Guest Opinion: The meaning of community


(4/22/2020)

 by Rachelle H. Schultz, Ed.D., Winona Health president, CEO

 

On March 26, our first verified positive case of COVID-19 was identified in Winona. This result validated what we believed to be true, that the virus was already in Winona. Limitations on testing, due to lack of supplies and laboratory capabilities across the state, resulted in a situation where we are essentially blind to the status of the spread of the virus in our community. This, too, is still true. However, from the first case to now, we continue to gain greater understanding of the challenges that this virus poses, and how we might combat those challenges.

First, we know that people can be carriers of the virus with no knowledge of this. They do not have symptoms (asymptomatic) and would have no reason to believe that they have the virus. The particular concern this raises is that people can be shedding the virus as they go about their normal activities, potentially exposing and infecting others around them. This is why physical distancing is so very crucial, along with hand hygiene, and other precautions. This asymptomatic timeframe is also the most concerning because it is invisible.

As we watch the numbers of positive cases increase every day in Minnesota, we have also learned that long-term care and other congregate living facilities are especially vulnerable. To date, more than 90 nursing homes in Minnesota have positive cases for COVID.  Many are struggling with a host of issues from staffing, to personal protective equipment (PPE), to containment and prevention. It is daunting to say the least. Each week we host a group call that includes all regional long-term care, assisted-living and group-home facilities to share information, see if anyone needs anything, learn from each other, and provide support.

These facilities in our region have essentially been on lock down for a month, which is very difficult for residents and families as well as staff. Communal dining was discontinued several weeks ago, and any type of group activities were also shut down. Further, universal masking is in place for all staff and residents, and temperatures and symptom monitoring is also being done on every shift. We all know these folks are vulnerable and we are all working to protect them and keep them safe. And the impact of these efforts on the quality of their lives is significant.

Recently the state reported the names of facilities with positive cases and, locally, Sauer Nursing Home was identified. The leadership and staff at Sauer have been diligently working to separate residents who test positive from other residents. All area nursing homes are prepared to do the same, and have identified distinct areas to accommodate this if needed. Beyond the distinct unit, the staff at Sauer have been using full PPE when working with any resident. In addition, we have a dedicated Winona Health physician who is monitoring all residents daily, evaluating symptoms, directing treatments, and talking with residents and their families about their wishes. Physicians at Winona Health provide her additional support and guidance as they evaluate the research, establish protocols, and continue to monitor emerging information on COVID-19.

I want to recognize the commitment and care that these staff and physicians have provided the residents of Sauer during one of the most challenging health situations we are likely to experience for years to come. The demands are huge and Sauer’s leadership and staff have risen to the challenge. There are the heroes you hear about in the news far from Winona, well, we have heroes right here in Winona in all of our health care facilities.

As a result of positive cases at Sauer, its leadership has identified the need to move the residents who have tested negative out of the facility, for the time being, to keep them safe from contracting the virus. We at Winona Health/Lake Winona Manor have been discussing this need with them and worked out a plan to safely transfer these residents from Sauer to Lake Winona Manor for an interim stay. We believe that this is the right decision for these residents and that we can do so safely. To be clear, when we talk about our family, friends and neighbors in our Winona Health mission statement, we mean everybody. Sauer residents and staff are part of our community, and we care about them as we do everyone else in our Winona service area.

Our first priority is safety for everyone. In our discussions to formulate this plan, a multitude of details were worked through and addressed. Lake Winona Manor has a distinct, separate unit that has not been in use. Completely separating this space is important as it allows us to monitor and evaluate over time the health status of these residents at a quarantine level of observation. As noted earlier, this virus is a wily one, and an individual could convert to positive quickly. Thus, our surveillance process is robust and constant. We have evaluated the distinct entrances/exits, the air handling system (there is no air exchange with any other part of the facility), food and housekeeping services, unit-specific staff, the level and type of PPE to be used (for both residents and staff), solid work-flow processes, and a robust surveillance plan. Most important, the ability to have this distinct unit in a self-contained manner gives the Sauer residents a safe and comfortable place to be, minimizing, as best we can, the disruption they are experiencing.

As luck would have it, a team from the Centers for Disease Control (CDC) arrived in Minnesota on Wednesday to assist the state and contacted us to provide support and assistance with our plan. Members of the CDC team, along with infection preventionists and epidemiologists from the county and Minnesota Department of Health were onsite on Friday and we were able to share our plan and get their insights and suggestions. The team was impressed with the thoughtful work and planning by all involved, and we were pleased to have additional expertise applied to this work.

This pandemic has instilled a lot of fear in people. We have heard the stories from across the country through many lenses – front-line workers, physicians, politicians, families, and people who contracted the virus. No one should underestimate this virus; at the same time, we should not be ruled by fear. That is when mistakes are made. The antidote to fear is information. It is actively seeking to understand. It is having a well-thought-out plan and an ability to adjust and adapt quickly as new information comes available. We have been doing this since the onset of the pandemic. It has served us well and will continue to be our approach.

Finally, everyone is a part of the pandemic mitigation strategy via adherence to the requests to physically distance six feet apart, practice frequent and correct hand hygiene, cover your cough (and sneezes), don’t touch your face, stay at home when you have symptoms of illness, and disinfect frequently touched surfaces. These are actions that everyone is capable of doing and they go a long way toward mitigating fear. Let’s ensure that, in our community, we all do what we can to take care of ourselves — and each other.

 

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