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MGH

Published On November 20, 2020

INTERVIEW

What Is Coming Next?

COVID-19 cases are again on the rise. MGH incident commander Ann Prestipino reflects on the road traveled so far and which next steps are critical.

In the fall of 2019, Ann Prestipino was teaching a course on hospital operations at Harvard Medical School. She brought in guest lecturer Paul Biddinger, chief of the Emergency Preparedness Division at MGH, who had the class work through a then-unthinkable scenario: A deadly flu pandemic hits a small community, straining resources, staff and supply lines. What should a hospital do?

Prestipino has been asking those kinds of questions her entire professional life. She chairs the MGH Emergency Preparedness Committee, which means that when the pandemic hit, Prestipino became the hospital’s chief incident commander, leading the nerve center through which critical decisions got made. Now that the first surge has subsided, her thoughts have turned to the coming winter.

Q: What scenarios are you mapping out for the months ahead? 

A: Right now we are trying to balance three tricky variables: non-COVID-19 patients, COVID-19 patients and flu patients. Those are all unknowns. Our decision was to make models and ask: What if we get the same number of COVID-19 patients as the last go-round? What if we got 50% of that number, and what if we got 150%? Everybody in our system has taken those three scenarios and translated them into surge plans. The guess right now is that we'll end up somewhere between the 50% and 100% mark. But that’s just a guess. Our experts have told me that two weeks in the future is about as far as we can accurately see, so we are preparing to move quickly if we see a second wave.

Q: If there’s another surge of a similar size, what will happen differently?

A: There has been so much clinical innovation—the proning of patients, the treatments we know to use and in what sequence and so forth. We’ve learned a tremendous amount and we’ll put that into play, which might make things easier in a second wave. We've also secured ventilators and PPE.

On other fronts, I’ll say that we’re very concerned about the mental health of our workforce. When you're dealing with a longitudinal situation like this—and we all know this pandemic isn’t over yet—you really need ways to revitalize and refresh staff. This includes thinking about their childcare issues, and how will those become more complicated because of school closures. It includes thinking about the anxiety of working in an environment where exposure to the virus is a daily reality. We need to do everything we can to support staff and their ability to be healthy and well.

Q: What about PPE supply, which was such a problem in the spring? Could it be worse if outbreaks are national or worldwide?

A: It was a problem, and as you probably know, the federal government didn't help us in any way. Again, this is a situation where modeling is the answer. We drew expert analysts from departments all over the hospital. They did an incredible job looking at what was ordered, what was allocated, what was actually being utilized. They projected how many people might need to go into a patient room and what that meant in terms of masks, gowns and our 14 or so critical supply items. When things started, we had about a two-week cache of these critical PPE supplies. Now, with additional kudos to our supply chain folks, we are working toward a four-week cache in addition to a more secure supply line.

Q: Will there be other changes?

A: MGH did see a disproportionate number of COVID-19 cases. As proud as we are of having taken care of these very sick
patients, the exhaustion of our staff points to a need to balance that load across the system and ideally across the city. And better utilizing other hospitals would be good for the patients too. There are also a few kinks in testing still to be worked out. We learned the breadth and depth of our laboratory capabilities, and how you have to shift strategies depending on the availability of lab and testing supplies.

Q: What are your takeaways from the first surge?

A: We’ve learned the importance of muscle memory, meaning that both drills and experiences of past mass casualty events and other disasters are instrumental in creating a skilled and nimble staff. People here did and have always done an extraordinary job. My main takeaway, frankly, has been a great sense of pride in the institution's resiliency and our ability to respond to anything that comes our way