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How a remote island hospital prepares for the coronavirus pandemic

Nantucket Cottage Hospital has 14 licensed beds, no intensive care unit, and only five ventilators. Over the past four days, we have confirmed our first three cases of the coronavirus on the island.

Nantucket Cottage HospitalCraig F. Walker

All communities in Massachusetts are making difficult choices in how to handle the coronavirus pandemic, and our hospitals are facing a test unlike anything we have ever experienced. On Nantucket, our situation is even more precarious.

Nantucket Cottage Hospital opened a new community hospital in February 2019. It was designed and built for routine care, standard surgeries and procedures, diagnostics, and emergency medicine. It serves our island of roughly 17,000 year-round residents well, and also accommodates our seasonal population that grows to nearly 50,000 during the summer. But it was not built for a global pandemic. No hospital is. Our team has been preparing for this situation for weeks, and our hospital is as ready as we can be. But limited medical resources combined with Nantucket’s remote location create the potential for a dire scenario for our community.


Nantucket Cottage Hospital has 14 licensed beds. We have no intensive care unit and only five ventilators, and these resources are most needed to handle acute cases of COVID-19. Other areas of the hospital have been identified as places to care for patients and increase our capacity if necessary, including outpatient departments. But if we face a significant surge of COVID-19 patients, our providers and facility could quickly be overwhelmed.

As a member of Partners HealthCare and an affiliate of Massachusetts General Hospital, Nantucket Cottage Hospital has been well served by our connection to a larger health care system during this crisis. Our colleagues in Boston have been supporting our COVID-19 preparedness and response efforts in many ways, and it has been helpful for us to tap into their medical expertise and resources. Yet we also know our fellow hospitals are facing their own challenges with similar shortages of PPE equipment and staffing concerns as a result of this pandemic.

On Nantucket, the math is daunting.


Should our town’s shelter-in-place order and social distancing efforts fall short, we will have a community spread of COVID-19 on the island. Assuming 15 percent of those infected will require hospitalization and 5 percent will need ICU-level care, we could be looking at more than 300 island residents needing a hospital bed and more than 100 requiring an ICU. Again, our hospital has only 14 licensed beds and no ICU.

And over the past four days, we have confirmed our first three cases of the coronavirus on the island.

Our hospital has longstanding and strong relationships with Boston MedFlight and the US Coast Guard, which we call on to transfer our most critical patients to the mainland. They have confirmed that they are ready and willing to help us. However, we know there is a possibility that our partner hospitals in Boston could be at capacity when we need them, leaving us with potentially limited ability to transfer patients needing ICU-level care.

This perilous situation has been exacerbated by an influx of our seasonal residents fleeing to Nantucket from New York City and other hotspots around the country to ride out this storm on the island. We love our part-time islanders and depend on them in many ways. And while we understand the instinct to leave the cities for a place with fewer people, Nantucket is not a safe haven during a pandemic. Given our limited medical resources, we have requested that those who have a choice of where to shelter in place make the decision to stay off the island and reduce the potential for a surge of coronavirus patients on Nantucket. They are much safer staying where they are.


In a joint statement with Martha’s Vineyard Hospital, we have conveyed this urgent message to the transportation hubs that serve as our vital connection to the mainland — the Steamship Authority and Hy-Line Cruises. We have also joined with our emergency management colleagues at the Town of Nantucket and given our assessment of Nantucket’s situation to our state government representatives, asking for any support they are able to provide for our vulnerable population.

Amid this crisis, we have also seen signs of strength and hope. As we have walked the halls of our hospital over the past week, we have witnessed the dedication and bravery of the Nantucket Cottage Hospital staff on full display. Our entire mode of operation has been transformed in a short period of time, and we have seen our employees rise to the occasion, adapt quickly to new roles and assignments, and lean on each other for support. Meanwhile, members of the community have been generous with their own offers of food, supplies, funds, and good will to our hospital. The island has truly rallied around its hospital, and we are grateful.

We will soon know the extent of the challenge we face on Nantucket, and whether our efforts to flatten the curve of infections were successful or not. We know we are not alone in meeting that challenge, and our community and brave health care workers give us hope that we can weather this storm together.


Gary Shaw is president and CEO of Nantucket Cottage Hospital. Dr. Diane Pearl is chief medical officer of Nantucket Cottage Hospital.

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