We first want to express our gratitude to the Nantucket community for the countless acts of generosity, goodwill and support for our hospital that we have witnessed over the past week. We thank everyone who has donated medical supplies or took the time to manufacture homemade masks, not to mention the many other offers of food, housing, and funding. Seeing our community rally around its hospital as we respond to the coronavirus (COVID-19) pandemic has been inspiring for everyone at NCH.

As our hospital has prepared for this unprecedented situation and changed the way we do business, we realized that the measures that have been implemented to protect patients and our staff may have created the perception that NCH is essentially closed to all but those suffering from COVID-19. That is far from the truth, and we want the community to know that we are open and here to care for you. While we have indeed rescheduled things like well visits and cancelled elective procedures to reduce the number of people coming through our facility, we continue to see patients at NCH for urgent, non-COVID-19 healthcare needs. We are taking every infection control measure to protect patients and staff, and are screening potential coronavirus cases outside the hospital at our drive-through evaluation site at the main entrance. If you have a medical need, please call us and we will do our best to serve you and your family. Our doctors are able to schedule visits with their patients via telephone as well, and we are working on rolling out video visits.

We now have five confirmed cases of coronavirus on Nantucket. These patients are quarantined at their homes and monitoring their symptoms with our clinical team. As we know, the majority of people diagnosed with COVID-19 have mild symptoms, and we have not yet had anyone on Nantucket become significantly sick or require hospitalization due to coronavirus. But we cannot let that fact lead us to become complacent. We must do everything possible to prevent the spread of this virus in the community, so we continue to urge Nantucket residents to follow all aspects of the town’s stay at home order and construction ban, limit trips to the grocery store, practice social distancing, as well as vigilant hand-washing and hygiene measures. The actions all of us take now and in the days and weeks ahead will determine whether we are able to reduce the impact of COVID-19 on our island and avoid a surge of cases that could overwhelm our hospital. We need the help and support of every member of our community to limit the potential spread of this virus.

Many people have asked about our plans to care for people who become infected, and we wanted to share a few details of what we have done to date, and what we will be doing moving forward.

We have already implemented numerous measures to prepare for coronavirus patients at Nantucket Cottage Hospital. The drive-through evaluation site at our main entrance opened on March 16 and was one of the first drive-through testing sites in the state of Massachusetts. We have identified an internal triage area for patients with suspected cases of coronavirus. NCH has also created a “high risk zone” in the Emergency Department and inpatient unit that will help isolate COVID-19 positive patients from others, including utilization of negative pressure rooms. Other actions include:

• NCH has brought in additional personnel to serve in its Emergency Department and inpatient unit.
• NCH is cross-training physicians and nurses from other units to assist in areas impacted by COVID-19.
• NCH is bringing in a new respiratory therapist to assist with COVID-19 specific treatments and train additional NCH personnel on ventilator use and other respiratory procedures.
• NCH has recruited auxiliary physicians and nurses to aid in the event of a surge as part of a reserve team.
• NCH has created cohort teams of physicians and nurses to reduce the number of exposed team members if one becomes infected.
• NCH is assisting with the town Health Department’s effort to recruit and train “tracers” to identify points of contact with confirmed COVID patients.

Another topic that has generated significant interest is the medical equipment available on-site at NCH and personal protective equipment (PPE) for our staff. NCH currently has adequate supplies of PPE based on current usage for roughly two weeks, and we continue to receive shipments from Partners Healthcare to bolster those reserves. We do anticipate that our usage will increase, which is the reason we have put out the call to the island for homemade masks and other medical supplies. We wanted to mobilize our community to preclude any possibility of running low, or running out. Meanwhile, we will use our approved, medical-grade PPE first and foremost, but continue to accept supplies from the community. Two items of note with regard to equipment:

• NCH has rolled out telemedicine capability in the emergency department and inpatient floor so physicians can communicate and check on COVID-19 patients without entering their room and contaminating scarce PPE.
• With the support of Mass General and Partners Healthcare, NCH has acquired 5 additional ventilators to care for patients who are in serious respiratory distress prior to transfer to a higher level of care. We are now working actively with our physicians, anesthesia and nursing staff to ensure we have the equipment as well as staffing levels and expertise to deploy them effectively.

We have been working simultaneously to solidify plans to transport those patients who may need ICU-level care, while also working through options to expand capacity inside our hospital and on the island outside our walls

Nantucket Cottage Hospital’s Incident Command has a task force dedicated to surge planning that has been meeting for several weeks. This surge task force has met daily to develop plans to address all of the issues presented by a potential surge of coronavirus patients, including hospital personnel, equipment and supplies, internal and external facilities, logistics and transportation. The Task Force has coordinated closely with our colleagues at Mass General and Partners as well as the town Health Department and local, state and regional emergency management agencies.

The surge task force has developed a strategy to maximize our internal capacity at NCH, if necessary, beyond our licensed capacity of 14-beds. The NCH surge plan includes four phases based on the number of COVID-19 patients requiring hospitalization, and methods to increase capacity including doubling-up patients in inpatient rooms and/or utilizing other areas of the hospital, including pre- and post-operative rooms and other areas typically used for outpatient care for COVID-19 positive patients.

Our expectation is to transfer any critical patients in need of hospitalization beyond our in-hospital capacity as well as patients in need of ICU-level care. NCH is in regular communication with Boston MedFlight and the United States Coast Guard regarding their operational readiness to transport COVID-19 patients to existing and emergency off-island facilities where there is a critical mass of providers, equipment and supplies.

NCH has prepared a back-up plan in conjunction with the town as well as state and regional agencies for additional space for COVID-19 or non-COVID-19 patients in the unlikely event these patients can’t be accommodated at the hospital or off-island facilities.

We wanted to provide this information to demonstrate our planning efforts during this unprecedented situation, and continue to be transparent with the community regarding our capabilities and resources.

We all have a part to play during this challenging time, and the best thing we can do now is stay home, practice social distancing, keep washing our hands, and support each other as much as possible – but at a distance. We thank everyone for supporting us.

Gary Shaw, FACHE, President & CEO, Nantucket Cottage Hospital

Diane Pearl, MD, Chief Medical Officer, Nantucket Cottage Hospital