Dr. Sarah Durney

Dr. Jake Merrell

Terry Odom

• 
• 
• 

As we watch the national and global scene unfold in reaction to the novel coronavirus pandemic, it may be tempting to feel helpless and trapped in this never-ending-quarantine.  

We would like to offer some updates on where we are with our community and some thoughts looking forward.

How many cases are in Wyoming?

The SARS CoV-2 virus which causes COVID-19 disease is already in our Wyoming community.  Most of the cases we are diagnosing in Wyoming are from patients without a known travel connection or COVID-19 exposure. Because of limited testing supplies, and effective self-quarantining of residents the true number of cases are unknown. It is already here. As of Tuesday, there were 29 reported cases in the state, with zero deaths reported.

How do symptoms present?

The virus frequently presents with nonspecific symptoms including a scratchy throat, mild fever, body aches, sinus congestion 5% of the time, abdominal pain/nausea is rare. Approximately five days later, respiratory symptoms start. This is usually a dry cough but can include shortness of breath and deeper bronchitis-type symptoms such as wheezing or a more severe cough.

Most individuals (80%) will have mild symptoms, 5-10% will have moderate symptoms — possibly requiring oxygen, and 5-10% will need more aggressive management with ventilator support. Many patients under the age of 20 are asymptomatic and can spread the virus unknowingly.

This virus is more contagious than the flu and carries a significantly higher morbidity and mortality rate.  

What is our community hospital doing?

Powell Valley Healthcare (PVHC) has worked quickly, setting up incident command over two weeks ago! Incident command is a group comprised of leaders in all departments of the hospital and some community representatives. This group meets daily to discuss how best to keep our patients and community members safe. Because of the restriction to keep group gatherings below 10 individuals, we are using virtual conferencing with phone and internet.

Early in March, even prior to having any cases in Park County, PVHC closed the care center and hospital acute care units to public visitation. This measure is an attempt to minimize any potential exposures to our most vulnerable patients, residents and healthcare workers. We then proactively initiated employee screening questionnaires, which monitor all employees for symptoms and prevents ill employees from working in the facility.

At the same time, all patients, visitors, and vendors were required to complete the screening questionnaire with questions recommended by CDC and WY Department of Health. Patients with respiratory symptoms were given masks and taken to their rooms quickly for evaluation. We began calling patients with significant medical conditions and patients over 65 in our outpatient clinics to reschedule them.

PVHC has been aggressive and proactive in protecting our community while maintaining the fine balance of patient care and outpatient service.

Currently, PVHC is performing limited outpatient surgeries and requires all surgical patients to be subject to a five-day self-containment prior to surgery. We are using our paramedicine program to take international normalised ratio (INR) testing to elderly patients’ homes to minimize risk in that vulnerable population. This week we started screening family practice patients in their cars using our questionnaire and will triage patients based on the screening. In addition, we are eagerly developing a telemedicine program to be available for patients who may need visits by phone. 

What do I do if I think I may have the virus?

If you have respiratory symptoms such as cough, sore throat, mild fever, or sinus congestion, please call ahead! Do not come into the clinic to be seen if you are symptomatic. We can do a lot over the phone! Together, we can decide if you require an in person evaluation or if it is something we can monitor with you at home.

All of these measures are an attempt to mitigate exposure to others and decrease the spread of COVID. We are trying to “flatten the curve.”

You can probably expect us to recommend self-quarantine if you have mild symptoms.

This means staying at home and isolating yourself from family members as much as possible; we will recommend keeping other family members home during the quarantine, and requesting a friend or relative perform essential grocery shopping errands. That individual should leave groceries on the curbside to minimize exposure.  

How is PVHC working with the community?

In regard to local networking, PVHC has been working with local assisted living facilities to help initiate preventative measures to protect the highest risk cohort (those over the age of 65). Information is being exchanged with local private practitioners. We are in regular contact with the Wyoming Department of Health and are updating our strategy and guidelines daily in compliance with their directives. We developed a COVID hotline for community members with questions. PVHC is actively sharing all new bulletins through social media and news outlets.

In addition, one of our ER physicians, Dr. Aaron Billin, is working with Park County, serving as the Park County health officer. He has been instrumental in disseminating information to our local businesses and community members, and has been working with both hospitals, providing recommendations.

How is PVHC managing the global medical supply shortage?

Our administrative leadership is daily monitoring supply and is actively working to conserve and procure valuable personal protective equipment such as gowns and masks as we struggle alongside hospitals all over the nation to get supplies. (Please do not take masks and gloves from our hospital.)

Globally, we know ventilators and PPE are in short supply.

Is there any hope? Where is all of this going …?

As we continue to watch this unfold, we offer some rays of hope.  

Nationwide, there are already many grassroots groups constructing masks and face shields for medical personnel on the front lines. Automakers and vacuum companies are working to manufacture more ventilators, field hospitals are being constructed to handle additional capacity (in Seattle), and groups of scientists and doctors are working toward developing antidotes and vaccines.

In regard to a possible antidote or medical treatment, we are seeing several promising drugs. Our colleagues in Seattle are trialing an antimalarial medication, hydroxychloroquine, on patients with severe symptoms — and they are seeing good preliminary results.

Their findings echo some of the positive data coming from China and South Korea. There are definite risks with this medication, and we currently have a national supply shortage with the medication.

It seems there are some foreign companies who may be willing to help supply doses for us in the near future. There are also several other antiviral therapies showing promise.

In regard to a vaccine, this will likely take time to go through FDA approval and is unrealistic as a treatment for the very near future.  

Nationally, we are working quickly to improve hospital capacity and generate more reliable supply chains to provide ventilators, personal protective equipment, and medications.

 Though there is promise, at this point we are relying on mitigating damage by staying home. Our healthcare system needs us all to work together to prevent the spread of COVID-19. We are buying time for treatments to be developed, hospitals to be equipped, and capacity expanded. 

One last thing…

As physicians and healthcare leaders in our little community, we are thankful for all of you and humbled at the outpouring of love for our neighbors.

We hear of individuals offering to deliver groceries, businesses that have remodeled their services to provide take home meals, and organizations that have creative ways of networking individuals with childcare.

We are blessed to have so many generous and selfless people serving in healthcare, the police department and in public leadership.   We truly have so much to be thankful for.

Finally, we just want to thank all of you for your sacrifices and for staying home during this uncertain, scary time. Please do not give up! Stay home for the health of our neighbors!

If you have any questions or concerns, you can call and speak directly to a clinical team member at 307-754-1242.

(Dr. Sarah Durney is the medical director of the Powell Valley Healthcare Clinic, Dr. Jake Merrell is the PVHC chief of staff and Terry Odom is the CEO of PVHC.)