COVID guide: Porter Hospital readies for fall 2020
MIDDLEBURY — Porter Hospital officials are thanking the Addison County community for helping the region deal with an initial wave of COVID-19 cases this past spring, but they’re asking residents to not let up on mask wearing and social distancing — especially since cooler weather is pushing people indoors, where the chance for coronavirus transmissions increase.
Porter officials recently shared information on the current state of COVID-19 in the county, how the hospital’s operations have evolved to meet current pandemic conditions, and how/when individuals should seek testing.
After more than five months of pandemic experience under its belt, Porter transitioned from a reactive mode — shutting down most elective surgeries in anticipation of an unknown number of COVID patients — to a more measured approach, steeped in a better understanding of the disease that has thus far afflicted more than 75 Addison County residents.
“Right now I feel we are well-positioned… both from a stockpiling perspective, but also having identified what we believe to be resilient supply chains,” Mike Leyden, Porter’s emergency preparedness manager, said in late August. “The only constant with the pandemic has been change. We, as an organization, have been even more resilient than we were aspiring to be back during the first wave. We look for curveballs.”
The onset of COVID-19 fortunately coincided with the onset of spring. People were asked to quarantine, but have been able to quell their cabin fever with big doses of the outdoors.
As Vermonters know, those comfortable outdoor conditions are fading with the leaves on trees.
“We know that proximity is a risk factor for transmission of COVID,” Leyden said. “We all just normally tend to get a little more bunched up indoors.”
The message from hospital officials: Make sure to keep using those masks and maintain at least a 6-foot buffer from others when you’re inside, with the possible exception of your family/residential pod.
Leyden is concerned about folks — particularly seniors — having to endure a possible six-month stretch of primarily indoor dwelling.
“It’s a lot more indoor isolation time, and it has it’s own consequences,” he said, alluding to mental health and the seasonal arrival of influenza. So health care centers will likely be contending with flu and COVID cases, both of which can carry serious health consequences.
“We have an older population in Vermont, and social isolation is a challenge to manage,” Leyden said.
But Leyden and interim Porter Medical Center President Tom Thompson are confident Porter and its partners — including the town and Middlebury College — will be able to cope with what COVID-19 could throw at the county during the months ahead while scientists work feverishly on a vaccine.
Here are some of the things Porter has been doing to stay prepared:
• Participation in weekly calls with experts at the University of Vermont Health Network (UVMHN), with which Porter is affiliated.
“We’re now shifting toward the forward-looking preparedness as we head into fall and winter,” Leyden said. “We talk about the latest guidance, access and results of testing, possible supply-chain constraints, personal protective equipment configurations, as well as other possible network impacts and strategies.”
• Participation in weekly calls with Vermont Health Commissioner Mark Levine, who briefs community hospital officials statewide on the latest national and statewide coronavirus trends.
• Weekly communication with the workgroup called Middlebury Information Sharing in a COVID Emergency (MICE), which includes officials from Middlebury College, the town of Middlebury and the local school district, in addition to Porter staff.
The hospital is constantly taking inventory of its COVID-related supplies.
“We’re really scrutinizing our quantities on hand of things that could be subject to supply shortages,” Leyden said.
Personal protective equipment and COVID testing items — ranging from glass pipettes to swabs — must be on hand to meet current needs and a potential second wave of cases.
“We want to make sure we’re as stockpiled as we can be,” Leyden said. “That’s not done in complete isolation; it’s done in partnership with UVMHN teams.”
Leyden expects Porter can now be more “refined and tactical” in the event of a future outbreak.
“I don’t think we’ll have to move as quickly to shut everything down and wildly modify our operations,” he said. “We’ve learned a lot more, so I think we can be more deliberate in how we take certain actions.”
THE TESTS WE NEED
COVID testing has continued to evolve across the country and in Vermont, and officials here are working to make sure Addison County patients will get the testing they need, when they need it.
Leyden said there are typically two categories of individuals who receive COVID testing:
• Those who are symptomatic, exhibiting physical signs typical of those afflicted by the coronavirus.
“If you are ill with anything that could resemble COVID, seek out the information on how to recognize the symptoms, but we want people to contact the health delivery system,” Leyden said.
Consult your primary care physician, who can refer you to testing options. Many COVID testing locations want the patient to have been referred by their physician.
If it’s a true emergency — you’re experiencing difficulty in breathing, mental status changes, etc., “it’s either appropriate to call 911 or seek care at Porter Hospital’s Emergency Department,” Leyden said.
• Asymptomatic individuals, who aren’t showing signs of COVID but still need to be screened because of quarantine issues or because they must often deal with the public.
“The main reason we conduct asymptomatic testing is to look at patients we’re bringing into the hospital to participate in a congregant setting,” Leyden said.
Also, if you’ve traveled outside of Vermont, done your seven day quarantine and want to follow up with a test for assurance so you don’t have to quarantine for a full 14 days, you may be eligible for a test. The DOH would be the place to pursue that kind of test.
The DOH has been running routine pop-up public testing sites for asymptomatic individuals, Leyden noted. These sites, he said, can give the department a heads-up if there are clusters of COVID cases in one or more areas of the state at any given time. Asymptomatic testing earlier this summer flagged a cluster of cases in Winooski.
Porter Hospital has curtailed its asymptomatic testing of late, according to Leyden. The hospital currently carries an inventory of 60 test kits and procures roughly 30 per week from University of Vermont Medical Center to replenish its supply, officials said. It used to be that Porter would administer a COVID test for anyone coming in for surgery. That standard was adjusted to in-patients (prior to being admitted). Now the hospital has a list of criteria governing COVID testing subjects.
“We’re trying to walk the line of appropriate defensiveness,” Leyden said.
Porter has also not confined itself into one testing system, according to Thompson.
“We’ve used a variety of options along the way,” he said. “If we got locked into one product, one brand, one processing vehicle, a shortage in that area would be catastrophic. We’ve seen a variety of practices employed, just so we can be adaptive.”
Meanwhile, Middlebury College has invested heavily in its own asymptomatic testing abilities. The institution required all returning students this year to report to an on-campus testing center for an immediate COVID test — and another one seven days later. The samples were sent off to the Cambridge, Mass.-based Broad Institute for processing. Students were required to stay in their respective rooms until the results were available, usually within 24 hours.
Tests will also be administered to students exhibiting potential COVID symptoms on an ongoing basis.
Officials at the college have plans for quickly responding to positive tests.
The college posted a dashboard online that shows how many tests it has administered and their results — negative, positive or inconclusive. It can be seen online at middlebury.edu/office/midd2021/covid-reporting-dashboard.
“The (college) program is as well-built as it can be, and detailed, and will run on it’s own track with connectivity to the DOH,” Leyden said.
“It’s going to be difficult to predict,” Thompson said of the future status of schools and colleges during the pandemic. “Every day on the news you see a different school shutting down or going remote. Obviously, I believe the most important part of the (Middlebury College) plan is the monitoring activities and the ability to respond in a quick manner.”