Coronavirus: How Cleveland Clinic Is Making Sure It’s Ready

Podcast Transcript

Cassandra Holloway:  Hi, thanks for joining us. You're listening to the Health Essentials podcast brought to you by Cleveland Clinic. I'm your host, Cassandra Holloway. Today, we're broadcasting virtually as we are practicing social distancing. We're joined virtually by the chairman of the Respiratory Institute at Cleveland Clinic, Dr. Raed Dweik. Dr. Dweik, thank you for taking the time out of your day to speak with us.

Dr. Raed Dweik:  Thank you for having me.

Cassandra Holloway:  Right now, many people are looking to their healthcare systems for answers. People want to be ensured that their hospital has the capacity, as well as the capability to care for them should they need it. Today, we're going to be talking about these steps and protocols that Cleveland Clinic is following to manage the current flood of COVID-19 patients, as well as how we're preparing for the surge of COVID-19 patients. Before we dive into all of that, we want to remind listeners that this is for informational purposes only, and doesn't replace your own doctor's advice. Dr. Dweik, I first want to start off by asking, can you tell us a little bit about your role at Cleveland Clinic pre COVID-19?

Dr. Raed Dweik:  I'm the chairman of the Respiratory Institute at the Cleveland Clinic, which is home for the department of pulmonary medicine, critical care medicine, infectious disease as well as allergy. So, at least three of our departments are the forefront of this fight as you may recognize.

Cassandra Holloway:  Since the onset of COVID-19, how have things changed for you and your team?

Dr. Raed Dweik:  Once we're aware that the first case was identified in the United States, at the Respiratory Institute, we really went into high alert trying to gather as much information as we can to prepare. And once the first case in Ohio was identified, we really went into all hands on deck situation where we're really starting to learn again as much as we can, connect with any people who experienced this before so that we'll be ready. When our first admission happened to us on Friday, the March 13th, we were prepared to take care of.

Cassandra Holloway:  I like how you mentioned the all hands on deck approach, people jumping into action immediately about this.

Dr. Raed Dweik:  Absolutely. This is the situation where that's the only way to manage. Absolutely.

Cassandra Holloway:  I want to talk Cleveland Clinic on a bigger scale. What has the health system done to protect the caregivers, the patients and the community?

Dr. Raed Dweik:  The Cleveland Clinic, we've been proactive about all these things that you mentioned. From the very beginning, we started to make sure that we limited visitation hours, for example, and not even just hours, but even the number of people to visit. So really, there are very strong restrictions on that. We also measure the temperatures of everybody who comes into our buildings, whether they are a caregiver or whether they are a patient or a visitor. We also had recently started handing over face masks, these cloth masks that are important for cough etiquette. We have sanitizing stations everywhere throughout the system and at the entrances of all buildings. We've also limited the number of entrances that are open so that we can control access to our buildings as well. So really, it's been a transformation in how we get patients in and out, and watch for people who may be sick to get into our facilities.

Cassandra Holloway:  Absolutely. And we've read a lot about Cleveland Clinic also postponing those non-essential procedures and moving a lot of what they can to virtual appointments.

Dr. Raed Dweik:  Correct. So actually, our outpatient appointments have of course, gone down significantly, but the number of those that we do virtually has skyrocketed. So, almost 70% of what we do now is virtual and outpatient. In the inpatient, as you also pointed out, following the governor's directive to delay or postpone non-incisive surgeries, we've been following that order as well. That has helped in many ways to preserve the personal protective equipment that we need for taking care of these patients, but also realign our caregivers so that they're ready to take care of these patients as well.

Cassandra Holloway:  Absolutely. I loved how you referenced Governor DeWine, and how we are so closely following his guidelines and that communication so clearly. Can you talk a little bit about how the communication between our president and CEO, Dr. Tom Mihaljevic, and how he is communicating with Governor DeWine?

Dr. Raed Dweik:  Yeah, they are really in close communication. I had a conversation with Dr. Mihaljevic just a couple of days ago, and he had just cut off the phone with Governor DeWine and the health director, Amy Actin. And so, we've been in close collaboration, and my understanding that Ohio was divided into three zones, the northern, middle and southern zones, and the Cleveland Clinic is coordinating with the state, looking at the care of patients within the northern zone, which includes our catchment area.

Cassandra Holloway:  Great. We know that Cleveland Clinic is actively caring for patients with COVID-19, can you talk a little bit about some of the best practices that you've seen your team, who is directly caring for these patients, the best practices that you've seen from them? I know you mentioned previously about PPE.

Dr. Raed Dweik:  Absolutely. So, lots of things we learn as we prepare for the taking care of COVID patients. The first thing we did was, I think helped us quite a bit, is to put all these patients ... we had the main campus in one place, we call it the COVID unit. Actually, they refer to it affectionately as COV-1, the area where we take care of these patients. There, we learn how to minimize the use of PPEs while keeping our caregivers and patients safe. Some of the things we learned for example is how to do appropriate donning and doffing, putting on and taking off the protective equipment. One thing we recognized very early on is that this is not something we are used to doing day in and day out, so we found it very helpful to have somebody watch you while you put them on and off to make sure you don't make any mistakes, and that really prevented us, I think from having unnecessary exposures. And that has been great.

Dr. Raed Dweik:  Other things we've learned from this unit is things we have never done before, including having anything we can have outside the room, we put it outside the room, to again, minimize exposure of our caregivers while continuing to take care of the patients. For example, IV pumps, dialysis machines, ventilator controls, all of those. We work diligently on putting them outside of the rooms and now has become a common practice for us to do that.

Cassandra Holloway:  To move everything from equipment wise, from the patient's bedside to outside of the room. Correct?

Dr. Raed Dweik:  Yeah, the controls of the equipment. Of course still, the patient has to receive the IV, the dialysis or the ventilator, but the way to control them, change them, go up and down, manage them, we can do that now while still outside the room, which is amazing. Advantage one, minimizes the exposure, but two, also minimize the use of personal protective equipment, which as you know, there's been a national shortage in these and preserving them is very critical.

Cassandra Holloway:  Absolutely. I love the idea of this buddy system that your team has implemented as well, watching each other and looking out, either before going into the patient's room and coming out as well.

Dr. Raed Dweik:  Absolutely.

Cassandra Holloway:  We've passed the point of only preparing for COVID-19 because we know it's here and we know it's our reality. What else is Cleveland Clinic doing as we continue planning for the bigger surge of patients when that does happen?

Dr. Raed Dweik:  We continue to learn as we take care of our own patients, but also we have reached out to other areas where they experienced this before us. Early on, we reached out to colleagues in China, Italy, the United Kingdom and more recently, Washington state and New York city to learn from the things that they have experienced and learned. I think the more you talk to these individuals and experts, the more you recognize it really boils down to three things, I call them the three S's, everybody calls them that now; the space, staff and stuff. Space, we mentioned a little bit, which is talking about how to cohort these patients in areas that are highly specialized so the teams can get used to taking care of these patients. The other one is staffing, and that involves multiple levels, not only physicians, but also nurses and respiratory therapists and other healthcare professionals, including advanced practice providers that can take care of them as a team, and we have to, in a way, teach them and they have to learn how to take care of COVID specific issues, not just critical care in general.

Dr. Raed Dweik:  The third issue is, for the lack of a better term, we call it stuff, which is ventilators. As you know, there's a lot of talk about ventilators being in short supply and also personal protective equipment. We've really had been paying close attention to these supplies and our institution, as well as ways to minimize them and we use them if possible.

Cassandra Holloway:  I want to ask you a little bit about, when you mentioned the three S's, if we could talk a little bit about the staff. I know that there's been talks about a labor pool at Cleveland Clinic and retraining, or training people who aren't used to being in one position into another position. Can you talk a little bit about that reassignment that's happening right now?

Dr. Raed Dweik:  Yeah, of course. Clearly, physicians in our Institute in pulmonary and critical care and infectious disease are on the forefront, and they're taking care of these patients already right away. As you recognize with now the canceling or postponing of non-essential surgeries and non-essential procedures, a lot of Cleveland Clinic caregivers who are really not very busy right now, but they could help if they were just given some extra training. So, we have done a lot in the last few weeks to prepare educational materials for them, to have them ready to help in taking care of these patients. We are looking at it as multiple levels of training, one hour critical care physicians and caregivers needed to learn about COVID specific care and we've done that already. The next thing is people who don't routinely do critical care, but maybe called upon in case the number of cases becomes high, and those they need some refresher of how to take care of critically ill patients, and we've done that as well. We also have developed learning modules for individuals who may not take direct care of these patients, but maybe useful in taking care of other patients while everybody else is busy taking care of the COVID patients.

Dr. Raed Dweik:  So, it's really a multipronged, multilayered approach to education, paired with of course, identifying which caregivers would fit in either category so that we can find out what kind of training they need and make sure that they get it.

Cassandra Holloway:  I'm curious, have you had a lot of staff raising their hand to volunteer to learn different areas or help out or pitch in where it's needed?

Dr. Raed Dweik:  I'm telling, the response has been unbelievable. I never expected that. Everybody wants to help, everyone is just, teach me, show me how to do it and I want to help. That's really has been the inanimate response pretty much from everyone. And usually when I have my daily calls with my Institute, I describe this as, for us as healthcare professionals, we have been preparing for this or our lives and this is like a calling for us. So really, I think I felt the same way from everyone. There's nobody that I asked to help that has not stepped up and helped, which is amazing.

Cassandra Holloway:  That's so encouraging to hear.

Dr. Raed Dweik:  Absolutely.

Cassandra Holloway:  And so, I also wanted to ask about the three S's; space, staff and stuff. What about space? Can you talk to us a little bit about the surge hospital that Cleveland Clinic is planning for?

Dr. Raed Dweik:  Yes. As you know, the Cleveland Clinic has the largest number of ICU beds in all of Ohio, so that we already have a lot of ICU beds, which is good to start with. Having said that, if you look at the initial estimates, the number of patients we are expecting to have may far exceed that number. The clinic has done multiple things in that regard. One, look at the inventory of our ICU capacity, intensive care unit beds, and make sure how much we can expand, and we can expand them several fold, and that's already undergoing. The other thing is looking at non-ICU beds and where can we have more of them as well. The third step, which you alluded to is looking at alternative sites, areas that are not traditionally areas where we take care of patients, but can we convert them to do that? The biggest one we're involved in is the health education campus. As you know, this is a large building on our campus that is being transformed into a hospital that can accommodate up to 1,000 beds.

Dr. Raed Dweik:  I can watch this every day from my office, because actually it's literally outside of my office. I see the trucks coming and leaving every day. It's been nothing short of impressive how quickly they were able to do that.

Cassandra Holloway:  We've talked a lot about the physical things that that Cleveland Clinic is doing to protect their caregivers. I want to talk a little bit about what Cleveland Clinic is doing to help protect the emotional and mental state of their caregivers, especially those on the front line. Can you share with any best practices that Cleveland Clinic has implemented for their caregivers' mental health?

Dr. Raed Dweik:  Of course, as you know, caregivers for us is [inaudible 00:14:31] on the forefront, because if you can't take care of your caregivers, they can't take care of our patients. That's something we deeply care about at the Cleveland Clinic. There are things that we've done within the Respiratory Institute, for example, including a few months ago, even before this happened, we appointed an institute wellness officer, which we didn't anticipate that we'll be using her services so much, and she's really stepped up into action and she's developed these neighborhood groups, for example, people who live next to each other to kind of, they can connect with each other with chats to help each other, not only at work but also outside of work. We also have developed these comfort areas for caregivers just outside the areas that are very busy, we have snacks or drinks or place to relax in the middle of a hectic day.

Dr. Raed Dweik:  Also, the Cleveland Clinic has a 24 hour, seven day a week caregiver hotline for any concerns or emotional support that they need, and that's available for all caregivers and it's staffed by behavioral health specialists, and that's been a great support as well. Of course, to me, I think the most important thing we've done in supporting people is communication. People in these times of uncertainty like to know, and again, our CEO has made a point very clear that what he knows, we all know. There's full transparency, and I've taken the same thing within the Respiratory Institute. I have a daily meeting with my leadership every day to discuss everything, and also every day at noon, we have what we call a COVID pulse check call, where we have a call with entire Institute to answer their questions, give them update, and see what's on their minds as well. I think all of that together has hopefully resulted in a lot of support for our caregivers.

Cassandra Holloway:  Absolutely. I love that message. The continuous communication should really help with this peace of mind and understanding the issue. And everything that Dr. Mihaljevic knows, all caregivers know.

Dr. Raed Dweik:  Absolutely.

Cassandra Holloway:  The last thing I want to ask you about here is about research. Can you speak to us about any COVID-19 research that's going on at Cleveland Clinic or how that's being handled?

Dr. Raed Dweik:  Yeah. One of the interesting things about COVID, there's currently no proven or approved treatment for the disease. So while you hear a lot about certain medications or certain things out on the internet and the public, there's really no approved treatment currently. The only way to be able to develop good treatments is to study them and research them, and the Cleveland Clinic again, is on the forefront of this. Since the beginning of the pandemic, we've had requests, I can say of over 30 different studies to study other interventions or tests in these patients. We have put together a team that looks carefully at all these studies and selects the ones that are most useful and more scientifically sound that can advance the science of treatment of these patients. We are about to launch the first study in the next few days, which is looking at hydroxychloroquine in patients with COVID, to see if it's effective or not. As you know, there are reports out there that it may be effective, but they have not really been very robust support, so the best way to do with is to study.

Cassandra Holloway:  Absolutely. Yeah. Like you said, research is such an integral part of solving this puzzle.

Dr. Raed Dweik:  Because it's a new virus, we don't know a lot about it. There's a lot more we don't know than we know, and the only way to get some answers is to do it in an organized way.

Cassandra Holloway:  Thank you so much Dr. Dweik for taking the time to speak with us today. I know so many people listening, myself included, have found what you've said and shared really valuable information.

Dr. Raed Dweik:  Thank you so much for having me. And again, I think the important thing to remember, our listeners, is the importance, I can't overemphasize the importance of keeping the social distancing. I know the cases in Ohio have been relatively stable recently, or not rising as fast, but that's because of social distancing. Social distancing works, it's working, we need to keep it until we are sure that the worst is behind us.

Cassandra Holloway:  It's everyone's sacrificing right now for the greater good, and it's working and we need to continue doing what we're doing.

Dr. Raed Dweik:  Absolutely.

Cassandra Holloway:  For the latest news about COVID-19, visit clevelandclinic.org/coronavirus. If you want to listen to more Health Essentials podcast featuring experts at Cleveland Clinic, subscribe wherever you get your podcasts from, or visit clevelandclinic.org/podcasts, and don't forget, follow us on Facebook, Twitter, and Instagram at @Clevelandclinic, all one word to stay up to date on the latest news and information about Coronavirus as well as your own health and wellness. Thanks again for listening. Take care of yourself and stay safe.