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Cayuga Medical's facility in 2017.

August 13, 2020

How Cayuga Medical Center Treats COVID-19

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With the risk of over a thousand infections predicted by Cornell’s reopening plan, one pressing question still remains unanswered — how will you be cared for if you become seriously ill with COVID-19?

Dr. Douglas MacQueen ’00, infectious disease physician at Cayuga Medical Center, outlined the symptoms of a serious COVID-19 infection and how patients will be treated, while Dr. David Evelyn, vice president of medical affairs, discussed the hospital’s preparation for a possible surge in cases. Cornell Health medical director Anne Jones detailed how Cornell Health would contribute to student treatment for COVID-19.

In the case of a serious outbreak

Cayuga Medical currently has 23 ventilators and 212 in-patient beds, including 16 intensive care unit beds, MacQueen said. But if there’s a surge in patients, the hospital will add 27 ventilators and 106 beds. MacQueen said that Cayuga Medical has followed requirements of the governor and New York State Health Department in planning for an expanded surge capacity.

If Ithaca sees a significant increase in patients, Cayuga Medical will employ a broad definition of beds and ventilators. In addition to older hospital beds that Cayuga Medical has in storage, Evelyn said stretchers and cots may be used as beds.

Ventilators will include not only traditional ventilators, but also anesthesia machines and transport ventilators. Anesthesia machines have ventilator components, but according to the American Society of Anesthesiologists, they are not meant to be used long-term.

The hospital would transform outpatient portions of the hospital into inpatient care areas to accommodate a patient surge, according to Evelyn. Some operating rooms may be converted into intensive care unit rooms, but the hospital will keep two operating rooms for emergency surgery purposes.

Cayuga Medical will also need additional healthcare providers to care for the patients in the added beds.

“Staffing will be increased in two ways: moving staff from outpatients practices and these newly closed outpatient areas to the new inpatient areas, and increasing the number of patients that a given staff member had to care for,” Evelyn said in an email to The Sun.

Increasing the number of patients a staff member cares for could be a safety concern. According to a study of over 150 hospitals, the likelihood that a patient dies within 30 days after they are admitted to the hospital increases by 7 percent for every additional patient that their nurse is responsible for.

If this expanded capacity is not enough to sufficiently treat patients, Evelyn said Cayuga Medical will transfer patients to other hospitals. Most patient transfers would occur within the Southern Tier Hospital group, which includes Binghamton General, Arnot Ogden and Schuyler Hospital. However, patients may also be transferred to hospitals in Buffalo, Syracuse and Rochester.

Signs of serious COVID-19 infection

Those who contract COVID-19 may initially experience cold-like symptoms such as a sore throat, coughing, fever, aches and chills, according to MacQueen. MacQueen emphasized the importance of staying attuned to individual health — even if many are accustomed to ignoring cold symptoms.

“If [symptoms are] due to COVID, it’ll be important to be kind of vigilant and see if those symptoms are worsening, and if they are, to get treatment,” MacQueen said.

Most people slowly recover from the cold-like symptoms caused by COVID-19, but a small percentage of cases may start to feel worse, and, as a result, experience more pronounced coughing or shortness of breath.

MacQueen said that if an individual develops symptoms such as severe shortness of breath, elevated heart rates, and elevated breathing rate, this may be cause for hospitalization. Clinicians also look for low oxygen levels in the blood and imaging abnormalities from chest scans or X-rays to see if someone needs to be hospitalized.

Standard of treatment for COVID-19

For patients with milder cases of COVID-19, clinicians will use supportive measures to assess and manage symptoms. Similar to a bad cold, treatments focus on easing symptoms by staying hydrated and taking over-the-counter medications such as Tylenol or Advil to manage fevers, MacQueen said.

“The most important thing is to be monitoring yourself, [and] decide whether or not you need to come into a setting to be evaluated further,” MacQueen said. “The reason for that is a small percent, even of young, healthy people, may go on to get quite sick from COVID.”

If a student contracts COVID-19, they will have access to primary care providers who will work with them to ensure they are cared for, Jones wrote in an email to The Sun.

“Our nursing teams will perform monitoring with students to ensure their needs are met and arrange for any assistance needed,” Jones wrote. “We also work closely with the Crisis Managers in the Dean of Students Office to ensure each student’s social and emotional needs are heard and addressed.”

MacQueen said it is essential to come to the hospital for evaluation and extensive treatment if symptoms worsen — especially if individuals begin to feel increasingly short of breath.

Serious cases of COVID-19 can cause lung damage, making it difficult for people to get the oxygen they need. To reduce the possibility of COVID-19 lung damage, many treatments focus on supplementing lung function with additional oxygen and artificial breathing.

MacQueen explained that the first step of treatment for more serious cases is providing supplemental oxygen. Depending on the patient’s vital signs and oxygen levels, oxygen may be administered through a nose tube, a face mask or a non-invasive ventilator — which applies pressure through the face mask and supplies oxygen.

Patients with more extreme cases of COVID-19 may require intubation, which involves the insertion of a breathing tube into the airway through the mouth, according to MacQueen.

Lung damage is not the only risk that a patient with COVID-19 faces — the patient’s own immune system can be dangerous. Experts postulate that the coronavirus elicits a severe overreaction — called a “cytokine storm” — from the body’s immune system, causing fluid buildup in the lungs and organ failure that can prove fatal if untreated.

“The body’s immune response, which can be too intense or become unregulated, tends to cause lung damage and lead to people dying, as opposed to just the virus itself,” MacQueen said.

Cayuga Medical uses dexamethasone as one of its treatments for COVID-19, MacQueen said. Dexamethasone helps keep the immune system from overreacting too much and damaging healthy cells and tissue.

Another standard COVID-19 treatment is the antiviral drug remdesivir, which has been shown to shorten hospital stays in randomized controlled clinical trials, MacQueen said. Remdesivir tricks the virus into thinking it is a piece of viral genetic material, and once it’s incorporated into the virus, the virus stops replicating.

An often-overlooked aspect of hospitalization, MacQueen noted, is that New York State restricted hospitals from allowing visitors to see COVID-19 patients to prevent transmission of the infection. Although this means patients are unable to physically see their loved ones while sick, Cayuga Medical provides iPads and other technology  for virtual communication.

MacQueen said that those who are hospitalized for reasons other than COVID-19 are allowed to have visitors for a set number of hours each day.