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Philadelphia brings in tent hospitals and extra staff for the coming coronavirus surge

The efforts are grim echoes of what happened in Philadelphia in 1918, when influenza ravaged the city.

The Hospital of the University of Pennsylvania is considering setting up field hospital tents on Spruce Street, between 34th and 36th. They could be served by the hospital's existing support infrastructure. The building on the left is the new Pavilion, which is expected to open later this month in response to the coronavirus crisis.
The Hospital of the University of Pennsylvania is considering setting up field hospital tents on Spruce Street, between 34th and 36th. They could be served by the hospital's existing support infrastructure. The building on the left is the new Pavilion, which is expected to open later this month in response to the coronavirus crisis.Read moreJOSE F. MORENO / Staff Photographer

For the first time in a century — since the 1918 influenza that killed millions around the world — Philadelphia is facing the prospect of hastily putting up field hospitals, some in tents, to save victims of a pandemic.

The Hospital of the University of Pennsylvania, in preparation for a surge in COVID-19 patients, is consulting with federal officials about closing off part of Spruce Street and commandeering Penn’s historic Quadrangle for hospital tents, according to Jeremy W. Cannon, a trauma surgeon helping coordinate the planning effort.

While Franklin Field hasn’t been ruled out, the university stadium is problematic because it’s under renovation. HUP is also working on setting up patient wards in the Perelman Center for Radiology and the Jordan Medical Education Center, each part of the larger hospital complex on Civic Center Boulevard.

HUP wants to set up field hospital tents on Spruce Street between 34th and 36th Streets, a busy stretch that forms the border between the Penn campus and the hospital complex. The arrangement would still allow cars coming from the South Street bridge to access the hospital complex. Such a closure would likely have to be coordinated with city officials.

“The nice thing about Spruce Street is that it’s close to the main hospital,” said Cannon, who came to Philadelphia in 2015 after nine years in the Air Force, where he helped set up field hospitals in combat zones in Iraq and Afghanistan.

Northeast of Penn, a federally funded field hospital already is occupying Temple University’s Liacouras Center, and hospitals all over the region have put up tents for testing and triage.

Health officials — while nervously eyeing New York City’s soaring casualties — say they hope never to have to use the emergency facilities. But the efforts are grim echoes of 1918, when the so-called Spanish Flu ravaged the city.

Then, historians said, buildings all over the city became annexes for hospitals overflowing with patients. Among them: a clubhouse at Broad and Arch Streets for the Catholic Philopatrian Literary Institute; a Republican club on Broad Street in Passyunk; and a residence for retired sailors in Devil’s Pocket, the tiny neighborhood south of Center City abutting the Schuylkill.

‘The right thing to do’

Cannon said he feels HUP “has plenty of resources,” but “it’s a matter of getting them to the right spot." The hospital is reaching out to medical equipment suppliers who specialize in fast delivery, critical at a time when hospitals around the nation lack everything from personal protection equipment for health care workers to ventilators for critically ill patients.

Other preparations are less visible to outsiders, but no less essential as health systems find ways to reassign health-care workers from their normal jobs to COVID-19 wards and other crucial tasks.

Temple Health spokesperson Jeremy Walter said some Temple staffers who don’t usually work at its hospital, like community physicians, have been reassigned there. Penn Medicine has a “comprehensive redeployment strategy” to ensure patients are still cared for during the pandemic, said Mike Iorfino, a health system spokesperson. Jefferson Health would say only that it is “considering a variety of surge-staffing options,” spokesperson Brandon Lausch said.

Main Line Health is lining up volunteers to work front-line jobs in preparation for a deluge of patients.

“It just seemed like the right thing to do,” said Vicky Largoza, a nephrologist at the health system’s Paoli Hospital who expects to work on diagnosing new patients.

In other cases, health-care workers are resorting to something like old-fashioned house calls to prevent infections that can occur if vulnerable patients have to visit busy medical offices.

At Penn, more than a dozen nurses who usually work in the infusion clinic with patients who need chemotherapy or other intravenous medications have volunteered to administer treatments at patients’ homes. Requests for the service increased as coronavirus cases rose, said Katherine Major, a registered nurse and the director of Penn’s home infusion therapy program.

At ChristianaCare in Delaware, health-care workers have been increasingly redeployed around the system over the last several weeks.

Susan Felicia, a nurse practitioner, worked in a high school “wellness center” — where students had received sports physicals, wellness visits, and other health services. When schools closed, she redeployed to the health system’s virtual COVID-19 practice, designed to treat and monitor patients with the coronavirus via telemedicine.

With prior experience treating heart failure patients and people with other complex needs, she felt prepared for her new role.

“What I feel is so valuable in this practice is, the patients aren’t left alone,” Felicia said. “It’s so scary. And I can say to them, you’re going to hear from someone tomorrow, and hear from someone every day until you’re better."

The 1918 pandemic took a terrible toll on medical professionals. So many doctors and nurses succumbed to the flu that nuns, nuns in training, and teachers all stepped in for nursing duty, said Temple historian Hilary Iris Lowe.

This time, health systems are taking steps to protect their employees and their family members. Programs to help stressed professionals cope with the mental toll of this work are being hastily set up. Temple has set aside dormitory space for health-care workers who fear spreading the virus to their families, while others are using hotel space for the same purpose.

“There’s always a concern,” said Largoza, the nephrologist at Main Line Health. “I have a family too, I have kids. You have to take the precautions. Unfortunately, this is a job I signed up to do.”

The challenge ahead

Staffing these new facilities is yet another challenge, whether people are working in tents, arenas, or other temporary health-care spaces.

In New Jersey, Gov. Phil Murphy is allowing medical practitioners from across the country and abroad to come volunteer on the front lines. James Garrow, a spokesperson for the Philadelphia Public Health Department, said the city is “putting out feelers in as many places as possible” to recruit for the Medical Reserve Corps, a federal volunteer force of medical and nonmedical professionals who have been staffing the city’s COVID-19 testing site.

The number of people who may be cared for in the field hospitals creates a major logistical concern, too. Ideally, virus-negative patients who are not critically ill would go to the tents, to free up space in the well-equipped wards for COVID-19 treatment. But no matter who is housed in the tents, HUP will have to figure out how to bring water, electricity, toilets, and other infrastructure to the sites, possibly including “negative pressure” isolation units to prevent the spread of infection.

Robert Lim, a surgeon and faculty member at the University of Oklahoma School of Medicine in Tulsa, said it would also be challenging to determine whether patients coming into the field hospitals are virus negative before they are admitted, since it’s taking so long to get test results back.

The biggest difficulty is not finding places to set up tent hospitals; it’s figuring how to keep them clean, Lim said. Like Cannon, he served in the military, spending 23 years in the Army, where he set up field hospitals under combat conditions.

“Housekeeping is crucial,” he explained. “The tents have to be cleanable.” That’s hard to do in one big space, like a convention center or stadium. “The cleanup is as important as anything.”

Largoza, at Main Line, has been practicing medicine for 25 years, but has never faced anything like this. She volunteered to help in New York City after the Sept. 11, 2001, attacks, she said, but was never called up. Now she’s preparing herself for what she expects will be her biggest challenge in the coming weeks.

“The volume,” she said. “If they’re really sick, that’s going to be tough psychologically, emotionally, physically.”