El Camino Health at the Forefront During COVID-19

While COVID-19 has presented extraordinary challenges globally, no one has felt it more acutely than those on the frontline, our incredibly brave healthcare workers. El Camino Health has been at the forefront of this crisis in an effort to stay ahead of the curve and prepare not only its own hospitals, but others in the area to best support Bay Area patients.

The Fogarty Institute is very fortunate to have Zachary Edmonds, MD, as clinical advisor on its team. Zach is a hospitalist practicing primarily at El Camino Health’s Mountain View hospital and is a site director for the Palo Alto Medical Foundation (PAMF) Department of Hospital Medicine.

Zach shared a behind-the-scenes look at El Camino Health as it prepared and rolled out its COVID-19 response.

An unprecedented timeline

As one of the first hospitals to have a known community transmission COVID-19 case, El Camino Health played a key role in setting the stage and helping shape best practices and government policy. While ramping up its response was resource-intensive, it paid off as the crisis unfolded.

In February, when the virus first appeared on the radar in the greater Bay Area, all COVID-19 testing was controlled by the Centers for Disease Control and Prevention (CDC), which supplied testing materials to the local county public health departments. At that time, a patient could only get tested by the hospital sending three samples (nasal and throat swabs and a blood sample) to the Santa Clara County Public Health Department. In addition, only patients with a travel history were being tested as the premise was that the virus was only seen in returning travelers.

In late February, El Camino Health infectious disease specialists were asked to see a patient in the ICU with an unexplained respiratory failure. After the examination, the specialists were concerned that the patient may have COVID-19. However, when they called the public health authorities, they were told that testing wasn’t allowed since the patient didn’t have a travel history.

The doctors felt the patient needed to be tested, and persistently communicated with the Santa Clara County Public Health Department until permission was finally given. The patient tested positive for SARS-CoV-2, giving credence to the growing notion that the virus was spreading within the community. This evidence helped change the CDC stance and allowed hospitals and clinics to start testing people without a travel history. “El Camino Health was a pioneer in that regard and did a great job working with both local and national health authorities to impact policy,” said Zach.

Great leadership pays off in best practices

El Camino Health was also at the forefront of smart preparation by setting up a 24/7 “command center,” comprised of leadership from the hospital administration, nursing and other groups within the organization. The center ensured that one or more healthcare professionals were (and remained) always available to manage the personal protective equipment (PPE) and information flow among different groups within the hospital, especially the emergency department and the ICU. Staffed constantly since early March, it contributed to open, transparent communication and consistent policies. As the situation and government recommendations continued to evolve and change rapidly, the center ensured there was always someone who had the latest information and could answer questions from any El Camino Health provider, no matter the time of the day.

“The leadership team at El Camino Health, as well as the infectious disease specialists, including Dr. Dan Shin, Dr. Carol Kemper and Dr. Daniel Chelliah, have all been tremendous,” said Zach. “They acted very quickly and prioritized open and active communication. The executive team has been very participatory and very present physically in the hospital, spending time at the command center, walking the hospital and being in the trenches — really creating a sense that we are in it together.”

The hospital has also shown incredible leadership around stewardship of PPE, which has been particularly important for N95 masks that are in high demand but short supply. El Camino Health recognized this concern and recommended that providers conserve resources early on. Best practices included placing a surgical mask over the N95 mask to protect it from exposure so it could be used throughout the day.

The El Camino Health leadership team and PAMF also prioritized mental health and well-being in these stressful times, with extensive effort and attention given to wellness and selfcare, which has been exceptionally well-received.

Helping other hospitals and organizations 

Once El Camino Health had its processes in place, it quickly moved to communicate more broadly with other entities, including PAMF and other local hospitals, to share best practices and lessons learned. The El Camino Health infectious disease team was invited to give the first Grand Rounds at Stanford focused entirely on COVID-19 in early March. When the local nursing homes began to struggle, El Camino Health quickly stepped in and offered to share equipment and staff.

“The hospital has remained a beacon in the community. It deployed resources quickly and broadly and had the foresight to ensure it had sufficient protective equipment,” said Zach, crediting its dynamic leaders. “Thanks to the cohesive and proactive leadership team and a robust partnership between the administration and the medical staff, we were able to execute quickly, which is the goal of any community hospital or organization.”

Looking to the future

El Camino Health’s Taft Center for Clinical Research is currently participating in several clinical trials focused on COVID-19, involving both diagnostics and therapeutics, and has assumed an active role in the development of evidence around testing and management.

The physicians are hopeful that some of the therapies that have been approved or are being tested will prove to be effective. These include Gilead’s Remdesivir, along with some other currently available agents that could have potential benefit.

“The creativity within the scientific and research community has been astoundingly impressive. People are looking at large groups of patients and trying to figure out if there are tools and treatments already available that we can deploy to make a difference,” said Zach. “Obviously, it’s premature to know if any will be ‘magic bullets’ or prove to be helpful at all, but there is a good deal of hope and optimism, and that is also infectious in a good way.”

There’s also promise on the diagnostic front, with multiple platforms receiving FDA approval to come online for point of care and rapid diagnosis. Lastly, while immune testing is still in the early phases, it will eventually help answer crucial questions about the immune system’s response to the infection: Does it confer immunity? How powerful is that immunity and how long does it last? While answers will take time, they will be important tools that allow us to better understand the immune response and how it may guide policy within and even outside of healthcare.

The hospital will continue to closely monitor virus activity, particularly as states begin to open.

While immensely proud of the work done locally, Zach shares his deep appreciation for the healthcare heroes currently working in New York City and other hard-hit areas. “In clinical medicine, this is really the first known illness that we’ve had to treat simultaneously on a global scale and that can conceivably kill us. Of course, we deal with influenza each year and others have had to face SARS and Ebola, but those were on a much more limited scale, geographically,” said Zach.

“It’s been inspirational to watch the physicians, nurses, respiratory therapists, lab techs – the whole team – show up day after day to care for patients. Everyone at the hospital has been incredibly professional, courageous and compassionate, which really feeds on itself. There’s no doubt it’s been a challenging and humbling situation that takes a large emotional toll. What’s really helped me and many others is focusing on the basics: Exercise, journaling, spirituality, meditation, music and hugs from my wife and two daughters. They’ve been keeping me going.”

 

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