OMAHA — Just a month ago — back when hardly anyone in the United States had tested positive for the coronavirus, back when the federal government spoke hopefully about keeping the virus from spreading in American cities, back when the mass cancellation of school and work and basketball seemed unimaginable — a small hospital ward in Omaha was at the center of the country’s effort to quash the illness.
Nebraska Medicine’s Biocontainment Unit is where the federal government sends people with the most fearsome pathogens. In 2014, its doctors and nurses treated Americans who contracted Ebola in Liberia and Sierra Leone. And in February, after a cruise ship near Japan became a floating coronavirus petri dish, those same doctors were tasked with helping more than a dozen American passengers.
The goal? To keep the virus’s presence in the United States limited to a handful of people who had been exposed overseas, and to prevent them from spreading it to others.
But even as the small group of travelers started to recover by early March, their doctors were realizing, as they had feared, that it was already too late. Cases were popping up in Washington State and New York, and the virus had already begun spreading within the United States. The hospital with the nation’s pre-eminent biocontainment unit was forced to sharply shift its focus — from keeping the virus inside its building to bracing to treat an untold number of patients.
“It was just a matter of time,” said Dr. Jeffrey Gold, the chancellor of the University of Nebraska Medical Center, who had been tracking with escalating alarm the reports from Asia, then from his own country’s coasts.
With only 65 beds meant for biocontainment or quarantine, the facilities in Omaha were meant to help stave off a pandemic, not overcome one already underway. So even as it continued caring for those cruise passengers, the medical team began conserving face masks, seeking new ventilators, attending pandemic prep sessions and facing the eventuality that the virus would spread in their own city.
When it did, they knew, there would only be enough biocontainment beds for the smallest fraction of patients.
“People were like, ‘Well, why are we panicking people?’ and ‘Why are we talking about pandemic?’” said Shelly Schwedhelm, who oversees the unit. “We see it. We see it coming.”
The first cases
The call came on a Monday morning last month around 3 a.m. A plane chartered by the federal government would be landing soon. Its cargo: one of the largest groups of coronavirus patients this hemisphere had seen.
A few hours later, on a chilly tarmac near the Missouri River, more than a dozen Americans from a cruise ship were greeted by doctors in elaborate protective gear. They stepped slowly down a towering metal staircase. And they headed off to quarantine.
The country’s goals at that time were clear: help those ailing citizens recover. And keep the Covid-19 disease from spreading within the United States.
As the days passed in Nebraska, most evacuees never developed serious symptoms, and those who did were stabilized. The two patients with the most severe cases became the first people enrolled in a national clinical trial for a medication intended to curb the progression of the illness. Neither Dr. Andre Kalil, who is overseeing their treatment, nor the patients know whether they received the actual drug or a placebo.
“In a dire situation like in the middle of an outbreak, we have to do the best science we can,” said Dr. Kalil, whose phone buzzes twice a day and reminds him to take his temperature, a precaution to ensure that none of the doctors seeing the coronavirus patients become infected themselves. “If you don’t do the right science, we’re never going to find what works.”
In addition to serving as caretakers, the doctors and nurses in the unit became friends and logistics specialists for their patients. When the passengers’ suitcases from the cruise ship did not arrive, the medical team went out to buy them clothes and toiletries. When two people in the unit requested high-speed internet access, the team made it happen. And when someone sounded down, the unit’s psychologist put on scrubs and a face mask and made an in-person visit.
But by the time the first of those patients flew home this month, doctors already knew that the nation’s containment strategy had faltered. They needed to prepare for an entirely new problem: More patients would likely be arriving soon, and not on government-chartered planes from far away, but in ambulances and cars from just down the road.
The meeting of hospital workers was an exercise in uncomfortable questions: How many hospital beds would be needed if the coronavirus has the same attack rate as a previous pandemic? Would they run out of protective gowns and the N95 masks that keep out pathogens? How many hundreds of thousands of Nebraskans might become sick?
“We don’t have a medication; we don’t have a vaccine,” Dr. Mark Rupp, the chief of infectious disease, told dozens of hospital workers who had gathered this month for a meeting to prepare for what might now be ahead. “So we have to do old-style, garden-variety infection control.”
In calm tones, but with alarming messages, hospital workers told their colleagues about contingency plans for setting up clinics to screen large influxes of coronavirus patients. They talked about finding support roles for medical students to assist professionals. To prevent theft, they encouraged nurses to hide face masks.
It became clear that in a full-blown coronavirus pandemic, a unit uniquely equipped to cloister small amounts of new pathogens would find itself in the same position as many American hospitals: overburdened, understaffed, undersized.
“We’re going to hope,” Ms. Schwedhelm told her colleagues as one bleak PowerPoint slide after another flashed across the screen, “that our best guesstimates are incorrect and it’s much less than this.”
Just a day after that meeting, a new case of coronavirus, the first in a Nebraska resident, was diagnosed in a woman who became sick after a trip to Europe. Medical workers who treated her were placed in quarantine. Others in her household also tested positive. So did a man who took the same flight as her.
By the middle of last week, daily life in Nebraska was being reordered. Schools canceled class because of the virus. Sports games were played without crowds. Seven members of one Omaha-area family received coronavirus diagnoses. So did a high school student from a rural part of the state, who had underlying health problems and a case serious enough to be sent to the biocontainment unit.