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Facing healthcare: perspectives from the front lines

GREAT BARRINGTON — The first coronavirus disease-positive patient was admitted to Fairview Hospital the first week of March. Although more patients have been treated since then, Fairview is seeing fewer patients overall, according to Dr. Adrian Elliot, medical director of the emergency department at the hospital.
“There’s been a large drop in the volume of patients altogether; we’re seeing two-thirds the patients we normally see,” said Elliot.
During the first month of the COVID-19 pandemic in the Berkshires, a toll-free call line established by Berkshire Health Systems recorded, on average, between 200 and 300 calls per day, and was available seven days a week from 7 a.m. to 7 p.m.
The call line was developed as a way to provide immediate access to nurses who could field and answer questions or concerns regarding COVID-19, from symptoms to whether an individual should be tested, speak with their physician, or be transported to the emergency department. A physician staffs the telehealth component in the event that the caller’s questions require a higher level of diagnostic discussion and recommendations.
The number of calls to the nurse triage and its accompanying telehealth component have since dropped considerably, to approximately 100 calls per day. As a result, the line’s hours have been reduced to 8 a.m. to 6 p.m. daily, seven days a week. The number remains 855-BMC-LINK, or 855-262-5465.
In the past month, Elliot says that people are waiting much longer than normal to come to the hospital for treatment. That could be related to the fact that outpatient elective procedures have been shut down. It could also be in part to the medical community’s efforts in advocating for people to stay at home, but it could also be attributed to a general feeling of fear, he said.
“We’ve seen people that would have normally come in earlier to get things treated that are waiting, and by the time they come in are requiring more care and may even be put in a risky situation,” he said. “There are cases where people have even passed away at home, not receiving medical care.”
Though Elliot wasn’t certain if that was particularly specific to COVID-19, he said that there does seem to be a fear of catching coronavirus disease in places where people congregate, and one place where people continue to congregate is healthcare facilities and emergency rooms where they’re treating patients who have the virus.
Still, Elliot reaffirmed that the people that need to be cared for should continue coming to the hospital.
“We work very hard at Fairview to make sure we’re safe by engineering changes through protocols and policies,” he said. “Don’t be afraid. We’re here to help.”
One of the difficulties in managing the situation at first was knowing if the virus had entered the Berkshires and how. Elliot said that the medical community learned early on that the virus wasn’t coming from travel cases, but rather people in the community.
Entering the ‘new normal’
Medical professionals have been trained to understand the causes and effects of diseases and infections, such as pneumonia and influenza. But coronavirus has presented brand new challenges for those in healthcare, according to Michael Piernock, a paramedic with Great Barrington-based Southern Berkshire Ambulance Squad.
“We understand those disease pathologies. We can prevent it, we can treat it. The pathology of this disease is not understood,” said Piernock. “You can’t compare this to the flu.”
Because the pathologies haven’t been determined and new information is being constantly introduced, healthcare professionals are finding themselves adapting to an ever-changing environment. The textbook on care has added new sections for treatment and prevention several times since the virus was declared a global pandemic, according to Elliot.
Currently, at the hospital, staff and administrators are donning personal protective equipment, including N95 respirators and face masks, eye protection, gloves and gowns. All patients and guests have to wear hospital-provided face masks as well.
Southern Berkshire ambulance squad is also donning the same personal protective equipment when responding to each call and requires all patients to wear face masks. The ambulance is cleaned with hospital-grade disinfectant after responding to each call or transport, said paramedic Craig Campbell.
“We’re diligent about decontamination,” said Campbell.
Squad members also expressed concern for contracting coronavirus — not necessarily for their own battle, but for what it could mean for others.
William Hathaway, director of operations at Southern Berkshire, noted that the amount of 911 calls have dropped by half. Despite a decline in the amount of calls the ambulance service is receiving, Paramedic Andrew Watts said that work in the era of coronavirus brings a different level of stress.
“I accepted early on that I would likely get it. But I find myself constantly wondering if I did enough after a call. Did I wash my boots good enough? I’m constantly retracing my steps,” said Watts. “I can’t let my guard down or de-stress like we might normally do to deal with the mental stress of the job. When I come home, I have to be just as careful to make sure I’m just as vigilant not to bring it back to my wife.”
Piernock agreed with Watts’ assessment.
“We’re dealing with something that’s not visible,” said Piernock. “You don’t bring heart attacks or strokes with you. They’re not on your clothes when you leave a call.”
Napoleon Martin, the lead CT technologist that’s worked at the hospital for three decades, said that his job is still busy, but in a different way. For the most part, his routine is the same, but includes an additional cleaning period between each patient. Exposure time has also been cut back as patients have been taken directly from their cars to the X-ray department.
Admittedly, Martin said he experienced a fair amount of anxiety early on and had concerns about having enough personal protective equipment, but says that he feels more secure on the amount of supplies the hospital has now.
“The founding principle remains the same; it’s our every day job to make sure we don’t transfer an illness to the next person,” he said. “[The virus] doesn’t change the outlook on what I do, things just got a little tougher.”
Despite all the changes, there have been some constants. Springtime is notoriously the time that a lot of babies are born and that seems to still be the case, according to Joan Pezzano, director of The Family Birth Place at the hospital.
Since February, approximately 30 babies have been delivered, said Pezzano in an interview this past Friday. Throughout that time, there have been no COVID-19-positive mothers, she added.
Though childbirth classes are temporarily canceled, other services are still available. The process, however, has changed as no siblings or grandparents are coming to visit.
“It’s difficult to tell patients, especially those who have been planning for nine months on how the birth will be,” she said, noting that families have been understanding under the circumstances. “The thing to remember is we’re taking care of two patients — not just one.”
The total effects that this pandemic has had on the healthcare industry are still unfolding, but with the growth of the use of telemedicine, Elliot says it’s an area that he estimates will continue to expand. While the hospital may be ready for such an expansion to the healthcare realm, ambulance billing models like Southern Berkshire still quantify the services as transportation rather than care providers.
“People may not want to go to the hospital as much with telemedicine. It’s hard to tell where this will lead us,” said Hathaway.

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