Coming up with something from nothing? Building a hospital policy and consensus for the diagnosis, treatment and management of a new viral disease.

Hospital Escuela in Tegucigalpa Honduras is a 1400 bed hospital, the biggest national reference hospital in the country and was not initially designated for the service of COVID19 infected patients. Because of its nature as a reference third level hospital eventually very sick patients who also had COVID 19 started  arriving. The first ever reported case in the country was initially received in our hospital and then referred to the designated hospital but during her stay other patients and personnel became exposed and infected because proper protocols were not in place.This made us very much aware of the need to develop flowcharts and protocols as well as determine what areas  of the hospital could we isolate from the rest of the patients who although the country was on quarantine kept coming.We want to share with you this experience and how technology allowed for the creation of groups in whatsapp and allowed for communication between different areas in the hospital without in person meetings.Teams were made up of people in the different services, medical specialities most of the time volunteering extra time to come up with plans that were implemented sometimes successfully others not so successfully.  

During this time different strategies were tried some of which were very unsuccessful specially because of the inexperience in listening to all parties and considering them to make decisions. We had to learn to listen and consider problems not only from the clinical and epidemiological perspective but also from the human aspect and how decisions affected all involved: patients and their families, care providers both in the hospital but also providers form the all the health network.