Commentary: Hospital, others were ready for coronavirus

Preparation and coordination were key in treating the nation’s first patient at Providence Everett.

By Jay Cook and Janine Holbrook / For The Herald

On the evening of Jan. 20 we learned that we would be caring for the first patient in the U.S. infected with the 2019 novel coronavirus, now called COVID-19.

Thanks to the preparation of Providence Medical Group clinic staff, Providence Regional Medical Center Everett hospital staff, the Snohomish Health District and coordination with Snohomish County Emergency Medical Services, we were able to safely and effectively screen, identify, isolate, test, transport and treat this patient with minimal exposure to other members of our community, swiftly and with the deepest compassion and care for the patient.

This remarkable feat was made possible due in large part to ongoing training in managing these types of highly infectious agents, which began with the ebola scare in 2014. In fact, many of these partners had just gathered on Jan. 2 to practice for a scenario such as this.

When the patient first arrived at the outpatient clinic, he quickly identified his recent travel history and correctly considered his flu-like symptoms to be consistent with reports of coronavirus that were beginning to emerge from Wuhan, China. Our staff immediately contacted the Washington State Department of Health and the Health District, whose personnel were readily available and extremely helpful in connecting with experts at the Centers for Disease Control and Prevention in Atlanta, who were already closely monitoring the outbreak in central China.

After the patient’s tests returned positive for the virus, our Infection Prevention nurse coordinated the efforts of our Infectious Disease doctors, Providence facilities personnel and a specially trained team of nurses — the Biocontainment, Evaluation and Specialty Treatment (BEST) team — to prepare for the arrival of the patient.

The Health District coordinated with local EMS providers to safely transport him to our hospital in an isolation device which was designed specifically for situations like these.

Upon arrival at Providence, the patient was placed in our biocontainment unit that was created for assessment of ebola patients. Since ours was the first patient with this virus known in the U.S., we admitted him to this unit to ensure the utmost safety for our patient and our caregivers. This unit is removed from routine patient and visitor areas and has enhanced barriers and precautions to prevent the spread of any infectious diseases.

Once our patient was admitted, our nurses and laboratory personnel, working in personal protective equipment (PPE) followed the processes they had practiced just weeks before.

Our Infectious Disease doctors assumed primary responsibility for medical management in collaboration with the Health District, Department of Health, and on-site CDC personnel. They utilized a telemedicine unit to remotely examine and communicate with the patient, while nursing staff in full PPE delivered bedside care.

Since that time, much has been learned about the care of patients with coronavirus. For example, since our patient was admitted, the CDC has clarified the appropriate level of PPE precautions required for the care of coronavirus patients, which are somewhat less restrictive than that used for ebola patients. This made day-to-day care much easier for our caregivers. In addition, across Providence St. Joseph Health, we rapidly implemented a screening system in our electronic health record to help identify patients at risk for this infection.

Lessons learned from our success in caring for the first patient in the U.S. with coronavirus have increased the world’s knowledge about this virus and are being implemented by other teams around the world. To facilitate timely clinical information sharing and advance care and treatment of this emerging infection, Providence worked with the CDC, Department of Health, Health District, and other partners to describe the identification, diagnosis and care of this patient in a case report published in the New England Journal of Medicine.

The patient was safely discharged and continued his recovery at home, with regular monitoring by the Health District. We’d like to thank all who have helped our patient on his journey to recovery; the successful care of this patient shows the importance of preparedness and many agencies working together.

By Dr. Jay Cook is chief medical officer and Janine Holbrook is chief nursing officer for Providence Regional Medical Center Everett.

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