Congress of Neurological Surgeons

It’s hard to believe that just over a month ago, the first case of COVID-19 was reported in Michigan. We were all aware that it was coming, but really couldn’t imagine the profound impact this virus would have and the rapidity of the viral spread. Many reasons have been postulated for why Detroit in particular turned into one of the country’s most serious COVID-19 hotspots, including the fact that our international airport, Detroit Metropolitan Airport, is one of the 5 busiest hubs in the country. The resurgence of Michigan’s economy in the last few years also resulted in a dramatic rise in international industry business travel, including to China, Korea, Japan and Italy.

In anticipation of the surge in Michigan, Henry Ford Health System (HFHS) took many key steps at early points in the crisis. A month prior to the first detected COVID-19 case in the state, HFHS began holding daily infection prevention calls to start COVID-19 related education and training amongst the staff, and we activated our Incident Command structure where all physician and administrative teams across all business units were included. In an effort to keep staff and patients safe, business travel and HFHS events were cancelled prior to the state’s mandates.

At the onset of increased COVID-19 admissions in mid-March, HFHS stopped all elective surgeries, which helped create the immediate and much-needed capacity to accommodate any surge. We temporarily closed many ambulatory clinics and redeployed resources — including not only supplies but also over 550 physicians, nurses and staff — to the inpatient settings. In accordance with Accreditation Council for Graduate Medical Education (ACGME) guidelines, HFHS declared a Stage 3 Pandemic Crisis, transitioning most residents and fellows to patient care areas in the most immediate need of clinical support. In taking these steps, we were able to quickly create ICU and general inpatient capacity.

To expedite diagnosis at the HFHS’s five acute care hospitals, the laboratory services became Michigan’s first same-day results lab for COVID-19, having the ability to process 1,000 tests per day with 93% processed in 12 hours or less. We also chose to be very proactive in testing our employees to safeguard our patients and our community, and we were also very transparent in our reporting of employee COVID-19 positive results to highlight the need for testing, and the need for aggressive prevention measures, throughout our region and beyond.

Like hospitals throughout the world, we experienced some supply disruptions for personal protective equipment (PPE) as global demand far exceeded production capabilities. Maintaining the safety of our health care professionals on the front lines remains a critical focus for the System. Thus, our supply chain team aggressively responded to the global constraints for these items by actively sourcing PPE from alternative sources, like TD Industrial Coverings, Inc., and we received more than 250,000 PPE donations from area businesses, including Ford Motor Company and the DTE Energy Foundation. The HFHS also implemented conservation policies aligned with the Centers for Disease Control and Prevention (CDC) recommendations to ensure the frontline workers continued to have the protection they needed. To help address the high demand for PPE, the photomedicine and photobiology unit in our Department of Dermatology rapidly developed an innovative process to sterilize N95 respirators using a special form of ultraviolet C (UVC), so the respirators can be reused. Ultimately, we were able to secure adequate PPE supplies to mandate a universal mask policy for all staff, employees, patients and visitors to any Henry Ford facility, and N95 respirators were made available to all staff in contact with suspected COVID-19 patients and for those performing any procedure at risk for aerosolization of bodily fluids.

The Henry Ford Research Team also embarked upon dozens of studies either underway or under development to understand disease progression and outcomes, and to treat or prevent COVID-19. With assistance from Vice President Michael R. Pence and Food and Drug Administration Commissioner Stephen M. Hahn, MD, Henry Ford launched the country’s largest randomized controlled, double-blinded study to determine the effectiveness of hydroxychloroquine in preventing COVID-19 in health care workers and first responders. Another study is underway on the antibody assessment and treatment in preparation for a potential vaccine that focuses on collecting convalescent plasma and using it in a clinical trial format for newly infected patients. We are also testing anti-viral agents, agents that inhibit the cytokine storm, convalescent patient serum and other novel approaches to treatment.

As the number of new COVID-19 cases decrease in Michigan and we extubate more patients from ventilators than we intubate, we’re beginning to perform time-sensitive ambulatory surgeries and procedures that were postponed due to the pandemic. We are starting with cases that can reasonably be accomplished on an outpatient basis using existing and available staff so as not to overburden the current inpatient needs for the hospitals. In our first week of restarting these ambulatory procedures, 80% of patients called were willing to be scheduled, while 20% preferred to wait given ongoing fear in the community of exposure. We have designated COVID-19-free operating rooms and teams, specifically assigned to these time sensitive non-COVID-19 cases to help reassure patients and families. Of 8,000 cases postponed since the start of the pandemic in mid-March, we hope to reschedule and perform 2,000 prioritized cases by mid-May in a staged way, taking great care to guard against another surge. All along we have been performing emergency cases with immediate threat to “life and limb,” but as we look to expand our inpatient surgical readiness in the weeks ahead, we plan to prioritize cancer, cardiovascular, neurosurgical and transplant cases given the risks of further delays to those patient populations.

The COVID-19 pandemic has challenged us to navigate through unprecedented circumstances, but it’s a challenge I strongly believe we will overcome together, and emerge even stronger as a profession, and as a community.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Steven N. Kalkanis, MD, FAANS
President, Congress of Neurological Surgeons
Henry Ford Medical Group
Detroit, Mich.