PANDEMIC PARADIGM – A COMMENTARY ON COVID-19

Personally, I think it’s an exciting time to be in healthcare.

Hear me out. Work used to be almost monotonous. Routine. Ear infection? Chest pain? Appendicitis? Go through the system. Whatever the issue was, be it medical or surgical, there’s usually a pathway. Go here. Follow-up there. If this, then that. ER. Admit to the hospital. Discharge. Physical therapy. Go through the system.

Life is boring. Boring is good. Therefore, life is good.

Hey, did you hear about that coronavirus? No, what’s that? It’s in the news these days, it’s in China. Do you think it can come to the United States in packaging materials? I don’t know. China is a long way away. This is rural South Dakota.

Hey, did you hear about coronavirus? It’s in Europe now. Europe? That’s a ways away from China. But still across the pond. This is rural South Dakota.

Hey did you hear about WHO? Who? World Health Organization. What about them? They just declared the novel coronavirus outbreak as a public health emergency of international concern. That’s their highest level of alarm. Wow… Good thing I live in rural South Dakota.

Ear infection? Diabetes? Heart failure? Colonoscopy? Did you have your mammogram? Did you get your flu shot? Any chance you might be depressed? 8 to 5. 5 to 8. Monday through Friday. Friday through Sunday. Another day in rural South Dakota.

Hey, did you hear about Washington? New York? California and Florida?

Uh oh. Meet in the conference room. Meet with the state. Meet with the Department of Health. Meet with the hospitals. Meet with the nursing homes. Meet with the local businesses. Meet with the schools. Go to work. Meetings, meetings, meetings. Come home. Rinse and repeat. What’s the plan? PPE? What do we have? What about N95s? What about PAPRs? Surgical masks? What about protective gowns? What about airflow? What about oxygen? What do you mean everything is backordered three months?

Everybody! There is a storm brewing! Stay 6 feet apart! Wear masks! Don’t spend too much time with other people! Wash and sanitize! What are you talking about? It’s such a beautiful day. The weather is perfect. The beautiful light breeze in the air. It’s so calm and peaceful. You’re making a big deal over nothing.

Hey, did you hear about South Dakota? It. Just. Got. Real.

Canceling Schmeckfest?!? Are you out of your mind? Whatever is happening in Washington, in California, in New York, or in Florida, is a long ways away from here. Of course COVID-19 is going to spread and infect tons of people in those places. Those areas are so populated, people practically live on top of each other. This is rural South Dakota.

Chest pain, coming to the ER. All hands on deck. Aspirin. EKG. Heparin and nitro drip. The chest pain patient needs two nurses. Prepare for an additional ER patient. There are now two ER patients and two inpatients that need our attention. The chest pain patient is having a heart attack. Let’s get the paperwork together to transfer. Come to ER. Get transferred out. Follow the pathway. Go through the system. What do you mean they can’t accept the transfer without a negative COVID-19 test? What do you mean that the system changed?

Ok. Breathe. Through the mask. There is a new system we need to follow.

We can do this. Full code? Put the patches on. Telemetry. Oxygen. Morphine and nitroglycerin. Heparin and thrombolytics. And pray that our neighbor doesn’t go into cardiac arrest. We are in rural South Dakota.

Dr. Hafiz, there was another nurse and two more CNAs who tested positive from their nursing home. Oh ok. Well, go through the system. Quarantine. Isolate 10 – 14 days. What do you mean this is the nurse’s second 24 hour shift in three days? How many nurses are they down to anyways? Why don’t they call in another nurse? They called 6 different agencies for temporary nurses, and there was no one? In the state of South Dakota? In the entire Midwest? Looks like everyone is trying to put out their own fires. This is rural South Dakota.

COVID-19 patient number 1. Escort to room 4. COVID-19 patient number 2. Escort to room 5. Non COVID-19? Escort to room 10. We need more oxygen! Prepare for an incoming ER. Cough and shortness of breath? Could be COVID-19. Someone needs to take this specimen to Yankton STAT. Gown, I need a gown! What you mean we went through 80 gowns in the past four hours? Can anyone come to restock our supplies?

A provider tested positive? Isolate 10 days. Reshuffle their patients. Reschedule the satellite clinics. Review the call schedule. Another provider was exposed? Quarantine 14 days. Who is going to cover the ER? That provider was scheduled this week! Closing down isn’t an option. This is a critical access hospital, not an arcade. We are not here for fun and games. Being open or closed can be the difference between life and death. We are in rural South Dakota.

The system is down? The wheel needs to keep turning! Please take all your grievances to COVID-19 directly. I’m sure the virus will take your concerns into consideration. I hear it’s more than happy to infect, I mean invite you over.

Remember that beautiful map of pathways, where the next step was neatly laid out? What’s going to happen when the ER is backed up and overflowing? What are we going to do when there is nowhere to be transferred? What if there are no hospital beds available? What happens when there is not enough staff? Because somebody caught COVID-19 at a crowded gathering and passed it on to their child, who took it to school, who then gifted it to their classmates, who brought it home to their loved one who works at the hospital.

These are very, very exciting times to be in healthcare. Exciting is not good. These are not good times.

Your Freeman Regional Health Services care team pleads that you are responsible during the holidays. Please be careful if you attend gatherings and get-togethers. Please wear a mask and practice social distancing. Please frequently wash or sanitize your hands. We cannot take care of all of the people who will need us if the system is overwhelmed. Let us all take small steps to prevent large problems. All we have is each other. We are rural South Dakota.