Summer 2020 CNA Graduation

Hospital Celebrates CNA Graduation

July 30, 2020 Bonners Ferry, ID

Boundary Community Hospital (BCH) and North Idaho College announced the graduation of the Summer semester Certified Nursing Assistant (CNA) class in Bonners Ferry.  Congratulations to the new Certified Nursing Assistants: Gracie Adams, Aidan Webster and Malin Worley, who will all be working at the BCH Extended Care Facility, and Nina Byler, who will be working at Sunset Home.

Standing (l-r): Gracie Adams, Aidan Webster, Nina Byler, and Malin Worley with Instructor Kris Patterson, RN in front.

Whether at the local hospital, or at home with in-home services, the person more than likely helping take care of your personal needs is a Certified Nursing Assistant (CNA).  A CNA is someone who has completed a certification course that includes classroom, lab, and clinical experience to ensure they are able to provide personal care in compliance with the state’s regulations.  Over the past eight weeks, our newest graduates have learned the ins and outs of what it means to be a CNA in Bonners Ferry.

With time spent training with nurses at Boundary Community Hospital, the students come away with an appreciation of the dedication and skills needed in the real world. Boundary Community Hospital and North Idaho College are very proud and excited for these CNAs to take on their roles throughout the community. Gracie Adams praised their instructor, saying “We couldn’t have done it without Kris!”

Next semester at Boundary Community Hospital in Bonners Ferry begins August 18 through October 15, 2020.  Space in the class is still available, so contact Kris Patterson, RN at Kristine.p@bcch.org or call (208) 267-3141, Ext. 4312 for more information.

Nursing in Boundary County

COVID-19 Update to the Community July 29, 2020

Hospital COVID-19 Update to the Community

July 29, 2020

Bonners Ferry, ID – Now that COVID-19 is present in our community, the Boundary Community Hospital COVID-19 Task Force made up of department leaders and medical staff has been meeting frequently to implement internal protocols so that we can meet the increasing challenges to keep our patients, nursing home residents, employees and community safe.

The BCH Clinical Medical Laboratory has some of the best COVID-19 laboratory testing in the area.  With improved testing capability comes responsibility to ensure prompt results to the providers ordering the tests.  Everyone is anxious to get the tests done if they have been exposed or think they have been exposed but keep in mind:

  • All tests require a Physician/Provider order faxed to the lab. Your provider may want to wait through a period of time after exposure to ensure an accurate test.  CDC recommends 5-7 days after exposure before testing.  It will depend on a number of factors which will be discussed with your physician/provider before the test is ordered.
  • Once the Lab order has been sent from the physician/provider, the patient should call the BCH COVID-19 Pre-Registration Line 208-661-5668 to pre-register for the test.  The pre-registration line is open from 8 am to 11 am Monday through Friday. The patient will be placed on a call back list for the next available pre-registration clerk to register the patient.  Please have insurance information ready. COVID-19 testing is not available without pre-registration. Patients MUST be pre-registered before coming to the Hospital for testing.
  • Once the patient is pre-registered, information about testing check in and process will be provided. COVID-19 testing of pre-registered patients is offered 10 am to 1 pm Monday through Friday.
  • Due to high testing volumes, be prepared to wait your turn. Testing is performed curbside with the patient remaining in the vehicle.

Emergency Check In – For the safety of everyone, including patients and staff, the Emergency Department has instituted curbside triage before accessing Emergency Services.  Patients driving in should park in the designated Emergency Check-in Parking spot under the Ambulance Bay and call the Registrar phone number listed on the sign.  Once checked in and screened, a nurse will come out to assess/triage and give further instructions.  If you are in an emergency situation, please call 911. As always, the Emergency Department is ready 24/7 to serve you and care for our community.

Outpatient (Non-COVID) Lab Testing – Non-COVID-19 lab testing is available Monday through Friday 7 am to 5 pm. Drive Up Lab Testing is available Monday through Friday 8 am to 3 pm. Park in one of the designated parking spots by Outpatient Services and call the number to register.  The lab tech will come out and take the needed samples at your car.

Visitor Restrictions in Place – All patients, visitors and staff are screened (including temperature checks) upon entering.  Everyone must wear a mask while in the facility.  BCH promotes social distancing “Western Style” and asks that everyone maintain a 6’ distance (the average size of a bear) from each other.

The BCH COVID-19 Task Force stays connected with Boundary County Emergency Management, County officials, Panhandle Health District, local hospitals and health care facilities as well as State agencies.  “We are always analyzing the current information, sharing our concerns and needs with other facilities, all while maintaining the healthcare needs of our community during this pandemic,” says Hospital CEO Preston Becker. “As a community hospital, we strive to provide the highest quality healthcare with compassion and respect. I am encouraged by the innovative thinking, the constant assessment, and desire to do what is best for the patient that is part of our daily discussions.”

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Lab Testing in Boundary County Part 1

Laboratory Testing for COVID-19 in Boundary County

By: Greg Botkin, MD, Medical Director, Boundary Community Hospital

Part 1 of 2

Dr. Greg Botkin

I will try to teach this using questions and answers:

1) I am somewhat skeptical about COVID (SARS-CoV-2) tests after all the critical reports I have heard in the news. Does Boundary Community Hospital have the kind of lab tests we need for meaningful results?

I think skepticism is understandable at this point. The tests everyone had in the early months of the pandemic were of questionable reliability, and we are still not sure how accurate the published numbers were. But the world’s best biotech companies were working on the COVID problem from the beginning, and in recent weeks they have brought out technology which should be far more reliable.

Our Hospital has pushed hard to obtain these products. We have now put together a set of instruments and reagents that should be as accurate as any testing platform in the country. By the time this article is published we will have run almost three hundred tests here in our lab. The results merit a high degree of confidence. When we inform patients about the presence or absence of active disease we believe we are providing the most accurate report that medical science can now provide.

2) How were you doing COVID testing before you had in-hospital tests?

We took the nasal swab here at the Hospital, sealed it up and shipped it to the state lab in Boise, where they tested with technology supplied by the CDC. That biochemical process was developed very early in the pandemic and was far from ideal, especially if one is transporting samples from hundreds of miles away. We sent tests from about a hundred Boundary County residents; all registered negative for active disease. Some of us question the accuracy of those results. We began in-house testing as soon as we received everything we needed for solid technique.

3) There seem to be many different kinds of COVID lab tests. Why isn’t testing simpler?

It would be simple if we were counting germs in a Petri dish. This is complicated because the body’s response to an invading virus is highly complex. Part of the challenge is to make a test that targets only the SARS-CoV-2 virus. A positive test must show a reaction to SARS-CoV-2 (the COVID virus) and nothing else. And it must be sensitive enough, theoretically, to detect every sample that carries the virus.

The BCH Clinical Medical Laboratory has several machines to perform COVID-19 tests.

4) Sort out the different COVID tests for us. Which one do I need?

We should draw this out on a chalk board because the molecular biology is a beautiful thing. That will have to wait. Think of it like this: if you think you might be acutely ill with COVID we need to test you for active viral presence. The virus organisms multiply rapidly in the body after one is inoculated; our tests should be able to detect viral particles about a week later, when one begins to show symptoms of infection. When the infection has run its course the virus is harder to find because your immune system has identified it and torn the viral organisms apart. There are some exceptions to this, and if you hear about individuals who test positive for months it does not mean they are harboring an active infection. It means that for some poorly understood reason our tests are still sensing viral fragments.

In our lab here we have three tests which work very well to detect active viral presence. Two of these detect the virus’ RNA (usually called a PCR test), the other detects a specific viral protein (usually called an antigen test). We need a nasal swab to run either of these tests. If we think one of our patients might be actively infected we confirm this with at least two different tests, and then we repeat the process with a second sample a few hours later. If final results are positive it means (subject to the limitations mentioned above) that you have an active COVID infection, and that you are infected now.

These tests are being run with increasing frequency in our Boundary Community Hospital laboratory. The demand may become heavy enough that we run into some logistical limitations, so if you find yourself in a slowly moving line please be patient with us.

There are pressing reasons to know which of us are carrying an active infection, and we are now capable of providing that intelligence with a reliable test that takes about thirty minutes to show results. You will need a physician’s order to have the test done here. The Hospital web site provides details about what one must do to be registered and have a sample taken by lab personnel.

5) What about antibody tests? They were supposed to answer all kinds of questions about COVID, like how far has it spread, and when can we safely go back to work, play, and school.

Antibody tests are very different from the PCR and antigen tests described above. Scientists, physicians and policy makers have great hopes that antibody testing will draw back the curtains and show us just how far this virus has invaded society. Our hospital is fine-tuning our antibody testing technology and it should be ready to serve our community very soon. I will write more about that next week.

Due to the increased number of tests requested locally, Boundary Community Hospital is limiting COVID-19 testing to 10 am to 3 pm Monday through Friday. Your provider will tell you where to park to register for the lab tests when they write the order and send it to the lab. Lab Techs will take the samples at your vehicle and send the results to your provider.

TSE and COVID-19

Here to Help – TSE and COVID-19

By: Wanda Wilkerson RN, BSN, CEN
June 4, 2020

Boundary Community Hospital, Boundary Ambulance, and Life Flight Network work as a team to get patients to the highest level of care as swiftly as possible for better outcomes.

The Covid-19 Pandemic has had many negative impacts on the medical field, but one unanticipated impact is on community members who are experiencing Time Sensitive Emergencies (TSE) like stroke and heart attack.

When the Pandemic began, all across the nation people were directed to remain at home and not come into hospital emergency departments (ED) in order to avoid overtaxing front-line emergency staff. People listened, they stayed home and self-isolated and watched the news and became more fearful. According to the Washington Post, ED volumes have been down by more than half all over the country. This in itself is not a bad thing until you wonder what has happened to all the heart attack, stroke, and trauma patients. From the highest acuity to the lowest acuity, people seem to be avoiding needed medical care out of fear of infection from the Covid-19.

It is extremely important to seek medical help for those emergent time sensitive events such as Heart Attacks, Strokes, and Trauma; for those times when every second counts to save heart muscle and brain matter; for those times when any delay in care and medical treatment can have a huge impact on the health of the patient and their families for the rest of their lives.

The news media have placed the fear in us to the point that many very sick people are not following up with their physicians or seeking emergency care, or even calling 911 for an ambulance when it is needed. There is so much misinformation out there resulting in people often not knowing who or what to believe. The increased stress alone would have us believe that there would be more heart attacks not less.

According to the Washington Post: “A report to be published by the Journal of American College of Cardiology on nine high volume Cardiac Catheterization labs across the country found a 38 percent drop in patients being treated for a life threatening event known as a STEMI – the blockage of one of the major arteries that supplies oxygen-rich blood to the heart. The study compared what happened this past March, when Covid-19 cases were climbing, with the treatments delivered from January 1, 2019, through Feb. 2020.”

The number of Stroke patients seeking medical help is also down by 30 percent in emergency departments as reported by the Washington Post.

Don’t delay if you recognize any symptoms of a STEMI heart attack which include chest pain, shortness of breath, dizziness, nausea, sweating, and possible pain up into the jaw or down the arm. Stroke symptoms include facial drooping; arms drift downward when asked to hold them up, as well as slurred speech. If the person shows any of these symptoms, call 911 immediately. Fast emergency medical services (EMS) transport to the hospital with pre-hospital notification that they are on the way can save valuable time when time is of the essence.

“Please seek medical attention when you or your loved ones need it,” says Emergency Nurse Wanda Wilkerson, RN. “Boundary Community Hospital has changed what we are doing and have new regulations, policies, and guidelines to help keep you and your loved ones safe as well as keeping the hospital and emergency staff safe. The key is to make sure people with symptoms overcome their fear and get prompt treatment that may save their lives or avoid long-term complications of untreated heart attacks and strokes.”

Boundary Community Hospital has been designated as a Level II STEMI, Level III Stroke, and Level IV Trauma Center by the State of Idaho. The designations for the Hospital are part of the Idaho Time Sensitive Emergency System (TSE) and are reserved for Hospitals that meet the stringent criteria established by the State as part of the statewide TSE system of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack.

PT Dry Needling

Dry Needling for Pain Relief

Dr. Jessica Seaburg, PT, DPT, OCS
Boundary Community Hospital Rehabilitation Services

By: Dr. Jessica Seaburg, PT, DPT, OCS
Boundary Community Hospital Rehabilitation Services

Dry needling is a technique physical therapists (PTs) use for the treatment of pain and movement impairments. You may have heard of the “opioid epidemic” and be concerned about how to manage pain without these addictive drugs. Dry needling can be a big part of the solution. It is an effective and very safe way to resolve muscle pain without pain medicines and their side effects.

What does dry needling look like?
During the treatment, a PT will insert a very thin, solid, “dry” needle, one without medication, into a muscle. This allows the PT to target trigger points, which are taut bands of skeletal muscle that may not be treated effectively by massage. PTs wear gloves when dry needling and observe all relevant safety guidelines.

Does dry needling hurt?
The sensation experienced with dry needling is typically a deep ache or cramp, which quickly subsides within about 30-60 seconds. Often the muscle will twitch or jump as the needle is inserted.

What can I expect from dry needling?
Dry needling is like pressing a “reset button” for the muscle. People typically have immediate improvement with pain and the ability to move the problematic area. It is common to experience some mild to moderate residual soreness for 1-2 days after treatment. Most people are nervous before receiving dry needling and then say, “Wow, I’m glad I tried that!”

What conditions can dry needling help?
Because dry needling treats muscle pain, it is especially helpful for conditions such as muscle strains, trigger points, tension headaches, and post-surgical muscle pain. Many people think all their pain is coming from arthritis or disc problems, when in fact much of it is coming from their muscles – and this pain can be greatly improved with dry needling.

I’m scared of needles – can a PT help me without dry needling?
Absolutely! Dry needling is just one tool in a large toolbox. In cases when PTs use dry needling, it is one technique that is part of a larger treatment plan. PTs have a host of other effective treatment options to help reduce pain without dry needling. In my experience, however, combining dry needling with other therapeutic treatments allows patients to return to their prior level of function more quickly.

Is dry needling the same as acupuncture?
No. Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles and supported by research. While acupuncturists and PTs use similar types of needles, the assessment, technique, and purposes of the treatment are different.

Is dry needling safe?
Yes! PTs are experts in human anatomy and receive extensive post-graduate training to be certified in dry needling, so the risks are minimal. Your PT will thoroughly evaluate you and provide education on possible risks prior to treatment.

Want more information on dry needling?
Check out: https://www.choosept.com/dryneedling

Where can I get dry needling?
Dry needling is a specialty for Physical Therapists. You should look for someone who has completed extensive post-graduate training in “Functional Dry Needling” through KinetaCore or similar program with experience in dry needling in a rehabilitation setting.

Dr. Jessica Seaburg, PT, DPT, OCS is a Physical Therapist at Boundary Community Hospital who specializes in restoring functional movement and is a Board-Certified Clinical Specialist in Orthopedic Physical Therapy.

OT Myths and Misconceptions

By Dr. Yahtil Huaute, OT, DOT
Boundary Community Hospital
April 8, 2020

Yahtil Huaute, OT, DOT is the Occupational Therapist at Boundary Community Hospital.

April is National Occupational Therapy Month! There are plenty of myths and misconceptions about occupational therapy services, the providers, and the history. Here are the top 5 myths or misconceptions of occupational therapy:

1. Occupational therapists help you get a job. Occupational therapy addresses tasks that occupy your time, not your employment. Occupational therapists (OTs) can assist in work hardening skills to allow you to return to your employment, or in the ergonomics of your working tasks, however the term occupation is pertaining to tasks that occupy your time. This can include working, homemaking, caregiving for others, taking care of yourself, cooking, cleaning, shopping, driving, and so on. The goal is to get you back to living the life you want!

2. Occupational therapy is for old people. OT’s work with every age, from birth to death. Approximately 1/3 of the national occupational therapy caseload is with children, this includes newborns in the NICU, toddlers in early development, school age children, and older children all the way up to transitioning into college. In working with the pediatric population, therapist are treating the whole family to allow for the best outcomes. Many adults attend occupational therapy for a variety of reasons including hand/arm injury, job ergonomics, or debility due to illness.

3. Occupational therapists only work in a medical setting. OTs can work almost anywhere! The most common settings are school districts, private clinics, home health, nursing homes, and hospitals. There are less common settings as well, including mental health settings, programs in the community, or within a private company. Working in a private company allows therapists to address employee needs and to avoid work injuries through good equipment placement, proper body mechanics, and adjusting the environment to avoid repetitive movement injuries.

4. Occupational therapists and physical therapists (PTs) are the same. There is some overlap between the two, however OT is focused on what people need to do in their daily lives and PT is focused on strength and movement. For example, if you have a stroke, PT will work on restoration of movement, coordination, gait and balance whereas OT will work on tasks like feeding yourself, dressing yourself, and other tasks you need to return to your life. OT will also make recommendations for, and provide training with, adaptive equipment as needed.

5. OT’s just play games and do puzzles with kids. Kids learn through play, so the play is therapy in disguise. A puzzle can be used to work on fine motor skills, visual scanning, attention to task, and the ability to see patterns. Playing with a ball works on kid’s hand-eye coordination, timing, adjusting how hard or soft to throw the ball, and visual convergence. If a kid looks like they are playing during OT, then they are doing exactly what they are supposed to be doing. Play is essential to children’s growth and development.

Rehabilitation Services including Occupational Therapy, Physical Therapy and Speech Therapy are considered essential healthcare services. The team at Boundary Community Hospital offers appointments Monday through Friday in Outpatient Services with some pediatric telehealth appointments.

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April 15 2020 Hospital Update on COVID-19

Hospital COVID-19 Update to the Community

April 15, 2020

Bonners Ferry – Boundary Community Hospital has established a COVID-19 Task Force made up of department managers and medical staff which has been meeting frequently to provide guidance and discuss internal protocols as well as continuing to assess the ever-changing environment and regulatory direction.   Some of the changes instituted by the Task Force include:

Curbside Check In for Emergency in the Ambulance Bay off Kaniksu Street

Emergency Check In – For the safety of everyone, including patients and staff, the Emergency team has instituted a new process for accessing Emergency Services.  Patients driving in should park in the designated Check-in Parking spot under the Ambulance Bay and call the Registrar phone number listed on the sign.  Once checked in and screened, a nurse will come out to assess/triage and give further instructions.  If you are in an emergency situation, please call 911. As always, the Emergency team is ready 24/7 to serve you and care for our community.

Lab Testing – Drive Up Lab Testing is available Monday through Friday 8 am to 3 pm. Park in one of the designated parking spots by Outpatient Services and call the number to register.  The lab tech will come out and take the needed samples at your car.

Acute Care – The Acute Care/Emergency lobby is closed.  A video intercom has been installed so you can talk with the health unit coordinator directly about your needs. For Saturday Outpatient Services (Lab or X-Ray), please call ahead to make sure the paperwork is in order and they will give you instructions on where to park and enter the facility.

Extended Care – Strict visitor restrictions are in place for the extended care facility/nursing home.  The nursing and activities staff are doing a wonderful job working with the residents.  Community members have been sending in stories and pictures to share with the residents. Share your blooming photos via email to stories@bcch.org.

Rehabilitation Services – Outpatient appointments with Physical, Occupational and Speech Therapists are considered essential services and are continuing.  All patients are screened before coming in and some pediatric patients are being seen through telehealth.

Primary Care – Many patients still need to see their primary care provider for a variety of reasons.  With existing patients, Dr. Layeux and Mike Yourzek, PA-C are conducting telehealth appointments when appropriate.  The Boundary Community Clinics team have patients wait in their vehicle until a medical assistant can escort them directly to the exam room.

Housekeeping – The housekeepers wanted to know how well the cleaner that is currently used kills all living micro-organisms including viruses and bacteria.  The Lab took samples of areas in various departments and multiple surfaces cleaned by Housekeeping and then tested them proving that the current method of cleaning is eliminating all bacteria and viruses. Great job housekeepers!

Drive Up Lab Testing Monday through Friday near Outpatient Services off Comanche Street

COVID-19 Testing – If you have symptoms and believe you need to be tested, CALL your Primary Care Provider to be screened.  Tests require authorization by primary care providers following the CDC and Idaho Department of Health and Welfare guidelines for testing and the authorization of Panhandle Health District.  If you have the provider order and need the test, please use the drive up lab testing which is available Monday through Friday 8 am through 3 pm. A copy of the provider lab order must be faxed to the lab by the provider before you can be tested. Test results have been taking three to five days and are provided directly to your provider. All COVID-19 samples accepted at BCH are sent to the Idaho State Lab for testing at this time. These tests are recorded by County of Residence and not by where the samples are taken. As of 11 am on April 15th, 31 samples have returned negative and 10 samples are pending results from the Idaho State Lab.

Everyone at Boundary Community Hospital and Boundary Community Clinics are grateful for the wide community support for our team.  A special thank you to the Disabled American Veterans for the nebulizer which we were able to put into service immediately.  The Hospital Auxiliary has donated head covers for the Emergency, Surgery and Clinics teams.  The cloth masks, takeout food deliveries, good wishes and prayers help keep the morale up and our staff focused on the essential tasks at hand — Caring for Our Community, Every Day.

Some Thoughts on COVID-19 in Boundary County

Some Thoughts on COVID-19 in Boundary County

April 1, 2020

By: Greg Botkin, MD, Medical Director, Boundary Community Hospital

I will begin with an apology. If you are reading this with hope of finding scientific clarity you will be disappointed. I thought the best way to do this would be to address the questions that now haunt the people of our county.

Is COVID here? As of noon on April 1, we have no laboratory confirmed cases in Boundary County. The hospital has sent out 20 or so. 16 came back negative, four are pending. I think it a mistake to estimate viral presence by lab results. We may have had COVID in this community for weeks or months without knowing it. The signs and symptoms are often very mild.

How many of us will be infected? As stated above, there may already be some penetration into Boundary County. Corona Viruses are highly contagious and spread through a region pretty easily, especially if the population is immunologically naive. Isolation may slow this down. I do not believe it will stop it. I cannot guess at percentages because we have not yet been able to collect critical immunological data. That should begin to change this week as we start measuring IgG antibodies.

Are the isolation mandates reasonable? This is impossible to answer without good prevalence data. We hope we are slowing the surge in emergency departments and ICUs in the areas hardest hit, which now seems to be worth the sacrifice. I am watching the numbers from Singapore, wondering if lockdown really stops viral spread. Prescient governance with balanced liberties ought to be a work in progress. The ecology of COVID will be better understood in a few weeks; one would hope such intelligence would increasingly inform policy.

Why do a few people get deathly ill with COVID while many, perhaps most, have minimal symptoms? We don’t know. This is being looked at very closely. We are desperately trying to find treatments that block the metabolic breakdown we see in our most severe cases. Maybe it’s personal genetics, or past infections, or environmental exposures, or some combination of these. Thankfully extreme disease seems to be rare.

Are there things I can do, besides isolation, to lessen my risk? There are no shortages of folk remedies for COVID. Many are biochemically plausible. Garlic, fungi, zinc, Vitamin C, strong teas, Brazil nuts, etc. We have good research explaining the anti-viral properties of some of these measures, none of it specific for COVID. Do your homework and try these protections if you are so inclined. Getting outside for exercise, work, and gardening may be the best medicine of all, especially during the beautiful springtime weather just ahead.

Why has testing been so ineffective? The science of building a reliable chemical test is highly complex. It takes trial and error to get it right and no one had time for that. The biochemists brought us the best tests they could make. It was an amazing bit of chemistry but far from perfect. In addition, sampling technique must be precise for reliable results, and no one knew what made for best technique. Nasopharyngeal sample? Oropharyngeal? Bronchial washings? Automated or manual processing? Then came the shortages – not because of conspiracy or mismanagement, but because you can only cook so many pancakes at once and some people have to wait. The shortages necessarily forced eccentric testing philosophies. Whom should we test? Asymptomatic juveniles? Yesterday’s trauma death? The various tabulations are going to paint very different pictures of COVID’s virulence.

We are now looking back with the realization that many of the negative tests were probably false negatives.  There are estimates of 50% error rate in China, and what we have used here in the states through the CDC may not have been any better.

Expect a change this week. A new generation of very precise tests has been cleared by the FDA and is being shipped to the front lines.

Can we have some of those tests? Yes and no. Our hospital has been capable of doing this kind of analysis for a couple of years. We have the instruments here to run the most accurate testing protocols available with a turn-around time of about 45 minutes. Unfortunately all the new testing reagents are going to the areas hardest hit by the pandemic. We will begin next-generation testing the moment we receive our reagents.

Will we, the Boundary County public, know the results? We report numbers to the CDC as mandated so they can monitor trends. I believe locals should have effortless access to local data. Names and identities must remain private, so we must take care to publish results accordingly.

If I develop cold-like symptoms could it be COVID? Are there other viruses still going around? When we evaluate respiratory disease here at our hospital we screen for 17 pathogens that commonly cause upper and lower respiratory disease. This is a lab test. So we usually have a rough idea of active infectious disease in our county. There are currently a handful of pathogens that could masquerade as COVID.

If I get severely ill what can I expect? Is our hospital ready? I have been impressed with the work the hospital is doing to get ready for this. We have a college of well-trained and well-informed workers who are putting the pieces together with careful confidence. But please remember: when a Boundary County resident becomes ill they should expect support from a network of caregivers – not just our hospital. Your primary care provider will play a big part. Paramedics are ready for specialized transport if necessary. Suppliers will be needed for home oxygen and equipment. Our Panhandle Health District will assist us with organization, especially as we follow those who remain ill in their own homes. Kootenai Health in Coeur D’Alene or other hospitals in Spokane may be part of your care, and their state of preparedness is both smart and strong. Together we will master this, one case at a time, although none of us know how that will look.

I would like to cut through the fog and read the scientific papers myself. Can I do this? The journals I read are making daily updates. If you have access to the internet you can read the same reports. Look at UpToDate for clinical summaries. Their material is reliable, succinct and easily understood. Go to the American Society for Microbiology for molecular biology, epidemiology, testing and policy recommendations. The American Chemical Society covers the molecular details of the science, some of it very complex, some of it plain. These three publishers, along with many others, have established open access to their COVID-19 materials. Boundary County residents should take advantage of this unprecedented movement in scientific publishing.

What comes next? What comes next will be difficult. We will have some positive test results from people right here in our county. When you get that piece of news it may feel like the demon of plague has planted his feet on our soil and started swinging his scythe. We will feel even more frightened than we feel today, and we will be tempted to reach for whatever weapons we have in our defense.

In my mind something else is happening.

These positives, these members of our community who show current or recent infection, are the earliest pioneers of an emerging society. Some will be actively fighting this thing, crushing and shredding viral particles day by day, killing this disease, perhaps preventing it from coming to your door. Think about that. These souls will be quarantined, largely unaided by medical science, isolated from the community’s companionship, supported entirely by devoted (and co-infected) friends and family. Some positives will have finished that battle, perhaps effortlessly, perhaps through indescribable pain and struggle, a few having come within heartbeats of death. And some positives we may lose. These will be our most fragile neighbors, lost in that fight, lost in the same way we lose neighbors every year to influenza and norovirus and cold viruses and heart disease.

As we do more testing in Boundary County the number of positives will probably rise. This does not signal the end of our world. It does signal the need for unusual courage, careful analysis, and extraordinary compassion. Medical science cannot stop this storm. But it can assist a good community that is determined to gracefully and courteously push through to the other side. And after twenty three years of practicing medicine here I believe this is who we are.

Are you finished yet? Almost. I would like to tell you some of those things that crowd into my mind in hard times…because this disease, like so much in medicine, can break your heart. I would like to write some of the things I am thankful for.

I am thankful we have time to prepare. We can look at Italy and China and Seattle and try to calculate what might best serve us here. I am thankful for the personnel and infrastructure in our medical community, which I believe to be unusually solid. I am thankful for the heroes I work with, nurses and lab technicians and physicians, all these with families at home, putting on their gear and going out to do the exam, collect the samples and ascertain the extent of a patient’s illness, every time, every case. I am thankful for the brilliant and cooperative spirit I have seen in medical sciences worldwide, and for open access, for the internet, and for educational and cultural opportunities for those isolated at home.

I am thankful that winter is on the run, that the fields are ready for the farmer’s wisdom and the farmer’s seed, and that an extravagant inland northwest is about to dress herself in springtime’s glorious light and quickening perfumes.

I am thankful to be reminded of human frailty, remembering that it is common and universal, as are spontaneous expressions of human mercy. In our suffering, as in our instinctive turning to attend the suffering, we are opening for discovery the deeper and mysterious qualities of who we truly are, and the similarities now manifest in every region of the earth confirm our enduring place in the family of man.

I am thankful for our immune systems. I am deeply thankful that this virus touches our little ones with a light hand. I am thankful for those who have fought this virus and crushed it, for the way these raise their fatigued bodies and tested minds, and for the way they seize hold of today, ready to receive the best gifts their new world has to give.

 

Boundary Community Hospital and COVID-19

By: Preston Becker, CEO, Boundary Community Hospital

As tents pop up near the Emergency Rooms at other Northwest Hospital Alliance* Member Hospitals in our area, I felt it was important to reassure Boundary County residents that your local community hospital is prepared if we are needed.  Boundary Community Hospital, Extended Care Facility (Nursing Home), and Boundary Community Clinics’ priority is the safety of our patients, their families, our staff and our community.

These are some steps we have been taking to ensure the safety of all.

  • Our staff is prepared – we have annual training, drills and protocols in place for handling pandemics and infectious diseases. We have daily meetings with all departments to discuss any issues. Chinna McKechnie, RN is our Infection Prevention and Control Director and she is doing an outstanding job ensuring that all staff are properly trained and willing to care for any COVID-19 patients.
  • While some items are in short supply for ordering, we currently have the supplies we need and have been working on contingency plans to keep everyone safe.
  • Our nursing staff are managing visitor access and movement within the facilities (Acute, ED, Outpatient, Clinic, and ECF). Our Extended Care Facility and Hospital Acute Care are performing extra screening for visitors and volunteers. We remind everyone, if you are not feeling well, call the patient or resident you want to visit instead of coming in person.
  • We continue to network with Panhandle Health Department, Idaho Department of Health and Welfare, Northwest Hospital Alliance, Boundary County Emergency Management Public Information Officer (PIO), Boundary Ambulance, and Boundary County School District.
  • Signs and symptoms include respiratory symptoms and fever, cough and shortness of breath. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome and sometimes death. High-risk patients for severe coronavirus disease are older and have comorbidities (other health issues). Remember to stay home and call public health, or your healthcare provider directly, if you experience any of these symptoms. It is best for our healthcare providers to treat you over the phone.  Additionally, the Emergency Department is not the treatment of choice for COVID-19, and should not be utilized unless your symptoms become severe or emergent.

On an additional note, it is important that we maintain a healthy blood supply for our facility.  “In these difficult times, giving blood is something healthy individuals can do to help the sick. The only source for blood—literally in many hospital procedures, the source of life—is another human being,” said Dr. Ralph Vassallo, Vitalant’s chief medical and scientific officer. “We need people to donate blood today, while following guidance from the CDC and other agencies.”

We encourage our community to participate in the local Vitalant blood drive on March 17th at the LDS Church. It is absolutely critical to avoiding another public health crisis: not having enough blood to meet basic patient needs.

As of March 13th, there continues to be no confirmed cases in the state of Idaho. Our own Infection Prevention and Control Director, Chinna McKechnie, is staying on top of the information and guidance in order to be prepared as a front-line hospital organization. Our top priority is to protect our community and staff in the event of a potential outbreak and we are prepared to do just that.

Stay informed: The Panhandle Health District has a hotline dedicated to assisting the public. If you have any questions about coronavirus or think you may be displaying symptoms, call 1-877-415-5225 or visit their website http://panhandlehealthdistrict.org/

 

* The Northwest Hospital Alliance includes: Boundary Community Hospital in Bonners Ferry, Benewah Community Hospital in St Maries, Bonner General Health in Sandpoint, Kootenai Health in Coeur D’Alene, Shoshone Medical Center in Kellogg,  Syringa Hospital and Clinics in Grangeville, Clearwater Valley Hospital in Orofino, and St. Mary’s Hospital in Cottonwood.

 

March 13, 2020