An Interview with Lincoln County Health and Lincoln County Health District

by Val Mohney

We had the pleasure of interviewing Ed Dzedzy Public Health Administrator for Lincoln County and Tyson Lacy CEO of Lincoln Hospital and Clinics.

What is the hospital doing to be prepared for an outbreak in Lincoln County?

Tyson: We are doing our best to make sure we protect all our patients that come in, and all our employees that are already here. We set up a screening station so anybody that comes to our clinics or the main campus in Davenport are screened for temperature and symptoms of any virus. For those patients that do have some kind of symptoms we set up a curb side screening clinic. Thanks to the Lincoln County Sheriff department for loaning us their command trailer to be used as our outdoors mobile clinic. We are keeping people that have no symptoms separate from people that do, to make sure there is no commingling as people check in and out of the hospital, etc.

We also have a negative-pressure room. For those that may have symptoms and require an overnight stay while we are waiting for test results we can get them in a room and do our best to isolate them and keep the rest of the facility safe.

In our outlying clinics we’ve locked the door, no more waiting rooms. When patients arrive at the clinic, they call in, then, we meet them at their car, screen them and then escort them straight back to their exam room. This way, there is very little patient to patient interaction. They aren’t exposing each other, which also reduces staff exposure.

People have been really great about wearing masks coming into our healthcare facility. If someone presents without a mask, we present them with a mask and there have been no issues.

Ed: I think the majority of people of Lincoln County are doing their best to do what they can to help curb this virus. Even if they don’t really want to, when asked, they are putting on masks and respecting the mission. Also, Lincoln County Hospital has done a phenomenal job in communicating with public health what’s going on with their patients and staff. The hospital lab has really helped to expedite lab testing and reporting. If they get a positive, they are calling us as soon as they have it, instead of just entering it into an electronic system, which can slow everything down. This way, we know we have a positive case as soon as the hospital does. This really helps us to jump on those cases and identify their contacts and get people where they need to be for their protection as well the protection of the community. They’ve also been very helpful in helping us if we have people who are quarantined at home, to get the resources they need so they can stay home and not have to go out.

Tyson: We now have four different avenues we can test people. We are trying to make sure we have local testing capacity. For the national labs the best case scenario is 5-10 days for test results. Having somebody wait for test results that is home and trying to isolate for ten days straight can get tough. We have 24 hour turn-around test results for our surgical patients. With the help of public health, the county, and through the Cares Act, in a couple weeks we are acquiring a piece of equipment that will give us locally a 45 minute turn around, which will be a great resource for us. While we are glad to have the equipment, finding the kits…the tests…to make it work has proven to be more difficult. Ed, through public health, and through the state Crisis Response team has been able to find us supplies, which is very helpful. Overall, we have been collaborating closely with Lincoln County Public Health and it’s made a positive difference.

Ed: The other thing the hospital has done, and is doing, is maintain a tertiary relationship with hospitals in Spokane so if they need back up or they have a patient they don’t have the capacity to treat, that relationship is in place so they can quickly forward patients to a facility in Spokane for advance levels of care.

In the event of an outbreak in Lincoln County, what capacity would the hospital have to care for COVID-19 patients? What is the potential for an outbreak in Lincoln County?

Ed: The thing about Lincoln County is that we are not a big population center, we don’t have a lot of congregate settings, we don’t have a lot of big shopping malls, we don’t have a lot of large industrial or food processing facilities where people are working closely together. I think if we were to have outbreaks, and it’s entirely likely that we could, it’ll be more of a family type of an outbreak, or a small business type of outbreak, which probably wouldn’t result in 20-30 cases. It might end up with 4 or 5 cases. Hopefully, between our relationship with the hospital and our preparedness activities, we can get on those cases fast, get them isolated and quarantined before that outbreak has an opportunity to spread farther.

Tyson: As far as the hospital’s capacity to respond, we have the negative pressure rooms that will keep patients with COVID isolated. For level of care, it is really going to depend on the severity of the onset of the illness. Many rural hospitals, including ours, don’t have ventilator capacity and our ability to care for a high-acuity patient for an extended period of time is limited – especially when it comes to the resources needed to care for a patient with severe symptoms from COVID-19. Our physicians can determine if someone can stay here, depending on how they present their symptoms, or if determined, we can transfer someone to Spokane where they have a full suite of services.

Ed: One of the things that is monitored on a routine basis as part of Covid preparedness is hospital patient occupancy. We continually monitor, throughout the state, what the occupied bed counts in both the hospital and ICUs. We look at what the trends are so we can look ahead and plan for where we are at, how many free beds do we have, what’s our capacity and look at when we should be getting concerned.

What has been the impact on hospital staff during this time? Has the overall patient load been lower or higher the last few months? Are there elective procedures happening?

Tyson: Initially, starting at the end of March, our patient volume was down over 40%. Thankfully through some of the government programs we only had voluntary layoffs for less than three weeks. We were pretty aggressive looking at different avenues to serve people, such as virtual e-check ins, which our providers are doing now. Our providers have been adamant that just because there is a pandemic, you can’t forgo your routine appointments or care. Providers did a lot of work personally contacting patients to make sure they got whatever necessary care they needed. Today it feels like we’re doing business as normal. Just taking extra precautions to make sure everyone stays safe. The governor lifted the ban on elective procedures on the 18th of May. The collaboration with public health early in the game got us ready to be able to treat patients safely. If there is any health issue whatsoever, don’t hesitate to call us and get help.

What has been the financial impact of COVID-19 on the hospital district?

Tyson: Because our providers have been able to get people in, the financial impact has not been too great. We have received ten weeks of payroll from the PPP program. We received CARES act funding, which will get us more than caught up. We will probably send some money back to the government, in fact. We are grateful to be in great financial shape overall. However, as we all know, there are many unknowns with COVID-19 and we don’t know what the future holds.

What does LCH have planned for the future? You are building a new clinic, what would you like the public to know about that?

Tyson: For the first time in 30 years we are building something new. We are really excited about what this new primary clinic can offer. The main floor is going to be more private, quieter, much larger than our current facility. We have capacity for growth. We are also looking at how to create and provide a behavioral health program for Lincoln County. The pandemic crisis has highlighted the need for a robust behavioral health program. We are looking at everything we can do to increase local access to health care. Our new clinic should be open in June of next year.

How many cases of coronavirus have there been in Lincoln County?

Ed: Lincoln County has confirmed four cases of COVID-19. All four cases have recovered. We are not at this point monitoring any cases or any close contacts. We are in a really good spot right now and hopefully we can stay there.

What can we, as residents, do to prevent spread in our small community?

Ed: What we need to do is continue the efforts that have already been started. Every county around us is seeing an increase in cases, which puts us at a higher risk. We have tracked numerous contacts in Lincoln County because they were exposed to someone from Spokane, Adams, or Grant county that tested positive. Luckily no one has gotten sick. We need to continue how we social distance, how we improve mask wearing. Mask wearing is a great opportunity to reduce risk. We need to look at hand washing, stay at home if we are feeling sick.Talk to your provider about the need to get tested. It’s all about layers of protection to help reduce the spread of the virus in the community. As we start to see these increases in cases, and if the community can’t start to curb the spread, it may impact the possibility of opening schools. We really need to come together as a community, looking at prevention strategies, so we can be proactive and positive to get kids back in school. We are working with every school district in our community to figure out how they can open safely.

How has public health and the hospital been able to work together to address the pandemic?

Ed: The collaborative relationship we share in Lincoln County has allowed us to be more responsive and efficient in responding to cases that have been identified, so we can reduce further transmission. Our hospital’s willingness to go above and beyond so that they can set up the resources for providing testing in a safe and manageable way that not only protects the privacy and the health of the potentially exposed patient and it’s separated from normal patient care. It wasn’t easy for them to do that, but they were able to do that and its worked very well because they aren’t having to commingle patients.

Tyson: Ed and his crew have been extremely helpful for us to bounce ideas off, as we look at strategies, protocols and policies. It’s a collective think tank, and we are trying to tap into all the resources we have so that the community knows we are on the same page and working consistently, that it’s a cohesive plan for Lincoln County.