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Disaster Response After Action Report

Christine Magnuson BSN, RN

University of MD Global Campus

Healthcare Administration Capstone

August 10, 2021

ABSTRACT

With the Covid 19 pandemic, people worldwide were panic-stricken because the disease was described as an extraordinary form of pneumonia, which made it hard for the victim to breathe. Within no time, the victim lost their lives. The rate of infection was high, and the condition was spread through touch. The disease could not be treated using the regular medication used to treat pneumonia. In a blink of an eye, hospitals in China were overwhelmed by the number of people that had already been infected. Medical practitioners also died as they tried to save people, and this push people to a state of panic.

After a short time, there were cases of infection in New York City and the government declared a state of medical emergency. Medical facilities had to act fast, and they decided to use RTPCR to test people. Most of the patients who lost their lives are patients with underlying conditions such as diabetes and chronic heart diseases. The incubation period of the illness is 2-14 days. The period taken for getting healed of the disease is 3-9 days depending on the severity of infection. Most people that did not survive died from 3- 9 days. Traditional spaces in various hospitals were converted to ICUs, and ventilators had to be sourced. Medical practitioners from multiple specialities joined in trying to save the lives of people. Provide hospital decided to boost their Telehealth services to reach out to patients that suffered from other illnesses and were at home and Covid 19 related patients that had to isolate and treat themselves at home. Doctors followed up on the status of the patients that were discharged from the Hospital via Virtual video calls and telephone calls. Any patient that was in danger would be taken back to the hospital and put under close observation.

Definitions

D-dimer protein component found after a blood clot breaks down.

Peripheral oxygen saturation (SpO2)

RR respiratory rate

BP blood pressure

BMI Body Mass Index

WBC White Blood Cell count

IL-6 interleukin-6

LDH lactate dehydrogenase

ALT Alanine Aminotransferase

AST aspartate aminotransferase

IL-,AST

CRP C- Reactive Protein Test

Contents

ABSTRACT 2

Definitions 3

INTRODUCTION 5

BACKGROUND 6

OUTLINE OF A DISASTER RESPONSE PLAN FOR COVID 19 8

our level of preparedness prior to the emergence of covid 19 8

The occurrence of the pandemic in 2019 10

Management of the crisis 11

Increasing the Hospital Beds At the Intensive Care Unit 12

Making Use of Critical Care Spaces 15

Increasing the number of hospital staff. 16

Increasing Critical Care Equipment 17

Emergency sections of the hospital 17

Ensuring that our staff members were okay 18

OUTLINE FOR CONTINUITY OF OPERATIONS 18

Follow up after discharge. 19

DISASTER RESPONSE AFTER ACTION REPORT 19

Lessons learnt 19

CONCLUSION 22

INTRODUCTION

Covid 19 pandemic will remain one of the diseases that hit the world so hard and left many people dead. It will be remembered as an illness that had very many variants. Finding its vaccine proved to be a challenge as some of the vaccines that were developed and inoculated into people resulted in the death of very many people. In New York City, Governor Cuomo gave orders that hospitals should not be strict to the incoming medical practitioners who would help manage the crisis. He also gave directives that health practitioners should be protected from civil liability. Finally, he made a directive that hospitals should look for ways through which they can be able to accommodate more Covid 19 patients.

Provide Hospital was forced to increase its capacity because it is one of the biggest Hospitals in New York City. It had to make it possible for both Covid 19 patients and other patients suffering from critical illnesses to get medical help. The transition to a facility that mainly handled Covid 19 patients was not an easy one, and it required so much cooperation from all the hospital staff. The event was a successful one because we managed to save the lives of very many people. However, it was equally challenging because very many patients and medical practitioners lost their lives. This report aims to show the response of Provide Hospital to Covid 19 and the lessons learned.

BACKGROUND

When the Coronavirus pandemic emerged, many cases were recorded in the US after President Trump stated that the disease was a hoax and refused to close the borders. Numerous cases were recorded in New York City between March-May 2020. The high infection rates were caused by the high population in the state and the dense population in the country. The virus infected 203000 people. Many cases of infections were recorded in areas where People of Colour lived, areas with high rates of poverty and among people aged 75 years and above or amongst people with underlying conditions. The death rate was 9.2% and 32.1% among hospitalised people (Thompson, et al, 2020). Therefore, the main aim of health care practitioners was to prevent infections from increasing, save the lives of the people that were already infected, and ensure that the highly vulnerable people do not get infected.

With the emergence of cases, hospitals used real-time reverse-transcription –polymerase-chain-reaction (RT_PCR). However, the health care practitioners could only test a limited number of people due to the shortage of test kits (Thompson, et al, 2020). The NYC and the New York State public health laboratories only tested patients that had been hospitalized. The patients that were not so sick were sent home because, by March, hospitals were overwhelmed by the number of infected cases. Yet, there was a shortage in personal protective equipment and laboratory tests. Hospitals also carried out contact tracing so that they could identify people that are at the risk of infection and to prevent the spread (Thompson, et al, 2020). As time went by, contact tracing was not possible. Between February to June 2020, 203792 Covid 19 infection cases were reported. 26.6% were hospitalized, and 9.2% died. In every 100000 people, 2263 were infected, 582 had to be hospitalized, and 198 people lost their lives.

In the months that followed, the number of infections kept on rapidly increasing. In the first week of March, 274 people were infected by the virus each day. In the fourth week of March, the number rose to 5132 cases per day. At the same time, hospital admissions increased by 1566 admissions each day. In the first week of April, the number of deaths increased to 566 each day. In every 100000 people, 7007 people between the ages of 45-64 were infected by the virus (Thompson, et al, 2020), and in every 100000 people, there were 2146 cases of hospitalization and 1311 deaths amongst people aged 75 years above. More males than females got infected, hospitalized and died. The minority group that was mainly affected by the pandemic was Blacks, whose infection rates were 1590 per 100000 people.Moreover, there were more cases of hospitalization and mortality amongst the Blacks (Thompson, et al, 2020). Records show that 699 out of 100000 Blacks were hospitalized, and 248 out of 100000 died. Amongst the Hispanics, 658 people per 100000 were hospitalized, and 260 per 100000 died.

The patients that were hospitalized showed similar symptoms of infections to the ones that were infected in China. Very many patients in the US showed many gastrointestinal symptoms. Most of the patients in New York had underlying conditions. 73% of the people had heart diseases, 58% had diabetes, and 23% had chronic illnesses (Thompson, et al, 2020). The symptoms that these patients showed include fever, dyspnea, myalgias, diarrhea and nausea. 79.4% of the patients coughed, 77.1% had a fever, 56.5% had dyspnea, 23.8% experienced myalgias, 23.7% had diarrhea, and 19.1% experienced diarrhea and vomiting (Goyal, et al, 2020) Patient that had severe breathing problems were subjected through invasive mechanical ventilation. The patients that got invasive mechanical ventilation were given vasopressor support. These patients were highly likely to get new renal replacement therapy.

Survivors took 3 to 9days to get well and get discharged out of the hospital. On the other hand, non-survivors died from 3 to 9 days (Mikami, et al, 2021). The bodies of the people who died showed increased heart rate and respiratory rate, lower oxygen levels in the body. They also showed the following changes, and their bodies showed the following changes. They had increased levels of D-dimer, IL-, AST, CRP, procalcitonin, ferritin, LDH, fibrinogen, and troponin. In the course of their admission, patients that would, later on, die showed the following changes an increase in WBC count, neutrophil proportion, LDH, and ferritin levels, and a decrease in CRP, D-dimer, and IL-6 in the initial weeks of hospitalization (Mikami et al, 2021) Their levels of LDH, CRP, D- dimer, AST, ALT, and procalcitonin increased. Both the survivors and the critically ill patients showed a decrease in hemoglobin and a rise in platelet count in the period they were in the hospital. The levels of hemoglobin keep on decreasing in critically ill patients. This is illustrated in the figure below.

OUTLINE OF A DISASTER RESPONSE PLAN FOR COVID 19

Our level of preparedness prior to the emergence of Covid 19

With the history of pandemics at hand, we were prepared for the occurrence of any other pandemic, especially after reading about the most recent pandemics such as the 1957 Asian flu, 1981 HIV/AIDS, 2003 SARS and 2014 Ebola. With the emergence of Ebola in Africa, we decided to act as fast as possible to try and get resources because we knew that there would be required whether we are prepared or not. Therefore, in response to the emergence of Ebola, the Emerging Special Pathogens Training and Education Center and other hospitals funded by the Department of Health and human Services’ Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) were in a mission to ensure that the United States of America was ready for the emergence of any pathogenic diseases (Hasan & Narasimhan, 2020).

In December 2015, we decided to develop a program that would help us manage any pathogenic infections that would, later on, come up. Since around that time there was Ebola, we used this program to act on any reported Ebola cases and test its effectiveness. After using the program, we discovered that the hospital was in an excellent position to handle any other cases of pathogenic infections that might occur in the future. After the emergence of Ebola, very many other cases of pathogenic diseases came up. These include Zika, measles, Candida Auris, and seasonal flu. Our hospital’s pathogens infections unit operates because the employees need to be well trained and be fully equipped. The information we gathered after handling Ebola infections has been our reference point for all the other diseases. The occurrence of Zika, measles, Candida Auris, seasonal flu, and many others helped us test the program. We discovered that in case of an occurrence of pathogenic infections, the nation and the department of health would be under so much pressure. Therefore, we decided to bring other internal and external partners who would help us contain the situation when it occurs.

In January 2018, we met with the Center for Disease Control (CDC), where we shared our concerns about the need for hospitals to be prepared for an outbreak of pathogenic infections. The CDC decided to organize a conference where the major stakeholders of various hospitals were educated on the need for them to train their employees and to develop units that would manage pathogenic infections that would occur in future. Therefore, as a hospital, we decided to train all the hospital staff on what to possibly do in case of the occurrence of a pandemic. We carried out 60 sessions to 300 clinicians who would be directly handling the patients that are suspected to be infected with pathogenic diseases. In June 2018, we developed a planning guide for our clinicians to know how to screen the patients, manage, and carry out considerations such as clinical or operational for the critically ill patients and stop the merely ill from becoming seriously sick. We knew that a pandemic would cripple the economy, and we decided to set funds aside to meet the emergency of the situation. We developed a laboratory that would be used to investigate the severity of any other pathogenic infection that would occur in the future. In the event where a pathogenic infection occurs, we wanted to respond with so much vigor.

In addition to this, initially, we tried to develop Telehealth services because we knew that there would be restrictions in movement. To our surprise, Telehealth was well received, and it became one of the ways through which we reached out to our patients. With the advancement of technology, most people at home had access to telephones and the internet, and they knew how to use phones.

The occurrence of the pandemic in 2019

After Wuhan China reported the first case of pneumonia which was very strange and killed many people within a short time, with the first case being reported in Wuhan, Hubei Province, China, our medical practitioners started studying the characteristics of the virus and the effects it had on people. Furthermore, we met with various stakeholders in the health care sector and decided that all hospitals ought to adequately prepare themselves for the emergence of the disease. Previously, we thought that the pathogenic infection was severe acute respiratory syndrome (SARS); therefore, we adequately prepared ourselves to handle another outbreak of SARS. CDC informed us that the president had been reluctant in stopping flights from China from getting into the country, and people who unknowingly got into contact with infected persons in China, came to the US with the virus. We, therefore, decided to screen any patient that had any travel history and kept the hospital on guard for any patient that we would discover was infected. The clinicians were told to isolate the patients to know the symptoms that these patients showed and stop the further spread of the disease. We then used the money we had set aside to purchase PPEs. After there were very many cases of infection, we managed to study the characteristics of the disease on both survivors and the non-survivors, and we gave out the information to the government so that the government would publish the information and give it out to the public.

Management of the crisis

After we learnt of the severity of the illness, we decided to develop our communication systems so that all our team members would be on board. The number of cases kept increasing with new strains coming up each day which means that we needed to act very fast. Therefore, developing a centralized management system would make it easy for the hospital staff to be accountable for any error conducted by our team. We would also be able to help the new staff know what they should and shouldn’t do. Most of the responsibilities were placed on the Chief Operations Officer, the Chief Medical Officer and the Managing Director. Due to the spike in cases and the severity of the cases, we decided to gather the medical practitioners that are well known for their expertise. We wanted to create a powerful team. All our hospitals ensured that their emergency units were up and running, and they chose the best of their doctors to deal with the issue at hand. The logistics department was also up and running because they were needed to provide PPEs when they were in demand.

We used the ICS method of operation. This method was used to organize, collaborate, and pass information concerning the activities that took place at all hospitals. This method was also effective in financial allocation inside and outside the enterprise. By the time we got to June, there were 212000 cases of infections in New York City. 55000 people were in hospital fighting for their lives (Uppal, et al. 2020). Our hospital being the main hospital around Queen, Bronx, and Brooklyn, we had to act fast; otherwise, people would lose their lives. Therefore, we decided to develop inpatient services, and severe cases care. With the increase in cases, the governor thought it wise for hospitals to increase the number of beds at their facilities because he knew that there would be more cases due to the high population in New York City. We decided to bring together all the large departments into one single Intensive Care Unit (ICU) department.

For the Telehealth services, we assembled a team which comprised of information technology, electronic medical record and clinical leadership representative to choose the appropriate staff for the job (Lau, et al, 2020). We made sure that we purchased the required equipment even if it meant that we would use second-hand equipment because we did not have so much time in our hands.

Increasing the Hospital Beds at the Intensive Care Unit

At the onset of the pandemic, one branch of the hospital had 300 beds. When the pandemic got to the boom stage, we handled 900 patients. One of the hospital branches in Bronx increased its hospital capacity from 50 to 200. The expansion was possible because we decided to use traditional beds, increased the number of medical practitioners and the number of equipment needed (Uppal, et al. 2020). To ensure that the additional space was conducive for the patients, we had to acquire resources such as backup generators, oxygen supply, monitors systems that record what is happening and isolated airflow. The additional spaces include areas such as postoperative regions, places where procedures are carried out, and rooms that are set out to purposely attend to critically ill patients (Uppal, et al. 2020). We set up tents and annexes in the hospital compound so that such areas could be used to attend to the less ill patients. This space was still not enough because the rate of infection increased. Therefore, we decided to set pediatric areas, psychiatric, fast track, and observation units into ICUs.

As time went by, we knew we had to get to other areas in hospitals because the disease that was of paramount importance to all medics at this point was Covid 19. We decided to use operating rooms, preoperative areas such as post-anesthesia care units. We also decided to send patients with other serious illnesses, such as cancer, to other hospitals that did not handle very many patients with Covid 19 because they lacked PPEs (Uppal, et al., 2020). Some of the operating rooms were converted to rooms where Covid 19 patients with critical conditions would be operated on. We tried as much as possible to control the infection rates because even the medical practitioners and other support staff were at risk of infections. The virus is spread by touch, and it is spread through the air. Therefore, we made sure that there were hand washing machines all over the hospital. We also ensured that the rooms where the critically ill patients were had positive pressure ventilation machines that decanted the air to get rid of contaminated air. Furthermore, all the staff: both subordinate and insubordinate, were provided with PPEs.

To ensure that airflow control was possible, we took advantage of High-Efficiency Particulate Air (HEPA) filtration devices to be negative airflow in these ICU rooms. These devices were placed outside the room so that in case the hospital staff did not have PPEs on, and then they would still be safe. But they needed to put on masks when they entered these ICU rooms. Staff were supposed to wear masks in ICUs that only had the available rooms which patients had to share. In the single rooms where each patient had their own space and when outside these rooms the staff were not forced to put on the PPEs (Uppal, et al., 2020). The ICU areas with available rooms had to have enough medical practitioners who worked in shifts so that they do not get overwhelmed by the work at these places. Furthermore, we also had to introduce oxygen supplies to various parts of the hospital. At the peak of the pandemic, our resources were overstretched because initially, we had planned for only 300 patients, and the hospital was forced to accommodate 1500. We had like 200 patients on ventilators. We were forced to look for other areas that could be used as care centers. Thus, we decided to use gyms.

With the reduced attendance to patients that suffered from other illnesses, we had to use Telehealth services to get to them. Our hospital decided to transfer some of the patients to other hospitals, and some still came back insisting that they needed to get in touch with a particular health practitioner. Therefore, Telehealth services were beneficial (Lau, et al, 2020). Furthermore, our new staff members who had been hired to test patients using the SARS-CoV-2 polymerase chain (PCR) had to know how to handle the various issues that would come up, which was only possible if they used the Telehealth devices.

All the face-to-face visits were converted to virtual visits to the hospital, and the patients that had mild symptoms of the novel Covid 19 were advised on what to do virtually. If the medications they were using were not of importance, they would be transferred to the hospital. As time went by, we expanded the eConsult program to make it easy for the patients to get to their doctors. All the medical practitioners from the hospital ranging from nutritionists, chronic disease nurses, and social workers, had to use telephone appointments to reach out to their patients. We also made sure that the hospitals’ on-site registrars and financial advisors used these services to register as many people as possible into the insurance system. Enabling people to get insurance would mean that they still get treated even after most of them had lost their jobs due to the closure of most businesses that came with the restrictions of movement. These devices made it possible for the experts to state what they needed, the corrections that needed to be made because it made it possible for people across various parts of the state to message each other (Lau, et al, 2020)

After there was a surge in the Covid 19 cases, the government decided to put up measures that would help contain the spread of the virus. Therefore, social functions were not allowed, and Lockdown restrictions were imposed. There were very many cases of people becoming mentally ill due to the lack of human contact. Therefore, most of the patients that had a history of mental illness and had been assigned to the hospital to receive treatment during the initial stages of the development of the novel coronavirus were allowed to see their doctors (Lau, et al, 2020) But as the number of cases of infections kept on increasing, we decided to change the services to virtual services. Doctors and the patients would have their usual checkups over the phone. We also developed a virtual buprenorphine clinic that would help patients initially addicted to opioids access their medication. We set a hotline that would benefit all the patients across the state to have access to these services. The government also allowed us to use telemedicine, and it was so effective in helping us reduce the cases of infections across the state.

Making Use of Critical Care Spaces

We decided to put the patients into reserved spaces in accordance with the severity of their condition. Initially, the areas that we considered the main ICU spaces for the hospital is where we placed the severely ill patients, and the patients that had mild Covid 19 symptoms were placed at the additional areas. We were also open for transfers from hospitals that could not handle a large number of patients or did not have the necessary PPEs to manage these patients. We had to ensure that our ambulances were up and about because most stable patients had high chances of moving from a steady state to the crucial stage if mishandled. (Hermann, & Deligiannidis 2020)

Increasing the number of hospital staff.

At first, the number of available hospital staff was only capable of handling the number of patients that the hospital exclusively set. Thus, with the occurrence of the pandemic the number of patients admitted at the Intensive Care Unit (ICU) increased by a significant proportion. Consequently, we needed to increase other medical practitioners because most of the doctors assigned for the ICU incidents started to complain about getting burnt out. We had to hire doctors that had just retired. The members of staff that had been sent home were redeployed. The skill of every individual at the hospital was made use of because many patients were dying. For instance, nurses took directives from surgical doctors to perform pruning on patients that had difficulty breathing (Powell & Chuang, 2020). On the other hand, Anesthesia physicians were charged with endotracheal intubations and to get vascular access. This made it easy for ICU physicians to attend to as many people as possible and relieve pressure off them. ICU nurses were responsible for monitoring dialysis. ICU doctors and nurses were used to train the non-ICU providers to control the number of patients. The non-ICU nurses used task-based nursing to take care of the patients.

We recruited additional medical staff from all over the country. We took medical practitioners from various disciplines. Some of the health practitioners were hired through coverage agencies, and others are people that offered to give out their help when they knew the state in which the country was at. The Department of Defense personnel that had medical training were told to help in hospitals. They went to various hospitals according to the need of the hospitals.

Increasing Critical Care Equipment

We decided to obtain machines that we knew would be useful in our urge to take care the patients. The equipment that was in high demand was the mechanical ventilator. We got these ventilators from federal stockpiles and local product vendors. We also purchased ventilators that we knew would be needed by patients initially ill but whose condition later stabilized (Uppal, et al., 2020). We also had to purchase renal replacement therapy machines because most of the patients with Covid 19 needed this therapy. We made sure that the hospitals had an ample supply of oxygen. Without adequate oxygen, it was possible that the hospitals would become frozen because ventilators stop working, which would result in the death of very many people. Therefore, in the case where the oxygen supply was not enough, we had to devise new ways of piping oxygen into the hospital to prevent casualties. Consequently, we decided to install sprinklers to thaw critical tank valves, and we decided to hire people that would monitor them to avoid any fires.

Some other types of equipment such as IV tubing, blood sampling tubes, infusion pumps, and dressings were in high demand, and we made sure that the supply chain department ordered new ones when we reached a certain level so that we do not run out of this essential equipment.

Emergency sections of the hospital

Before the occurrence of the pandemic, the hospital staff would communicate with all the medical specialties in the hospital. However, with the emergence of the pandemic, there was a need for a smaller one that would speak to the team that focused on working on patients that had Covid 19. The team that was created had to ensure that the medical practitioners who handled Covid 19 had all the supplies they needed.

Protecting health workers

To protect Frontline Workers from infections, we ruled that all of them were required to wear protective equipment such as the N95 respirator and eye protector equipment. As time went by and the number of infections kept escalating, we decided to get PPEs for the subordinate staff because we needed them, and if we did not provide the PPEs, we would be forced to let them go home.

OUTLINE FOR CONTINUITY OF OPERATIONS

We decided to use our Telehealth services to send messages to patients that contracted Covid 19 and could not come to the hospital because the hospitals were full all over the state. We sent them messages on how they should identify Covid 19 by the symptoms it showed. We gave them tips on the first aid measures to take before they could get access to any medication. To get their medicine, we ensured that they had access to the hospital’s line where they ordered for treatment, and the drug would get delivered at their doorstep. We also educated them on how they were supposed to isolate themselves from family members while at home. The doctors would check on the patients frequently via the phone.

We used Telehealth services to eliminate any mental and physical risks brought about by Covid 19. In some of the hospitals, we decided to use video screening so that we could distinguish patients that needed to be taken to the ICU and the ones that would be fine if they remained in spaces where there were no ventilators (Lau, et al, 2020) all rooms were video enabled so that doctors and nurses would watch the patients from far off. The ICT department set up a program that would enable the family members to communicate with the patients that were in ICU for a very long time, and they could not visit them due to restrictions. This prevented cases such as the patients falling into depression due to isolation and the family members being overly worried. /

Follow up after discharge.

After patients are discharged, there are high chances that they might get infected, or they might go through the effects of the disease or the medication they were taking while at the hospital. Therefore, the patient was required to send messages where they would state their condition on a daily basis. If there was any unusual sign, then the physician was supposed to call back later and have the patient admitted at the hospital immediately.

DISASTER RESPONSE AFTER ACTION REPORT

Lessons learnt

Management of the Covid 10 pandemic was not easy initially because the disease had and still has very new variants every day. Moreover, the disease killed very many people in a short time (Uppal, et al. 2020). To be able to address these challenges, the management of the hospital decided to meet up to look for new ways of handling the crisis at hand. The top team met daily and made sure that they asked the hospitals heads across all the hospitals how they ran things (Uppal, et al. 2020) We also discovered that it was paramount for the hospitals’ staff to know how to use technological gadgets because it was of great importance that medical treatment is done virtually due to the restrictions put by the government. We also got the challenge where some of the patients could not speak in English, which made it hard for the medical practitioners to give them the medical assistance they require. Hence, the Telehealth systems should be modified in such a way where there is a translator between the patient and the doctor.

We also learned that enabling the patients and the family members to communicate with each other was quite helpful to them because it enabled them to bond with each other. We also made sure that we increased such services as much as possible. Still, this time, we would also allow the doctors to talk to the family members so that they offer the family members advice on how their loved one is doing (Lau, et al, 2020) We also learnt that allowing people that had lost their jobs to have access to insurance services was one step that saved the lives of 50% of our patients. Therefore, we are still looking for ways through which we can ensure that these services are permanent even after the pandemic is over, or we shall ensure that the hospital reduces the hospital package by a certain percentage.

It is essential to ensure that the health practitioners on the frontline to save people/s lives are motivated because they were risking their lives and their families to save people. Therefore, it is paramount for every small win to be celebrated. The health practitioners should also be commended for the excellent job they do so that they continue with their work effectively. These health practitioners and the people that had been hired at that point to work with health practitioners were supposed to be quick to get the actual figures of the people that have been healed and discharged and the patients that have been recently admitted so that the management would call other hospitals and ask them if they had any space for transfers to be possible (Chokshi & Katz, 2020) This quick action and keeping statistics on the number of beds that are available determined if people lost their lives or if the lived. We also learnt that we must make sure that adequate attention is not just given to the people that we are sure will survive, but it should be given to the people that we know might die but still need to be treated with dignity. The government should set aside funds that will cater for any emergencies that might come up in the health care sector to reduce cases of medical practitioners in the frontline lacking PPEs and putting themselves in danger or their salaries being delayed.

The health of the medical practitioners must be taken into account at all times. Due to the increase in the number of patients, it was paramount that the health practitioners work extra hours. However, their well-being was of utmost importance to us because if they were not healthy, then people would lose their lives (Schaye, et al 2020,). There has to be a schedule that is strictly followed so that the medical practitioners get as much rest as they can. It is also essential to allow the health practitioners to meet with each other occasionally to encourage each other and look out for each other. The medical practitioners should go to counselling after they handled very many people in critical condition and watched other people die without them being in a position to help out or living with the constant fear of getting a hazardous disease that has no cure (Schaye, et al, 2020) The physicians ought to be given financial assistance so that they would take care of their family members in case any one of them contracted Covid 19. Every day, a new Covid 19 variant comes up, and there is a need for the medical officers to be educated on how they can handle the new variant (Samarasekera, et al, 2020) Thus, the medical practitioners need to keep on educating themselves on the latest variants and the symptoms. The hospital needs to organize means that the medical practitioners can use to learn about these variants. Hospitals should organize video conferences where experts are invited to talk about the new variants.

Documents that highlight how the transition from the normal operation to operating under a crisis should be drafted so that physicians know how they can handle a similar situation. Physicians should be educated on how they should conduct themselves during a period when there is a crisis so that patients still feel like they are honored. The State Department of Health should develop interventions that focus on saving people who are likely to survive instead of concentrating on the first come, first-serve basis where the people who are capable of paying for the service get PPEs even if they have minimal chances of survival. These interventions will make it easy for physicians to use the available scarce resources to save the lives of very many people.

The State Department of Health should also listen to the doctors’ grievances and how patients infected with these pathogens should be treated. In the case of Covid 19, a large percentage of the patients that were put in ventilators lost their lives. Physicians didn’t have to perform cardiopulmonary resuscitation (CPR) on them. Yet, the state did not side with the physicians on their decision not to resuscitate (DNR), forcing physicians to carry out multiple CPR, which contributed to most of the contracting Covid and dying. Various hospitals across the state acted differently concerning CPR. Some offered CPR to the patients, while others did not. Therefore, family members of the patients would call physicians of some hospitals careless, which mentally affected the health practitioners and confused the trainees.

CONCLUSION

In conclusion, the Covid 19 pandemic is a pandemic that put the lives of many people on hold because of its severity. New York City was most hit because of its high population. Between March and May, close to 203000 people were infected by the disease. This prompted President Donald Trump and his administration to put strict measures so that they could protect people. They restricted movement and put lockdown. Medical facilities had to develop strategies to handle the situation, or people would lose their lives. Horizon Hospital was well prepared to handle the strange illness because it had previously seen the panic that the outbreak of Ebola caused in 2014.

Within a period of 3 days, people were losing their lives, and as many other variants came along, the death rates kept on increasing. The people that were mostly hit by the pandemic were people of color and people aged 75 years and above. Medical officers employed real-time reverse transcription-polymerase chain reaction (RT_PCR). There was a shortage of PPEs and laboratory tests due to the increase in the number of infections and hospitalization cases. Doctors had to stop the medical attention they were giving to some of the patients to minimize contact. Initially, the hospital was prepared to handle 300 people at the Emergency Department, but we were forced to increase the number of people we managed.

We decided to get a room from traditional spaces to admit as many people as possible. Ventilators were put in the extra rooms that were used as ICUs. The number of medical practitioners was also increased to cater for people who did not get any help in other hospitals. We also decided to make our Telehealth services stronger because we knew that it was the only way medical practitioners could reach out to other patients suffering from other illnesses apart from Covid 19. The Telehealth services targeted patients suffering from mental illnesses and were forced to go home and the ones that were recovering addicts.

The lessons learnt from responding to Covid 19 pandemic are that it is crucial for medical facilities to set aside funds that can be used to cater for pathogenic infections in the future. Medical facilities should also develop their Telehealth services that can be used even after the pandemic is over. These services help people medical practitioners and their patients to talk even if they are in different continents. The health of medical practitioners should be taken into account to prevent cases of burnout because if they are not fit to carry out their day-to-day functions, they commit very many errors, some of them is causing the death of an individual. Medical practitioners should therefore be given enough compensation, and their working conditions should be looked into. In addition to this, they should be encouraged from time, and they should be able to access psychological help. Making it easy for people that lost their jobs to have access to insurance services enabled us to save the lives of very many people. Thus, the government should continue to channel funds that will cater to the treatment of people out of employment but need medical help and cannot afford it because the infection they are treating is costly. Medical facilities should also try and waive the cost of medication so that it is affordable to everyone.

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