Norton Healthcare President and CEO Russell F. Cox answers questions about how Louisville’s largest health care system is dealing with the pandemic
Norton Healthcare officials are “very comfortable” with the Louisville-area’s largest health care system’s ability to handle a surge in COVID-19 patients, according to Russell F. Cox, president and CEO.
As of Monday, Norton Healthcare had 550 patients, including 34 who have tested positive for COVID-19, at its five hospitals. Overall the system has 1,174 beds, including 163 intensive care unit beds. Eighty of the system’s 222 ventilators were in use as of Monday, and the system has the ability to convert 134 anesthesia machines to ventilator use.
“As of right now, from a capacity perspective, we feel very, very comfortable with where we are,” the Norton Healthcare CEO said, adding that if capacity needs to be expanded to handle a surge of patients, up to 1,469 beds could be in service. “We hope we’re doing enough things to stem the tide, that we won’t be forced to use that surge capacity, but we’re ready to do so if necessary.”
Along with the CEO, Steven T. Hester, M.D., MBA, division president, provider operations, and system chief medical officer, answered additional questions about Norton Healthcare’s ability to respond to the crisis.
Does Norton Healthcare have enough medical staff to treat everyone?
Russ: “We’ve been very compliant with the cessation of elective surgeries; we’ve ended all elective sorts of diagnostic procedures. We’ve instructed people that it’s not the place to come to the emergency room unless you have specific symptoms. So we have volumes that have really gone down. We are ready. We are well-staffed.”
Are staff who have been sent home to self-isolate being paid?
Russ: “We’re telling all employees that during this next 30 days, you need not worry about how things are going to impact your paycheck. If you’re asked to go home, you’re going to be paid. You’re not going to have to use your [paid time off].”
Why does Norton Healthcare have more employees with COVID-19 than apparently other systems do?
Russ: “When you look at an organization that has that many hospitals, that many physician offices, and when you look at the fact that 57% of the community is entrusted with your care, it’s going to make sense that that number is going to correspond.”
Why does it take so long to get back test results?
Russ: “We’ve tested 1,715 people. We’re still waiting on results of 754 of those tests.
“These are not tests that are done within a hospital. They’re not an immediate response test. They have to be sent to labs. And those labs, as you can expect, have been overrun for the past two weeks. … Our numbers change every day based on the numbers of tests that we get back.
How many Norton Healthcare employees have tested positive and are they caregivers?
Russ: “As of Sunday night, we had 45 employees that have tested positive. We’ve tested 250 employees.”
Dr. Hester: “They are across the system, clinical and nonclinical employees. … We have 16,000-plus employees. So, when you look at that, we’re going to have positives just from community spread, whether they’re health care (providers) or not.
Is there enough personal protective equipment for all clinical staff?
Dr. Hester: “All staff have access to the PPE. All staff are using the PPE. And one of the things I want to talk a little bit about, is … we initiated our policy where we’re doing universal masks for all of our clinical staff. We moved this forward because … as this spread has continued to increase in the community, we’re seeing more and more asymptomatic patients come to the hospital for other conditions, but the concern is that they may very well be sharing the virus.
“So in that sense, we moved to the universal mask [policy] for our health care providers and staff. So that’s going to allow us, we think, to again, protect the community better, as well as continue to protect our caregivers.”
How can the community help?
Russ: “Simply put, it’s to follow the admonition of Gov. [Andy] Beshear and Mayor [Greg] Fischer and stay healthy at home. It absolutely is the best gift that you can give our caregivers. It’s the best way that you can show your support for our caregivers — is to follow those things that we talk about all the time.
“I know it’s spring break week. I know that everybody would like to be somewhere else. I know there’s this temptation to go on a short trip or go out of the community and come back. We ask you not to do that. … By going away and coming back, it really does put our caregivers at risk.
“I cannot stress enough the importance of hand hygiene. What we know for sure about this virus is that it’s very contact-sensitive. It’s very surface-sensitive. It stays on surfaces for six to seven days. So that hand-washing regimen becomes so very important to us.
“Obviously social distancing, I can’t say enough about this. Six feet at least, but we know for certain that the more that we practice that, the better it’s going to be for all of our caregivers.
“The more that you practice those habits, the more that you prevent that spread, the better that we can conserve that personal protective equipment that is so important to us.”
Norton Healthcare’s Erica Coghill discussed the coronavirus with two Norton Healthcare physicians, including our system epidemiologist.
Here’s a COVID-19 Q&A with James M. Frazier, M.D., vice president, medical affairs and quality, Norton Healthcare; and Paul S. Schulz, M.D., infectious diseases physician with Norton Infectious Disease Specialists and system epidemiologist for Norton Healthcare.
What’s the difference between coronavirus and COVID-19?
Dr. Frazier: Coronavirus is actually a family of viruses. There are several coronaviruses, and they’ve been around for a long period of time. They’ve been known to cause common colds for a long time. COVID-19 is actually a disease caused by the SARS-CoV-2. This is a novel coronavirus. It’s only been around for about three months, and we’re still learning quite a bit about it; but it’s part of a bigger class of viruses.
What are the symptoms of COVID-19?
Dr. Frazier: Most of the time what we’re seeing are more upper respiratory symptoms. A lot of times fever, but not always. Cough, shortness of breath, sore throat, maybe a scratch in your throat. Gastrointestinal symptoms are less frequent, but we’ve seen that as well.
How is COVID-19 transmitted and how long does the virus live in the air or on surfaces?
Dr. Frazier: There are two main ways that we believe it is transmitted. One is by droplet or airborne spread, and the other is by contact. We think right now that the coronavirus lives in the air for several hours and on surfaces for up to six or seven days, which is one of the reasons why we feel like it’s so contagious.
If someone with the virus sneezes, we think you could walk into the room even after they’re gone and potentially still be infected, particularly if you make contact with an infected surface.
Why the ‘6 feet rule’?
Dr. Schulz: The idea of the “6 feet rule” is that it’s going to help prevent contact with a droplet, and if there is any aerosolization of the organism, you should be far enough away that you’re not infected. But some of this with this new virus remains uncertain.
What can I do to avoid getting it?
Dr. Schulz: Frequent hand washing, cough etiquette, and staying away from crowds. For sure, stay away from people who you know are ill.
If you are ill, stay away from other people.
All those things apply to this and aren’t really that different. We don’t have a vaccine, unfortunately, but that’s a possibility maybe later on this year. But for now, it’s the basics of preventing transmission of a virus.
Dr. Frazier: You can avoid getting COVID-19 by the typical measures that you would avoid any other virus. Hand hygiene is extremely important. Obsessively washing your hands and using hand gel, wiping down surfaces in your office as well as your home, practicing social distancing, maintaining a 6-foot radius from other folks whenever you possibly can. Avoid large gatherings; try to maintain your space inside your own house as much as you possibly can. Again, not sharing drinks with other family members and washing your hands. I can’t stress that enough.
Should I wear a mask to avoid getting sick?
Dr. Schulz: It’s not generally recommended for a person out in the community to wear a mask and considered for the most part unnecessary, particularly if you’re already practicing social distancing and the things that we talked about.
Another issue that’s happening right now — and it’s real — is if you are using masks and other personal protective equipment, the health care workers really need that. Supplies are short and getting shorter, and we hope that people wouldn’t be using those things in situations where there’s essentially no risk. Then, a person who really needs it doesn’t have it to help take care of somebody.
Dr. Frazier: I don’t think they would be helpful for the general public. Certainly, if you’re immunocompromised, or in our facilities if a patient is being seen in one of our outpatient care centers or in the hospital, we very well likely may put a mask on the patient, but for someone in the general public, I doubt it really helps very much at all.
If I think I’m sick, what should I do?
Dr. Schulz: Well, if you think you’re sick, first and foremost, I wouldn’t do anything differently than I would have done before the coronavirus was an issue. There’s not a necessity to get tested, and there’s not a necessity to get evaluated.
Obviously, if you are sick with the coronavirus and you go to a facility to get tested or evaluated, you could infect somebody else. I think the main message is that if you would not have sought care prior to the coronavirus being in our community, you probably don’t need to seek care now.
Please take our online questionnaire if you’re concerned about your symptoms. If you need to get care, try a remote visit using Norton eCare. If that doesn’t work for you or you have trouble getting through, make an appointment at a Norton Immediate Care Center.
What happens to a patient who suspects COVID-19 and goes to a Norton Healthcare facility?
Dr. Frazier: If you’re having symptoms, first of all, call ahead before you seek care so we can be prepared. We will immediately place a mask on you and place you in a private room. Then our providers will come in with their personal protective equipment, maintain as much as possible a 6-foot distance while they’re asking you questions and then proceed to examine you to determine if you require further testing or perhaps you can be sent home and self-quarantined until your symptoms are resolved.
What is PPE?
Dr. Frazier: When we say personal protective equipment, what we’re really talking about are gowns, gloves, masks etc …. A lot of people have been referring to the N95 mask: This is what we use for typical airborne diseases such as tuberculosis. We use those specifically in the facilities for aerosolizing procedures and any time we may cause a virus to be emitted into the air around the patient.
Why does it take so long to get back test results?
Dr. Frazier: The number of tests that are being done now and sent out to the national labs are just simply taking a long time to process, to come back. I expect that’s going to improve once more laboratories are able to test at a more local level. As for now, just be patient as we’re working through this. We were initially told three to five days; we’re finding out now that it’s five to seven days and sometimes even longer to receive the lab results back.
Is COVID-19 deadlier than the flu?
Dr. Schulz: I think that’s a better question answered retrospectively, but I understand the concern. For sure, it seems that there is a higher rate of mortality and bad outcomes in people that are older; the Centers for Disease Control and Prevention (CDC) gives guidance around people over the age of 60 based on data from other countries, and also people who have chronic illness.
But I think overall that the real challenge is a test that maybe is not that good, that gives significant false negative rates. There is also limited testing in the United States, and probably a lot of people out there that had either asymptomatic or very mild illness, never sought care — and then we wouldn’t really know if they had the infection. Then that really skews the data.
If you’re looking at, for instance, hospitalized people or people who have a positive test, you start skewing the data towards a higher mortality.
Is there any piece of hope that you can give people?
Dr. Schulz: The vast majority of people in the community are not going to be harmed in terms of their health. The hope is, is that this is going to be a short, limited situation, and we’re going to come out the other side and go back to, for the most part, business as usual.
Dr. Frazier: Our own data is showing that about 90% of hospitalized patients are going home with very minimal symptoms — they’re doing great. That’s consistent with what we’ve seen in other countries and what’s reported out there as well.