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Strategies from hospitals on the front lines of the COVID-19 fight

COVID-19 is a huge challenge for many U.S. hospitals, from large cities to rural areas. The next few weeks are expected to be especially difficult, as critical supplies dwindle and health care workers are stressed. William Brangham talks to Dr. Phillip Coule, chief medical officer for Georgia’s Augusta University Health System, and Michael Dowling, president and CEO of New York's Northwell Health.

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  • Judy Woodruff:

    As you have been hearing, this is a tough time for many hospitals in larger cities and in smaller ones. And there are growing concerns for rural areas as well.

    The next few weeks are expected to be especially difficult, as workers are pressed, and there is serious concern over a lack of protective equipment.

    William Brangham has the latest in our series of conversations with health care workers and officials on the front lines.

  • William Brangham:

    We get two perspectives on this now from two different medical centers around the country.

    Dr. Phillip Coule is chief medical officer for Augusta University Health System in Georgia. And Michael Dowling is president and CEO of Northwell Health in New York state.

    Gentlemen, thank you both very much for being here. I know you're both busy, trying to care for all the people coming through your doors. And we appreciate you being here.

    Michael Dowling, to you first.

    We have all who are — all of us who are not in New York are following what has been going on there, and we see how difficult it seems to be. You run the biggest health care system in that state.

    Could you just give us a sense, how are things there? What are your ICUs like? Are they full now?

  • Michael Dowling:

    Yes, obviously, we're in the epicenter right now in New York.

    So, it is hectic, extremely busy. The numbers are pretty extraordinary. In our health system alone right now, we have got about 2,500 positive patients, COVID-positive patients in our hospitals. That grows every day by about 300.

    So, life changes. I mean, everything about a hospital, everything about the way you worked a month, a month-and-a-half ago is all different. The hospitals are all working together. We're collaborating, but we're managing and trying, obviously, to stay ahead of it, because we're in the midst of a major, major battle here with a very resilient competitor, the virus.

    But my view is that we will persist here and, at the end of the day, we will make sure that we win in this battle against this virus, and that's the way — that's the optimism you have got to have in a situation like this.

  • William Brangham:

    And, Dr. Coule, I understand, being in Georgia, you might be a little bit behind where New York is right now. I understand that you have been doing an enormous amount of testing of patients and of people in the general population.

    Can you give us a sense of how — what the value of that testing is, what it allows you to do?

  • Phillip Coule:

    Sure.

    So, we do have advantage of being later in this wave of patients that we expect from COVID-19. We have a distinct advantage, being an academic medical center at Augusta University, where we were able to get ahead of the curve on testing.

    And we have been testing quite some time, a very efficient telemedicine screening program, as well as a drive-up testing program, that has allowed us to identify those at risk and identify positive cases to help us stay ahead of this.

    Other areas within Georgia, as you know, even rural areas, have been hit hard, particularly Albany, Georgia. Some of those patients are being transferred to us. And then some other rural areas where this appears to be hitting harder, those patients are coming the our facility.

    But as of right now, we have a team that has helped us keep ahead of this thing.

  • William Brangham:

    And I'm curious, Dr. Coule, staying with you for a moment.

    We know that lots of hospitals facing very, very sick patients have had to wrestle with these very wrenching decisions, that, in an era of limited capacity, a limited supply of things like ventilators, that people have to wrestle with, how do we decide who gets a scarce ventilator and who doesn't?

    How do you think about those things? How do you as a system debate those things?

  • Phillip Coule:

    Sure.

    So one of the principles of a disaster is triage, and you have to triage and make very difficult decisions about who is the greatest benefit for a ventilator.

    For example, if you can predict that a very elderly patient is not going to survive, then perhaps, if you do have scarce resources, then you need to reallocate that resource.

    Now, we're not to that point, and we're — have the advantage of being able to have those discussions in the setting of the calm before the storm. Others, unfortunately, have been thrown into making those very difficult decisions very early.

    As it stands now, our medical center, we are counting the surplus of ventilators. We are worried about it, but, right now, we're in good shape.

  • William Brangham:

    Michael Dowling, obviously, as the head of a much bigger system, I'm curious.

    You have an enormous number of employees who are working with people on the front lines. How is your staff, how are those front-line workers holding up? How are they doing?

    I understand some of your staff have already themselves become infected.

  • Michael Dowling:

    Yes, we have had quite a number of staff infected, both on the front lines, as well in as in the management staff.

    But I have been out on the floors, and I have been out in the ICUs, and out meeting with staff. And I can tell you that, when you're out there and you watch the dedication and the commitment of these staff, it is pretty extraordinary.

    A key part of it, of course, is making sure that you have the supplies. All of the debate in the national media about masks and gowns and gloves and ventilators gets people concerned, not only the providers, but also the public.

    But when you're able to assure your employees that you have the masks, that you have the PPEs, personal protective equipment, that they don't have to worry about that, that one of your mainly foresight is to make sure the staff is safe and secure, that helps enormously.

  • William Brangham:

    Indeed.

    Dr. Coule, we have been seeing governors, mayors, public health officials all across the country saying, we need everyone to stay inside. If you're not an essential worker, please stay home, keep your distance from others.

    I understand that that has been a particular challenge in rural areas around you, where people simply are not listening to those warnings.

  • Phillip Coule:

    It has.

    In fact, we were particularly concerned about our churches and houses of worship, and actually actively — our pastoral staff actively reached out to them to encourage them to not hold in-person services.

    Unfortunately, we do have some churches to the south of us that we either didn't reach or they didn't get the message, but they held in-person services despite that. And we're now seeing the impact of that with outbreaks that are tied to those churches.

  • William Brangham:

    All right, you both are obviously doing incredibly important work, and we thank you both very much for being here, Dr. Phillip Coule and Michael Dowling.

    Thank you both very, very much.

  • Michael Dowling:

    Thank you so much. Thank you.

  • Phillip Coule:

    Thank you for having me.

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