By JEFF CLEMETSON | La Mesa Courier

On April 1, Alvarado Hospital admitted its first confirmed COVID-19 patient, a situation that Alvarado CEO Robin Gomez described as “very fortunate.”

“Many other hospitals in the county cannot say that. There were many more that had positives before we did,” she said.

As of April 6 when Gomez was interviewed for this story, Alvarado was caring for eight patients either with COVID-19 or under investigation for the virus — one on a ventilator. So far, Gomez reported, Alvarado is on pace to not be overburdened with patients like what is being experienced by hospitals in places like New York City and Italy.

Although it took several weeks for Alvarado to see its first COVID patient, it began dealing with the crisis weeks ago.

“In the beginning when it first started hitting, we had a line of patients out the door just wanting to be rapidly tested. I don’t have rapid testing, my tests come back in 24 hours,” she said. “The testing medium was very specific and we didn’t have that many test kits, so what we ended up doing was the patients who were coming to the hospital that had active symptoms and were being admitted to the hospital, we tested every single one of those patients. That way, as a hospital, we knew what we were dealing with.” 

Safety measures

Part of knowing what they’re dealing with is taking added precautions at the hospital.

Nurses that care for COVID patients follow specific guidelines entering and exiting patient rooms.

“We call it darning and dropping gowns. You put on the gown; you put on the gloves; you put on a N95 mask; and then you put on a surgical mask over the top of that, then a face shield on top of that,” she said. “In talking to the staff we say, ‘Hey we are actually probably safer here because we know where the COVID patients are, we have the protective PPE equipment to protect our staff against this virus.

“We did a lot of things proactively,” Gomez added. “Number one, conservation of PPE (personal protective equipment). When I say PPE, it’s not just masks. We’re talking about face shields. We’re talking about regular surgical masks that are not N95s and you’re talking about N95s themselves.”

Alvarado also only has around 150 mediums used for tests, and some of those are set aside for staff in case there is an exposure and everyone needs to be tested. “I always have to make sure I have enough mediums to test employees along with patients,” Gomez said.

Beyond the protective equipment and the strict guidelines on how to use them, Alvarado has also made structural changes to where patients are treated. To reduce the chances of virus-laden droplets from spreading, the hospital has started cohorting patients. COVID patients and those under investigation for the virus are on their own floor. There is also a floor for COVID patients requiring a ventilator.

Because Alvarado Hospital is an accredited geriatric emergency hospital, a third floor has been emptied to treat aged patients over 65 yeas old that are recovering from COVID-19. Gomez said that as patients recover from the virus, they go into a “convalescent” stage of recovery.

“Maybe you need a little bit of supplemental oxygen, making sure you’re getting proper nutrition and all that,” she said, adding that the county has done a good job in getting hotel rooms or even college dorm rooms for younger patients to recover in but since older patients need a little more attention, the county asked them to step in.

“So, patients that are no longer needing acute hospital-level of care, but can’t go back to the nursing home because they’re [COVID] positive, they’re going to be brought here and we’ll keep them here until they meet a set criteria and can be discharged safely.”

Supply chain woes

Even with taking all the precautions and following the best practices available, there are still some aspects of managing a hospital during the pandemic crisis that are beyond the control of hospital administrators.

“When you see on the news that we never know what we are going to get in our supply chain, that’s no joke,” Gomez said.

For example, on a recent order for 500 large and medium N95 masks, Alvarado ended up receiving 200 smalls. The hospital is also having a “hard time” getting cleaning supplies.

However, Gomez said, the hospital’s environmental services director has kept Alvarado supplied by finding some “phenomenally resourceful” solutions.

“We ordered five or six cases [of the usual cleaning wipes] in our last order and we got none,” Gomez said. “But what our EVS director has done is she was able to get the liquid stuff. We could get the dry wipes, that’s easy, and we put together buckets and we did a makeshift container so we can pull them right out of the top like the other buckets were and we distributed those out on the floor with all the proper equipment and all the proper solutions to clean.”

And although Gomez said the hospital is equipped with enough N95 masks for nurses to get one a day for “a number of weeks,” she still worries about keeping the hospital properly stocked.

“PPE and general supplies is such a big issue. It really, really is such a big issue,” she said. “I just can’t say, ‘Oh we’re OK for today and tomorrow.’ I got to look ahead three weeks, four weeks because the reality is, I’m only allowed one order a month. That order goes in on the first of the month. Literally, my director, she woke up at 11:45 at night and at midnight she submitted our order because it’s first come, first serve in the queue.”

The hospital has also begun reusing N95 masks by using a hydrogen peroxide sterilizer.

“We’re able to sterilize and we get about half of them back,” Gomez said.

The good news for the hospital’s supplies is that it is well stocked with ventilators — 28 total — and medication.

“The hydroxychloroquine — we have it and so if it comes down to needing to be used, we have it; we have azithromycin and those are the two big ones being talked about on the news all the time,” Gomez said, adding that Alvarado has at least three weeks of doses. Although Alvarado is in possession of these drugs, they are still experimental and unproven thus far at treating COVID-19 and have lately become controversial as the Trump administration pushes for their use and the scientific community wants a more restrained approach.

Public praise

Gomez is very proud of her staff and how it has adapted to the challenges brought on by the pandemic.

“I’ve worked in healthcare for over 25 years and I’ve never worked with a more cohesive strong leadership team,” she said, adding that her team is using a variety of communication strategies to keep up moral at the hospital.

“We’re not just fighting COVID-19 right now, we’re fighting fear, because there was an element right away of fear,” she said. “When they say the situation is fluid, it’s absolutely true. And what I’ve found is transparency alleviates fears, because if they know what I know, they know what I know.”

The communication strategy is working and Gomez shared that a nurse recently volunteered to work on the COVID unit.

“It is phenomenal the way our staff is stepping up to care for these patients and the energy they’re bringing, it is really heartwarming,” she said.

The community has also stepped up in heartwarming ways. The hospital has received a number of donations, including “dirt cheap” produce from a market that the hospital gave out to staff; donations of masks that Gomez was “very grateful” for because those masks will be given to hospital staff that are not on the COVID floors; and Dominoes recently treated ER staff to pizza.

“I want to thank the public,” Gomez said. “Everyone has been so supportive and so kind. People have put flowers on our front lawn and said, ‘Thank you healthcare heroes.’ They put some banners on our lawn last week, which was awesome, thanking the healthcare workers.”

—Reach editor Jeff Clemetson at [email protected].