Since March of 2020, when the first confirmed case of the novel coronavirus was announced in New Hampshire, the impact on the healthcare industry has been evolving every day.
From facility shutdowns, setting up testing sites, to the vaccine rollout, nothing could have ever prepared the medical community for the toll that continues to this day. There have been epidemics in recent history – the swine flu and Ebola virus – that threatened to tax the health care system, but the COVID-19 pandemic was unique. There was no manual for health officials on how to respond to a worldwide health crisis, no playbook on what to do when a highly contagious, highly deadly virus spreads across the globe like a wildfire.
Masks became the latest fashion statement, “social distancing” was the phrase of 2020 and hand sanitizer was used more than ever. But through it all, the local medical community has worked around the clock to navigate the changing world around them to continue with the mission of caring for the people of this region.
Monadnock Community Hospital President and CEO Cyndee McGuire remembers Feb. 26, 2020 like it was yesterday. Hospital leaders participated in a webinar with the Center for Disease Control and the American Hospital Association centered around the topic of COVID-19.
“On that day, we decided as a leadership team to open our incident command center,” McGuire said. It was done as a preemptive measure, as up to that point there had not been a single case of coronavirus confirmed in New Hampshire. Then on March 2, an employee at Dartmouth Hitchcock in Lebanon tested positive for COVID-19, changing everything.
“From that point on, we kicked into a pretty high gear,” McGuire said.
Employees who could were asked to work remotely, hospital officials locked down the facility and put protocols into place, like screening staff and patients upon entering the building.
“Everything we did had to be evaluated,” said Rich Scheinblum, Chief Financial Officer at MCH.
Scheinblum said that the CDC and State of New Hampshire offered guidelines on how to operate, from how to serve food to seeing patients.
“Every single department had to look at their processes and what they were doing,” Scheinblum said.
Shawn Harrington, medical director of employee health at MCH, said it was exciting to be a part of the incident command team to come up with the changes across the hospital.
“This is the first time the US has been faced with a nationwide health crisis of this magnitude,” Harrington said. “The advice and suggestions were changing very rapidly.”
He said they had to change everything about how health care was delivered. Harrington said he would change in his garage when he got home and “decontaminate in my guest shower.”
By March 16, McGuire said, the way the hospital operated was completely altered.
“We pretty much shut down anything that was deemed elective,” she said. “For a period of time, we really had a limited number of patients in our facility.” Only urgent and emergency care was done in the hospital with the remainder switched to the telehealth model. They created a surge plan in the event of a community outbreak requiring mass hospitalizations.
At the end of May, McGuire said, the hospital began bringing back some non-emergency medical services.
“A lot of planning by a lot of smart people went into that,” Scheinblum added.
While so much has come back, things are far from normal. Scheinblum said it will likely be another two years before it does.
“It’s not like we’re going to be able to flip a switch,” he said.
Carrie Klonel, a family physician at Hearthside Family Health in Peterborough, said they essentially shut down office visits for a month or two, trying to limit interaction with patients as much as possible.
“At that point what we were doing was really patient needs based,” Klonel said.
She said from a scientific standpoint, the pandemic is both interesting and scary.
“People didn’t know what PPE was or how their vaccine was made,” Klonel said. It’s also frustrating for Klonel because she believes the pandemic could have been eradicated a lot quicker if everyone did their part.
One of the biggest changes was the transition to telehealth. McGuire said the hospital didn’t put a lot of emphasis on it pre-pandemic, but the switch became critical to operating.
“It’s not ideal for every patient,” McGuire said. “But it’s a more efficient system to have access to medical care.”
Luc Shippee, Medical Director for Monadnock Health Partners and an internal medicine physician, said one of the biggest challenges early on was not knowing.
“This was brand new, you couldn’t really give anybody good answers as to what to expect,” Shippee said. One patient reported a loss of smell and taste, “and I didn’t have a lot to tell her,” he said.
“The other factor was just trying to figure out how to take care of patients in the way you always have,” Shippee said. “If you did see people, how did you see them?”
He said the rapid fire barrage of new information made it difficult to apply. “Every day there was something new you had to learn,” Shippee said. “It seemed like every other day the guidance was different.”
Shippee said the transition to telehealth played a huge role in being able to address patient’s concerns. Harrington said a lot of visits were done through telehealth during the restrictions and about 20 to 30 percent of patients continue to utilize it.
“It was something that was on our radar before the pandemic, but rarely used,” Harrington said. “But virtual care has come a long way and is actually really rewarding.”
Klonel said Hearthside was doing telehealth type visits before the pandemic “and continued to do them through the worst of it.”
“I’d say its probably doubled, but still a small proportion of overall visits,” she said. “Whatever works best for the patient is what we do.”
Even to this day, Shippee said the topic of COVID-19 is consistently brought up.
“There rarely is a visit when that isn’t part of the conversation,” Shippee said. Harrington agreed, as people are really excited about the vaccine rollout. “It’s really the talk of every visit,” he said.
Both understand the need for patients to talk about it because it has been a challenging year.
“It wears on everybody, from our kids to our grandparents,” Shippee said. “I think everybody’s feeling it.”
McGuire said at the peak of the pandemic, the hospital was conducting 50 to 60 COVID-19 tests per day, but that is now down into the 15 to 20 tests per day range. As of March 11, MCH had administered 9,325 tests resulting in 449 testing positive. There were only a handful of COVID-19 patients who were admitted to MCH over the year, officials said.
“It’s what we do in healthcare, we take care of our people, take care of diseases,” McGuire said. “And it’s been a very long haul.”
Over time, rapid testing became available at practice locations, but they have not been able to make it an option for the greater community.
Shippee said he has seen in the low 100s of patient positive cases in his practice. There was a spike after both the Thanksgiving and Christmas holidays.
“It was kind of a daily occurrence that you’re getting someone’s positive result or a couple of them,” he said.
Klonel said they started conducting COVID-19 tests in the practice’s parking lot and still do them that way now, up to 10 per week. They also do all the testing for MacDowell.
“They don’t even encounter another person,” she said. She said they have received some positive test results but no patient was really sick or required hospitalization.
One interesting aspect of this year is that Klonel has yet to diagnose a single case of the flu
MCH began its vaccine rollout in December and to date, 480 total staff and vendors have received the second dose at MCH. Others, mostly new hires, have received the first dose. The opt in rate for vaccination is around 85 percent.
While the vaccine offers a level of protection, McGuire knows it’s not a time to let up.
“There are still so many unknowns,” McGuire said. “We still can’t let out guard down.”
Klonel said she gets a lot of questions about the vaccine rollout and has even sat with some patients and helped them register.
“We hope to eventually have vaccine allotments in the practice,” she said.
Like every other health care institution, the availability of personal protective equipment was scarce and a real cause for concern. Many items were put on allocation and others were simply unavailable.
“We really had to utilize all our resources to get what we could to protect our staff and our patients,” Scheinblum said. “It was touch and go.”
Scheinblum said the hospital had always worked to keep up with their supplies, but it quickly dwindled.
“We did a great job with it until our supply chain got cut off,” he said.
They received assistance from local businesses like NHBB and SoClean, and the community stepped up in a big way by donating thousands of cloth masks and another group used 3D printers to make face shields.
It has been an ongoing problem to some degree, but not like it was from March to the start of summer.
“We still have some issues in certain areas, but not where we feel like we’re at risk,” Scheinblum said.
Klonel said the community donated when supplies were unavailable, from N95 and cloth masks to pulse oximeters.
“To see how our community pulled together during this time was very heartening,” Klonel said.
When the hospital did resume operations it came under strict protocols and procedures to ensure safety. Patients scheduled for appointments are spaced out to avoid more than one person coming and going from a practice at one time and the use of waiting rooms was eliminated. Environmental changes were implemented, like the use of iWave air purifiers to produce better air flow and scrub the air of virus particles.
“A lot of work and effort went into this,” Scheinblum said. “And that’s not cheap pieces of equipment.”
Treatment areas had to be spaced out and because of that, the Bond Wellness Center was closed and is still currently used for physical therapy. McGuire said she understands the disappointment the community feels about the fitness center still being unavailable.
“But we feel the need to focus on the direct patient care kind of work,” she said.
“We haven’t forgotten about it and know it’s important to the community,” Scheinblum added.
Scheinblum said the hospital was in a good position financially and can’t even begin to imagine “what this would have done to us,” if they weren’t. He said “we were probably going to have one of our best fiscal years,” but the onset of the pandemic changed that dramatically. There were months the hospital lost $3 million and another where it was $4 million, Scheinblum said. Net revenue was down $12 million for the fiscal year ending Sept. 30.
Because of the financial impact, MCH instituted a furlough on May 8 of 80-plus employees and guaranteed pay and benefits through the end of the month and benefits through the end of the fiscal year. By the beginning of August, 60 were brought back.
“The reason we were able to do that is because we had a strong balance sheet,” Scheinblum said. But the remaining were permanently laid off and salary cuts were put in place for administration and managers. They froze tuition reimbursement and retirement matching as well to prepare for the worst possible scenario.
MCH did receive $7.5 million in CARES Act funds, resulting in only a $500,000 loss for the fiscal year.
“We were operating in the mode of what if this continues going like this and no one comes to help us,” Scheinblum said.