Jefferson’s Daughters

So here’s the latest: cases in our county are still at the cluster stage, probably because we are quite rural and thus there are fewer opportunities to come into contact with large crowds or travel on public transportation. However, we’ve had three deaths in the county. We have a mobile field hospital being set up in the largest town to deal with non-COVID patients, leaving the two major hospitals available for people with the virus. Testing is still minimal and strictly controlled – basically you have to be already hospitalized with virus symptoms, a health care worker who has been exposed or someone who is severely ill (and thus needs to be hospitalized). Test kits are back-ordered from Quest and LabCorp. Given the rate at which COVID-19 spreads, I’m betting we have three to four times the reported numbers.

In our clinic, we have tested five people, none of whom were positive. Frankly, in two cases I don’t believe the results – those two had pretty much classic symptoms and spent several weeks in a hot spot where community spread was already established. I also suspect that if were were to test our staff, there are three or four who would have antibodies indicating they have had the disease. But they were all sick much earlier in the year, before any testing was even being considered.

I mentioned in an earlier post that we were switching to phone and telemedicine visits as quickly as possible, and we have continued that activity. We now ask patients to come in and register, then wait in their cars. We give them a color-coded, numbered sign to put on the dashboard. A smaller, matching card is kept at the reception desk and the rooming medical assistant uses the small card to find the right patient. The signs are laminated so they can be decontaminated as soon as they come back in the building. We still have chairs in the waiting room but the seats are blocked off and arranged so no one can sit closer than six feet. Instead of doing walk-in labs, we schedule patients for lab appointments, trying to keep at least 15 minutes between visits. I triage patients in their cars if necessary. All of these activities are designed to provide patient services while minimizing the umber of people in the clinic and the amount of contact between patients, staff and other community members. Basically the only patients who come in for visits are the rare walk-in triage, people who really must have a physical exam or something like a pap, and the chiropractic patients. Our psychiatrist and behavioral health staff have switched to phone visits only.

Something like a pandemic brings out both the worst and the best in people. It’s been disheartening to find that other primary care offices and clinics have just shut down for the duration of the pandemic. Their patients are coming to us for help. We don’t have their medical records, which makes it tougher. Access to specialty care has always been difficult for our patients, but it’s even more so as many specialists have also closed their offices.

Most of our staff have been wonderful – coming to work consistently, being patient with each other (we’re all tired, stressed and a bit cranky). Our food closet has been in high demand – the case manager served 17 people in a week when her normal is two or three. A receptionist spent 30 minutes today listening to a man who just lost his brother (non-COVID-19 issues). He desperately needed to talk and she was his first contact because he’d been in self-quarantine. Then we have the idiots who are bored with being stuck at home in the city, where most of the cases are, so they go for a drive (we’re talking a string of 30+ cars) and stop at the local store in our area for snacks. These are the same idiots, who – despite the large sign saying counter service only and a barricade across the aisle – try to climb over said barricade to get into the back of the store.

Our admin team is spending anywhere from two to four hours a day on conference calls – updates on the clinical aspects of the pandemic; coordination calls with local public health and other disaster-preparedness folks; calls with the state public health; calls with the state on licensing, regulatory and financial issues; calls with the feds and the national community health center organizations on changes in grant requirements, financing from the stimulus/rescue bills. We’re all on information overload – our heads are so full our brains are running out our ears. Our board of directors held its first-ever virtual meeting last week.

We’re managing. We’re fulfilling our mission and serving our community and we will by-God keep doing it until we can’t stand up any more. Hope you all are also holding on to the important things in life – family, friends and giving back. If we do, we’ll come out of this stronger, with a renewed sense of purpose and hope.