WATERTOWN — In the early days of the COVID-19 pandemic, hospitals and health care centers were learning about the virus in real time.
While there was confusion and fear, there was also the underlying notion that society needed to move forward and work together to make it through the largest public health crisis in 100 years.
North country health care providers, while they dealt with a smaller number of patients compared with other hospitals in the state early on in the pandemic, many have been met with challenges along the way. The challenges span a wide spectrum, including financial strain, the canceling of elective surgeries, the lack of personal protective equipment and furloughs. But local health centers have adapted and grown in ways that will carry them into the future of health care in the region.
While the world is still working through the virus and the United States approaches the one-year anniversary of the first confirmed case in the country, many lessons have been learned along the way, and vaccinations carry the hope of a brighter tomorrow.
Right as the pandemic began, River Hospital in Alexandria Bay was in the process of conceptualizing its strategic plan for the future, the efforts of which focused on the advancements of rural health care and how to keep health care local and close to home. It was also in the middle of finalizing an affiliation with Upstate Medical University in Syracuse at the same time — during the final year of the hospital’s largest renovation project in its history.
“We were really doing a lot of work as a hospital around health care sustainability,” hospital Chief Executive Officer Emily E. Mastaler said. “Right as the pandemic started, that emergency really crystallized for us how important all of the things that we were talking about and working and planning for were because it brought this level of clarity around how essential those efforts were when faced with preparing for something like COVID-19.”
Though it was an unknown disease in the United States, the Centers for Disease Control and Prevention and others offered as much guidance as they could on COVID-19 from the start.
Watertown’s Samaritan Medical Center CEO Thomas H. Carman said guidance from the CDC at the beginning of the pandemic was to ensure a reduction of morbidity and mortality for those who were afflicted with the virus, ensuring the minimization of disease transmission, ensuring that staff were protected and ensuring the viability of health care systems.
Due to that guidance, Samaritan began to think about how to accomplish all four of those things and make sure the hospital was still there for those with other diseases who would continue to require care as well.
It was at this point in March that the hospital set up its resource line, as they were anticipating a high call volume from members of the public with questions regarding COVID-19. From that moment on, the line has been tremendously busy, according to Mr. Carman, taking in more than 10,000 calls to date.
The hospital also set up a free standing testing site away from the main facility in order to avoid people overwhelming the hospital’s emergency department or coming in and sitting next to others in the waiting area if they suspected they might have COVID-19. The site has administered close to 17,000 tests at this point, according to Mr. Carman.
“Whether or not we need to do testing forever in a drive-thru scenario is yet to be determined, but the concept of making things convenient for the patient so that they literally have to do as little work as possible to get the service that they need is certainly something that we continue to explore,” hospital Chief Operating Officer Andrew Short said.
Lewis County experienced very few cases of COVID-19 in the beginning, and less than its counterparts across the tri-county region.
“In some ways it was almost an abstract experience for those of us significantly away from large population centers,” Lewis County Health System CEO Gerald R. Cayer said. “We all read the newspapers and saw the evening news and saw those dead lined up on New York City streets, hallways jammed with people. That was only five and a half hours away from us, but it could have been on the other side of the globe.”
Lewis County didn’t see its first two virus patients until the end of March. Both individuals were later discharged and it was another couple of months before the hospital saw another COVID-19 patient. This continued until about the middle of October, when there was what Mr. Cayer called a “super spreader” event in the county.
From that point on, though numbers may still be lower than in more heavily populated areas, Lewis County has seen many COVID-19 patients, some who were ultimately unable to recover.
A struggle across the state, and country, for many months amid the pandemic was securing PPE, or personal protective equipment.
“At one point in time, I believe in early March, we were really looking at a quickly dwindling PPE supply,” said Jeremy Slaga, chief administrative officer at St. Lawrence Health System. “Now we can, with the same amount of effort that we were looking at just to keep PPE accessible to patients in those highest risk areas, with that same level of effort we’re able to offer that standard of PPE across the board, even in the low risk areas.”
Aside from hospitals, federally qualified health centers are in a unique position to provide affordable health care options for anyone in any given community, according to Ray M. Babowicz, director of communications, government relations and marketing for the Community Health Center of the North Country.
“All we hear about is the hospital systems, but obviously there’s a lot of other providers in any given community providing health care that can take a lot of the pressure off of the hospital systems in any situation, but certainly during this pandemic over the past year,” he said. “Somebody needs to release that pressure and health centers can do that and that’s what we do basically across America.
“We’re meant to be the safety net,” he added.
As with any provider of health care, when the pandemic hit, the first order of business was to make sure all patients and health care teams were as safe as possible, which caused a lot of services to be either muted or shut down temporarily for a period of time.
Like tri-county hospitals, the health center didn’t close — it remained open for any type of emergency care that was necessary, Mr. Babowicz said.
He noted that the pandemic caused the center to focus on launching telehealth services, which it was working on before COVID-19 struck, but became mission critical amid the pandemic.
According to Mr. Babowicz, telehealth has been one of the bright spots to come out of the pandemic, especially in rural America where access to care is challenging. Here to stay, he said telehealth needs to be developed and utilized where appropriate, and as efficiently as possible, for the people the health center serves.
11 months later
Back at River Hospital, different types of access to health care have been shown as essential through the pandemic. Making progress out of necessity, advancements of telehealth came into play.
Ms. Mastaler said when faced with something like a pandemic, access to health care is not only about making sure there are enough inpatient or bed availability resources, but also about how to reach people to continue their care and meet their needs despite distance and limitations.
Through the advancement of partnerships, the hospital made sure the resources River has went as far as they could. Now, 11 months into the pandemic, Ms. Mastaler said River and other health care systems are refining and strengthening resources that are further understood to be essential.
“To maximize our patients’ or communities’ access to those resources when they need them the most takes coordination and partnerships and collaboration with the Department of Health at the state level and then public health more regionally,” Ms. Mastaler said. “That’s not new, it’s further emphasized when you’re looking at something like COVID-19 on a global scale at a pandemic level.
“I hope that creative ways for our patients to access care, like telehealth, continues to stick around,” she added.
One of the lessons Samaritan has learned through the pandemic, according to Mr. Carman, is how important it is to communicate, particularly across the organization with staff and key stakeholders.
With both the resource line and testing site, among other duties, Samaritan’s staff has proven to be invaluable through the pandemic.
“Our staff have been incredible with what they’ve done,” Mr. Carman said. “They are providing tremendous care to our patients, they’re compassionate, and I also refer to them as courageous because they’re dealing with patients who have this virus every single day.”
Since the beginning, the pandemic forced Lewis County Health System to rethink basic operations, Mr. Cayer said. That has involved COVID-19 testing to incoming groups of new employees before they enter the building for the first time and increasing infection prevention capacity by adding a second full-time infection preventionist. Mr. Cayer said it’s not outside the realm of possibility for a third to be added.
Other practical measures include reducing the number of entry points into the health system and developing a work-from-home policy because there are some departments and jobs that lend themselves to being successful working from home. A new development for the system, Mr. Cayer said, he thinks it will stick around for some time.
“We’ve learned how to adjust our operations, we are still performing those activities that we weren’t performing at the start of COVID,” Mr. Cayer said.
One of the biggest things Richard Duvall, CEO of both Carthage Area Hospital and Claxton-Hepburn, has been impressed with through the pandemic is that all of the north country regional hospitals have worked together closely to ensure they’re providing the best care they can for all patients, and working collaboratively to meet the needs and directives of the state and federal government.
“We have worked on the potential need to redistribute patients and those are conversations that we had very early on actually before it became a directive from the state,” Mr. Duvall said. “That continues today, to make sure that all of the facilities are prepared to transfer patients back and forth if necessary so no one facility gets overrun and is unable to serve the population that they take care of.”
Echoing colleagues across the north country, Mr. Duvall noted that the staff have been tremendously helpful and supportive during this time that is difficult for everyone.
“The employees at both facilities have stepped up to take care of their friends, families and neighbors, and to continue to provide that care despite the uncertainty of what we were facing early on,” Mr. Duvall said. “Still to this day, even with almost battle fatigue from being in this heightened sense of awareness and concern about the pandemic and the different spikes in the community, I think the workforce has done an amazing job.”
Two of the St. Lawrence Health System’s hospitals, Massena and Governeur, are on the smaller end, with their service lines less concentrated and not necessarily centralized across the geography of St. Lawrence County, Mr. Slaga said. With that in mind, confirmed positives and COVID-19 patients under investigation were, and still are, concentrated at Canton-Potsdam Hospital.
To do this, the second floor was converted, with 31 beds that can be scaled and staffed up to be negative pressure rooms. Each room had an installation for negative pressure and then positive pressure was places in the common areas outside of the rooms.
“The airflow is constantly creating almost a mini negative pressure unit for each one of those rooms which can hold up to 31 patients,” Mr. Slaga said. “With that same concept in mind, we looked down at the emergency department where the other emergency departments throughout the health system had some capacity for negative pressure and COVID testing.”
Working with EMS and EMT, the health system worked to redirect those potential COVID patients or known positives to Canton-Potsdam Hospital, and created an EDRU — an Emergency Department Respiratory Unit. Four bays with negative pressure now sit out in front of the emergency department proper.
Looking to the future
According to Ms. Mastaler, River’s long-term focus is thinking about what the lessons of COVID-19 have taught in terms of partnerships and relationships and strengthening those systems — the ties that bind healthcare systems together. Also in focus will be thinking creatively about making sure people have access to local health care to meet their needs.
Samaritan, like health care providers across the tri-county region, realized the benefits of telemedicine during this time where social distancing has become the norm, and hopes to continue to explore its benefits one the pandemic is no longer the public health crisis it is currently.
Still dealing with the pandemic every single day, but keeping an eye on the future, the Lewis County Health System has stayed committed to its capital project, getting ready to initiate a capital campaign to help with the fundraising. Clearly addressing the pandemic is job one, but there are other activities they can’t lose sight of and the system’s future is one of those, Mr. Cayer said.
Almost all policies and procedures implemented at the beginning for both Carthage and Claxton-Hepburn hospitals are still in place today at both facilities. Long term, Mr. Duvall said he thinks requirements around social distancing not only in public but also in the workspace will continue, as well as enhanced infection control practices, and maybe even more awareness to the public about responses to crises such as this.
Like many, if not all, hospitals dealing with COVID, both hospitals under Mr. Duvall’s leadership have separate spaces for COVID positive patients, and he said he could foresee something along those lines, or better design of the current rooms that all of the facilities have, continuing on to be more capable of being able to flex or be used for whatever emergency happens to come in.
One thing Mr. Slaga thinks will stick around in a post-COVID world is effective governance and leadership under the structure of pairing clinicians with non-clinicians to gain new perspectives. Another is interoperability.
“We had to, at least across all our three hospitals, really start to standardize things to the point where they can be easily scalable under different scenarios or circumstances,” he said. “Our day to day operations became COVID countermeasures, as opposed to necessarily treating a specific patient for a specific subspecialty in a specific setting.”
Though each hospital and health care facility has proven capable during the pandemic, a common theme among the various providers of the north country has been to note the importance of working together to serve the region and help out where needed, whether its sharing resources or lightening the patient load of a fellow provider.
“I think for us, and for me personally, the pandemic has re-emphasized how important it is for all of us to work together,” Mr. Babowicz said. “No matter who we are, whether it’s a health center, a hospital system, any other community based organization, we all need to work together to provide the best care possible in the communities we serve. No one can do it on their own.”