'Preparing Has Been My Waking Life'

Apr 8, 2020

He describes it as a massive surge, a tidal wave, an unprecedented volume of patients infected with the coronavirus pouring into their hospital seeking help. It hasn’t happened yet, said Dr. Justin Held, section director of hospital medicine at University of Cincinnati Medical Center and 2004 Xavier graduate, but it will start ramping up soon and peak in just a few weeks.

Held, an internist and associate professor of internal medicine, is on the COVID-19 Emergency Preparedness Team for UC Health, making sure that each site in the system is doing everything it can to be ready. As a hospitalist who cares for acutely ill hospitalized patients, his responsibility is inpatient services, the team responsible for making sure the hospitals have the beds, staff, protective gear, ventilators, respirators and meds that will be crucial to keeping patients and caregivers safe when the flood arrives.

He draws inspiration from the values he learned at Xavier about contributing to the greater good as he works to make sure the Cincinnati community is as prepared as it can be.

“We’ve been doing everything we can to make preparations in our inpatient and emergency department settings to absorb what we predict is going to be a massive surge of patients that are infected with this virus,” he said. “New York is obviously out front, but we think that wave will spread over the country, and it’s going to hit places that are more densely populated first.”

Right now, he said in late March, the numbers in Hamilton County are manageable, but they’re also about a week behind because that’s how long it’s been taking for test results to come back. Which means that there are more cases of COVID-19 infections in the region than are currently confirmed.

“We have been seeing significant numbers of patients that have symptoms compatible with COVID-19, and we’re testing all the patients that get admitted with respiratory issues,” he said. “Some are positive, some negative, and many of those patients are recovering and going home before their results come back. But I think what we’re trying to prepare for mostly is what might happen over the next four weeks, which is the time frame we think cases will pick up.” 

He is “deeply concerned” that what might look like a small number of infected patients with the most serious cases of COVID 19 could multiply, like it has in New York, and overwhelm the critical care capabilities of all the hospitals in Cincinnati.

“There are a fixed number of resources—beds, vents, doctors and nurses—to take care of those people,” he said. “Not only could you face terrible issues like not being able to offer mechanical ventilation to every patient who needs it, leading to poor outcomes, but the hospitals getting swamped are also not able to offer appropriate care to patients not related to COVID-19, so people could die from things we normally can prevent like heart attacks. Our job as a service to the community is to make sure all those critical access points remain open and functional.”

Preparing has meant canceling outpatient procedures to free up beds and staff and keep potentially infected people from coming into the hospital. It has meant making sure they can provide the basic elements of clinical care—having enough bed space for new patients, enough pharmacy supplies, the right technology systems in place, and ensuring public safety for everyone involved in the response. Their supply of N-95 masks is good for now, but he’s concerned it won’t be enough.

“At the moment we’re able to procure batches of these things to resupply but just given the volume of folks we’re expecting, everyone is really worried about that supply drying up,” he said.

In addition to his duties on the COVID-19 Preparedness Team, Held and his team are also seeing patients, including some who are hospitalized with COVID-19. There were about 50 known cases of coronavirus in Hamilton County in late March, with about 100 patients under investigation at UC Health hospitals awaiting test results. That problem is being resolved as the hospital labs have prepared to do their own testing for COVID-19, which means results will be available in hours rather than days. Held said the hospital did not have any known COVID-19 deaths at the time, but it’s possible that lagging test results will confirm that some patients who died recently had the virus.

Held tries to reassure his patients when he visits them in the hospital, he said. But he realizes they’re scared, and approaching them wearing full face shields and masks, protective gowns and gloves can cause additional anxiety.

“Our job is to reassure them that because they are sick enough to be in the hospital, they are in the safest place they can be, and we can help support the rest of their needs like hydration and nutrition,” he said. “God forbid if they get sicker, we want to be able to provide the necessary critical care to all patients who require it.”

With such a dangerous infection, they monitor patients closely for signs it is worsening so that they can catch those before they start to go downhill. It can happen rapidly, he said. “We know most people with it will not need to be hospitalized, but with our patients that do need it, we watch very closely because it can get worse very rapidly. A patient can go from just a little oxygen through the nose to in a few hours need support from a ventilator.”

Held said the work he’s doing now in response to the coronavirus fulfills his goal of becoming a physician in the community, an aspiration that was reinforced by his Xavier education.

“I truly feel my value and professional work is about giving back to this community,” he said. “It’s the reason I stayed in Cincinnati for my residency and my professional life. There’s no question that the curriculum at Xavier is heavily influenced by service, which resonated with me long after graduating.”

By France Sloat, Office of Marketing and Communications

Read more stories about Xavier on the Front Lines of COVID-19.