SEAFORD – When The Beatles’ “Here Comes the Sun” plays at Nanticoke Memorial Hospital, you can see the smiles on the face of doctors, nurses, and staff members because that means another COVID-19 patient has either been taken off a ventilator or released from the hospital.  The good news is the staff is hearing the song much more often, hospital President Penny Short said.  [caption id="attachment_36104" align="alignright" width="225"] Bayhealth's Sussex Campus has planty of capacity, says President Terry Murphy[/caption] Bayhealth Hospital’s Sussex Campus in Milford has 100 ventilators on hand, with the ability to add 68 more to meet a surge, but as of May 1 only 16 of those ventilators were being used, Bayhealth President and CEO Terry Murphy said.  COVID-19 positive cases are likely to spike again in Sussex County as the state awaits results from thousands of tests administered since late April – including 1,600 to poultry workers during the week of May 4 and thousands more to residents going to drive-thru testing stations throughout the county.   As of May 5, Sussex Countians had been tested 9,115 times – a rate of 415 per 10,000 residents and more than a third of all statewide tests – compared with 211 per 10,000 in New Castle County and 243 per 10,000 in Kent County.  In Sussex County, Hispanics account about 38% of the positive cases, mainly because they’re testing positive at a 72% rate, far above other ethnicities that the state can categorize. Sussex has a higher percentage of younger Delawareans who have tested positive, and at least 61 of the county’s 75 deaths have been over the age of 65.   The state is only providing demographic data where there are at least 11 cases, and none of the 61 deaths that the state reported on through May 5 were Hispanic (44 were white and 17 were African American).  But hospital executives say they’re focusing less on the number of positive cases – that’s a function of all the additional testing – and more on how many of those positive cases are converting to hospitalized patients.  That’s consistent with what Gov. John Carney outlined May 5, when he said he’s basing his decisions to reopen the state’s economy in large part off the two-week trends for total hospitalizations and new hospitalizations, as well as rolling five-day averages for the percentage of positive tests and new positive cases.  The state won’t break out the hospitalization figures for its three counties, but interviews over the past week indicate that despite a flood of new positive cases, those aren’t translating into hospital admissions in Sussex.  That’s doesn’t mean the hospitals are getting overconfident that the worst is past.   [caption id="attachment_197877" align="alignleft" width="300"] Dr. David Tam says there are a lot of variables to predicting a potential surge.[/caption] “I don’t think we’ve reached a peak in hospitalizations for my part of Sussex County,” Beebe Healthcare President and CEO Dr. David Tam said. “There are so many variables. It may be this week, or it may be a month; that data is not available in terms of a predictive model. Our models are holding up to see where we are with admissions, but they’re changing on a daily basis. The original models were created in large metro centers but I’m not sure you can apply the same model to Lewes and Rehoboth; it may have a different outcome in the next few weeks in a positive way.”  While Beebe continues to see an upswing in inpatient admissions, the number of patients on ventilators or in intensive care are not as high. Tam said his hospital is using more beds today for COVID-19 or persons under investigation, but the rate at which that number has increased has slowed down to some extent compared to two weeks ago.  In other parts of the county, the story is a bit different.  “We think we’ve plateaued on hospitalizations and are seeing our lowest numbers of hospitalized COVID-19 cases in several weeks,” Bayhealth’s Murphy said. “That goes to why testing is so important. You’re focusing on populations with a rise in positives so you can focus on reducing the hospitalizations. That requires focused testing.”   Treating positive cases as outpatients  Beebe is using an outpatient strategy to reduce the number of hospital admissions, pivoting its Georgetown walk-in facility to be a COVID-Positive Care Center.  “Rather than saying ‘go home and wait it out,’ we’re treating them to reduce the chances of getting sick,” Tam said. “They can come to our clinic in Georgetown and get seen or have a telemedicine session.”  Using this type of strategy, hospitals can see patients who have had positive tests a few weeks earlier. Patients with comorbidities, like diabetes, or having shortness of breath can therefore be better tracked and monitored without admitting them.   “By providing care for patients who are COVID-19 positive or under investigation for having the virus, we are providing a safe, centralized place for patients to go to receive all of their COVID-19 related care needs,” said Bobby Gulab, senior vice president and chief medical officer of Beebe Medical Group. “We are helping to reduce community spread by giving patients a place for care and allowing other medical offices across Sussex County to care for their patients safely too.”   The importance of testing  The state and the three hospitals have focused their community testing efforts on their three parts of the county – Bayhealth in Milford, Beebe in Georgetown, and Nanticoke in Seaford. They’ve organized a series of six community testing locations over two weeks geared toward high-risk populations and families and housemates and people with chronic diseases like diabetes. In fact, from May 4 to May 5, the results from nearly 1,000 tests were added to the DPH database. Working with the Delaware Division of Public Health, the hospitals are testing with the secondary objective of identifying opportunities to educate residents who may be living in high-risk situations, such as multifamily residences. One focus is on the Hispanic and Haitian communities in the county who may not be getting tested or treated either out of fear or out of a lack of information about their options.   [caption id="attachment_167584" align="alignleft" width="214"] Nanticoke's Penny Short: "The more we educate, the less it will spread. "[/caption] “These are not just regular drive-thru testing locations,” said Short, who is also a senior vice president of Peninsula Regional Health System, which completed its acquisition of Nanticoke in January. “We’re giving each person getting tested a care package with masks, hand sanitizers and education materials they can share at home. We’re connecting them with social services and talking about ways to isolate themselves. The more we educate, the less it will spread. If you can truly quarantine, it will flatten our curve. The more that we’re out there, the better chance we have of keeping people out of the hospital.”   The purpose of testing is to determine where you need to focus your epidemiological efforts, or tracking how the disease is moving through the state, Murphy said.  “The numbers are going up because testing is going up,” said Short, who along with Tam at Beebe have had a “baptism of fire” since they started their new job leading their respective hospitals within a few weeks of the start of the pandemic.  Bayhealth’s Murphy said the drop in hospitalizations can be tied to the testing efforts.  “We’re seeing great news on the back-end because of the great work on the front-end,” Murphy said, mentioning that ChristianaCare was the first to do widespread testing in Georgetown. “But it’s also important to remind everyone that our ER is open and that it’s safe to come in.” 

 Communication is key 

The hospitals say they’ve ramped up communication between themselves and the state. They have twice-weekly conversations with DPH and talk to the governor once or twice a week. As a result of these calls, they decided to target educational messaging to the Hispanic and Haitian populations through Facebook Live, radio stations, and Telemundo.  “There is capacity and we’re flattening the curve, but we’ve got to keep it going,” said Wayne Smith, president and CEO of the Delaware Healthcare Association (DHA). “A big part of our success is based on organization and communication. We’re all being supportive of each other and the CEOs are prioritizing issues and formalizing consensus. The three institutions’ incident commanders all meet regularly, and they are able to prioritize and take common approaches to challenges like the [poultry] processing plants.”  The hospitals are generally doing similar things to protect patients and staff. They screen every visitor or employee who comes through the door. They are working with hotels for people who feel uncomfortable going home because they're worried about exposing their families. In some cases, they’ve identified retirees and granted out-of-state privileges, but say that to this point they haven’t actively brought anyone on board. And they’re working with other hospitals like Nemours and ChristianaCare and with local nonprofits like La Red Health Center and La Esperanza Community Center to help educate citizens.   “I’m seeing a glimmer of hope,” Bayhealth’s Murphy said. “I’m feeling like the state is doing well with its testing plan and focused on the right communities and we're also doing well on the hospital side.”  “There’s still a tremendous amount of uncertainty, even at this stage,” DHA’s Smith added. “I hope people have seen that predicting where this will go has been pretty much guesswork – educated guesswork – but we don’t know a lot about this virus yet. Asking about lessons learned is premature. We just have to do basic blocking and tackling while we learn.”  --Peter Osborne posborne@delawarebusinesstimes.com