March 31, 2020
Silicon Valley Children’s Hospitals Struggle to Keep Ventilator-Dependent Children Safe in Center of California’s COVID-19 Outbreak
Just down the road from the largely shuttered headquarters of Apple, Google, Facebook, Tesla, and thousands of other technology corporations, a small cadre of clinicians is hard at work trying to keep California’s most vulnerable children safe from a pandemic they may never understand.
Campbell-based Children’s Healthcare Organization of Northern California (CHONC) Pediatric Hospital and its nearby sister facility, CHONC Saratoga Pediatric Subacute, are Northern California’s only facilities dedicated to providing long-term subacute care to ventilator-dependent children. With limited supplies of personal protective equipment, the devoted teams of nurses and respiratory therapists have so far been able to stave off the illness, but time is not on their side.
“When you are situated in the middle of California’s hot spot for COVID-19,” said hospital administrator Steve Tu, “it isn’t a matter of if coronavirus will strike us, but when.”
To aid in the fight to safeguard their children, Tu and his team have launched a campaign to acquire the equipment necessary to fight this and subsequent pandemics.
The patients at CHONC are children as young as a few weeks to 21 years of age who are ventilator-dependent and suffer from multiple complex diagnoses. Where most children are at minimal risk from COVID-19, even the common cold is a life-threatening event for the patients of CHONC. Last year, a similar facility in Southern California lost four children to an outbreak of influenza.
Tu and his team are battling to ensure such an outbreak does not occur in their Santa Clara County-based facilities, but the odds are not in their favor. “Our nurses, respiratory therapists, and other clinicians and supporting staff are working around the clock to prevent respiratory infections each and every day. Doing what we are doing is nothing new,” he said, “but the precautions we must take, and the danger posed by this particular pandemic virus is something no one has ever experienced.”
Every day presents new challenges, and every sniffle, cough, and low-grade fever is cause for testing, isolation, and concern. For Chief Nursing Officer, Nino Flores, his need to maintain clinical rigor is tested by a lack of sufficient equipment. Recently, he filmed a short video at CHONC Pediatric Hospital asking for donations of badly in need of equipment and supplies.
In the video, Flores can be seen on the floor among facility children and dedicated staff wearing a face mask, his words muffled enough that on-screen captioning is required.
Unlike other facilities, every patient at the CHONC facilities is on a ventilator, thus there is no shortage of ventilators. Fortunately, most of the ventilators are new, with the rest scheduled to be replaced in May (prior to the onset of the pandemic).
What is on the list are items ranging from a pair of robotic UV whole-room sanitizers ($103,000 each) to $20 plastic face shields. The list also includes masks, gloves, goggles, disposable gowns, touchless thermometers, and of course, significant quantities of difficult-to-find N95 masks.
Compared to other big hospitals, CHONC’s facilities are small, and focused on long-term high acuity care. With only 31 (CHONC Pediatric Hospital) and 36 (CHONC Saratoga Pediatric Subacute) beds and a median length of stay of nearly three years, there is less of a chance for a newly admitted patient introducing a pathogen. For some, if not all, of their childhood, CHONC is considered a child’s home, and the clinicians and supporting staff who work there are their extended family.
At the same time, the nature of the healthcare workforce (by necessity, many employees also work at other facilities) and the facilities’ location at the epicenter of California’s outbreak means the risk of having a pathogen introduced by one of their 300-plus employees is high.
Currently, all CHONC facilities are closed to non-essential staff and visitors, including family members, which means parents can only see and speak with their children either by videoconference or by telephone. This significantly reduces the infection risk, but also creates a level of stress and the pain of separation for children and families who have experienced too much of both. CHONC’s pediatric day health centers, Scribbles & Giggles, closed one location located at the Ann Darling School in San Jose, and have limited services provided at their Saratoga campus to children of the region’s essential employees.
Against this backdrop, the clinicians and supporting teams at CHONC do what they can, with what they have. They have fought this fight every day for years, but this time feels different. It’s a difficult time, and it won’t get any easier in the days and weeks and months ahead.
For the children and staff at CHONC, fighting COVID-19 on a daily basis is the new normal.
Donations to CHONC can be made at www.reachyourpotential.org.