By DALE SINGER
When Dr. Amy Compton-Phillips explains how Providence Regional Medical Center in Everett, Washington, treated the first patient in the U.S. to have been diagnosed with the novel coronavirus, three words came up often: abundance of caution.
As executive vice president and chief clinical officer of Providence, the hospital's parent system, Compton-Phillips took a crash course in the coronavirus in mid-January when the hospital began treating the man in his mid-30s who had developed symptoms after returning from a trip to Wuhan in China's Hubei province, the epicenter of the fast-moving outbreak.
The Centers for Disease Control and Prevention announced Jan. 21 that the patient in isolation at Providence Regional Medical Center was the first person in the U.S. with a confirmed 2019 novel coronavirus diagnosis. (The Associated Press reported the patient was released home from the hospital in early February.) On Jan. 30, the World Health Organization declared a global health emergency as the outbreak of coronavirus accelerated and spread well beyond China, where thousands of cases had been confirmed.
By Jan. 31, the CDC was screening travelers for symptoms of coronavirus at 20 U.S. airports. And by Feb. 3, Americans who had spent time in China in the past two weeks were being funneled through one of 11 U.S. airports to undergo enhanced health screenings. Americans who had been to Hubei province in the past 14 days faced the possibility of a federally authorized quarantine. At the time 11 cases of coronavirus had been identified in the U.S. and the risk of contracting the virus was considered low in the states.
Infectious disease protocols
Providence Regional and other U.S. hospitals train and prepare to safely care for patients with novel and potentially deadly contagious diseases. The experience gleaned from a widespread outbreak of the Ebola virus in West Africa a few years ago had helped sharpen training and protocols for infection prevention and control and safeguards in caring for patients in a manner that minimized risk of exposure to caregivers and others. The CDC said 11 patients were treated for Ebola in the U.S. during the 2014-2016 epidemic.
"We learned a lot from the Ebola scare," Compton-Phillips said. "We've been preparing for this. If you had asked me about this back in 2015, I wouldn't have been able to answer it the way I can now. We learned that we had to be prepared, because it was just a matter of time.
"We developed the capacity to use electronic medical records and to use protocols for isolation and infection protection, and we had drills to show we know how to use them. We tried to dot every I and cross every T. So far, it seems to be working well. We can't afford to be complacent."
First human-to-human transmission in US
The second patient in the U.S. with a confirmed case of coronavirus, a woman in her 60s who had traveled to Wuhan, was hospitalized at AMITA Health St. Alexius Medical Center in Hoffman Estates, Illinois, near Chicago last month. That hospital said in a statement that "given the advanced information and training provided by the CDC, our staff was well-prepared to care for this patient."
The patient was being "monitored in isolation, in accordance with established infection control protocols," the hospital statement said, and AMITA "has contacted the small number of patients and staff who may have come into contact with the patient."
At a press conference Jan. 30, Dr. Allison Arwady, Chicago Department of Public Health Commissioner, announced the woman's husband had shown symptoms of coronavirus and was being treated in isolation at St. Alexius Medical Center. The man had not traveled to China, but had been in close contact with his wife before she entered the hospital. He is the first person in the U.S. known to have contracted the illness in human-to-human transmission.
Limiting contact with other patients and with health care personnel is a key in treating coronavirus and preventing its spread, Compton-Phillips said. Using specialized equipment such as negative pressure room ventilation systems, and robots like the one seen here for communication and other tasks helps the hospital achieve that goal. Treating clinicians wear protective gear including helmets with a full faceplate and a blower to force air through a particle filter for the wearer to breathe.
"When you're taking a swab from a patient's throat or nose," she said, "there is a possibility for the virus to get into the atmosphere. We use negative pressure ventilation in rooms, so the air doesn't whoosh out when you're opening the door. It comes in instead. We use isolation chambers when we are moving patients (with infectious disease) through the hallways."
Robots are particularly good at facilitating patient communication and minimizing staff exposure to infectious agents, she said. "Every time you go in and out, there is a small risk, but you can never get it to zero.
"If you want to have a conversation with a patient," Compton-Phillips explained, "you don't have to do it with a nurse or a tech person in a full mask and gown and hood. The patient can communicate back and forth using a kind of FaceTime functionality."
The hospital also can send personnel to a patient's home for testing, to minimize public exposure before a diagnosis. At home, the patient can await test results, and self-quarantine until the outcome of the test is known.
"We use an abundance of caution simply because we don't know how this disease is going to progress," she said of coronavirus.
With the symptoms of the coronavirus similar to flu-like conditions that can be common in the winter months — cough, runny nose, sore throat, fever — anyone who suspects they have the virus should call a doctor, she said. Many people in the Seattle area have followed that course.
"They've traveled, they're sick, they're getting screened," she said of those with the highest risk. "That's the right thing."
But with all cases in the U.S. to date traced back to China, Compton-Phillips said, people who have not traveled there or been in contact with someone who has need not be alarmed.
She said that all of the common-sense techniques to avoid getting sick and spreading illness still apply — things like washing one's hands frequently, or avoiding others when one is sick. Following standard advice — get immunized for diseases one can help prevent and use good hygiene to avoid the ones one can't — remains the best path to follow.
"Whether it's SARS or MERS or Ebola," Compton-Phillips said, "those ways to fight germs are incredibly good."