Vineet Chopra, MD, MSc; Eric Toner, MD; Richard Waldhorn, MD; Laraine Washer, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0907.
Corresponding Author: Vineet Chopra MD, MSc, University of Michigan, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Chopra: University of Michigan, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109.
Dr. Toner: Center for Health Security, Bloomberg School of Public Health, Johns Hopkins University, 621 East Pratt Street, Baltimore, MD 21202.
Dr. Waldhorn: Georgetown University, 3800 Reservoir Road, Washington, DC 20007.
Dr. Washer: University of Michigan, F4151 University Hospital South, Ann Arbor, MI 48109.
Author Contributions: Conception and design: V. Chopra, E. Toner, R. Waldhorn, L. Washer.
Analysis and interpretation of the data: E. Toner.
Drafting of the article: V. Chopra, E. Toner, R. Waldhorn, L. Washer.
Critical revision of the article for important intellectual content: V. Chopra, E. Toner, R. Waldhorn, L. Washer.
Final approval of the article: V. Chopra, E. Toner, R. Waldhorn, L. Washer.
Administrative, technical, or logistic support: V. Chopra.
Collection and assembly of data: V. Chopra, E. Toner.
“…make them believe, that offensive operations, often times, is the surest, if not the only (in some cases) means of defence.”
Table. Essential Components of a Hospital Preparedness Plan for COVID-19
VA Sierra Nevada Health Care System
March 14, 2020
Transfer of possible COVID-19 patients in a hospital setting
Dear Editor:I am writing this letter in response to a recently published article by Dr Chopra. Recently in our intensive care unit we received a patient -a “PUI” (person under investigation for corona virus disease - COVID 19), on non invasive ventilation (NIV) from the emergency department. A question was raised of how to transfer the patient safely while on mechanical ventilation (MV) or NIV. I have taken this opportunity to address the issues related to patient admission and airborne precautions during their stay .Patient should not be transported out of the negative pressure isolation room unless it is absolutely necessary.If patient is on room air and needs to be transported he needs to wear a surgical mask. Healthcare professionals (HCP) need to maintain at least 3 feet distance from the patient during transfer unless medically necessary. HCPs should also wear standard personal protective equipment (PPE) and a surgical mask with a face shield during transfers . If patient is on oxygen delivered via nasal cannula the transfer/transport guidance is the same as #2. During transfer it should be ensured that hallways and elevators are cleared and in the enclosed spaces there is only necessary staff along with the patient .If the patient is intubated we need to ensure that there are high efficiency particulate air (HEPA) filters for both the inspiratory and expiratory circuits on the transport ventilator. HCPs should also wear standard PPE and a surgical mask with a face shield during transfers . If the patient is on NIV then the recommendation would be to consider discontinuing NIV if possible, or intubating the patient if clinically justified. This has to be judged against risks and benefits related to the transfer. If patient is transported with NIV then he would be considered “very-high” risk for airborne transmission of the virus. In that case the recommendation would be to consider N-95 masks for all the healthcare workers who are involved in the transportation in addition to standard PPEs. Consider additional precautions as mentioned in #4. References:1. https://www.cdc.gov/coronavirus/2019-ncov/index.html2. Lindsley WG, Noti JD, Blachere FM, Szalajda JV, Beezhold DH. Efficacy of face shields against cough aerosol droplets from a cough simulator. J Occup Environ Hyg. 2014;11(8):509-183. Gammon J, Hunt J. A review of isolation practices and procedures in healthcare settings. Br J Nurs. 2018 Feb 08;27(3):137-1404. Seto WH. Airborne transmission and precautions: facts and myths. J. Hosp. Infect. 2015 Apr;89(4):225-8
Jingwen Li, Xi Fang, Qing Zhang, Zhicheng Lin*, Nian Xiong*
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (D.J.L.,N.X.); Wuhan Red Cross Hospital, Wuhan, Hubei, China (X.F., Q.Z., N.L., N.X.); Harvar
March 20, 2020
Emergent hospital reform in response to outbreak of COVID-19
TO THE EDITOR: Dr. Chopra and colleagues discussed preparation of U.S. Hospitals for Coronavirus Disease 2019 (COVID-19) (1), which broke out initially in December 2019 Wuhan of China (2). Immediately after the outbreak, the local Government designated seven hospitals to exclusively admit and intensively treat such flooding-in new patients (3). Our hospital, Wuhan Red Cross Hospital (WRCH), was one of them and turned into a COVID-19 treatment system on January 21, 2020. In agreement with Dr. Chopra et al’s suggestion, we set up full time emergency management of operation task force as well as a well-resourced infection prevention team to coordinate and oversee COVID-19 operation. However, the number of COVID-19 patients was far beyond the bed capacity of respiratory departments in Wuhan so that every designated hospital had to reform into an infectious disease treatment center. Accordingly, we made seven hospital-wide changes. First, re-dividing WRCH into cleaning area for medical staff use and polluted area for treating in- and out-patients. Meanwhile, five passageways including patient channel, employee channel, administrative personnel channel, cleaning personnel channel and sewage channel were established to meet the requirements of hospital infection protection. Second, search for all kinds of personal protective equipment actively such as fit-tested N95 respirator and protective clothing from local and government resources(4). Moreover, to minimize transmission, a surgical mask was given to each patient. Third, urgently purchasing medical rescue equipment such as extracorporeal membrane oxygenation (5), mechanical ventilators, liquid oxygen tanks providing ample oxygen, and negative-pressure isolation system to support the treatment. Fourth, training all medical staff with infectious disease hospital instructions for self-protection and COVID-19 treatment with a standard protocol of Chinese Guideline. Fifth, to increase the bed capacity and reduce cross infection, patients without fever were all discharged within 24 hours, allowing hundreds of fever patients admitted the next day. Sixth, recruiting more doctors and nurses specialized in infectious disease. Fortunately, expert teams from Wuhan Union Hospital and Sichuan province came to strengthen the treatment forces. Seventh, a rear service team formed, including both our administrative staff and social volunteers, working together with greatest efforts to fully ensure the clothing, food, housing, travel and safety of key frontline personnel and steady operation of the hospital. Until March 15, 2020, reformed WRCH had received 15,000+ outpatients of fever, treated and discharged 1,200+ inpatients with COVID-19. Hopefully, our experience could be useful for other hospitals in similar epidemic situations.Author Contributions: JL, XF and QZ drafted the manuscript and share first authorship. NX and ZL revised the final manuscript. NX and ZL are responsible for summarizing all data.Funding: This work was supported by grants 2016YFC1306600 (to NX) and 2018YFC1314700 (to NX) from the National Key R&D Program of China, grants 81873782 (to NX) from the National Natural Science Foundation of China.References:1. Chopra V, Toner E, Waldhorn R, et al. How Should U.S. Hospitals Prepare for Coronavirus Disease 2019 (COVID-19)? Ann Intern Med. 2020.2. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020.3. Swerdlow DL, Finelli L. Preparation for Possible Sustained Transmission of 2019 Novel Coronavirus: Lessons From Previous Epidemics. JAMA. 2020.4. Ng K, Poon BH, Kiat PT,et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med. 2020.5. MacLaren G, Fisher D, Brodie D. Preparing for the Most Critically Ill Patients With COVID-19: The Potential Role of Extracorporeal Membrane Oxygenation. JAMA. 2020.
Chopra V, Toner E, Waldhorn R, et al. How Should U.S. Hospitals Prepare for Coronavirus Disease 2019 (COVID-19)?. Ann Intern Med. 2020;:. [Epub ahead of print 11 March 2020]. doi: https://doi.org/10.7326/M20-0907
Download citation file:
Published: Ann Intern Med. 2020.
Hospital Medicine, Infectious Disease.
Results provided by:
Copyright © 2020 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use