Miller Report 5/4/2020

Miller Report 5/4/2020

 

William Miller, MD, FACP

 Chief of Staff, MCDH

Many, perhaps most, hospitals in the US continue to face problems with not having enough supplies to fully respond to the COVID crisis.  The lack of readily available COVID testing remains a big part of that challenge.  Supply chains for medical supplies, including personal protective equipment, have been disrupted.  These supply chain disruptions are effecting more than just COVID related items, but also medications and equipment that have nothing directly to do with the pandemic.  Our hospital is certainly effected by this and in speaking with some of my colleagues who are working at other rural hospitals it is much the same story elsewhere.  There also seems to be a significant problem in coordination of efforts at state and federal levels that then trickle down to impact us locally.

To keep things in perspective, there is a bright side. As a society, we are making amazing strides in developing testing given how long it took to develop a test for HIV/AIDS for example, which was about 4 years.  We are into this COVID pandemic by only a few months.  And, of course, it is reasonable that resources be diverted to COVID “hot spots”.  Yet, one cannot help but feel frustrated.

Soon we will begin to start relaxing at least some of the shelter-in-place restrictions following the plan developed by our State leaders.  However, much of that plan calls for testing using either PCR or antibody, to accurately determine the true prevalence of the disease.  This type of testing is simply not readily available.

Last week, MCDH was poised to participate in a wide spread testing program through the Sonoma County Health Department that would have given us access to about 1,200 tests which would have been performed by the newly opened Chan-Zuckerberg Biohub Lab at UCSF.  We excitedly starting making plans to open free, drive through testing.  However, no sooner did the UCSF lab get up and running then it quickly became overwhelmed and we are now told not to expect any tests in the “foreseeable future”.

False starts, conflicting information and guidelines that change on a frequent basis seem to be the hallmark of our response to this health crisis.  Having said that, I remain cautiously optimistic.  We are slowly moving forward in our testing capability here.

One reason for optimism is that Adventist Health (AH) started managing our hospital this week.  We expect that this will increase testing capability and indeed, they were helping us out even before this recent step.  Due to their sharing of their limited testing capability, we have the ability to do the Abbott test, with its one hour turn around, but we only have enough tests to use them on patients admitted to the hospital.  We do have the ability to send out the test now to our sister hospital in Ukiah which has a larger analyzer.  Also, we still have the ability to send to Quest.  Turnaround times on the Quest test have improved and we have enough test swabs to move forward more aggressively in testing some of our population.

With a relaxation at some larger hospitals on the restrictions to do elective surgery, we are starting to get inquiries about the feasibility of doing pre-op COVID testing.  That is a service that we want to provide and are working to set up.

In the meantime, we remain fortunate in that the prevalence of COVID out here on the Coast is extremely low as judged by the fact that we have no patients getting admitted who are sick with the disease.  It remains our strong desire to be able to open up testing to the general community.  Our lab and x-ray departments are open for business.

 

Tabatha Miller

City Manager, Fort Bragg

Over the last couple of weeks, many of us have noticed an increased level of tension and anger in our community. This is not unique to Fort Bragg and is reflected in nightly news stories and social media postings. As City Manager, receiving public input in all forms is my job. I also understand that “the City” or “the government” is an easier target for that frustration and anger. Truthfully, things are never black and white and it is almost impossible to strike the right balance, the feedback is often fair and offers a different but valid point of view. I signed up for it. But some of what I see and hear isn’t just blame or anger directed at government. It’s frustration taken out on those who are just trying to do their job, live by the rules and contribute to our combined health and safety.

There are a few businesses which have and continue to operate in violation of the shelter in place orders. But almost all of the local businesses the City has investigated are legitimately operating within the current and sometimes complex 14-page County shelter-in-place order. What each of us would define as Essential is not necessarily what the Health Officer has defined as Essential.

We all know that the City relies on the transient occupancy tax (TOT) and sales tax generated by the hotels and other local businesses. But so does the community. These businesses provide jobs, generate local income that is spent locally and contribute or sponsor many of our community events and nonprofit organizations. These folks are neighbors and friends who like all of us are just trying to survive COVID-19 and the economic aftermath of the shelter-in-place orders.

 

 

I have spoken with several hotel owners and operators who are trapped by the state and the county’s shelter-in-place orders. When they tell potential guests that they cannot rent them a room, they are yelled at, spit at and receive scathing online reviews. The Police Department has had to respond to several calls to handle these outraged “guests.” Many of the online travel services are still taking reservations. These applications aren’t set up to screen for essential purposes or to know when the orders will be lifted. So those who made the reservations are angry when they can’t check into the hotel and many local citizens are angry that hotels are still taking reservations.

When hotel operators go through the efforts to vet a guest to ensure that they are traveling for essential business, the guest is insulted by the intrusive questions and requests for documentation. Finally, if a guest is confirmed as on essential business, and parks in front of the hotel, some become the target of verbal harassment, social media posts and shaming. Same goes for the hotel who may be reported to law enforcement for violating the order.

Fair or not, the shelter-in-place orders require that many businesses have to assist with enforcing the orders. In government, this is our job – again we signed up for it. But it isn’t what clerks, cashiers, bank tellers, or restaurant workers agreed to do. Businesses have a significant list of social distancing protocols that they must develop, implement, post and enforce. Their staff, those folks working on the front lines so that we can continue to have food, healthcare and basic services must also enforce mandatory face coverings, good hygiene and six-foot distancing, just so the business can operate.

Please, these individuals do not deserve to have our frustrations or anger directed at them. Like all of us, they are trying to follow the rules, make a living and survive. They are not taking a political stand or making a statement; they are just following the law. Why are we fighting with each other? We should support our local businesses and their employees. We are all in this together and we should look out for each other.