Metro Health doctor: COVID-19 not going away

System is addressing inefficiencies while increasing preparedness for subsequent waves.
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Metro Health delivered on a tall order after COVID-19 laid bare inefficiencies in the state and national health care systems, but with Gov. Gretchen Whitmer’s executive order set to lift June 12, the local health care system warns Michigan is not out of the woods yet.

Dr. Raki Pai, cardiologist, chief population health officer and president of the medical group at Metro Health – University of Michigan Health, said when COVID-19 came to the U.S., it was a harsh wakeup call for health care systems’ regular operations.

“I think we thought, and the President (Donald Trump) for a while thought, COVID won’t hit us here,” Pai said. “This may have been the thinking in January, and we found out that wasn’t true.”

The main impact on Metro Health, Pai said, was COVID preparedness, including gathering PPE, ventilators, hospital beds, sedatives and any other necessary equipment for a potential resurgence of the virus.

“All of that COVID planning was an unanticipated cost,” Pai said. “It definitely impacted health system economics. Also, Gov. Whitmer — who I absolutely respect with regard to the shelter-in-place order — but that made the month of April the worst for us.”

After Whitmer’s shelter-in-place order, which took effect mid-March and required all designated nonessential businesses to close while essential businesses could operate with restrictions, Metro Health was forced to close several clinics and accelerate its digital health care strategy.

“It really was taking a pretty good, well-working machine and knocked it off the tracks,” Pai said. “That was a tall order for the team, but we delivered on that.”

Pai said Metro Health has patient patterns separated into four categories. First are the urgent care patients, those suffering from heart attacks, strokes, automobile accidents or similar scenarios. Pai said those people still are coming in regardless of COVID.

The second category is the hesitant group, or people who are afraid to leave home and seek care unless it is absolutely necessary.

“My parents are like that,” Pai said. “We have to really restore confidence with these patients.”

While the development of a vaccine is going to reduce the fear of COVID, Pai said the medical community still has a major hurdle to clear. Currently, there are more than 100 vaccine compounds in the process of being tested, but there still is the logistical probability of producing enough for the U.S.

The next category is the very reluctant patient. Pai said these people may have intense fear or even PTSD because of COVID and are choosing to wait it out instead of going to the hospital.

“We have seen an uptick in our ER visits, not particularly for COVID, but because patients who are delaying care are now showing up in the emergency room,” Pai said.

The last category involves patients who have involuntarily exited the health care system. This usually involves patients who had employer health insurance but were let go from their jobs in the wake of COVID and subsequently lost coverage, Pai said.

Previous Business Journal reports noted health care experts hinting at a possible second wave of COVID infections in the near future. Pai said it is still reasonable to expect that, although some of the models in West Michigan predicted a surge of COVID patients in April, which did not happen.

“We’re only a 208-bed hospital, and that would have been an Armageddon situation,” Pai said in mid-May. “At this point in time our ICU is full, and about 30% of the beds there are COVID-positive patients.”

This does not rule out the possibility of added waves or ripples in the rate of infected persons will happen in the future. Pai said Whitmer’s order has been successful in flattening the curve, but worried when the economy is “reopened” there could be the risk of cluster outbreaks on a community basis.

“The smaller communities could be potentially less impacted,” Pai said. “But no doubt it would create — and some countries have observed this — a situation where you could have to quarantine whole blocks and neighborhoods.”

Pai said the availability of COVID testing has gone up relative to even three weeks ago, although testing still is limited. In diagnosing the lack of available PPE, Pai argued too much of the U.S. supply chain was concentrated in China. Understandably, when COVID spread across China, the country chose to nationalize all of its PPE, including masks and hand sanitizer, leading to a shortage here.

“I think one of the things we’re going to learn from this is for mission-critical equipment, we got to make a lot more of that stuff here,” he said. “This isn’t the last pandemic.”

The current pandemic isn’t going away for a while either, Pai said. He predicted Michigan — and the U.S. — will have to continue to find ways to deal with it for the next few years, at least.

According to figures from the Kent County Health Department in mid-May, there were 52,350 total COVID cases and just over 5,000 resultant deaths in the state of Michigan. In Kent County alone, there have been almost 3,000 cases and 58 deaths.

Pai also was candid about how COVID has affected operations at Metro Health. Recently, the health system rolled out temporary salary cuts. Pai cited declining revenue as the reason for this decision and the cuts will likely be in effect for six months.

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