Fighting a war against the enemy you can't see: How VA Medical Center battles coronavirus

Step into the main atrium of the Richard Roudebush VA Medical Center, and what is most striking is the quiet. Normally the entrance hall bustles with patients heading to appointments and visitors stopping in.

But now, amid the coronavirus outbreak, with no elective surgeries and no visitors allowed, the typical hubbub has slowed. The 159-bed Indianapolis hospital, which is usually at 80-85% capacity, has only about 50% of its beds filled.

This, hospital administrators fear, is the calm before the coronavirus storm.

Predictions for when the surge might come vary. Initially the hospital braced for April 18 then perhaps April 14 or 15. Those last two days have now come and gone.

State officials now say maybe the end of the month. Whenever the surge comes, if it comes, Roudebush will be ready, said Richard Griffith, chief strategy officer and incident commander for the coronavirus response.  

“We are managing the veteran volume really well right now. I think like many health systems we are waiting for the surge,” he said. “We want to make sure at the VA that we’re prepared.”  

Like many Indiana hospitals, Roudebush started preparing at the start of March for what many feared could be an onslaught of critically ill patients suffering the ravages of the SARS-CoV-2 virus.

As Roudebush ramped up, many of the staffers who have military experience applied what they learned in the service to the task at hand, battling the unknown and unseeable foe that is coronavirus.

“For those of us that have been veterans, you kind of know how to manage because that’s what you get trained to do," Griffith said. "We’re not going to redesign the whole hospital, but it’s going to feel like that.”

Changes came even before the hospital saw its first patients with COVID-19, the disease the virus causes. The hospital, which granted IndyStar journalists rare access inside the facility, set up a command center staffed by about two dozen employees, each one wearing a vest that delineates his or her role.

Two inpatient units with about 25 beds each became dedicated COVID intensive care units. Because the units were ready before the first patient arrived, the staff could do some simulation training, said Dr. Grant Gilroy, the ICU’s medical director.

If the hospital sees a surge of patients, it can repurpose at least two additional units into more space for COVID care central, Griffith said.

As of Saturday, Roudebush had 127 patients who had tested positive for the coronavirus and 10 who had died, according to the U.S. Department of Veterans Affairs. Across the country, 5,305 veterans had tested positive for the disease and 315 had died.

The number of patients will likely increase in the coming days and weeks as Roudebush is now reaching out to community and rural hospitals to offer to care for any veterans hospitalized in those facilities.     

“Right now we’re making sure that every veteran that we can take care of is at the VA,” Griffith said. “We expect our percentage to go up as we bring more veterans back from the community.”

VA employees also are falling ill with the disease. An April 15 New York Times article reported that 1,604 VA employees have tested positive for the coronavirus and 14 have died.

At Roudebush, 72 employees have tested positive, and two have died, a VA spokesman told IndyStar. 

Responding to reports that VA employees across the country have lacked sufficient personal protective equipment, five organizations, led by the American Federation of Government Employees, wrote a letter to the Veterans Health Administration. The letter refers to a "dangerous shortage" of PPE, saying that employees' lives have been lost. 

Two days later, the Veterans Health Administration responded, saying that it was working hard to make sure all employees have what they need to stay safe.

From drive-thru tests to ICU care

One of the places in the hospital where employees must wear full protective equipment is at the drive-thru testing clinic. If a doctor recommends a test, veterans not sick enough to require hospitalization can make an appointment to be tested at the clinic, which is located in a rear parking lot, without ever leaving their cars.

Results are available within two to three days, said Sean Clemons, a Roudebush nurse. The clinic performs 10 to 20 tests a day.

Anyone entering the hospital undergoes a brief screening in the atrium. Both patients and employees must answer if they have a new cough, shortness of breath, fever, diarrhea, or any other symptom consistent with a coronavirus infection.

Those who confirm they have none of those symptoms receive a sticker with the day’s date on it. If a person answers yes, he or she is given a mask and then sent to a high consequence infection unit for further screening.

“They get put into a room, the doors are closed, and the nurse does a bedside triage, so we’re decreasing exposure to anybody else,” said Erika Swanson, a nurse who is helping to manage the unit.

“We’ve had quite a few patients,” she added with a sigh.

Suspected COVID patients who arrive by ambulance also go to a special respiratory emergency department in a space that used to house the wound clinic. The unit opened the morning of March 28.

Fifteen minutes before it officially opened two patients arrived via ambulance, said Kristen Garvey, a nurse and assistant emergency department manager.

Since then, the respiratory emergency room has had as many as 10 patients seeking treatment at one time.

Adapting to changing practices

At first the regimen proved challenging, but as the weeks passed the staff has adjusted to the new way of doing things, said Tosha Draper, nursing supervisor for the facility and incident operations chief.

"The way we take care of patients is different. The way we move throughout the facility is different,” she said. “It’s a different way of thinking.

"I don’t think I was ever taught in school how to operate as a nurse in a pandemic. The focus now is being creative and maximizing our resources, figuring out other ways to care for patients, not just the ways we were taught in school.”          

Everyone also must be adaptable and change direction as best practices change. Last week, for instance, only people on the front lines were wearing masks.

As federal recommendations changed, the hospital started encouraging everyone who wanted to wear a mask. Assured that the care teams have what they need, Griffith donned one recently for the first time.

“The thing about COVID is that it’s so new that our understanding of what’s needed has changed,” he said. “If you want to wear a mask, you should wear one. We have not put a 100 percent policy in place, but I have changed my own practice in the last week.”

One of the practices that coronavirus has changed that is the hardest for everyone is the prohibition against visitors, particularly those for patients in the last days of their lives. The hospital will give patients and family members iPads if needed so they can communicate with one another.

But when patients near death, nurses recognize there is no substitute for human contact. VA staff never want to see a veteran die alone, said Ryan Wadsworth, a nurse, so now when patients take their last breath, a nurse is always by their side.

Although it’s not easy, Wadsworth — who served in Iraq, Aghanistan and Somalia — said he and his colleagues find ways to persevere.

“I do feel like the VA is uniquely equipped to handle things like this,” he said. “I’ve been in situations before where you might not have everything you would want for the situation. But you pick up and you move on and you deal with it and you get it done, and that’s what we’re doing here.”

Contact IndyStar reporter Shari Rudavsky at 317-444-6354 or shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.