CONWAY — Health-care providers from around the Mount Washington Valley met by conference call on Wednesday to discuss work they have been doing to deal with the COVID-19 outbreak and prepare for the possibility of a surge in the number of cases.
This was the second conference of the medical community led by Memorial Hospital about the coronavirus. The first was held two weeks ago.
This time, only eight Memorial Hospital senior leaders were present in person. The rest, including emergency responders, Saco River Medical Group, White Mountain Community Health Center and other health-care and town representatives, dialed in.
As of Wednesday, New Hampshire has 137 positive tests for COVID-19, seven in Carroll County, one at Memorial Hospital. Nineteen people are hospitalized; one person has died.
The meeting began with hospital President Art Mathisen giving an update on what is being done at the hospital. On Tuesday, it increased visitor restrictions so only patients and staff can enter the hospital. In essence, no visitors.
There are exceptions for people who have chemotherapy or are in a hospice situation, but even in those cases, visitors are limited to one person.
Mathisen noted that the hospital is preparing to be able to expand from the 25 beds it has to between 75-80 beds in the hospital. “We’re calling them ‘spaces’ right now because we’re still working the actual beds for those spaces. But that’s what we’ll have for the actual capacity in the main hospital, and then the capacity of another 32 low-acuity patients in our PT/Ortho building,” he said.
In addition the hospital is creating more negative pressure rooms, which keep an infection from spreading outside the room. The hospital currently has three, but renovations are being made in the emergency department and medical/surgical department to add between 12 and 20 negative pressure rooms.
“We’re going to go from three to 12 and possibly more than that which is really outstanding,” he said.
Conway Fire Chief Steve Solomon reported that last Friday, the Bureau of Emergency Communications changed its screening from travel-related screening to what they call “pandemic screening.”
“Now anybody who presents with flu-like symptoms — there’s actually 12 different questions they ask, and if you have two or more of those ‘yes,’ they are listing it as flu-like symptoms,” he said, and giving it a code of to indicate a potential COVID-19 patient. In that case, EMS has to don personal protective equipment prior to contact.
Mathisen said the hospital currently has a good supply of personal protective equipment for staff, but noted, “There has been an extreme shortage of testing,” and the hospital has responded by limiting testing primarily to inpatients at the hospital and health-care workers that the hospital is trying to get back to work.
“Then, if the physicians or nurse practitioner or physician assistant determines that somebody else that’s not in-patient needs a test, that’s their call as a clinician,” he said.
High priority tests are sent to NorDx, a MaineHealth system member, for testing, and Mathisen said if the kit is sent out by courier in the afternoon, “you usually get the tests back by tomorrow morning.”
However, the hospital is not able to get all tests results returned so quickly.
Memorial has collected swabs for 68 people to be sent out for testing over the past two weeks; 33 of those test results are not yet back.
Dr. Ross Emery of Saco River Medical Group said that practice is experiencing long delays in getting results back, noting that doctors have been waiting for eight days for the test results on one patient.
Test results are critical for patients and providers in the health-care setting because they have the potential of exposing more people to the virus and using up personal protective equipment and other resources that are in limited supply.
People with flu-like symptoms but can take care of themselves, are being asked to do just that, while staying home, isolating and keeping surfaces clean.
“The bottom line is most people that come in with the symptoms, really the only need is for them to go home, drink fluids, stay away from people and get better,” Mathisen said.
Health-care providers at the hospital, Saco River Medical and White Mountain are giving patients similar advice, and asking anyone who thinks they may have flulike symptoms to call rather than coming in. In order to keep people as safe as possible, they are also switching appointments to tele-health calls when possible.
The good news, said Julie Hill of White Mountain Community Health, “we’re finding that our patients are really wanting to stay home as much as possible which is fantastic. We also see ourselves in a position of trying to help the hospital by trying to keep people out of the emergency room as much as possible.”
Mathisen thanked White Mountain Community Health and Saco River Medical Center for that work.
“You guys are hitting the nail on the head. As much as we can continue to do that, its very appreciated by us,” he said. “We appreciate the teamwork. That’s exactly the effort we need across the board.”
“We’re going to actually come to a point probably in our plan where you’re not going to be able to enter the hospital potentially because of what’s going on unless you have an actual emergency,” he said, adding that one plan being considered by the primary care department is meeting people as they try to enter the hospital campus and giving them a sheet with information for a tele-medicine appointment where they can call in to get help.
Pamela Clay-Storm, a nurse at Kennett High School, asked what guidance she should be giving to patients about contact notification if they are not being tested but have symptoms that could be COVID-19.
The latest Health Advisory Newsletter from the N.H. Department of Health and Human Services, which includes CDC guidelines, recommends if you’ve had exposure to someone who’s being managed without a testing that you’re supposed to self-quarantine for 14 days, she said, but another guideline said the person who was exposed should just monitor themselves for symptoms.
Mathisen said, “First of all, this virus is a bugger, right? Because it presents in so many different ways from very bad to I don’t even know I’m carrying it to a lot of in between.”
He agreed the guidelines keep changing, and said “Depending on which HAN (Health Advisory Newsletter) and it’s slightly different and we’ve been struggling to keep up with this also.”
Memorial’s Dr. Matt Dunn said the latest guidance is for people who have symptoms to stay home at least seven days from when their first symptoms appeared and at least 72 hours since recovery. Close contacts are advised to self-quarantine for 14 days.
Emery of Saco River Medical Group said, “I think the bottom line is, as this ramps up, we’re going to have to assume that most illnesses that are respiratory or flu-like illness could be COVID. So when you advise someone that you may have COVID based on your symptoms, we’re not going to test, it will be a good idea to reach out to any contacts they had that would be considered close contacts so that they can then self-quarantine.
“That’s the only way we’re going to keep this from spreading more widely. The good news is we’re already telling everybody to do this anyway, so it’s not a real change in what is being asked of the entire community.”