CMC adapts to surging cases, testing demand

A 1,000%-plus surge in demand for covid testing, brought on by burgeoning cases nearby and across the country, is forcing the local hospital to adapt its operations.

Before the more-contagious Delta variant of the SARS-CoV-2 virus led to outbreaks of COVID-19 at various regional outdoor events, Coulee Medical Center had been testing one or two patients a day for the virus. Now they’re testing 30-40, Ramona Hicks, CMCs chief executive officer, said Friday, and a local surge of covid is testing CMC’s capacity to handle them.

The hospital originally had two rooms prepared just to handle any covid patients and recently had to expand its preparation to other rooms, installing the right kind of isolating ventilation systems.

Hicks said they’ve been working on a way to speed up the testing process to get people through it faster. And a building last used for storage, the Education & Sim Lab, has been converted into a drive-up testing center.

Doctors may now issue a “standing order” for a patient to get the test, bypassing a clinic visit. Even a visit to the facility’s walk-in clinic can take hours, and appointments to the regular clinic often are booked weeks in advance.

The logistics of completing lab tests can take days after a negative initial test result, which must be followed up with a more accurate one that is sent to an outside lab.

That crunch is not only inconvenient for patients who should then wait in isolation for the next result, but also keeps health care workers off the job at the time they’re most needed.

“It’s really getting to be kind of a crisis mode in our departments,” Chief Financial Officer Kelly Hughes said to prime hospital district commissioners for an equipment purchase Monday night.

They approved ordering a $55,000 piece of equipment to address the problem, allowing for the more accurate tests to be done immediately at CMC, with a return time of about two hours instead of two to four days.

Chief Medical Officer Dr. Sam Hsieh told commissioners the delta variant is twice as contagious as earlier variants and causes more severe illness, especially in unvaccinated patients.

“But being vaccinated does not mean 100% immunity,” Hsieh cautioned, noting more than 5,000 “breakthrough” cases reported in vaccinated persons in Washington state alone, where about 15,000 doses a day are jabbed in arms, according to the state Dept. of Health.

The current load of cases has been challenging for CMC, which, like other small, rural hospitals, regularly sends patients to larger hospitals for cases it can’t handle on a regular basis. CMC has no intensive care unit; patients needing such care, whether from a stroke, heart attack or covid, normally go to a larger hospital in Spokane, Wenatchee, Moses Lake or elsewhere.

Hsieh said he’s been “amazed” by the response of providers at CMC. “They continue to truck through all the obstacles that the pandemic has thrown at them and the governor has thrown at them,” he said, refering to Gov. Jay Inslee’s recent mandate that health care workers be fully vaccinated by Oct. 18 or face dismissal.

But now, as the delta variant surges and cases in local counties occur at the highest rate since the start of the pandemic, CMC and other facilities are preparing for tougher circumstances.

Hicks said they are working with the Dept. of Health and others on “crisis standards of care.” That term refers to a “substantial change in usual healthcare operations and the level of care it is possible to deliver, made necessary by a pervasive disaster” such as the COVID-19 pandemic, according to the American Nurses Associaiton.

About 94% of covid patients hospitalized from February through Aug. 9 were not vaccinated, a state Dept. of Health study released Aug. 25 says.

And, if patients who should be taken to larger facilities can’t be moved because they don’t have the capacity to accept them, CMC’s staff will soon have the help of an “intensivist telemedicine” program that give doctors and nurses access to ICU specialists for help. It’s not an ICU, but it’s “the next best thing,” Hsieh said.

Hicks said transfer to larger facilities have been limited lately. “The systems that we have in place are really at the breaking point,” she said.

Inslee’s recent mandate is complicating the situation even more in a region where vaccine rates are relatively low and hesitancy to get the shot is high.

It will affect 70-75 CMC employees, about 10 of whom may seek an “accommodation” for medical or religious reasons. Hicks said 25-30 employees “may be affected” by the mandate, and she’s keeping a close watch on the minimum numbers needed to run each department.

“This mandate is going to make us pay attention,” she said.

The hospital had secured 140 Moderna vaccine doses for a drive-through event Sept. 1 in the parking lot. As of 6:50 p.m. Tuesday, 25 appointments to receive them were still available.