Letter from UCGH CEO Re: COVID-19

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Dear Union County Friends, Family, and Community,

I wanted to give you an update on the current status of Union County General Hospital and our Clinics and how we are coping with the current COVID-19 pandemic.  Our state has great focus on the number of available beds and even the Governor has concerns over healthcare’s ability to maintain capacity and to expand capacity if needed.  Many hospitals around the state have had to expand their beds in order to take care of COVID-19 patients, some of the immediate issues are the reduction in healthcare staff from either their COVID-19 sickness or their immediate families.

Since day one, the focus of our hospital and clinics has been in controlling the potential impact on our staff and assuring they were as safe as possible and we as an organization maintained the ability to provide much-needed healthcare services to our community.  Up until the past couple of weeks, we have been very successful in doing that.  However, we have had staff members who have either already tested positive or had the potential that they will have COVID.  We have been very fortunate that these exposures were either family and/or community exposures since our staff has practiced excellent infection control measures including wearing healthcare grade masks.  We are approaching the worst-case scenario we feared for some time.  Cases are increasing dramatically, and staff potential infections could limit our ability to take care of our community.

In addition, from the beginning, the hospital has been in preparation for the worst-case scenario.  We have been ordering and stocking up on medical supplies and ordering specialized equipment for us to take care of COVID-19 patients.  We have enhanced our cleaning at the hospital and clinic and have added specialized UV light treatments after medical grade cleaning and disinfectant products are used.  We have ordered and received specialized oxygen that will give high flows up to 40 liters a minute to help patients and keep them off ventilators.  We purchased negative flow units that are portable to ensure we can expand our infection control patient rooms to be able to take care of additional patients.  Our staff has had numerous education sessions to be educated, focused and able to take care of our community.

We have participated in the state’s Hub & Spoke model of transferring patients who are critical to a higher level of care.  Recently we have had to hold patients for 1-2 days before a bed becomes available at one of the higher-level of care hospitals.  This is due to the increasing number of COVID-19 patients requiring a higher level of care, plus the number of healthcare providers at these hospitals with sickness themselves.  These facilities have been forced to go to extreme patient-nurse ratios and have had to close beds because they do not have the staffing needed for those beds.  The overtaxing of healthcare has always been one of our biggest concerns.  

Your hospital and clinics here at UCGH have put numerous new processes and procedures in place to take care of our loved ones within our community.  However, we are faced with many difficulties.  One of our biggest difficulties early on was the purchase of laboratory equipment to test for COVID-19.  We were put on a waiting list in the beginning and were not able to have delivery until September.  Currently, we have the equipment but obtaining the testing kits has been very difficult.  We have been swabbing around 10 or greater patients per day, however, we have only been successful in obtaining around 90 test kits for a month or month and a half.  As you can see the math does not add up.  We had to make the hard decision that the BioFire kits will be reserved for our sick and more critical patients and all asymptomatic patient’s tests will be sent to the state lab.  This is not an easy decision, as we are very aware of the burden this presents to our community on getting their workers back to work in a timely manner and for adhering to the quarantine mandates.  However, as healthcare professionals, we must have those resources available to the critical patients, your critical loved ones.

Another area we have worked hard from the beginning is to communicate with our community what the current status is and how we are preparing for today and tomorrow.  Below are some of the questions that we receive daily.  Education and communication are very important for your ability to properly prepare and mitigate risks.  Please do not hesitate to reach out to your hospital if you should have concerns or questions.  We are here for you and work hard each day to ensure that.

Questions:  

  1.  What kind of machine does the hospital have to do COVID testing?
    • BioFire FilmArray Torch
    • The BIOFIRE® FILMARRAY® system is an FDA, CE-IVD, and TGA certified multiplex PCR system that integrates sample preparation, amplification, detection, and analysis. This simple system requires just 2 minutes of hands-on time, with a total run time of about an hour – you get fast results to assist in better patient care.
    • BIOFIRE® COVID-19 was developed with funding from the U.S. Department of Defense (DoD) by leveraging an existing contract agreement with BioFire Defense. This is the second of three tests being developed for diagnostic use as part of bioMérieux’s strategic response to the COVID-19 pandemic.  Test kits will be available for commercial distribution in the United States under the EUA as well as internationally where regulatory approval allows. 
  2. Is it a rapid test?
    • No, the testing equipment that UCGH purchased is a full PCR testing panel.  Meaning that it will give numerous testing data at the same time.  COVID-19 is just one, along with Influenza A & B, and many others to count there is a total of 21 in the Respiratory panel.  Many of the rapid tests do not have the high sensitivity that the BioFire has, some as low as 70% accuracy. 
  3. Why do some COVID tests have to be sent to the state while others can be done at the hospital?  
    • At the beginning of the year, UCGH did not have a lab machine to test for COVID-19 antigen.  We ordered one early on, however, we were put on a waiting list and were told not until October.  We did obtain the machine in September and had to go through rigorous testing prior to its use on patients.  We have been ordering numerous kits; however, we have been unsuccessful in stocking up any kits.  In fact, we have only received a portion of our orders.  The number of kits we have been able to obtain is far less than our testing numbers.  We are working hard to gain more kits, but so is every other hospital in the US and internationally who use the same machine.  We will continue to work hard to get more kits.  We are also looking at other machines to be able to expand our testing abilities.  We are told that all manufacturers are limiting the number of their kits you are supplied in order to provide for all.  With the increased number of testing, they are unable to keep up with demand. 
  4. What are the symptoms of COVID?
    • Fever or chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea 
  5. If I am around someone who is positive, when should I be tested?  Including secondhand exposure?
    • Maybe, not everyone needs to be tested for COVID-19.
    • If you have symptoms of COVID-19 and want to get tested, call your healthcare provider first. Most people will have mild illness and can recover at home without medical care and may not need to be tested.
    • CDC has guidance for who should be tested, but decisions about testing are made by state and local health departments and healthcare providers.
    • You can also visit your state or local health department’s website to look for the latest local information on testing.  cv.nmhealth.org
    • People with COVID-19 can still spread the virus even if they do not have any symptoms. If you were around someone who had COVID-19, it is critical that you stay home and away from others for 14 days from the last day that you were around that person. Staying home and away from others at all times helps your hospital and health department in the fight against COVID-19 and helps protect you, your family, and your community. 
  6. If I am around someone who is positive, do I need to quarantine also?  And for how long?
    • Yes. You should still self-quarantine for 14 days since your last exposure. It can take up to 14 days after exposure to the virus for a person to develop COVID-19 symptoms. A negative result before the end of the 14-day quarantine period does not rule out possible infection. By self-quarantining for 14 days, you lower the chance of possibly exposing others to COVID-19. 
  7. Isolation Instructions if you were notified you are positive for COVID-19.
    • You have symptoms of COVID-19 but you have not been hospitalized in an Intensive Care Unit, you aren’t currently getting chemotherapy, and you don’t have uncontrolled HIV.
      • Stay at home in isolation until all 3 of the following are met:
        • At least 10 days have passed since your symptoms first appeared: AND,
        • At least 1 day (24 hours) has passed since you no longer have a fever without the use of fever-reducing medication (like Tylenol, Advil, Aleve, or aspirin); AND,
        • Your symptoms have improved
    • You have symptoms of COVID-19 and were hospitalized in an Intensive Care Unit, are currently getting chemotherapy, have uncontrolled HIV, or your doctor says you are severely immunocompromised.
      • Stay at home in isolation until all 3 of the following are met:
        • At least 20 days have passed since your symptoms first appeared: AND,
        • At least 1 day (24 hours) has passed since you no longer have a fever without the use of fever-reducing medication (like Tylenol, Advil, Aleve, or aspirin); AND
        • Your symptoms have improved
    • You have no symptoms of COVID-19.
      • Stay at home in isolation until:
        • 10 days have passed since the date you got your positive COVID-19 test, as long as you do not develop symptoms in the meantime.
        • If you do develop symptoms, then switch to the isolation instructions for those with symptoms. Your ten days of isolation at home will begin from the first day you have symptoms, not from the day you were tested.
        • Note: If you have a severe immunocompromising condition without symptoms, you must isolate 20 days from the date you were tested.
    • Instructions for people living in your house (they are considered close contacts)
      • They should:
        • Remain at home and limit contact with other people for 14 days from the time your isolation period ends. This will likely end up being 24 days.  During this time, they should watch for fever and symptoms. If these occur, they should get tested right away. If there are no symptoms, they should wait 7 to 10 days after your positive test to get tested.
    • Instructions for people you were around:
      • You will also need to contact any people you were around for two days before your symptoms started or before the day you got your positive test if you do not have symptoms. The hospital and/or the Health Department will also assist with the tracing of your contacts.  If there were any people who were within six feet of you for more than three minutes (even if you had masks on), you should tell them about your positive result and tell them to:
        • Remain at home and limit contact with other people for 14 days from the last day that you spent together. During this time, they should watch for fever and symptoms. If these occur, they should get tested right away. If there are no symptoms, they should wait 7 to 10 days after the last time they were together. 
  8. How does this affect my employees on how long they should be out of work?
    • For employees who have been exposed to a person who has tested positive for COVID-19:
      • If a person has been exposed to someone with COVID-19, there is a 14-day period during which they might become infected. That is sometimes called the “incubation period” for the disease. The 14 days runs from the last date they had close contact with the person with COVID-19. 
    • For employees who have tested positive for COVID-19:
      • When a person is diagnosed with COVID-19 they must remain isolated at home until they are no longer infectious. Some people with COVID-19 have symptoms while others do not. The best approach to determining when isolation can be discontinued is based on when symptoms begin or, for those who do not have symptoms, the time since the positive COVID-19 test was collected. Requiring a negative test to allow someone to return to work can be problematic because people may intermittently shed non-viable virus for a while after they are no longer infectious. NMDOH does NOT recommend that employers require employees to provide proof of a negative test before they may return to work. 
    • Due to the extremely high number of COVID-19 cases, NMDOH is not able to provide return to work or work excuse letters. We recommend that employers use the recommendations above in conjunction with an employee’s test results to determine when it is safe for them to resume regular activities, including work. If an employer needs assistance making this determination, they may call the NMDOH COVID19 hotline at 1-855-600-3453. 
  9. Can UCGH take care of me if my symptoms get bad?
    • Yes, we will not turn any patient away.  Your test may not be done on the BioFire, but you will receive a test if you choose.  If your symptoms do not meet the criteria, the test will be sent to the state lab.  You may receive a telemedicine visit through the clinic, or you may also be seen in person if needed in the clinic.  If you present to the Emergency Room, you will be evaluated and treated appropriately.  If your symptoms are critical, we will try to transfer you to a higher level of care as available, or we will take care of you at the hospital. 
  10. What can I do to help me and my family from getting COVID?
    • Just like with many other illnesses, the best way to prevent illness is to avoid being exposed to the virus that causes COVID-19. This requires taking steps to protect yourself and to protect others.
    • To protect yourself, clean your hands often and avoid touching your eyes, nose, and mouth with unwashed hands, as well as avoid close contact by avoiding other people who are sick and putting distance between yourself and other people. 
  11. Who is at the highest risk of getting really sick if they get COVID?
    • Older adults and people of any age who have serious underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.
    • Advice for people at higher risk of severe disease includes:
      1. Stay at home as much as possible
      2. Make sure you have access to several weeks of medications, groceries and supplies in case you need to stay home for prolonged periods.
      3. When you go out in public, keep away from others who are sick, wear a mask, limit close contact, and wash your hands often.
      4. Avoid crowds. 
  12. How are healthcare providers doing in my state?
    • I believe they are beginning to feel the stress and pressure of 8 months’ worth of hard work and non-stop preparation and anxiety.  In some areas around the state, they are seeing nurse/doctor-patient ratios that are extreme.  They are worried about their families and taking something home.  But they are compassionate, highly educated and know that we all depend on them.  We are truly blessed for our healthcare workers here in our community and we are fortunate that they are compassionate and dedicated to our mission.  We are all in this together, and together is how we will be successful.  We are a tough team here at the hospital and giving up is not in our nature.  I am so proud of each and every staff member, and I am proud to get to work alongside them. 
  13. How is UCGH doing with being prepared to take care of COVID?  Do we have enough healthcare providers, equipment and supplies to take care of our community?
    • As above, we have been proactively preparing from the beginning.  We have stocked up supplies, ordered additional specialized equipment, completed education, performed daily advanced infection control practices in order to maintain and enhance our ability to take care of our community.  Our staff are few, but we are prepared.  If COVID-19 does infect our healthcare staff, it will be tough to find replacements.  Many NM hospitals are fighting for agency staff and the cost of those agency staff has tripled.  That is why it is so important to protect the staff we have. 
  14. What are some of the plans in healthcare to be able to continue to take care of COVID patients who become really sick and require hospitalization?
    • NM has developed a tier system that when times become even more critical; asymptomatic positive healthcare providers, wearing appropriate PPE, will continue to work and take care of patients.
    • We do not have enough healthcare providers to have asymptomatic staff quarantine.  However, we have medical grade PPE, including N95 masks to protect the staff and the patients from exposure.
    • Please see the NMDOH site for specifics on this tier approach in critical times. 
  15. Does the hospital have plans for a testing machine for COVID antibodies?
    • Our current chemistry analyzer with small additions can run COVID antibody testing.  We have already begun making these adjustments, however, the test has not received FDA approval.  We are unable to test on patients without FDA.  It has been submitted to the FDA for EUA, but it has not been approved as of yet. 
  16. How do we know how many active positive cases do we have at any one point in our community?
    • This is a difficult question since some patients become sick and get better within their quarantine period, while some are sicker longer.  However, my best guess is to add the new positives within the last 14 days to get an approximate number. 
  17. How long does it take to get a test result back from the state?  Why are they so backed up?
    • With the increased testing and COVID-19 sickness in our country, our state lab has been flooded with testing above their capabilities.  They have begun using texting as a means of communicating positives and negatives with patients to help speed up the process.  Currently, our facility is seeing a 9-11-day lag time for turnarounds with the state lab. 
  18. Do antibiotics work against the Coronavirus?
    • No. Antibiotics do not work against viruses; they only work on bacterial infections. Antibiotics do not prevent or treat coronavirus disease (COVID-19), because COVID-19 is caused by a virus, not bacteria.
    • Providers can treat symptoms and other diagnoses that the patient may be symptomatic with. 
  19. When should I seek medical care if I am sick with COVID-19?
    • Mild COVID-19 cases still can make you feel lousy. But you should be able to rest at home and recover fully without a trip to the hospital.
    • If someone is showing any of the below signs, seek emergency medical care immediately
      • Trouble breathing.
      • Persistent pain or pressure in the chest.
      • New confusion.
      • Inability to wake or stay awake.
      • Bluish lips or face. 
  20. Where is the US, NM, and UCGH concerning a Coronavirus vaccine?  What will be the cost of the vaccine?
    • The hospital has signed contracts with the NMDOH and CDC to be a distributor of the COVID Vaccine once available.
    • The first potential vaccine was submitted for approval last Friday and two others are thought to be within 2 weeks of submittal for approval.
    • Most of the vaccines will require a second dose, approximately 4 weeks after the initial.
    • The state is working on a tier system of making the vaccine available.  In all communication, front line healthcare workers will be in the first tier.  The depth of the tier will be determined by the number of vaccine doses released to the state and our county. 
    • We will follow the CDC’s and NMDOH’s mandates on vaccine administration.
    • All information coming from the state, there will be no charge for the vaccine.  However, there may be a charge for administration.
    • We are working on getting a specialized medical freezer.  The ultracold vaccine must be kept at -60 to -80 degrees.  The efficacy of the vaccine is thought to be in the 90s.  More information will be forthcoming as available.

I hope this provides some education and guidance, stay safe and compassionate.

Tammie Stump, CEO

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