30-Apr-2020

PARRISH - Capstone Rural Health Center is offering regular daily testing for COVID-19 at its Parrish and Double Springs clinics, and has made adjustments to deal with the virus pandemic, including teleconferencing with patients and finding ways to obtain supplies.

F. David Jones, executive director of Capstone Rural Health Center, said Tuesday in a teleconferencing interview from Parrish that probably 200 tests for the virus have been performed by the clinic to date.

The clinic didn't know quite what to do when the outbreak occurred.

"There were a few weeks there where we knew something was brewing," he said. "We were trying to pivot and see what to do. We didn't have enough testing."

Within a couple of weeks, they learned they could do a nasal swab test and send it to the state. However, there were only able to get testing capacity up a little, "because tests are not falling off the shelves," he said.

Temperature checks began to be given to employees and visitors when they walked into the building, he said.

"We tried to screen to keep the sick people out and the well people in, which is kind of odd. It's the opposite of what we do," he said."

Few were coming in for testing. Then after a couple of weeks, "people really got worried" as shutdowns began, he said.

"We went through a time where we treated people in cars and we would make a tent and treat them under the tent," Jones said. "We were just trying to do different things and seeing what would work for us" to treat patients and still protect the staff members spread out over five locations.

Losing half the staff to sickness would make the job difficult, he said. Staggering the staff would not work, because sites would have to be closed down.

"So far we've managed to keep all five clinics open, which is good," he said. "We're a safety net center so we don't want to close." Safety net medical facilities are obligated to provide service regardless of insurance or ability to pay.

Three days of "pop up tests" were carried out in Double Springs, where their clinic is located in the Winston County Health Department, allowing close cooperation between the two staffs, he said. "They did supply some testing for us," he said.

After a slow first day, the second and third day resulted in about 20 patients each day. The next week they moved on to Arley for a day of testing, followed by one in Parrish.

"We did maybe 30 tests on Friday, maybe two weeks ago. Ten percent of those tests were positive," he said.

As part of a stimulus package from the U.S. Department of Health and Human Services, the clinic's main funding agency, the clinic has been able to test for free in most situations, even if the patient has insurance, he said. The insurance companies are waiving co-pays on the tests.

"If we use the state labs, it doesn't cost anything as long as we can get the actual nasal swabs they use," although those flocked swabs have been the hardest for the clinic to get, he said. "We robbed all of our flu tests of those, as they have that particular (swab) in it. We have about 80 on hand now, and then we'll have about 300 coming in on Friday."

As for other protective supplies, Jones said the state brought some supplies early on. "We were really aggressive about asking for support earlier," knowing shortages would likely happen, he said. Supply lines later started failing, preventing them from ordering what they needed.

"In fact, we're all in competition with each other now," Jones said. "It is kind of an odd thing. A nurse at home and a hospital are all competing to buy limited equipment."

Temperature probes even "went fast," as employees were checking their temperature so much, he said. "We got some, and then we got some forehead type thermometers. We probably have a couple weeks supply of everything except the testing."

He said in terms of disinfectant spray and cleaning supplies, the staff has sometimes tried to buy an extra supply if found.

"You just got to do what you've got to do to survive," he said, noting supplies like that are rationed out and carefully used. "We try to keep people from spraying a whole bottle up in the air, but we have to decontaminate the room. It is kind of an insidious disease. Even if they don't have the COVID or suspected COVID and it is just a check up, we're still pretty much wiping down those beds and spraying a little Lysol in the room, the doorhandles" and other items, and making sure the patient rooms are generally clean after each patient.

Jones said the operation almost ran out of hand sanitizer and found a company in Pelham selling by the gallon. Although it was more expensive, they bought cases of that sanitizer, refilling the bottles they already had.

Capstone early on started having teleconferencing visits online with patients for light consultations or initial visits.

"It's really bridging the gap between A to Z," Jones said. "It has helped us out a lot. A lot of our patients don't want to come" and wind up sitting in a waiting room with sick people at the moment, something that is being seen in primary physician offices, he said.

Jones guessed most primary care facilities have seen a 40 percent reduction in patients, with many elderly people particularly concerned about being vulnerable to COVID-19.

"That's understandable," he said. "The way Medicare, Medicaid and Blue Cross relaxed their restrictions for telehealth has helped us a good bit. I don't know if they are going to go away on (April 30, the end of the state's stay at home order) or not. I suspect there will be an extension of being able to see people," adding that trends indicate that service may become permanent in society.

As the doors are not closed, the Parrish clinic has remade the employee entrance to be the sick patient entrance, and some patients have been seen in cars.

"If they are not truly COVID symptoms, we'll let them come in," Jones said. "If they are hallmark COVID - which we are learning is not really hallmark COVID - we try to keep those in the cars and either go out and see them or test them, and give instructions for home care.

Mostly patients call in advance. If not, Jones said they are caught at the door by greeters stationed there, asking them questions of their symptoms and taking temperature readings.

As for the employees, "we've had a couple of scares but no one has tested positive," he said.

Jones emphasized Capstone is doing daily testing at its Double Springs and Parrish clinics from 8 a.m. to 4 p.m. each day, ending an hour ahead of closing.

He anticipates getting more requests from employers to see testing at their work sites, such as from manufacturing home or meat processing plants. He said the clinic is trying to "gear up" to address minimizing large outbreaks at workplaces were dozens or hundreds could be working by removing sick workers early.

Jones said Capstone is also addressing mental needs, using online conferencing tools such as Doxy.

"We actually got a grant from the United Way to do like 200 of those visits free of charge just to help people through the COVID and help with their social isolation," he said. "It has affected people who are trying to stay in, especially those who are extroverts and not necessarily introverts. When you don't see your groups or fellowship with your church friends, it does take a toll on you," he said.

He urged the public to continue to perform the basics, such as social distancing to keep six feet away, hand washing, wearing masks in public and avoiding large meetings.