Boston Medical Center Is Well-Prepared for COVID-19 Surge
Ravin Davidoff, chief medical officer, says testing, PPE, protocols informed by “tumultuous” spring wave
The latest COVID-19 surge, which experts fear could increase even more after Thanksgiving gatherings, will not swamp Boston Medical Center (BMC) as did the first wave last spring.
Lessons from the pandemic’s deadly early months have led to careful planning and preparation for adequate testing, hospital beds, and personal protective equipment (PPE), says Ravin Davidoff, chief medical officer of BMC, the School of Medicine’s teaching hospital.
“I am so proud of our BU faculty, who to a person stepped forward in the first surge,” Davidoff says. “As challenging as this marathon is, the faculty will be there to help us manage this because of all the lessons we’ve learned—the physicians, the advanced practice providers, the nurse practitioners, the physician assistants, our nursing colleagues, environmental services.”
Hospitals in states spared the worst of the virus earlier this year are less prepared, grappling with the recent surge that has raised COVID’s US death toll to more than 260,000. Massachusetts has seen its daily caseload exceed 2,000 on many days in recent weeks, and some epidemiologists forecast more deaths in the next few weeks than last spring, despite better treatment now.
As of early Tuesday, BMC had 49 COVID-19-positive patients, 9 of them in the intensive care unit.
Davidoff, who’s also a MED professor, associate dean of clinical affairs, and BMC’s senior vice president of medical affairs, spoke to BU Today about now versus then.
With Ravin Davidoff
BU Today: Are you and your staff rested enough and amply staffed enough to provide care during this surge?
Ravin Davidoff: We feel well prepared for almost anything that comes our way. The first surge was so tumultuous, but we were able to deliver care to all the patients who came here, and at the same time take care of emergent non-COVID patients. During that, we shut down many of our elective and ambulatory operations. We learned how to modify operations, allowing us to feel prepared for the next surge and beyond. We learned about infection control, how we keep patients and employees safe, about protocols to care for people, the options, to reimagine hospital operations in this next phase.
We’ve established amazing predictive models, which help us to anticipate what’s coming, rather than to react to what comes through our emergency department. We feel well-equipped from a staffing point of view—respiratory therapists, nurses, physicians, and other providers.
As challenging as this marathon is, the faculty will be there to help us manage this because of all the lessons we’ve learned.
Do you have enough PPE and ICU rooms?
We have PPE for many months, probably a year’s supply with anticipated surge in demand. Our supply chain people have been incredible. The other piece is, we have stood up testing to such a great degree, we get all our results within 24 hours. We have numerous machines that allow us to navigate through the supply chain problems that sometimes occur. Instead of having people waiting in the hospital for days to determine if they were COVID-positive, as happened in April, now we would know within hours, at the latest within 24 hours. That helps us triage and decide which patients should go to what location.
In terms of ICU capacity, we do have the capacity. We have 63 ICU beds; we were able to go up to 88 during the first surge. Our predictive modeling does not suggest we will need as many as that, so we are equipped to take care of that number of patients, and have alternative spaces where we can care for people with ICU-level care. And we actually have more ventilators now than we had prior to the first surge.
What we did in April, May, and June was stop everything other than emergency care. Now, we have more of a titration approach. We will take care of all of the emergency and COVID that we need to, and then dial the other things up as needed, or dial them down. We’re planning on reducing some of our elective operating room volume in December. There are many outpatient procedures that we have; they could be elective surgeries in ophthalmology, ENT, different specialties. Those are not life-threatening or incredibly time-sensitive, and we’re planning on backing down the space there, so we don’t have to cancel people at the last moment. If the COVID volume and other volume is not as high as we think it might get, then we will fill those blocks with patients who need that surgery.
Cancer cases, for example, we don’t want to delay. But, say, a joint replacement—which is uncomfortable and a patient needs that, but it can wait several months without affecting the person’s longevity, but the quality of life may be impacted—we would say, if we need the capacity and ICU beds [for COVID and emergency cases], let’s delay that case so we can care for the people who need those beds, and open and close the spigot according to our modeling and the reality of what we’re facing.
We look at our numbers every day, our forecasting, and then we are making these decisions with multidisciplinary teams to help us make the right clinical calls.
BMC has been active in COVID clinical trials for therapy. What have you learned from those trials that will improve care?
We’ve learned more from what’s happening globally and locally in research. Early on, it was felt it was better to put people on ventilators. We realized that isn’t the right way. We’ve learned if patients lie face down, they oxygenate better; that is a way, perhaps, without needing to put them on a ventilator. In trials with hydroxychloroquine and azithromycin, it turned out that that may be harmful. We learned dexamethasone might be helpful for a subset of patients. We have remdesivir available commercially; where it fits in the armamentarium is open to question.
I give you those examples to say we participated in a large number of trials. We participated in the Pfizer vaccine trial, and have 265 participants in that trial. That is one we feel proud of. That, I think, ultimately, is going to transform the course of this disease. It’s 90 percent efficacious in preventing the development of disease, and when people get it, the disease is not as bad.