Every part of health industry adjusts to COVID-19 outbreak, from ER care to physical therapy

The scenes at hospitals across the world have been described as war zones, as the fight against COVID-19 escalates.

Southeastern Idaho may still be in the calm before a potential storm.

And emergency room doctors like John Conner at Portneuf Medical Center are waiting on the front lines. He said he has not had to evaluate a confirmed COVID-19 patient yet, but the state reported Friday night there were more than 180 confirmed coronavirus cases and three deaths in Idaho. A dozen of those cases were in Eastern Idaho, counting a third case confirmed Friday in Bannock County.

PMC has safety measures in place that continue to evolve as the environment changes. All visitors and patients are being health screened, no visitors are allowed with few exceptions and other measures are in place. The up-to-date policy is available at portneuf.org.

While Conner said he had not met a confirmed coronavirus case at the center, he said he could have unknowingly. PMC is only issuing coronavirus tests for those who require hospitalization.

“We are seeing some people who are afraid that they might have it. We are seeing people who have symptoms and might have it,” Conner said. “We are seeing the usual: Hip fractures, hip dislocations.”

He said he evaluated a woman Tuesday who had some symptoms associated with coronavirus but did not fit the guidelines for receiving a test and was therefore sent home without being tested.

Conner advises people to self-isolate to flatten the curve so that hospitals are not overwhelmed.

“The scary part is if our system is overwhelmed, the medical care delivery system is overwhelmed and I get the virus and I can’t come in and take care of you and you have the virus or anything else: heart attack, stroke, pneumonia,” Conner said. “If 40 or 30 percent of the actual care providers are home sick, what can you do? How can you provide care for everybody else who needs it?”

On top of quantity of staff, the number of acute-care hospital beds could also be a concern in the state.

There could be from nine to 11 hospitalized coronavirus patients per one acute care hospital bed during the peak of the outbreak, according to the Associated Press.

“Regarding bed utilization, hospitals have crafted processes and strategies as part of their emergency response planning and are refining them in light of this outbreak,” Idaho Hospital Association spokeswoman Darryl-lynn Oakes told the AP. “This can include a number of actions and is based on both the community need and the needs of the individual patient.”

While hospitals prepare for an influx of coronavirus cases, where does that leave other places in the health sector, such as those involved with mental health, physical therapy and even eye care?

For places in Pocatello, it means continuing their services even after Idaho’s shelter-in-place order Wednesday, but with caution and safety.

Amid the coronavirus crisis, all options were on the table for the South East Idaho Behavioral Crisis Center in Pocatello, including closing down, according to its executive director Matt Hardin.

But it was decided that it would continue to run 24/7 as Hardin said it was deemed essential. The crisis center will reach its one-year anniversary in April and Hardin said it has around 30 employees.

“Just because there’s a virus that’s very serious and should be viewed as serious, that doesn’t discount drug use, suicidal ideation, psychosis — all the things we deal with on a daily basis,” Hardin said. “Those things just don’t go away.”

Hardin said the building is being sanitized in the same way it was before for protection against anything from flu to HIV. People are being health screened at the door and referred to a primary care doctor if they show symptoms of coronavirus.

Hardin said those with coronavirus will not be denied at the door, but they will be kept separated from the rest.

“If there’s a confirmed case and they are extremely suicidal or if they're going through a psychotic episode or something, we still want to help them as much as we can,” Hardin said. “We wouldn’t say that they can’t come in, even though we would take extreme measures.”

There has been a slight dip in visitors to the crisis center, but there could be a reversal in this stressful climate, according to Hardin.

“Financial stress is huge with mental health and substance use, so I think this could ricochet back in our numbers at any given time and that’s just kind of the nature of our business anyways,” Hardin said. “Sometimes we dip and the next day we have 20 people in the building.”

Just like the crisis center, Physical Therapy Specialists of Idaho sees itself as essential.

”One of our main objectives is pain management,” said Corey Rasmussen, the owner of the physical rehabilitation company. “If we’re not open, those patients are going to the urgent cares and emergency rooms to try to get treated for pain and they already have their hands full dealing with the virus.”

While Physical Therapy Specialists of Idaho attempts to continue to treat customers effectively, it is also applying additional safety precautions.

Rasmussen said equipment and tables are more spaced out and sanitized immediately after use. All of his therapists wear gloves and a customer is denied at the door if they have any symptoms of illness, even if it could just be from allergies.

Physical touch is still used for manual therapy if necessary, such as by applying pressure for joint stiffness after surgery.

Even with new protection measures, Rasmussen said the number of people coming in is declining, noting it has been cut by a third in the past week.

“No. 1 is the community safety and be able to be available for PT services,” Rasmussen said. “But at the same time from a business standpoint, I need to be able to provide a safe environment for my employees (first off), which I feel like we’ve done. And two, give them a quality of life that they can make their payments on their houses and their bills and food on the table.”

Alameda Vision Center in Pocatello has seen fewer patients too, and new restrictions have been implemented because of Idaho’s shelter-in-place order.

The vision center is asking customers to avoid coming in for nonessential reasons, such as getting prescription sunglasses, according to its assistant optical manager Brent Ashcraft.

Appointments can still be set up if someone needs a new prescription or to treat an eye ailment, among other reasons. The center recommends each patient is accompanied by no more than one person.

Ashcraft also noted it will take time for people to receive new frames because of disruptions in manufacturing caused by the coronavirus outbreak.

“A lot of framing manufacturers buy parts from China and elsewhere in the world, like Italy. Italy’s a big supplier. So with Italy on lockdown, the companies said we can’t do anything about it,” Ashcraft said. “Most people are understanding.”

The vision center is trying to serve its purpose as an eye care facility while also applying additional sanitation measures. If a patient asks for the refractor, called a phoropter, to be sanitized before they use it to test their vision, their request is fulfilled to put them at ease even though the phoropters are already cleaned after every use anyway.

“We just have to be very diligent in cleaning after every single person,” Ashcraft said. “People still want to come in and get seen. But for those patients that don’t, we completely understand. We don’t have a problem with waiting until things get a little bit clearer to see them again.”