Michigan’s first field hospital is no longer accepting COVID-19 patients, less than a month after opening its doors to the public. COVID-19 hospitalizations are leveling off, and health systems no longer need TCF’s beds as an option for overflow.
The TCF Regional Care Center, in downtown Detroit, opened on Friday, April 10, and admitted its first patient that Sunday. On May 1, MDHHS confirmed that the field hospital would accept no more transfers, and the final patient was discharged on Wednesday. All told, the hospital cared for 39 people.
According to a spokesperson for the field hospital, the move is a “pause,” not a “closure.” Its beds and equipment (though not its staff) will remain in place in the event of a second surge of COVID-19 cases. Leadership at the facility, and outside experts, see the low census as a sign that Michigan fared better than anticipated during this first surge.
Lynn Torossian, the field hospital’s CEO, called it the “best-case scenario.”
Dr. Jenny Atas, who was tasked with getting the facility operational, says social-distancing and a milder-than-projected surge contributed to the low patient count. But she also recognizes that many hospitals were on the brink of collapse. She and others are prepared for a second surge. And if they have to reopen TCF, they plan to make some changes.
“There’s several things I would have done differently,” said Atas.
Lessons from the surge
In late March, as COVID-19 cases descended on emergency departments in southeast
Michigan, Dr. Jenny Atas was on the ground in Detroit, scouting sites for a field hospital. Atas is an emergency physician. As medical director of the Region 2 South health care coalition, which serves Wayne, Monroe, and Washtenaw counties, she sat right in the middle of the state’s beleaguered health care system.
Working with the Army Corps of Engineers, Atas selected the TCF Center, which could house 1,000 patients in non-critical condition.
While COVID-19 hospital admissions were rising at the time, available data suggested that Michigan’s critical care infrastructure—its beds, ventilators, and staff—would accommodate the projected surge. So Atas and MDHHS decided not to build an ICU at the field hospital. They also decided to only admit patients 10 days after the onset of symptoms, based on advice they were getting from medical leaders in Detroit, and administrators from the Jacob K. Javits Center in New York City. Both groups said to be wary even of non-critical cases; some of these patients were developing an aggressive immune-system response known as a cytokine storm that quickly drove them into critical condition.
Stringent admissions criteria and no ICU helps explain why the TCF Center saw so few patients, even when other hospitals were nearing capacity.
“If I had to do it again, I would definitely put an intensive care unit in there,” said Atas.
But more importantly, she added, you must have staff who can work in an ICU. Staff for the TCF Center came from multiple sources, among them the Defense Department and the United States Public Health Service Commissioned Corps. This is the second thing Atas learned: When requesting federal support from FEMA, you need to be specific.
“You really have to specify what you need coming in,” she said. “When you request these teams, you want clinically active teams.”
In other words, simply requesting a “nurse” won’t cut it.
Would an earlier opening have helped?
For at least one hospital system, the TCF Center might have been a more useful resource had it opened a bit earlier.
According to an update from spokesperson David Olejarz, the Henry Ford Health System hit its peak on April 7, with 752 patients hospitalized with COVID-19. Michigan’s largest health system, Beaumont Health, also peaked on April 7, with 1,223 hospitalizations. (Henry Ford's count includes confirmed positive tests in their hospitals, while Beaumont includes confirmed and pending tests.)
In that first week of April, as construction was underway at TCF, Henry Ford’s Detroit hospital was admitting a lot of nursing home residents. When these patients were ready for discharge, their skilled nursing facilities were often reluctant to receive them, given the risk of further spreading the disease.
Bob Riney, Henry Ford’s president of health care operations and chief operating officer, said that if this happens again, it would be helpful to have a “transitional” facility for those elderly patients.
“If that facility had opened two or three weeks earlier, we probably would have sent some additional patients there, because we were feeling really, really tight,” he said.
But by the time TCF opened, he said, Henry Ford’s hospitalizations had started to level off. “It wasn’t going to be easy,” he said, “but we could hold our own.”
Beaumont did not provide a comment for this story.
Henry Ford was the partner hospital in setting up the TCF Center, providing leadership, staff, and IT support. As COO, Riney is responsible for assessing Henry Ford’s surge capacity and deciding how sites like TCF will fit into a plan for transferring overflow patients.
If there is a second surge, he said a “reasonable” threshold for reopening the TCF Center would be health systems reaching 25% available bed space. If given the command, Atas says TCF could become operational again in five days.
What’s in store for this big empty space?
The construction and staffing of the TCF field hospital was an expensive and complex effort, convening local, state, and federal agencies to convert 350,000 square feet into a specially outfitted medical facility in just nine days. Though the accounting has just begun, the cost is already well into the millions.
According to the Army Corps of Engineers, the construction costs came in at $9,452,813. That includes erecting room partitions, retrofitting the HVAC system to create negative pressure, and designing and building a system for delivering oxygen to the patients’ bedside, among other improvements. Under FEMA’s public assistance grant program, FEMA covers 75% of that cost, with Michigan picking up the rest.
For some resources at TCF, FEMA is paying the full amount. For example, Region 5 administrator James K. Joseph says FEMA will be fully funding the logistical, transportation, and bed-construction work provided by the Michigan National Guard. The cost of other federal resources will be known once those agencies submit their expenses to FEMA, according to a FEMA spokesperson.
For the foreseeable future, the massive field hospital isn’t going anywhere. Other than retaining staff, who have left the premises, the TCF Center stands by, ready for a second surge.
“I feel very fortunate and very privileged to have had that experience as an emergency physician,” said Dr. Jenny Atas, who guided the TCF Center from convention hall to field hospital. “Because you never know when you’re going to need to do it again.
“And I definitely, easily, could do it again. In my sleep, quite frankly.”
Michigan Radio, Bridge Magazine, and The Detroit Free Press are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb firstname.lastname@example.org at Bridge, Kristen Jordan Shamus email@example.com at the Free Press and Kate Wells firstname.lastname@example.org at Michigan Radio.