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On the front lines

How the pandemic has played out at Fort Dodge’s hospital

-Messenger photo by Elijah Decious
An empty hallway on the second floor of UnityPoint Health — Trinity Regional Medical Center leads to the 2N wing. The wing, currently not in use, has been readied by the hospital as an area to hold more patients in the case of COVID-19 surges. The wing has not been used since May, when UnityPoint changed the way that it housed COVID-19 patients, requiring less floor space.

Editor’s note: This is part of a series examining the impact of COVID-19 on our community six months into the pandemic.

After summer months that brought large waves of COVID-19 infections, UnityPoint Health officials contend that Trinity Regional Medical Center (TRMC) has held its own.

But despite months where Webster County saw as many as 500 positive cases come in, leaders recognize that the pandemic is far from over and say that the public’s cooperation with public health measures will make the difference in determining how many will come out healthy and whether local health care infrastructure will become exhausted.

“We’re still seeing sick people here, and we’re still seeing people die,” said UnityPoint Health — Fort Dodge CEO Leah Glasgo. “When you look at our (coronavirus) stats compared to that of other countries, we need to do more than we’re doing today.”

In serving Webster County and the surrounding regions, an average of five to 10 coronavirus patients remain in the hospital on most days. Hospitalizations remain at a steady, average level.

-Messenger photo by Elijah Decious
Though the floor of the 2N wing at UnityPoint Health — Trinity Regional Medical Center is mostly empty, it show subtle signs that the hospital is ready should the facility experience a surge in COVID-19 patients requiring hospitalization. Face shields on the walls and rooms for nurses to don and doff protective gowns remain ready at a moment’s notice.

Three simple measures can help Webster County get to the other side, Glasgo said: wear a face covering, stay six feet apart and stay home if you’re ill — all virtues continuously professed by Webster County Public Health.

After preparing for the worst in March, TRMC operations on the surface have returned to looking almost as they did before the pandemic, save for the front door screening stations.

Through peaks in June and July with the biggest peak of COVID-19 patients in August, TRMC continued to offer the wide array of outpatient and elective services it suspended from March to May. Those furloughed, about 10% of the hospital’s 1,100 employees, returned by mid-summer with a few extra tasks to complete: conveying a smile from behind a mask and screening themselves before work, to name a couple.

“I commend our nursing teams, because they’ve had the heaviest lift on this,” said Glasgo. “I’m most proud of the work I see (staff) doing and the care that they’re giving.”

With early business closures at the beginning of the pandemic, the fear of the unknown as TRMC prepared for its first patients was the most prominent stress in March and April. But even with the ebbs and flows of more recent months, Glasgo said they’ve been able to handle everything the novel coronavirus could throw at them.

-Submitted photo
A high-flow nasal canula has proven to be one viable alternative for some COVID-19 patients in respiratory distress without the need for a ventilator. Ventilators are much more invasive, requiring sedation and constant rotation from the back to stomach by a team of nurses.

A wing of the hospital’s unused second floor was prepared to elevate TRMC’s capacity from 49 acute inpatient beds and 14 intensive care unit beds to 85 and 23 beds, respectively. So far, it has only been used for two days.

“However, that is because we were separating COVID and non-COVID patients,” near the beginning of the pandemic, said Shannon McQuillen, vice president of TRMC. “We aren’t doing this anymore, as it is considered best practice to keep all critical patients on the same unit and keep the unit staff together.”

The hospital can surge up its capacity limits at any time, but Glasgo said it would come at the expense of elective surgeries and less urgent care. Intensive care unit capacity levels play a large role in determining that next step.

“(Looking at ICU numbers) is how we start to talk about what we’d do next,” Glasgo said. “It may not be that we have to stop seeing (outpatient) people here, we just call for help.”

As the UnityPoint system bulked up on other equipment like ventilators, she said that different parts of their geographic system in Iowa have been impacted at different times, during which staff were able to travel to help others in need with fluidity. Only once, during the August peak, did Glasgo say that TRMC was not in a position to be able to assist other parts of the UnityPoint system. TRMC was not, at any point, distressed enough to require assistance from others.

-Submitted photo
A photo provided by UnityPoint Health — Trinity Regional Medical Center demonstrates the reality of being on a ventilator, required for some COVID-19 patients with severe difficulty breathing. Patients intubated on ventilators must be sedated and rotated periodically from their back to their stomach by a team of nurses to reduce the risk of other complications.

In preparing for the worst, however, TRMC sourced a new type of respiratory equipment that helps coronavirus patients breathe without the need for sedation and constant back-to-stomach turning by a team of nurses. Many patients have fared well with high-flow nasal canulas, which connect pressurized air to the nose without intubation.

“Everyone thought ‘oh, we’re going to run out of ventilators.’ That really wasn’t the case,” Glasgo said. “We have people that need ventilators, but not the number we thought.”

The CEO said the standard of care went to high-flow nasal canulas, depending on the need for oxygen.

“The basic premise is we want to keep people awake and alert,” she said.

UnityPoint’s respiratory clinic, opened March 20 on Second Avenue North, marked nearly 3,000 visits before its closure July 31.

But with a good handle on preparation and improved knowledge with information that isn’t changing as rapidly, the next frontier is education.

“The problem now is people have decided (COVID-19) is a hoax,” Glasgo said. “They’re not listening to science anymore.”

As the county enters flu season, McQuillen said the hospital is preparing an aggressive education plan to ensure that as many people as possible get their flu shot — one thing they can do, rather than another thing canceled. Glasgo said TRMC has seen greater enthusiasm for flu shots this year, so far.

“It’s the one thing they can do to control their environment and not get influenza,” McQuillen said.

Similarly, Fort Dodge infectious disease specialist Dr. Megan Srinivas said that the public’s next moves will be critical to determining how Webster County emerges from the pandemic. Srinivas formerly served patients at Fort Dodge’s Community Health Center.

“I understand there’s a lot of fatigue in this (at this point). But we’re now in one of the most dangerous points of the COVID-19 curve,” she said. “What we do now dictates (how many) lives are lost next and how quickly we can get on top of this.”

As of Thursday, Iowa’s death toll stood at 1,303. By the end of the year, The Institute for Health Metrics and Evaluation, one of the top epidemiological institutions in the world, projects that another 1,020 people will due to COVID-19. By contrast, with universal mask use, projections estimate that 300 more people would die.

But no matter the numbers, Glasgo said TRMC is ready.

“We want to be prepared to serve our community, that’s our goal.” she said. “I would say we have prepared for the worst. Do I think we’re going to get to that point? I sure hope not.”

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