PLATTSBURGH — The COVID-19 pandemic forever changed policy at the University Vermont Health Network-Champlain Valley Physicians Hospital.
“If you come in with a respiratory illness right now and you’re being hospitalized, you’ll get tested,” Keith Collins, MD, said.
“The symptoms are so similar to all of these viruses that we test for. We test for RSV. We test for influenza, and we test for COVID. Then anybody we suspect of one, we test for all of them. Influenza and COVID we do have treatments for. RSV, we still really don’t have treatments for that beyond some things that just apply to pediatrics and they’re marginally effective. They have toxicities in adults. We have no treatment for RSV except maybe a bone marrow transplant. Again, we don’t deal with that here. and again, the treatment is maybe marginal.”
After COVID, CVPH examined its policies about how to isolate for respiratory illnesses in general.
“We have greatly altered what we used to do,” he said.
“We now have a policy that incorporates all of the respiratory viruses in essentially one policy that our infectious control practitioners – Erica, Bonnie, and Chris. All three were infections control RNs. Bonnie is no longer with us, unfortunately, but they spent a lot of time working very hard to come up with a rational approach to all these pathogens. We have people on any given day that are in our hospital with all three viruses. So, our hospital needs to address how to handle all of these viruses, not in individual silos, but basically in a rational, coherent way. That’s been done really within the past, I would say, six months that we’ve come up with a good way to incorporate all of them into one particular policy. They are the ones that really did it.”
EDWARDS LEGACY
The late Bonnie Edwards was an infectious control practitioner that worked in the Infectious Disease Department for more than 23 years, according to Erica Moore, RN, Infection Prevention Manager at CVPH.
“But she worked with us for a very long time and had a very strong influence, very analytical, used the science to help make the decisions and not use emotions,” Moore said.
“That’s not easy to do when you’re in healthcare because in healthcare emotions are what drives us as humans and make us humans. We cannot ignore Bonnie’s influence on infectious prevention. She was very pivotal in our team. Kristen Broughton is the other IP.”
The team used information from the Centers for Disease Control and Prevention to create CVPH’s algorithm.
“When you look at the CDC, there’s information that talks about looking at the percentage of your population,” Moore said.
“So why would you do something in Clinton County that is different than Essex or Franklin or across the lake over in Vermont? Often we compare and say why did UVM do something different than CVPH? Because we’re not the same exact population. You want to look at what the pressures are on your community. and so when you’re looking at the CDC’s information on how to handle COVID or flu, the percentage of your community numbers dealing with COVID or flu would influence when we activate, when to wear masks for direct patient care.”
Moore cited the uptick in flu, much larger than COVID, for which the hospital implemented masking for direct patient caregivers.
“COVID has been trickling for the last few months,” she said.
“It comes up, and it comes down. But COVID is a much lower pressure than influenza, and influenza is acting like influenza. But for years, we have been focused on COVID and forgot about flu. So why is flu out there? It could be for a lot of things, and I don’t know all of our community’s numbers.”
CVPH implemented masking for direct patient caregivers to protect their and their patients’ health.
“We don’t want them to get sick,” she said.
“We want to make sure they are here to take care of you because we have some great healthcare workers. But we need to be here to take care of our patients who are ill and we have way more flu patients getting admitted. Way more patients going to the hospital testing positive for the flu and going home and way more patients who are getting tested outpatient, not going at all to the ED and staying at home. Those numbers are way, way up compared to that of Covid or even RSV.”
COVID SHIFT
During the pandemic, CVPH staffers learned what really needed to be done for isolation, which is almost always respiratory.
“The insanity over having hand wipes at every grocery store kind of went away, thank goodness,” Collins said.
“Again the vaccines I consider the biggest change for us. I think if it hadn’t been for vaccines, I don’t know how we would’ve controlled this. I really don’t. But then we did find some really good treatments.”
Real treatments emerged from CDC and National Institutes of Health sponsored studies.
“People were throwing drugs at the wall to see what would stick at first,” Collins said.
“We did it here. I think vaccines and scientifically studied proven treatments have made the biggest difference and still continue to make the biggest difference.”
New York State continues to track positive COVID tests over time by region and county.
“We keep track of how many people were tested, how many tested and went home, how many were admitted,” Moore said.
“Our local health departments and our state health departments wanted to know who was being tested and went home.”
VARIANTS
COVID tests detect the presence of the virus but doesn’t tell what variant, which is done by genomic sequencing.
“It changed,” Moore said.
“People understand it better. We understand it better. I think it’s a community approach, too. A hospital is a hospital, but the people who come to it are the community and we have to work with the community. It’s not just the hospital.”
Nursing homes. Assisted livings. Schools. Public. Consumers.
“We are the entity in which people come to where they’re sick,” Moore said.
“When you have a mild sniffle, do you need to be here? Do you rush to the (Emergency Department)? No, but when you’re sick you need to be here. We don’t want to turn you away. So when you step back and look at the bigger picture, the hospital is an entity, but we are part of the community.”
When COVID first hit, there was fear and uncertainty.
“That drove a lot of people here, and we needed to step back and understand what everybody was feeling because fear is a driver of consuming things when we don’t know what’s going on,” Moore said.
“There was fear in our community. There was fear in everybody. So, I think that’s what hit us first, and then we started to understand and science came out that helped us.”
COMMUNITY
During the pandemic, the Plattsburgh community stepped up to help the staff at CVPH.
“Folks dropped off food,” Chris Blake, program manager of Media Relations & Communications, said.
“There was all kinds of stuff. I can’t speak to the folks that were actually doing the care, but I believe it helped a little. Putting in one of those long shifts and making those tough decisions and seeing all of that, you knew that there was a community outside that was backing you up.”
ALL HANDS
“I think the other thing is that while this was very clinical, our environmental service workers, our kitchen folks, the facilities people, the work and dedication that was on display during that period of time was inspiring,” Blake said.
“Everybody worked together to kind of support these patients and this family and beyond that. But it was reciprocal because the community was returning that favor.”