Command Unit Drives Hospital’s COVID-19 Response

At least twice a week, Nicola Harwood, the emergency preparedness coordinator at St. Joseph Hospital

At least twice a week, Nicola Harwood, the emergency preparedness coordinator at St. Joseph Hospital in Orange County, California, joins two to three dozen colleagues in a large conference room at the hospital to discuss how the facility is responding to the COVID-19 crisis. The conference room functions as the hospital’s command center, large enough for participants — who wear masks — to sit 6 feet apart, to prevent the spread of the novel coronavirus, which causes COVID-19.

Each meeting includes hospital leadership, physicians, nursing supervisors, environmental services and security personnel, social workers, infectious disease doctors, communications officers, protective equipment procurers, hospital lawyers, finance officials and a hospital mission specialist, who’s conversant with St. Joseph’s goals as a Catholic facility. The hospital personnel who attend these meetings cover various aspects of what makes the hospital work, including day-to-day operations, logistics, finance and planning.

“It’s ultimately my responsibility to make sure we’re all on the same page,” says Harwood, who lives in Yorba Linda, California.

For each gathering, Harwood has a document with a straightforward list that helps shape the group’s mission: What is the hospital’s current situation? What do I need to get done? What do I need to get it done? Who’s going to get it done?

[Read: Unsung Heroes Fight the COVID-19 Pandemic.]

Harwood, 49, doesn’t dictate who should tackle which issue or how they should solve it. Rather, she leads a discussion to determine which groups of specialists need to work on which issues. This promotes teamwork and efficiency, Harwood says.

“I’ll say, ‘This what we need to work on,'” Harwood says. “I’ll give them the room (to discuss problems and solutions). Operations, planning and logistics (officials) will talk about what they need to do. Sometimes they’ll meet with each other. If you allow them to break into groups, they can work on four problems at one time.”

Harwood and her aide use an online document to keep track of which tasks need to be done and which ones are pending. “As things get resolved we put the solution in the spreadsheet,” Harwood says. “If something is done we put it into the ‘completed’ section. It’s a living document.”

As leader of the command center, Harwood has to develop policies and approaches for a wide array of issues, from determining how many beds the hospital should have available for COVID-19 patients to ensuring clinical personnel have the personal protective equipment they need to care for end-of-life situations for COVID-19 patients.

“It is our practice at St. Joe’s that no one dies alone,” Harwood says. “Our caregivers donate their time, if necessary, to ensure that someone is at the bedside at the end of life, holding their hand and offering a prayer, including COVID patients.” The hospital developed a program to train caregivers how to comfort patients in their last moments. About a half-dozen nurses volunteered to get the training and to be there for dying patients who had no one else to be with them in their waning moments.

Before the COVID-19 pandemic hit, Harwood’s job primarily involved creating and reviewing policies to ensure the hospital was prepared for natural disasters like earthquakes and wildfires, both of which occur in southern California with regularity. In her role, Harwood would meet routinely with local government officials and representatives from other area hospitals to develop a unified response to such events.

Harwood is also a terrorism liaison officer with the Orange County Intelligence Assessment Center. The center is an information and intelligence-sharing network that analyzes and disseminates “information on all criminal risks and safety threats to law enforcement, fire, health, private sector and public sector stakeholders” to protect residents, visitors and critical infrastructure while protecting civil rights and civil liberties.

During the pandemic, for example, some sovereign citizens — people who question the legitimacy of government and don’t believe laws apply to them — have expressed belief that the COVID-19 pandemic is a conspiracy created by the elected and appointed officials in order to deprive individuals of their civil liberties. These individuals have tried to get information about hospitals. Some sovereign citizens are suspected of trying to get information about hospitals to “prove” their theory that COVID-19 is a government conspiracy. They’ve been known to file what many legal experts consider to be frivolous court motions. In the spring, during the first weeks of the pandemic, some sovereign citizens reportedly printed out semi-official looking cards that said they were exempt from having to wear masks.

In her role with the OCIAC, Harwood helps keep the intelligence center informed about individuals who are trying to gather intelligence on her hospital and the tactics they use.

“One of our local hospitals had a gentleman with a gun try to force his way into the emergency department, so we exchange information to help keep everybody safe,” Harwood says.

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Much of her job, pre-pandemic, involved networking, “When a disaster happens, the last thing you want is to not know who to reach out to,” she says.

WHaOne of the significant ways Harwood’s job is different during the COVID-19 pandemic is that she and her colleagues have had time to prepare for a crisis they knew was coming, rather than getting ready for a sudden disaster that could strike suddenly with little or no warning.

“In a way, we had the luxury of preparing for a slow-moving pandemic that allowed us to respond the way we did,” Harwood says. In January, alerted by articles in medical journals about the initial outbreak of COVID-19 in China, infectious disease specialists at St. Joseph anticipated the hospital — and the country — would need to deal with the deadly disease. Harwood and other officials formed a task force to prepare for the arrival of the pandemic.

By March 13, based on plans developed by the task force, the hospital had created a dedicated intensive care unit of 12 beds to treat COVID-19 patients. Overall, the hospital has 463 beds.

About that time, it was clear that COVID-19 had arrived in Orange County. Harwood and other hospital officials launched the command center.

As the need for capacity has grown, the command center has added COVID-19 beds. As of mid-July, the hospital has 52 ICU beds for COVID-19 patients and 42 additional ones for patients who don’t require intensive care. The COVID-19 beds are in three dedicated negative air flow units on two floors.

St. Joseph Hospital is in Orange County, which is one of four suburban jurisdictions driving a spike in COVID-19 infections in recent weeks, the Los Angeles Times reported. In response to the surge of cases, California Gov. Gavin Newsom ordered a new set of closures to try to blunt the spread of the virus. Newsom shut down indoor operations for bars, restaurants, movie theaters and zoos throughout the state.

Governor Gavin Newsom, a Democrat, ordered bars closed and restaurants, movie theaters, zoos and museums across the nation’s most populous state to cease indoor operations. Gyms, churches and hair salons must close in the 30 hardest-hit counties.

The number of COVID-19 patients the hospital has cared for has ranged from between 40 to dozens at a time. The hospital has the capacity to about double the number of COVID-19 beds it currently has, Harwood says.

“We’ve turned this hospital almost inside-out to make it this amazing center of care for COVID-19 patients,” Harwood says. “We’ve turned it into a highly-infectious disease response hospital, and it wasn’t built for that.”

In addition to planning for emergencies, Harwood has experience helping patients directly. She’s a certified medical assistant and has worked as an emergency medical technician. Before joining St. Joseph, she worked as a civilian contractor for the Navy on a Marine Corps Base in Orange County.

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Harwood says she and her colleagues are prepared to keep the command center going through the end of the year, and beyond if necessary.

“I work with this amazing team of individuals who’ve demonstrated incredible out-of-the-box thinking,” she says. “It makes me proud to work for this organization and the people who work here.”

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