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

Coronavirus Information

2020 Festival of Hearts Recap

With Grateful Hearts

February 2020 Bonners Ferry Herald

Fry Healthcare Foundation Board members received a demonstration of the new Bipap and Ventilator
funded at the Festival of Hearts. Right to Left – Kevin Callos, Vice President; Phyllis Karnes; Janis Kerby, Secretary; Patti Duscher, BCH Cardiopulmonary Manager; Preston Becker, BCH CEO; Jenny Fessler; Ed Sample; and Blanche Studer

With grateful hearts, the Fry Healthcare Foundation Board of Directors has announced that the Festival of Hearts gala raised over $52,000 this year. Most of the money will be used to help fund the recently installed 3D Mammogram equipment at Boundary Community Hospital.  Tickets sold out early with many tickets going to the sponsored tables.

The atmosphere was elegant and the food prepared by the master chefs at Kootenai River Inn was delightful. Teresa Rae, Treasurer of Fry Healthcare Foundation and Boundary Community Hospital Trustee Dennis Dinning joined forces as emcee and auctioneer extracting high amounts for the auction items while keeping the event fun and relaxed.

The Dessert Dash returned this year and was a rousing success, raising $6,605.75.  “This fun event has tables pool their money to be the first to choose from all of the wonderful desserts donated by local businesses and bakers. The extra dollars and cents in the total are important as tables strategized on what to bid and which dessert the table wanted to win,” said Teresa Rae.  It is a fun way for everyone at the event to participate and share the desserts with many take-home boxes providing an extra amount to share.  A special thank you to the restaurants and individuals who created the beautiful and delicious dessert array.

During the event, many of the attendees raised their paddles so the Hospital can purchase a Trilogy 100 BiPap and Ventilator for emergency and respiratory therapy.  According to Patti Duscher, BCH Cardiopulmonary Manager, “We may not need to use the BiPap and ventilator very often, but when we do, it will save a life. We appreciate the generosity of the community in funding this essential, life-saving equipment.”

During the Festival of Hearts, Dennis Dinning and John Mace presented a check for $3,306 to Fry Healthcare Foundation from the “For the Ones” Corn Hole Tournament to benefit the 3D Mammogram Capital Campaign.

Boundary Community Hospital Trustee Dennis Dinning with his cousin John Mace presented a check for $3,306 which were the proceeds from the recent For the Ones Corn Hole Tournament. “John and I believe that the Corn Hole Tournament was a success and we’re glad we could have an event to bring awareness and help fund 3D mammogram exams for this community.  A special shout out to the sponsors of the Corn Hole Tournament – Mi Pueblo Restaurant, Edward Jones Investments, Riverside Auto Center, Bonners Ferry Veterinary Clinic, JB’s Tire and Automotive/Les Schwab Tires, Boundary Tractor, Boundary Abstract, Super 1 Foods and VFW Post #3622, as well as everyone who braved the snow and participated.”

The Fry Healthcare Foundation and our community have raised $1.4 Million to benefit the hospital over the past 22 years. A heartfelt thank you to everyone in the community for your continued support of the Foundation and its fundraising efforts on behalf of Boundary Community Hospital.

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Early Detection

Early Detection – Tests That Can Save Your Life

By: Susan Layeux, MD
Boundary Community Clinic Medical Director
March 2020 Bonners Ferry Living Local

Screening for the most common cancers is highly recommended by organizations like the American Cancer Society (ACS), the American Academy of Family Physicians (AAFP) and the U.S. Preventive Services Task Force (USPSTF).  As primary care providers, it is our goal to detect treatable cancers early, to decrease the burden of disease and death.

Many people decline screening tests because they do not have symptoms.  But the reality is, most cancers do NOT have symptoms in their early stages, when they are the most curable.

The four most common cancers are: Prostate (in men), Breast (in women), Lung, and Colorectal cancer.

Lung cancer accounts for more cancer deaths than colorectal, breast and prostate cancer combined.

Some current screening recommendations:

  • LUNG cancer screening is recommended for any person age 55-80 who has smoked the equivalent of 1 pack per day of cigarettes for 30 or more years, and is either still smoking or quit less than 15 years ago. That is done with a limited (lower radiation dose) CT scan of the lungs.
  • COLORECTAL cancer screening is recommended for all adults aged 50-75. The three most common ways to screen: 1) Colonoscopy every 10 years; 2) a stool test for blood and DNA shed from cancerous/precancerous cells (current one on market is Cologuard) every 3 years; 3) or a stool test for blood, every year. Colonoscopy is still considered the “gold standard”, and people must understand that if they have a positive screen in one of the stool tests, a diagnostic Colonoscopy will then be recommended.
  • BREAST cancer screening is recommended for all women from ages 50-75 using a 3-D Mammogram. The various societies have disagreement with how often to screen between the ages of 40-50, and the interval of screening (every 1 or 2 years). Much depends on family history.
  • PROSTATE cancer screening recommendations have changed. The only current available test is a blood test called PSA (prostate specific antigen), used to test men from ages 55-69. However, it is an inadequate screen because a high PSA is not only seen with cancer. It can be high because of an enlarged prostate or a prostate infection. Screening is individualized based on your history.

The details about benefits and risks of each type of screen can be found on the USPSTF website www.uspreventiveservicestaskforce.org.  They give the recommendations for the average person as well as every exception.  Our goal at the Boundary Community Clinics is to keep current with the guidelines and present each patient with the best recommended screening based on their personal and family history, and to answer questions about risks. The good news is, Medicare and most commercial insurances cover screening costs at 80-100%.

Early cancer detection saves lives. Please do not wait until you have symptoms to be screened. Talk to your Primary Care Provider about what screens are right for you.

The Time to Act is Now

The Time to Act is Now

By: Alana Temple, RN, BSN
Boundary Community Hospital

Heart disease is the leading cause of death for both men and women. Every year about 735,000 Americans have a heart attack. Boundary Community Hospital has made various efforts to improve cardiac care and outcomes for those presenting with heart-related problems.

Life Flight Network, Boundary Community Hospital and Boundary Ambulance work together in a Time Sensitive Emergency to get patients to the highest level of care as fast as possible.

On July 10, 2019, Boundary Community Hospital received designation from the Idaho Time Sensitive Emergency Registry as a Level II STEMI facility. This means that anyone seeking treatment due to cardiac issues from either Boundary Community Hospital (BCH) or Boundary Ambulance can expect to receive the best of care as defined by the Idaho State Registry guidelines. Two years of cardiac patient data were reviewed by state surveyors to ensure compliance with the designation.

When patients present to the hospital with chest pain, they must be quickly triaged. This begins with our Health Unit Coordinator, who is usually the first person on the hospital team that you will meet. When you state that you are having chest pain, they will quickly alert the Registered Nurse in the Emergency Department, and you will be taken into a room. Once your care begins, the guideline timer begins. Ultimately within the first 10 minutes of arrival into the treatment room, an EKG will be performed. This is the first diagnostic tool that is used for cardiac care. Blood will be drawn for laboratory testing, you will be placed on a cardiac monitor, and vital signs taken. You may be given baby aspirin to quickly chew.

A STEMI (ST elevation myocardial infarction) is the most life threatening cardiac event that can happen and quick intervention is the key. A STEMI is a very serious type of heart attack where a major artery to the heart has been blocked and it is detected on an EKG. Time is of the essence as oxygen and nutrient rich blood to the heart muscle is not able to circulate properly and causes damage. Once a STEMI is recognized, the goal of the TSE team is to have you on your way to a cardiac catheterization lab (the closest facility is Kootenai Health) within 90 minutes of the diagnosis. Cardiac catheterization may have the ability to re-open the blocked cardiac artery. In the course of the state survey, Boundary Community Hospital’s Emergency Team was found to meet and/or exceed all of these parameters.

Quick intervention is vital in any type of cardiac emergency. It is extremely important that care is initiated as soon as possible. Call 911, which will dispatch Boundary Ambulance with their life saving equipment and highly trained Paramedics. In addition, all Boundary County Sheriff’s Department patrol vehicles have been equipped with Automated External Defibrillators (AED). When a 911 chest pain is dispatched, the Hospital TSE Emergency Team is alerted so they can begin preparation.

Boundary Community Hospital is proud to have received the Idaho Time Sensitive Emergency Level II STEMI Center designation and will continue to strive to provide excellent care for our community. Together, we can save lives.

The Gift of Caring

For the Ones