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ARHS Physician Provides Insight of Preparations and Operations with COVID-19 Case Increase

Lisa Kaufmann, MD, who is Appalachian Regional Healthcare System’s Medical Director of the hospital medicine group.

By Harley Nefe

As the number of positive COVID-19 cases continues to increase throughout the High Country, community members may be concerned whether the local healthcare system, Appalachian Regional Healthcare System, has adequate resources and if it can handle the rise in cases.

“We’ve been seeing cases for a while, but of course it has picked up considerably (recently), and I know there’s an appropriate worry in the community about having acute care capacity,” said Lisa Kaufmann, MD, who is Appalachian Regional Healthcare System’s Medical Director of the hospital medicine group. The hospital medicine group cares for all nonsurgical adult patients that are in the hospital.

Kaufmann said she has an interest in infectious diseases and before she joined ARHS 6.5 years ago, she was on the faculty of the State University of New York, where she was a part of the state emergency response system. Therefore, Kaufmann keeps an eye on infectious disease epidemics in other countries. 

“When I saw the reports out of China, I got together with our infection control nurse and the really talented person who operates our materials management department, and we talked about needing to be prepared,” Kaufmann said.

Kaufmann noted that ARHS began preparing quickly in the spring and was ready to have a safe place to put COVID-19 patients before they ever received their first case.

In March, ARHS implemented a 24/7 incident command center as part of its emergency response plan. Leaders from every ARHS department took a role in planning for COVID-19 surges.

Some of the arrangements ARHS made involved renovation of three units in the hospital that are now fully established in order to take care of a total of 23 COVID-19 patients. One is a COVID-19 intensive care unit which treats more severe cases. A second area was converted into a COVID-19 unit for people who are less seriously ill, but still need to be in the hospital. The third unit is an overflow area. Repurposing these units to care for COVID-19 patients was not an easy task. In additional to installing new medical equipment, many of the rooms needed to be retrofitted for negative pressure – meaning relocating walls, ceilings and HVAC ductwork needed to occur. During these conversions interdisciplinary teams worked around the clock for weeks to make sure the units were completed.

Regarding personal protective equipment (PPE), Kaufmann said ARHS has been very proactive and has actually never run low. “We’ve had to make some changes, like with which company we deal with if they were running out. But we’ve actually done really well with the PPE, so we’ve never had a day where there wasn’t the equipment that the staff needed to protect themselves,” Kaufmann said. “Some of that’s planning and some of that’s the commitment of the administration to put the energy and the resources behind getting the equipment, so that the staff are adequately protected.”

Over time, the recommendations and guidelines for the COVID-19 situation have changed. Back in March, there wasn’t the initial recommendation that every visitor that came to the hospital should have worn a mask

“The recommendations have changed over time as people get more knowledge about how the virus actually behaves, and we’ve modified what we do,” Kaufmann said.

Now, every hospital staff member wears a medical grade mask all the time, even if they are just around each other with no patients present. When staff are with patients, they wear eye protection no matter what the patient is there for. In addition, all visitors are tested when they go to the hospital.

“Now that there’s so much illness in the community, even if people come in for something else, and they test negative, they could be incubating it. So because of that, we all are wearing protection, all the time,” Kaufmann said. “If people want the community to be safer, it’s really, really important that they wear masks and clean their hands. People over the age of 2, unless they have mental impairments — or some other reason that they cannot wear them — should wear a mask when they are around people who aren’t in their household. If people were doing that, we wouldn’t be having a surge here. We’re choosing as a community how we handle things and all choices have results.”

Every day, all of the hospitals in North Carolina report to the emergency management response system to provide an update on bed occupancy, their ventilator inventory and how many of those ventilators are being used. Therefore, the entire state has an idea of where people might be running short on equipment and where it can be sourced.

“We’re comfortable that there are other resources that will come to help us if we need it. But we would really prefer to not see the people that we know from the community and from church – or friends and fellow community members coming in with an (COVID-19) infection they could have avoided. It’s very sad to see people you know socially come in really sick,” Kaufmann said. Regarding staff morale Kaufman commented, “Our people are working more shifts than normal; we are working quite hard, but certainly at this point we are able to take care of what we are getting.”