Cleveland Clinic Avon Hospital President Dr. Rebecca Starck believes the COVID-19 crisis has led to innovations with proven benefit now and in the future, despite uncertainty about virus surges as communities reopen and the lack of an effective vaccine.
Preparations completed weeks ago to deal with the frightening possibility of patients flooding emergency departments – something that did not happen when Ohioans took stay-at-home orders seriously – has both Avon Hospital and the Clinic system well prepared should the virus take off again, or when the next health crisis emerges. She made particular note of hospital staff who voluntarily cross-trained so they could assist in the emergency department or elsewhere in the hospital as conditions warranted.
She emphasized that a virus spike can be blunted if people continue to be responsible for their own health and the health of others. She said handwashing, social distancing and wearing masks in public are among the things everyone should consider.
Starck also addressed other pandemic-related issues.
The Clinic will test anyone age 61 or older, with an underlying condition, and a written order from a Cleveland Clinic physician. Underlying conditions include heart, lung, liver or kidney disease, diabetes, obesity or being immunocompromised. The Clinic also provides testing for its staff, first responders and those who have been exposed and are symptomatic.
While the Clinic has ramped up testing capabilities to 1,400-1,600 per day across its Northeast Ohio system, Starck said insufficient supplies of reagents hamper efforts to increase that number. She emphasized there are sufficient personnel and equipment to handle testing. As reagents become available, the Clinic will be able to test up to 2,200 a day.
Despite that increased capacity, not everyone who wants a test can be tested. “We do not have capacity to test 'the worried well,' ” she said, adding, “We truly need to reserve testing for those who are sick.”
Prior to ordering a test, doctors look for COVID symptoms, which have wide variations including fever, body aches, loss of taste or smell, gastrointestinal symptoms like diarrhea and dermatological conditions. She said because symptoms are not clear cut, an assessment by a clinician is often required.
INNOVATIVE WAY TO TRACK COVID PATIENTS
Anyone who tests positive is automatically placed in a program where they are monitored for two weeks. She said it is important to note that 80% of COVID patients don't need hospitalization so this monitoring is done from their homes.
The Clinic has developed an app for smartphones that connects to an individual health care record and allows patients to record symptoms and progress in their charts.
If their health worsens, they're directed to contact their physician and/or to come to the hospital.
She said this is just one of the innovations Cleveland Clinic quickly developed to address care for COVID patients.
CARING FOR THE MOST SERIOUSLY ILL
“Everyone had to learn to provide care in a different way,” Starck said. “Just like in the community, we needed to keep everyone safe.”
She acknowledged that at first, “Everyone was really scared, but the support we received allowed us to rise to the occasion.”
She said not only did hospitalized patients receive excellent nursing care, they received “excellent compassionate caregiving.” Nurses were acutely aware they were standing in for family members who were not allowed to visit, Starck said.
TELEMEDICINE PROVES ITS VALUE
Telemedicine, or telehealth, is another innovative technology that has proven its worth after patients afraid to see their doctors in person canceled appointments.
“The emergency required us to flip the switch,” Starck said. “It's a new model of care and it's really good for patients.” She acknowledged that patients and providers initially felt uncomfortable discussing medical issues via technology. Tweaks made it easier for both, she said.
The health care industry at large – doctors, health insurance companies and the Center for Medicare and Medicaid Services – has recognized the importance of telemedicine, according to Starck. It is an effective way to ensure that patients continue to receive care for other conditions or to maintain their overall health. It's safe for those concerned about leaving their homes, and it's convenient, she said.
She also emphasized that if any patient feels critically ill or is experiencing shortness of breath or chest pains, they should go to the emergency department immediately. On the other hand, telemedicine is a great option for those feeling sick, but not sick enough to go to the hospital.
DON'T BE AFRAID TO SEE YOUR DOCTOR
“Don't neglect your health,” the doctor advised. She understands people were afraid and did not know how bad the virus would get. The Clinic and other health care institutions have seen a drastic decrease in in-person appointments in the past two months. “There are a lot of other diseases that people put on the back burner because they were worried about getting infected. That makes us concerned that it will cause other health crises.”
Starck said the Clinic has worked hard to communicate that people should feel comfortable keeping or scheduling in-person appointments with their doctors. Appointments currently stand at 75% of pre-COVID appointments.
FACILITIES ARE SAFE
“We also want to make it very clear that this is a safe environment for them to come to,” Starck said.
“Our facilities look different. Everyone is screened at the door for a temperature and are asked questions about feeling well.”
Hand sanitizer is at the door, seating areas have been rearranged to create spacing; floors, including elevator floors, are marked so people know where to stand; and staff constantly wipes down surfaces. Staff adjusted schedules to ensure waiting areas are not crowded and everyone is asked to wear a mask. She said masks are not mandatory because certain health conditions make wearing a mask difficult.
“These are all the things we have in place to assure patients they will be safe here.”
STAYING SAFE AS COMMUNITIES REOPEN
“It's all about risk reduction,” Starck said about safety precautions as businesses and communities reopen. “We don't know how prevalent the virus is in our community. It's very possible it can resurface.”
In a best-case scenario, an effective vaccine that can be available to enough people to minimize infections will not be available until 2021, she said. Meanwhile, the doctor says hand-washing, physical distancing and masking matter, especially in public places. She says it's important to remain super vigilant and recommended avoiding crowds and cleaning heavily used surfaces at home and car door handles.
“The virus is a threat,” she said. “It's still important for each of us to stay safe and keep our fellow community members safe.”
GRATEFUL FOR COMMUNITY SUPPORT
Starck said she and staff deeply appreciate the outpouring of support they've received, and continue to receive. “I can't tell you how much the community's support meant to us.” She said they received everything from meals to gift cards, N95 masks, face shields and other personal protective equipment.
Contact freelance writer Michele Murphy at Avonlakemurphy@gmail.com.