It was only a matter of time before a more common catastrophe—such as flooding—layered itself on top of the COVID-19 pandemic.
MidMichigan Medical Center in Midland had relatively fewer COVID-19 patients compared with the rest of the state before devastating floods struck. The 324-bed hospital in central Michigan had just nine COVID patients when reports came last week that floodwaters were about to crest, prompting the hospital to evacuate some high-risk patients as a precaution. (Flooding had already forced 10,000 residents to evacuate.)
More hospitals will be forced to deal with two crises at once as the season for hurricanes, tornadoes, flooding and wildfires arrives.
“The best institutions that respond well are really proactive with their management planning, “ said Richard Ganotta, a senior lecturer of health administration at New York University’s Wagner Graduate School of Public Service. “They plan ahead, they plan with speed to be able to respond quickly, and there’s a degree of standardization and predictability with respect to the training that serves them well.”
At MidMichigan, patient evacuation posed new challenges. Safely moving three critically ill COVID-19 patients to a nearby medical center had to be coordinated to mitigate healthcare personnel’s risk of virus exposure, said Diane Postler-Slattery, CEO of MidMichigan Health, the medical center’s parent health system. “In all of our decisionmaking we are thinking about how we handle subsets of patients.”
While the pandemic has complicated addressing the flooding, Postler-Slattery said the fact that the hospital had been in a heightened state of alert for months in some ways made it easier to manage. “COVID incident command became flooding incident command, and that made it easy to make sure that we were not forgetting about COVID while we were dealing with the flood,” Postler-Slattery said.
She recognizes there could be an uptick in COVID-19 cases in the flood’s aftermath because so many residents are now in shelters, where it’s more difficult to practice social distancing and other advised safety measures.
“It’s kind of like, what do you do,” Postler-Slattery said. “If people don’t have electricity and there’s six- to seven-feet of water in their homes, the safest place for them to be is in a shelter. We just have to deal with the multiple complications.”
MidMichigan has kept its two coronavirus testing centers open during the flood and has been working with the county health department and the Michigan National Guard to remind residents of the importance of following safety practices.
But the Michigan flood serves as a stark reminder that the season for extreme weather is arriving.
For healthcare providers in areas where massive storms, hurricanes, tornadoes or wildfires have become seasonal occurrences, their care delivery plans increasingly have to factor in disaster response.
Skip Skivington, vice president of healthcare continuity management and support services at Kaiser Permanente, said COVID-19 must be factored into both disaster preparedness planning as well as in normal care delivery operations for at least another year.
“We’re going to have to simultaneously deal with the crisis while we provide healthcare delivery,” Skivington said.
Since Kaiser has been running its emergency operations 24/7 to deal with the pandemic, it will take less time to shift focus on another disaster. He said much of the infrastructure is now in place to address the pandemic, so it can be integrated into any new response effort.
Since the pandemic began, Kaiser has closed a number of its medical office buildings to centralize its care delivery settings and preserve supplies of personal protective equipment. The result has been a greater reliance on telehealth.
“We’ll incorporate that (telehealth) more strongly into our plans going forward particularly if we get a second wave of the virus,” Skivington said.
The ongoing threat of the coronavirus presents providers with a dual challenge: developing emergency response plans that both address the immediate health needs associated with such disasters without compromising the months of effort spent stemming the pandemic’s spread.
Nick Cagliuso, senior assistant vice president of emergency management at New York City Health + Hospitals, said talks began in early February to map out the system’s response to a sudden surge in patients with respiratory issues during a heavy snowfall. Since then the planning has carried over to prepare for how the system will deal with COVID-19 patients if a hurricane strikes. Hurricane season along the Atlantic and Gulf coasts begins June 1.
Much of NYC H+H’s incident command structure was activated in January, but many of its emergency response practices were developed years ago when coping with crises like the 2009 H1N1 swine flu outbreak and Hurricane Sandy in 2012.
In 2015, NYC H+H developed a systemwide special pathogens program after its Bellevue hospital treated the city’s only confirmed case of Ebola virus. The plan developed to address a possible Ebola outbreak has since been modified to address seasonal flu and the current coronavirus pandemic.
Such efforts allow the system to make quick decisions when needed and adapt its response as the pandemic evolves, Cagliuso said. “Going through all of those different previous events has absolutely informed our work today.”
Like NYC H+H, Memorial Hermann in Houston has found the months spent addressing the pandemic has helped the system more quickly mobilize its own hurricane preparedness effort.
Tom Flanagan, vice president of trauma service line and system integration at Memorial Hermann, said its incident command has been split into two teams, with one dedicated to preparing for hurricane season while a second team remains focused on COVID-19 response.
He said he doesn’t anticipate the two teams will need to come together in the foreseeable future since Houston’s rate of new coronavirus cases has started to flatten in the past three weeks. But Flanagan said the two teams might work together to speed up the response effort for both hurricanes and COVID-19 if there is a sudden uptick in cases.
“We’re used to running a hurricane (response) for five or 10 days and having our (emergency) command center operating under that type of scenario,” Flanagan said. “With COVID we actually ran our command center for 11 weeks, and during that time we were able to start to identify where we could optimize our folks best.”