As COVID-19 spreads, Yale and hospital prepare
With COVID-19 cases multiplying in the region, Yale University and its medical affiliates continue to move as swiftly as possible to adapt and expand treatment areas, shore up supplies, and prepare doctors, nurses, and support personnel for long hours of intense work that could last months.
Yale leaders have been monitoring the global spread of COVID-19 for weeks and making predictions about local impacts. Early each morning, a COVID-19 advisory committee composed largely of Yale medical, nursing, and public health experts discusses the state of the virus’ spread and adjustments Yale might make to its response. Insights and recommendations that emerge are relayed to Yale President Peter Salovey and his leadership team.
The top three floors of Smilow Cancer Hospital have been converted into negative pressure COVID-19 wards for seriously ill patients. Lodging near Smilow and Yale New Haven Hospital (YNHH) has been arranged for physicians working long or back-to-back shifts. And more than 300 Yale School of Nursing faculty, students and staff have volunteered to provide support should cases surge. As necessary and appropriate, they would help with triaging, drive-by testing, bedside care, and support tasks at various sites.
Employees are even giving their own blood: Yale New Haven Hospital ran a blood drive for hospital and university workers.
“This is a rapidly evolving situation, but we are prepared,” Nancy Brown, dean of Yale School of Medicine, said in an interview.
Part of the five-hospital Yale New Haven Health system, Yale New Haven Hospital is independent of the university, but closely affiliated, serving as the teaching hospital for Yale’s medical and nursing students.
Cases of COVID-19 are rising around the country. As of March 26, there were more than 80,000 cases nationwide, in all 50 states, Washington, D.C., and Puerto Rico, major news organizations reported. More than 1,000 patients with the disease have died in the U.S.
To meet the anticipated spike in demand for health care in New Haven and surrounding communities, Yale’s Schools of Medicine, Nursing and Public Health are working in tandem with Yale Medicine, the medical school’s clinical practice, and the hospital, to equip and organize amid unprecedented circumstances.
The schools, health care providers, and hospital have been working to bolster supplies, including personal protective equipment, assessing patients by telephone and video when appropriate to minimize disease spread, and deploying medical, physician assistant, and nursing students to help with telehealth visits at the HAVEN Free Clinic, for example. The clinic is a student-run primary health care clinic that partners with Yale to provide the New Haven community comprehensive, high quality health care at no charge.
Students are also serving the elderly by delivering groceries and calling them at nursing homes to offer companionship amid intense social isolation.
“I realized how important it was for my grandmother to be able to socialize over the phone, and thought, ‘Why can’t I help older people in the New Haven community in the same way?’” said Laura van Dyck, a fifth-year medical student interested in geriatric psychiatry who contacted New Haven-area nursing homes to organize conversations among older residents and medical students. “It was very moving, in a chaotic time, to have 20 other YSM students respond right away to me, when I wrote seeing if people wanted to help.”
And from the earliest days, Yale’s medical leadership has been studying the best available evidence about how best to treat the new, fast-moving virus.
“Our clinical leaders have conferred with colleagues in China and throughout the world to learn from their clinical experience and enhance our protocols for caring for COVID-19 patients,” said Brown, the medical school dean.
Amid the clinical preparations, scientists across Yale are assessing the spread of COVID-19 and studying the virus itself.
Yale public health researchers are developing models of the pandemic that will help direct resources to the most urgent needs, for instance, while other researchers are studying how COVID infects cells, how the immune system responds, and ways of disrupting that process. The medical school’s Clinical Virology Laboratory developed testing for COVID-19 in-house, enabling rapid testing for health care workers.
Still others are exploring how patients’ genetics affect outcomes, initiating clinical studies for new therapies, and developing new ways of quickly producing essential medical equipment.
To coordinate these and related efforts, the university has established a COVID-19 Response Coordination team (CoReCT), a multidisciplinary, multi-school response spearheaded by Brown.
“Yale University and Yale New Haven Hospital have been working diligently to prepare for this pandemic,” said Yale President Peter Salovey. “I am proud of the work our doctors, clinicians, researchers, and students are doing to keep New Haven as healthy as possible — and to contribute meaningfully to the global fight against COVID-19.”
A gym becomes a field hospital
Preparations on Yale’s main campus are intended not only to care for the Yale community but also to minimize the strain on local hospitals. For example, Yale Health, which provides healthcare for the majority of Yale’s employees and students, has established a field hospital in Payne Whitney gymnasium’s Lanman Center.
With 50 beds to start and a maximum capacity of 100, it will serve COVID-19 patients from the Yale community, including students, faculty, staff and their dependents, who are not so ill that they require immediate hospitalization, but who cannot care for themselves. The goal is to minimize the burden on local hospitals as the disease spreads and the hospitals fill with the gravely ill.
“We hope we never have to use it,” said Yale Health Director Dr. Paul Genecin.
At present, the Lanman Center will fall under Yale Health’s license to deliver acute care, and as such is limited by the state to serving members of the Yale community (students, staff, faculty, dependents). Yale is currently exploring ways to make the center available to people beyond the university community.
Field hospital personnel will offer general care, such as monitoring of vital signs, plus provision of food and hydration.
“It will not be ICU-level care,” said Nanci Fortgang, Yale Health’s chief clinical operations officer.
Logistically, the conversion of the gymnasium into a temporary hospital has presented an array of technical challenges. For weeks, teams of nurses, doctors, facilities personnel, plumbers, electricians, and others have been transforming the center’s four basketball courts and circular track into additional treatment space for handling an expected surge of patients. Workers have installed hand-washing stations around the gym. Other workers have been building nursing stations, metal-framed rooms to house decontamination areas, a room for conducting higher-risk procedures if necessary, and a room where doctors and nurses can remove clothing that may have become contaminated.
“The crew we’re working with — they’ve done miracles here,” said Yale Heath’s Linda Ehrenfels, clinical manager and director of nursing.
The Lanman site also is likely to shelter some hospitalized COVID-19 patients who become well enough to be discharged, but who continue to need supportive care or who should remain sequestered from elderly or immune-compromised relatives. This use is intended to minimize the spread of infection to extended members of the Yale and New Haven communities and relieve hospital crowding.
“I am proud of this work,” said Genecin. “It will provide a critical backstop for members of the Yale community — but will also benefit the New Haven community as a whole. By mitigating transmission of the disease within Yale, and by preventing members of the Yale community from needing to go to the hospital, we will be easing the strain on local hospitals and clinics.”
“I’ve been at Yale almost 25 years. I’m an emergency room nurse by training,” Fortgang said. “I’ve never been involved in anything of this magnitude before. This is about our moral compass and our good citizenship, and trying to make a contribution in a situation none of us has ever been through before.”