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Apple a Day

A COVID-19 update on our preparedness efforts, forecast modeling, and call for community support

Kent Mattson, interim CEO and Dr. Josh Overgaard, Internal Medicine Physician and Chief of Staff
March 31, 2020
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A special COVID-19 edition of our program to update and inform our communities on the current response efforts at Lake Region Healthcare, Prairie Ridge Hospital and Health Services and Mill Street residents. Guests interim CEO, Kent Mattson, who also serves as the Incident Commander in our emergency response structure, and Lake Region Healthcare internal medicine physician and chief of staff, Dr. Josh Overgaard share perspectives on the planning, forecasting and ways the community can help


Katie Johnson: Good morning and welcome to Apple a Day and a special COVID-19 edition of our program to update and inform our communities on the current response efforts at Lake Region Healthcare, Prairie Ridge Hospital and Health Services and Mill Street residents. My guests today are interim CEO, Kent Mattson, who also serves as the Incident Commander in our emergency response structure, and Lake Region Healthcare internal medicine physician and chief of staff, Dr. Josh Overgaard.

I want to thank you both for taking time out of your busy days and also thank you for the long days you're putting in. There are so many questions, so many uncertainties, so many important things we want to talk to our listeners about today. We certainly won't cover it all in the few minutes we have here, but let's dive right in. Kent, maybe you can start us out with a little bit of background. What has the response effort looked like so far and what is it focusing on today?

Kent Mattson: Thanks Katie. There's a lot of questions that we know that are floating around on this coronavirus or COVID-19. When we first recognized that this was going to be a global pandemic with a local impact, one of the things that we did was we organized our Incident Command structure. And the Incident Command structure at both Lake Region Healthcare and Prairie Ridge Hospital are ways to organize the work to respond to an emergency event, to organize what we have to serve the nine communities that we're here to be a healthcare solution for. Coordination between our hospital in Elbow Lake, our clinic in Morris, our hospital in Fergus Falls and our clinics in Fergus Falls, as well as the clinic in Barnesville is critical to taking care of the COVID patients that might present needing hospitalization as well as the COVID patients that might not need to be hospitalized but need medical support outside the hospital, but also making sure that we've got coordinated structure to take care of patients that aren't needing support for COVID, the surgeries, the day to day type health situations that we're here to serve the community for.

So one of the things that we started to focus on early on is doing this in a way that is aligned within Prairie Ridge and Lake Region Healthcare and some of the unique features that we focused on in our Incident Command structure is really around four principles. Number one, we want to take care of the patients and keep them safe. Number two, we want to take care of our employees and medical staff and keep them safe. Number three, we want to take care of our community and keep it safe. And number four, we want to coordinate and conserve the resources, that's our people, our places and our things, because what we've recognized, what's happening in other states is this is not a sprint, rather this is a marathon.

COVID-19 is a threat that's going to last quite a few months and we want to make sure that we are in it for the long haul and doing it in a coordinated fashion. So we're looking at this on an enterprise basis, meaning the communities that rely on us to be taken care of. We want to make sure that we're putting the services at the right location, we want to make sure that right level of care is available for people, and we want to make sure that the right level of support to take care of those people at those places is implemented. And communication is the key. We're trying to get the message out amongst all the nine communities that we serve to make sure that they know where to go for the care that they need at the right time.

Katie Johnson: And it really is a tricky balance, isn't it? Preparing for this marathon of COVID-19 while also responding to the everyday medical needs and keeping the daily business operations running. Josh, you are there on the front line working in the Respiratory Assessment Center, working with our staff both in Incident Command and with patients every day. Give us your perspective. What are you seeing and hearing from patients?

Dr. Overgaard: Sure. Well, I think first off, everybody's a little bit unsure of what to expect and what to think. There's a lot of uncertainty and nervousness in some situations. So our Respiratory Assessment Center is something that we set up to try to help make sure that we're taking care of our patients as well as we can and also protecting the rest of our patients and population and staff from the potential spread of infection. So we have a space that we've developed within the clinic where we're trying to funnel all the patients who need care that's not an emergency, but for those patients that may have the virus, we don't know, and get them cared for in one place in such that we're limiting the spread to other areas.

And so far it's been working really smoothly. We have a team of nurses and providers down there every day who know the protocols well. They understand how to protect themselves, they understand how to protect their patients. We're getting people in and we're getting them the appropriate level of testing and we're getting them the care that they need. And so far we've had really good feedback for that. The process that we're using to try to ensure that we have people in the right places, we've developed a hotline that people can call if they think they have symptoms that may be due to the COVID virus.

And at that time, they speak with a nurse who's well-trained and has all the information hopefully that she or he needs and can direct those people that call to, are you in a situation where it would be safest for you to stay at home and manage your illness there? Do you have a situation where you should be seen by a provider in the Respiratory Assessment Center? And then they could direct them there. Or, does it sound like they have a critical illness and should seen more emergently in the emergency department? And direct them there. And for some people, it's appropriate to have them screened in our drive up COVID screening line and we can direct them there as well.

So far, as I said, that's been going really smoothly. We've also set up virtual visits in our clinic such that for those people who have more routine needs, they can be seen to by their primary care provider or someone else in the clinic, we have them call in or video in and we can see them and I think that's a really important piece to trying to keep this thing under wraps.

Katie Johnson: We should mention that hotline really is just our regular phone number. So calling the clinic in Fergus Falls or in Elbow Lake or calling the hospital number. So just the regular number that you would call, say that you'd like to speak to someone about COVID symptoms and you'll be directed right to those screening nurses. Do you have any sense yet for, you've mentioned the drive through testing, any sense yet for what testing numbers and results have looked like here yet?

Dr. Overgaard: Sure. We have tested between the drive up, the emergency department and the Respiratory Assessment Center, we've tested about 80 people. The number of tests return is quite a bit smaller. Unfortunately, we're seeing delays of over a week to get our test results back. That's a situation that we're actively trying to troubleshoot. We're looking at other ways of securing those tests and getting results in a more timely fashion. This is something that is changing day by day. I should give the caveat that almost anything I say now is probably going to be obsolete by tomorrow. But so far it's been 80. There are a number of tests yet that are pending. It would surprise me none to find that one or many of them are in fact positive. We have every reason to think or believe that this is something that's within our community already and we just don't know to what degree yet.

Katie Johnson: Great. Kent, we did have our first confirmed positive test case announcement from public health regarding a positive case in Otter Tail County on Sunday. The message you sent out after that announcement basically said, "Yep, we've been expecting that. No reason to panic. Stay the course." What do you want people to know that's changed or hasn't changed based on knowing we have a positive test in the county now?

Kent Mattson: I think, Katie, it's important for people to understand that all along, we have assumed, expected and known that this virus is in our communities. The public reports, as Josh mentioned, are delayed and so a lot of people watch the map that's progressing. And we're not relying on the map. We are behaving as if it is in our community and that's not a cause for panic, it's not a cause for high level anxieties. That's just our reality and I think what we have to do is we have to embrace that reality and we have to figure out what we can do to change the result because right now, regardless of whether or not we have a positive test result, it's not going to change our continued intense efforts to acutely focus on the safety of our patients and the safety of our employees and our medical staff. It's not going to change the fact that we're trying to take the best care we can of the community and it's also not going to change this coordination that we've been so intensely working on over these last few weeks.

The reality is we are using all of the resources at Lake Region Healthcare to organize for when we start seeing more positive cases come to our communities. We know that people are going to be looking to us for answers, so we're coordinating heavily with Otter Tail County and Public Health to provide questions that people are going to have. We know that a lot of people will be taken care of outside the hospital, but we also know that a lot of people are going to be acutely sick. And so what we're trying to do is plan for the resources that we have to bring to bear for that and we think that by coordinating the care at Prairie Ridge in Elbow Lake and in Lake Region Healthcare, that we're going to be able to take care of as many people as we can in the communities, but we also have to recognize that we are going to have to work with our partners outside our communities and transfer some cases if the load gets to be too heavy for us to care for locally.

But again, we know that there's been positive cases out there in counties around us. It was just a matter of time when Otter Tail County had its first case. It doesn't change a lot for us, but it does make the public, I think, understand that this is very real and we hope the public takes it very seriously.

Katie Johnson: Absolutely. And when we talk about the planning for this potential influx of patients, could you tell us a little bit about what that planning entails? What kind of data are you getting to help support the plan for this influx?

Kent Mattson: So one of the things that we are watching as well as I think the general population is watching is what's happening in New York, what's happening in Detroit, what's happening at the state level, but we've got some resources over this last week that has been intensely looking at local data to try to take some of the modeling that shows when this might start in Fergus Falls and Elbow Lake and the communities we serve, how big it may be, meaning how many patients that we're going to try to manage, and how long this may last. We don't have that modeling yet complete and we don't want to release that information until we're sure that it's refined as much as possible. But what we do know is that it's probably going to start to escalate in April or May, it's probably going to start to see its peak in June or July, and it's probably going to last into August.

We hope to communicate amongst the community more details around that. But what we do know is we're different from the metropolitan area. We have a higher aged population and because of that, we're going to get people that are sicker than you're seeing in some of the metropolitan markets. So regardless of what the estimates show, and we do know that those numbers are going to be high and we do know that those numbers are going to provide people with some anxiety, but we're trying to take a calm and steady and diligent reasoned approach to this. We need to remember that all of these forecasts are estimates and we hope and we pray that the modeling overshoots things, but to be prudent, we need to plan for the worst case scenario to create the best possible outcome. And all of the numbers that we see just make it more and more imperative for the entire community to practice the measures that we're preaching to slow out and even out this forecasted surge.

We talk about flattening the curve. That means to slow it down and stretch it out so we're not overly stressing our healthcare system. We need people to practice what we preach and really take it seriously. Social distancing is important. Without that, our healthcare system, not just in our area, but in Central Minnesota and the metropolitan areas is going to be overrun. So we need to protect our community and equally as important, we need to protect our healthcare workers who do this important work of caring for people, who are going to be called upon over these next month to take care of COVID-19 patients, as well as take care of the regular type of healthcare that we're here to do.

So I guess what I'd say is we have some numbers internally. We know that we're not going to take care of or be able to take care of the high numbers that might come as at one time. So we have to practice those social distancing measures to spread that out, slow the demand and not overstress the system.

Katie Johnson: You mentioned the healthcare workers and how important it is to protect them to protect that resource have these people available for patient care. Dr. Overgaard, you represent that group of people on this interview today, the frontline staff and direct patient care, the team in the ER, in the clinic, the folks we have screening our patients, the EVS staff working to clean and disinfect all of the areas. There are a lot of people involved. What do you have to say on their behalf or to them?

Dr. Overgaard: Katie, this is a challenge that is unlike anything any of us have seen before in its nature and in its magnitude, but I couldn't be more proud of the people that I work with. This is a group of people that is stepping up to the plate. They've got their hand in there and they're ready to help. They are completely invested in taking care of their neighbors and they're willing to go to lengths that they've never thought they'd have to go to do that. And I think that's great. But we are all concerned. The information that we have and the things that we see on the news tell a story of a challenge that seems sometimes insurmountable. And if this is left unchecked, this is something that could stretch us beyond the limit of our usual capacity. As Kent alluded to, we're putting plans in place to weather that surge, but worst case scenario, we're in a place where we're starting to run out of supplies, we're running out of equipment and we're running out of people to do the work.

So I'd like to echo what Kent said in terms of following our social distancing. The models we look at, we may have the opportunity to cut our peak almost in half. And that's an incredible difference. So on behalf of all of us here, if there's anything you can do to stretch out your trip to Walmart or go without the things that you were going to get at Fleet Farm or call your friends instead of showing up, that matters. Those are meaningful changes. We've seen that in the data from other countries that have employed these measures successfully and the difference is striking. We can make that difference. And everybody listening to this has the power to affect that to some degree. So in short, my message is we care about you and we're here for you and we need your help.

Katie Johnson: Thanks. Sara Brenner, an infection prevention coordinator, stated well today when she said what does compliance look like when you talk about social distancing and the stay at home call to action? It really means acting as if all people you come in contact with are infected no matter where you are. People are concerned about knowing where the positive test cases are and it really doesn't matter. Act like every person you come in contact with is infected and make your contacts outside of your family or your home as minimal, as feasibly possible.

Dr. Overgaard: Absolutely. And the reality is that one of the great tricks this virus has employed is that it's really sneaky in the way that it can transmit itself from person to another. People that don't feel sick or don't feel very sick can be contagious. And the virus, we think, can travel in the air for some distance. We think that it can live on surfaces for quite a long time. So even though you may not get within six feet of anybody, when you go to the store, you might touch something at the register that they had their hand on after they had wiped their eye or whatever. There are all these things that we come in contact with that have the potential to cause problems and we ourselves may be the asymptomatic carrier and we don't know. So it really is important and it's tricky in that way. We can't know if we're a part of the problem. So we have to assume that we all are.

Katie Johnson: Act as if we are. Great information. Thank you both for everything you've shared. I don't intend for, I know our intent is not to be alarmist or to cause panic. Our message all along has been how important it is to stay calm, but also to be realistic and to note why it is so important to flatten this curve. Any other last comments either of you want to share?

Kent Mattson: Well, I think what's important to know is that today, we may not be in a crisis, but the best information that we have is that we will soon be in a crisis. And so we all have to take this serious. We are pouring countless hours of staff time day in and day out to do crisis care planning. We are trying to do that with compassion and care, which is going to be critical to surviving this virus threat and as we've heard, to change its course, but at Lake Region and Prairie Ridge, it's what we do. We take care of people, we take care of the community.

In this instance, we know that there's a war coming at us and our staff are heroes and they're going to be running right into those bullets. So we're just asking the community to do what it can do to prepare so we can take care and be there to take care of the community when the community needs us. And we're going to face the unknowns that lie ahead. We're going to be diligent, we're going to have calm focus, we're going to have these common values of trust and compassion and stability and hope that link our providers together, but we're really just asking the community to do your part. Practice that social distancing, stay at home because it's not just an inconvenience, it's an essential and it's critical to us being able to be there for you. We just can't emphasize that enough.

Katie Johnson: Kent and Dr. Overgaard, thank you both for joining me this morning for providing this update to our community on the COVID-19 crisis. And thanks to you and to everyone on our teams throughout the organization, our partners in public health, our partners in emergency management and law enforcement. We're working together and we're working on behalf of the community and all we can ask is, like you said, that as we continue to go to work for you, please stay home for us. Thanks for listening and have a great day.