As of April 15, the world had seen almost 2 million confirmed cases of COVID-19. The United States had almost 600,000 confirmed cases, far outpacing Spain which has the next highest national count.
In fact, the US had more confirmed cases than the next three countries of Spain, Italy and France combined. Considering the disparity in testing, U.S. numbers could be even higher. As of April 14, per capita testing in the U.S. was only half that of Italy.
In the U.S., Pennsylvania ranks fifth among the 50 states with confirmed COVID-19 cases – 1,273 of the 25,450 cases in the commonwealth were in Bucks County, which ranks sixth in the state.
Of the six community hospitals in Bucks, St. Mary Medical Center and Doylestown Hospital comprise the largest capacity with almost 60 percent of the 978 staffed hospital beds in the county between the two.
Ann D’Antonio, vice president of Marketing & Communications with Trinity Health Mid-Atlantic (which owns St. Mary Medical Center) stated that while personal protective equipment stocks were sufficient for staff to meet CDC guidelines, Mid-Atlantic was working with various vendors to increase those supplies.
D’Antonio stated that ICU and ventilator capacity were being monitored daily and efforts to source additional equipment with organizations across the country were ongoing. She stated that anesthesia machines were being proactively converted for use as life support ventilators.
Dr. Scott Levy, chief medical officer and vice president of Doylestown Hospital, said that current data indicate a flattening of new cases. Since admissions tend to trail diagnoses by a week, Levy said that in-patient admissions are still rising but are expected to peak shortly as well. Current COVID-19 inpatients number roughly 35, according to Levy, who added that 10 to 12 are critical and a third of the critical cases are on ventilator life support.
Levy stated that comorbidities such as renal disease, hypertension, cardiac issues, diabetes and obesity are negative factors in case outcome, and critically ill patients seen at the hospital range evenly from middle age to elderly.
There are two COVID units at Doylestown Hospital – a critical care unit and a step-down unit. While COVID cases have been increasing, other cases have been declining.
“I have little doubt that people are reluctant to come into a hospital with any medical issue,” Levy said, adding the fear of being in the same building as COVID-19 cases has “significantly” lowered admission for otherwise serious cases involving such issues as chest or abdominal pain. Eventually, they come in through the emergency department with sometimes dire consequences for their delaying treatment.
“We are extremely proud of the work we are doing here and are creating a hospital within a hospital,” Levy said, explaining that the COVID units are a distinct and separate physical entity. He added that every person within the building is wearing a mask, including patients.
Levy stated that the greater health risk is delaying care due to fear of contracting COVID at the hospital – a situation he stated was less risky than potential exposure in other public places, which do not temperature-screen and mask people who enter as Doylestown Hospital is doing. “I’m more anxious walking into a supermarket than I am walking into the hospital,” he said.
Daily incident command meetings at the hospital cover essential inventory of PPE according to Levy, and he attributed help in the stock of such items as masks to both effective stewardship and generous support from the community. While N95 masks under normal conditions are designed for single use, overnight re-sterilization has expanded their use to 25 cycles for each mask, highlighting the continued challenge that Doylestown Hospital, like many others, continues to have with stock of PPE.
Hospital staff in the COVID units also wear disposable surgical masks over the N95 mask to further protect it from exposure to airborne virus. A shortage of gowns and shoe covers has been a challenge.
While St. Mary is converting anesthesia machines for use as ventilators and is actively searching for more, Levy expressed confidence in ventilator supplies at Doylestown. He attributes that to the facility’s advanced cardiac and vascular care which has effectively provided enough stock for currently anticipated need. He added that the postponement of elective procedures has allowed redeployment of those ventilators to the COVID critical care unit.
A current challenge is COVID testing. In-hospital point-of-care testing is still unavailable. And while the two other platforms for testing through LabCorp have improved turnaround time over the course of the month from a week down to 24 hours in most cases, those tests are unusable as the hospital awaits reagents.
“When you hear all this rhetoric of the equipment being ready, it’s like having a car without any fuel to run it,” Levy said, emphasizing the challenge of obtaining testing reagents. He stated that the hospital hopes to have those reagents sometime before the end of the month.