Even though Flathead County on Wednesday still hadn’t reported a single case of COVID-19, health care professionals are already feeling the full strain of the coronavirus pandemic as facilities grapple with limited testing capabilities and take stock of critical resources that could be exhausted with an influx of sickened patients.
Dr. Doug Nelson, chief medical officer at Kalispell Regional Healthcare (KRH), said efforts over the past month to prepare for the likelihood of COVID-19 spreading through the Flathead Valley are paying off.
“The mood at KRH is great, actually, because we know it’s a national problem and we know it’s likely to arrive here but we have had some time to prepare,” Nelson said. “In the last week or two as the reality of the epidemic has become much more clear, we have really been ramping up to take care of patients if and when they come.”
Both at KRH and North Valley Hospital in Whitefish, officials are following national screening guidelines issued by the Centers for Disease Control and Prevention (CDC), which limits testing to patients who fall into four high-risk categories.
“Despite what you might have heard, the availability at this point of COVID testing for patients is still very limited, so we have to reserve those tests for people who are in high-risk categories,” Dr. Jason Cohen, chief medical officer at North Valley Hospital, said. “And that is both because we have limited supplies of personal protective equipment that is needed to safely test patients as well as limited supplies of testing kits.”
Those high-risk categories include patients who are hospitalized with respiratory failure for which there is no explanation (for example, they do not have flu or pneumonia); people experiencing symptoms who have had known contact with someone who is positive for COVID-19; people exhibiting symptoms traveling back from a foreign nation experiencing an outbreak; and patients with symptoms who have chronic conditions and are over the age of 65.
To expedite patient screening, KRH has opened two respiratory screening facilities at either end of the Flathead Valley that are reserved strictly for people who are referred by a health care provider or clinic.
Cohen said the screening clinics are in place to protect health care professionals, community members and patients from unnecessary exposure, but said they could quickly be overwhelmed if people without referrals begin turning up.
“That would totally overwhelm these facilities and undermine their effectiveness,” Cohen said. “These facilities are set up for people who have symptoms and need to be evaluated. We are hoping that only people who are in dire need of evaluation are showing up in these facilities. This is a plea for partnership.”
There are two site locations effective March 18. One is at the Family Health Care walk-in location in Kalispell. Another is at the Flathead Valley Orthopedic Clinic building in Whitefish. Both locations are staffed by Kalispell Regional Medical Center and North Valley Hospital staff and are identified with “Respiratory Screening Facility” signage.
For more information on the locations and hours of operation, as well as related updates, visit krh.org.
KRH officials have been meeting with county health authorities for more than a month to make preparations for the possible arrival of patients sickened with COVID-19, according to Nelson, and in the past two weeks the organization has taken numerous steps to expand the hospital’s capacity to keep up with a projected uptick in demand while emphatically encouraging community health measures that help “flatten the curve.”
“If there is a rapidly expanding epidemic and lots of people get sick at the same time, there is a potential to overwhelm the resources of the health care system as we try to take care of the small minority of people who do get really critically ill,” Nelson said. “So rather than having a peak of lots of people who get sick at the same time, the idea is to flatten the curve where you decrease the spread of the virus amongst a population so a smaller number of people get sick at the same time. And that is why we have been so adamant about social distancing.”
Nelson said the hospital has also been limiting non-essential hospitalizations, in large part by limiting elective surgeries — operations that a patient needs to have but that are not immediately critical.
“We currently have plenty of bed capacity, and we are doing everything we can to free up additional space,” Nelson said.
KRH has 18 adult intensive-care unit beds, as well as 12 intensive-care beds that it can make available in the old intensive-care unit.
“We have made specific plans for the use of those facilities for the sickest of the sick, or basically those who need ventilators,” Nelson said.
The organization has additional capacity at North Valley Hospital and at the Montana Children’s medical center, while operating rooms are equipped with anesthesia ventilators.
Nelson said he remains hopeful that the measures to expand the hospital’s capacity will allow the facility to provide care for all patients and perform lifesaving functions by artificially ventilating patients who experience acute breathing difficulties.
As patient numbers grow globally, however, some countries, such as Italy, have experienced scenarios in which health care providers cannot furnish all patients with the same degree of care, forcing them to make extremely difficult decisions.
“We are fortunate in the Flathead Valley to have had no known cases at this point, but we are making preparations for worst-case scenarios and that includes ensuring that we have appropriate advanced directions for our sickest patients,” Nelson said. “We are also developing an ethics committee as part of our hospital structure, and we have gotten some appropriate direction from a legal consulting firm. If we do get into a situation like we’ve seen in Italy where we have to make really hard decisions about who should get care, we want to be able to make those decisions in an organized and ethical way.”
“We certainly hope we don’t have to make those decisions,” he added, “but we are trying to make plans for every contingency.”