Workers on the front lines of coronavirus response at 6 US hospitals reveal what they do when a suspected case comes in

A medical worker puts on a face shield during a drill as part of preparations for a potential Middle East respiratory syndrome (MERS) outbreak, at a private hospital in Bangkok, Thailand, June 24, 2015.

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A medical worker puts on a face shield during a drill as part of preparations for a potential Middle East respiratory syndrome (MERS) outbreak, at a private hospital in Bangkok, Thailand, June 24, 2015.
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Athit Perawongmetha/Reuters

Hospitals across the US have negative-pressure isolation chambers, face shields, and infectious-disease experts at the ready. They’re all preparing for somebody to walk through their doors with a case of the new coronavirus sweeping the globe.

A hospital in San Diego, California confirmed yet another case of the coronavirus on Monday. That patient had been under federal quarantine after being evacuated from Wuhan, China, but other US patients have contracted the virus from contact with family members who had been there.

The outbreak has spread to over two dozen countries since it started in December. More than 43,000 people have gotten sick, and more than 1,000 have died. The US has confirmed 13 cases in total; the first was identified at the Providence Regional Medical Center in Snohomish County, Washington, on January 21.

“Once we either identify or a patient self-identifies as potentially being at risk, we try incredibly hard to prevent any kind of spread beyond that moment in time,” Dr. Amy Compton-Phillips, chief clinical officer at the Providence medical network, told Business Insider.

Medical staff at other hospitals, similarly, don gloves, goggles, and masks before seeing potential coronavirus patients.

“A lot of our patients are from many different countries and travel,” Kim Leslie, an emergency-department nursing director at Swedish Hospital in Chicago, told Business Insider. “The likelihood of us coming across it is high, so we’re trying to have a plan for what to do.”

Medical staff at six US hospitals described how they handle patients who might have the new coronavirus. Here’s how they’re preparing and what one hospital did after a case was confirmed.

If you’re sick and recently visited China, call ahead

In late January, Leslie said, a man came into the emergency department at Swedish Hospital saying he was sick and had recently visited China. That raised a red flag.

The first thing medics want to know is whether a potential patient traveled to China in the last two weeks. The second question is about symptoms: Medics are looking for fever with respiratory issues like coughing or shortness of breath.

Those are the two criteria for potential cases of the new coronavirus, according to guidelines from the US Centers for Disease Control and Prevention (CDC).

People wait in the waiting room at Milton Keynes University Hospital in Milton Keynes, England, June 8, 2018.

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People wait in the waiting room at Milton Keynes University Hospital in Milton Keynes, England, June 8, 2018.
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Hannah McKay/Reuters

Saint Francis Memorial Hospital in San Francisco has signs posted in multiple languages telling people to inform the hospital staff if they have these red flags, according to Dr. Kathleen Jordan, an infectious-disease specialist at the hospital.

“Everybody that comes in is screened and asked about those two risk factors,” Jordan told Business Insider. “If they have those risk factors, then they’re isolated immediately.”

Of course, if a patient has had contact with someone confirmed to have the virus, then any symptom is a concern.

The CDC recommends that people who think they might have the coronavirus call their doctor before visiting a hospital or clinic unless they have a medical emergency. That allows staff to organize safe transportation if needed and prepare for the patient’s arrival to minimize risk of spreading the virus.

Someone with undiagnosed coronavirus sitting in a waiting room could spread the illness to other patients or healthcare workers.

“The scary part for me would be someone just kind of coming into an ER, especially with how crowded they are nowadays,” Mia Martinez, a flight nurse at Lurie Children’s Hospital in Chicago, told Business Insider.

Coronavirus patients get a negative-pressure room

Anyone who has virus symptoms and recently went to China is given a face mask and escorted to an isolation room.

Swedish Hospital uses a negative-pressure chamber with a ventilation system that keeps air pressure inside the room lower than the air pressure outside it. That way, air flows into the room but not out. Hospitals also use this technology to prevent the spread of tuberculosis.

A negative-pressure room in the emergency department of Washington Hospital Center, April 30, 2009 in Washington, DC.

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A negative-pressure room in the emergency department of Washington Hospital Center, April 30, 2009 in Washington, DC.
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Mandel Ngan/AFP via Getty Images

“We’re certainly using lessons learned in flu and tuberculosis,” Jordan said. “But because we don’t know as much about the coronavirus we sort of err on the side of caution and we’re using a higher level of protective equipment.”

Anybody who enters the room where a potential coronavirus patient is being treated wears protective gear, including gloves, gowns, eye protection like goggles or a face shield, and an N95 respirator mask.

Medical staff with protective clothing work in a ward specialized in receiving any person who may have been infected with coronavirus, at the Rajiv Ghandhi Government General hospital in Chennai, India, January 29, 2020.

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Medical staff with protective clothing work in a ward specialized in receiving any person who may have been infected with coronavirus, at the Rajiv Ghandhi Government General hospital in Chennai, India, January 29, 2020.
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P. Ravikumar/Reuters

Some hospitals, like the one that treated the Washington patient, use TV screens to video chat with patients inside the room for simple check-ins in order to reduce medical workers’ exposure.

Richard Martinello, an associate professor of infectious disease at the Yale School of Medicine, works at a doctor’s office that does not have negative-pressure rooms, however. So when a patient came in saying he had been to China and felt sick, Martinello said his staff brought the man to a back room, far from other patients. The man’s condition was mild, so the staff sent him home with a warning to stay in the house and wait for his test results.

“We’re really using the same criteria that we would typically use day-to-day for persons with the flu or with other infections to determine whether or not they need to be hospitalized,” Martinello said.

The test came back negative.

Questions for potential coronavirus patients

Epidemiologists ask potential coronavirus patients a list of personal questions: Whether they have recently had sex with anyone (especially while traveling), which specific locations they visited, who they had contact with, what they ate, and what they did in each place they went. That helps doctors determine the patient’s risk of exposure to the coronavirus.

In the meantime, medics take a blood sample and swab the back of the patient’s throat, then send those materials to the local health department for testing.

Taipei mayor Ko Wen-je looks at a negative pressure isolation room (shown on the monitor) during a drill at the Taipei City Hospital Chunghsin Branch in Taipei, Taiwan, June 4, 2015.

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Taipei mayor Ko Wen-je looks at a negative pressure isolation room (shown on the monitor) during a drill at the Taipei City Hospital Chunghsin Branch in Taipei, Taiwan, June 4, 2015.
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Pichi Chuang/Reuters

At Swedish Hospital, the questioning was enough to determine that their patient had not been exposed to the coronavirus.

“After that scrutiny, [he] did not meet the criteria to be concerned. So we lessened his level of isolation, out of that room, and considered him just your basic average flu,” Leslie said.

Even if a patient is confirmed to have the coronavirus, there is no specific medication for it, so doctors simply treat the symptoms and ensure the patient gets enough oxygen and fluids. If the person doesn’t have difficulty breathing or other serious symptoms, doctors will likely send them home and tell them to stay away from other people.

A positive coronavirus test does, however, initiate a flurry of communication between the hospital, its local public health department, and the CDC.

A worker in a protective suit checks the temperature of a passenger arriving at the Xianning North Station in Xianning, a city bordering Wuhan to the north, in Hubei province, China January 24, 2020.

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A worker in a protective suit checks the temperature of a passenger arriving at the Xianning North Station in Xianning, a city bordering Wuhan to the north, in Hubei province, China January 24, 2020.
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REUTERS/Martin Pollard

“We had a lot more people consulting on this case than the average person with the flu,” Compton-Phillips said of the first US coronavirus patient. The network she oversees includes 51 hospitals and more than 800 clinics.

“There was a lot more coordinating phone calls with public-health organizations, with the CDC, with the New England Journal, with other people caring for affected patients, so that we could learn really fast from clinician to clinician,” she added.

Dr. Jon Mark Hirshon, a professor of emergency medicine and epidemiology at University of Maryland School of Medicine, summed up the entire process like this: “First we identify, second we isolate, then we inform.”

Since there’s no cure, medics treat symptoms

If patients’ symptoms are severe, they’ll be hospitalized. On February 3, a husband and wife diagnosed with the new coronavirus in San Benito County, California, showed worsening symptoms, so they were transferred from their home to a hospital at the University of California, San Francisco. Medical transport teams wear the same protective gear as hospital workers, Martinez said.

“You keep it on the whole time,” she added.

An Polish medical air rescue helicopter takes part in a rescue operation after a thunderstorm in the Tatra Mountains, in Zakopane, Poland, August 22, 2019.

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An Polish medical air rescue helicopter takes part in a rescue operation after a thunderstorm in the Tatra Mountains, in Zakopane, Poland, August 22, 2019.
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Agencja Gazeta/Marek Podmokly/Reuters

Doctors gave the Washington patient drugs to prevent nausea, acetaminophen and ibuprofen for fever, cough medicine, saline fluid for hydration, oxygen, and antibiotics. After seven days in the hospital, he also received an experimental antiviral treatment called remdesivir.

“Usually, just like the flu, it’s symptomatic treatment and supportive treatment,” Leslie said.

As of February 3, the Washington man had gone home with nothing but a cough.

From the moment a potential patient calls or walks into the hospital, Compton-Phillips said, handling their case is a careful process.

“They’re scared. They’re sick. They need compassionate care,” Compton-Phillips said. “So we’re trying to provide that personalized and compassionate care, while at the same time minimizing any potential for transmission.”

Have you been personally impacted by the coronavirus epidemic? Is your city or community on the front lines of this disease? Have you or someone you know been tested or diagnosed? We want to hear your story. Please email science+coronavirus@businessinsider.com