Baystate Health has been leading the way in treatment for COVID-19 by keeping patients off ventilators

dhook

President and CEO of Baystate Health Dr. Mark A. Keroack reported that the health system has been able to keep more COVID-19 patients off ventilators at higher rates than nearly any other health system in Massachusetts. This has meant a much quicker rate of recovery and the ability for people to leave the hospital.

The Massachusetts Hospital Association releases data daily on the number of patients that are on ventilators. Hospitals across the state are averaging 35% to 40% of their COVID-19 patients on ventilators, Keroack told MassLive on Friday, adding that Baystate has had approximately 20% since the outbreak began.

The numbers are so low because physicians at Baystate are more reluctant to use ventilators for COVID-19 patients too soon because once they are on them a person’s lungs start to rely on aided breathing. This is partially due to a deconditioning of the chest muscles.

“It’s not that a ventilator isn’t good,” said Dr. Andrew Artenstein, the Baystate Health chief physician executive and chief academic officer. “Because obviously, if you can’t get enough oxygen, any other way the ventilator is lifesaving. The problem with the ventilator is it keeps you in the hospital longer.”

The unusual thing about COVID-19 is that a person could have very low levels of oxygen in their bloodstream but not feel uncomfortable because the body is getting rid of carbon dioxide very effectively.

“It kind of pulls people into thinking ‘oh my God, we’ve got to put this guy in a ventilator because his oxygen levels are low’,” said Keroack. “Well, what they really need is oxygen because they’re able to move out the carbon dioxide effectively.”

Artenstein said that a patient, once they are put on a ventilator, is in the hospital twice as long with the COVID-19 infection. So doctors at Baystate have been looking at treating their patients in one of two ways.

The first option is to attach a nasal cannula that administers a high-flow of oxygen that aids breathing. The second is to lie the patient in the prone position which opens a different area of the lungs to aid a patient’s breathing.

“It’s worked in other diseases and it may do a better job of just getting to the parts of the lungs that need to be opened up that need the oxygen,” Artenstein said.

With funding from the National Institutes of Health, Baystate has had a department that has almost two decades of experience in research of Acute Respiratory Distress Syndrome.

“We’ve had studies going on funded by NIH for years. Not around COVID-19, but around other types of what’s called, ARDS, acute respiratory distress syndrome,” said Artenstein. “There’s always been a lot of interest and work done on acute lung injury and [COVID-19] is a different version of acute lung injury.

Keroack also pointed out in a Q&A with Sen. Eric Lesser that one of the other issues that have been prevalent since the outbreak began is avoiding going to the hospital if there’s a problem.

“We are well below 50% of the capacity that we had built,” said Keroack.

Baystate had prepared beds for much higher numbers of infected, “thinking that we might have an epidemic that was as bad as New York for example.”

Keroack said that even though there is a pandemic, the hospital is still able to care for patients with non-COVID-19 related illnesses. As of Friday, there are 350 patients being treated for other ailments.

“One of the things we are hearing from our doctors is that patients may be waiting a little too long [for treatment],” said Keroack. “We’ve seen the number of kids with ruptured appendices’, for example, who if they came sooner would have had a much simpler operation or people with large heart attacks that might have had small ones if they came sooner.”

Like at Baystate, the majority of hospitals in Massachusetts have been very good at separating those that are infected with the virus and other patients, according to Keroack.

The supply of protective equipment has been difficult across the U.S. and in what was described as almost like a covert operation, Artenstein recently hit headlines after getting a supply of N95 masks to Western Massachusetts and navigating a couple of FBI agents who questioned them.

“I don't like to be held hostage by anybody and I don't understand why the greatest country in the world [is] relying on other countries to make this or make that. We need to get back to making things here in America,” said Springfield Mayor Domenic J. Sarno on Thursday. “We’re cannibalizing each other to get supplies, to get something we need.”

With the need for equipment increasing and the supply, unable to keep up with demand, Keroack told MassLive that he has been working with local manufacturers which he thinks will be the ultimate solution to the shortage.

“This may well do a lot to reverse what has been a trend towards globalization in the supply chain,” said Keroack. “I would certainly be willing to spend a little bit more on masks and gowns if I knew I had an in-state supplier that could be reliable as opposed to some supplier from China where the next pandemic could get [the supplies] shut off.”

The hospital is running low on gowns and is looking to use poncho’s that can be bought from stores locally as a solution.

“It's an acceptable substitute, but it's a little bit more clunky than the specially designed gown,” Keroack said.

Baystate facilities, as of Friday, are treating 137 patients who are confirmed COVID-19 cases, and 13 of these are in critical care units. There are also another 35 patients who are suspected of having the virus.

Baystate Medical Center in Springfield has the greatest number of COVID-19 patients in the system, with 127. Baystate Noble in Westfield has 6, Baystate Wing Hospital in Palmer has 4, and Baystate Franklin in Greenfield has none.

Baystate announced on Friday that its hospitals have now tested more than 4,000 people for COVID-19 and just under a percent have tested positive.

Baystate has treated and discharged 251 patients and transferred another 68 to post-acute care facilities. Another 363 did not require hospitalization.

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