The early days of the COVID-19 pandemic presented everyone, including LVMC, with an unprecedented set of circumstances. Everyone – from healthcare to education to commerce — had to react without the benefit of prior experience. To say that Covid-19 has impacted healthcare delivery in the U.S. would be a complete understatement.
Virtually every facet of patient care has been drastically affected. The effects are being felt in every area, from hospitals to the outpatient setting, and importantly to the people who deliver these services.
As we’ve seen nationwide, hospitals have borne the brunt of Covid to an incredible degree. From March 1 to June 30, 2020, hospitals' overall losses in the U.S. exceeded $200 billion. Emergency Department visits plummeted, but the average patient seen was sicker and more likely to be admitted to the hospital. LVMC was not immune to this impact.
Across the country, Intensive Care Units were inundated, resulting in well-publicized ventilator shortages. Rural hospitals with the scarcest resources were hit hardest, especially if there was an outbreak in a residential care facility in their town. The cancellation of elective surgeries and a reduction in elective services alone cost hospitals $161 billion in the same four-month period. Personal Protective Equipment costs exceeded $2.4 billion. In some cases, the cost for items was 10 times greater than before the pandemic.
Mortality rates were unknown, but we could see the disastrous effect that Adult Respiratory Distress Syndrome, or ARDS (due to Covid) had on patients. Absolutely every effort was made to ensure quality patient care while protecting the frontline care providers. Caring for a patient with ARDS in the CCU was and is a sobering and difficult task.
In essence, hospitals across the nation have seen large negative profits throughout the pandemic. That was only partially mitigated by the Coronavirus Aid, Relief and Economic Security (CARES) Act, which provided money to hospitals and providers who were heavily impacted.
With the advent of “Shelter in Place” and social distancing, outpatient visits to physicians decreased significantly. “TeleVisits” video visits, which were available only in limited circumstances previously, were brought into far more common use. Still, the patient encounter volume was way down. Operating costs remained high, and the impact was felt acutely by the clinics and, of course, the private practice providers. The people with comorbidities such as obesity and diabetes who were most in need of ongoing medical care are the same group most at risk should they contract Covid-19. This barrier between physicians and their most needful patients only increased the risk of serious disease for those patients.
Frontline healthcare workers were, and are, greatly affected by day-to-day caring for the Covid patients. Just suiting up with all of the necessary PPE to be in the same room with a Covid patient is an ordeal — not to mention doing it 10 or more times per shift. Adding that protective gear was an additional requirement added to the already labor-intensive task of caring for very ill people on both the Medical-Surgical and Critical Care Units.
After working with infected patients all day or night, many healthcare workers isolated themselves from their families as safety precautions. This ranged from removing clothes in the garage and showering before joining the family to quarantining themselves in one part of the house to living in an entirely different place such as a hotel or RV. The stress of potential exposure and their families' impact actually caused a few people to opt-out of caring for Covid patients. Every professional I know outstandingly rose to the occasion.
That is not to say that there were no consequences to this. Depression, anxiety, insomnia, and mental distress are present in some form in large numbers of Health Care Professionals on the front line. This is simply human nature. Fortunately, society recognizes the effort being made in this arena, so the public perception of and attitudes toward health care workers is overwhelmingly positive. Nursing and hospital administration are watchful for affected individuals hoping to mitigate these unfortunate elements of caring for these patients.
This discussion would not be complete without mention of the societal implications of this pandemic. Millions have lost their jobs in the economic shutdown and have lost any health insurance they may have had. The risk of contracting the disease and the risk of dying from Covid are disproportionately higher in lower-income and minority groups. Suicide rates are somewhat difficult to pin down but are definitely on the rise in many areas. Domestic violence, which was stable in the early days of the pandemic, is increasing. Financial stress and social isolation are two of the leading causes of these problems.
As we enter what looks like a second (but so far smaller) wave of Covid-19 cases, we can apply many of the things we have learned so far. Ways to safely re-use PPE on the same patient, try alternatives to a complete lockdown to lessen business disruption, and continue elective surgeries with Covid testing of every patient are just some of the ways we are responding with a bit more moderation than in the early days of the pandemic.
Finally, let me give my take on LVMC and its response to Covid-19. From the outset, the staff's response at the hospital and Lompoc Health clinics has been nothing short of amazing. The patient care areas, especially the CCU and Med-Surg, rose to the occasion with people willingly entering harm’s way on behalf of our patients. The other major challenge early on was finding adequate PPE and creating ways to cope with the shortages. Enough cannot be said for Director of Materials Management Neil Imano and his staff, who tirelessly pursued every supply avenue to keep us safe.
As is commonly known, there was a huge outbreak at the local U.S. Federal Penitentiary. Care for these patients fell to our hospital, and though at times it threatened to overwhelm us, it never did. We handled many very sick patients and worked closely with the intensivists at Santa Barbara Cottage Hospital if they needed a higher level of care. We were caring for people far sicker than we had previously and doing it very well. The LVMC administration rapidly set up a Covid overflow in the Physical Therapy area, which greatly expanded our capacity to care for patients as the number of Covid patients grew.
All of this helped keep LVMC in a somewhat better position than that many hospitals face, especially rural ones.
The Lompoc Health - North Third Center and North H Center clinics have recovered. They are operating at or above pre-Covid levels.
I am proud of every facet of LVMC and how we weathered the pandemic in those difficult early days, and how we are continuing to care for our community. It should give us confidence that we can face whatever comes our way in an uncertain future.