‘There’s no book for this’

Central Peninsula Hospital has not yet admitted any COVID-19 patients for treatment, but the staff and administrators have spent the last few weeks planning and restructuring the hospital for that eventuality. The Clarion visited CPH on Tuesday to get an idea of what those preparations look like.

Almost every aspect of the hospital, from the front entrance to the emergency department to the gift shop, has been modified to meet the challenges of an unprecedented global pandemic.

Modified protocols

All visitation to the hospital was suspended on March 28 after Gov. Mike Dunleavy issued Health Mandate 11, which requires Alaskans to practice social distancing as much as possible. The hospital allows for rare exceptions including end-of-life visits and minors who are developmentally disabled and require assistance, according to a March 28 press release from CPH.

The front entrance is no longer staffed by the Hospital Auxiliary — the hospital’s volunteer corps — but instead by a hospital employee, who screens each person as they enter the hospital. Bruce Richards, public information officer for CPH, said the front entrance has also been partially blocked off in order to make sure people have to pass the screening station before entering.

People who walk up to the front entrance are asked if they’ve experienced any of the symptoms associated with COVID-19 — fever over 100 degrees Fahrenheit, cough, shortness of breath or loss of sense of smell — as well as if they’ve been in contact with anyone known to have the disease, and if they have recently traveled out of the state. All of the questions are asked from at least 6 feet away.

After the screening, people are given a mask if they don’t already have one, and a nametag that states the reason for their visit. Every person inside the hospital, whether they were an employee, a patient or a newspaper reporter, was wearing a mask at all times.

CPH has been accepting donated masks from the community, and Central Peninsula Health Foundation Director Kathy Gensel said on Tuesday that over 1,500 masks had already been accepted and distributed throughout the hospital. Visit www.cpgh.org/facemask to learn how to donate.

Richards said that people can still come to the hospital for necessary visits like for lab work, but all elective procedures have been postponed, which has led to a dramatic reduction in foot traffic. In the two hours spent at the hospital on Tuesday, fewer than 10 patients were observed throughout the different departments.

The hospital’s gift shop and cafeteria are closed, but employees are allowed to eat in the cafeteria as long as they sit one person to a table.

Richards said that the possibility exists of a hospital employee needing to be isolated away from home, such as if a family member travels out of state or tests positive for the virus. For those situations, Richards said, an arrangement has been made for hospital employees to stay in the residence halls of Kenai Peninsula College, which are currently empty due to in-person classes being canceled by order of the governor until May 1.

Testing and treatment

The emergency department at the hospital has measures put in place that allow the ER doctors and nurses to test for COVID-19 and treat many non-coronavirus patients without even walking into the building.

Inside the ambulance bay, which is normally where patients would be dropped off, an enclosed space has been built that contains three negative pressure examination rooms. These examination rooms can be used to see patients with mild conditions, coronavirus-related or not, and allows for extra capacity within the ER for more serious cases. Shayne Pond, director of the emergency department, said building the examination rooms took about 24 hours.

As of Tuesday, 141 samples have been collected at the hospital, Richards said, with four of those coming back positive, and 20 of the tests awaiting results. The turnaround time for tests varies, Richards said, and is mostly based on where the tests are sent. Tests sent to the state lab in Fairbanks take between 24 and 48 hours to process, but tests that are sent to the Mayo Clinic, a commercial lab in Rochester, Minnesota, usually take a bit longer.

Anyone who requires hospitalization from COVID-19 will likely start their treatment in the emergency department, Richards said. The ER is equipped with two negative pressure rooms, so treatment could occur there, or the patient could be moved to a different negative pressure room in the hospital in order to leave the ER open for more new patients.

Any hospital staff interacting with someone suspected of having COVID-19 or confirmed positive must put on a gown, a mask, a face shield and gloves before entering the patient’s room and must immediately remove those items upon exiting the room so that they can be decontaminated or thrown away.

Expanding capacity

Almost all of the beds throughout the hospital sat empty on Tuesday, and several rooms were being turned into negative pressure rooms so that they could be used to treat any COVID-19 patients that need to be admitted.

Negative pressure rooms are designed to allow air to flow in, but not out, preventing any contaminated air particles from escaping. The Centers for Disease Control and Prevention recommend treating COVID-19 patients in negative pressure rooms in order to prevent cross-contamination. Richards said that the hospital already had four negative pressure rooms, and the plan is to increase that total to 20. Large HEPA filters can be seen outside with air ducts connecting the filters to the new negative pressure rooms.

The hospital has five ventilators, which are used to treat the most severe cases of COVID-19. The State of Alaska received a shipment of 60 ventilators on March 30 from the national stockpile, but Richards said that CPH had not requested any additional ventilators out of that shipment.

Many hospitals in the state, including South Peninsula Hospital in Homer, have addressed the possibility that they would exceed their capacity to treat COVID-19 patients by designating “alternate care sites” that are usually located in a different location than the hospital and would be used to treat any patients with a moderate form of COVID-19.

Richards explained that CPH has taken a slightly different approach and instead cleared out certain areas within the hospital to increase their surge capacity without having to move patients off-site. Five different surge “phases” have been identified by the hospital’s incident command team, Richards said, and the hospital is capable of increasing its capacity on-site by as much as 150%. In the event that an alternate care site is needed, Richards said that the hospital and the Kenai Peninsula Borough have identified the old Soldotna Prep School building as the location that would be used.

Richards said that the reasoning behind the hospital’s approach to surge capacity is that the equipment needed to provide proper treatment is more readily available within the hospital, so it made more sense to find extra space within the hospital rather than look to separate location.

“How do you set this up at an alternative site?” Richards said, pointing to an array of equipment hooked up inside an empty patient room. “Suction, oxygen, that kind of stuff, that’s really important to have. And so it makes sense. The space is here.”

One of the locations inside the hospital being used to increase capacity is the old OB/GYN department. Last November, construction was finished on a new wing of the hospital that included expanded facilities for their obstetrics department. With the OB/GYN department now in the new wing as of last Monday, the old location is being restructured to increase general patient capacity.

Other locations to be used for surge capacity include the endoscopy department in the River Tower and rooms normally reserved for surgery patients.

Dana Brundon and Alyse Harrington, both surgical nurses at the hospital, were in the process of clearing out rooms in the old OB/GYN department on Tuesday to make them available for new patients. Brundon said that dealing with the unexpected is all part of the job when it comes to being a hospital nurse.

“In the role that we work in the surgical realm, you’re always in an anticipatory state,” Brundon said. “We’re concerned, but we have a high level of reliability here and the overall feel of the organization is one of just being aware and being prepared. It’s not stress, or anxiety, or panic or chaos. It feels very reassuring, and we’re updated daily on what comes down through the governor and the CDC.”

Richards said that, despite the unprecedented nature of the COVID-19 pandemic, he wants peninsula residents to feel confident in their local hospital’s ability to handle the task at hand.

“There’s no book for this,” Richards said about the hospital’s approach to dealing with COVID-19. “And we’ll all be stronger for it afterwards. I know I will be. But I want people to be able to count on their community hospital. I grew up here, I was 5 years old when I moved here. I love this place, and I love this hospital and what it’s grown into. It’s special. A lot of people live in places because they have a hospital, and I want people to know and trust we’re working on being as prepared as we can.”