HEALTH
Pandemic Lessons
Past outbreaks, and national history, inform hospitals’ response to COVID-19 BY YIWEN LU
I
t has been more than five months since a stay-at-home order was first issued in Illinois due to the novel coronavirus pandemic. Despite limited reopening of parts of the U.S., COVID-19 continues to devastate many communities. The number of deaths has reached more than 180,000 as of August 31, making this the secondmost fatal pandemic in the U.S., only outnumbered by the 1918 Spanish Flu’s 675,000 deaths. The country has also seen more recent global pandemics, but none of them have affected the U.S. as dramatically as COVID-19. During the 2014–2016 Ebola outbreak in West Africa, which ended with more than 28,600 cases worldwide, the U.S. Centers for Disease Control and Prevention (CDC) trained more than 6,500 U.S. health care workers, but in the end, only eleven people were treated for Ebola in the United States. Between 2009 and 2010, the H1N1 swine flu pandemic caused an estimated 60.8 million cases in the U.S. and resulted in 12,469 deaths. Back in 2003, the SARS outbreak lasted for nine months, but there were only eight confirmed cases in the U.S. and no deaths. Now, in dealing with COVID-19, the health care system’s current strategies for managing a pandemic are under scrutiny around the country, including in Chicago. “What coronavirus has done is that it exposed chronic problems with how infectious diseases are handled,” said Dennis Kosuth, a part-time nurse at Provident Hospital in Grand Boulevard. Kosuth was involved in the protest against the closure of Provident Hospital’s emergency room in early April, when the pandemic had just started to significantly hit Chicago. To Kosuth, the closure showed incapacity for a COVID-19 surge and the deep roots that caused it. “[This happened] not because people aren't smart or doctors don't know what to do, but that the health system is all based around profit, rather than based around what people need,” he said. Looking at where we are today in the history of pandemics in the U.S., and
the history of the federal government’s management of medical supplies for pandemics and other emergencies, we can see what we’ve learned and been able to apply to COVID-19—and what we’ve failed to address. While Ebola was deadlier than the novel coronavirus that causes COVID-19, the CDC was able to efficiently contain it in the U.S., in part because the disease was not spread by respiratory droplets, according to Dr. Emily Landon, executive medical director of infection prevention and control at the University of Chicago Medicine. At the time, UChicago Medicine tested and isolated potential patients who came to the hospital. But in the end, there were no confirmed cases, John Hieronymous, a nurse at UChicago Medicine, told the Weekly. (The Weekly attempted to contact four other hospital systems on the South Side, but none responded.) During the H1N1 flu pandemic, however, with the need in the U.S. orders of magnitude greater, the hospital experienced a stretch in intensive care units (ICU) and supply capacities. Many health care centers and governments in the U.S. had begun to prepare plans for disease outbreaks during the 2003 SARS epidemic and 2005 avian influenza outbreaks, according to HealthDay News, and were able to benefit from activating those plans. But in the reality of a pandemic, there was more to learn. Landon told the Weekly that UChicago Medicine’s experience with H1N1 taught the hospital to use its supplies “smartly,” to screen patients at entry so that they could be more promptly isolated, and to restructure the design of the emergency room. “When we built our new emergency room, we built a pandemic wing, so that we could change the airflow quickly and lock off a number of rooms. They could be used for exactly this [COVID-19] scenario,” she said. “We were able to make use of the stuff that we invested in because of what we learned from 2008.” In addition to making the emergency department more compartmentalized
than before, allowing patients to be better separated from each other, Landon said that the new building construction also allowed the hospital to expand its ICU capacity in many more rooms.
W
hile hospitals have learned from past pandemics how to improve their infrastructures in response to increased demands for medical treatment, the supply chain still lags behind. Though UChicago Medicine, for example, built ICU capacity and the ability to separate patients into its physical infrastructure, bolstering its ability to handle a pandemic, Hieronymous, who was involved in the organizing efforts at National Nurse United, is concerned that its supply management strategy still makes the situation “chaotic.” Like most American hospitals,
UChicago Medicine uses just-in-time logistics, meaning that the hospital only purchases medical supplies needed for a few days or a week. Because it would be costly or potentially wasteful to stockpile more vaccines, drugs, and disposable equipment, keeping the inventory low seems to these hospitals to be the most efficient option. In a pandemic, there are fewer options when critical supplies run low. “There is no wiggle room in the system. Everybody is impacted negatively, so that ability for the system to flex and provide support in a local or regional area is not available,” said Chris Martin, a spokesperson for the Illinois Nurses Association. Hieronymous alleged a just-intime strategy left UChicago Medicine “completely unprepared.” “With changes happening day-to-day, it was clear that there was no set plan. There were no supplies
UChicago Medicine converted roughly 7,000 square feet of space into COVID testing/treatment space in early March, shortly after cases started to spread in Chicago. PHOTO COURTESY OF U OF C MEDICINE
SEPTEMBER 2, 2020 ¬ SOUTH SIDE WEEKLY 17
