There’s an old British military adage that civilians have co-opted: “Proper planning and prevention prevents poor performance.” Backcountry skiers practice burial recoveries; bankers stress test their systems to see if they’ll survive an economic downturn.
For St. John’s Health administrators, one of the most apparent emergencies the coronavirus pandemic presented was an outbreak at the Living Center. Despite a bevy of precautions, the facility isn’t hermetically sealed, so cases in the long-term care facility seemed likely at some point.
That point came in late September, when one resident tested positive for the virus. From there the plan was put into action.
“All the leaders within the organization ... everyone knew exactly what the plan was,” said Marsha Sensat, chief nursing officer and administrator of the Living Center. “When we had to activate that plan it was smooth.”
That initial outbreak affected nine residents and four staff members, though another staff member recently tested positive. Wyoming Department of Health guidelines say a positive test triggers weekly surveillance testing of all residents and staff until the entire facility goes two weeks without a positive.
At the Living Center that took about three weeks, a time that was “scary as hell,” said Greg Miles, whose father is in the Living Center. During that time all nine infected residents were transferred to the acute care side of St. John’s and given some combination of the treatments like remdesivir and dexamethasone that have become common parlance for many Americans.
None died, which seems remarkable considering that nearly two in five deaths in the United States from COVID-19 have been in long-term care facilities. Other facilities around Wyoming have not been so lucky, with Life Care of Cheyenne seeing 11 resident deaths as of Monday and Shepherd of the Valley in Casper having 15 in that same time, according to Wyoming Department of Health data.
“One of the reasons why we so far have not had that with our residents with COVID is that we’re part of this wonderful medical community, and so we transferred the residents to the hospital,” Director of Nursing Cheryl Sawyer said.
Not all long-term care facilities are part of a hospital system.
“They have to call an ambulance for the residents to be transferred to hospitals, whereas I can just roll people through the hallway,” Sawyer said.
Access to quick care allowed Living Center staff to achieve two goals, isolating infectious residents from others and starting care as quickly as possible. Now, about a month and a half removed from the initial outbreak, residents are showing marked signs of improvement, according to Sawyer and Miles, whose father was sick.
In other long-term care facility outbreaks the virus has spread rapidly, often infecting dozens of residents and staff members. With roughly a quarter of the residents sick with COVID-19, the staff had to clamp down and control the outbreak.
“When you’re in an outbreak situation you do as much as possible to have residents stay in their rooms,” Sawyer said.
Keeping residents from interacting effectively mitigates spread, but it can exacerbate the isolation and loneliness that have become more prevalent since the pandemic began. Especially for residents with brain changes, altering routines can be disruptive and confusing.
However, Director of Community Relations Beth Furlong said the residents took things in stride, even the nasopharyngeal swabs for the PCR tests they had to take each week.
“Distraction and music and caregivers that know them and love them and are holding their hands, that goes a long, long way,” she said.
Isolation and anxiety also affect the families of residents, many of whom visit often. So Sawyer sent daily updates, keeping loved ones in the loop while the facility was basically locked down.
“The updates were really helpful, and the measures they put in place I thought were good,” Miles said.
Miles has been able to visit his dad and talk through the window, as well as through FaceTime calls, and he said he is amazed at his dad’s recovery, which progressed quickly from hospitalized to relatively normal. Still, he knows COVID-19 remains a danger to the Living Center, though he hopes his dad has some immunity built up.
Sawyer, Furlong and the rest of the staff also know a repeat is possibile. Because of the recent staff case the Living Center remains on the Health Department list of facilities with active outbreaks. They hope their precautions and surveillance testing will keep the current situation to just the single case.
But they also feel ready should another outbreak happen because of the lessons they took from their successful management of the first one, which, they say, is due in large part to their planning.
“We learned that the emergency plan we had put in place back in March worked,” Sawyer said. “And, of course, we’ve been able to fine-tune it.”