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Robin Kish: Communities around the world are responding to the COVID-19 pandemic. Like many regions in the U.S., Palm Beach County has expanded testing for all residents to help slow the spread of this deadly virus. How do you begin designing a massive testing operation for 1.3 million people? We asked the Health Care District of Palm Beach County's Lead Pharmacist how she's helped write the prescription for COVID-19 testing, one patient at a time. Today, we take you behind the scenes of Coronavirus testing on this edition of Here for your Health. Welcome to the Health Care District of Palm Beach County's podcast, Here for your Health. I'm your host Robin Kish. The Health Care District is a unique healthcare system located in Palm Beach County, Florida. We provide County residents access to primary care, hospital and school health services, skilled nursing, and long-term care and lifesaving trauma and air ambulance services.

Through all of these programs, the Health Care District focuses on filling the gaps in the healthcare delivery system and being the safety net for Palm Beach County. The coronavirus pandemic has placed the Health Care District on the front lines of the COVID-19 response in Palm Beach County as we test patients of any age with, or without symptoms, at multiple sites throughout the County. On this edition of Here for your Health, you'll learn how a pharmacist has paved the way for testing of over 20,000 patients for COVID-19. Our guest today is Dr. Hyla Fritsch, Executive Director of Clinic Operations and Pharmacy Services for the Health Care District and the District’s C. L. Brumback Primary Care Clinics. Welcome Dr. Fritsch.

Dr. Fritsch: Thanks. It's good to be here.

Host: Doctor, can you share with our listeners, how a pharmacist helped launch such a massive operation now having tested over 20,000 patients for COVID-19?

Dr. Fritsch: Well, with a lot of help, seriousness though, it was an incredible team effort over the past two months. Really none of this could have happened without the leadership and support of the Health Care District’s Chief Executive Officer Darcy Davis, and the Chief Medical Officer, Dr. Belma Andric, along with my incredible team. And they're really the ones who made this testing a reality. Currently the Health Care District is operating the largest drive through testing site in Palm Beach County with the support of Palm Beach County Emergency Services, the Florida National Guard, and State of Florida emergency management. Additionally, we have a smaller drive-through site in Belle Glade and walk up testing sites in Belle Glade, Jupiter, Delray, West Palm Beach and Lantana. The Lantana facility is dedicated primarily to first responders.

Host: Dr. Frisch, tell us a little bit about when you learned you would be spearheading a drive through testing site to serve the 1.3 million residents of this County.

Dr. Fritsch: Well, I'll back up a little bit in this story. Even before our stay at home orders had been issued on March 13th, and talk of a drive-through testing site had started, we had prepared for and started testing for COVID-19 at some of our clinic locations. And then everything changed. The County and State worked out plans utilizing the Florida National Guard to set up a testing site, but they needed a provider to actually perform the testing. And we of course were that provider. So the team came in on Saturday before the Tuesday, when the drive through testing site would open and we developed the plan, worked out the logistics and prepared for opening on Tuesday.

Host: Sounds simple, right? The drive-through testing site was planned for the FITTEAM Ballpark of the Palm Beaches in West Palm Beach. What were your initial thoughts about having the site there and the challenges that it presented?

Dr. Fritsch: Well, the first challenge was we'd never even seen the site before. So we quickly pulled together some aerial photos of the ballpark and working with the County Emergency Management and the Florida National Guard and our team here, we identified where the drive through area would be staged. Then we had to design our testing protocols so that the County and national guard could then start their processes for traffic controls, signage, and how they would coordinate the non-testing part of the site.

Host: Okay. So let's take this piece by piece. What went into the decisions on the testing protocols?

Dr. Fritsch: Our first priority was designing a process and flow that would ensure the highest level of safety for our staff and the patients who would be tested. So we looked at the site and discussed different scenarios about where to place, check in, how the check in process would work at the site, where the nasal swab test sample would be taken, how the test sample would be packaged for delivery to the lab. Each of these pieces of course had their own challenges. So as we went through each step that Saturday before the Tuesday opening, we mapped out a very efficient and safe process. Early on, it was established that patients would need an appointment in order to be tested. There would be no walk-up testing and everyone had to be in a car to drive through for the test. When at the testing site, all car windows were required to remain closed, except when we needed information or we were actually administering the test.

As patients arrived in their cars for their appointment, they would first be screened to confirm if they actually had an appointment. We wanted that to take place before the patient was in the actual line for the test. So nothing would slow down that line. From that point, patients would drive to the next tent location where our staff with all the appropriate personal protective equipment, such as masks would obtain any additional information we needed. Confirm if one or two people in the car were being tested and place the appropriate testing kit under the windshield wiper for each car, then the next step in the drive-through lane would be the tent where the nasal swab test is actually performed. Again, staff were equipped with all of the appropriate PPE in this case, masks, gloves, face guards, head covers, and gowns. After testing the test file had to be appropriately stored and prepared for shipping to the lab. Another team who handled the post-test process at the testing site.

Host: So I can imagine the care and planning that had to go into every one of those steps was paramount to ensure that staff and the patient's safety was maintained.

Dr. Fritsch: Indeed, we walked through all of the different scenarios that could occur in this process. And there were many contingencies that we had to prepare for. We tried to lock down the process very tightly since this is how you ensure a smooth and efficient process, as well as the greatest amount of safety for everyone on your team.

Host: You mentioned that appointments were required for this site. Does that mean you had to make preparations before testing?

Dr. Fritsch: Oh, definitely. There is a lot of pre-work the days that lead up to a patient's testing appointment, we set up a dedicated number for patients to call and schedule their COVID-19 test. Our call center team performed a brief registration of the patients into our electronic health record. And then they scheduled that appointment.

Host: Why were appointments required? We've seen on the news that some test sites don't require appointments. You can just show up.

Dr. Fritsch: Well, appointments were critical for the number of tests that we would be performing. We're testing over 400 patients a day at that site. So after a patient was scheduled for an appointment, another team at the office would prepare the test kits for the following day. So for each test, an order had to be dropped in the chart, a lab requisition was printed. And so that we could also print the patient labels. Then the vials were labeled with those patient labels and then double checked and bagged. The test kits with the labeled vials were then placed in the box alphabetically by name in the appropriate lane of traffic. So they could quickly perform the next day when the patient arrived for their test. Then at the tent prior to the testing, staff would confirm the information on the test file and make sure spelling, and all other information was correct. If there were any errors, we were able to quickly print another label right there in the field, but we could never have administered as many tests each day, if we were printing every patient's label right there at the testing site.

Host: Can you share how many people staff the call center, the test kit preparation, and the test site on testing days?

Dr. Fritsch: Well, for an operation like this, it definitely takes a village. So our call center has 25 staff receiving calls and scheduling appointments. There were 12 to 15 staff preparing test kits each day. And at the test site, we would have anywhere from 20 to 40 staff, depending on the number of lanes that we had open for testing.

Host: And of course you had a lot of support, like the Florida National Guard, helping with operations and the County, a lot of hands on deck. So when did the testing begin and what was the response the first day? I understand the phone lines just lit up.

Dr. Fritsch: Yes, they definitely did. Our first day of taking calls for scheduling was March 30th. And the actual testing started the next day. The Health Care District’s testing hotline received 50,000 calls in the first hour of operations. We tested 255 people the opening day, which is a smaller number than typical. It was kind of like a test run for our first day.

Host: Why do you think you saw such a high demand and what did you think of that?

Dr. Fritsch: Well that people needed our services. People are concerned. They wanted to know what their status was. Did they have the virus? We were the first testing site to offer a large scale testing in Palm Beach County.

Host: How did you know how many appointments to schedule each day? Especially with that initial demand.

Dr. Fritsch: We started small to make sure our process was solid and everything flows smoothly. And then we would open additional lanes based on the demand for testing and the number of kits we had on hand. Some days we only had two lanes that averaged around 400 appointments total. And then some days we had four lanes operational, which actually would book about 800 appointments in total. We wanted to reach as many people as we could as quickly as possible.

Host: What's the turnaround time on test results. And how are patients notified?

Dr. Fritsch: Well, really the turnaround time is determined by the lab. We typically see results in five to seven days. Sometimes the lab is able to provide them faster. We call patients with the results as they come back to us.

Host: Earlier in this podcast, we had talked about anyone can come to be tested regardless of their age, or if they're symptomatic. Why was it decided to go that route?

Dr. Fritsch: Well, Robin, as I'm sure you're aware a person can be positive for COVID-19 and be completely asymptomatic and unaware that they're infected. So they don't know that they're spreading the virus. The goal is to test everyone that wants testing. This helps identify people who may be contagious and it helps suppress that spread of the virus.

Host: So now how many sites is the Health Care District operating for testing?

Dr. Fritsch: Well, we're currently testing at seven locations, seven locations spread throughout Palm Beach County.

Host: So the access has increased over time.

Dr. Fritsch: Yes, definitely. We started with our one drive-through testing site, and now we have multiple sites throughout the County.

Host: And what type of reporting are you doing on the testing?

Dr. Fritsch: Oh, we're very good at that. We track everything we possibly can. We track positive and negative results. We track ethnicity, age genders, zip code. We provide reports to the County and also report all positive cases to the department of health epidemiology department.

Host: So behind the scenes, I know every day in the command center, as we call it, you can see charts with numbers, covering white boards from wall to wall. What do all those numbers represent?

Dr. Fritsch: Yes, we definitely had a lot of whiteboards in our command center. We had to be able to plan the amount of appointments we can schedule ahead of time and to be able to track the amount of kits that were used in order to get accurate numbers for the County and to track for replacements. So we tracked appointments that were scheduled tests that were performed, damaged files, no shows. And in case of drive-through sites, the number of lanes that we use that day, it was a lot of information on a lot of whiteboards.

Host: How demanding is this role in terms of work hours for you and your operations team?

Dr. Fritsch: Oh goodness. At the beginning it felt like we worked around the clock. I actually didn't see daylight for several weeks. My team and I were putting in 14 to 16 hour days to make sure everything was operationally at its peak. We made a lot of adjustments to our processes and oftentimes had to accommodate for rapid changes due to circumstances that were outside of our control, such as the weather. It was exhausting, but I have an amazing dedicated team who always gave a hundred percent.

Host: There's so many moving parts to this process from scheduling appointments to picking up the testing kits and then delivering them, to packaging individual lab kits for each of the patients to the testing outdoors, which is safer. But as you said, it's dependent on good weather to collecting the samples, getting the samples to the lab, contacting patients with results, paperwork throughout; what would have been the biggest challenges along the way?

Dr. Fritsch: Well, really the biggest challenge, and I think the cornerstone of success of the operation, has been to try to account for every scenario and mitigate as much as we can behind the scenes so that the field teams are in the best position they can be to help as many people as they can in the best way possible. Weather is a big challenge for us when we have a weather event here, which as you know, happens a lot in South Florida, we have to shut down our drive through and outside testing facilities, if there's lightning or excessive rain. And when that happens, we have to go behind the scenes and redo all of those steps. So printing requisitions and labels and building those kits, it literally has to all start over again, sometimes that's 600 to 800 test kits in one day while we're still trying to make the kits that are coming up for the following day. We had a quote that was written on one of our whiteboards that really sums up what we did. It was from Walt Disney, quote: “It's fun to do the impossible.” And I have to say, I feel like my team did that every single day and, and continues to do it throughout this entire process.

Host: Well, it's been a remarkable undertaking. As a doctor of pharmacy, what does your training and experience bring to this important role?

Dr. Fritsch: Well, that, it's a funny question and I actually think about it a lot. My pharmacy training has really taught me to problem solve and to think on the run, pharmacists in general are great multitaskers. So that's a huge asset in an operation like this, but my actual pharmacy training and education, really not too much. What really did help prepare me was my role with the County Emergency Management Team as a participant in their exercises for hazard events, including like bioterrorism training and natural disaster response. I was able to pull from that training a lot during this time. I mean, it's all disaster management, just in this case, it was a different kind of disaster. I was also part of our response to the H1 N1 outbreak in 2009. So I use some of that history to help with this as well

Host: As the number of tests now climbs toward 25,000, Dr. Fritsch, how rewarding has this undertaking been for you?

Dr. Fritsch: Well, it's an amazing feeling. I mean, I'm a really big advocate for public health and I'm grateful to be a small part of such a big undertaking that is helping so many people. I mean, it really is a humbling experience.

Host: It must feel good to see some of the thank you signs that patients display on their car windows or any feedback that you get.

Dr. Fritsch: Oh, absolutely. And we do get that. It's great for my team. I love that they see, that they see it in the moment as they're testing. We have patients that have signs that say, “I love you” and “Thank you, Angels.” And we get all kinds of feedback through our social media. And I really think that this is making a huge impact on our community. And that is absolutely our goal.

Host: So we're looking at this from a couple months in perspective, but what do you think testing is going to be like for the future?

Dr. Fritsch: Well, I think it is important for everyone to know that testing for this virus remains an essential part of our ability as a community to manage this contagion. It will be with us for a long time until an effective vaccine is developed. There are so many unknowns about symptoms and whether or not someone can get the virus multiple times. The Health Care District is increasing access with two new mobile health clinics that are hitting the road in the County to neighborhoods and underserved areas. We recently rolled out our newest mobile coach that we affectionately call “Scout”, which is being paid for through the County, by the Cares Act funding.

Host: So the story continues. We'll have to catch up with you maybe a few months into this and see how Scout and some of the other sites are doing with all the testing. Dr. Fritsch, thank you so much for joining us today and sharing how the Health Care District’s health care heroes ramped up operations in just two days to roll out what is the largest test site in Palm Beach County, one that has tested over 20,000 patients in the first two months of operation. Please check out our other Health Care District podcasts at Health Caredistrictpodcasts.org. If you have a suggestion about a future podcast, topic, have any questions or just want to offer some feedback, please call (561) 804-4111. Today's podcast is brought to you by the Health Care District of Palm Beach County. If you or someone, you know, needs a medical home, please encourage them to call the Health Care District’s C. L. Brumback Primary Care Clinics at (561) 642-1000 to make an appointment for a medical visit or for testing, or you can visit www.brumbackclinics.org.