ON THE SCENE: COVID impacts Elizabethtown Community Hospital

John Remillard, president of the Elizabethtown Community Hospital (Photo provided)

Across the country and our region, hospitals like Elizabethtown Community Hospital have been hit hard by COVID-19. In New York state, they were largely unaware of the scope of the oncoming medical tsunami until it exploded on our shores in early March, arriving with thousands of passengers at New York City’s metro airports.

Within days, the state Legislature approved $40 million to address the feared epidemic and broad powers for Gov. Andrew Cuomo to manage the novel coronavirus. A challenge was that there was no federal plan in place and confusion about the best approach to fighting the disease. A problem was a lack of understanding of how the disease spread and no knowledge that people showing no symptoms were significant means of distributing the virus. Early on, many thought youths were not very contagious or that with warmer weather, the virus would die out; neither proved to be true.

Still, others thought that social distancing and wearing masks were too simplistic as a means of reducing the spread of the virus or that mandating their use was government overreach.

What was known was that throughout the United States, there was an extreme shortage of masks and other protective equipment, ventilators and the ability to test people for the virus. The problem is that the manufacturing of many needed items had shifted abroad, and stores no longer stored supplies but relied on purchasing to meet demand. The difficulty with this model is that Asian manufacturers were first responding to an increased demand for these products within their own country, coupled with not being able to gear up to meet a growing worldwide need.

For New York’s business, health and political leaders, it was like jumping into a war canoe for the first time with a third of the paddles needed and no previous experience of paddling together. What did happen is that Cuomo took the coxswain’s seat. He pulled together a team of medical and public health professionals to give him advice and held daily media briefings to keep New Yorkers informed, all the while exclaiming that the state’s residents are tough and will get through this together.

The challenge was daunting. Within five weeks of its first case, New York state had more confirmed people infected by the coronavirus than any other country in the world, along with one the highest number of deaths. Yet, remarkably, by May 7, New York reduced the rate of increase to less than 1% and within a month to .25%. Getting there involved some costly mistakes, later corrected, that included elder care facilities being required to accept older adults infected with the disease.

What worked was individuals’ efforts combined with businesses, local government, schools and hospitals stepping up to meet the challenge; hospitals like the Elizabethtown Community Hospital.

Elizabethtown is part of the University of Vermont’s six-hospital Health Network serving patients and families in northern New York and Vermont. The facility services all of Essex County with two campuses, one in Ticonderoga and the other in Elizabethtown, each having an emergency department, X-ray, rehab services and specialty clinics. In addition, they have six health centers spread throughout the county providing primary care.

“In March, when the pandemic hit, it changed our world overnight,” said John Remillard, president of Elizabethtown Community Hospital. “We were required by the New York State Department of Health to prepare for a big surge. We had to rethink and retool our organization so that we could provide care for people in 38 beds as opposed to the 25 we had. We had to change care so that people wouldn’t come out for routine or elective care. We had to cut our volumes at our health centers and hospitals significantly.”

The number of people coming to their emergency rooms and health centers dropped. The hospital closed two health centers and their specialty clinics, resulting in a massive drop in income, primarily by postponing all elective services. At the same time, the hospital ramped up their telemedicine services so that patients could still see and interact with their physicians. Fortunately, the Cares Act was passed by Congress, which helped cover much of the lost revenue.

“The impact of the pandemic on our physicians, nurses and other personnel was enormous,” said Dr. David Clauss, chief medical director and director of emergency medicine. “It completely changed the character of the patient visit as we shift a significant portion of routine to remote telemedicine care. Now no one is coming in except for necessary care. Everything, from screening and scheduling questions, masking the patient encounter itself, has changed. As an example, having an emergency encounter where both of us, doctor and patient, are wearing masks, and neither of us seeing the others face changes the nature of that experience tremendously.”

The hospital provides primary care to the Essex Center for Rehabilitation and Nursing. The corridor linking to the two facilities had to be sealed off with elaborate safety procedures to prevent the virus’s potential spread between the two facilities, a barrier that has since proved critical and effective. Equally essential has been the strong working relationship between the hospital and the Essex County Health Department.

An added emotional burden is that hospital staff doing the everyday work they love can put their own families at risk; a difficulty also carried by people who work in convenience, grocery and hardware stores, school teachers, and people in the hospitality and restaurant industry.

The good news is that many local residents stepped up, sewing together needed masks and gowns and often bringing meals and snacks for the hospital staff. Northwood School created highly effective face shields that are still in use. These and other examples of community support provided needed and gratefully accepted emotional support.

A bit of good news out of all this hardship has been learning how telemedicine can be an effective way for hospitals to improve and extend care to the communities they serve. Added it that providers, patients, regulatory bodies and third-party payers are coming to appreciate the benefits as well. As a result, health care will never go back to exactly the way it was.

A challenge is that even if an effective vaccine was discovered tomorrow, the reality is COVID, while it will be impacting our lives for some time to come. Consequently, the medical team at Elizabethtown Community Hospital will continue to need the general public’s help.

“By far, the most important way the community can help and play a role is to continue to do the things we know work to minimize infection,” said Clauss. “It’s not sexy, but continue to wear that annoying mask, to structure your day so that you are minimizing unnecessary contact and wash to your hands thoroughly and often. That’s how the North Country can continue to get through this without further tragedy. Not taking risks is how the community can help the hospital, help all of us.”

(Naj Wikoff lives in Keene Valley. He has been covering events for the Lake Placid News for more than 15 years.)