Across the region, hospital and laboratory disaster plans have been rewritten in the face of shortages of supplies and staff. The capacity for testing, hamstrung early in the outbreak by federal missteps, is expanding and drive-thru testing has arrived at UW Medicine's Medical Center Northwest and is in the works elsewhere. Researchers who just weeks ago targeted tropical diseases now hunt drugs that can knock down COVID-19.
Washingtonians are living history.
“I lay awake a lot at night, thinking about that,” said Dr. Wesley C. Van Voorhis, a University of Washington infectious disease specialist. “It just boggles the mind that this is going on. I don’t think there’s any way this is going to be as bad as the 1918 flu, which had such a high mortality rate. But it isn’t good.”
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When Elizabeth Schneider and a dozen friends fell ill days after attending a Feb. 22 house party, none could get tested for the then-emergent virus. Even those who tested negative for the seasonal flu couldn’t get a coronavirus test.
Since coronavirus’s arrival in the United States in January, tests for the disease have been in short supply. Many test kits in the initial batch that the Centers for Disease Control and Prevention sent to Washington state were defective, and federal restrictions prevented nongovernmental labs from attacking the backlog. Now a shortage of nasal swabs — plastic sticks topped with a sponge — is forcing clinics to triage testing.
Schneider and others ultimately signed up for the Seattle Flu Study to get checked for coronavirus. The research study — which has since been ordered not to provide coronavirus tests — couriered a test kit to her Eastlake neighborhood home; the results, delivered March 7, showed she had coronavirus.
“It’s quite frustrating,” said Schneider, a 37-year-old scientist working in biotechnology. But, she continued, “I do have hope, and I do think things are going to get better. There are a lot of great scientific minds working on vaccines and therapies right now.”
Testing capacity has expanded rapidly in the region since March 4, when UW Medicine and other nongovernmental labs were allowed to test, State health officer Kathy Lofy said in an interview Friday.
Lofy said she has been told providers are setting up drive-thru testing sites, which they are just starting to deploy. Moves by state authorities, she said, mean the tests should be free to patients.
Watching as the outbreak killed and infected dozens of residents and workers at Kirkland’s Life Care Center, health officials realized how devastating the disease can be in long-term care facilities, Lofy said. She encouraged other public health managers to demand centers screen visitors and staff for the virus and limit visitors.
Gov. Jay Inslee’s March 10 order slashing visits to care facilities was a small piece of the sweeping restrictions imposed since the disease broke out. The hope is that isolation will slow the coronavirus’ spread, as it did in China, so that Pacific Northwest hospitals are not overwhelmed when the worst arrives in the weeks ahead.
“We’re learning that all this stuff can be done in our free society,” said Van Voorhis, the UW Medical Center infectious disease doctor. “I’m pretty amazed.”
Hospital practices evolve as the disease spreads. Doctors at the UW Medical Center, where Van Voorhis consults weekly, now pass the duty pager — constantly buzzing with requests for COVID-19 guidance from physicians at hospitals as far away as Alaska and Wyoming — so the on-call staffer can sleep.
At Providence Regional Medical Center in Everett, which reported the first U.S. coronavirus case on Jan. 21, Dr. George Diaz and his team developed a remote monitoring protocol they believe can keep enough space free to deal with the coming spike in infections.
“Hospitals are brick and mortar, and it’s not easy to create more beds,” said Diaz, section leader for infectious diseases at Providence. “It became clear to us that we needed to find a way to manage surge. … We also knew that it is only a small portion of patients that develop severe illness.”
Diaz, who treated America’s “Patient Zero” in January, said that in less than a month the hospital developed and launched a program through which coronavirus patients are sent home with equipment that allows nurses to monitor them remotely. Most recover without extensive treatment; those whose oxygen levels dive or temperatures spike are hospitalized.
The system built on a telehealth program connecting specialists at larger facilities in the Providence Health & Services network to smaller, rural hospitals. Diaz said the innovation is scalable, and has already helped as Washington progresses up the bell curve of new coronavirus cases.
“We don’t know where we are on the curve, as far as how much worse this is going to get,” Diaz said. “But at this point we’re managing it pretty well.”
Since mid-January, the lab Van Voorhis directs, UW Medicine’s Center for Emerging and Re-emerging Infectious Diseases, has been testing drugs that may knock down coronavirus; that work is being paid through gifts to the university, Van Voorhis said, as grant funding moves too slowly to match the need. At Providence, clinical trials are underway using a drug, remdesivir, previously tested against Ebola.
Those treatments can come online only if testing is available, but supply shortfalls, particularly when it comes to testing stocks and protective equipment like respirators, have been acute.
Gloria Brigham, director of nursing practice with the Washington State Nurses Association, said caregivers have been reusing disposable masks, tucking them in paper bags at the end of shift for use the next day.
Early in the outbreak, Brigham said, facilities weren’t properly limiting access to protective equipment. Patients carried off stacks of surgical masks set out for in-clinic use, and highly protective equipment wasn’t reserved for caregivers who needed it.
Caregivers who had treated coronavirus-infected patients weren’t always notified, said Brigham, herself a registered nurse. When workers were notified and quarantined, procedures were erratic — workers bounced in and out of quarantine, and had to use banked paid time off while isolated.
As coronavirus settled in, Washington hospitals tightened controls on protective equipment, Brigham said. Most now put quarantined workers on paid leave, and work to protect caregivers who, because of age or existing medical conditions, are more likely to die if infected.
All those responses could have been in place before the outbreak. But Brigham said she’s glad they’ve come ahead of the surge.
“Hospitals and other health care facilities are going to be stretched to the limit,” Brigham said. “It’s really, really important that organizations take care of their caregivers.”
Nurses and other health care providers “want to stay on the frontline,” Brigham said. Doing so, though, gets difficult as society shuts down.