Federal and state governments have important roles when it comes to fighting COVID-19 in the United States, but the rubber really meets the road at the local level.
In a 22 county region that includes San Antonio, that work is done by STRAC — the Southwest Texas Regional Advisory Council — a network of 35 hospitals and first responders. Eric Epley is STRAC’s Executive Director, and right now he’s running the show at the Regional Health Medical Operations Center — RHMOC.
The RHMOC is housed in a building constructed to withstand an EF-3 tornado. Much of the work is done in a room that looks something like Mission Control at Johnson Space Center in Houston.
The centerpiece is a giant screen with several displays and a satellite map of San Antonio in the center. There is a tracker of the number of COVID-19 cases in Bexar County, and as well as the Johns Hopkins world COVID-19 tracker.
Epley said these displays give the groups of people working their “situational awareness.”
For a cavernous room containing around 175 people, the operations center is surprisingly quiet and calm. People sit in clusters and are focused on their work.
“The Joint Information Center is right here with the media,” Epley said as he gestured toward a room of about a dozen people working studiously at laptops. Pointing to the groups arranged before the display, he identified the organizations they represent.
“Fire command staff. Police department. Metro Health obviously is one of the main agencies and the Regional Medical Operations center is right here,” Epley said.
In the Regional Medical Operations Center, representatives from the big hospital systems in San Antonio are in constant communication with smaller, rural hospitals throughout a region the size of West Virginia.
“They’re all assigned essentially a sister hospital to be their buddy and to make sure they’re getting the right information feed,” Epley explained, “And if those rural hospitals have any requests they can funnel them back in here to the regional operations center.”
One of the things everyone is focused on right now is increasing capacity. South Texas needs more Intensive Care Unit beds, more protective equipment for health care workers, more health care workers and more supplies — like ventilators. But it's hard to know how much more is needed.
“Capacity is one of those moving targets,” said Epley.
They’re working on it.
“All of the hospital command centers are activated and they’re meeting several times a day with leadership,” Epley said. “They’re having conversations with their physicians and those plans are in place to be able to surge up, the problem is at some point there is more demand than there is capacity.”
Epley stressed there’s enough capacity today and there will be enough capacity tomorrow.
“But it’s looming,” he said. “A little bit like a tidal wave that you’re in the shadow of and you can see the tidal wave and you know it's coming but it's not there yet, so we’re preparing as best we can to be ready.”
There are 1,000 ICU beds in this region, and most of them are already in use. Beds are being rearranged to free up critical care space, but more beds will be needed. Epley said they’re working on getting temporary hospitals up and running.
“Motels or other buildings are great because they exist and you can turn them on quickly. But you have to staff them. Mobile hospitals have the challenge of having to set them up. That's what's going on in our head right now,” he explained.
Then there’s the question of supplies — things like ventilators. Epley said area hospitals have the life-saving breathing machines on back-order, but he has to plan for the worst case scenario: that they won’t get them in time.
“We have some strategies that have come out of the West Coast, where they can utilize ventilators (in) some innovative ways, maybe even for a couple of patients at a time,” Epley said. “I mean, there's some really good videos if you want to go look on YouTube.”
Also, healthcare workers; more nurses and other health care professionals, will be needed.
“We're working with agency nurses and even retired nurses. There's lots of plans to bring other people back,” Epley said, then added, “Mainly it's keeping our workforce healthy and trying to keep the exposures down.”
Gov. Greg Abbott announced Sunday he is implementing waivers for more nurses to start working in Texas. These waivers will allow graduate nurses who haven't yet taken their license exams, people with expired licenses or retired nurses to practice in the state.
To reduce COVID exposure, healthcare workers need personal protective gear, and lots of it, but that’s also in short supply. Companies like 3M have ramped up production — it says it’s started making 100 million N95 respirator masks a month. While not ideal, there are Centers for Disease Control compliant mask patterns online that people can sew.
But some projections put the need for masks in the low billions. No matter how you do the math, there may not be enough for the surge.
Unless, Epley pointed out, Americans flatten the curve — that is, slow the spread of the virus and flatten out the upward spike in cases.
Epley said if you’re not a healthcare worker, a first responder or another essential worker, flattening the curve is your only job right now.
“The way a civilian can respond is to stay home, wash your hands, don't run out and buy every bit of toilet paper, the supply chain is strong,” he said.
Stay home, he said. Get creative about ways to make this work, as a community… from a distance.
“That would be perfect. That would help a bunch. And if they want to learn how to make masks, they can make masks.”