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Health experts are concerned about a resurgence of coronavirus cases this fall and winter. COVID-19 cases in Evanston peaked in mid-May, bottomed in late June, rose slightly in July and plateaued to around five cases per day over the past two months.
NorthShore University HealthSystem has created a coronavirus resurgence plan. “If and when things start to heat up again, we are ready,” stated Dr. Neil Freedman, head of Pulmonary, Critical Care, Allergy and Immunology at NorthShore and Vice President of Acute and Post-Acute Care Integration. Dr. Freedman is the lead physician in charge of managing Northshore’s COVID-19 patient care and the effort to develop a resurgence plan.
This plan incorporates learnings from treating patients last spring and early summer. COVID-19 hospitalizations peaked in late April and early May, with upwards of 180 to 200 patients including 42 to 44 in intensive care at Northshore’s Glenbrook and Evanston hospitals. “The good news is that now we are much better prepared. We learned a lot from those first three months,” Dr. Freedman emphasized.
The plan details what happens in NorthShore University hospitals, group medical practices and immediate care centers. Dr. Freedman stresses the importance of a comprehensive plan, including all types of care facilities. The resurgence is likely to coincide with the flu season, creating demands on the whole system, he explained. According to the Center for Disease Control (CDC), the flu season in the U.S. starts in the fall, peaks between December and February and can circulate as long as late May.
NorthShore will continue to cohort COVID-19 patients at the Glenbrook hospital. Evanston hospital will be reserved for patients with medical needs that cannot be served at Glenbrook, such as labor and delivery.
The resurgence plan prescribes specific changes to staffing, supplies, personal protective equipment (PPE), space and work flows for different numbers of COVID-19 hospitalized patients.
- The Baseline mode, defined as up to 25 COVID-19 patients, requires no change from normal staffing, PPE and care practices. Minor adjustments from Baseline mode will be necessary for more than 25 patients but less than 50.
- The plan for Contingency mode – more than 50 and fewer than 75 COVID-19 patients – requires some adjustments, such as modifying space in the ICU and expanding step-down capacity at Glenbrook Hospital to care for the additional patients with COVID-related illnesses.
- Critical mode – more than 75 but fewer than 100 patients – entails more significant changes.These include redeploying staff from other areas to assist in the ICUs, and perhaps moving elective procedures away from Glenbrook to other Northshore facilities.
- If the number of COVID-19 patients exceeds 100, NorthShore may need to expand the critical care unit at Glenbrook Hospital and temporarily suspend certain services across the system to accommodate the needs of the ICUs, emergency centers and inpatient settings.
Dr. Freedman stated that outpatient care – medical group practices and immediate care centers – have readily adapted to the new environment. Most of the group offices have become very efficient and savvy at telemedicine, and the four major immediate care “supersites” tasked with COVID-19 testing and walk-in care are able to ramp up or down very quickly, according to need. Adjustments to the drive-through testing facility on Woods Drive in Skokie are in the works to keep staff and patients warm and safe during colder periods.
Hospitalizations in Suburban Cook County have fallen since late April and held steady at about 12 to 14 per day since mid-June, despite increases in COVID-19 cases in the past two months.
COVID-19 fatality rates also have declined. Fatalities in Evanston peaked in mid-to-late June with two fatalities in the past 60 days.
Dr. Freedman attributes lower hospitalization and fatality rates to a shift in age demographics of recent COVID-19 cases. Around half of new COVID-19 cases in Evanston in the last 12 weeks were younger than 30 years old compared to just 20% during March though late July. Only 9% of new COVID-19 cases in the past 12 weeks were older than 70, compared to 27% in the spring and mid-summer.
There have been some therapeutic advances in patient care, but these have all been on the in-patient side and for very sick patients, Dr. Freedman explained. One of the most important is proning, which involves carefully shifting patients from their backs to their sides and stomachs to improve oxygen levels.
NorthShore is involved in many studies and clinical trials that will “hopefully enlighten physicians and staff on better ways to care for patients,” said Dr. Freedman. These include several studies on convalescence plasma for people who have been exposed to the virus and Regeneron’s polyclonal antibody treatment, REGN-COV2, for patients who have tested positive but are in the first several days of Illness. NorthShore is one of several patient-enrollment sites across the country for the FDA trial of REGN-COV2. While there may be some limited data available by early December on the REGN-COV2 trial, it will take longer for conclusive results, he said.
Dr. Freedman cautions that despite some promising therapies, COVID-19 is not a curable disease. “I keep telling my patients in my office and anybody I can talk to that this is not a curable disease. But it is at least controllable by following common sense rules such as wear your mask, wash your hands, socially distance, get your flu shot and stay at home if you are sick.”
Headquartered in Evanston, NorthShore University HealthSystem is an integrated healthcare delivery system, including five hospitals and a 900 physician multispecialty group practice, NorthShore Medical Group.