Prepared in San Diego: Scripps Health Readies for the Surge

The leadership team at San Diego­-based Scripps Health has experience at disaster preparedness and emergencies but even that preparation could not quite prepare any team for a public health emergency the scale of COVID-19.

It was the first week of February when 167 American citizens being evacuated from Wuhan, China, touched down in San Diego, on their way to being quarantined at Marine Corps Air Station Miramar. Now some two months later, projections from the University of Washington show that the state of California could see its peak number of cases in the next week.

The leadership team at San Diego­–based Scripps Health has experience at disaster preparedness and emergencies, dispatching medical relief teams to Haiti and Nepal after earthquakes, to Houston after Hurricane Katrina, and to the California wildfires of 2018. Not even that preparation could quite prepare any team for a public health emergency the scale of COVID-19, however.

HealthLeaders editor and leadership programs director Jim Molpus caught up with Scripps Health CEO Chris Van Gorder and Chief Medical Officer Ghazala Sharieff, MD, a few days ago on what they are expecting.

HealthLeaders: What have been the higher priorities as the team readies for the expected surge in COVID-19 patients?

Van Gorder: We are moving into a higher preparation phase. We are starting to work on our surge capacity. Our staff members were getting very nervous about contamination, so we put up our surge tents out in front of our hospitals and clinics. We quickly designed a methodology in which patients who were worried about potentially being infected could call, and our staff—in proper PPE—could approach them in their car and take test swabs.

HealthLeaders: When did you start to look at the supplies you would need for this sort of outbreak?

Van Gorder: Two months ago, we started trying to buy supplies and realized very quickly we were going to run out. Our major vendors, like Medline, and our GPO HealthTrust were already telling us that supplies were in short supply. Our supply chain people have done a phenomenal job of trying to source all sorts of things. And of course, through social media and on the internet now, and I must get half a dozen emails a day in which somebody knows somebody who can get a mask from China, et cetera. And our supply chain people run down every single one of those leads. Most of the time you find out that the masks that they're talking about are not accessible in the United States, or they're counterfeit, or they can't actually deliver the masks in short order.

HealthLeaders: How has the difficulty in testing affected the response for your team?

Van Gorder: Even going back to those first flights of quarantined patients from China who landed here, even then we wanted to test, but they didn't fit the very narrow criteria, so we couldn't get them tested. But right after the FDA allowed for emergency licensure of laboratories—literally within 48 hours—our laboratory was licensed, but our capacity was very limited. We could do up to between 40 and 80 patients a day, which is nowhere near what we needed.

Hologic is a lab manufacturer of equipment. They're here in San Diego, and have a machine called the Panther Fusion. That was to be the key machine if we could get ahold of it. At that time, [New York] Gov. Cuomo was calling Hologic and saying he wanted all [that] the company had in New York. And so, it took a little bit of local pressure, but we got the machine.

But then, after we got the machine that could do up to a thousand tests a day, we couldn't get the reagents for it. The reagents for that machine just came in two weeks ago, but we're limited to a total of 2,400 tests. Now our godsend may be the Abbott point-of-care testing equipment. It’s a complete kit with its own swabs. We can do a turnaround in five minutes on the positive test and about 13 minutes on a negative test. We'll be able to do a couple of hundred tests a day now, if the reagents and supplies last.

HealthLeaders: Have you begun to measure the financial impact?

Van Gorder: We stopped all our elective procedures and our visits and all those things. We're losing money as a healthcare system now for sure. Once you canceled that much work, our costs now are clearly exceeding our revenues. But we've got a strong balance sheet and can weather the storm. Hopefully, the government will continue to help hospitals catch up and get reimbursed.

HealthLeaders: Projections seem to change every day for what type of surge to expect. How do you plan for that?

Sharieff: We must be very creative at Scripps. We are thinking of how we can use our ambulatory surgical centers. Or can we use anesthesia machines in a surge to hold us over instead of ventilators. We are tracking throughout the day how many patients we have in ICU, and how many in medical-surg units.

Van Gorder: It’s a difficult question. How do you plan when you don't know what the numbers are going to be? We've looked at the national and state projection. We took the Johns Hopkins modeling, and our own data scientists had done our own modeling. It's frightening. We have roughly 1,200 beds, and our projections if we were successful in our community with a social distancing at 30%, then by June, Scripps would need 8,000 beds to be able to keep the capacity needs that this community is going to require.

That's why I've been so aggressive in working with the community, and we need to continue the urgency for social distancing and sheltering in place.

HealthLeaders: How do you keep communication up when things change so fast?

Sharieff: We do a daily update to all our staff, and they look forward to that daily update so we can share with them how much activity we have seen. And sometimes, even just within a single day the guidelines for treatment may change, so we're trying to keep all our staff informed on that as well.

HealthLeaders: Chris, on a personal level, you have some particular skills that may help, as a former police officer, reserve assistant sheriff for San Diego County, and a licensed EMT. Scripps also led medical relief efforts in Haiti and New Orleans after hurricanes. Do you think some of those lessons learned will help in a public health emergency of this scale?

Van Gorder: In a way, I feel like I’ve been training for this my entire life, but at the same time, how can anyone prepare for such an unprecedented situation? In Haiti, we expected not to have the tools we would normally have to do the job. As a result, we did what we could for those we could help. Katrina was much the same, and we were okay with that. As a law enforcement officer, you never know what you will run into, but you know you must trust your training. You know you’re expected to run in when everyone else is running out.

This emergency will require a different attitude from those in healthcare. Here at home we expect to have everything we need, and if we don’t have it, we know we can ask for it and get it right away. But as we see some areas surge beyond their capacity and critical supplies become harder to come by, we have got to learn to be more flexible and innovative, and maybe even break the rules to help our patients, community, and even each other.