Springfield Business Journal Editor Eric Olson reflects on the impact of the COVID-19 pandemic in a Dec. 1 interview with Brent Hubbard, president and chief operating officer of Mercy Hospital Springfield; Dr. Tim Jones, president of Cox Medical Group; and Katie Towns, assistant director for the Springfield-Greene County Health Department.
Eric Olson: Merriam-Webster selected pandemic as the word of the year. What other health care word would you use to describe the year?
Brent Hubbard: An unusual year. Not only unusual, but groundbreaking. You look at how we’re doing this interview today and how we’re utilizing technology. It has been accelerated five to 10 years.
Dr. Tim Jones: Stressful – from a medical perspective, clinical provider perspective, certainly. The health care industry is full of stress, I think, just at a baseline, but this is a different level of stress than we’ve ever experienced. Health care organizations aren’t particularly the most nimble of industries typically, but this has forced us into becoming a nimble industry. This has forced us to make moves we’d never had to make before. The amount of stress it’s put on because it’s kind of the antithesis of the way a lot of us work day to day in our normal jobs pre-COVID. Not just on the health care workers but administrators to people cleaning the rooms to cafeteria workers, every employee in our organization has had to change the way they work and worrying about their safety.
Katie Towns: Revealing. This situation has opened our eyes to many of our strengths, but also some of the gaps and our vulnerabilities. We only have room to improve on those certain things that we’ve found out about ourselves, our community, our workplaces, our employees, our leaders. We’ve all been able to sort of sit back and, at moments, reflect on those things and look at the opportunities that we have to move forward.
Olson: How would you grade our response to the coronavirus pandemic? And statewide and nationwide, I’m interested in hearing your grades for those areas, too.
Hubbard: The last nine months have been a community effort to slow the spread of the COVID virus. Our community health partners have worked so well together, and that’s not unusual here in Springfield. We always come together in times of need. Secondly, our business owners have gone above and beyond to try to keep our community safe. They instituted mask-wearing social distancing and also been very creative on how to operate differently. There was a bubble over Springfield the first few months. Another contributing factor is how the city officials, how the Springfield-Greene County Health Department and also the (Springfield Area Chamber of Commerce) have served as conveners to protect the community. The leadership has really been remarkable. Unfortunately, somewhere along the way, mask wearing has become political. That’s definitely a shame. Research has shown that it can reduce the spread of virus and Dr. Jones can speak to the science of that more than I can, but everyone that doesn’t wear a mask ... especially in public, that may inadvertently help the virus spread. Locally, some communities have chosen to institute masking ordinances, which has been really critical to slowing the spread, but other communities have chosen not to. Similarly, masking is where we have opportunity statewide. And then nationwide. We’ve seen a lot of variation from state to state in masking ordinances and mandates. Look at the East Coast right now. Through masking mandates, they’ve really done a good job. You look at heat maps, and they’re in a light yellow, whereas the middle part of the U.S. is in a dark red. We can do a better job in the middle part of the United States with masking. I’d have to really give our response, especially in the Springfield community, as an A. We didn’t have a blueprint to look at. It was really coming together as a community to determine the best solution with the information we have.
Towns: We are very fortunate here in Springfield. We have that midsize city effect, and I think that has afforded us a lot of opportunity especially early on, like Brent alluded to, with community leaders really just rallying around the fact that we had to pay attention to the situation and look at science to help dictate what we were going to do in response. And fortunately, we had support from leadership not only at the city and county level but across sectors that were really important, including faith-based, business leaders, even all the way down to child care. Unfortunately, going back to that word revealing, I think at a public health level, we have definitely seen lots of opportunity for improvement in a more coordinated and standardized approach across the state. Probably even federally, as well. We look forward to opportunities to help improve those situations, but I can tell you that public health measures like this that really are black and white, according to science, and given the opportunity to respond locally and have that control, creates a myriad of disparity across the region and the state that has effects on our health care institutions and our economy. Without those things being improved, I think that it will have those continued effects long term. Science dictates very simple options and I think we have not necessarily reacted in the way that we could to make the situation better for individuals, as well as our entire population across the state. Mask ordinances being one. I am proud of our community still having the occupancy measures in place. We are pretty much on our own in terms of that in the region.
Jones: I couldn’t agree with what they said more. One of the things that we were blessed with here locally was the gift of time, and that’s something that nobody had control over. When we saw this starting to hit the coasts back in March, there was a mobilization. What are we going to do? We had a (personal protective equipment) crisis here at Cox, because again, who was going to anticipate this? We had space issues. Staffing, we were fine. We really were blessed with that gift of time from a preparedness standpoint. It’s interesting to see when politics trumps science. This is simple science. The effect that it’s having on us starting kind of late summer and August when both systems started to see this kind of surge, there was some bravery involved, certainly on the Springfield side, leading that charge and on a mask mandate, really emphasizing occupancy and spacing out and really taking this serious. From a CoxHealth perspective, our census on a daily basis is around 20% to 30% Greene County, the rest is from outlying [counties]. The grade I’d give us locally, the Springfield metro area, I’d say A-. If you look at our service areas, probably about a million people that can come into this area. We only had about 20% that had a mask mandate up until recently and our census reflects that. I would give the regional response, kind of out of our control per se, probably a C-, from the state level ... it’s just been disappointing. Politics has gotten in the way of science.
Olson: Gradewise, is that a D or a failing grade?
Jones: If I was feeling generous, I’d say a D. From a physician standpoint, I try to look at things from a simplistic perspective and at the end of the day, we know masks work. I think we all sound like a broken record. There was an opportunity to set thresholds with masking mandates. If you had counties with zero positivity, I’m all right with that to some degree, but when you start to see the exponential increases in positivity rates across the entire state, then that’s when it’s time to act. What we see right now from a positivity standpoint, that’s not our current state. We know we’re two weeks behind and that’s the problem. We know intervention three months ago could have curtailed this to some degree. At 7 this morning, we had 150 people across CoxHealth; right when this meeting started [at 8:30 a.m.], I refreshed and we have 165. That’s the kind of change we have. Thirty of those are not in isolation, so 130 people in our system are requiring some sort of intense care, which is a stress around the system. And keep in mind, people aren’t all of a sudden stopping to have heart attacks, right? They’re not all of a sudden starting to not have complications related to their surgeries or newly diagnosed cancer. When all your resources go to treating one issue, which is a very time intensive care diagnosis, then those things have to give, and that’s when we have to start making difficult decisions.
Olson: Looking back at the shutdowns, from your perspectives would you have done that differently?
Jones: We had to. It was a PPE situation. We were down at one point, like five days of PPE in our system, and that’s a scary thought. Keep in mind, we only had maybe a census of two people, but we didn’t know when this was going to hit.
Hubbard: The shutdown both from a health care industry perspective, but also all industry perspective, was hard on everybody. Most industries suffered in that time and few thrived. From a health care standpoint, we can’t go back to shutting down. That delays care. That prevents people from having those cases that are elective at the time, to more urgent in nature if they’re not done timely. As Dr. Jones mentioned, the gift of time is what we had. The shutdown allowed us time to stock up on PPE. In some cases, we manufactured our own PPE, so that really also gave us an opportunity to learn more about the virus. In reflecting on that, that was one of the most important things we did as a community was to shut down. A little painful, but created that bubble to allow us to be more prepared.
Towns: We had such limited information back in March when we got our first case. I remember that day quite vividly. We knew a lot of it was coming from travel, and that was about it. From a public health perspective, we really needed that time to allow people to sort of learn from the coast that we’re experiencing the transmission at greater rates than we were, how the virus transmitted, what it was going to do. It allowed for some of those resources to start to flow. I’m really proud of our community; Mercy and Cox both came to the table, and we initiated a very early community test site. I think we were the second in the state to stand one up. At this point, we’re lacking some of those direct resources still.
Olson: Looking ahead, would you recommend another stay-at-home order?
Towns: From a public health perspective, we take a look at these things from all sorts of angles, not just the disease angle. But economic hardship on individuals is oftentimes just as bad if not worse than having a disease itself. We can force other situations that are grave public health concerns from a stay-at-home order. What we have to do, if we ever are to get to that sort of situation, would be to look at where resources along with those stay-at-home orders were going to come from. If they’re not there, then I don’t think that we are able to sort of move back into that situation that we were in April. We can’t allow children to go hungry and to not have a safe place to go. Those are the things that we think about in terms of all different angles of this response. The case counts are higher than they’ve ever been, so from that perspective, we are very interested in ways that we can slow that spread.
Hubbard: Our destiny is definitely within our control as individuals. Masking is the No. 1 way to stave off a stay-at-home ordinance. I can’t reiterate that enough. It’s the least disruptive thing we can do as individuals, but the most effective at the same time. We’ll probably see a steeper trajectory here over the next few weeks on into January and February. You look historically at every major holiday, and we see a bit of a spike in our numbers. And we’ve got two major holidays that are almost back to back. We continue to open up more COVID-designated units. We’re up to five nursing units now.
Olson: Is this a tipping point moment?
Hubbard: Yes. We’re seeing perfectly healthy people that are now on ventilators that may not make it off.
Jones: One of my biggest concerns is virus fatigue. My fear is the community started to become desensitized to it. The numbers don’t mean as much. There’s just not that sense of urgency in the community. I would love for everybody who thought this thing wasn’t real to just take a quick tour through our COVID unit. I don’t think we’re at our peak yet. I think we’re at a tipping point on a lot of levels from a staff standpoint, from a morale standpoint. I never hope I’ve been more wrong in my entire life.
Olson: Meanwhile, help is on the way. Mercy was selected as a vaccination site. How was that decision made and where do we go from here? Does each community have a site?
Hubbard: There were several sites selected across the state. Some of the major factors in determining those sites were the ability to store the vaccine using ultra-cold freezers, having the logistical expertise and capabilities to accommodate the vaccination requirements and being able to distribute. Our teams have been working over the last several weeks to prepare and develop really robust plans to ensure we’re ready to administer the vaccine. We do anticipate that front-line caregivers who have direct contact with COVID-positive patients will be the first eligible to receive the vaccine. We do expect the first delivery of the vaccinations in that December timeframe. [Editor’s note: Mercy administered the first COVID-19 vaccines in Springfield on Dec. 14.]
Olson: Have those guidelines been issued to you as far as administering the vaccine?
Towns: We were involved pretty early on helping with conversations about the state plan regarding phases. I think everybody’s sort of aware of health care workers being the first and then those with chronic conditions, high-risk, as a next phase and then sort of the opening into the adult population and then probably children, because the susceptibility is just not the same. The timeline is just very unclear at this point.
Jones: But many polls have shown that only about 60% of people trust this vaccine enough to take it right now. And that’s concerning. It’s not just the availability aspect. Those kinds of things are just going to slow another potential weapon we have to control this thing. So, it’s another fight from a messaging standpoint that we’re already talking with our providers about.
Olson: What does the rollout of this vaccine look like? How many months into next year do we feel like the community could have a good coverage of vaccinations? You mentioned the lack of confidence, but also the rights issue. Can you require someone to be vaccinated?
Jones: That’s something we’ve wrestled with at Cox. Right now, we mandate everyone to take the flu shot unless they have a medical exemption. Employment law allows us to do that. We know what the complication rate is, which is exceptionally small. There’s a lot we don’t know about these, we’re fully transparent. I’m very pro-vaccine and I’ve said day one, when I’m eligible, sign me up. Having said that though, not everybody’s going to feel that way. The number of people that were tested in these trials, even cumulatively – it’s a relatively small number, and you’re talking about potentially vaccinating millions. From a medication standpoint, we can go through adequate phase trials … and all of a sudden side effects pop up and things show up. We think it’s safe. If you look at the science, there’s no reason to think that it’s not, but again, we don’t know. We have to presume that as millions get vaccinated across the spectrum, as time goes on into the spring or at least summer, that nothing goes wrong. You take that on top of only 60% of people will take it. My hope would be if everything went well, without any major speed bumps or hiccups, that by September, we could get back to some sense of normalcy.
Towns: We’re thinking about the same timeline. But normalcy doesn’t really feel normal until you’re able to feel that on a personal level. That might be different for a lot of people.
Olson: Do you have any advice for business owners who are working through these decisions? Particularly, I’m thinking about staff back in the office and what that looks like.
Towns: Workplaces are the second known place of transmission after home. Where you can and when you can, allow people to work from home. And then when you can’t, what we’re offering and aiming for even here internally is zero exposures at work. When you have to have people in your environment, your office ... use the tools that we have available to us. Pretty much six feet distance is the best way to assure that you’re not going to have exposures at work. I know that quarantine is hard. I was quarantined and had to stay home for two weeks and it is not fun. But I think it is one of the things that we can do and employers can do to protect other employees.
Jones: I 100% agree if there’s an opportunity to work remotely. We still have about 1,500 people that work remotely here at Cox.
Hubbard: There’s a lot of companies that are doing some very creative things in order to accommodate the workforce, but also accommodate customers. That’s one of the most underutilized resources, learning from each other.
Excerpts by Features Editor Christine Temple, email@example.com.
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