VA Northeast Ohio Healthcare System
Creating a New Normal: VANEOHS Tackles COVID-19
The storm was coming. It had ravaged China and Italy, and now COVID-19 was rapidly making its way across the United States, bringing major hospitals to their knees, and killing the elderly at an alarming rate.
VA Northeast Ohio Healthcare System officials knew it was only a matter of time until the deadly coronavirus claimed one of their own. Even as they began preparing, they also braced themselves for the worst.
“Our population skews to older Veterans,” said Dr. Todd Smith, the hospital’s deputy chief of staff and an internist. They have “multiple comorbidities and a lot of different illnesses. … Our first thoughts were … how can we mitigate the risk?”
Smith and Beth Lumia, MSW, VA Northeast Ohio’s associate director, set up an incident command the first week of March and began working through every contingency they thought the health care system might face. Other health systems had run out of ventilators and other supplies. Rumors circulated that doctors were being forced to decide who would live and who would die. VANEOHS was determined to not be caught off guard.
“It all boiled down to, ‘Are we going to have enough resources at the right time and in the right place to take care of Veterans?’” said Lumia.
The call came March 15, 2020, in the wee hours of the morning: The Cleveland VA had its first positive patient.
“We all had the visceral reaction of, OK, this is happening,” Smith remembered. “It was important work. It needed to be coordinated 24 hours a day. … It was a very intense time.”
At first, they didn’t know if they would have to isolate staff members, recalled Jeff Rusnak, chief of the Patient Transfer Center, but as much of the country scrambled to find personal protective equipment for medical workers, the Cleveland VA had a stockpile of powered air purifying respirators (PAPRs). There weren’t enough disposable gowns, but they did have washable ones.
COVID-19 tests were a different story, said Smith, but scientists at the Cleveland VA were soon developing their own tests.
“We did amazing work with [testing]. … The Cleveland VA is an academic medical center. We teach and we have researchers. … We had good logistics contacts within different companies that made machines. … We ended up with four [testing] platforms.” Between them, he said, “we were able to piece together … the testing that we needed.”
VA also relied on community partners like the Cleveland Clinic, University Hospitals and MetroHealth to increase testing capacity: “We were able to … leverage the academic community that we’re a part of in Cleveland, as well as leverage a lot of the in-house expertise that we have in testing and research, laboratory work and laboratory operations,” Smith continued.
It was always something. If it wasn’t the tests, it was the swabs to perform the tests. At one point, Smith said, staff members checked every room to count how many swabs they had left.
Hospital staff also developed detailed plans for increasing COVID capacity. Regular patients would be moved from the medical ICU to the surgical ICU, for example, and the MICU would be reserved for COVID patients. The engineering department converted regular hospital rooms to negative pressure rooms. A new education program would train nurses, preparing acute care nurses to serve in the ICU, and training ambulatory care nurses to take their places on the acute wards.
Somehow, they never ran out of space. “We would meet with the different services,” said Rusnak, who oversees all movement of patients into, out of and within the hospital. “We would tell them what we’re seeing, what’s happening, and what the plan is. … Every day was changing.”
“People did amazing things, from standing things up that would typically take months … in 12 or 24 hours, or just working hour after hour after hour,” said Smith, noting that the regular business of the hospital didn’t stop because of COVID. Veterans still had heart attacks and they still developed cancer. After almost a year, everyone is stretched thin.
“Morale is always a concern,” said Lumia. “Even if you didn’t have COVID, there’s not a single one of us who hasn’t been impacted by it. … Our way of life has changed, hopefully not forever.”