On March 19, Lynn Barr, Founder and Executive Chair of Caravan Health hosted a webinar to address the challenges rural providers face as they prepare to manage the response to the novel coronavirus pandemic in their communities. More than 300 providers joined the webinar eager to learn how to address the challenges they face in communities with older populations, many who have social determinants of health that escalate the risk of spreading COVID-19.
Lynn commented that rural populations are at equal, if not higher, risk than urban communities. Rural communities are geographically separated, but socially close. Despite the close social fabric, rural residents do not have the luxury of in-home grocery and meal delivery service and may have no other choice than to visit stores in person. Social distancing, which helps to prevent the spread of the virus, becomes more of a challenge. In addressing this issue, Lynn referenced the March 16, 2020, paper by the Imperial College COVID-19 Response Team that changed the national perspective on preparing for and mitigating risks entitled, ‘Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand.’
Tim Putnam, President and CEO of Margaret Mary Health in Batesville, Indiana also joined the discussion and shared his concerns for patients and staff. Margaret Mary recently had their first patient test positive for the coronavirus. As a result, three staff members who treated the patient were placed in quarantine. Since then, the hospital has implemented more rigorous protective measures, including restricting families from visiting patients. These measures are difficult for everyone but should make a difference in transmitting this highly contagious virus.
Having staffing in quarantine means decreased capacity to care for non-COVID patients, including serious conditions like cardiac illness and accidents. Margaret Mary Hospital has been recording a daily video message for staff and releasing video messages with the Mayor to inform the community. Communication has been aided by a COVID-19 24-hour hotline for concerned citizens to call with questions and receive information.
The hospital’s preparation for the novel coronavirus also has also included:
- Re-directing and cross-training staff
- Staging for different levels of triage and care
- Segregating the organization to a clinical and non-clinical side.
- Storing masks in silicone gel packs in case they need to be re-used
- Implemented visitor restrictions
We polled our webinar participants and the top three worries were insufficient ventilators, insufficient ICU space, and not enough doctors. 37% of attendees who responded to the poll responded that they had fewer than five dedicated ICU rooms and 29% had none. More than half of the survey respondents (55%), had fewer than five ventilators available.
With limited supplies and support, rural providers must be innovative and fully prepared for a situation that is unlikely to be small or short term. To watch the webinar and hear additional comments and suggestions from providers, please click here.
A recap of the Q&A session that followed the presentation is below.
Can a provider do a telemedicine visit with the provider present in the clinic on a computer, and the patient in a different exam room?
A big part of isolating people is to have them segregated and this should qualify as a regular appointment, although we don’t yet have an answer to that.
I may not understand rural make up, but wouldn't rural hospitals transfer to the urban hospital if they were critical?
Yes, you would want to transfer the critical patients to the urban hospital, however, if they don’t have the capacity, they won’t be able to take them. We see this happening in Italy. If we do not flatten this curve dramatically, we won’t be able to transfer our patients.
Are there any suggestions on how to educate our community members on the seriousness of this and the recommendation of social distancing/isolation? It seems as if people do not grasp this.
Caravan is working on messaging right now such as mobile technology patient engagement apps that we will be rolling out to our clients to help with this. Other suggestions are to use your EMRs, contact your local churches, community organizations, local radio stations, and other leaders and ask them to help broadcast the information and help to educate and inform the community in safe ways.
Creating a WiFi hotspot in hospital parking lots can help provide residents with internet access, and some providers are using text messaging and phone blasts to remind patients to wash their hands and call before they walk into the clinic.
Caravan Health is dedicated to providing you with the latest resources to help manage the COVID-19 pandemic. Please check out our COVID-19 Resources page to learn more.