he said. 

“We’ve seen in our county a doubling of the cases every couple days. We will at some point be stressing our capacity, but we are not at this point,” Brenner said.

SUNY Upstate is working to increase its bed capacity, Paolo said. The county and state have developed contingency plans should all hospital beds become filled. Onondaga County Executive Ryan McMahon announced March 26 that the county will use Syracuse University’s Manley Field House as a “surge site” hospital if needed.

Yuri Pashchuk, clinical director of medical-surgical, critical care and progressive care unit services at St. Joseph’s Health, said physicians at the hospital work with others in the area to communicate on the current and future needs of their facilities, he said. 

“At this point I would say that we are confident that we have what we need to take care of those patients,” Pashchuk said.

Patients who come to St. Joseph’s presenting symptoms of COVID-19 undergo a screening process, Pashchuk said. Once a lab result is returned, the hospital either continues isolating the patient or removes the restrictions.

The treatment plan for patients with COVID-19 is not that different than those for people who don’t have the virus, Pashchuk said. There’s greater supportive care, but patients are treated for the symptoms they have.

SUNY Upstate has seen numerous people come to the hospital with a fever, cough and shortness of breath, and some have been very sick, Paolo said. If an individual comes to the hospital with respiratory problems, the patient is identified as a suspected COVID-19 case and is moved to a separate room. 

“It doesn’t mean that we think you have COVID, it just means that you get extra precautions so that in case you do, you’re at low likelihood of transmitting it to anybody else,” Paolo said.

Health workers at SUNY Upstate who see patients identified as possibly having COVID-19 put on goggles, gowns and N95 masks, as well as head and shoe coverings. After visiting the patient, employees remove the protective clothing systematically and wash their hands, Paolo said.

Patients who arrive at Upstate Community Hospital’s emergency department with symptoms such as a cough or fever are placed in the geriatric emergency care unit, which has been transformed into an isolation unit, Brenner said. 

A separate room now serves as a “warm and cold room,” allowing health care workers to put on necessary equipment before entering the “hot zone.” 

Employees are also more aware of social distancing guidelines at work, Brenner said. There’s collective optimism among the staff, but also more anxiety.

Brenner feels the same anxiety as all community members, and is worried to an extent that makes sense, he said.

“I know that some people will get very sick from this illness, and even die, and I don’t want to be a part of causing anyone to get sick or to die,” Brenner said. “But I think that’s a shared anxiety amongst all the health care workers, and really everyone who’s living in this current situation.”

He takes precautions when entering and exiting the hospital, wearing a different set of scrubs in and out of the facility. When he returns home, he immediately takes a shower and washes his clothes. 

“I think we’re all taking proactive steps to limit transmission of this disease, especially to people who really are at higher risk,” Brenner said. 

Several local hospitals have confirmed cases of COVID-19 among their employees this week. St. Joseph’s confirmed seven cases of the virus Tuesday, and Upstate University Hospital reported Thursday that 16 staff members and two students have contracted the virus.

Pashchuk said he’s very confident in the processes St. Joseph’s has in place. The hospital will continue to learn from its colleagues to make changes and protect its staff, he said.

Paolo feels a sense of apprehension as a health care professional at the onset of a pandemic. He thinks about catching the virus and bringing it home to his three young daughters. Some of his colleagues have newborns, and have moved out of their house to avoid spreading the disease, he said. 

Doctors at SUNY Upstate now hold meetings online, going to the hospital only to treat patients and performing only clinical care in groups. The hospital staff isn’t panicked, but is reasonably concerned about COVID-19, Paolo said.

“We want to keep ourselves all as healthy as we can so we can care for the people who need us,” Paolo said.

Though Upstate Community Hospital’s emergency department has seen fewer patients overall, and those with symptoms of COVID-19 can often go home, Brenner said the department will experience an uptick. Right now, the hospital is focused on its teamwork skills. 

“Let’s make sure our processes work when we’re able to work at a moderate pace, and when we do pick up to a strenuous pace, hopefully the wheels don’t fall off the bus too quickly,” he said.

Published on April 3, 2020 at 10:11 pm

Contact Emma: esfolts@syr.edu