INDIANAPOLIS, Ind. — When the first victim of the COVID-19 virus died in Indiana, it fell upon Community Health Network Chief Executive Physician Dr. Ram Yeleti to express his sorrow at a statehouse press conference standing next to Governor Eric Holcomb.
When that patient died, there was a Community Health Network nurse by her side.
Dr. Yeleti has emerged as a Marion County medical group public leader with his blunt assessment of the coronavirus challenges ahead for Indianapolis’ hospital community.
“So the capacity has always been an issue, and we are still very concerned especially if we don’t flatten that curve, we do anticipate a surge.”
Dr. Yeleti said 90% of the intensive care unit beds throughout his system are already filled with patients suffering from the flu, heart attacks, strokes or other medical issues that predate the coronavirus pandemic.
“One of the key things that we’re trying to do right now is trying to do what we call cohort our patients, so we’re taking certain wings of certain hospitals and making those areas, those wings, more for those persons who we may call a person of interest who if we don’t know that they have it, and if they definitely have it, too, so we’re trying to block off or section off certain areas of our hospital to do that.”
In questions submitted by CBS4 and in an interview conducted Tuesday by Community Health Network staff in the sterile hospital environment, Dr. Yeleti said he felt cautiously optimistic of his system’s current ICU capacity.
“I’m still nervous a week from now we may not have enough capacity so we’re still looking at other alternatives of how we utilize wings that we have not utilized before. Again, our surgery centers and operating rooms are looking at all the different options that we have because even though we are reasonably at capacity today, I’m really worried we won’t be in a week.”
Dr. Yeleti said his staff has been forced to become creative in the rationing of vital medical supplies and devices that could be in short supply when the anticipated surge hits.
“The biggest issue for us supply wise is the facemask, the n95 masks. We’re already at a critical level right now and somewhere in the next couple days we’re very, very concerned about that.”
Dr. Yeleti said even hospitals are not immune from price gouging by manufacturers of in-demand supplies.
“So cohorting allows us to reuse those masks,” he said of his staff. “They’re trying very innovative ways of when can I reuse and not reuse and not put our carriers at risk or the patients at risk but that’s a very big concern.
“We’re being very innovative and, as I mentioned before, even like with ventilators. We’re being very careful in deciding who needs a ventilator. We have what we call BioPAT and CPAP machines and one can use those instead of ventilators and even more esoteric things of using one ventilator for two patients so you really have to become innovative in these times of crisis especially when there’s critical issues of supplies.”
Dr. Yeleti predicts those shortages will become even more acute in rural and small community hospitals throughout central Indiana.
“It is going to be challenging because a lot of these rural critical care hospitals, critical access hospitals, don’t have the ICU capabilities and they don’t have the ventilators so I would anticipate all of our surrounding hospitals, not just Community, but all the big hospital centers will be able to accommodate facilities that cannot handle the surge. A lot of critical access hospitals may not have any ICU beds or if they do they may have only one or two ventilators so we do anticipate that and I again am nervous about that because its very challenging about how we do that. So all the hospitals in town are trying to work together and how do we actually have access to all our bed controls to see where these patients actually go.”
Marion County Public Health Director Dr. Virginia Caine briefed City-County Council members earlier this week that public health and hospital authorities may need to contemplate off-site locations for COVID-19 testing and the housing of some patients.
“The biggest issue for that actually is going to be testing,” said Dr. Yeleti. “There’s gonna be a lot of patients who are going to be moderately to seriously ill but if we know they don’t have COVID-19 we may be able to discharge them or transfer them to another bed sooner. Some of the tests may take up to four days to get back so that’s probably the biggest issue about that. For patients that are very sick they can stay in a critical care bed for up to ten days or two weeks at times.”
Dr. Yeleti said the presence of a coronavirus patient in a hospital room leaves that room unusable for several hours as sanitation crews must wait for the COVID 19 droplets to drop to the floor before cleaning.
The Community Health Network staff asked Dr. Yeleti our final question about when Marion County can expect to be hit with the coronavirus surge.
“That’s really hard to predict,” he said. “What we do is we have a dashboard that we look at every day of our current assessment of where we are with beds and physicians and nurses and so on. We are trying to prepare for the worst, but honestly I can’t tell you what that worst is going to look like.”