WASHINGTON -- In the spring of 2020, the doctors and hospital staff at Fort Gordon, Georgia, prepared to face an unfamiliar adversary in unfamiliar conditions.
Then the patients started pouring in.
“COVID-19 was a curveball for us,” Col. Carlene Blanding, commander of the Eisenhower Army Medical Center, said Thursday during a live discussion.
At Eisenhower, a white rectangular structure on Fort Gordon’s northeast end, the medical staff had no formulated outline to respond to the pandemic. They only had emergency procedures for an H1N1 outbreak. “We looked at this plan and found that it really was not going to be viable for COVID,” said Col. Charles Haislip, deputy commander for clinical services.
During the tumultuous early days of the COVID-19 pandemic, doctors and nurses at this Army installation wedged in the eastern Georgia community of Augusta found themselves scrambling for answers.
How could they continue to serve their patients, both in emergency and non-emergency capacities, while meeting COVID-19 safety protocols?
“It was almost as if we were transported to 200 years ago of the practice of medicine, where as a provider, there is no targeted treatment for these patients,” said Lt. Col. Ian Rivera, a staff nephrologist.
Without a known vaccine at the time, hospital staff felt helpless as they watched COVID-19 patients wither.
“You were figuratively relegated to sitting at your patient's bedside … holding their hand just praying they can make it and supporting them through that,” Rivera said.
The pandemic hit closer to home when a member of Rivera’s staff contracted the virus.
The medical teams had to lean on each other’s expertise and lessons learned from previous pandemics. They spent two weeks in late June 2020 devising a multi-disciplinary plan that not only met the expectations of patients and stakeholders but kept staff free from infection.
They learned they could not use time-based elements to build the plan, but base it from current conditions, Centers for Disease Control and Prevention data and guidance from the Army’s senior leadership.
Nearly 15 months later, the staff feels confident in their abilities to respond should another spike in cases arise. Rivera and his team also pioneered a new COVID-19 treatment by using a special filter for dialysis treatments with existing technology for dialysis machines. This allowed them to extract the virus from the blood of patients with extreme cases, such as pneumonia caused by COVID-19.
“I feel very reassured that I have in my toolkit options to give to patients who are at their worst with a truly virulent organism that is life threatening,” Rivera said. “And that speaks to all our teammates, not just at Eisenhower but across the globe.”
The distribution of vaccines by the Army has also helped curb the disease’s spread. Through July 12, more than 428,000 Soldiers have been fully vaccinated and over 479,000 at least partially vaccinated or about 66% of all active duty with at least one dose.
Nationwide, nearly 182 million Americans have received at least one dose of the vaccine.
Pandemic shift
The hospital initially went almost entirely to virtual appointments, except for some emergency cases in the intensive care unit. Some patients still awaited critical surgery appointments, as well as patients who had normal primary care screenings. They had to limit the number of staff physically at the hospital and have some physicians work from home.
“While we were protecting staff, we were unable to deliver health care like we normally do,” said Col. Peter Markot, deputy commander of administration. “We knew we had a responsibility to develop a restoration plan.”
The staff decided they could better serve patients by bringing their pharmacy outdoors. Pharmacists and staff stood outside for dozens of hours servicing customers as they picked up prescriptions in vehicles.
Col. Ron Gesaman, deputy commander of nursing, said that the pandemic severely impacted Eisenhower’s core lab. With limited ICU staff, the Army recalled retired doctors, nurses and medical staff to help care for patients.
Eisenhower leaders brought in five platforms to test for COVID-19 and synchronized its normal lab procedures to those needed for treating coronavirus patients.
“It was a big, big shift,” Gesaman said. “Our staff really trained themselves on those platforms.”
Eisenhower’s health care workers had to expand their ICUs from a 12-bed facility with individual rooms to a larger capacity, while still reserving eight beds for non-COVID patients.
“When you think of how we have pivoted from training nurses on how to take care of combat ballistic injuries to an almost completely foreign medical respiratory injury to patients that required us to do treatments that we've never heard about before, I’m very proud of the team and what we went through,” Gesaman said.
In the 15 months since, Gesaman said that they’ve implemented equipment and software upgrades to expedite processing prescriptions while providing a sanitized, disease preventative environment.
The staff compiled a 25-page paper describing what they could have done differently during pandemic response. Dr. James Mosher, Eisenhower director of operations, said that among the lessons learned the staff found that they can never keep enough testing equipment and supplies to meet the demand of care.
“You suddenly realize you don’t have enough,” he said. “When we went into areas of testing, we thought we had enough but because of the rate of people coming in that needed to be tested, we realized our order supply wasn’t there. What we needed from our vendors wasn’t making the shelf in time.”
They also realized the need to care for hospital staff exposing themselves to the virus and potentially risking their families.
Eisenhower’s staff learned how to shift schedules and care for staff whose work schedules had been impacted by closed schools and child development centers. They started communicating better through teleconferencing and phone calls and learned to distribute critical information faster. But more importantly they helped staff acknowledge and cope with their fears.
“This was very much the unknown,” Blanding said. “The mental health and the physical health of our teammates were very, very critical.”
By December, news of a possible vaccine brought hope to the staff and they eagerly awaited the opportunity to begin administering the vaccine later that month. According to recent data, COVID-19 hospitalizations have risen, but remain lower than in December.
Maj. Chris Dunbar, Eisenhower infectious disease physician, encouraged Soldiers and families to consider receiving the vaccine, as young people also can contract the disease. Getting vaccinated can also help protect vulnerable populations.
“I’ve seen firsthand just how devastating this disease can be,” Dunbar said. “This is not just a disease of the elderly and not just a disease of those who have multiple medical problems. But it is affecting young and healthy people, too. It can cause long-term complications.”
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