Hospital ready for increase in COVID-19 cases

By STACIE BARTON editor@ky-leadernews.com

As the coronavirus pandemic infects more than one millions Americans in the past week, Muhlenberg County is beginning to see a sharp increase as well, adding more than 160 cases since last Monday alone. As the Thanksgiving holiday arrives this week, administrators at Owensboro Health Muhlenberg Community Hospital prepare for a possible surge, but are optimistic about their ability to keep fighting to help their patients receive the best care during this unprecedented time.

There are currently six negative airflow rooms available at the hospital. These rooms are specifically designed to minimize the airborne spread of viruses, including COVID-19. This is separate from the nursing home at the hospital, where they have a wing for long term care patients who are diagnosed with COVID-19.

“The average number of COVID patients in the hospital on a daily basis is probably three or four,” said Kathy Myer, vice president of patient care services at the hospital. “Those patients usually stay a couple of days.”

Myer said the plan for care is very individualized because the symptoms related to COVID-19 can vary, and includes an array of concerns and demands placed on the patient's family members. She said when the community follows recommendations it is very helpful, including wearing a mask, washing hands frequently and limiting exposure to large groups and gatherings.

Dr. Heather Garrett, who is the medical director for the hospitalist program at OHMCH, is one of the primary providers making decisions about the plan of care for local patients with COVID-19.

“I just filled up my last COVID bed before coming down here, so we've got six right now, and that was a change from this morning, when I had two,” Garrett said. “My hope would be that people will be cautious during the coming holiday season, but the reality is, I know that not everybody is going to adhere to the recommendations. So I think we're going to see a big jump, especially after the Thanksgiving holiday.”

Garrett said a person without any symptoms of COVID-19 can turn a family get-together into a situation where people may get infected. “I think [the infection rate] is going to climb, and then we're going to hit Christmas, and then New Years... it can be a little scary. If you look at how bad it's gotten in other parts of the country, sure, we've been quite fortunate here, up until this point.”

“We're just so glad we're here,” Myers said. “It's a tough time to be a healthcare provider, in a pandemic, but we're all going to tell the story. It's doing the best we can, trying to learn every day what else we can do, because it's still about the care of patients, and nothing is more important to us than the care of the patient.”

“It's been constantly increasing this week,” said Kim Lear, nursing director in the emergency room. As the hospital intakes more COVID-19 patients in the ER, Lear said they are making additional room for patients with the virus. “We have three patient rooms plus a waiting area that if needed could be used for treatment of asymptomatic patients, so that gives us four treatment areas in the ER for COVID patients.”

The hospital is relying on their connection with the larger Owensboro Health Regional Hospital in Owensboro for support when patients need more than the local hospital can offer. “For a rural hospital, if a patient's condition does not improve, or worsens, then we transfer to our sister-hospital where a pulmonologist and critical care medicine doctors are available,” Myers said.

There is a COVID steering committee that is made up of providers and leaders from across the healthcare system who collaborate on how to optimize resources, and respond to the changes as they arise. This includes plans for expanding the space available for COVID-19 patients as needed.

The hospital in Muhlenberg County has five ventilators available, but Dr. Garrett said that as more is known about the illness, there is a push to keep patients off the breathing assistance devices. “Before, as soon as you saw COVID, you put the patient on a ventilator. Now, it's about trying to keep them off the ventilator,” she said.

“There are a couple of alternatives to prevent intubation and mechanical ventilation,” Myers added. “So we have those treatments available.”

Dr. Garrett pointed to more access to antiviral medication that was sparse at first, but is now increasingly available to even rural hospitals. “When the pandemic first started, you had to go to Vanderbilt or Louisville, so we would send patients there, but now we actually have it here, so I can do some of the antiviral treatment here.”

“And today, we had the first conversations about a new medication for outpatients,” Myers added. The hospital is making plans for how to administer the intravenous medication, and remain flexible to the ever-changing circumstances surrounding this illness.

“I look across the country, some of the survival rates for the most severe illness does seem to be improving,” Garrett said. She still worries about the longterm effect, as she has seen patients who have struggled to regain their health after being ill with COVID-19.

Even as the staff at OHMCH prepare for more cases in the coming weeks and months, they are working together to bring the best care to their patients. Donning a long list of protective garments, they visit with their patients when they can, and try to give comfort with the treatment.

New visitor restrictions have been put in place, and the hospital is allowing one support person for outpatient, inpatient, clinic visits or surgery. The staff uses iPhones to allow family to visit with COVID-19 patients, and they can chat via video using the phones.

These restrictions help reduce the risk of transmission to patients, and while these visitor restrictions are a hardship for some, it also helps keep the hospital staff safe. “Reducing the risk of transmission and protecting our workforce is so important, so we can make sure that we have the people to serve the patients,” Myers said.

The hospital has seen cases among staff members, and it's an ongoing challenge. These cases most often come from outside the hospital setting, when staff is exposed to a family member or friend who has COVID-19. With the amount of protective gear hospital staff must wear, spread between coworkers is fairly rare.

A shortage in workforce is a real concern, and they are constantly balancing resources every day to fill shifts of team members who have been exposed to the virus and must remain in quarantine.

“We're just so glad we're here,” Myers said. “It's a tough time to be a healthcare provider, in a pandemic, but we're all going to tell the story. It's doing the best we can, trying to learn every day what else we can do, because it's still about the care of patients, and nothing is more important to us than the care of the patient.”

These hospital administrators also want people not to put off other healthcare issues, such as doctor's visits or other medical emergencies. They stress how stringent the cleaning protocol is in the hospital, and the community should feel safe taking care of their medical needs, and not put off needed care.

As the coming weeks bring new challenges and people are torn between the desire to be together during the holiday season and the reality of uncontrolled community spread of COVID-19, Myers has one last piece of advice, “Wear a mask, wear a mask, wear a mask.”