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Six months in

A look back and a vision forward on COVID-19

-Messenger photo by Elijah Decious
Fort Dodge Community Health Center’s CEO, Renae Kruckenberg, demonstrates how a COVID-19 test is processed.

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

As the United States surpassed 200,000 deaths from COVID-19 Tuesday, the numbers have been difficult to wrap one’s head around — staggering, confusing and rapidly changing.

Since the coronavirus pandemic began, COVID-19 has killed more Americans than those killed in battle during the Korean War, Vietnam War, Iraq War, War in Afghanistan and Persian Gulf War combined.

While pandemic, social distancing and “flatten the curve” became a routine part of the world’s vocabulary, the virus has killed enough Americans to equate the Sept. 11 terrorist attacks happening every day for 67 days.

As those in our community clamor for a return to normalcy, more Iowans have died than the number of students enrolled at Fort Dodge Senior High School.

-Messenger photo by Elijah Decious
Testing equipment at Community Health Center demonstrates what a positive test result for SARS-Cov-2 (commonly known as COVID-19) looks like.

But six months since the novel coronavirus made its entrance into Iowa and descended from pinpointed instances of those receiving it from other travelers returning home to community spread — where those diagnosed may not know how, where or from whom they were infected — many have gotten lost in the numbers. And with that loss, a disorientation of where we started, where we are now and where community experts and institutions think we’re headed next.

To find a semblance of a grounding presence in how Webster County has fared after a cacophony of bleak predictions, daily case updates and deaths, The Messenger has turned its gaze to the experts in Fort Dodge, Webster County and rural Iowa.

Where did we start?

Let’s start from the beginning.

As supermarkets in Fort Dodge were wiped of supplies of toilet paper, hand sanitizer in short supply became an ad hoc form of currency and employers sent workers home amid bleak predictions prompting a state of public health emergency, local institutions on the front lines of combatting the virus had a lot on their minds.

-Messenger photo by Elijah Decious
Staff at Fort Dodge’s Community Health Center wait for new patients at the streamlined entrance for rapid COVID-19 testing, set up in the parking lot behind their downtown building. On left is Rhonda McFadden, financial advocate for patients; on the right is Colleen Miller, chief operating officer.

UnityPoint Health — Trinity Regional Medical Center (TRMC) immediately activated and refreshed disaster preparedness plans in place to handle the other familiar disasters, like tornadoes and hurricanes. Non-urgent outpatient and elective services were immediately put on hold, as one of the larger hospitals in rural north central Iowa braced for the worst, resulting in the furlough of about 10% of its Fort Dodge employees.

CEO Leah Glasgo said that while the early months of the pandemic were some of the slowest for the hospital, different regions that make up the widespread UnityPoint system in Iowa weren’t all hit at once, but rather in different ways at different times.

“At the beginning … everyone was talking about running out of ventilators,” Glasgo said.

But despite a fear of the unknown and a rapid fire of constantly changing information, the CEO said that TRMC made sure everything was in place for when the first COVID-19 patient arrived.

Immediately, the hospital system started to build a robust supply of ventilators, which many feared would be in short supply if those in need overwhelmed the healthcare system, Glasgo said. Anesthesiology equipment was repurposed to be on standby, should the need for more equipment arise, and high-flow nasal canulas became an option to assist with respiratory distress without sedating and intubating patients.

-Messenger photo by Elijah Decious
Community Health Center CEO Renae Kruckenberg demonstrates how a COVID-19 diagnostic test is processed, using a testing control. The cartridge on the table is subsequently placed into a machine smaller than a home printer, which reads the results for COVID-19 tests in a matter of minutes.

A wing of the hospital’s second floor was readied for a potential surge in patients.

TRMC’s preparedness and ability to more nimbly adapt to circumstances, Glasgo said, is one benefit of the larger UnityPoint system.

“The governor’s proclamation on March 17 changed the world of public health,” said Kari Prescott, director of Webster County Public Health (WCPH). “We completely shifted all our efforts into preparing for and responding to anticipate situations that could happen in our county.”

Incident command immediately focused on enforcing the governor’s proclamations, isolation and quarantine policies and communicating with healthcare providers.

“Uncertainty and fear of the unknown replaced our daily routines,” Prescott said.

As agencies activated plans some hoped they’d never have to use, others immediately channeled their focus into vision for anticipated future needs that has paid off well.

“It was like everybody else, you try to do what’s best for patients and staff,” said Renae Kruckenberg, CEO of Fort Dodge’s Community Health Center (CHC).

In March, it could take up to eight days to receive test results as clinics sent away to the state and private labs for processing.

“The contact tracing then became difficult because we were waiting so long for results that it became difficult to have patients waiting in limbo for days,” said Ann Feser, nurse practitioner at CHC.

Nearly everyone interviewed by The Messenger attributed the magnitude of this virus and the fear it has caused to a fear of the unknown amid information changing as rapidly as the virus can spread. All of them said public health interventions, closures and ongoing recommendations to wear masks and social distance have been well justified by the results produced in six months.

Where are we now?

After six months, Webster County alone has seen 14 deaths and 1,241 positive cases.

Thanks to quick thinking by CHC, testing equipment ordered in March arrived in June, one of the slower periods of activity for CHC. Since then, the time to receive test results has gone from up to eight days to about 20 minutes — the only rapid testing available within 100 miles, Feser said.

“Once we got our in-house machine, things really started to ramp up,” Kruckenberg said.

As testing time has sped up, Kruckenberg said CHC testing offers a 96.7% accuracy rate for positive results and 100% for negative results. The clinic, with a separate set-up for COVID-19 testing, can test any where from 100 to 180 patients per day.

As CHC ramped up advertising to let the public know where they can get tested, honed knowledge informed best practices on when to get tested. CHC now recommends getting tested five to seven days after an exposure for the most accurate results, unless you have symptoms, in which case you should be tested sooner.

And after knowledge and practice developed, some equipment turned out to be needed less than originally thought.

“Everyone thought, ‘oh we’re going to run out of ventilators,” Glasgo said. “That really wasn’t the case.”

Many needing respiratory assistance fared appropriately with the less invasive high-flow nasal canulas, Glasgo said, which do not require sedation and regular back-to-stomach rotation by a team of nurses.

As cases poured into the county over the summer, many from a prison outbreak at Fort Dodge Correctional Facility, Glasgo said that TRMC experienced surges in patients during the months of June, July and August — the biggest of which was in August. The hospital has not tapped into its surge area since May. In the months following, a different approach was adopted to caring for COVID-19 patients, meaning TRMC didn’t have to utilize as much space.

Glasgo said the hospital was not close to overwhelming its total capacity, which serves those in Webster County and many surrounding regions of Iowa, at any point over the last six months.

In that time, public health interventions became politicized and chastised, Prescott said.

“I have been in public health for 20 years,” she said. “I have never witnessed a situation so polarized and so politicized where it significantly affected the work we do in the public health arena.”

And while she said the number of cases and deaths has lived up to be worse than trajectories at the onset of the pandemic, Dr. Megan Srinivas, an infectious disease specialist who practiced at CHC until August, said the evolution of information about the disease has been nothing short of remarkable. She said that Webster County and Iowa have yet to reach its peak in cases.

“From a scientific standpoint, we’ve learned a lot, but still have a lot to know,” Srinivas said. “We spend decades studying the average virus.”

Srinivas, through her role at the University of North Carolina School of Medicine, is helping lead one of many efforts in the race to develop a vaccine.

But politics have started to meddle with the science, she said, leading many to refuse to listen to public health and medical experts.

Where are we headed?

With flu season getting well under way, the fear of the unknown may make a resurgence as many worry about the compounding effects of influenza and COVID-19.

Prescott said that for public health, the compounding effects will be unpredictable.

“Unfortunately, the coronavirus is not going away and flu season is upon us,” she said. “We ask the community to have patience and understanding, not only with our department, but with schools, skilled nursing facilities and our health care system as we continue to navigate the pandemic and other illnesses in our community.”

WCPH will continue to focus efforts on preparing for mass vaccination clinics for a future coronavirus vaccine.

“Our agency expects more cases,” she said.

CHC will be doing both flu and COVID-19 tests for many patients, Kruckenberg said.

“The symptoms are similar, so it’s not going to be an easy differential to make,” Feser said. “You’re definitely going to have to get a test.”

And like with COVID-19, the same rules will apply: stay home when you’re sick, get tested and isolate. The focus will be on early testing.

“I hope it’s not going to be a huge influx with flu season, but it potentially could,” Feser said.

TRMC remains ready for whatever happens next, not expecting the worst but prepared with a plan, should it happen.

“We want to be prepared to serve our community, that’s our goal,” Glasgo 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.”

But many of those surveyed cautioned locals not to put too much in faith in the vaccine as a silver bullet to pre-coronavirus normalcy. Wearing masks, refraining from large groups and other protocol are here to stay for the foreseeable future.

“A vaccine isn’t going to be the magic end-all (solution). The emphasis on this as a magic solution is misguided,” Srinivas said. “It will help prevent people from getting ill, but we don’t know what the efficacy of the vaccine will be.”

Like the flu shot, the efficacy rate could be 30-60%. Many in the medical and research field are realistically hoping that the vaccine will simply reduce the severity of symptoms, particularly for those with preexisting conditions that put them at risk for complications.

Srinivas also said the vaccine might need to be taken every year or semi-annually, like the flu vaccine.

In the mean time, she said high levels of public adherence to mask wearing is one of the single best ways to get the public through the crisis.

“That small piece of cloth can save so many lives and enable us to reengage with the economy and reduce those struggles we’re seeing happen throughout the country,” she said.

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