HJNO Nov/Dec 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2020 37 Every year we learn lessons from our ex- periences, and that was never more appar- ent than this year. Our situational awareness over a broad range of areas—from cemetery cleanup to evacuations—is better than at any time in recent history. Unlike during Hurri- cane Katrina, we are far more in tune with the work the thousands of healthcare workers, contract services and professional organi- zations are doing in order to more smoothly coordinate our response. Our response this year was robust and effective, but it is always worth mentioning that this work takes us all working togeth- er. We are in great debt to the residents, the volunteers and the local officials who refuse to let these challenges break their tremen- dous spirit. This year has not been easy, and we are all tired—both physically and mentally. But just as we react to lessons learned in emer- gency management, we encourage all Lou- isiana residents to use this year to mentally prepare themselves for what is ahead and to remember that these disasters can be as psy- chologically grueling as they are physically. There is no shame in seeking mental health services when needed, andmany of us do and will need it given this most unusual 2020. n Rosanne Prats, MHA, ScD, received a masters and doctorate at Tulane University. She came to LDH with healthcare work experience in the federal, state and private sectors. Prats’s role is to develop and implement a state- wide network of emergency care for disasters. She works closely with local, state and federal agencies to develop policies, procedures and state plans for emergency response. She serves as the grant principal investigator for the Hospital Preparedness Program (HPP) for pre-hospital and hospital preparedness planning. Over the past 20 years at LDH, Prats has developed the Emergency Support Function 8 (ESF-8) Health and Medical Disaster Response Network for the state. She has coordinated the health and medical response ef- forts for catastrophic events such as Katrina/ Rita (2005), Gustav/Ike (2008), H1N1 (2009), MSC252 BP Oil Spill (2010), Isaac (2012), March and Au- gust Catastrophic Floods (2016), Harvey/Maria/ Irma (2017), and most recently COVID-19 and the six hurricane storms of 2020. as 1,000 additional beds to care for the sick could be needed, so a task force was formed to consider our options. We settled on the Morial Convention Cen- ter site and designed the facility to hold as many as 2,000 patients, expecting we would receive a variety of convalescent patients who were medically stable but required iso- lation. But soon after the facility opened on April 6 with 15 patients, it became clear that the greatest need was for medically fragile but stable nursing home patients infected with COVID-19. Within 10 days of opening, the patient cen- sus at the MMS peaked at 108 patients as staff at the facility immediately began to expand the admission criteria to accept patients with greater needs. As we added staff at the MMS who could effectively care for nursing home patients, the facility became a lifeline for con- gregate care facilities to send COVID-positive patients to recover safely and without infect- ing additional staff and residents. With zero fatalities at the MMS, it is not hyperbole to say that the MMS was a facility that saved lives. As of this writing, more than 400 patients have been served at the MMS. It can be difficult to find silver linings amid disasters that cause so much misery and death. We were fortunate this year in avoiding natural disasters striking more highly pop- ulated areas of the state, which could have created a much greater strain on resources and may have resulted in even more lives lost. In fact, with just a few exceptions with help from our friends in Texas, we were able to manage nearly all of our response using in-state resources. Even so, the people of Southwest Lou- isiana have experienced tremendous loss and have a huge amount of rebuilding work ahead. But, we are also grateful to them for heeding the warnings of local officials and for their patience in relocating to unfamiliar areas to stay out of harm’s way. and they did so in a remarkably smooth and orderly fashion, keeping residents safe and healthy in the process. Another key investment in our prepara- tions that helped us claw through this high- ly challenging year was the time we have spent building relationships with hospitals and nursing homes. Wherever possible, we have included hospitals and nursing homes in our preparations, embedded their staff with our own during disasters and kept them apprised of departmental orders that would affect their operations. Their feedback and advice have been invaluable and have helped us steer clear of major mistakes that could cost the state resources, time and, most im- portantly, additional lives. Although those investments have clear- ly paid off, disasters always seem to have a way of highlighting weaknesses in our medi- cal infrastructure, even as they show howwe have applied lessons learned. The contagious nature of the coronavirus ravaged nursing homes early in the pandemic and proved a persistent foe for these facilities as the cri- sis played out. This was particularly true in older fa- cilities that were built during an era when shared rooms were more common, mak- ing cohorting strategies more challenging. To their credit, nursing home operators and Office of Public Health staff established high- ly cooperative relationships in implementing infection control, testing and isolation strat- egies early in the pandemic, but physical lim- itations were often a barrier. Assisting nursing homes and other con- gregate settings in their isolation strategies was where we found the Medical Monitor- ing Station at the Morial Convention Center in New Orleans most useful. Known as the MMS, Governor John Bel Edwards autho- rized the facility after modeling projections indicated hospitals were in danger of reach- ing capacity. Projections showed as many Rosanne Prats, MHA, ScD Executive Director of Emergency Preparedness Louisiana Department of Health Office of Public Health