Doctors detail their Covid – 19 response plans

An army of physicians are working together to help patients who have been diagnosed with the Covid-19 corona virus, according to Dr Delroy Jefferson, Medical Director of the HSA.

Speaking at a press conference last Thursday, Dr Jefferson said that Cayman was in a very intense situation right now with the Covid pandemic, but fortunately the Islands had various physicians within various facilities coming together to plot a way forward so that people within the community could feel comfortable and have hope.

Out of the 66 positive corona virus patients seen in Cayman so far, the age range went from 14 to 85 years, with the average age being 43. Fifty-two per cent were males/48 per cent females, in line with what the world was currently seeing, he said, with a “relatively even spread” across the ages. Patients presenting the most severe symptoms were over 50 years of age, in the main. Most had underlying health conditions. Eleven people had been admitted to hospital with three patients having been admitted to critical care, two of whom were ventilated, while all had managed to get off the ventilator and were “doing very well”. All the eleven except for one had other significant health issues relating to diseases such as hypertension, diabetes and pulmonary problems.

“As a country, were doing fine,” he said, explaining that it had been a combined effort, with doctors from the Cayman Islands Medical and Dental Society, Doctors Hospital and Health City joining those at the HSA.

“Everyone has come together to fight this war against the virus,” he said.

While patient might present with corona virus at any of the hospitals, depending on the severity of their symptoms, they would either recover at home, or, if moderately ill, they would be kept in hospital for treatment. Dr Jefferson explained that Cayman’s medical fraternity had a four-phase plan to deal with Covid-19 patients. In phase one of the medical response to an outbreak, patients would initially be kept at a five-bed respiratory unit at HSA, which could be expanded to seven beds. Patients who required ventilation would be kept at the Critical Care unit. HSA could provide ventilation for seven patients but that could be expanded, if need be, as they have enough ventilators to support 36 patients and there was a programme to bring more ventilators on island, Dr Jefferson said.

Dr Archita Joshi from Health City Cayman Islands said that phase two of the plan, in the event that that the Health Services Authority’s Critical Care unit was full, Health City would take patients. She said they had earmarked 11 ventilated beds within their own medical intensive care unit. This included two beds with airborne isolation rooms, an ideal circumstance in which to have corona virus patients. In addition, there was also a provision for 24 ward rooms where they had a central oxygen supply. These could be used if they did not need critical care, but did require hospitalisation.

“If there is a further surge where we need more ventilated beds or hospital beds, I’m sure both hospitals will collaborate to see how we can increase this capacity,” she explained.

Hospitals also have to reserve beds for people with non Covid-19 related problems, Dr Joshi outlined. Currently the surgical unit at the HSA and the first-floor ward at HCCI were both reserved for such patients and she said if there was another surge, she was sure both hospitals would try and increase the number of beds that could be made available for Covid-19 patients. Both hospitals could also make use of anesthesia machines, whereby HSA had four and Health City had five. If that situation arose, they could use these for the purpose of ventilation. These comprised both phase two and phase three plans, she said.

Dr Stephen Gay, anesthetist and pain management specialist at Doctors Hospital, explained that when the HSA and then Health City’s capacities were reached, the plan would go to phase four, where patients would be sent to the Doctors Hospital. This phase would be if Cayman saw a critical surge in cases, he said. This was a point at which the Islands wanted to avoid, he stated.

“The capacity of HSA and HCCI together is about 27 ventilated and 54 non ventilated beds, then the spillover will be going to a dedicated alternative care facility and Chrissie Tomlinson (Doctors Hospital). Chrissie Tomlinson, as a 13-bed hospital is not great, but we certainly have three bed spaces dedicated for infectious disease and they are negative pressure rooms, with two anesthesia machines should the need arise,” he explained. “Should patients need to go to the alternate care facility, the situation would be dire, but they should have all the comprehensive aspects of care required at any other hospital.”

Dr Gay said the community did not want to get to this stage and that was why Cayman’s leaders had instituted isolation and containment measures.

Dr Jefferson said that Cayman was at the early stages of phase one and that government had put in place measures so we never got to phase two or three.

“We all hope that we remain the way we are. We are very fortunate in the Cayman Islands. I mentioned the collaboration between the various hospitals. Never before have I we seen this degree of coming together of minds.” Dr Jefferson said.