Announcement

Health Care during COVID: A local snapshot

Tuesday, July 7, 2020

(July 8, 2020) The impact of COVID-19 on first responders and health care workers cannot be overstated — long hours, hazardous conditions, and a grueling toll on physical and emotional well-being have become the new global standard.

Locally, as of early June, many at Atlantic General Hospital in Berlin have been working seven days a week, since February, to do everything they could to quell the pandemic.

However, along with the incredible hardships, there are also emerging stories of success and lessons learned, as workers slowly adjust to what is commonly being referred to as “the new normal.”

Among those leading the effort at AGH are Director of Infection Prevention Niki Morris, an Ocean Pines resident who has been with the health care system for 16 years. She is a certified ICU nurse and became the IP manager, about a year ago.

“I walked into the measles and a pandemic! I thought, what is this?” she said. “Last April, we had the re-emergence of the measles, so that was the first thing, and then I rolled right into the COVID pandemic. So, I’ve learned under fire.”

Tackling a pandemic

During a June 6 interview, Morris said AGH had been focusing on COVID-19 (at that time) for 15 weeks. Staff started working on treatment and prevention in February, and opened the first local testing center on March 20, on 10th Street in Ocean City.

Morris said the office became a full-scale respiratory clinic and was specifically staffed with “providers,” or experts in their field who are licensed by the state. Staff overhauled the building’s interior and doubled the number of air filtration systems, along with many other improvements designed to meet CDC guidelines to treat potential COVID-19 cases, as well as evaluate and help treat other respiratory conditions.

“ImmediCare at 10th Street was our first baby. It took a lot of work and effort to get that place set up,” Morris said. “It was unique, in that it was more than just swabbing and sending you on your way.

“We could focus on COVID, but also look at strep throat, the flu, respiratory infections and sinus infections — we evaluated patients for all of it,” she continued. “Most places were set up just for COVID screenings, but we actually went above and beyond that to offer those services to the community.”
As of June 5, the clinic had swab-tested 577 people, Morris said.

More recently, AGH also collaborated with the Worcester County Health Department to set up a testing site at the south end of the county, in Pocomoke.

“That area was underserved when it came to COVID services — there weren’t a whole lot of places for testing, and especially free testing,” Morris said.

Along with setting up satellite outpatient clinics, AGH’s Berlin facility added ventilators and ICU beds, and built a COVID-only wing with additional ICU space. AGH previously had eight ICU beds, but was able to more than triple that number, to 25.

The emergency room was also split to “clean and dirty,” or respiratory and non-respiratory cases.
“If you come in with a fractured ankle, I’m not going to put you next to somebody who’s coughing and has COVID symptoms,” Morris said.

Like everywhere, the nursing staff at AGH has faced difficult conditions because of the pandemic. Morris said those caring for the sickest patients had to wear “PAPRs,” or Powered Air-Purifying Respirators, and Tyvek hazmat suits for 12-13 hours a day.

“That’s a very taxing job,” she said. “It can be very difficult, mentally and physically.”

To help prevent burnout, Morris said staff used a “team nursing” model with rotating shifts. Hospital leadership constantly re-evaluated existing models to look for creative solutions.

“Everybody’s kind of stepped up to the plate,” she said.

Among the external challenges, Morris said many local health care systems have struggled to get necessary testing supplies. Simple issues of logistics, she said, often got between a hospital and a swab, or an N-95 mask.

“I know that you see on the news that there’s a ton of it out there, but that’s not necessarily true,” she said. “But we’ve done an excellent job — at no point has it come down to if someone needed to be swabbed, that we couldn’t screen them or test them.”

Compounding the issue, she said, was that initially the only test-processing site in Maryland was far away, in Frederick County.

“[Testing] wasn’t something that was readily available,” Morris said. “But the State of Maryland has been really helpful, and we’ve worked closely with the Worcester County Health Department all along.”

Morris said COVID-19 services in the region and the ability to get necessary testing materials have vastly improved, despite some trying times early on.

“The staff here at Atlantic General have done an amazing job at making sure we have what we need, when we need it,” she said. “It’s much, much better now than it was.

“Early on, commercial labs were having trouble getting swabs out for outpatient use. The same was true with PPE [Personal Protective Equipment]. We had the same struggles that everybody else had,” she continued. “Just in March, we were [short on supplies] because of the burn rate of what we needed on a daily basis … but that too has gotten better.”

Morris credited staff with creative ordering and conservative usage to help offset shortages. She said both approaches are still being used, today.

“We don’t know what tomorrow is going to bring,” she said. “Just because we have [supplies] today — summer is coming and more people are coming into town, so we’re just kind of watching our numbers and seeing where we’re going, as an organization.”

“The new normal”

Morris said she does not expect a return to “normal,” at least not as everyone previously knew it.

“I don’t think we’re going to have an ‘old normal,’ or normal like we had before. That’s just not where we are,” she said. “With this virus, we may see a little lag time in the middle of summer, but I think this fall we’re going to see it come back again, so we have to prepare for that.”

With everything that’s been done, however, Morris said the hospital environment is among the safest places to be.

“It’s safer coming here than it is going to a store,” she said. “We have the proper PPE, and we have the right people doing the right screenings and putting the right people where they need to be, safely.

“I always say I feel safest at work. We have everything we need here, and we’re conscious about it and talking about it every day,” Morris added.

During the peak of COVID-19 cases in Maryland, while Worcester County was largely spared — at least statistically — AGH was not. As of June 8, there were 239 confirmed cases in Worcester, compared to 984 in nearby Wicomico County and 4,353 in neighboring Sussex County, Delaware.

Many of those cases in lower Sussex County came through AGH.

“On paper it looked like we didn’t have any [cases],” Morris said. “I actually had someone at the hospital entrance one day say to me, ‘So, you guys don’t have COVID here, right?’”

As for why COVID-19 didn’t spread more rapidly through Worcester County, Morris pointed to the Worcester County Health Department, who conducted “contact tracing,” or logging of those who had been near to all 239 Worcester COVID cases.

“Our health department has been dedicated to doing those case investigations,” Morris said. “When I get a positive case I report it … and they call them and follow up with all their contacts, using their contact tracers.

“Letting them know and putting them on home quarantine makes all the difference in the world,” Morris continued. “A lot of areas didn’t have the resources to keep doing those case investigations, and you can easily see where some of those areas were. So, testing and case investigation were the way to keep [COVID] under control, and we were fortunate that they have been doing a great job with case investigation.”

The wholesale effort — including inpatient and outpatient care, cooperation with neighboring agencies, and all the precautions and planning — also helped to largely spare the medical workers in Worcester, Morris said.

“We put a lot of things in place and … we were just talking about how lucky we’ve been with our staff — knock on wood,” she said. “You read about these hospitals losing hundreds of staff members. But, if we see a problem, we identify it and address it immediately.”

Lessons learned

Going forward, Morris said there’s a lot the hospital can learn from the pandemic, especially about operational efficiency.

“One thing I said to my boss is how much leaner we’re going to be, as an organization,” she said. “We always had everything we need or better than we need, or multiple choices. When COVID came, that wasn’t the case. We had to figure out, where am I wasting stuff and what can I do to make this better?”

Morris said the hospital system also learned more about the efficiency of telemedicine and teleworking. Today, most or all staff meetings are online, something Morris said has made the operation even more efficient.

“I think we’re just going to be leaner as an organization,” she said. “I also think we’re going to be cleaner, meaning there will be less clutter. You won’t walk into an office now and find a bunch of brochures on the wall. If we don’t absolutely need it, that might just be a place for dirt to settle or germs to gather. So, all of that stuff has changed, and for the better.”

To the many still concerned about about COVID-19, Morris said all of the hype about hand-washing and face coverings is absolutely true.

“We learned washing our hands in kindergarten, right? Now, the public is way more conscious than they’ve ever been about touching doors, washing your hands, hand sanitizer, not touching your face — and those things are important,” she said. “That’s how you get sick, even if it’s not COVID. That’s how we get the flu or any other virus that can live on a surface.

“It’s just about making those right decisions and making sure we’re washing our hands. And, I’m a firm believer in masks. I know they work, because we’ve taken care of plenty of COVID patients,” she continued. “We will continue to require masks in our hospital, not only for the safety of our patients, but for the safety of our staff too. If a patient is coming in sick, we need to take care of them and make them better. But also, if a staff member is healthy, we need to make sure they stay that way.”

The other important takeaway, she said, is how much everyone can benefit from a little collaboration.

“I think Worcester County overall has done really well utilizing our resources, and we’ve developed great relationships with the health department and others, all the way down to the Berlin Nursing Home right in our front yard,” Morris said. “There’s been a lot of community effort and it’s so nice when everyone comes together for one cause. Those are some of the things that we’ll take away from this. We were always friendly, but now we know we can count on each other if we need something.”

Announcement

Health Care during COVID: A local snapshot

Tackling a pandemic

“The new normal”

Lessons learned

Member Login