With a plane of passengers inbound from Wuhan, a county health team springs into action

Earlier this week, 195 Americans evacuees were released from their two-week quarantine inside a California Air Force base with a clean bill of health.

Behind the scenes of that first mandatory CDC quarantine in more than 50 years was a team of medical providers who rapidly mobilized an emergency response and carefully monitored the group’s health and well-being day and night.

“What was unique about this effort was the way a local county health system was able to support a federal response in such a short amount of time,” said Dr. Michael Mesisca, the emergency department medical director at Riverside University Health System, who helped lead the effort.  

During that two-week period, rotating members from the medical center saw about 140 patient visits from the evacuees in their mobile clinic stationed inside March Air Reserve Base in Riverside County. I caught up with Mesisca to hear more about how the county health system was able to organize so quickly, what life was like for the health care workers on the quarantined base, and his thoughts on what’s to come as the coronavirus spreads beyond China.

Q: How did you got involved with the quarantine late last month?   

A:  We received a phone call from the Centers for Disease Control at 4:30 p.m. that a plane with Americans from Wuhan, China was set to land in 11 hours. They asked how quickly a county-wide team could mount a full-scale medical response. We had already developed a full emergency response system and established relationships with the county’s Emergency Management Department, Riverside EMS Agency, Riverside University Medical Center, and the Behavioral Health and Public Health teams. Those allowed us to quickly respond with a large-scale effort.

The groundwork for this effort was created several years ago when the emergency department (ED) came up with a plan to improve our full-scale disaster response. It started with the ED, but now it’s a multidisciplinary team. We also partnered with the county‘s public health and emergency management department (EMD). We have regular meetings about how to coordinate on a large-scale disaster plan. So, when the CDC called, we were able to have five agencies on the initial call.

Q: What happened after that initial call from the CDC?

A: Our health system already had a mobile medical clinic with a primary care team, registration team and three exam rooms. They were already scheduled to work the next day. I thought: Can we use that? The hospital leaders agreed.

One of the doctors and an ED nurse leader from our disaster team went out in the middle of the night and transformed the mobile clinic into more of a free-standing ED, adding capabilities like wound care and suture care.  We were well aware that the U.S. government hadn’t quarantined Americans to this extent for about 50 years. When that happens, people lose certain freedoms like seeing their own doctor. We wanted to create a high-quality medical environment for them. It was also important to be able to deliver safe and quality care on the base because transferring patients would have an impact on the security of the medical center.  

Q: How many people were involved in providing care?

A: It really took a village. There was a team on the base, but there was also a lot of support and set up running at the hospital as well, including an incident command center. On site, during the day, we had two licensed vocational nurses, a registration clerk, a primary care physician, an ED physician and an ED nurse. On the first day, we sent additional ED nurses, some of whom were skilled in pediatrics to help with the lab draws. Overnight, we had one ED physician and one ED nurse. There was an ambulance on the base next to the clinic for standby.

Q: How did the health care workers feel about their own risk?

A: We were very consistent with personal protective equipment. We wore N95 masks, gloves, eye protection and gowns. We treated everyone as if they had the coronavirus even though they didn’t have symptoms.

Health care providers volunteered to step into this environment. But any responsible person runs through scenarios: What am I exposing myself or others to? You have to consider not only the risk of getting sick but also being put into quarantine yourself and how that would impact your other responsibilities. I’m super proud of the response from everyone: There was no hesitation to step in and serve.

Q: What kind of care did people receive from your mobile clinic?

A:  The mission of our team was to address all non-infection issues and support the CDC in screening efforts. We discovered that there was a group of people with chronic issues like hypertension and diabetes who hadn’t accessed medical care in China for some time because they were concerned about virus exposure. We had about 140 total patient encounters.

Q:  What happened if people did need to be transferred to the hospital?

A: The plan from the beginning was to bypass the emergency department. With credentialed ED physicians on the base, we could transfer patients directly to inpatient areas, where there were pre-assigned beds with personal protective equipment ready. If we put patients from the base in the ED during cold and flu season, it would consume a lot of resources during a time when we’re already surging. We also had a separate entrance which would ease unnecessary alarm for other hospital patients. Part of the design was to provide enough resources and support to prevent an impact on the medical center.  

Q: What kind of lessons did you learn?

A: We learned about what supplies we needed to have on site, like an EKG machine. We also figured out how to have medicines delivered quickly. We had the full support of our hospital pharmacy and lab supporting us in rapid fashion. The county sheriff’s team delivered the prescriptions and any urgent supplies because they could get into the secure base more quickly.

We had a behavioral health team on site that specialized in crisis intervention. They became the distributors of hygiene supplies like deodorant and toothpaste, as well as bikes, scooters, kites and soccer balls. It wasn’t initially intended but it worked out well because they could easily initiate conversations with people and offer casual support. If people wanted to talk further, we had a table across the site where they could have a more in-depth conversation. Some people were stressed about transitioning back to work. Others were concerned about prejudice. The behavioral health team had close to 100 encounters.

Q: What was it like on the base?

A: Quarantine sounds very ominous, but this was really a happy group. The guests were in their own comfortable rooms like a hotel. One recent morning, when I showed up, there was a dad and daughter flying a kite. There was schooling so children would have education. We had activities like yoga classes on the base which really humanized the whole experience. The guests were super appreciative and thankful to be back from China.

Q: What did you think of the media coverage?

A: There was a lot of focus on concerns from the local community, health risks, policy, and why the plane landed here. That was all critical, but I appreciated the coverage that portrayed the human element: what was really going on for individuals on the base. I wish the public could have seen earlier what I did from the very beginning. There were kids flying kites and playing soccer. This was a group of scared and grateful Americans coming home.

Having the media physically present wasn’t an option, which I think was appropriate. But the guests could take their own cell phone calls and videos, keeping others’ privacy in mind. CNN did a live broadcast with one of the residents.

To me, there’s also a story in how quickly we could mobilize and transform a family practice mobile clinic. The strong teamwork in this county is part of why I took this job. This effort exemplifies that approach: We brought key leaders and key players together to solve problems in a way that was mutually beneficial. We value our calling to serve our community.

Q: What do you think of the road ahead?

A: Watching what’s happening in China, it really doesn’t look good at this point. With this virus being asymptomatic for so long and how easily it spreads, I think here’s a long road ahead. We are watching this very carefully.