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The Pulse

  • PAs Responding to COVID-19 in Rural NC
    by Josh Newton, PA-C
    Medical Director, Mountain Community Health Partnership
    Spruce Pine, NC
    Wake Forest PA Program Class of 2011

    Many may think that rural family medicine consists of deep community ties, caring for every generation of a family, and working 8-9 hour days, versus 12-16 hour days, tireless conference calls, and a total overhaul of organizational infrastructure to meet a public health crisis. But that is what’s happening Western North Carolina. The biggest battle Mitchell & Yancey counties were facing a few months ago was a dwindling population and how to hold on to their shrinking healthcare system. Due to multiple changes in ownership and a consolidation of major services to larger hospitals in the region, Blue Ridge Regional had been slowly dying. The community was left with a handful of small private practices and a federally qualified health center (FQHC), Mountain Community Health Partnership (MCHP), trying to reinvent their healthcare system.

     

    COVID-19 hit and all that changed. Suddenly, the understaffed hospital was prepped to be filled to the brim and family medicine providers were brushing up on their ACLS and critical care skills. Once cases hit Raleigh, we knew it was coming our way and it was just a matter of time.

     

    Mountain Community Health Partnership began to scavenge for PPE. We had recently expanded our regular orders for gloves, gowns, & surgical masks while COVID-19 was focused in Asia, but soon realized there were no N95s and only limited staff were “fit” tested to wear these masks. Since scheduling someone to fit test would take over two months, we found a local mining company that could fit test the staff and began collecting donated masks from private individuals, hardware stores, and local corporations. The local community pitched in as well, as quilting clubs and textile mills began producing cloth masks for the clinics and other essential workers in the community.

     

    MCHP began a drive thru testing facility. When NCDHHS suggested that testing stop, we feared that the lack of positive cases in our county would give the community a false sense of security. We pushed ahead with testing, even though turnaround times exceeded 14 days, meaning we had to assume community spread prior to knowing whether or not a patient was positive for COVID-19. We decided to keep staff from each site separate to reduce the risk of exposure and transitioned some staff to working remotely. We set up new protocols for respiratory illness patients and treated them in isolated areas that we could easily clean. We assigned a single provider in each county to handle all COVID-19 cases and coordinate testing. Using CDC guidelines, we worked to build an iron wall of defense. Sadly, despite all these measures, the first case hit hard.

     

    The first case of COVID-19 in our county exposed two thirds of our staff. We shut down two of our clinics and moved all visits to telehealth. Reimbursement laws have long kept FQHCs out of telehealth and, as a result, we were unprepared. However, we didn’t let that stop us. Our amazing staff worked hard and mobilized staff, developed protocols and procedures, and began reaching out to patients within a week. Overnight, we had become a virtual clinic.

     

    There was a threefold increase in calls after the first positive. Many were anxiety related, and we were fortunate to have an amazing behavioral health team that had been doing virtual wellness checks. Our staff had very similar anxieties, and we recognized it was important to support one another. Inspirational passages were shared and taking three deep breaths every hour became part of our culture. Then, a week after the first case, we had our second case. Having treated the first case, we had intimate knowledge of how to handle it. We were pulled into a lot of meetings with county commissioners, hospital executives, health department personnel and county employees to provide guidance and advice to our community.

     

    With telehealth up and running, we were able to shift our home visit program into food delivery as we utilized our small fleet of outreach vehicles to bring groceries and meals to those in need. By this point we were managing 20-30 suspected cases, which were all isolated at home. Cases increased including some older patients who required hospitalization. Our hospital has been understaffed for some time now, and our providers comprise the majority of rounding providers at the hospital. We are now having to figure out how to keep our clinics operating while supporting 24-hour coverage at the hospital. The hope is that we will not experience another surge in our area, but we would rather have done too much than too little. Our goals now are to continue to ease our patients into telehealth and then work with funding sources to see if we can begin serum antibody testing. We suspect this will be the cornerstone to allow our communities to emerge safely from this pandemic, as well as giving us the epidemiological data we need for the future.

     

    This has been an odd journey for me as a PA. I am used to keeping my head down and taking care of my patients. Every week I would see a hundred people, and we had a seamless operation to coordinate every aspect of their care. Now, I spend my days contemplating extremely difficult decisions, in a world of utter chaos. Each decision determining the course of 96 employees and the future of our community. If we choose wrong, we could lose the largest source of healthcare for our community and endanger the health of the people I care most about. I am so thankful to work with an amazing team, where we all debate and discuss every decision and move forward methodically, putting our community and staff needs first. We have each other’s back and that gives us the strength to blaze what has been a difficult path. This is my home and my community and I want to see us emerge from all of this stronger and closer…and I believe that is exactly what we are doing.

     

     

     

     

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