Dr. Nanette Mickiewicz
On June 9, when Dr. Nanette Mickiewicz, president of Dominican Hospital, was asked how many COVID-19 cases were in the hospital, she said, “Zero.” That’s a big change from when the contagious coronavirus arrived in March.
Here she talks about prepping for the pandemic, using gear that provides more protection than N-95 masks, getting faster test results and adopting a game-changing treatment.
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You’re an infectious disease specialist. When did you and your team first become aware of this novel coronavirus coming out of Wuhan, and what steps did you start to take to potentially prepare for its arrival in Santa Cruz County?
One of the first steps was to set up tents outside the emergency department to screen incoming patients with respiratory symptoms for COVID-19.
We learned about the novel coronavirus at the same time most everyone else did, back in November of last year. In early January, well before the full scope of the situation became clear ━ that we were facing a global pandemic ━ we activated our emergency preparation.
Though it was the challenge of a lifetime, it also provided an incredible opportunity to put our robust emergency plans into action. We have trained for this. We drill multiple times a year to ensure we are prepared for an eventuality such as this. We immediately put together a COVID-19 task force and set about to ensuring we were equipped to handle any surge in patients.
A lot of our preparation mirrored what we do every single year to address seasonal flu. As unprecedented as the situation was, we also felt that we were starting from a place of comfort and deep expertise.
How did you ramp up your testing, forecasting and precautions? What obstacles did you face?
First, we made sure we were following all guidelines from the local and state Departments of Public Health and the Centers for Disease Control (CDC) with regard to safety precautions for both staff and patients.
That was our first priority.
We applied our considerable experience in preparing for H1N1, SARS, MERS, and Ebola throughout the years. The biggest ongoing obstacle has been obtaining the various supplies needed for testing. However, the County and Stanford have been very good partners, and we worked closely with them to successfully escalate testing.
Our parent organization, CommonSpirit Health, has also been very supportive in terms of getting us the supplies we needed.
Part of these preparations was assessing how much personal protective equipment you had, ventilators and ICU beds.
What did you do when you realized the quantity of resources you would need to combat this coronavirus?
A pop-up market created by staff in Environmental Services and Nutrition enables hospital employees to buy necessities that can be hard to get.
When the scope of the issue became clearer, we immediately stood up our Incident Command Center, and began to hold daily COVID-19 task force meetings.
We quickly developed and implemented a plan for managing personal protective equipment in partnership with our employees and our physician staff. We were fortunate to have adopted the use of controlled air purifying respirators, which are more protective than N95s and can be reused.
We already had a large stock of controlled air purifying respirators and our staff had been trained on their use.
Room capacity was another consideration. Within a week, we figured out how to nearly triple our ICU bed capacity and we identified other, specific areas of the hospital for the treatment of COVID-19 patients.
We had ventilators of our own already, and rented additional units. We also had all the equipment needed to transform regular patient rooms into negative airflow spaces.
Ensuring we had an adequate staffing pool was paramount. We worked to cross-train nurses and clinical staff, so that they could support multiple areas and needs within the hospital.
The outpouring of generosity from our community at this time has been incredible. From personal protective equipment to Plexiglas for our lobby area, to meals upon meals for our staff, we have been surrounded by their love and concern.
To support our staff, our Environmental Services and Nutrition teams developed a pop-up grocery store in our café with food staples and toilet paper! So many people inside and outside of the hospital have stepped up.
When did you get your first case? Can you describe that situation? How did you confirm it was COVID-19?
We aren’t permitted to share details due to patient privacy rules, but information can be found on the county website.
When did you realize there was community spread of COVID-19?
As a part of our Incident Command Center and COVID-19 task force activities, we participated in daily meetings with the county Health Officer, Dr. Gail Newel.
She and her team did an excellent job of keeping us updated, and immediately shared with us when they’d confirmed community spread had occurred.
Take us inside the Emergency Department and the ICUs during the peak of COVID-19 admissions. When was that? What was it like for your doctors and nurses?
A Dominican Hospital staffer, wearing a controlled air purifying respirator, along with a face-shield, does a swab test on an employee. This helmet system provides more protection than an N-95 mask and can be reused.
One of the first actions we took to support our Emergency Department and ICU was to set up our emergency tents.
During the height of COVID-19 volume in March and early April, they served as an extension of our ER waiting room. All patients with respiratory and/or flu-like symptoms are being triaged and screened for COVID-19 in these tents, rather than inside the Emergency Department.
Fortunately, we haven’t really seen a real peak yet, but should there be an influx of patients requiring care, these tents will allow us to expand our regular capacity.
Our staff and physicians are active participants in our regular emergency drills and so are well-prepared. However, reminders are important, especially in times like these.
Our Infection Prevention and Clinical Education teams developed an educational program for our staff and physicians on proper donning, doffing, cleaning, and storage of personal protective equipment.
They were also trained in proning—a method of ventilation in which patients are positioned face-down prior to intubation for optimal oxygenation—and vendors were tapped to provide protective intubation boxes.
Before we had testing capabilities onsite, every patient meeting the symptom criteria for COVID-19 was treated as a person under investigation, and many were admitted. It was quite tense for our patients and their loved ones, staff, and physicians while we waited for test results to come back.
Once we were able to test in-house and obtain results in a matter of hours, anxiety levels came down.
At the peak of the surge, what was the single biggest challenge your hospital faced?
We struggled with two big challenges as the volume of potential COVID-19 patients spiked: testing capacity and turnaround time, and the constantly changing guidelines coming down from the CDC and state and county health departments.
Though testing timeframes took a while to get to where we needed them to be, we were always able to successfully diagnose or rule out COVID-19 and treat patients accordingly. We are grateful to our partners at the county, Stanford, and other laboratory sites, and most importantly to our outstanding Lab department. They are superstars.
The guidance from the federal, state, and county levels was changing constantly as understanding of this new virus evolved and new information became available. We had to be nimble and make rapid adjustments accordingly. Our infectious disease leadership adjusted in real time, and worked tirelessly to make sure our staff was aware of each new development and requirement.
What did your staff find to be the most effective treatment for people hospitalized with COVID-19?
Dominican was fortunate to obtain convalescent plasma early on, and it has been a real game-changer. It provides patients suffering from severe COVID-19 with antibodies, helping to boost their ability to fight the virus.
Recently, the county has secured a stock of remdesivir, which has been shown to be effective in treating patients with COVID-19. Dominican has been able to obtain some of this stock to have ready for any positive patients in our care.
What are your concerns as you look to the months ahead?
As we move forward into a “new normal,” Dominican’s priority will be to make sure we have adequate stores of PPE and testing in the community. Thanks to our preparation and careful management of these resources, we’re feeling good on both of those fronts right now.
Our community is slowly beginning the process of reopening, and we know what a relief that is for everyone. We just ask—plead, really—that folks continue to take all appropriate precautions. Wear your masks when you are outside the house, socially distance, wash those hands over and over and over.
Santa Cruz County has been a model for successful COVID-19 response and our infection rate reflects that. But remember that the virus is still out there, and we want you all to remain safe and healthy.
We’re hearing about hospitals running huge deficits due to the cancellation of elective surgeries and empty beds. Can you share the situation at Dominican Hospital? How will the hospital weather this financially?
One of the most significant ways Dominican has helped prevent community spread of infections like COVID-19 is to limit the number of people inside the hospital. To that end, we have been significantly restricting visitors to the hospital since early March.
With a few exceptions, like a birth partner in our Birth Center, visitors are not permitted.
Dr. Mickiewicz describes lab employees who process COVID-19 tests as superstars.
We can’t thank our community enough for their patience with us and their compliance with our policies. They have dutifully stayed away, and significantly helped us reduce traffic in the hospital—and in so doing have greatly reduced the risk to our patients and staff.
That said, it is vital that the community knows it is safe to receive at Dominican.
Like many hospitals nationwide, Dominican Hospital has seen some decline in admissions for conditions like heart attacks and strokes, suggesting that patients are putting off or avoiding ER visits.
The important thing to remember is that ignoring symptoms and postponing your care may increase your risk of serious complications. Our hospital and our Emergency Department are safe, and ready to provide immediate care for urgent and life-threatening conditions.
We continue to take significant steps to ensure it remains safe to provide and receive care at Dominican, including our strict visitor policy, screening all patients for COVID-19 symptoms and ensuring they are wearing a mask, daily staff symptom monitoring, rigorous social distancing, isolating patients with suspected or confirmed COVID-19 from other patients at the hospital, enhanced cleaning and disinfection processes throughout the hospital, and adjusting operating room schedules to allow for additional cleanings after each procedure.
Dominican Hospital has successfully managed infectious diseases alongside standard patient care for generations. We have weathered many storms in our nearly 80 years of service to this community, and through it all have always put patient safety first.
Given the lessons you learned, how do you change the way you prepare going forward?
This experience has really reinforced a lot of our established processes.
Moving forward, we will continue to activate our Incident Command Center early, to allow us to act nimbly and proactively, as we have been able to do in this case. This unique challenge has solidified our partnerships with the county and our community.
We have been in the trenches together, supporting each other and relying on each other, and that collaborative spirit will be so important when the next emergency arises. We are so lucky to be part of such a caring and resilient community. It is our greatest strength.
Photos provided by Dominican Hospital