Preparing for the next wave of COVID: Harborview’s lessons learned

VIDEO: Preparing for the next wave of COVID: Harborview's lessons learned

SEATTLE — The COVID pandemic has changed life as we know it. Restrictions are slowly being lifted, but the coronavirus is still in our community and doctors are trying to prepare for a potential second wave.

Harborview Medical Center – UW Medicine’s head of infectious disease said implementing the lessons we’ve learned from the first time around will be key to saving lives.

“I think the way we practice medicine is going to be fundamentally changed,” said Dr. John Lynch, the medical director of infection prevention and control at Harborview.

Content Continues Below

When the outbreak hit, Lynch was tasked with setting up the hospital on a system level to handle COVID-19 and a possible flood of patients.

“My job here is to keep the patients and our employees as safe as possible,” Lynch said. “How do I make UW Medicine work? How do we respond to this?”

Coronavirus tents now flank the entrances of HMC and employees come and go in masks. These are just the most visible signs of the COVID-19 pandemic.

He said when coronavirus hit the United States – first in Everett – Harborview got involved from the get-go.

A 30-year-old man returning from Wuhan, China, was diagnosed and then hospitalized at Providence Medical Center, but HMC had a role in the response too.

“There were actually a large number of people who were exposed in that workup,” Lynch said.

Public health leaders called on HMC to help with their home assessment team, a group of doctors, nurses and infection prevention professionals who went to homes and hotels to test people for COVID-19.

“That was a big moment,” Lynch said.

But no one else tested positive, and at first it seemed like that was it.

Then a month later, everything suddenly changed.

Newly available testing showed a respiratory outbreak at the Lifecare Center in Kirkland was the coronavirus and it was killing patients.

Cases and deaths exploded and turned the eyes of the country were on Kirkland.

“It was a critical juncture in the whole United States,” Lynch said.

The crisis at Lifecare triggered a realization for UW Medicine. A patient at UW’s Valley Medical Center who had just died had been a patient at Life Care.

“Because that patient had been in the Kirkland facility, we decided to do some testing on him and we did determine he was positive,” Lynch said.

That positive test sent shockwaves through the hospital.

“That for us was sort of the lightbulb over our head, that that this disease was out already,” Lynch said.

It meant dozens of employees at Valley Medical had been exposed.

“We didn't have a system. No one knew what was going on, Lynch said.

It launched a desperate race for staff testing while the hospital prepared for the worst.

“So you can see, very large number of events and a huge amount of activity happened in that first 48, 72 hours,” Lynch said. “It's been all hands-on deck at a level I've never experienced in my career,” he said.

Lynch said UW Medicine needed to figure out how many masks, gowns and face shields it had. It also had to figure out where to put coronavirus patients.

“What happens if we have twice the patients in two days, three days, five days? Where do we put them?” Lynch said.

Harborview made the decision to set up tents for all suspected patients, shutting down half of the block outside of the hospital.

They set up another "respiratory plus" tent for people with underlying conditions and trained employees how to suit up from head to toe.

Infrastructure had to be changed to create more negative pressure rooms that direct air outside.

“Our facilities engineering team has created additional spaces by altering how air flows, particularly in our ICU,” he said.

All of this was on top of the hospital's regular duties as the region's only Level I trauma center.

“It’s been hard. It's been a ton of work. It's been basically working every single day since that day,” Lynch said, rubbing his face.

Nearly three long months later, there are fewer COVID-19 patients in the ICU.

But Lynch worries coronavirus will be back, whether it's another surge of cases with the lift of social distancing rules or in the fall-winter season.

“I’m very aware and concerned we're going to see more infections. The question is, how many more infections?” Lynch said.

He said doctors have learned critical lessons that must be in place when the virus returns, and the stakes are life and death.

One lesson is making sure hospital staff members stay home when they're sick.

“Health care workers, we are trained — not by the book but culturally— to come to work when we are sick and do the work that we need to do. We don't want to put our burden on someone else,” Lynch said.

He hopes that lesson will be applied to every workforce.

“That going to be a big deal. You cannot be at a hospital, and I would argue any job, if you have symptoms,” then stay home, Lynch said.

Another lesson: Have a better system in place where people aren’t worried about access to or the price tag of COVID-19 testing.

“A lot of testing is still embedded in a traditional health care process where you have an insurance card and you know you get a test with a doctor or someone orders it. I think we need to get away from that where everyone can get a test, and there is no concern about cost or thresholds and it's easy,” Lynch said.

The price of ignoring these lessons could result in more casualties.

“How do you anticipate everyone who's responding to COVID will be able to handle this next wave?” KIRO 7’s Deedee Sun asked.

“I think it's something we're wrestling through right now.," Lynch said.

Lynch said there's a third lesson that’s still unfolding, and it involves managing the toll the disease is taking on hospital staff.

“Burnout for doctors, nurses, custodians, cafeteria workers,” Lynch said.

They've been struggling to balance care for COVID-19 patients and care for their families.

“That combination of stress is, I think, just astounding, and I think we're going to be dealing with that going forward for an indefinite amount of time. And it definitely makes me worried,” Lynch said.

The implications of that stress and burnout are still unfolding.

“How that's all going to play out is still unknown, but we need to start thinking hard about it and addressing it,” Lynch said.

The reality is, there's still more we don't know than what we do.

“It’s really hard. We do not have answers. It is frustrating, it is stressful. It is uncomfortable in ways I didn't anticipate,” Lynch said.

But he said there is something he’s certain about.

“I want to make it really clear, COVID is not going anywhere. Most of us, the vast majority of us are not immune, which means we can still get infected,” Lynch said.