CADILLAC — COVID-19 will come to Cadillac.
That's according to Munson Cadillac's chief medical officer, Dr. Joe Santangelo. But the hospital and the broader Munson healthcare system are preparing for the pandemic, Santangelo told the Cadillac News in a Thursday afternoon phone interview.
What follows is an edited and condensed version of that conversation.
CADILLAC NEWS (CN): What is the hospital's surge capacity and what is surge capacity?
SANTANGELO: There are a certain number of patients that we usually expect to see in our clinics, at our urgent care, emergency department, and in the hospital. Surge capacity means: what's the flexibility that you have to see more patients (in the event of something that needs that, like a natural disaster or in this case, of course, COVID-19)?
Being part of a healthcare system, we have a large surge capacity because we're not just one hospital. We're part of a nine-hospital system in Munson Healthcare.
We have the ability to move equipment and supplies and patients around in northern Michigan as we need to.
There are a lot of different estimates on how many people are going to get sick from COVID-19 and how many people are going to need to be in the hospital. What we're trying to do is to prepare for the worst and prepare for a fairly large number of people who are going to be sick and need to be seen in an office or an urgent care or emergency department, and also a large number of people who will need to be admitted to the hospital.
The way we plan for how we do that is by having a tiered disaster management plan.
That plan is kind of the same regardless of which natural disaster it is. So if there was an earthquake in Cadillac, and suddenly there were 200 people who were injured, we don't have 200 hospital beds. But we have a plan for how we deal with a sudden influx of patients like that ... It's just a matter of, as patients start to get here, activating those different levels of that plan.
CN: What happens if every single hospital within the system is full?
SANTANGELO: Well the good news is that healthcare has great relationships with other hospital systems like McLaren and Spectrum ... The bad news is, if every hospital within northern Michigan is completely full, then probably all hospitals in Grand Rapids and Saginaw are also full with patients.
... We're trying to slow the spread of this disease, so we don't get so many people sick all at once to get into that kind of situation.
CN: What is the overall surge capacity throughout the system? do you have a number?
SANTANGELO: I don't. I can tell you Cadillac Hospital is a 49-bed hospital. That's how many beds we are licensed to have. We don't usually have 49 people. But the surge capacity also means, what's our nursing capacity outside the hospital? how can we help the people in the emergency department? We have a 17-bed emergency department. It's really hard to give a specific number and I apologize because I know it would be nice to have a number ... We really just are going to try to be as flexible as possible to find ways to take care of people in the way that they need.
CN: Are there parking considerations during an outbreak?
SANTANGELO: The logistics are often part of the problem. How do we get people in and out of rooms and contaminate the least number of people possible? How do we make sure that our cafeteria can serve meals to everyone? How do we make sure we get everything where it needs to go and where do we put people's cars and their belongings? I'm glad we have done some of that planning beforehand and aren't having to scramble now.
We would triage people. Let's say you drove to the hospital and ended up getting admitted—we might ask if we could move your car for you.
CN: Would you also have to wipe down somebody's car if you're acting as a valet for them?
SANTANGELO: Great question. We've always put patients at the center of what we do and we don't ever want to hurt anybody — a patient or one of our employees — and so absolutely those considerations of personal protective equipment we need and when, where, so that our staff and visitors don't get infected, it's really important to us.
CN: Talk to me about the emergency room. Are you already prepared and how do you know you're prepared?
SANTANGELO: We practice situations like this ... I think we're prepared as we can be. We have a good triage process ... If there's a lot of people in the waiting room we have a triage process where we decide: "okay you can wait in the waiting room ... you should wait in your car ... you should be seen right away. You have a more mild illness and can be seen over here in this other section of the ER."
And then we've been doing a lot of communication with our providers and nurses and respiratory therapists and everyone else about how these patients are going to flow through our building.
CN: Is it reasonable to expect that any potential COVID-19 patients will go to the ER first?
SANTANGELO: Some potential patients will come through the ER, but a lot of patients with COVID-19 are probably going to call their doctor's offices and describe their symptoms to their primary care office, and then end up getting tested.
Not all patients who have COVID-19 are going to need to be in the hospital. The majority of people are going to need to stay home and drink lots of fluids and get rest and recover on their own at home. So, I don't think most patients with COVID-19 will be in the emergency department, but certainly, for patients that need to be in the hospital, most of them will come in through the emergency department.
CN: So, 49 beds — it sounds like you're planning for that not to be enough?
SANTANGELO: We're definitely planning for worse than that. I don't think there's any question that COVID-19 will be in Cadillac. There will be cases in Cadillac. It would be shocking if there was not a single case in Cadillac.
Having said that, a lot of this really depends on the timing.
If Cadillac has 200 cases and they happen all at once, then even our surge capacity is really going to be tested. If Cadillac has 200 patients, and they occur over six weeks, then that's something that the hospital can accommodate.
A lot of this has to do with timing. Can we delay how quickly COVID-19 spreads in Cadillac and can that delay then help us to manage the patients that we have over time?
Does that make sense?
CN: Yeah. I would love to have hard and fast numbers but it sounds like they don't exist.
SANTANGELO: I'm not trying to be coy. The reason they don't exist is because there are things that we can do in emergency situations that we can't do in non-emergency situations (Santangelo said people might remain in emergency room beds for longer than the usual standard as an example of something that might happen during an emergency situation).
How do we become creative? If we hit the max of our surge capacity and that next patient comes in, our hospital team is going to say, "All right, what are we doing? We're not sending them home. Where do we put them? how do we solve this problem?"
CN: Is it possible that you could tap into other facilities? You just bought Pine Grove (Athletic Club). Could Pine Grove become a quarantine center?
SANTANGELO: We don't have that plan right now. If things get to the point where we're having to be creative and use different properties in different ways, then I think those are discussions that we'll have. That would be pretty extreme, but if we get to that point that might be a discussion that we have.
CN: Talk to me about isolation beds. How many does the hospital have and do you have the ability to re-arrange the set-up so people can be isolated if need be.
SANTANGELO: All of our hospital rooms are private rooms, so any of our rooms can be used as an isolation room, meaning we could put a patient in there, close the door and then make people put on or take off personal protective equipment when they go in and out of the room.
CN: Do we have enough ventilators?
SANTANGELO: We won't know if we have enough until we know how many patients we have. Cadillac is inventorying ventilators ... there's different kinds of ventilators ... it's hard to give a specific number because there are different types ... being part of a system, we could move ventilators around hospitals as well.
CN: What happens if hospital staff gets sick?
SANTANGELO: We send them home. Or if they need to stay in the hospital we take care of them just like we take care of other patients.
CN: Do you think that the risks to healthcare professionals have gone down because now they know to be taking the precautions?
SANTANGELO: We know that taking care of yourself with personal protective equipment really works. We know that if you take off personal protective equipment appropriately and you wash your hands appropriately, that your risk as a healthcare professional is low.
The hard part is that I'm a healthcare professional myself, and there are times where you're caring for patients where things don't go perfectly. I do think that the awareness that we have and people being trained on using the correct personal protective equipment makes a big difference.
CN: What I'm seeing in my Facebook chat groups is that people have some COVID symptoms and they'll talk to their doctor and they don't get tested. The doctor is like, "Well, go home. Stay home if you're sick." Kind of like what happens sometimes with the flu. Not everyone gets tested.
How many people are gonna end up getting tested (for COVID-19)? Are you going to just sort of work with the assumption that you do have this and just go home?
SANTANGELO: We're in a phase where we really want to know who has COVID-19, who they've come in contact with, and what their course is — how sick they get. We need to know that right now. So if people are worried about having COVID-19, they should contact their health care professional. There's also a lot of resources. Munson Healthcare has a recorded line. The health department has information. The CDC has a website.
At this point in the pandemic, if you are worried that you might have COVID-19, you should reach out. There may come a point — just like you described during the flu season —There may come a point where we say, "If you have these symptoms you likely have it so you don't need to be tested we're just gonna treat you this way," but right now we want people to reach out so that they can be tested if they need to be.
CN: So if people think that their primary care provider has blown them off, should they call the health department and say, "I think I have COVID-19?"
SANTANGELO: I think it's tough because some people might feel like their primary care provider blew them off, but really their primary care provider might have given them the right advice.
If you call your doctor and you say, "I have a fever and a cough," and they say, "Well are you feeling okay in general?" (and you say) "I just feel like I have a cold." And then they say, "Well, have you traveled anywhere, or have you come in contact with anybody who's started to be tested for this or anything?" And you say "no," your doctor might say, "You know what, right now we don't have any cases in northern Michigan. Why don't you take care of yourself and we'll just stay in touch?"
It might feel like you're getting blown off but that might be the right advice.
Having said that, I always want people to feel free to reach out to the health department or those other resources that we just talked about.
CN: Are you still recommending people get a flu shot?
SANTANGELO: We're still seeing influenza. So, protecting yourself against influenza is important. If you haven't gotten the flu shot, I think it's still a good idea to get one. Consult with your health care provider about making sure that they agree.
Reporters note: A lot of these questions came straight from a Society of Environmental Journalists tip sheet for coronavirus coverage. Thanks, SEJ.