As confirmed cases of the new coronavirus spread in the U.S. this week, hospitals in Oklahoma are preparing for the threat of an outbreak.
Oklahoma has yet to see any confirmed cases of the coronavirus that causes COVID-19. However, hospitals and health officials have said they’re ready to treat patients in case the virus spreads to the state.
As of Tuesday afternoon, there were 60 confirmed cases of coronavirus in 12 states and six deaths, according to the U.S. Centers for Disease Control and Prevention. Five people have tested negative for the virus in Oklahoma, and one test is pending, according to the Oklahoma State Health Department.
Dr. Dale Bratzler is the enterprise chief quality officer for OU Medicine, a health care system that includes OU Medical Center, several primary care clinics and the University of Oklahoma Health Sciences Center.
Teams of representatives at OU Medicine have met several times per week to discuss the coronavirus and to put policies into place that aim to protect students, staff and patients in the event of an outbreak, Bratzler said
“We have a large task force on the hospital side preparing for what we think, it’s likely, we will see cases (of coronavirus) in Oklahoma,” he said.
“Right now, we’re in the planning phases, but should we start seeing cases we will set up an incident command center to make sure we have all of the supplies to take care of patients.”
Staff at OU Medicine are asking patients whether they have traveled recently to countries where coronavirus outbreaks have been reported, such as Italy, Iran and South Korea, Bratzler said. If someone has traveled to an affected area, they are treated away from other patients.
“But honestly the question is, ‘does the country of travel make that big of a difference,’” he said. Bratzler acknowledged some countries have more cases, but pointed out cases that appear to be spreading in the state of Washington.
“We will have to figure out how to continue to appropriately screen patients,” he said.
One concern for hospitals is a possible shortage of medical supplies — such as surgical masks, gowns and gloves — much of which is manufactured overseas, especially in China. However, Vice President Mike Pence on Saturday said the federal government will contract with U.S. manufacturer 3M to produce more masks.
Over the past week, OU Medicine implemented a policy to conserve supplies, Bratzler said. Because the facility is a teaching hospital, when a team of students, residents and doctors goes into an isolation treatment room to see a patient, they all wear protective gear, he said. They are now supposed to only take in staff who are “absolutely necessary.”
All departments have been asked to reduce the use of medical supplies when appropriate, Bratzler said. And highly protective masks have been stored for use on only particular patients, he said.
The hospital also has started to identify negative-pressure isolation rooms and train staff on how to care for isolated patients that have developed respiratory issues, Bratzler said.
When OU Medical Center responded to Ebola in 2014, the hospital opened a two-bed biocontainment unit to isolate patients, Bratzler said. The hospital is prepared to reopen the unit if needed, but if a large community outbreak of coronavirus were to occur the unit “simply wouldn’t be that useful,” he said.
Would the health care system be prepared for a coronavirus outbreak?
“I think any of us would say ‘yes,’ with caution,” Bratzler said. He said it would depend on how big the outbreak was. However, OU Medical Center, with the only Level One trauma center in the state, has the necessary infrastructure and already cares for “a lot of sick patients,” Bratzler said.
“What we’re hoping for is the public health methods to prevent spread of the infection would be the principal means of reducing the number of cases,” he said.
OU Medicine is in the midst of training physicians on how to use the system’s telemedicine platform as an alternative to face-to-face office visits, Bratzler said. In the case of an outbreak, telemedicine can help doctors keep patients out of the waiting room and determine whether patients need hospital care at all, he said.
“We’re taking it very seriously, primarily to make sure we can provide primary care to those patients and protect patients,” he said. “We don’t want to see that (coronavirus) spread.”
Health system Integris Health, which operates hospitals and clinics across the state, is monitoring the situation and looking to the World Health Organization, and federal and state agencies for updates and guidance.
“In response to global impacts on the availability of personal protective equipment, like masks and gowns, we are emphasizing reduction of unnecessary waste,” said Brooke Cayot, a spokeswoman for Integris.
“Our caregivers are being instructed to only use these items when necessary. We are also taking efforts to ensure we have appropriate supplies and medications that may be needed if the virus were to present in Oklahoma.”
Hillcrest Healthcare System operates hospitals and clinics throughout eastern Oklahoma including in Tulsa, Cushing and Henryetta. Spokeswoman Rachel Weaver Smith said facilities are conducting “table-top exercises” and mock drills in hospitals and clinics to ensure they have an effective process to screen, isolate and treat patients.
“We ask that any patient seeking care in our clinics and hospitals don a mask if they have symptoms of fever, cough or trouble breathing,” she said in an email. “In addition, our teams are following the recommended screening and prevention protocols set by the CDC.”
If a patient is suspected to be at risk of having the virus, they are isolated until staff can reach a state health department epidemiologist for guidance, Weaver Smith said.
Rachel Clinton is an epidemiologist at the Oklahoma State Department of Health and is part of the team that leads outbreak investigations, such as on emerging pathogens like the coronavirus.
She said the state has plans and infrastructure in place in case of an outbreak.
The state has made preparations for several outbreaks in the past — such as for the West Nile virus, measles and mumps, Clinton said.
“Every outbreak is a little different,” she said. “But it’s the same systematic approach.”
The health department works closely with clinicians, and medical and emergency staff across the state to provide guidance on outbreaks, Clinton said. The team provides 24/7 consultations with physicians on patients who might present concerning symptoms, she said.
The Centers for Disease Control and Prevention headquarters in Atlanta is handling the state’s testing for the virus for now, Clinton said. But Oklahoma should have the capacity to conduct its own testing within the next couple of weeks, she said.
Once the state lab in Oklahoma City has the ability to test for the virus, Oklahoma can complete tests faster and at a higher volume, Clinton said.
“Any time we have to send specimens to the CDC, there’s going to be a lag time,” she said.
Clinton said the CDC’s requirements currently allow states to only test patients who meet a certain criteria. CDC expanded the number of patients qualified for testing late last week.
“Having testing here will make it much easier to get results out faster and test more people because if we do get point to where we have community spread, we want to be able to test more quickly,” she said.
The department looks to CDC for guidance, and as more information about coronavirus becomes available the team might modify its response plans, Clinton said.
“It’s important for people to understand there’s always preparedness occurring,” she said.
Symptoms: The most commonly reported symptoms of COVID-19 include fever, dry cough and shortness of breath, according to the World Health Organization.
Who’s at higher risk: If you are not in an area where the virus is spreading, have not travelled from an area where the virus is spreading, or have not been in contact with an infected person, your risk of infection is low, according to WHO.
Those at highest risk for are people who have traveled to locations affected by the virus and health care workers.
Prevention: Wash your hands; avoid touching your eyes, nose or mouth; clean and disinfect frequently touched surfaces at home, especially when someone is ill; get plenty of sleep; drink plenty of fluids; eat a nutritious diet
Who’s at risk of developing severe illness: Though information on COVID-19 is developing, WHO says older persons and people with preexisting conditions such as high blood pressure, heart disease or diabetes are more likely to develop serious illness.