COVID-19, Virtual Care
Dr. Rhonda Medows of Providence St. Joseph, “The Road Ahead for Health Care Providers”
It’s been just over two months since the first confirmed domestic case of COVID-19 in the United States at Providence Regional Medical Center in Everett, WA. Since that day, January 20, we have seen cases and deaths increase exponentially across the United States, state governments have enacted shelter-in-place or stay-at-home orders to flatten the curve, and the curtain has been pulled back on many of the shortcomings of America’s health care system.
United States of Care’s Board member, Dr. Rhonda Medows, is President of Population Health Management for Providence St. Joseph Health System, which serves communities in seven states: Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. USofCare invited Dr. Medows to take part in a tele-briefing to share what Providence St. Joseph has been and currently still is experiencing on the ground in Washington state. The details were sobering and shine a light on the uphill battle that our health care providers are facing as the COVID-19 pandemic continues.
Dr. Medows described where she saw problems begin, with the shortage of testing kits and delays in getting results. Without adequate surveillance testing, there is no baseline data to use to plan for what is to come or share with states who are just beginning to see cases increase in their communities. Hospitals must now plan for the worst case scenarios and have difficult conversations, including which patients will get the limited ICU beds and ventilators if there is a surge.
She recommends prioritizing test kits for those who are sick enough to be admitted and the frontline providers who are treating them. If test kits become more available, health systems can broaden the circle of who they are testing. However, in places like Washington and New York, the time for surveillance testing has passed. And access to adequate PPE supplies remains limited, so it’s best to ensure that masks, face shields, and swabs are reserved for frontline providers serving in-patient needs and not used for surveillance testing.
“The biggest concern at this point is securing the Personal Protective Equipment needed by frontline caregivers: doctors, nurses, EMS, and first responders. We have a shortage of critical supplies: N95 masks, face shields, long testing swabs, and ventilators,” Dr. Medows shared. “The ventilator situation is dire in different parts of our country. Providence St. Joseph goes through 3,000 masks per day and are facing down a shortage of 4 million N95 masks. Without these masks, our frontline medical providers are at risk of infection and once they fall, we will be in real trouble.”
Providence St. Joseph has not received any ventilators as of yet from the U.S. federal government, but they are not waiting. They have gone out on their own to try to secure the PPE that they need. However, despite having placed orders both domestically and internationally, they do not know when items will actually arrive due to back orders. “We need the President to fully enact the Defense Production Act to ramp up production of ventilators and other critical PPE and supplies. It has never been more important,” said Dr. Medows.
In the meantime, Providence St. Joseph has turned to the community for help in securing what they need. They’re relying on local mask campaigns. They contacted the American Veterinary Medicine Association, who reached out to their members in Washington about donating ventilators. Through this effort, Providence was able to secure a few additional ventilators, but are still woefully short.
To further protect frontline care providers, Providence St. Joseph has turned to technology solutions. Their express care locations have gone 100% virtual. They’re also using virtual care, telehealth, nurselines, and chat bots in order to keep primary care clinics and hospitals for those who have fevers or respiratory issues and need to be seen.
Dr. Medows praised the work of the state governors and partners in states where they are located, but stressed the need for the federal government to act: “Get funding and supplies to hospitals and health systems. We need it.”
Understanding that support for their front-line health care providers goes beyond the physical protection from COVID-19, Providence St. Joseph also started behavioral health supports for their frontline care providers and other staff in Week Two. Help is available 24/7 via phone and virtual visits, and “buddies” are assigned to check-in on people who are struggling. Staff working off-site are helping provide support to frontline caregivers, including arranging childcare.
USofCare is committed to acting quickly, providing rapid response and relief support to our state and federal partners. We submitted a policy agenda to Congress focused on benefitting both people and the health care system, and on March 25, the U.S. Senate voted to pass extraordinary legislation that included many of our suggestions and reflected the five pillars of our agenda. We’ve partnered with Project N95 to meet the urgent PPE needs of providers and states, and are connecting state partners with resources, best practices, and volunteers through the US Digital Response team. And on our dedicated COVID-19 website, we are making valuable information, tools, and resources available to state and federal leaders, key stakeholders, and the public at large.
When asked what the general public can do, Dr. Medows said “Stay home. Staying home slows the spread and prevents overwhelming hospitals already facing shortages in the necessary supplies.” Let’s all commit to #stayhome so we can #savelives.
USofCare will remain nimble and look to do whatever we can to support the COVID-19 response effort at all levels.