Health Infrastructure Feeling Effects of COVID-19

During a public meeting of the Valley County Board of Health, alongside representatives from Frances Mahon Deaconess Hospital, STAT Air Ambulance, Prairie Ridge, Valley View Home, the Chamber of Commerce and county health officer Anne Millard, one issue became clear—health infrastructure in Valley County was starting to feel the pressure brought on by an increase in COVID-19 cases.

Board of Health chair Clay Berger presided over the meeting on Oct. 21 and opened by stating the meeting’s purpose to “one, establish an open line of communication with Valley County residents, businesses, health partners and public officials. Two, is to assist Valley County residents, businesses, health partners and public officials with gaps, needs and strategies to cope with COVID-19 management.”

He also encouraged the participants to stay on topic, avoid politics and focus on assisted living, health care and public officials needs and to provide insights and suggestions. Due to the nature of public meetings, the board was unable to take any action that was not on the meeting agenda specifically and the two-and-a-half-hour meeting did not yield a consensus on what actions the county would take, forcing them to schedule a second meeting for Wednesday, Nov. 4.

Health Department director Lynn Miller opened her update on their COVID-19 fight saying, “We have been absolutely swamped here at the health department as you can imagine.” Contact tracing, notifications and tracking data has consumed so much of their time that it has been impossible for her limited staff to keep up. She alluded to difficulties with contacting individuals resistant to the process, but made sure to add, “Thank you to those of you who have been pleasant on the phone.”

As of Oct. 26, at 5:55 p.m. the county reported 66 active COVID cases, 277 recoveries, 347 total cases and four deaths caused by or related to COVID-19. Thirty-two of those cases were recorded since Oct. 20. Twenty-four were female and eight were male. Two were under 10, two were in their 20s, one was in their 30s, eight were in their 40s, three were in their 50s, 10 were in their 60s, four were in their 70s, two in their 80s and none in their 90s.

Discussing the numbers, Miller said, “It’s still just increasing at a rate that we just don’t want to sustain, so I just want to thank everybody who is cooperating and is doing the things that are the only things that we can do, which is to wear masks, distance ourselves from each other and to use hand hygiene.”

Health officer Dr. Anne Millard briefed at the time that there were 12 hospitalizations ranging from their 40s to 50s with the majority being in their 50s. Since the meeting the number has gone down slightly to nine, with seven confirmed COVID positive inpatients out of nine total, as of Oct. 27.

Millard said she was, “Just impressing upon the community that there are very sick people here. There are people we can’t fly out because we have not been able to find beds in other places. Billings Clinic has been non-divert this week (of Oct. 19).” Millard said that has affected the transfer of other non-COVID patients as well, which occurred when FMDH had lacked the requisite staff to care for a non-COVID patient.

“So, when all this COVID stuff started, we were all worried because we didn’t know what it was going to do, and we didn’t want to overwhelm health care systems,” she said. “Well I hate to tell you Valley County, but you have overwhelmed your health care system.”

“Everybody does what they want to do,” said Millard, highlighting that many were not following the governor’s directives for phase two. “And I think that’s reached the point in this community that has put us with people in the hospital like this—that are younger people, that are people that are vital community members, there’s people that own businesses, there’s people that run farms and ranches and now they’re sick and in the hospital and that’s not getting done. And I think the community needs to do something about that as well as take care of our other people who could get this disease and get really sick from it. We’ve had four people die so far; I’m hoping not to have a fifth.”

Millard recommended the county initiate a four week “reset” where they go back to phase one conditions and try to interrupt the spread of the disease. That reset would include shutting down businesses for that four-week period.

Glasgow Area Chamber of Commerce and Agriculture Director Lisa Koski pushed back on a four-week break saying it would cripple some small businesses and potentially force them to close for good.

Koski added that businesses were doing what they can to mitigate COVID, and she pushed back on the idea that businesses can require employees and patrons to wear masks. She pointed out that a lot of businesses do not pay sick leave and that many of the employees would be worse off after being quarantined due to COVID. “Lives are important, so this is not misleading,” she stated, “but shutting businesses down is going to be detrimental to our economy.”

Maggan Walstad of the health board pointed out that a lot of business employees were not wearing masks and that it raised concerns for citizens that were “in their golden years, so to speak.”Walstad stated, “How do we tell the business community the importance of wearing masks to stay open.”

Koski pushed back, “You know we can practice and practice as a business community, but until it’s enforced nobody’s going to. I mean the majority aren’t going to follow it, I’ve been in places where people have masks on and people walk in and go, ‘oh, you have to wear a mask here?’ and they walk right out the door. So, people are on both fences, so until it’s going to be enforced in our community people aren’t going to.”

Enforcement became a key point for businesses. Haylie Shipp pointed to the lack of general enforcement as a reason why, she specifically, did not enforce the mask requirement inside her store. She said the county needed to do a better job and she felt that asking customers to put on a mask would lose her sales and hurt her business.

The issue discussed was what enforcement would look like. Dr. Millard pointed out that enforcement of the mask mandate would likely be closing down businesses that do not enforce the mandate within their stores, restaurants and bars. In effect, putting the onus back on businesses to make sure everyone in their stores was masked up in order to avoid further interruptions to their business operations.

A meeting between Berger and the Chamber on Oct. 23 produced an understanding between the board of health and businesses that strict adherence to phase two guidelines—which many businesses were unaware of according to Berger—would be preferable to a four-week shutdown. That meeting also helped give businesses an understanding of how to encourage mask participation and social distancing. They were set to deliver more encouraging signs rather than ones that say “mandate” and would focus on positive participation to keep stores open.

Berger summarized the Friday meeting’s results saying, “[Businesses] all agreed, four weeks of strictly following Phase II would be better than going back to four weeks of Phase I.”

One of the more alarming briefings during the meeting on Oct. 21 came from Clay Berger discussing the impacts from COVID-19 to STAT Air flights. Berger stated that in September they had a drastic increase in flight volume. A normal month is around 50 flights. In September that number grew to 81 flights and more than 50 percent (47) were COVID positive patients. Berger stated that those flights require more crew time due to the fact that the majority were either intubated or on CPAP machines to keep their O2 stats up.

The increase in demand on crews has compounding effects that required STAT Air to turn down a number of requests for service. Those requests required other air ambulance services to respond to the region to transfer patients to a higher level of care. Berger said the service denied 18 requests due to having both crews out. In each case, they were able to find outside services. Berger added that, as of Oct. 21, they had flown 48 flights in October. Of those, 32 were COVID positive flights and 23 requests were turned down due to a lack of available crews.

Discussing his crew’s tempo, Berger said, “They are very professional and very proactive and upbeat, but they’re getting tired.”

Berger did highlight that, even though his crews are in frequent contact with severe COVID cases, the infection rate among his crew was .13 percent. He credited the disciplined use of PPE and disinfecting the plane for that low rate. Berger said that none of his staff’s infections were related to on the job contacts. He used that infection rate to highlight the effectiveness of PPE in preventing the virus’ spread.