Difficult times characterized by health care heroism, ‘civic friendship’
Pandemic preparation: If needed, all of the Ross Heart Hospital's ICU beds can be put to use for COVID-19 hospitalizations.
Four weeks ago, Ohio Gov. Mike DeWine and Columbus Mayor Andrew Ginther announced they had made the difficult decision to limit spectators and cancel the expo at the Arnold Sports Festival to be held March 4-7. Central Ohio didn’t identify its first case of COVID-19, the disease caused by the novel coronavirus, until 10 days later.
Though the news surprised many, the decision reflected weeks of discussions among community leaders from many sectors about planning for what appeared imminent: an international pandemic that would become a public health crisis in the United States.
During an online panel discussion Tuesday about the COVID-19 pandemic’s impact so far, Andrew Thomas, Ohio State Wexner Medical Center’s chief clinical officer, reflected on the university’s ongoing preparedness efforts. The pandemic planning began with a conference call with 80 university participants on Jan. 22, one day after the first U.S. COVID-19 case was identified.
Disaster preparedness comes with the health care and higher education territory, and Thomas, also senior vice president for health sciences, said the medical center has been effective at ramping up patient testing, partnering with Battelle on filling supply-chain gaps and cooperating with Ohio hospitals near and far to prepare for the expected surge in COVID-19 cases. On March 12, the university announced suspension of face-to-face classes through spring semester and by March 16, employees who could were required to work from home.
Amy Fairchild, dean of Ohio State’s College of Public Health, hosted the panel discussion featuring Ohio State experts and guest speaker Irwin Redlener, director and founder of the National Center for Disaster Preparedness at Columbia University. Redlener, a national expert on the public health ramifications of large-scale catastrophic events, was scheduled to visit Ohio State for the event, which was converted to an online discussion over Zoom. President Michael V. Drake joined the conversation as well.
“Public health is the normally invisible foundation for healthy populations,” Fairchild said. “This moment in time has exposed the ways in which the foundation has collapsed. We need to see investment in a strong, fair, nimble public health infrastructure, not just to prepare for a pandemic, but to support and protect us day in and day out and year in and year out.”
Redlener called attention to the threat the pandemic poses not just to people infected with the coronavirus, but also to uninfected patients who need care for urgent problems or chronic diseases. Outpatient offices are closed and health care professionals are volunteering to shift their attention to the “COVID onslaught,” he said. “We are going to have trouble getting the kind of care that we’re used to. The world of the non-COVID patient is worth talking about.”
There are lots of unanswered questions – like when and how will this end – and a lot of people to worry about: at least 60 million Americans living in rural areas already short on health professionals, and low- and middle-income families that desperately need the federal relief checks approved by Congress to put food on the table.
But, Redlener said, we will emerge more resilient and able to adapt better to crisis as individuals and, ideally, as global citizens.
“If we come out of this situation with a new appreciation for the necessity of the international community to cooperate and collaborate to solve major planetary challenges … that would be a wonderful thing,” he said.
Between now and then, there will be a surge in COVID-19 patients in Ohio, said Michael Oglesbee, director of Ohio State’s Infectious Diseases Institute (IDI) and professor of veterinary biosciences.
The IDI has led a partnership among Ohio State academicians and clinicians, the Ohio Department of Health and the Ohio Hospital Association to design a “contact network” model that takes into account the effects of disrupting networks through social distancing. The model predictions are refined daily based on the latest symptomatic test-positive COVID-19 cases reported.
Current predictions suggest cases will peak in the second or third week of April. The cumulative number of cases over the surge could number as high as 210,000 – compared to an estimated 375,000 cases had Ohio not adopted widespread social-distancing practices. These predictions are still changing as testing capability improves, Oglesbee noted.
“Our most recent results indicate that the social distancing appears to be even more effective than initially estimated,” he said.
The social distancing and stay-at-home orders are taking an enormous toll on businesses around the state and nation, and eventually will cost a lot for the insurance industry, said Philip Renaud, executive director of the Risk Institute at Ohio State’s Fisher College of Business.
In times of crisis, Renaud said, businesses should first establish and maintain daily contact with a critical incident management team. This group can work together to identify essential activities and employees, communicate internally and externally while activities are reduced and help the company make an orderly transition back to normal practices.
“We’re not going to flip the switch and suddenly tomorrow have normal business activity,” he said.
Some people, including a host of Ohio State students, have been able to adapt quickly to what Moritz College of Law Professor Marc Spindelman described as a sort of ad-hoc mutual aid society, looking out for others’ well-being without expecting anything in return in recognition that “need is part of crisis.”
“The social distancing and isolation we’re practicing is a great heroic act of civic friendship,” he said.
Two examples: Medical students whose clinical rotations were suspended set up a child care operation for front-line doctors, nurses and other health care professionals whose lives were upended by the closure of schools. And Ohio State students are also behind the community-outreach Help Columbus Facebook page, where people can offer support or request aid.
This kind of arrangement, not mandated by government or law, Spindelman said, “works because it’s voluntary.”
Panelists pondered what individuals, institutions and governments should do, balancing what the science says with public policy implications, to help prevent an unmanageable spike in COVID-19 cases in the next couple of weeks.
Drake likened the aggressive social-distancing measures taken by colleges and universities to extending 30 feet of rope to someone treading water 20 feet from shore.
“I’d like to look at what’s the most we can do that’s likely to continue to have an effect, get there, bend the curve as flat as we can, and then release restrictions in a gradual fashion as we see that it’s safe,” he said.
Several panelists predicted that people will come out of the other side of the pandemic with more empathy for the needs of others and especially grateful to health care professionals for their loyalty and commitment. Oglesbee noted that we should also be on the ready for the next infectious disease that inevitably will come along.
“We really need to maintain vigilance in the absence of disease,” he said. “The problem goes away and we forget about it. We cannot do that.”
