A COVID-19 pandemic update with RiverView Health

Jess Bengtson
Crookston Times

The Times recently reached out to RiverView Health CEO Carrie Michalski to get a COVID-19 pandemic update on how their health facility is handling patient care, community transmissions, positive cases and vaccinations, and other healthcare needs beyond the virus such as workforce challenges. Here's a look at the Q&A...

Times: How has the COVID-19 pandemic affected RiverView and its ICU over the past year? How about over the past couple of months?

Michalski: "I think we are closer to two years now than one. There probably isn't any aspect of our operations that haven't been impacted by the pandemic. And we could probably write a book vs. an article on this question. We could start with our role to deliver healthcare. In terms of treating COVID our team has been amazing and the collaboration we have had with local public health and our regional tertiary hospitals has been exceptional. We all share knowledge, treatment protocols and resources. RiverView has highly skilled physicians, and once treatments for COVID were developed and tested around the world and in the US, the medications were made available to all hospitals, so critical care COVID patients rarely needed transfer to a larger tertiary center. Our internal medicine physicians, pharmacists, respiratory therapists and nurses could deliver the treatments right here in Crookston.

Meanwhile our patients continue to need care for things other than COVID. Life keeps happening and with so many resources needed for early waves of the pandemic and the decision in MN to stop all outpatient procedures that were not deemed emergent or life sustaining turned our business upside down and delayed care for many patients, not just here in Crookston, but everywhere. Just like businesses on main street, we had weeks where our revenue was only 25% of normal, and like many other industries, some of our service lines have still not fully recovered. So we have relied and are still relying on Federal Provider Relief Funds to compensate for the continued lost revenues and the increased expenses of operations during the pandemic. Some of the increased expenses are operating a COVID hotline, COVID testing service, Required Entrance Screeners, using more protective equipment and more labor for enhanced cleaning protocols.

For the workforce, we know that health care workers are generally pretty resilient. They have a deep passion for the work they do and a desire to save lives. So when called to action in March of 2019 our team was facing the unknown and fears that all of us had because we didn't know enough about this disease and our team rose to the challenges of getting the work done to ensure patient in our care had every need met. We are proud of our team and I think we all felt good that we were fighting the good fight. When the vaccine arrived in December of 2020 we felt some relief, the majority of staff were vaccinated quickly and then they volunteered to cross train and set up vaccination clinics as soon as we could. In fact I believe RiverView was the first site in Polk county offering COVID 19 vaccinations to the public. It was joyous and we celebrated. We felt renewed optimism about the future. We also grieved for the lives that were lost to COVID before the vaccine was ready. Little did we know then how distorted and politicalized the availability of a vaccine option would become. Health care workers are tired. Not just in Crookston we have baby boomers who have elected to retire, even though their pre-pandemic plan was to work a few more years. We have health care worker who have decided to change careers and work in manufacturing, or seek self-employment. We have students once dreaming of working in health care changing their minds and going in another direction. We have doctors and nurses, respiratory therapists and laboratory scientist, chemical dependency counselors and home health aides who have made tremendous sacrifices to ensure care remains available. We had nursing assistants in long term care isolate themselves, even from their families, only going between work and home for months to protect the elderly residents they cared for until a vaccine was available. So now nearly two years later, with no end in sight, they are tired and weary and in need of support and encouragement. We pride ourselves as a great place to work and even in the pandemic we continue to rank in the top 75 hospitals in the country to work. We have added mental health support services for our employees, provided paid time off for illness and quarantine, and have a great team that works with us to provide some pandemic safe fun to break up the days. We really miss potlucks and maskless fellowship and we long for a bit of normal."

Times: How many patients are currently being treated for COVID in your hospital or ICU? (In-patient)

Michalski: "We consistently have had 2-4 hospitalized COVID inpatients on any given day over the past six weeks. For the first time since July we have seen two consecutive days with a handful fewer COVID hospitalization around the state, but we are also seeing the cases rising pretty rapidly in the youngest patients, both birth-age 10 and age 11-19. Because of this the region is now looking at overall pediatric care capabilities and how can we work together if we see a surge in the need for pediatric hospital beds."

Times: Do you have an approximate number of how many COVID-positive people RiverView has treated since the beginning of the pandemic or even just this year?

Michalski: "RiverView has played a role in diagnosing or treating a high percentage of the COVID positive cases that Polk Co and Red Lake Co keep up to date on their public dashboards. To give some additional perspective as of yesterday we had performed 8,455 COVID tests during the pandemic and we have been just one of several sites for the community to be tested and September has been alarmingly busy. We are projecting to surpass 1,000 COVID tests processed just in the month of September."

Times: Are you experiencing staff shortages like the rest of the nation seems to be?

Michalski: "Yes, we have workforce challenges. Our baby boomers are peaking at retirement age now and demographics show there are more retirees than new graduates to fill positions in Polk, Co, in MN and in most of the US. Those trends will be with us for many years. So all industries are competing for the limited new comers to the job market. So we have to be competitive, we all want to continue to have great access to the health care services we need. To keep that we need highly trained workforce, so it is critically important that we support the health care workers during this difficult time.  They serve the community and we should not take them for granted. More and more we hear stories of people shaming health care workers who are vaccinated, wear their masks or express support for strategies to reduce the spread of COVID. At a time when the professional work is more difficult than we have seen in decades, health care workers should be lifted up in praise & thanks, instead many feel they can't share there professional opinions and must avoid talking about COVID all together. Small things matter, like the shout out our team got from a community member at the Chalk it Up Event, it refills a tank that has been running on fumes."

Times: Do you foresee the use of masks in all healthcare facilities for years to come?

Michalski: "We have always implemented varying degrees of masking in the health care setting to protect patients and staff from various infectious disease, but COVID 19 has made the process widespread and mandated now by OSHA through its Emergency Temporary Standards for all persons on our hospital campus. Is it here in it's current form forever? We really don't have the crystal ball for that but we do know it is with us at least through the summer of 2022. At that time we will have the OSHA Standards, guided by the CDC, either sun-setted, extended or possibly made permanent. Once the dust settles we will see more and more experts digging into the data. We surely have seen many hypothesis's that influenza may have been almost non-existent last year due to social distancing, mask wearing, staying home when ill and improved hand hygiene. There is always learning to be had from a crisis and I think we all have learned over the past two years that toughing it out and showing up at work or school when you are terrible ill isn't the smart thing to do. It puts a lot of people at risk, including those that have weaken immune systems. We could surely connect you with one of our clinical leaders for a deeper perspective."

Watch for an upcoming update on RiverView's new facility and plans for the old buildings.

RiverView Health