The COVID-19 pandemic has led to fears that hospitals would be overwhelmed by the surge of patients. But Hilo Medical Center, which serves as the main hospital for the second largest city in the state, is suffering just the opposite problem.

It has yet to admit its first COVID-19 patient.

Though the Big Island has had 81 diagnosed cases of the disease so far, the majority of those cases were in West Hawaii, and most were able to recuperate under quarantine at home.

While the expected surge of COVID-19 patients hasn’t happened in East Hawaii, all the hospital’s other admissions have dropped precipitously.

Hospital admissions in Hilo Medical Center overall have fallen by about a third. Emergency room admissions have dropped from a daily average of up to 159 patients to a current average of about 80 patients.

“Patient volume has dropped off in practically every aspect,” says hospital spokeswoman Elena Cabatu.

The drop-off has come at a steep financial cost.

The hospital and its two smaller sister hospitals in Ka’u and Kohala are now projecting a budget shortfall of about $26 million by December, only partially made up by $11 million in federal aid for COVID-19 preparations.

“We’re going to try to be very smart with our money,” says Cabatu.

But she’s also hopeful that the state or the feds will come up with more aid to meet the shortfall.

Combating Fears Of Going To The Hospital

Some of that reduction in patients is good news. Most of the closures and other social distancing measures inspired by COVID-19 has worked equally as well in curbing influenza cases.

“We had our flu numbers fall off the charts,” says Cabatu.

But she fears that many patients are not coming for more problematic reasons.  Some may have lost their employer-backed health insurance. Some may be afraid of being exposed to COVID-19 at the hospital.

That latter fear, believes Cabatu, is unfounded. Because of its precautions, the hospital may be one of the least likely places to pick up the virus.

All staff and patients, and anyone else entering the hospital for any reason now get their temperatures taken at the hospital entrance, and are not allowed to proceed without a day-pass tag. Patients are allowed no visitors.

All patients admitted to the hospital, even for elective procedures, now get mandatory COVID-19 testing, and the hospital usually gets the results back within 24 to 48 hours. New barriers have been erected and waiting rooms have been rearranged to maintain social distancing.

The hospital has hired several new staffers specifically as “COVID cleaners” to make sure, for instance, that frequently touched surfaces are also frequently disinfected.

The hospital has even hired nursing students from the University of Hawaii Hilo nursing program to beef up its staff in case there is a surge of COVID-19 patients. Those extra staff will have to remain on call until there’s a cure or a vaccine.

Turning To Telehealth

The hospital staff is also looking at ways to deliver more care online.

“Through our patient portal, we’re going to provide telehealth visits with our providers where it’s appropriate,” says Cabatu.

About two weeks ago, with no shortage of space and the coronavirus situation at least temporarily under control, the hospital resumed scheduling elective surgeries.

The hospital also appears well-stocked in terms of beds and equipment. Hilo Medical Center currently has a total of 130 acute care beds, with plans in place for another 12 intensive care and 64 regular medical-unit beds if they’re needed.

Under normal conditions the hospital’s  stock of 123,600 surgical masks would last nearly a year, and its 12,610 N95 face masks would last for over two years. In a worst-case Stage 4 Covid-19 outbreak, the hospital still estimates that current stocks of surgical masks would last for 74 days and N95 masks would start to run out after 145 days.

Stocks of such items as gloves, gowns and face shields aren’t as abundant: in a Stage 4 COVID-19 outbreak, the hospital would likely run out of existing stocks of gloves after 23 days, gowns after 30 and face shields after 16. (Cabatu notes, though, that in a pinch, face shields can be re-used.)

But the hospital can also draw on equipment stocks from sources such as the Red Cross, and has more equipment already on order.

The hospital has 41 adult, one pediatric and one neonatal ventilator on hand, with one additional adult ventilator each deployed at the Hamakua and Ka’u hospitals.

Convincing Patients To Return

She doesn’t think that the situation at Hilo Medical Center is unique.

“If you look at marketing campaigns out there (for other Hawaii hospitals such as Queens and Kaiser), it’s all about instilling confidence and safety into patients and welcoming them back,” she says.

Likewise, she says, “Our messaging has been going out, saying that if you need medical care, don’t put it off.”

But the message is not that the COVID-19 crisis is over. That won’t happen until there’s an approved and effective medical treatment and a proven vaccine.

Until those are in place, Hilo Medical Center has to be ready at any time for an outbreak such as the one that occurred in Kona, where at least 30 COVID-19 cases were all linked to workers and their families at three McDonald’s restaurants.

The hospital has opened two COVID-19 testing locations: one in the parking lot across from the hospital’s main building, where testing is done from 10 a.m. to 2 p.m., and a second at Puna Community Center in Pahoa, which is open on weekdays from 9 a.m. to 4 p.m. Testing at the Med Center parking lot facility in Hilo requires a lab order from a doctor, but there are no such requirements at the Pahoa location, which accepts anyone who walks in.

In the past 10 weeks at the two locations, the hospital has tested a total of 995 patients.

Cabatu says the Medical Center’s next priority is “trying to normalize all the precautions and looking into any additional precautions that we can take to improve the safety of our patients and staff.”

“We want the public to know that this is a safe place to come for care,” she says.