As of Sunday, nearly 33,000 people have tested positive in the U.S. for COVID-19. Just over 400 of them have died. Government and health officials continue to preach social distancing, proper hygiene and good housekeeping in the hopes of stopping the spread of the disease, particularly to the elderly and those with heart disease, diabetes and lung disease. According to a recent study published in the New England Journal of Medicine, SARS-CoV-2, the virus that causes COVID-19, can live in the air and on surfaces between several hours and several days. The study found the virus is viable for up to 72 hours on plastics, 48 hours on stainless steel, 24 hours on cardboard, and four hours on copper. It is also detectable in the air for three hours.
Mt. Graham Regional Medical Center CEO Roland Knox and hospital spokesman Ryan Rapier agreed to answer several questions about the hospital’s response to this unprecedented threat. The following are the highlights of the interview; in some cases the questions and answers were edited for the sake of brevity.
Q: So I see you’ve amended the way people come into your facility.
A: Knox: Absolutely. All visitors to the organization and to the facility and patients, we have them coming through limited access points. For services at the hospital itself, they’re entering through the emergency entrance. We’ve closed off the front lobby. so they come through the emergency entrance and they do a screening. “Do you have a cough? Do you have respiratory distress?” And then taking your temperature and if someone has a temperature of 100 degrees or more we immediately give them a mask and they go through a continued screening at that point.
Q: Have you found cause to test any of your patients here?
A: Knox: Yes, we have had cases that have been tested, but all of those tests have come back negative at this time. They’ve recovered and we’ve discharged them.
Q: How busy are you nowadays?
A: Knox: The new normal is there are very few patients coming to the facility. Most people are, I think, at home and taking care of their minor coughs and colds themselves and trying to feel better, but emergent patients are still coming through our emergency room and then diagnostic tests are still being done, like labs, imaging. We’re still doing those. We’re also giving the patients the elective. If they choose not to come in at this point in time, too. A lot of patients have chosen not to come in that’s why there’s not very many people here. We also had a meeting with all of the primary care clinics and other physicians within our community on Monday to ask everyone, ‘What’s everyone doing? How can we help each other?’ And the clinics are really where patients are coming through. The clinics at this point are really doing a majority of the screening and taking care of the patients with those symptoms that should be taken care of in a clinic environment.
Q: So Gov. Doug Ducey shut down elective surgeries on Thursday. How many people did that impact locally?
A: Knox: I don’t know the numbers off the top of my head, but what I do know is that our staff is very proactive and because they had advisements from the American College of Surgeons that elective procedures should be discontinued they have been contacting our patients since last Monday and saying ‘This is the situation, it’s an elective. Would you like to still come in or not?’ Most of the patients were saying, ‘No, I’ll wait until this is settled.’
Q: How many beds do you have? How many doctors?
A: Knox: We have 49 licensed beds and 79 physicians are credentialed with facility.
Q: We’ve all heard about a shortage of test kits, personnel protective equipment. Are you concerned?
A: Knox: I think right now we’re concerned,yes. I think we have the same concerns as all hospitals in this environment we have today. I think the concern is about the unknown. That’s really the most concerning part is not knowing exactly what we need. As an organization we’re constantly doing emergency preparedness we’re aware. So I think part of us being prepared is knowing that you have to have that certain level of concern because each and every time you have an event like this you don’t know exactly what’s coming. So we are always looking to see how we can help ourselves and what could be our weak points.
Q: If you had to list the top five concerns, what would those be?
A: Knox: I think our list is the same as the whole country. Which, is first and foremost, the test kits. Second, is going to be the PPEs, the personal protective equipment. Third would be the potential volume of patients coming in and that volume the next one would be the ventilators and the space to be able to handle them. Those would be the top five, I’d say.
Q: Do you believe you have a sufficient number of test kits at this point? Are you concerned? Do you have the ability to get additional kits? What about personal protective gear?
A: Knox: Yes, to all of those. Yes, what we have right now are meeting the demands that we are seeing. Yes, we have fewer than what we anticipate we are going to need and yes, we are do have resources to get additional test kits as we need them. (As for personal protective gear), we’re not getting them daily, but at least weekly we’re getting additional shipments. We have a very active materials management that has resources and continues to work with the county and the state and our suppliers
Q: There are different levels of concern. What level of concern do you have about those five?
A: Knox: That’s a good question. I don’t want to seem over-confident, but I am very confident. On a scale of one to five, one is that there’s no concern and five is there is a concern about it, I’m closer to the one and half to two. and I think that’s because if I were to say one, that’s a naive approach to how you prepare. One of the things you do to prepare is you recognize that things can happen, you acknowledge that and you put your resources toward that to counter it or mitigate it. So I’m closer to that two probably.
Q: Being in a rural community, does that put you at more of a disadvantage than other facilities or do you feel you are better situated because we’re in a rural community with fewer people?
A: You ask very good questions. I would agree, sometimes it’s a disadvantage because we are removed from the metropolitan hospitals and some of the interactions that occur at a political level. Legislatively you want to get those in leadership positions’ attention. But, we’ve taken steps to help us have those channels of communication and those networks, like with the Governor’s office. We had our local general surgeon, he attended for the hospital a meeting of chief medical officers in Southern Arizona with Governor Ducey on Tuesday afternoon and expressed and got the governor’s attention as to what we need here. So we have those avenues. And then we’re very involved with the Arizona Hospitals Association so we have that connectivity. So the rural part is that you need those connectivity with those networks to be able to get those resources when you need them. So yeah, we’re removed, from we’re helping ourselves in that manner. The positive about it is this is a very united community. When there is a situation or a triggering event like what happened last Friday when we all became aware of the positive case in Pima, it was amazing how this community pulled together and what was pulled together in a very short period of time, with the resources of the Graham County Health Department. They pulled together a team in a matter of a few hours and had an action plan as to how to go forward. So again, both yes, it can be a challenge, but also yes, it also gives us the ability to be flexible and and do what we need to do in a very timely fashion.
Q: You told me earlier about your chief nursing officer, Lori Ray and some steps she’s taken should things get worse. Tell me more.
A: Knox: On Saturday (March 14) she implemented what’s called the Incident Command System. That means she’s now activated a response system so that you will have people alerted to ‘We may need to react quickly to a situation’ and how would we react to that situation. We’ve already planned out our staging and phasing based on the volume of patients that would come in, how we would triage them and where they’d be in our facility and where our other resources may be.
A: Rapier: I think the key thing to get across is no one has ever been through this before. This is all new. We have planned. we have done everything that we know to do to be ready for this. On the hospital side of things, I don’t know how we can be more prepared, but so much of when it goes down, so to speak, is dependent on how a community reacts and as Roland said, we have a community that really pulls together, but all of your best laid plans can get overwhelmed if people panic, and overreact. If people will stay calm, recognize that this is uncharted territory, that we’re working under a plan that has been in place for a long time, we anticipate it will go as smoothly as possible. Can we anticipate everything? No. But if people overreact and if they panic, that can have a detrimental effect and that’s in any community...We have kits to meet our needs right now, but we don’t have enough kits to meet everyone’s desires right now. If everyone will just take a deep breath and recognize that reality we’ll be OK.
Q: Are we doing a better job of spreading the message about social distancing? Have we turned that corner yet?
A: Knox: Not turn the corner, but I think there are steps being taken that are helping everything. I think even the youth now, now that we’re getting more information about statistics in other countries, the youth are aware of it too, now. And by youth, I mean someone less than 45 years old. That’s a big bubble of people that up until this point have probably felt invincible, but are now starting to see that not only are they getting it, but there are severe cases and that they can also die from it. So I think as more and more of that information gets out, people are going to be less cavalier about how they are and how they interact with each other.
A: Rapier: You asked if we’ve turned the corner. I think we’ve turned the corner with a segment of the population that has bought in and you want to keep those people from panicking, to be quite frank. But on the other hand, you have a whole segment of the population that still has not accepted that this is a real issue. But we’re starting to have an effect on those people’s behavior, which is a positive thing, whether they actually buy into what’s happening or not, at least their behavior is changing.
A: Knox: We’ve been proactive and our most focused area is to keep the health care providers healthy. We want them to be healthy and ready when the community needs them. That’s really been on our Number One step and that’s really what’s prompted a lot of these items that we’re doing to minimize the number of people coming to our facility. We realize that the more people that are coming to our facility the more chance that our healthy care workers can be exposed. We want to be prepared through this process, because it’s not going to be a week process, it’s not going to be a month process this is going to be around and we need our staff. The second step is when the people do come to us that we have the ability to access what their current condition is. Is it something they can take care of at home or is it something that they need our help with here? Do they need to stay in our facility for a period of time to get better?
Q: How would you describe your equipment levels?
A: Knox: Mt. Graham Regional Medical Center has itself very well positioned and prepared itself the best it can as a rural hospital in comparison to some of the metropolitan hospitals as to what they have and the volumes they’re going to experience. Ours are going to be less and we feel very prepared for them. Do we have enough ventilators — if we filled all 59 beds — for everyone? Absolutely not, but we don’t believe the numbers are going to get to that point. We have 15 ventilators, but at this point we’re going to treat them as they come in and access and phase in as where to put them as they come into the facility.
Q: Can you expand your bed capacity?
A: Knox: We’re at 59 beds now, but there are six beds in our pre-op, six beds in our post-op area and four beds that can be stretched to six beds in our (gastro-intestinal) suite, so that’s an additional 18 and we can convert three of our four operating rooms into other rooms, too. So we’re at 22 additional, that could get us up to 71 and then we have additional spaces within our organization that we know we could expand to, too.
Q: Are you taking efforts to train the rest of your staff, so in a worst case scenario, your ob-gyns, general surgeons and orthopeds stepping in and helping out?
A: Knox: I’m smiling because our staff is incredible and our managers are incredible... They all have that mind set that this is my primary job, but if there’s something else I can do to help, I will...We have staff stepping forward and saying ‘I can also help in this way, I have these skills sets, I just need to re-sharpen those skills’...that cross-training has already started..
Q: What else do you want the community to know about the hospital’s efforts?
A: Knox: The amount of resources and the continuous communication and the continuous activity that’s going on within our hospital itself, within a group of hospitals that we work with in Southern Arizona, with the state and with our connections and our networks. We communicate on a day-to-day basis to address those five (top concerns). What do we need to do a little bit more of today? What is the item we need to pay attention to today, the most? This is a 24/7 thought process right now.
A: Rapier: We’re all family. Not just the hospital staff, but the whole community is a family and so you’re being treated by family. Now more than ever that’s important to keep in mind to put into practice. We’re going to get through this as a family. If everybody, including the community at large, does their part, we’ve prepared for this. Feel confident that we’ve prepared to the fullest of our ability and now let’s all come together and get through this together. And when we come out on the other side –whenever that is – we will be stronger and we’ll be OK.