Liz Schofield listened as the phone rang once, then twice, before a woman picked up.
“I’m calling to get in touch with you about your test results,” said Schofield, a Main Line Health critical care nurse, pausing to let her words sink in. “I’m sorry to tell you that you have tested positive for coronavirus.”
Schofield had already been on the phone for nearly two hours Wednesday morning. Every call, about 20 by 11 a.m., had been to inform people that they were infected. One of them told Schofield he had an immune-compromised wife and was worried she would die if he spread the virus to her. During a call with a man who is 37 — the same age as Schofield — she could hear young children in the background.
“It’s hard,” Schofield said of working on Main Line’s weeks-old “COVID Communications” team at the corporate offices in Radnor. “I just hope they get better.”
Across the United States, hospitals have been dealing with a disease disaster made worse by the federal government’s failure to act in the early weeks, when better containment might have been possible. Now, with U.S. case numbers exploding, testing is still a bottleneck, and there is a dire shortage of everything from low-tech face masks to high-tech ventilators. In New York City, a doctor at a hospital with 13 deaths in one day told the New York Times just days ago that the situation was “apocalyptic.”
Philadelphia-area hospitals are now preparing for “the surge.” That’s a medical term referring not just to the deluge of patients but also to how hospitals plan to do the near-impossible: provide adequate care without adequate resources.
“We anticipate we are no more than two weeks behind New York City,” P.J. Brennan, chief medical officer of the massive University of Pennsylvania Health System, said Thursday. “Cases are doubling every two to three days. We had 46 confirmed cases last night. You do the math.”
The math suggests that in two weeks, April 9, Penn’s six hospitals, including the flagship in West Philadelphia, could have at least 1,472 coronavirus patients. And the peak of the crisis, Brennan said, is projected to be in late May or June.
“The extent of the surge and how long it will last is hard to predict,” said Bruce Meyer, president of Jefferson Health System. “There are many variables. What is the length of hospital stay? What is the home-care ability? And we don’t know how to factor in potential new treatments.”
Effective therapies, if they come, will not come soon, so hospitals large and small are repurposing, reconfiguring, and reinventing their operations.
Jefferson is working with fabric designers at its East Falls facility — the former Philadelphia Textile Institute — to make face masks and find ways to re-sterilize used ones.
Temple University has agreed to let the city use the Liacouras Center as needed to expand Philadelphia’s hospital-bed capacity. Temple’s health system, meanwhile, turned its entire Boyer Pavilion — a 10-story building normally dedicated to neurosurgery and orthopedic surgery — into a coronavirus hospital.
“It has a parking garage and separate everything, so we can separate confirmed coronavirus cases,” said Michael Young, president of Temple’s system.
Temple and many other hospitals have set up tents outside their emergency departments so people with respiratory symptoms can be evaluated without exposing other patients. Virtua Health System, the largest in South Jersey, has also turned the auditorium of its Camden hospital into such a “triage” center.
Penn’s pull-out-the-stops strategies include converting space in the former Graduate Hospital, which is now a rehabilitation center, and racing to set up a 118-bed intensive care unit on the first two floors of the still-under-construction, $1.5 billion Pavilion patient tower.
Perhaps the biggest struggle for hospitals is keeping their most precious resource — workers — healthy.
Penn, for example, now checks employees’ temperatures at hospital entrances. If they seem fine, they get a surgical mask to wear throughout their shift; the mask is stored in a bag and reused daily unless it gets ripped or visibly dirty. In normal times, not all employees would don masks, and even those providing patient care would not wear masks at all times.
The personal risks are relentless. Many physicians and nurses feel as if they’ve been thrown into a war, said oncologist Ravi Parikh, a physician at the VA Medical Center in West Philadelphia.
“But unlike traditional wars,” he and two colleagues wrote in an op-ed for The Inquirer, “these soldiers don’t sleep in trenches; they return home each night. Each trip home requires a renewed commitment to containment — to isolate their families from the disease they have spent the day fighting.”
Hospitals are literally begging for the provisions they need for that fight. At Einstein Healthcare Network, operator of a major safety-net hospital in North Philadelphia, key departments have switched to foraging and fabricating protective equipment.
The fund-raising office “has transformed overnight to lead the charge in managing and securing PPE donations for our frontline employees,” said Einstein spokesperson Damien Woods. “Our facilities management team turned their office into a makeshift factory to build homemade face shields. Hospitals have changed incredibly over the past few weeks.”
Amid the stress and turmoil, many hospital officials are reluctant to be candid about their plans. Asked about their surge preparations, numerous systems — including Camden-based Cooper University Health Care, the Veterans Affairs Hospital in Philadelphia, and Trinity Health, which operates Mercy Catholic Medical Center in Darby — responded with only vague answers, or said nothing.
In contrast, Main Line on Wednesday allowed an Inquirer reporter and photographer to speak with doctors at Lankenau Medical Center, one of its four acute-care suburban hospitals, and to tour the “command center” at the corporate offices.
Besides fielding questions from clinicians and employees, the command center calls patients with test results. Schofield and six other nurses worked the phones Wednesday at tables arranged in a U-shape around a whiteboard. First, they called patients getting bad news, so they could begin staying away from family members as soon as possible.
“We want you to quarantine yourself for 14 days,” Schofield told a woman who was experiencing mild symptoms. “It sounds like you’ll be OK, but please see a doctor if you start to notice shortness of breath."
Hospitals are planning for scenarios health professionals hope never to confront, from deciding which critically ill patients get to use scarce ventilators, to where corpses can be humanely stored if the morgues are overrun.
“The mood has been anxious,” said Matthew Gietl, assistant nursing manager at Lankenau Medical Center, a 341-bed hospital in Lower Merion Township. “The anxiety just kind of hangs around, with everyone waiting for that surge to come in.”
At Lankenau and its other hospitals, Main Line has erected drive-up tents where people can get swabbed for the virus while in their cars. Of the 2,000 people who have given specimens, almost a quarter had tested positive for the virus, while an additional 1,000 people were awaiting their results as of Wednesday.
The hospital system has access to 201 ventilators, with “dozens on order,” said Jack Lynch, Main Line’s chief executive and president. The system’s intensive care capacity could grow from 131 beds to 250 by converting other spaces, such as the pre-operative and post-op areas.
Volunteers and medical students have been sent home to minimize the risk of spread, but the students may be asked back if needed.
Officials are concerned about burning through their supply of protective equipment but say a recent donation of 8,000 masks has kept them going — for now. “The biggest need I have right now is rapid testing,” said Mark Ingerman, the system’s chief of infectious diseases.
Main Line could do 45-minute molecular testing — if the federal government would send the chemical reagents vital to the process. So, like other facilities, it must send samples away and wait up to five days for results.
During that delay, hospital workers and patients must presume patients could be contagious, and precious supplies must be used in their care
“The quicker we get those tests back, the better,” Ingerman said.
As for worst-case scenarios, Main Line is awaiting state guidance on how to prioritize patients if ventilators must be rationed. And it plans to bring in refrigerated trucks if the morgues are full.
“I don’t know where they would park them,” Lynch said, “but whatever we’d do, we’d handle the deceased with great respect and great care.”