PROSSER, Wash. – Situated between what would become two hot spots for COVID-19 in southeastern Washington, leaders at Prosser Memorial Hospital wasted no time creating a drive-up COVID-19 testing site.
A month ago, hospital leaders converted a specialty clinic a stone’s throw from the main hospital to initiate a community COVID-19 response. With staff shifts, canceled surgeries and the need for other continued urgent health care including expectant mothers and patients with strokes and heart attacks, Prosser Memorial had to do what all hospitals did to address a pandemic: Pivot on their own dime.
They assembled a team to do the majority of the triaging, assessing patients from their vehicles in full personal protective equipment.
Two medical assistants, a receptionist and Carolyn O’Connor, a family medical doctor, compose this COVID-19 team most days, although other providers sub in and cover weekends and some shifts.
On Thursday at about 8:15 a.m., the team rolled a cart and carried a sign out of the clinic. They erected a white tent with a table inside, some face shields and other medical equipment at the ready should they need it. Each parking stall has a makeshift sign with the phone number patients should call when they arrive. A fully geared team will greet them once they do.
Daniel Solis asks them all the questions about their symptoms: Have they been coughing? Have they lost their sense of taste? The list goes on.
A medical assistant typically in the hospital’s orthopedic clinic, Solis said the team volunteered to be a part of COVID-19 screening efforts. In the staff shifts, Monique Saenz, who has worked in the same clinic as Solis as a receptionist for more than a decade, is now strictly answering the COVID-19 hotline.
It’s different, she said. She used to answer the phone and never knew what would be on the other line. Now when the phone rings, she knows the person could be sick with the virus that has caused a global pandemic. Saenz takes down the person’s name, insurance information (if they have it, though they will see and test anyone regardless) and sometimes, if the team is busy, the color of their car. With one team, they can only serve one patient at a time, and Saenz will warn patients about a potential wait.
Past 9 a.m. that Thursday, the team had not seen anyone, which was not unusual. Mornings have been slow, but activity varies widely: One day they will see four patients, 15 the next. In a month of operating, the team has tested 208 people, predominantly those with bad symptoms and many who are at high risk for developing severe illness with COVID-19.
Prosser is a small city, with about 6,000 people, but O’Connor said patients are coming from surrounding towns, some even making the half-hour drive from the Tri-Cities because they cannot get into their medical providers there for testing.
So far, O’Connor’s team has found COVID-19 in high percentages in their community; 31 of the 208 people they have tested as of last week have had COVID-19, or 15% of all the patients they’ve tested. This makes sense geographically, by the numbers. Prosser is in Benton County, where 36 people have died from the virus, and the local health district estimates 487 have confirmed or probable cases of COVID-19. West of Prosser is Yakima County, which has 923 confirmed cases, 43 deaths and a 17.4% positivity rate.
The majority of the people tested, of course, do not have the respiratory virus, and O’Connor said a big part of their role is to educate and assuage fears.
“A lot of what we do is reassure people and give them information,” O’Connor said, noting that she’s seen patients with high blood pressure and other physical signs of stress. The team has stacks of printed handouts from the Department of Health and the Centers for Disease Control and Prevention that they give patients before they leave.
Pulling out of the parking lot is just the beginning of a person’s relationship with the COVID-19 team. The unique part of how Prosser Memorial staffers are treating COVID-19 is their ability and the team’s goal to check in on patients. Every person treated at the drive-up screening site will be called daily by a staff member to check in on their symptoms. Typically, Solis or Daisy Magana, O’Connor’s medical assistant, calls patients until their test results come back negative, or until it has been 12 days since they have tested positive or three days after the patient no longer had symptoms.
These calls have come in handy. On more than one occasion, a patient has gotten worse and needed to return to the clinic. The team can take full X-rays and do blood work at the COVID-19 clinic, allowing them to take chest X-rays if they need to, and when they feel a patient has gotten worse enough to need more attention, they send them to the emergency department.
“Most people get sick on the fourth and fifth day, so once you’re sick, about five days later you can be feeling better or you’re crashing,” O’Connor said. “We follow up to 12 days for that reason; some people that feel good will then crash a few days later.”
So far, four patients at Prosser Memorial have been admitted to acute care for treatment for COVID-19. Two of the four patients were sent to the Tri-Cities for treatment in an intensive care unit. Prosser Memorial has two ventilators but no ICU.
The team acknowledged that at first they were fearful of doing the work, especially with how frequently guidance around the coronavirus changes. Personal protective equipment has not been a problem so far, although it’s always a worry.
“It was initially scary, but we feel well-protected,” Solis said. “There’s still a bit of fear but not as bad.”
After schools were closed for the rest of the school year, the Prosser School District swept its classrooms clean of hand sanitizer, gloves, towels and any masks they had and donated four truckloads to the hospital. The only thing the team wishes they had were thermometers, so patients can monitor their fevers at home. One staff member has checked Amazon every day. She wants to hand them out, as lots of people do not seem to have one at home.
Even with the potential for loosened mitigation strategies, the team is not under the illusion that they will be finished anytime soon, especially as more testing supplies become available. The hospital is using a lab company out of Bellingham that can deliver results in 24 hours, instead of the sometimes 11-day period they waited when they started a month ago.
“I think we’re going to be here a while,” Saenz said.
So far administrators at the 25-bed critical access hospital have not had to cut staff salaries or furlough any staff members. Leaders say that’s largely due to their financial standing prior to the pandemic. That doesn’t mean they don’t share the same financial concerns that other rural hospitals in Eastern Washington have about the future. Even still, the team has fallen into a routine over the past month.
“Medicine has never been done this way,” O’Connor said, but added, “It’s what we have to do, regardless.”
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