Lakeland Regional Preps for Up to 1,000 COVID-19 Patients

Lakeland Regional Health is gearing up to treat up to 1,000 COVID-19 in-patients a day when the virus reaches its peak in three to four weeks, a hospital official told the City Commission on Monday afternoon.

Predictive analytics forecast that 50 percent of those will need to be treated in an intensive care unit setting and half of those will need to be on ventilators for up to four weeks, Michael Spake, senior vice president of external affairs for Lakeland Regional Health said.

To provide for that, Lakeland Regional has been working around the clock to secure supplies from local to international sources, Spake said.

And the hospital has been devising plans for staffing, including retraining some doctors, nurses and technicians to work in intensive care and critical care capacities, and has been coordinating with partners at independent surgical and ambulatory centers to provide backup care, equipment and supplies, he said.

The hospital currently has the capacity to ventilate 175 patients at a time, or if need be by forking the ventilators in two to provide breathing capacity for up to 350 patients, Spake said. On Monday, only 33 of those ventilators were in use, he said.

“The state is using several predictive models,” Spake said. But relying on a model from the University of Washington School of Medicine, “It appears our peak will be at the end of April or beginning of May. This model shows May 2 at our peak. We are keeping our eye on that date.”

After that, there should be a gradual decline, provided there is not a second surge, he said.

Through a slide presentation (seen here or below) and questions from commissioners, Spake addressed a range of issues during the City Commission meeting.

City commissioners and their top staffers met via teleconference today. Citizens could view the meeting online or via cable and make comments via a phone line, although it seemed most had quit holding when it was time for citizen comments near the end of the two-hour, forty-two-minute meeting.

Numbers

As of 3:50 p.m. Monday, Lakeland Regional Health was treating 91 patients in a COVID-19 care unit, five of whom have had test results returned as positive for the virus. The rest were awaiting results and had other conditions requiring hospitalization.

Between March 24 and Monday morning, Lakeland Regional has had 23 test results come back as positive and 479 as negative among both inpatients and outpatients. That statistic does not include test results for patients seen through Watson Clinic, the Polk County Health Department and other private facilities.

The numbers have been going up day-by-day and are expected to climb exponentially.

Testing

The health system has opened a testing center for its employees and staff and for city and county first responders. That test site is in the LRH Family Health Center, across from the emergency department.

The Polk County Health Department has been able to speed up test result returns and is now getting results back within 48 hours for hospital patients and health care professionals who need tests.

Tampa General Hospital is providing 24-hour turn-around for Lakeland Regional’s highest-priorty patients, such as expectant mothers in respiratory distress.

Lakeland Regional is working with the city to have a drive-through testing site operating by April 20 at the RP Funding Center.

And Lakeland Regional is working to have in-house testing capacity within four to six weeks. However, Spake said, testing equipment manufacturers are prioritizing delivery of equipment based on current need.

Staffing

Nurses who typically work in medical unit or surgical units are being trained to work in intensive care units.

All the code teams are being trained to respond to multiple codes at once.

An internal notification system has been implemented to ensure that COVID-19 test results are delivered as soon as possible so that others who may have been in contact with a positive patient can be quickly notified.

The hospital’s physician group doctors and registered nurses are on standby for hospital work if needed.

Lakeland Regional is working with partners, including Lakeland Surgical and Diagnostic Center and Watson Clinic’s ambulatory center, to provide relief and backup volunteer staffing of anesthesiologists and certified registered nurses and critical care workers, if needed. Both facilities were shut down March 20 after Gov. Ron DeSantis ordered elective surgeries halted.

Facilities

An engineering analysis has been completed to ensure that COVID-19 treatment areas are isolated from other patients.

The emergency department is already set up with a pod system that allows isolation of COVID-19 patients.

As of April 13, the hospital expects to have the Pablo campus ambulatory center, near the intersection of South Florida Avenue and Edgewood Drive, set up as a respiratory treatment center for COVID-19 patients who do not require hospitalization.

Lakeland Regional is working with partner Lakeland Surgical and Diagnostic Center to set up additional bed capacity if needed. And the hospital and Department of Health are exploring setting up non-traditional sites, such as hotels, for bed capacity if the need arises.

Protection for other patients

A drive-through center has been set up for patients who are on the drug Coumadin and require regular blood tests so they do not not need to leave their cars.

Lakeland Health Physicians Group has launched telehealth video visits for patients who do not need a personal physical exam. And various types of specialty care is also available through telehealth.

A very restricted visitation policy is in effect at the hospital and only limited companion care is allowed at ambulatory centers.

As of this week, temperatures of workers, staff and visitors will be taken via infrared thermometers at entrances of all Lakeland Regional facilities and those with temperatures above 99.9 will be sent home, Spake said.

Equipment

In response to the worldwide shortage of personal protective equipment, health system staff has been working in overdrive to ensure there will be enough personal protective gear by tapping into traditional and non-traditional sources locally and abroad.

The hospital has the capacity to track the usage of personal protective equipment and supplies, much like an air-traffic controller tracks plane location, Spake said.

Clinical and other staff is being trained in usage and safe disposal of personal protective equipment.

Supplies – everything from monitors, to extra coding equipment to body bags – are being accumulated and stored in both on-site and offsite storage facilities

Watson Clinic

In a separate presentation, Watson Clinic Managing Partner Steven G. Achinger, M.D., spoke about how the massive physician practice, which provides between 40 and 50 percent of the hospital physicians, has been responding to the COVID-19 crisis.

The March 20 governor’s order to halt all elective surgeries had an immediate impact at Watson Clinic, Achinger said, and “we were not prepared for the economic impact.”

The shutdown resulted in an immediate $600,000 drop in daily revenue stream, which meant there was not enough volume to sustain certain other services and 388 employees had to be furloughed.

There was an immediate halt to a wide variety of patient procedures, from injections to relieve pain in joints to routine mammograms to well-patient checks, Achinger said.

“I would think we are a microcosm of how the shutdown order has impacted all private physicians in the community and in the state,” Achinger said.

The economic impact on Watson Clinic employees, including senior administrators who took deep pay cuts, is undoubtedly similar to what businesses throughout the community are feeling, Achinger said, but there is a need “to focus on what is best for the health of the community.”

Watson Clinic facilities remain open; some like the urgent care centers and physician offices, have seen a definite increase in COVID-19 activity, Achinger said.

“Between March 13 and March 20, we sent out 129 tests. Two were positive and one was equivocal. That was 1.8 percent.

“Between March 21 and March 28, we detected three more positives on 85 tests. That gave us a 5 percent positive rate.

“In the next week, we have six positive cases among 51 test results that are back so far. That is an 11 percent positive rate,” Achinger said.

The lag time for getting test results back in an office setting has been gradually dropping and is now about five to eight days, he said.

Two weeks ago, Watson Clinic began offering telehealth visits as well as typical in-person office visits, he said. The telemedicine option is available to all who have a smartphone, tablet, laptop or desktop computer with a working webcam and microphone. Patients can access the system through the clinic;s MyChart patient portal. So far, more than 860 telemedicine visits have been conducted, he said.

“Since the March 20 order we cannot perform endoscopies and similar procedures so we have a lot of anesthesiologists and registered nurse anesthetists not doing a lot of work,” Achinger said. These and other Watson Clinic staff can who are furloughed can volunteer to go to work at the hospital if needed, he said.

“Certified registered nurse anesthetists can work in ICUs. Most of the hospital nursing staff will need backup, especially as some of them drop out of the workforce due to mandatory quarantine, and we are prepared to provide backup if the hospital needs it.” Achinger said.

Commissioners tapped into Achinger’s medical expertise with a variety of questions.

To Mayor Bill Mutz’s question about how long after the peak should the commission wait before reopening public parks and other publlc facilities., Achinger said, “We don’t want to let our guard down too quickly. We have closed everything but essential services. We will need to come back piecemeal, starting with what is lower risk and is better able to continue to provide social distancing.”

Achinger said that he does not expect to be able to provide non-urgent medical services for at least eight weeks and “we should consider if it is not safe to get a (screening) mammogram, is it safe for children to be playing together on a slide?”

Achinger’s advice was to monitor and allow people to get back to normal on a step-by-step basis as interaction becomes safer.

To questions from Commissioner Philip Walker regarding people not understanding social distancing, Achinger explained the growth model as “every case will lead on average to infect two more people and each of those will infect two more and so on. Through social distancing and other measures, once each person infects only one more person, we will plateau.”

And Achinger said, there is no way of know how many people are carrying the virus without showing symptoms but able to infect others. It is important to continue to emphasize social distancing to residents, he said.

Spake’s presentation to the City Commission:

Video: The discussion about COVID-19 response took the first hour and a half of today’s meeting