As virus ebbs, BMC eyes next challenges

Hospital checklist: Secure test kits. Provide postponed care. Prep for next outbreak.

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PITTSFIELD — After admitting the state's first coronavirus patient March 7, Berkshire Medical Center staffers were among the first to care for a surge of people sickened by a new disease.

Today, with a handful of COVID-19 patients, the hospital is in the vanguard again, as officials look to the next medical need.

Even before restrictions are lifted fully on elective procedures at Massachusetts hospitals, caregivers at BMC are reaching out to people who delayed care and need it urgently.

"Our world changed in early March. We adapted and we adjusted," said Dr. James Lederer, chief medical officer and chief quality officer for Berkshire Health Systems, the hospital's parent company. "But, always in the back of our minds was the worry that we're missing people who need care."

To be sure, the disease remains a focus as BMC leaders press to obtain a reliable supply of test kits and prepare to handle a fresh outbreak.

Should that second wave come, the hospital would be in a different situation, officials say, given all that staff has learned since March.

Now, COVID-19 patients would arrive in a hospital that has banked plasma collected from people who recovered from the coronavirus and has a supply of other emerging therapies against the disease, including Interleukin 6 (known as IL-6) and the experimental drug remdesivir.

Doctors also can determine more quickly who is infected. The hospital has a limited supply of test kits that produce results in 45 minutes; they mostly are used with patients in the emergency department.

Other tests return findings in 24 to 48 hours, compared with waits of up to 10 days in the early phase of the pandemic.

COVID-19 admissions stood at four Saturday, down dramatically from the 25 confirmed and 25 suspected cases the hospital faced in March as it struggled to secure tests and dealt with staff exposure to the disease.

As of Saturday, BMC had cared for 94 COVID-19 patients and discharged 74. Seventeen people died of the disease while at the hospital. Most of the 479 people who tested positive at BMC recovered on their own in the community, according to statistics provided by the hospital.

The past two months have taken a toll on the institution as well. David Phelps, president and CEO of Berkshire Health Systems, estimates that the nonprofit has been losing $23 million in revenue a month. It projects losses of up to $65 million, not counting the $15 million it received through the federal CARES Act.

At the peak of its COVID-19 admissions, the inpatient census in mental health fell 30 percent. Care provided in the emergency department was down by the same amount.

"We should count our blessings that Berkshire Health Systems is financially successful and we start with resources," Phelps said. "So our clinicians and our staff never had to worry about where they'd have to do their jobs or were subject to furloughs."

Though it remained open, the Pittsfield hospital lost up to 40 percent of its business in the initial months of the pandemic, Phelps said. To get that back, BMC is encouraging patients to come in for postponed medical care once the governor's office sanctions the resumption of elective procedures.

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To do that, the public must overcome fears of contagion, officials concede.

"We've scared folks so significantly over this virus that we turned the hospital from a place that was safe and nurturing and helpful to one that now you had to be scared of," Lederer said. "And that's not us at all."

As it rebuilds lost business, BMC still must engage in the kind of triage that guided its care for coronavirus patients.

"The backlog is so significant that it will take time, and so we still have to apply the greatest benefit to the most needy," Lederer said.

Phelps says the hospital has crafted guidelines to evaluate the changing medical needs of patients who delayed care during the pandemic.

"They've worsened over time, as you might imagine," he said. "They need to avoid future issues that would be far more problematic if they're not tended to."

With the crisis of rising COVID-19 admissions over, Phelps said the hospital has been preparing to again provide its normal range of medical care.

Already, the weakened medical condition of incoming patients is being felt, said Brenda Cadorette, a registered nurse who is BMC's chief nursing officer.

"Even though our census remains low, lower than normal, I think our acuity is higher," Cadorette said, referring to a measure of sickness. "It seems people have waited and they are now sicker when they come in."

Some of those patients were cared for in BMC's intensive care unit, even as ICUs in other hospitals around the state filled with COVID-19 patients.

Lederer said the hospital has been contacting patients who postponed care due to the pandemic.

"I think it's the population of patients who still have a significant concern and fear of COVID in general, and the environment that we're in," he said.

"That level of fear prevents them from getting their test or their screening or their procedure. And we are inviting the high-risk people to come back," he said.

"We call them, we connect with them, we make sure they're still otherwise healthy and apparently COVID-free by symptomatology. And we test all of these patients before they come in for their procedures. But, it has to be a patient decision to be a part of that."

Larry Parnass can be reached at lparnass@berkshireeagle.com, at @larryparnass on Twitter and 413-588-8341.


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