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PACHS Preparedness Key for Handling COVID-19 Pandemic

April 15, 2020
By Joseph Schany , Emmetsburg News

"We are not just waiting for something bad to happen, we are prepared for it," said Dr. Thomas Getta, M.D., of Palo Alto County Health System (PACHS), discussing the current COVID-19 pandemic and the hospital's capabilities in handling the crisis.

"They have really done a great job here," said Dr. Getta. "We are following the guidelines, the protocol. We have meetings every day and we are constantly reassessing our preparedness."

Part of that preparation comes in the form of a newly erected shed in the south parking lot of PACHS?in Emmetsburg which will be used as a COVID-19 screening structure if the demand were to make it necessary.

Article Photos

WEAR A MASK - According to Dr. Thomas Getta, M.D., PACHS, “The theory behind that is that you're not really protecting yourself but if you're one of these people that could potentially feel a little ill but they don't feel ill enough to go to the doctor, don’t even think twice about it, wear a mask. You could potentially lessen the transmission of a virus to some other person.” Pictured above (from left): Laura VanHeuvelen, Mary Dotson, and Kara Currans.

"As of Friday, April 10, we set up this structure outside because if we do have a marked increase in volume we'll be able to screen our patients out there more rapidly than having them come through our clinic," said Dr. Getta. "Currently we have what's called a respiratory clinic which is in our South pod. We have three pods in our clinics here North, East, and a South pod. We've designated our South pod to be strictly patients who come in with fever or respiratory issues and that currently serves as our screening area. The South pod has a designated access and you can only go in and out through one door. We have a negative pressure environment there which means that any germs or viruses that are in that environment will stay in that environment. Before that air leaves the environment it will go through a specific filter which filters out all viral particles so nobody in the community would be exposed when we see people in that particular pod."

Dr. Getta also pointed out another April 10 update.

"As of Friday, if we have a patient who comes into our emergency department and we suspect they are high risk for COVID-19 based on certain risk criteria, and they come in having respiratory issues and/or a fever and we think that the patient is strongly suspicious for COVID, we are going to send them directly to Mercy in Mason City or wherever they want to go but we typically send the majority of our patients to Mason City. We would send them and just do the testing there because the turnaround time for them is quicker than what we have here."

Currently, testing for COVID-19 has a turnaround time of 2-3 days through the Iowa Department of Public Health (IDPH), which is improved from a previous 4-7 day estimate. However, according to Dr. Getta, Mason City receives results the same day by sending tests to Mayo Clinic where the lab processes them using on-site equipment from Quest Diagnostics, a large company that runs these tests.

"If we have someone that we want to get the test back right away, that person is going to be leaving our institution and going to Mason City."

According to Dr. Getta, there is a screening protocol to determine if patients are low risk, medium risk, or high risk based on a point system, with questions like, "How long have you felt ill/had symptoms?" and "Do you have a fever?" the first to be asked.

"Fever is one of the major criteria that we use," said Dr. Getta. "You don't have to have a fever but it's real suggestive of COVID. If the patient has symptoms less than seven days they will be considered high risk and that's one point because if someone has had symptoms greater than 10 days, if it's COVID, it is probably waining or its probably not COVID. The longer that you're sick the less likely it is to be COVID. Another point is shortness of breath I'm not just talking cough, I'm talking shortness of breath. One of the symptoms that we are seeing in people who have COVID is air hunger where they just feel like they can't get their breath. That doesn't mean they have a cough necessarily, but that's an important criteria. A cough would be separate criteria and another point. Some people notice smell is not as apparent, things taste dull or they don't have a sense of taste. Also, we are finding out diarrhea or nausea is potentially a symptom of COVID. If the patient previously traveled or has been exposed to somebody who has COVID that's another one or two points. Those are the preliminary criteria."

Mercy Medical in Mason City will be the COVID-19 center for all of the affiliate critical access hospitals in Palo Alto and other surrounding counties. They will receive COVID patients and have prepared their hospital for the demand. In the event that Mason City reaches capacity, Dr. Getta says that some of their patients may be transferred elsewhere.

"If Mason City gets full then what's going to happen is their so-called well patients, non-COVID patients, will then be sent to the critical access hospitals and we will take care of patients. For example, people who had a heart attack and need to be hospitalized for two to four additional days will come to us. Somebody that had just a routine pneumonia, a nursing home patient not ready to go home yet and maybe needs to be hospitalized for three to four days of skilled nursing care may come to us. Mercy in Mason City will treat them, they will stabilize them, and then they will send them to us. Theoretically we will be able to handle this surge that unfortunately has been realized in New York and in Boston."

Dr. Getta continued, "Let's carry out even a worse scenario. Let's say they get so overburdened at Mercy in Mason City that they get filled to the gills. Those COVID patients who've been stabilized will be sent back here and we do have the capabilities to manage those patients. But we don't want to take care of the real sick COVID patients here because frankly we just don't have the capacity to deal with a lot of sick patients. I suppose we would not want to handle more than one but if somebody has COVID and they come here initially we can stabilize them but then we'd get them transferred to Mason City as soon as possible."

So far, as of Friday, April 10, COVID-19 has not infiltrated Palo Alto County. According to Dr. Getta, as of Friday morning, PACHS has completed 18 tests for COVID-19 with all tests coming back negative.

Dr. Getta attributes the negative results and low case count across other nearby counties to the aggressive campaign to stop the spread through wearing masks, good hygiene, and social distancing.

"We are seeing great numbers and diminished projections as a result of the aggressive social distancing. By social distancing what we are going to do is prolong the duration of this exposure potentially, however that is way to our advantage because we are going to have less taxing of our health system so we are not going to see the large surges that happened in New York where they are so full they're concerned about running out of ventilators. But more importantly it's going to buy time that we can develop a vaccine so we can vaccinate patients so when they have these mini-surges over the next 6-12 months we will be protected. It's frustrating but hopefully we will look back and say, 'Man, I'm really glad we did what we did.' It's a price to pay but it is a small price to pay."



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