January 2021

The Onley Community Health Center is a low-slung brick building with a green awning and roof, tucked just off U.S. 13 on Virginia’s Eastern Shore. The center is one of five operated by Eastern Shore Rural Health System Inc. for roughly 31,000 patients annually in Accomack and Northampton counties in the territory of A&N Electric Cooperative.

Life was about as normal as it gets at a bustling health care facility. Then, in spring 2020, COVID-19 became the all-consuming watchword. At press time, the two counties, with a combined population of about 43,500, reported nearly 1,900 confirmed cases, 164 hospitalizations and more than 50 deaths, according to the Virginia Department of Health. At one point in May, 18% of the tests conducted at Eastern Shore poultry plants came back positive, as Accomack became the third-highest COVID-19 hot spot in Virginia.

Because of location and resources, rural health care is always an issue, and the novel coronavirus has presented a challenge like no other. Cooperative Living sat down with three health care professionals from the Onley Community Health Center in a socially distanced setting as they described dealing with the deadliest pandemic in a century. Their lightly edited remarks follow.

JENNIFER LUCAS: Probably in the January-February time frame, it was like, “OK, we need to keep this on our radar and look out for this because it’s coming.” That started to change when we started to shift our operations here. We split up into teams — providers taking care of potential COVID patients in the beginning, providers taking care of sick but non-COVID patients, and providers taking care of well patients who needed routine things like checks for blood thinners. That way we were protecting ourselves. If an employee got sick, we weren’t all out at the same time. But it quickly changed and we all became COVID providers for the most part. We did a lot of telehealth at that point.

NICOLE MARSH: When COVID hit, we had to slow down, reduce the number of patients seen and figure out how we were still going to take care of people. That was an abrupt change in how we operate. That was a little bit stressful, to take care of people if we couldn’t physically see them because we didn’t have enough personal protective equipment. There wasn’t an instruction manual on how to deal with this. It was a matter of everybody coming up with one.

LUCAS: We had a staff meeting one morning that was like, “How are we going to do this?”

CHRISTINE WALDENMAIER: It was a total, total change, more than we would have ever expected. The place was pretty much emptied out and we went to totally telemed. We had a hall designated just for COVID. I happened to be assigned to the COVID hall, so we were doing testing outside the building, where we swabbed them. The big thing was that we cleaned and cleaned and cleaned everything we touched. I mopped the floors because they wouldn’t let the cleaning people come down the hall. We were double gloving; just trying to keep the virus out of the building as much as we could.

WALDENMAIER: As a health care person, you’re exposed to everybody. So there’s always a little nagging wonder in the back of your mind: “Do I have it?” Every time you end up with a sore throat or a sniffly nose, it’s “Oh no, here it comes.”

MARSH: I see kids, so I have to be in their faces. There’s no way to check their ears without being close to them. But it does add a note of caution that I never had before. I wear a shield and safety goggles and a mask, but that scares the kids.

LUCAS: Everyone started wearing scrubs and not dressing in regular clothes. You wore things that could go right in the wash. I would come home, take my clothes off, throw them in the washer and run in the shower. The kids were at home [girls age 4 and 1 at the time] because day care was closed. They’d be in the living room, so I’d come in the back door and run into the shower before they realized I was home. Then I was like, “Now we can see each other.”

LUCAS: Family members helped out a little bit. We reached out to some high school girls who were willing to come and kept that through the summer. It’s definitely an adjustment.

MARSH: We’ve had moms in the hospital delivering that are COVID-positive. I see newborns and that is considered a high-risk category if they were to get COVID. So, if anyone in my household is sick, I can’t come to work until everyone has been cleared. That’s another child care challenge.

MARSH: Prior to COVID, if a patient called and needed an appointment, a nonmedical person would be able to tell them, “OK, Jennifer Lucas has an opening at 11, so come see her.” COVID halted all of that. Usually, people would call for an appointment to be told the next opening was four or five days later. That wasn’t going to work with COVID. People who needed COVID tests could not wait. So all calls went through a person with medical training, which was a completely different setup — and we get thousands of calls.

WALDENMAIER: It was just different because so much of it was telemedicine. It was calling people all day long and following up with positive COVIDs.

LUCAS: There had to be some priority. Someone might say, “I really want to be seen for my diabetes. I just want to know how it’s doing.” We had to tell them, “Sorry, we can talk on the phone, but you cannot come into the building.” We did a lot of in-car visits, where they would pull up and we’d come over to the door. That’s how we ended up doing blood thinner checks; it was all done outside. For a while, they halted vaccines and then they started doing set times in a single room on the pediatric hallway, where you had to come in through the back door. You vaccinated maybe one child in the morning and one in the afternoon.

LUCAS: It was all over the board. They could be mild when they were diagnosed and then it would worsen. Testing supplies were limited at first, so you had very strict criteria on who could be tested. In the beginning, a lot of people you talked with that might have had it, but they didn’t meet the testing criteria. You’d tell them to stay home, watch and wait, and if they developed a symptom, then they could qualify for a test and call back. We were limited to how many tests we could do because of supplies.

WALDENMAIER: We were reusing a lot of things. The PPE just wasn’t there at first.

MARSH: Luckily for children and myself, most kids tend to have very mild illness with COVID. But the things that have stood out for me the most have happened at the hospital. We had moms that were COVID-positive — this was back in April — coming in to deliver, so their spouses could not be in there with them. Some of these were first-time moms. I can’t imagine having to deliver a baby with nobody in there that you know. That was, for me, “Gosh, this is horrible.” On the adult end, we’ve had so many families that have lost multiple family members.

WALDENMAIER: No two cases are the same. I work with a lot of older patients. But one guy, a poultry worker, he’s a younger guy and he’s still struggling to breathe. He’s never gone back to work. Some people are very susceptible and it affects them strongly.

MARSH: I think the hardest message to get out is, “Yes, for you or your child, it may seem more mild than the flu. But it also could be the opposite and put both of you into the ICU.” It’s very hard to communicate that. Part of it is COVID fatigue. You can only quarantine so many times. We have lots of families who say, “If I stay home again, I’m going to lose my job.” Or it’s a single parent and they don’t have any food and don’t have a smartphone to easily do grocery pickup.

WALDENMAIER: I think the people who needed calming down were not necessarily the ones who had it, but the people that potentially were exposed. “Do I need a test? Do I have symptoms? What do I need to do about work? How much work do I need to miss?”

LUCAS: We had a collaboration with the hospital [Riverside Shore Memorial Hospital] that if someone was sick enough that they needed a chest X-ray, rather than bringing them into our building here, they went to the hospital. It was kind of a community decision on where we send the sickest people.

MARSH: Luckily, I would say Eastern Shore Rural Health did a great job of having a team of people who could do the education so it did not fall to just us, because we were busy trying to see people in the building. There’s no way we could have called back 50 people at the end of the day to calm them down or reassure them.

MARSH: It’s the same way you test older people. You’re just glad that they’re not old enough to fight you. Newborns aren’t a problem. You can hold them down a lot easier than you can a 3-year-old.

 

WALDENMAIER: With 7- and 8-year-olds, you have your mask and all of your stuff on. They’re in their car. They don’t know what you’re going to do to them and they’re strong. They will not turn their heads toward you and you’re just trying to get them to look at you, so you can swab them. And they’ll remember that experience for years.

 LUCAS: Any potential COVID symptoms now, we’re still seeing telemed. The increase in the use of telemed is probably one of the good things to come out of this.

MARSH: I think everybody did a great job of just saying, “OK, life is now completely different and we have to shift gears.” Everybody was willing to jump in and do what needed to be done. Christine has swabbed probably thousands of people by this point. She always does it with a smile under that mask. Just like the rest of the country, we are COVID-fatigued. But we have to have the extra precautions in place, our masks and our shields. That’s our job.