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An Update from Your Northwest Arkansas Health Care Providers: COVID-19 Preparation, Response, Engagement, Recovery, and Reestablishment into New Delivery of Care

Posted by: Justin Freeman on Monday, May 18, 2020

As the region’s health care providers, we are committed to caring for patients in the safest way possible. In our work together, we are learning more about COVID-19 every day and working together to provide the safest, quality care to all our patients. Along with protecting our patients, caregivers and staff, we are working to provide the most accurate, up to date information to the public. As we gain new knowledge, we will continue to adjust our response. Though the spread and full impact of COVID-19 is still unknown, we are focused on what we do know and modifying our processes and protocols accordingly.
Questions many in the community are asking include:

• “How are you all doing?”
• “Is it safe to go to your hospitals and clinics?”
• “What are the chances of getting COVID-19 if we do go?”
• “How serious is this really in Northwest Arkansas?”
• “We keep hearing about a possible surge, what does that mean?”
• “How much longer will the Coronavirus last? So, we can get back to normal?”

How are we doing?
It has been over 60 days of extremely long, intense hours as we methodically and thoughtfully planned, prepared and responded to COVID-19. Early on we made the difficult decision, along with Governor Asa Hutchinson’s directive, to suspend all non-emergent procedures and surgeries so we could help slow the spread of the virus and preserve our PPE. An acronym, many likely did not know just a few weeks ago…Personal Protective Equipment. PPE is used every day by health care personnel to protect themselves, patients, and others when providing care. It includes eye protection, sanitizers, gowns, gloves, facemasks, and shoe covers. Our community response to ensuring we all have enough PPE has been phenomenal. We’ve been engaged in our Northwest Arkansas (NWA) community for decades, and we are yet again overwhelmed by the community’s generosity. Several local organizations and universities including John Brown University, Northwest Arkansas Community College, and University of Arkansas donated PPE. We especially would like to thank JB Hunt, Walton Family Foundation, and the Walmart Foundation for their combined contributions of over $3 million for PPE and increased testing capacity.

We recently began providing non-emergent procedures again. We have put many precautionary procedures in place, and we can assure the community that we are a safe place to receive care. We’ll remain vigilant and ready in the event we do see an NWA COVID-19 surge, and we are committed to taking care of those that need our health care services to ensure the health of our region.

While suspending non-emergent procedures, postponing non-urgent clinic visits and other services was the right thing to do for the health and safety of our patients and community, it has caused significant changes for our workforce and are concerned about the financial implications of our respective health care institutions. It is our oath to take care of people under any and all circumstances, but we will have to contend with our financial realities. It has impacted our workforces with the elimination of positions and furloughing others. 

Reflecting on the last 60 days…. 
The primary reason we asked people to stay home and put visitor restrictions in place early on, is because COVID-19 is highly infectious, and it can spread rapidly. We also had a limited supply of PPE to protect patients and workers.

We have now been able to build our supplies of PPE through the generous support of the community. With a greater inventory of PPE and the collaborative work we’ve done to date, we are ready to provide expanded health care services to the community and we are prepared in the event there is a COVID-19 surge.

We have stringent screening methods in place for those that come to our facilities, including our staff. We have shared our screening protocols with employers in the region as they develop their protocols in slowly opening venues. We want to stay vigilant, protect our PPE, but we want the public to feel comfortable and safe when coming to our facilities – we want them to understand the why.

We also want to remind the community and for them to have confidence in the fact that there has been extensive communication and operational collaboration among their health care community, from the beginning. Due to long time personal and professional relationships among the health care systems and the Northwest Arkansas Council Health Care Transformation Division established last year, we had a natural forum and were able to pivot our focus on our health care destination work to focus on the COVID-19 crisis here in NWA.

Initially with all the confusion of the national media and individual health care messages, we believed it was important that we quickly pull together and deliver unified messaging. Especially in a time of crisis, it is critical to have clear, concise, trusted messaging and speak as a health care community not as individuals. In the early days that was our primary work. Almost simultaneously we took our work to a clinical and operational level. The regional hospital’s operational and clinical leaders began to collaborate and started COVID-19 surge planning. We limited visitor access, implemented screening protocols for those entering our facilities, established workstreams addressing safety measures, established dedicated COVID-19 inpatient units in our hospitals along with dedicated staffing and workflows that are separate from all other patient care. We homed in on our areas of expertise, ventilators, equipment, statistics addressing capabilities, PPE assessment and established offsite COVID-19 testing locations throughout the region. We are prepared. And believe it will be important that we continue this work moving forward to remain vigilant to benefit the health and life of all people in Northwest Arkansas.

Along with working and coordinating with our regional health systems, the Governor commissioned work for joint planning among the 16 largest hospitals in the state, including Mercy and Washington Regional. As we watched the impact of COVID-19 around the world, in our country, and how health care systems were overwhelmed with the sickest of patients, learnings from it afforded us the benefit of planning and coordination locally, regionally, and as a state to be as prepared as we can and will continue to be.

As the health care voice in the region, we also believed it was important that we intentionally reach out to all populations and ensure we met the community where they were and are hearing our messages. Collectively we transitioned our outreach programs to focus on COVID-19 in our non-profit, Hispanic, Marshallese, employer communities, and then some. All our communications and materials are in multiple languages. We also developed and deployed an Employer Guidance Document. We continue to develop and disseminate information as dynamics change in our community. 

“Is it safe to go to your hospitals and clinics? What are the chances of getting COVID-19 if we do go?”
The short answers to these questions are absolutely it is safe and while there is always a chance, chances are minimal for exposure due to the extensive measures we’ve taken to ensure patients and visitors are not exposed. Along with those coming to our facilities adhering to ours and the Arkansas Department of Health’s (ADH) recommendations. The most patients we have had in our COVID-19 units were at the beginning of April 2020. In the last several weeks our combined census (number of patients in our hospitals) has been in the single digits, with many days not having any COVID-19 patients in our hospitals. We take care of infectious disease every day and we are prepared to care for people who need health care safely and effectively.

Since March 2020, we have delivered almost 1000 babies and continued to care for our patients with emergent needs…

During this time, we have delivered and welcomed almost 1000 babies and new residents to Northwest Arkansas. Out of the 1000 babies, we had 15 sets of twins! We’ve cared for their mommas in our hospitals and some of our tiniest patients in our Neonatal Intensive Care Units (NICU).

During this time, we have continued to care for our patients with emergent needs and surgeries. One of our patients recently shared, “All of the doctors who attended to me were excellent. For being in the hospital during such a crazy time (COVID-19), the staff was calm, kind and confident. Left me feeling very at ease and confident in my care.”

Health care administers and clinicians are concerned that people may be putting off care, waiting until a problem becomes more difficult to treat because of fears about coming into clinic offices and the ER. Extraordinary measures have been made as described previously to make care safe, in all our locations, including the emergency rooms.

Our clinics are offering video and telephone visits to give patients peace of mind. In many cases, there may not be a need for an in-person visit. Even if there is, for those with chronic or new conditions, safeguards are in place. Ultimately, patients should know that the health care community can care for them whether it be in their facilities or in a virtual visit.

How serious is this really in Northwest Arkansas?
While we have not experienced a real surge of COVID-19 in our region, we must take COVID-19 very seriously. The region has done a good job to help slow down the spread of the virus. We have all worked hard to do so, but our journey with COVID-19 is not over. We cannot let up and we must continue the habits and social practices that keep us safe.

As we slowly open more of our health care services along with the business community slowly opening, we must do it in a smart, safe way that protects our public health. We do know the virus is highly contagious, and those with underlying health issues are more susceptible. We are concerned for our elderly and vulnerable populations. If these populations contract the virus, their struggle to recover is significant. We really want to encourage that they stay in place as much as they can until we know the threat of the coronavirus is minimal. We hope the community will continue to support these vulnerable populations by identifying their needs and helping to meet them, in turn allowing them to stay in place. It is safer for all of us to stay in place but as the community re-enters into our new normal, we cannot reiterate enough to do it safely, smartly and adhering to the ADH guidelines.

We keep hearing about a possible surge, what does that mean?
A surge means an increased number of COVID-19 cases, increased number of patients requiring hospitalization (medical beds), staff and consumable resources (PPE). Essentially in a health care context, a surge is a burdening need placed on health systems effecting our ability to deliver care. Surge capacity is the ability to house and treat patients above the standard volume.

To date, we have not had a real surge but have done a lot to prepare us if we do.  The community continues to do a good job to help slow down the spread of the virus. We have dedicated COVID-19 beds and COVID-19 designated areas; we have identified additional space that could be converted relatively quickly if there were indeed a need for additional beds. With dedicated COVID-19 units, we’ve expanded our capacity to take care of a surge, if one does occur. 

As more testing is becoming available and being done by those having procedures and employers bringing employees back to their workspaces, it will lead to an increase in the numbers, simply based on broader testing.  If that occurs, we do not want the community to be alarmed but rather continue to stay steadfast in their social practices that help slow down the spread of the virus.

How much longer will the Coronavirus (COVID-19) last? So, we can get back to normal?
According to the Centers for Disease Control and Prevention (CDC) “A COVID-19 outbreak could last for a long time in your community. Depending on the severity of the outbreak, public health officials may recommend community actions designed to help keep people healthy, reduce exposures to COVID-19, and slow the spread of the disease.”

Specific to Northwest Arkansas, Dr. Steve Goss, Mercy Clinic President recently shared, “I think most believe we will be dealing with COVID-19 for another 12-18 months. It is unclear how returning to normal or opening back up is going to affect the infection rates in the near term but, at best, there is likely going to be steady, low level activity with some upticks along the way. One of the things we are unsure about at this point is the seasonality of this virus. Will it act like influenza and pick back up next fall and winter? Not sure. But this time next year we should know so much more. Of course, the development of an effective vaccine will have a significant impact on the spread of this coronavirus and will afford a sense of security and well-being to folks thereby allowing greater freedom in our routines, interactions, and moving about. Hopefully that will be sooner than later.”

These are the Things We Know, and the Things We Do Not Know:

What We Do Know: 

Follow the Appropriate Guidelines: It is imperative we all continue to work with the Arkansas Department of Health, local, state, federal governments and follow the appropriate guidelines. We must keep in place as we can, and we must stay vigilant. This is not going away soon.
Personal Protective Equipment (PPE): We are learning and have a better understanding of appropriate levels of PPE inventory. Again, the community response to our PPE needs has been phenomenal. Like most businesses, our inventories were relatively small but to be better prepared for a surge or another health crisis, we are evaluating stocks to ensure we do not have excess supplies (that expire) and address how we have enough.
Collaborative Concise Messaging and Operational Preparation: The clear and concise messaging and operational preparation work that has been done up until this point by the regional health care community will benefit generations to come. This will not be the last infectious disease to sweep our nation and the work we’ve done to date will influence and impact generations to come. It will last a lifetime. 
Virtual and Telehealth Clinic Visits: Video and telehealth (telephone) visits are available with most of the region’s health care providers. For routine and easily diagnosed illnesses, these can become much more convenient for you and your loved ones.
COVID-19 screening and testing options: If you are concerned that you have COVID-19 or have been exposed, there are screening and testing options across the region. You can find information on those in our recently updated COVID-19 Local Resources document.
Workforce: While suspending non-emergent procedures was the right thing to do for the health and safety of our patients and community, we are concerned about the financial implications of our respective health care institutions. It is our oath to take care of people under any and all circumstances, but we will have to contend with our financial realities. It will and has impacted our workforces with the elimination of positions and furloughing others.

What We Do Not Know: 

COVID-19: While we are learning new things about COVID-19 daily, it is an evolving situation and it is difficult to predict what the future and our new normal will be like. We make assessments and stay vigilant daily and adapt as we need to.
Workforce: With the financial implications this has had on our respective health systems, we do not know when or if we will bring back our talented workforces that have been furloughed.
Antibody Testing: There is still a lot of discussion around antibody testing. Antibody testing should not be used to diagnose active infection. If a test comes back positive, there is still uncertainty what to make of positive results for antibodies. The uncertainty is twofold; how long do the antibodies persist, and are they protective. What is certain is that the individual has had an active infection in the recent past and helps understand more about disease prevalence.

ADDITIONAL TRUSTED RESOURCES 

Several resources from the NWA Health Care Community can be found on the NWA Council’s website: https://www.nwacouncil.org/health-care
• Centers for Disease Control and Prevention COVID-19 Guidelines:
www.cdc.gov/coronavirus/2019-ncov/index.html 
• Arkansas Department of Health COVID-19 Guidelines: www.healthy.arkansas.gov 
• American College of Occupational and Environment Medicine and MDGuidelines® COVID-19 Practice Guideline: https://info.mdguidelines.com/wp-
content/uploads/2020/05/ACOEM-COVID-May-8-public.pdf 

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