It was time to send out the alert. Dr. Doug Olson, medical director of Northside Hospital Forsyth’s emergency department, had just received the call that he knew was eventually coming: the Northside system had its first patient with COVID-19.
Dr. Olson had been tracking the new disease’s spread since it was first detected in Wuhan, China, and it was advancing closer and closer to home — South Korea, Japan, Seattle, New York, Atlanta.
Northside had convened a task force to prepare. It created new protocols. It bought protective equipment. It studied the novel coronavirus. They were ready.
Dr. Olson got the call in the evening, around 9 p.m. The patient was at Northside’s hospital in Canton.
When he hung up, Dr. Olson sent out an alert to providers across Northside’s Cumming campus.
“It’s here,” he said. “It is now in Northside.”
Four months later, Northside Hospital Forsyth is grappling with a second surge of patients infected by the virus, mirroring an increase in infections and hospitalizations across Georgia in recent weeks.
As of Thursday, 2,322 patients are currently hospitalized from COVID-19, according to the Georgia Emergency Management and Homeland Security Agency. Georgia’s previous high was 1,637 on April 23.
In Forsyth County, 38 new hospitalizations have been reported by the Georgia Department of Public Health since June 23, bringing the county’s total to 119 since the pandemic began.
Dr. Joe Funk, the Northside system’s chief of staff, told Georgia Health News that its hospitals are seeing “a sharp rise” in COVID-19 patients, “including ICU patients,” from people not wearing face coverings or social distancing in public. That’s true at Northside’s Cumming campus, too, Dr. Olson said.
Armed with Northside’s emergency contingency plan and more information about how the virus behaves and responds to different methods of treatment, Dr. Olson said the hospital has “full capacity” to handle the second surge of patients.
“We’ve been prepared for this the whole time,” Dr. Olson said.
‘A different beast’
The virus concerned Dr. Olson early on. As the number of cases surpassed previous outbreaks of SARS and MERS, Dr. Olson worried about a worldwide pandemic. When cases were documented in South Korea and Japan in December and January, he knew it was headed to the U.S.
What he would be dealing with was less clear. Information from China wasn’t easily verified, he said. When the virus reached the U.S., a lack of tests made it difficult to track the virus’s transmission.
When the first patients infected with the virus came to Northside Hospital Forsyth, Dr. Olson realized it was “a different beast.” Except for children, all kinds of patients were getting critically ill, not just those in at-risk categories like the elderly or those with pre-existing medical conditions.
Indeed, the recent surge of hospitalizations has included more patients in their 40s or younger.
“We were actually also seeing them in healthier younger people,” Dr. Olson said, “that actually have significant respiratory symptoms from this illness.”
The symptoms from the virus varied greatly, too, making it hard to diagnose, especially without widespread rapid testing available early on.
“It can act very much like the flu. It can act like bronchitis,” Dr. Olson said. “It can act like upper respiratory illness, like pneumonia.”
Northside decided to assume every patient with a respiratory illness had COVID-19. Staff wore full personal protective equipment. Patients were given masks and kept in “respiratory isolation” to prevent the spread of the virus while the hospital waited for test results. Northside is still using that procedure, Dr. Olson said.
The latest treatments
Treating patients was another matter. Initially, doctors only had anecdotal data from methods used in China, Japan, South Korea and early outbreak centers in the U.S. in Seattle and New York.
“We didn’t know exactly what was going to work best for these patients,” Dr. Olson said.
Gradually, Northside saw COVID-19 as an autoimmune response characterized by inflammation that was causing “respiratory compromise” in a small number of patients.
Those patients exhibit symptoms similar to Acute Respiratory Distress Syndrome, Dr. Olson said. There’s also evidence that the virus can cause an increased risk for stroke, heart attack, encephalitis, and organ dysfunction, he said.
“The vast majority of patients that have it may not even know they had it,” Dr. Olson said. “It felt like the common cold, or flu-like. But then you have this small population that don’t do as well.”
Those patients require ventilator support and medications. Northside used the anti-malaria drug hydroxychloroquine briefly but stopped after studies showed it possibly put patients at greater risk. The hospital is using dexamethasone and remdesivir on a case-by-case basis.
Dr. Olson said the most effective medicine they’ve used has been tocilizumab, a drug commonly used to treat inflammatory disorders like rheumatoid arthritis.
“We felt we could target this systemic illness with this medication,” Dr. Olson said, “and we’ve actually been successful using this medication, and we’ve actually been successful using this medication from very early on.”
The latest treatment option is convalescent plasma. Northside is asking people who have recovered from COVID-19 to donate their blood, which might contain antibodies that could help fight the disease in patients that are critically ill.
Dr. Olson sees a future of “peaks and valleys” with COVID-19.
“My gut tells me this is going to be here for a while,” he said.
The best chance to prevent the virus’s spread is proper hand hygiene, wearing a face covering, and minimizing large crowds.
He’s also confident that Northside is equipped to handle the recent surge in hospitalizations from the virus. The hospital system learned a lot from watching health care systems in Seattle and New York hit hardest by COVID-19 early on and struggled with limited resources, he said, and in response, Northside formed a task force to develop a plan to deal with a potential surge of infected patients and keep them and hospital staff safe.
Northside bought PPE and ventilators. They developed procedures to expand capacity for COVID-19 patients into regular hospital floors. They placed hydrogen peroxide vaporizers that kill bacteria within 1,000 square feet of the machine, Dr. Olson said.
All campuses initially erected tents outside to see patients who might have COVID-19 but were less critical. Northside Hospital Forsyth never had to use it, Dr. Olson said, but could get it back up in 24-48 hours if needed.
And while COVID-19 surges again, the hospital has also had an increase in patients dealing with “day to day emergencies,” Dr. Olson said.
“Even if we had twice as many [COVID-19 patients] in a week as we did this week,” he said, “we will still do whatever we need to do to make sure we take care of patients that we need to take care of.”