COVID-19 started as a distant threat in Wuhan, China, an unusual viral pneumonia spreading quickly through the region. Knowledge was sparse, but Scripps Health leadership was monitoring the situation closely. Could this new coronavirus spread to the US? In January 2020, nobody really knew.
The threat became much more real on February 5, when Americans in Wuhan were evacuated to Marine Corps Air Station Miramar for quarantine. Like it or not, the virus had probably reached San Diego.
Scripps responded by setting up a corporate command center, and satellite commands at all its hospitals, to coordinate its response. Miramar is only a couple of miles away from Scripps Memorial Hospital La Jolla. If anyone under quarantine needed acute care, that’s where they would go.
“We had hundreds of people at Miramar who potentially had coronavirus, so we geared up for that possibility,” recalls Scripps president and CEO Chris Van Gorder. “The military made it clear that anybody who tested positive, even if they weren’t really sick, was not going to be permitted to stay on the Marine Corps base. Then we started seeing cases in Washington and California.”
"We planned, as did every hospital in the community, to go to 140 percent of normal capacity and set up remote care sites.”Chris Van Gorder, Scripps president and CEO
For Van Gorder and his colleagues, setting up the command centers, and other coronavirus-related responses, meant carefully designing a plan and successfully implementing it. Scripps had assembled similar groups during San Diego’s deadly brush fires in 2003 and 2007, and had sent emergency response teams to New Orleans in 2005 after Hurricane Katrina, Haiti in 2010 after its magnitude 7.0 earthquake and Nepal in 2015 after its 7.8 earthquake.
These experiences paid off this February. One of the first steps was making sure Scripps had enough personal protective equipment and other critical supplies to manage the emerging crisis.
“Early on, we were ordering more ventilators,” Van Gorder says. “We were concerned that San Diego hospitals could be completely overwhelmed. We planned, as did every hospital in the community, to go to 140 percent of normal capacity and set up remote care sites.”
The corporate command center — which was set up in two rooms to support social distancing and safety protocols — included experts on infection control, logistics, communication and other key areas. Van Gorder and Ghazala Sharieff, MD, Scripps chief medical officer, clinical excellence and experience, are co-incident commanders.
The response teams throughout the system have developed a daily briefing on Scripps hospitals’ total number of COVID-19 patients, occupied ICU beds and ventilators in use. One of the pandemic’s many challenges has been its duration. Previous emergencies were acute and fast, lasting a few weeks at most. The coronavirus has persisted for months, is showing few signs of diminishing and could spike at any moment. Scripps is keeping 30% of its essential supplies in reserve, just in case.
“In a normal disaster situation, we’d be planning to move from the disaster response back to normal operations by now,” says Debra McQuillen, RN, chief operations executive at Scripps Mercy Hospital, who runs the command centers for both Scripps Mercy Hospital San Diego and Scripps Mercy Hospital Chula Vista. “With COVID-19, we have to do both at the same time.”
Because COVID-19 is a brand-new disease, it has been a moving target — both therapeutically and logistically. Scripps command teams work closely with leadership at other San Diego hospitals, as well as government officials, to mount a cohesive response.
“Regulations from the CDC, county and state change rapidly,” says Dr. Sharieff. “We’ve had to make adjustments almost on a daily basis. Plus, we want to stay in lockstep with what other health care systems are doing.”
Scripps, Sharp, UCSD and other hospitals communicate almost daily. These interactions have driven a more cohesive health system in San Diego — a potential silver lining to the ongoing crisis.
This coordination has also helped ensure each patient receives the care they need. While the outbreak has so far been relatively manageable in San Diego County, there have been hot spots, such as the South Bay and Imperial County, where hospital intensive care units have quickly exceeded capacity.
Vetting the flood of incoming data on the disease has been a critical, ongoing task at the Scripps Corporate Command Center. Its centralized teams work with front-line clinicians to assess information, send out daily bulletins and ensure that care throughout the system follows the latest evidence.
“When new information comes out, the care lines go back and redo their treatment algorithms,” says Dr. Sharieff. “They send it to us, we put the stamp on it and distribute through our physician network. In critical care, changing these guidelines is an almost daily thing.”
One of the greatest challenges is communicating these changes as they happen to the front-line staff.
“This is a dynamic situation,” McQuillen says, “and we’re learning new things about the virus and its transmission along the way. We always want to be using the best information we have at that time.”
Scripps has made hundreds of adjustments, large and small, to manage its response to the coronavirus pandemic. When the 1-800-SCRIPPS call center started receiving more than 3,000 calls a day, Scripps created a dedicated COVID-19 Nurse Line with a staff of around 60. Scripps also set up surge tents to test patients quickly and safely.
“Safety is our top priority,” Van Gorder says. “We don’t want people walking into the emergency room, uncertain of their COVID-19 status, and waiting. So, we set up surge tents as testing cabanas to add capacity when necessary. We created a whole process linked to the nurse call line, so that a patient can access Scripps via virtual visit and, if needed, then make an appointment, drive to a cabana and a staff member with proper safety equipment will go to their car and take a sample.”
But even as Scripps works overtime to care for patients, there is ongoing concern about front-line providers who have been asked to bear the brunt of the crisis for months.
“This is not a short-lived situation; we are in this for the long haul,” McQuillen says. “We need to support people who are emotionally drained at this point. We’re looking for burnout or emotional stress and looking for ways to support them through that. It’s different now, because patients don’t have their families to support them, and that falls to staff as well. They tell me it’s both a source of stress and a sense of satisfaction. They’ve been able to connect with patients in ways that they really haven’t before.”