Transcription:

Prakash Chandran (Host): This Ridgecrest Regional Hospital COVID-19 Podcast was recorded on April 20, 2020.

The COVID-19 pandemic is changing quickly and affecting communities across the United States in different ways. Ridgecrest Regional Hospital is closely monitoring the outbreak and working to ensure they are prepared and ready to take care of any patients that could potentially have the virus. We’re going to talk more about that today with Jim Suver, the CEO of Ridgecrest Regional Hospital. This is a podcast from Ridgecrest Regional Hospital. I’m Prakash Chandran. So, Jim, let’s just start with how are things going at Ridgecrest?

Jim Suver, FACHE (Guest): I think in some ways, we are very blessed that it is slow. We’ve had very few positive in the community and our inpatient census has been low and certainly we want people to be healthy. We’ve had good compliance with staff, our physicians in the community about using some of our drive through, having patients call us if they are sick prior to coming in and I think all these together have resulted in us being able to spend a lot of time preparing for a surge, if indeed that’s going to happen.

I think we’ve had some of the same challenges as other hospitals have had, shortage of supplies which is almost a daily occurrence monitoring that as well as some huge decreases in financial revenue that will later impact us a couple of months down the road.

Host: So, when you talk about some of those things in anticipating that surge, talk to us a little bit about what that means for you.

Jim: What we have heard from our peers around the country is if you do get a CV-19 surge, it happens very, very quickly and it happens exponentially. Where a week ago from having no patients in the hospital to having 20, all of which are requiring intensive care level support with half of those being on ventilators. And so, part of our surge capacity implementation has been to have some nursing units that are open and ready for overflow. It’s been making sure that staff is cross-trained, if we have to pull some of our clinical staff from our ambulatory services and have them help with inpatients. It means lining up extra doctors both in the Emergency Room, the hospital Medicine Program as well as intensivists.

Host: Now you mentioned that the numbers were low and I’m curious as to why you think that is. Like why are the numbers for Ridgecrest lower than the rest of Kern County?

Jim: I think there’s probably four things. One, I believe the state of California was very proactive with Governor Newsom in starting to do the Stay at Home and the social distancing. I think that helped kick start California and I think statewide, we’ve had less of an increase than people originally thought we’d have. Number two, it’s nice to be in a rural area. We are fairly spread out. We don’t have a lot of multistory apartment buildings. We don’t have a major university. So, our people have been able to Stay at Home, but we’ve also been able to I think easily practice social distancing.

The third thing is I just think are early efforts that stopped people from potentially bringing in CV-19 from other areas. People were very cognizant. And I suspect we probably have more people that have actually had CV-19 over the last several months but I think they stayed at home, they got over it and so we never saw them in the hospital. Right now we have four positives out of that. And the last one and probably the most sad one is we’ve not done enough testing. We’ve tested people that have come to us that have been ill. But we’ve not reached out into the community to see who potentially has it and is healthy enough to get through it without other problems and due to this lack of testing, we’re still at risk for the next several months to actually have a second surge assuming the first one doesn’t happen. If we let our guards down on the social distancing and the staying at home, we could actually have a surge because we’ve not done enough testing and I believe that’s a nationwide problem as well but for us is very, very acute. We have not had the testing supplies to do what I think is an adequate statistical sample for [00:04:16] and our employee base. Bases in town.

Host: Yeah, I know that there is right now just a significant focus on testing and results, and it is sad to see that there just aren’t supplies. Can you give us any sort of sense for when that might be rectified and for someone listening to this, who may not be exhibiting symptoms, what is the criteria in which they should go in to get tested?

Jim: I think people that have the symptoms that are mentioned on the CDC website. People that are having shortness of breath, they’re febrile, they have lost the sense of smell. But I also think, because we can rule in and rule out flu much easier, even if we don’t do a CV-19 test, we can test you for flu A and B and in many cases, just because flu season has lasted a bit longer; that actually can rule out CV-19. When things will get better, we actually got our Board of Directors to give us emergency funding to buy two new lab analyzers and so, we’re ready to start running tests locally which would result in the ability to do a lot more testing and a lot more rapid turn around rather than the one to two days we’ve been experiencing now where in the previous months we were waiting sometimes up to six days to get a lab result back.

The challenge is because of the government approvals required for the lab reagents which are the supplies that go in the lab analyzers, we have the equipment sitting ready to go, we can’t run any tests because we don’t have the necessary supplies to run the tests. We’re also cautiously optimistic that by the end of May, we should be able to do the antibody testing and again, these are just some delays through the approval process as many of the antibody tests right now come from China and have yet to be validated by our FDA.

So, it’s been a source of frustration for us. Certainly, the hospital has invested the money to do the testing, but we’re going to need a pretty consistent supply chain and that’s tied up with federal regulators.

Host: Yeah, that makes sense. And just for the lay person here, can you talk a little bit more about what the antibody test means? I think they understand that the test for COVID tells you whether you’re positive or not, but what is an antibody test?

Jim: An antibody test would indicate whether or not a particular person has actually had CV-19 and if their body has built up some immunities. That would mean that they are actually safe to go back to work, that they are no longer infectious. From what we know about the virus now, though we are leaning about the virus all the time; that this will actually rule out people that actually are safe to return to work including my hospital staff and things like police officers and many of our essential employees we can essentially rule out. That they would either already had it or they have a resistance to it and it’s a blood test as compared to a nasal swab which is what we use for CV-19.

Host: So, I just want to talk at a very high level about the staff that you work with who we very much appreciate. Have they had the supplies that they need? Have there been any concerns about how they stay protected as they perform tests for people that might have the virus?

Jim: Our staff have been great about following the use of personal protective equipment. And our patients have been great about calling first if they believe they have symptoms and our drive through actually took people out of the waiting rooms. We also shut down all of our elective services. We went to Telemedicine for our clinics. For some of our essential services like radiology and lab patients wait outside and they are called in one at a time. And we’ve also from a management point of view, been very careful at looking at the number of days. We have an inventory of various supplies and when we thought we would not have enough to handle a surge or to handle inpatients and keep our staff safe; that’s when we decided to close off many of our outpatient services, mainly due to lack of PPE.

Host: It really sounds like you’ve been very proactive around making the right decisions as they come about, and I know a part of that has to do with the hospital preparedness plan. I know we hear a lot about – in the news around hospitals having plans in place to make sure that they are ready when situations like this occur. Can you talk a little bit about what that looks like at Ridgecrest?

Jim: Well we’ve been really blessed to have a very strong disaster preparedness plan and staff that know how to execute and particularly this one which is more of a clinical one. You may not know Prakash, that we actually had an earthquake here last July which gave us time to get all of our disaster preparation up and some of the hard assets such as tents and generators and some of those things. So, the experience as horrible as it was from the earthquake, actually made this a little bit easier. I think we’ve been able to tailor it and because we’ve not had an exponential surge here and in fact, we’ve had no positive inpatients at this point; we’ve had more time just to perfect our processes and take it at more of a controlled rate as compared to say some of the cities on the east coast that have had an exponential increase and have had to move very quickly. We’ve had time to think things through.

Host: Let’s talk about reopening plans. Are there any?

Jim: Yes, we actually now have moved a little bit off surge preparation since we think we’ve had enough focus on that to how are we going to reopen. And even though we’re going to follow guidance from our local health department as well as our state; we also have an obligation to get reopened for some services as quickly as we can because there’s other health issues in our community besides this virus. And we’re very worried that people are not seeking care for things that they ought to seek and a couple months down the road, their symptoms are going to be far more acute or they would have been in pain for two months unnecessarily. And so, one of the first things we want to reopen is our physician offices and even though we’ve been doing a lot through Telemedicine, Telemedicine doesn’t work for everything.

And with the reopening of our physician offices, then our diagnostic services as well. That’s probably what we’re hoping to do hopefully in the first part of May. Again, we’re going to have to look at the statistics as well as follow guidance from our government as well. But again, I’m very, very concerned that – we want to make sure all healthcare issues in our community are being addressed and I think the longer that we stay at home, the more some of these issues are going to build. We’re also very worried about the mental health of our community and another reason why we would like to look at the first weeks of May for the diseases of despair. Because this is very hard on many people to be out of being able to socially interact with other human beings. And that’s another concern we have and that’s why we’d like to make sure potentially our mental health is open as well.

Host: Well this has been hugely informative. Jim, is there anything else that you’d like to share with our audience before we sign off here today?

Jim: We appreciate everybody doing the right thing. Looking at what our community has done. We see people with masks. We see people being six feet away from other people. We see a lot of our businesses which I know is economically devastating but closed down. We’ve had great cooperation with our city government. So, I wanted to thank the community for that.

Host: Absolutely. Thank you all so much and thank you Jim. I really appreciate that. That’s Jim Suver, the CEO of Ridgecrest Regional Hospital. Thanks for checking out this episode of Ridgecrest Regional Hospital Podcast. Head to www.rrh.org/covid19 for more information. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.