Houston We Have a Problem: Ground Zero for the US Coronavirus Outbreak

Friday, February 28th, 2020, 4:15 PM—Houston We Have a Problem

I looked at my messages and noticed I had missed a call from the county's health district epidemiologist. I wondered what she was calling about but wasn't too worried. As the contact person for infectious disease at our clinic, it was not unusual for me to receive communication from the health department. When she answered the phone, I jokingly asked her what she had to report late on a Friday. What she said next changed our world: two days previously, a patient in our clinic had tested positive for coronavirus (COVID-19).

As I listened, gathering the details, I frantically looked up the case. I typed a message furiously to my chief medical officer:

Houston we have a problem.

One of our patients tested positive for COVID-19.

I am on the phone getting the details.

Press conference at 7:00 PM.

Reviewing the chart, I saw that the patient was a local high school student who had presented to one of our clinics two days earlier. He had a high fever and a rash. The patient had not traveled outside the country. In our electronic medical record (EMR) system, the screening algorithm identified the patient as potentially infectious. He had been appropriately triaged and placed in a room with a mask on. The providers taking care of him documented that they wore appropriate personal protective equipment. So far, so good.

Washington State—Ground Zero for the US Coronavirus Outbreak

Six weeks before I got this call, the first person hospitalized due to COVID-19 had occurred at a hospital in town. Now reacting to the first community-acquired case of COVID-19, The Everett Clinic opened its command center at 6:30 AM on Saturday, February 29. As it was a weekend, the focus was on containment. Initial operations focused on developing an urgent care strategy, placing greeters at all clinic entrances, and supply chain assessment.

From our previous experience with the 2009 H1N1 pandemic, we knew that diagnostics and supply chain management would be challenging. Our immediate concern was our supply of N-95 respirator masks. I led the clinic's response during H1N1, so we had a plan. Post H1N1, in the after-action review, we created a disaster response depot in our warehouse. Included in this were plastic barrier gowns and N-95 respirators. The Director of Materials Management instructed her team to place orders for more N-95 respirators and surgical masks immediately. We hoped the orders placed over the weekend would be in the front of the queue before the distributors were inundated with orders on Monday. We were relieved after the Director and I drove to the warehouse, pulled three pallets, and located our stash of N-95 respirators. Our relief was short-lived.

Monday, March 2^nd—the Command Center

I was seated next to the Director of Materials Management in the incident command center when she informed me that over 10,000 surgical masks had been issued over the weekend. At the current utilization (burn) rate, we would soon have a critical shortage. In the 12 months preceding the pandemic, the clinic used 360,000 surgical masks, at a burn rate of approximately 1,000 per day. We projected that we would need 100,000 surgical masks per month at a burn rate of 3,333 masks per day. This estimate was very accurate—we have used 1.5 million surgical masks in the 12 months since the beginning of the pandemic. Mask supplies were the tip of the iceberg—we faced multiple shortages throughout the pandemic.

The First Week's Response

The Everett Clinic was as well prepared to face the challenges of a pandemic as any organization. Our leadership was stable. Many of us had been part of the H1N1 response. We had cultivated close relationships with the Washington Department of Health (DOH), participating in the influenza monitoring program and submitting influenza specimens to the DOH for years. After the first case of corona-virus was hospitalized...