BY: Rachel Burt
As the COVID-19 pandemic swept the nation and world, shuttering schools and businesses left and right, hospitals and healthcare providers were put in the unique position of having to quickly pivot in order to continue providing services to patients in a safe and effective manner.
Across the tri-county region, Samaritan Medical Center, Lewis County General Hospital, and the St. Lawrence Health System worked to create surge plans in the event that their hospitals would become overwhelmed with COVID positive patients, which luckily has not happened, gathered personal protective equipment to keep both staff and patients safe, and implemented many other changes to deal with the virus as best they could.
Even so, the hospitals stopped elective surgeries per state directives and ultimately had to furlough staff. Each are now facing cuts in revenue this year compared to last, but the healthcare providers continue to push on and innovate in the face of our “new normal.”
Samaritan Medical Center
In the first few weeks of the virus really taking hold in New York, Samaritan CEO Thomas Carman said it was not uncommon for the hospital to receive upwards of 300 calls a day from those wanting to know what was going on and whether they had the virus.
Unfortunately, with the virus being new to everyone, healthcare professionals included, answers were not always readily available.
Dr. Vivian Keenan, of the pulmonology and critical care departments at Samaritan, said one of the things she was most impressed by during the pandemic was how the medical community worked together.
“There’s this sort of environment of learning and sharing, I think the biggest takeaway was how we sort of pulled together in this as a medical community to make sure we were taking care of these patients when we didn’t have a lot of information and there were a lot of questions and confusion about what was going on,” she said. “We were sort of learning, along with the rest of the medical community in the world, what treatments would actually work for these patients.”
According to Dr. Keenan, a lot of her department’s treatment with Coronavirus Pneumonia, or Acute Respiratory Distress Syndrome, is supportive in terms of supporting patient oxygenation, making sure that they are helping them ventilate. With so many unknowns still, she said that of the medications that Samaritan was giving for coronavirus, many are still just in clinical trials.
Early on in March, Samaritan started both visitor and staff screening, and visitation was not allowed except in the case of end of life visits and things of that nature. With limited entrances, Samaritan staff asked a standard set of questions to visitors and continue to do that today. In addition to asking if people have any symptoms, they are also asking these days if they’ve had any travel outside of the county. Staff are also temperature checking everyone as well, something that Mr. Carman believes has helped tremendously.
Because there is no hospital on post at Fort Drum, Mr. Carman said Samaritan is the base’s largest provider, providing about 95 percent of the care.
“We really sat down with them and took them through our service plan,” he said of their COVID strategy. “We were in communication with them on almost a daily basis, sharing information back and forth, and making sure that we were meeting their needs and expectations as well.”
According to Andrew Short, Samaritan’s COO, the three biggest challenges at the hospital during the pandemic were starting a resource line, creating a testing site, and developing the surge plan.
At one point during the pandemic, Samaritan was staffing its resource line from 7 a.m. until 11 p.m. The first day of the line was March 16, with the primary objective of protecting emergency room staff and giving people who were calling with questions just about COVID a dedicated resource to call.
To date, Samaritan has had almost 7,000 calls in through it’s resource line, said Mr. Short.
When Samaritan opened its off-site drive-thru testing site days later in its urology building, it was very restrictive with who could be tested due to a limited amount of supplies. People had to have clear signs and symptoms of the virus before they would schedule an appointment for testing.
“We all had a great desire to test as many people as we could, but we just didn’t have the supplies,” Mr. Short said. “Our primary goal with the testing site was to get it off site, keep people away from the campus, because we were still in this mindset of expecting a huge surge of patients.”
The idea for the drive up testing site was taken from publicly posted information from the University of Washington- the state where the U.S. COVID outbreak originated. Since March 19, the site has tested over 4,000 people.
Recently, Samaritan partnered with the state to be a New York State Testing Site where they can offer free tests for people for any reason, not just a clear display of symptoms.
“We’re really excited to be able to now begin to offer testing although it’s somewhat limited, we’re limited to about 300 a week,” Mr. Short said. “We’ve also launched a web page that anybody that wants a test can just request an appointment online.”
As for Samaritan’s surge plan, a large part was a state directive for every hospital to put a plan together to be able to staff at least an additional 50 percent of beds. Samaritan’s biggest challenge, in Mr. Short’s opinion, wasn’t so much finding empty rooms to put beds in, but identifying staff for those beds.
“This country has been in a nursing shortage for as long as I can remember, and we generally staff close to 100 beds a day,” he said. “So, we’re looking at trying to find an ability to get to at least 150. And we challenged ourselves to try to double that number.”
Samaritan eventually put a plan together to have two ICUs. This was a major challenge because it takes a lot of equipment, a lot of specialty physicians, and it takes specialty nurses. Time had to be spent training staff to jump in and work in different areas during this time.
When the pandemic began, Samaritan had been renovating its waiting room, so it didn’t actually have one in the beginning. Instead, the hospital used its front lobby, splitting it in half with a waiting room for people with respiratory or COVID like symptoms and another for patients who didn’t have those symptoms.
Due to the decrease in the volume of services being provided at Samaritan, the hospital furloughed 230 people, approximately 10 percent of its employees. Over 25 percent of those volunteered for the furloughs. Since then, 102 staff members have been called back, with the rest having their furloughs extended indefinitely.
Though more services have resumed and Samaritan is once again performing elective procedures, the hospital is still facing $15 million in projected revenue loss for the year, according to Mr. Carman.
“We only had one patient that required a ventilator and we were very blessed that we had no deaths,” Mr. Carman said. “Our staff did an incredible job and worked so well together. They treated our COVID patients with such respect and dignity, while taking care of themselves, and ultimately doing what was right for the patients as well.”
Early on in the pandemic, Lewis County General Hospital (LCGH) put a group together called the “COVID-19 Action Team” and began meeting daily, according to CEO Gerald Cayer. In those first few days and weeks, LCGH was receiving a lot of guidance from the state Department of Health as well as a number of briefings through various trade associations.
As a team, it began digesting that information and working through how do to operationalize actions while still trying to create easy access to health care.
“What was decided for us is elective surgeries would no longer continue,” Mr. Cayer said. “Operational changes included a process of screening individuals before they entered our campus, redeploying how we would use our staff for the new reality that was coming before us. We were really focused on not having to lay people off or furlough individuals because recruiting and retaining good people in healthcare in the north country is not always easy. However, we did reach a point where we initiated voluntary furloughs and it impacted about 45 people.”
LCGH was one of the first facilities in the north country to have a COVID evaluation and testing clinic, separate from any of their outpatient practices, that they called the “Call First Clinic,” according to Dr. Sean Harney, chief medical officer of employed practices. People could call, make an appointment, and get a COVID evaluation and test in a drive-thru setup.
LCGH has now expanded testing to multiple sites in Lewis County. Clinics will take place in Lowville twice a week, and until the end of August two will be run in Harrisville. There are also two clinics in Beaver Falls and two in Lyons Falls.
“The reference lab is going to have a courier pick up the specimens after each testing day and they say within three days, we’ll be able to call the patients back with results,” Dr. Harney said. “Because we’ve been able to secure some rural health funding, we’re able to pay for the staff, and through the support of the governor’s office, we have the equipment, the test kits, the PPE and the reference lab fees covered, so it’s completely free to the consumer.”
Seeing a marked decrease in the number of children receiving vaccinations and prenatal visits, LCGH ran a campaign to try to keep children up to date on vaccinations and initiated a drive-thru prenatal clinic, so patients didn’t have to go inside the building to have a visit with an obstetrician.
Outpatient preventive services were markedly diminished because of patients not accessing LCGH’s services during the pandemic, so in response, they have a campaign going right now through outpatient practices to catch people up on those health preventive, maintenance type services.
Though LCGH has experienced $5.7 million in operating losses relating to COVID-19, it has also benefited from the stimulus programs that the federal government has established.
“We are certainly not break even,” Mr. Cayer said, “But I’m very appreciative and thankful for the support of the federal government in helping us get closer to break even than we would have been otherwise. We were the recipients of those stimulus resources as well as some local resources.”
As of now, LCGH is pretty much back to normal in terms of patient and service volumes, Mr. Cayer said.
When it came to COVID, the first two positives in Lewis County happened to be the first two patients who were hospitalized. And so, all of the precautions that would be taken with any infectious disease were put into work in place. The patients were placed in negative pressure rooms, the hospital was appropriately supplied with protective equipment. What was different was the lack of general understanding of this particular virus, being that it was so new, and so there was a lot of fear associated with it.
“We did have two positive patients in our hospital, but we did not have anybody on a ventilator,” Mr. Cayer said. “In hindsight, looking back to that, we did not have any staff that got affected during care of those patients, so our use of PPE was effective.”
Mr. Cayer believes that there will be another pandemic in the future and hopes that LCGH, along with healthcare providers worldwide, has learned the lessons needed to avoid the mistakes that were made with COVID-19.
“My hope is moving forward, the pandemic experience has created an awareness with our community that things like vaccinations and preventive measures really do make a difference and can allow our communities to be healthier,” Mr. Cayer said. “It will elevate, and I think force, individuals to think more critically about their role in stopping the spread of disease, not only the coronavirus, but others that we live with every day, and generate a renewed discussion on the importance of vaccinations in our communities and keeping each other safe.
In the beginning, one of the challenges facing the St. Lawrence Health System (SLHS) was everything was changing so rapidly. Now that they have some months of experience under their belts, they’re not experts, but they’re learning from all of the scientific research that’s being done on what might work and what doesn’t work, said Dr. Julie Vieth, emergency department chair for Canton-Potsdam.
Dr. Vieth and her colleagues benefitted from SLHS’ collaboration with Clarkson University, which provided them with things like clear intubation safety boxes. Each time a patient is intubated, there is a high-risk moment of staff exposure to airborne droplets, especially around the mouth, nose and eyes. To help minimize the risk to staff, Clarkson’s Coulter School of Engineering machine shop built clear intubation and transport covers specifically for SLHS’s clinical team. The holes and see-through design allow staff to safely conduct the intubation procedure in a contained, lower-risk environment.
SLHS has also benefitted from its Department of Clinical and Rural Health Research taking part in a clinical trial for hospitalized patients with COVID-19 pneumonia. Under the guidance of Canton-Potsdam Hospital Rheumatologist and principal investigator Eyal Kedar, MD, the research department has opened a Phase-3 clinical trial investigating tocilizumab (Actemra™). This multi-center trial is sponsored by Genentech and aims to enroll 375 patients who are hospitalized with COVID-19 pneumonia at sites across the nation.
St. Lawrence Health System was the only rural site in New York selected for participation in the trial.
During the pandemic, as part of its surge plan, it was decided across the health system that Canton-Potsdam Hospital (CPH) would be the center at which all COVID-19 inpatients are managed until its surge capacity is reached, but SLHS does not foresee this happening. In the event it does occur in the future, SLHS will redirect patient flow to sister affiliates, Gouverneur and Massena Hospitals.
Before the pandemic surfaced in the north country, CPH’s infection prevention team identified a need for a first-stop emergency department COVID Triage area for patients showing COVID symptoms and/or having identified potential exposure, so a new Emergency Department Respiratory Unit (EDRU) was designed and built just inside the main entrance of the hospital.
Simultaneously, CPH was renovating two floors to be equipped as Airborne Precaution Units in the event there was a surge in COVID patients.
“The EDRU has five beds that are negatively pressurized and are ideally suited to having airborne precautions,” Dr. Vieth said. “In other words, ideally suited to care for patients that have an infectious disease like COVID.”
According to Dr. Jason Lorenc, director of the emergency medicine and urgent care service line for the health system, when test results would take days rather than hours and somebody presented to any one of the system’s hospitals with certain symptoms that could potentially be COVID, they were considered a person under investigation (PUI).
If those PUIs needed to be admitted to a hospital, they were directed to CPH, because, in addition to the separate negative pressure isolation areas built in the emergency department, they also built a negative pressure unit upstairs for patients that needed hospitalization. So, until they got the COVID tests back, they would admit those patients to that specialized area in the hospital.
SLHS furloughed approximately 400 workers across its three hospitals on March 20. During the first week of July, 23 positions across all levels of the System were permanently suspended.
For the month of April, SLHS’ volumes were roughly 50 percent of budget, according to Chief Administrative Officer Jeremy Slaga, Esq. In May, volumes improved to approximately 60 percent. With patients returning and volumes finally trending in a positive direction, SLHS reopened additional clinical services and invited hundreds of staff, approximately 240, back to work.
“One of the things that I learned from a very early experience here is just how grateful I am to work for an organization that is as adaptive and nimble as St. Lawrence Health System is,” said Dr. Lorenc. “Changes that we had to make in terms of our policies, our procedures, and just the sheer way we do things were coming so fast and furious, and it was refreshing to see how well our staff responded to all those changes and how responsive our administration was to our needs.”