Johns Hopkins All Children’s Hospital is no stranger to challenges. 

After a Nov. 28, 2018 Tampa Bay Times investigative report detailing low-quality clinical care in the Heart Institute, the hospital saw a tumultuous time: within a little over a month, almost the entire senior leadership team was let go, and federal officials started investigating to ensure that regulations were met.  

Since then, Dr. Joe Perno has worked with the hospital to rebuild the trust of the community as Chief Medical officer and all previous administration has now been removed.  

“It was intimidating and scary,” Perno said. “I mean, the entire leadership team was let go, the hospital was facing challenges and then I was asked to be part of the new team to bring us through those challenges. Part of me is like excited and honored and part of me is scared because it’s a big challenge, and if I don’t succeed, then I could go the same way the previous team did.” 

Perno said that restoring trust is an ongoing project that the hospital is making good headway with. As for regulatory concerns, a surprise inspection that Perno said is essential for keeping the hospital open was scheduled anytime between March and June.  

“It’s a never-ending process,” Perno said. “It takes a minute to lose the trust of someone. It takes years to rebuild that trust.” 

Then, another challenge rose: a global pandemic.  

On a typical, pandemic-free day, Perno monitors the medical staff: he vets incoming medical professionals, ensures that every doctor is keeping up with things such as their education and licensure and handles any issues among medical staff, including behavioral or clinical problems that arise.  

However, with the coronavirus, “a whole new level of work” has been added to make sure that the medical staff is prepared for anything.  

“[The workload] has increased a lot,” Perno said. “It’s become a 7 day a week job at this time because my regular job is still there and then on top of that, we’re dealing with all the issues that are related to the pandemic and the anxiety of all our staff at the hospital. It’s a tough thing to deal with for everyone, so that’s just adding to my workload.” 

Pulled from the ER, Dr. Perno now spends one week working from his hospital office and one week working remotely. The entire administration team has been split in half, working from home and office on alternating weeks to limit exposure. If half of the leadership team were to become exposed to the virus, the other half would still be able to run the hospital. 

“It’s a challenge,” Perno said. “It’s different. It’s hard doing everything over the phone or over the internet. You miss the interactions with your work colleagues. It feels like so many times things are easier with a face-to-face conversation, even across a mask, than it is across the internet.” 

Perno said this tactic has the same idea of alternating emergency teams utilized during hurricanes. One team would stay at the hospital without leaving for the duration of the hurricane. The second team would then relieve the first after the hurricane had passed.
 

“It reminds me of a hurricane in the weeks leading up to a hurricane when we know a hurricane’s out there and it’s coming towards us,” Perno said. “You’re watching the news and monitoring its path and you’re preparing for it, and it’s that anxiety of waiting for something to happen. That’s kind of the phase we’re in right now with the coronavirus pandemic. We’ve utilized some of our similar emergency procedures with the splitting of the teams and whatnot, but this is unlike any other crisis that I’ve ever seen.” 

While the hospital has seen very few cases, the atmosphere is stressful according to Perno.  

“Everyone is still working hard,” Perno said. “We are cutting back on staff throughout the organization so that means when you are working, you’re working harder than normal, and the fear of the unknown is stressful for people. You can’t go anywhere without hearing about it and it’s only worse when you work in a healthcare facility. Our day-to-day has changed.”  

Changes around the hospital are not hard to find: a mask is required even for those not providing clinical care, like Perno who wears a handmade cloth mask when working at his office. Certain personal protective equipment, also known as PPE, is required for certain patients, along with certain testing. The hospital has also seen limits to surgeries and non-emergency care provided.  

Additionally, the hospital is planning for a potential surge of patients and the possibility of caring for adult patients. With the hospital being a “unique specialty” hospital that traditionally provides care for patients up to their 21st birthday, Johns Hopkins All Children’s has reached out to other local hospitals in the Bay Area, offering to take pediatric patients. This makes room for adults at other hospitals whose primary expertise is not with children. 

The state has also granted a waiver to allow JHAC to give care to anyone 25 years of age or under, “alleviating some of the burden on our adult counterparts in the Bay Area”, according to Perno. 

“it’s a mix of dealing with what’s going on today with what could potentially happen tomorrow,” Perno said. “and also planning for… when social distancing is over when will probably get busy with all the patients that aren’t coming in now that need to come in, how we’re going to handle that.  

Other procedures changed not in response to the virus itself, but because of the public’s response to the virus. To diminish the spread of flu during a busy season, the ER had placed face masks at the entrance, encouraging people to don a mask if they had flu-like symptoms.  

“Well, people were pulling up to the front of the ER and hopping out of their car and taking all the masks and taking off in a panic,” Perno said. “Same thing with the hand sanitizer in the rooms near the patients. They were stealing our hand sanitizer, and we’re trying to save it for our healthcare professionals, so we had to change where we keep some of the supplies.”  

Now, these materials are posted where only healthcare workers have access to instead of general areas.  

As for PPE, the hospital has not seen shortages as of yet. However, Perno mandated that men, including himself, must shave in order to wear different PPE. Men with beards need to wear Power Air Purified Respirators, or PAPR hoods, which the hospital has very few of. Clean-shaven men can be fitted to the traditional N-95 mask unless their facial structure requires otherwise, saving the PAPR hoods for those who need them. 

“It’s a sore subject,” Perno, who had a beard for the last four years and imposed the mandate, said.  

However, the greatest challenge Perno says the hospital is facing isn’t supplies or a beard mandate to redistribute PPE: it is a combination of both declining morale and financial struggles.  

“There’s no end in sight,” Perno said. “We don’t know when this is going to get better as it’s true for everyone in the country. But, working really really hard and not knowing when it’s going to end is a difficult thing.”  

As for the financial burden, Perno said that the cancellation of routine, otherwise known as elective, surgeries are causing strain on paying the bills “just like any other business”. Elective surgeries are surgeries that are not considered emergencies and are planned at convenient times, ranging from things such as scoliosis surgery to tonsil removal. Surgeries related to trauma, such as a car accident, or emergencies such as appendicitis are still happening. 

The government might step in according to Perno, but no action has been taken yet.  

“So, we’re trying to make plans to get through this on our own,” Perno said. 

Personally, Perno cited morale and motivation once again for his greatest obstacle. 

“Trying to walk around and make sure that the staff feels supported and that we appreciate their work, making sure that they have everything that they need to do their job,” Perno said. “Not that it’s challenging per se because we have enough equipment but keeping people’s morale up in this situation is very difficult.” 

In an effort to keep morale up, one staff member hands out a message every day. Perno says that some are meant to make you laugh, others make you think and some just to say thank you.  

“I like them,” Perno said. “It’s kind of a neat thing.”  

This isn’t the first global pandemic the world has experienced. Perno said that this latest disease “shows us that these things can happen” and the importance of keeping a pandemic supply, whether that consists of backup ventilators, PPE or medications. Additionally, Perno mentioned the importance of monitoring where the next potential pandemic may be.  

“It’s not always possible, but the idea is to try to be as prepared,” Perno said. “Like we get prepared for hurricane season, as a country we should be prepared for another pandemic.” 

Perno is looking forward to finding the balance for exiting quarantine that is neither too slow, affecting livelihoods, or too fast, causing a resurgence of disease.  

“I’m hopeful that we don’t see reoccurrence of disease, but I’m expecting it to be with us for a long time until we can get a vaccine,” Perno said. “In a perfect world, it’s a one-time vaccine, but it’s probably more likely to be like flu vaccine where every year we need to get it. I hope people learn from this the importance of having a vaccine. If we can have a vaccine, we’d get people vaccinated and we’d be back to work in no time.” 

For those without a medical worker in the family, Perno advises that people listen to the advice that’s being put out, including washing your hands, wearing a mask in public and staying home. Mentally, he encourages finding outlets for anxiety such as exercise and developing a routine.  

“I think the worst thing people can do is just watching the news endlessly,” Perno said. “It’s good to be informed, but there’s a limit.”