Health care workers, public face stress, uncertainty in pandemic’s first year

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Of all the changes brought about by COVID-19, among the most prominent has been the impact on hospital and medical staffs battling the pandemic as well as on the mental health of all, from first responder to the average person.

There is little that is the same, comparing life pre-pandemic to now in regards to working at the hospital, said Marian Martin, R.N. and Emergency Department manager at Bonner General Health.

Of its 25 beds, Bonner General has eight rooms set up for COVID-positive patients, with the rest dedicated for labor and delivery, postpartum and acute/critical care. The hospital has seen an increase in sick employees, resulting in staff shortages, and the increase in cases has pushed the Sandpoint hospital to near capacity.

“Overwhelming at times,” Martin described a typical shift. “Although the numbers of patients are similar or slightly less than usual, COVID patient care is much more labor-intensive due to the isolation precautions required.”

She is concerned not only about patient care but also about her co-workers — will she and her co-workers be able to stay healthy so there is enough staff when needed.

“Emotionally, it is wearing, there is no end in sight and how will we do it without enough staff,” Martin said. “There should be a work/life balance and for the staff in the Emergency Department that has been difficult because we are always asking them to work extra.
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Comparing life now to before the pandemic reached U.S. shores a year ago in Washington state, spreading to Idaho by mid-March, and looking toward the future, Martin had a simple message on how to get there: Take care of each other.

"Please wear a mask, just to help your fellow people,” she said. “It is as simple and polite as opening the door for someone. Just do it for the sake of your loved ones. If you don't wear a mask, social distance, and wash your hands frequently to help decrease the COVID cases, there may not be enough staff to care for all patients who are in need of care for all medical needs and illnesses.
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Kevin Knepper, CEO at Kaniksu Health Services, said one of the changes KHS has seen over the past year has been an increase in behavioral health patients as a higher rate of people experience or see increased rates of depression and anxiety.

Before the beginning of the COVID-19 pandemic, there was already a shortage of behavioral health specialists available in the area. At Kaniksu Health, there are currently 12 individuals working in the behavioral health program, he said.

“[That shortage has] been exacerbated. In our depression screenings, depression shows up much more,” he said, “There are more instances of depression being a co-morbidity.”

One silver lining for patients, Knepper said, is that there has been a decrease in no-show rates for people seeking help for mental health problems, because patients suffering from conditions like depression often find it easier to meet virtually than in-person.

“It’s actually led to what I would term better patient access,” he said. “The no-show rate is [usually] super high, because they’re suffering from depression and things that make it harder to show up in-person.”

Health care as a whole has also changed, he said, with moves toward more telemedicine and even more thorough safety protocols. Those telemedicine appointments tend to work well for adult patients, he said, but are more challenging for pediatric care.

Health care professionals have also been struggling with many of the same issues their patients have in addition to working to provide care, Knepper said.

“We’re just burnt out, tired, frayed,” he said. “And then you add how tedious the safety practices are, to make sure you get it right, to make sure you don’t accidentally create a high contact exposure.”

KHS is the largest primary care provider in the area, Knepper said. Because of that, they have been administering many of the COVID-19 tests. That also means that for the individuals running the testing clinics, there’s a high risk of viral spread if thorough safety precautions are not met exactly.

At the beginning of the pandemic, Gov. Brad Little shut down most operations in the state, the the KHS responded in kind, Knepper said.

Eventually, KHS reopened with new safety protocols: Front door screenings, temperature checks and mandatory masks, which proved the most controversial.

Even given those safety measures, one wrong move could mean risking exposure for front-line workers, he said.

“[The testing staff are] seeing anywhere from 40 to 100 positive patients a day,” he said. “It’s tedious.”

Now a year into the pandemic, the uncertainty surrounding COVID-19 has moved from questions about the virus itself to those concerning vaccine rollout, and acceptance.

“Much like the beginning, there was a lot of fog [concerning the virus],” he said. “I think that same fog is around the vaccine now.”

Timelines for vaccine rollouts have been unclear, he said, often changing day-to-day. There is also uncertainty about vaccine acceptance.

“We live in a community where vaccine acceptance may be low,” he said. “That’s something we’re trying to feel out, what levels of supply we have and what level of public acceptance.”

To do that, he said, the KHS health care providers are looking at previous years’ vaccination rates for the flu vaccine. In Idaho, flu vaccinations for adults 18 and older were at 41.4%, according to data from the Center for Disease Control.

Regardless of how popular vaccinations are, Knepper said, achieving herd immunity through vaccinations will be essential if the public wants to return to any semblance of normalcy anytime soon.

“It’s time to do what’s right for the community and not just what’s right for yourself,” he said. “If we don’t have wide acceptance of the vaccine, we’re going to live like this for another year.”

Cindy Barnes, an advanced practice registered nurse who works at several of Panhandle Health’s local clinics, said at the beginning of the pandemic staff were blindsided — but the changes made due to the pandemic also led to innovation that will help her provide service long-term.

Telemedicine, Barnes said, has been a huge benefit.

“It’s something we thought about for years now but never did,” she said. “it’s this visual one-on-one that’s even better in some ways.”

Although telemedicine does have drawbacks in the case when patients need to be examined, overall the service has been effective and helped in providing care for patients with depression and anxiety, Barnes said.

At the clinics she works at, much of the care is centered around family planning, STD treatment and some primary care — particularly for new residents who haven’t been able to establish another primary care provider yet.

More recently Barnes said she also took on a project to help promote staff health.

“It’s just been fun, which sounds strange,” she said. “[But] we have these creative women that want to care for their co-workers … it’s been fun for me.”

Bonner County EMS Chief Jeff Lindsey said his crews had a pretty good idea of what they were dealing with given their experience with respiratory illnesses. However, they did not know how prolific the novel coronavirus would be in the community.

They kept close tabs on medical response in some of the nation’s hardest-hit communities such as New York City, Lindsey said. They also resolved to hew to Centers for Disease Control & Prevention guidance for healthcare workers, even though that guidance would sometimes change.

“We just made the decision from Day 1 that we were going to stick to CDC guidance,” said Lindsey.

The department also made a conscious decision to sidestep the politics of the pandemic and follow the emerging science and make sure that the county’s patient population and frontline EMS workers were kept as safe as possible.

“I don’t care about the rest of it,” Lindsey said in reference to the politics surrounding the pandemic, such as the wearing of masks.

Bonner EMS converted one of its back-line ambulances into a COVID-19 transport vehicle. Plexiglas was installed to create a barrier between the driver and the patient compartment and employed other measures to minimize exposure to medical supplies and other equipment.

However, the department was responding to three or four COVID-positive cases per day at the height of the pandemic, which required the use of frontline ambulances, which would then have to be disinfected with a fogging device, a process which takes about an hour.

Lindsey said a half-dozen EMS employees contracted the virus, but have since recovered. The department also leaned on a Stanford University study which showed that lab ovens could be used to sterilize masks and extend their useful life, which proved essential when there was a run on personal protective equipment.

The pandemic did, however, facilitate Lindsey’s goal of stationing emergency medical technicians and paramedics for up to six months instead of rotating them out to the county’s other stations. It helps employees take pride in their station, allows them to get to know other first responders and patients in the community.

“You learn your area,” said Lindsey, who was already migrating to a longer-term staffing model before the pandemic took hold.

Lindsey said EMS workers have acquitted themselves admirably during the pandemic. They respond to calls without complaint day in and day out.

“I can’t say enough about our frontline EMS employees that I get the privilege of being the department head of,” Lindsey said.

Bonner County Commissioner Jeff Connolly said the biggest shifts during the pandemic involved conducting public hearings remotely over video services and finding ways for employees to work remotely.

“We’re getting used to and we’re getting better at it,” said Connolly.

But Connolly acknowledges that Zoom video conferencing and other video-sharing programs are not for everyone, especially those who are not as technologically savvy as those who were born or raised in the digital era.

Connolly believes tech-aversion is reflected in the smaller number of people who dial into remotely to participate in public hearings and meetings.

“Public engagement is off, which isn’t great. But we are still able to hold our [land use] planning hearings and get the job done,” he said.

Connolly said some public hearings prior to the pandemic would attract 50-60 people. The remote hearings draw in crowds of 15-20, he said.

However, Connolly believes the county is seeing enough public engagement to get a proper sense of the variety of their views.

Bonner County Road & Bridge, the sheriff’s office and EMS department are operating the closest to pre-pandemic functions.

“All of the emergency responder-types are definitely still working at the same level that they were,” said Connolly.

Connolly believes counties and municipalities should have a better say in how federal pandemic relief funding is apportioned.

“Each person in the layers of government that touches it, the more confusing it is,” he said. “We know what the community needs are.”

Craig Northrup, Caroline Lobsinger and Victor Corral Martinez contributed to this story.