John Sikes, CRNA, MBA, ACHE, Chief Executive Officer
March 30, 2020
We are all experiencing a pandemic from an infectious disease called coronavirus, or COVID-19. As employers, the primary concern is always the protection, health and well-being of your employees. The coronavirus is caused by the severe acute respiratory syndrome, coronavirus 2 (SARS-COV-2), and is part of a large family of coronaviruses (CoV). It is believed to have started in late December 2019 in the city of Wuhan, China and now has now spread to 200 countries and territories. Coronaviruses are transmitted from animals to people, with this strain of coronavirus thought to have originated from a seafood market in Wuhan. While the initial symptoms of COVID-19 resemble that of the common cold, the infection can lead to pneumonia, multi-organ failure, severe acute respiratory syndrome and even death. The elderly and those people with preexisting chronic health conditions have accounted for most deaths from COVID-19.
Any leader of any company must take this type of outbreak seriously from the very beginning. Specifically, in the anesthesia world, we must take it seriously due to the simple fact we are on the frontlines of healthcare if there is an outbreak in our state or community. It is prudent for us to understand the worst-case scenarios of any crisis and form an action plan accordingly. The physical nature of a pandemic virus such as COVID-19 can be devastating, both personally and to our organization. Let’s examine three physical considerations an anesthesia group must consider during the crisis: the virus, supply chain and anesthesia workforce.
The Virus: Do Not Take COVID-19 Lightly
Employers must take any pandemic seriously and begin educating themselves and their staff about the outbreak. A sign to take caution is when the outbreak is beginning to be covered by the news media and the government gets involved. It is not the time to debate internally over your company’s reaction or overreaction. Prudent leaders need to understand the ramifications of the pandemic and begin planning immediately.
The biggest concern around the COVID-19 virus is the fact that it mutated very quickly and has proven to be deadly. At this point in time, experts say and statistics have proven that the elderly and those people with multiple co-morbidities are most vulnerable to being infected and not surviving. The death rate in some countries is alarming. For example, Italy has had 101,739 people infected and 11,591 have died. In the United States, there have been nearly 3,000 deaths from coronavirus.
Finally, a virus such as COVID-19 should not be taken lightly because early on, no one could predict the extent or severity of the spread. Testing, treatments and vaccines take time to develop. Scientists are working around the clock looking for these answers, but in a matter of 3-4 months, COVID-19 has infected 776,000 people worldwide. Strict universal precautions, rigorous handwashing and social distancing are necessary to prevent contact and spread of the virus. When working in a hospital, constant Personal Protective Equipment (PPE) is always advised with an N-95 mask being worn. One Louisiana-based physician has written a thorough description of how COVID-19 patients are presenting and being treated, offering sobering insight into the severity of the virus, linked here.
Supply Chain for Anesthesia Care
The supply chain issues associated with COVID-19 extend to all types of businesses worldwide. In anesthesia care, there are several supply chain issues that can devastate an anesthesia group. The first supply chain issue is having enough PPE to safely care for infected patients and not put the anesthesia providers at imminent risk. The second potential supply chain issue is whether the facility will be able to replace surgical supplies as needed while the global economy is essentially stagnate. Thirdly, an impending anesthesia drug shortage is a top concern. What are the capacities of the emergency departments, intensive care units and operating rooms of your facility? What is the current ventilator supply level and do we have the personnel required to manage them? These are a few of the very issues that have shuttered anesthesia practices across the country. The unknowns have caused elective surgeries to come to a halt. Elective surgery will start again when there is a sense of a fully functioning supply chain and visibility of a flattening infection rate.
A crisis such as COVID-19 is a time when humans need to and should take care of humanity. Most anesthesia providers have chosen their profession with a primal desire to help people. In times of crises, people tend to do what they normally do, but harder—much harder. As healthcare professionals, we want to be part of the solution. So many have already stepped up to the plate and made a tremendous difference for the betterment of all.
Anesthesia professionals need to appreciate the potential devastation a virus such as COVID-19 could have on the workforce. We should consider some current facts regarding our profession:
- There is currently a provider shortage for both anesthesiologists and CRNAs.
- CRNA schools are producing the lowest number of graduates we have seen in a long time.
- 18% of CRNAs are over 60 years of age. Should they be on the frontlines of care?
- Our CRNA population is set to have record retirement rates over the next five years.
- What is the impact on your anesthesia group if you have one, two or three anesthesia providers test positive for COVID-19? How will that impact your surgery department during their two weeks of quarantine?
- If a working anesthesiologist or CRNA test positive, how would your facility handle all the people that were exposed to that infected provider?
As anesthesia professionals, we always want to help. In times of dire need, we come through every time. However, it is essential to be smart with how the skills of these extremely valuable people are best utilized. All anesthesia providers must be diligent in using protective gear and proper handwashing. Try to limit exposure by having the person who intubates the patient also place a central line and arterial line at that time. Separate your group into teams if possible, thereby limiting exposure if someone tests positive. Keep OB as separate from the OR, ER and ICU as possible to prevent cross-contamination.
Above all, anesthesia providers must work together during this time of crisis to provide the best possible care to every single patient. Even though our schedules have been changed, our expectations are different and our typical workday does not look the same as it once did, we must take our own health seriously so that we can best serve our patients. The health of our country depends on our physical wellbeing during this pandemic.
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