Adena Health System

Adena Health System (AHS) held a virtual Town Hall meeting about the coronavirus on Friday, March 20, updating information presented to the public through a virtual Town Hall meeting hosted by Adena on March 17.

The March 20 meeting featured speakers Wael Haidar (Infectious Disease Specialist at AHS), Dr, Kirk Tucker (AHS Chief Clinical officer), Christopher Brown (Ross County Health Commissioner), Ben Avery (Administrator of the Ross County Health Department), and Katherine Edrington (AHS Chief Operating Officer).

Dr. Tucker presented information for Amy Robertson (AHS Director of Quality and Infection Prevention), who was absent.

The panel of speakers addressed various COVID-19 concerns, and Town Hall viewers messaged questions about COVID-19 to the panel of speakers during the meeting.

Asked to provide updates on where Ohio and Ross County stand on coronavirus, Christopher Brown described the efforts to combat the coronavirus crisis as “more of a marathon than a sprint.

“It’s very important that you take care of yourself both physically as well as mentally,” he said.

Brown offered a few safety precautions during the crisis, such as social distancing, staying six feet away from others when leaving home, hand washing (for at least 20 seconds) and using hand sanitizer (for at least 20 seconds) (Centers for Disease Control and Prevention [CDC] state the hand sanitizer should contain at least 60 percent alcohol), the importance of not touching one’s face, eating healthy and creating distractions such as meditating, praying, playing board games, gardening, spring cleaning and walking “around the neighborhood” while in isolation.

Dr. Haidar commented on new information about COVID-19. He said the New England Journal of Medicine reported last week that the virus “can stay in the air a few more minutes longer than we anticipated” (Haidar had stated during the March 17 Town Hall meeting that the virus could stay in the air for 20 minutes). “They’re saying up to three hours. What does that mean? That means droplets can float in the air a little bit longer. It doesn’t mean that its the same viral load and it doesn’t mean it’s as infective. We don’t know what to make of this information yet. I don’t want people to think it’s changing … from droplets to airborne yet … It depends on multiple factors: the temperature, humidity, maybe barometric pressure … We think it’s droplet but we’re not 100 percent sure.”

Haidar said coronavirus is “a viral infection that goes into the lungs and causes respiratory infection, not upper respiratory infection, so the symptoms are a little bit different: fever, myalgia (muscle aches and pains), muscle ache, fatigue, cough, chest pain and shortness of breath.” Haidar cautioned the public to avoid “a lot of (false) information on social media and websites,” and to “look up the right information” and share that information with others.

Speaking for Amy Robertson, Tucker said best ways to protect ourselves from coronavirus are hand hygiene (washing hands for 20 seconds with soap and water or using hand sanitizer after touching frequently-used surfaces); staying home when sick and experiencing low-grade fever, cough, shortness of breath or congestion; disinfecting frequently-used surfaces such as mobile phones, phone handles, and door knobs; avoiding hand shaking and touching one’s face; avoiding or limiting discretionary travel; sending one person with a list in hand when shopping; wiping off shopping cart handles with sanitary wipes; using hand sanitizer before getting in one’s vehicle after shopping; and shopping at off hours.

Edrington said a number of changes have been implemented at Adena Health System to protect patients and staff from COVID-19, including screening at all doors, postponing elective procedures indefinitely, eliminating valet parking, requiring workers not on the front line of clinical care to work at home, and ridding the cafeteria of dining tables and self-serve salad bars. Edrington said patients can continue to come to the hospital for doctor appointments at this point, but said that is subject to change in the coming days. She also indicated that AHS is “focused on telehealth,” providing for patient visits “through telephone and televisual.” Phase One telephone patient visits with health providers went live on March 23 and Phase Two televisual visits went live on March 20, Edrington said.

Tucker also addressed coronavirus testing, stating that “ODH has advised public health officials (on March 19) that testing of the masses in order to screen for (COVID-19) is simply not feasible anymore.”

Tucker said viral swab kits used to test patients and testing kit reagents located at Adena’s lab are “starting to run short.”

“They have redirected health systems to focus their testing on those that have been hospitalized or are severely ill, and that is to help make clinical decisions on treatment in triage and to be also used on healthcare workers who have fallen ill in order to rapidly identify the infected and allow the non-infected to return possibly to duty,” Tucker said.

Asked if people with virus symptoms are tested and told to isolate, Haidar said that “depends on if its upper respiratory or lower respiratory,” but added that Adena is continuing to treat the needs of all its patients. Haidar said that those coming to Adena for COVID-19 are tested for the flu through the use of a respiratory infection panel that tests for other viruses (such as rhinovirus) to rule out those viruses.

“If we have still have a high index of suspicion, if a patient requires the proper test or they’re very clinically ill and require a hospital stay, they might qualify for the COVID-19 testing and yes, we are testing for that,” Haidar said. “A lot of things look similar in medicine … sometimes you have a bacterial infection that looks similar. And we test for strep-pneumo sometimes, or Group A strep ... and if that is positive, clearly we give them the appropriate antibiotic.”

Addressing Adena’s ability to conduct drive-thru COVID-19 testing, Tucker said Adena has the ability to do so, but is concerned about running out of supplies. “I’ve sequestered some of the test kits for corona and respiratory infections panels and dedicated their use only for inpatients,” Tucker said. “If you present that you are sick enough to be admitted, we have the ability to test you.”

“We have the test and we would like to give the test, but we don’t have a treatment for the virus,” Brown said “If you feel ill, stay away from others, self isolate,” said Brown. “Of course, if your symptoms get worse, especially with shortness of breath, you will definitely want to call your clinician, to come in if you have to do so and get evaluated.”

Responding to the question, “As you look forward to prepare, are you talking about weeks or months?” Haidar said,”We actually have models that we are using in our area based on our population. We have approximately nine counties that we (AHS) cover, so based on our population and the models, how it’s been in the world, in the U.S. and in Ohio, we think this might take a few weeks. These are all predictions, but these models seem to be accurate. Probably 12 weeks is what we’re looking at, but again, this is (not) concrete, but I think this is where we are going to end up.”

Haider discussed a number of drugs that could potentially be used to treat COVID-19 and referred to Hydroxychloroquine, or Plaquenil, as “showing promising results.”

“Adena is looking into some studies and seeing if we can get some stockpiles for backup (for severely ill patients),” he said.

When asked if a sore throat with white patches is cause for concern, Tucker stated that “COVID-19 is not presenting with upper respiratory symptoms. What we mean by that, upper respiratory symptoms, is from the throat up and that would include a sore throat or laryngitis, nasal congestion, runny nose or affected eyes. So the white patches and sore throat do not suggest COVID-19”. Tucker advised those suffering from a sore throat with white patches to see a health provider for rapid strep testing and antibiotics.

Regarding the turnaround time for COVID-19 testing, Haidar said tests performed at AHS are sent to the Ohio Department of Health (ODH) or private labs. ODH sends the results of testing to AHS within 24 to 48 hours and private labs send the results in three to four days, including transport time, Haidar said.

“ODH has very strict criteria for testing,” Tucker added. “If ODH says they won’t run the test, we’re sending the swabs to LabCorp and they have graciously agreed to help us test patients. According to Tucker, turnaround time for COVID-19 test results is 4 to 5 days.

Regarding social isolation, Ben Avery said “the social isolation measures we are incorporating now could actually extend the time we are looking at here, so if we are doing a good job, it might take a lot longer. Distributing those patients over time is what we’re trying to accomplish.”

Responding to Avery’s comment, Tucker said, “What Ben is referencing here is when people follow good public health directives, the curve gets less high and then the time period in which you are tackling it spreads out longer. The primary purpose here is whatever you can do so as not to overwhelm the local health care system and the resources is a very important principle.”

Responding to the question,”How can I ensure my loved one in a nursing home facility is safe?” Brown said, “You’re not allowed to visit nursing homes at this time, but you can still call.” He also suggested that those with concerns speak with nursing home staff about virtual visits, such as Skype and FaceTime.

Adena Health Systems Hotline for people with COVID-19 symptoms is 740-542-SAFE.

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