N.H. Healthcare Leaders Discuss Readiness For Coronavirus Outbreak | New Hampshire Public Radio

N.H. Healthcare Leaders Discuss Readiness For Coronavirus Outbreak

Mar 22, 2020

Credit File Photo, NHPR

On this edition of The Exchange, we get an update from Dr. Ben Chan, New Hampshire's state epidemiologist, about the current extent of coronavirus in the Granite State.

Then we talk with healthcare leaders in Manchester, the state's largest city, to discuss their efforts to prepare for an expected surge in cases and steps they are taking to keep healthcare workers safe with a shortage in personal protective equipment such as gloves, masks, gowns.

We also hear from a family doctor about challenges his practice is facing in addressing medical issues in addition to Covid-19.

Air date: Monday, March 23, 2020

GUESTS:

  • Dr. Benjamin Chan - State epidemiologist for New Hampshire. 
  • Kris McCracken - President and CEO of Amoskeag Health, (formerly Manchester Community Health Center).
  • Dr. Joseph Pepe - Catholic Medical Center President and CEO and President of GraniteOne Health, a network of New Hampshire hospitals that includes Catholic Medical Center in Manchester, Huggins Hospital in Wolfeboro, and Monadnock Community Hospital in Peterborough.
  • Dr. Douglas Phelan - Elliot Family Medicine at Bedford, Attending Family and Preventive Medicine Physician.

 

Transcript

This is a machine-generated transcript and may contain errors.

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy. and this is The Exchange.

Laura Knoy:
New Hampshire's health care workers are preparing for a possible severe spike in patients with COVID-19, but some feel like they're doing so with one hand tied behind their backs, lacking enough protective gear like gowns and face masks. Meanwhile, testing remains limited in New Hampshire and state guidelines shifted late last week. The Department of Health and Human Services now says that given national supply shortages, testing resources should be reserved for the very ill health care providers and first responders. Today, in exchange. How? Granite Staters who work in health care are doing what they need and how they're coping. Let's hear from you, especially if you work in this sector. We begin the hour with Dr. Benjamin Chan. He's the state epidemiologist. And Dr. Chan, you've been very generous with your time throughout all this. We really appreciate it. Thank you.

Dr. Benjamin Chan:
Happy to be here. Thank you.

Laura Knoy:
What are the new guidelines around testing, Dr. Chan?

Dr. Benjamin Chan:
Yes. So we released and some additional guidance last week both to health care providers and to the public around who should be prioritized for testing. As I'm sure many of your listeners are aware, there are national shortages of many of the supplies that are necessary to test someone for COVID-19. Right. It's not just the test kits. That personal protective equipment that's necessary is in short supply with the swabs are in short supply. Some of the reagents in the lab that are necessary for preparing a sample before testing are in short supply. So we have really asked the public and health care providers have prioritized testing for those who are critical for responding to the COVID-19 threat. Right. That includes health care workers and first responders. We want to know if they are infected with COVID-19 because they have the potential to spread the infection within health care facilities. For example, we want to know if people who live in congregate settings or long-term care facilities might have the virus because of the severe impact that COVID-19 can have. As we've seen in other areas of the country, anybody that's hospitalized with severe illness certainly should be tested. But as we as we know with this virus, the majority of people will only have more mild symptoms. And so where we've put out guidance for people that have more mild but potentially upper respiratory or mild flu like illness who don't, otherwise the medical care to stay at home until their symptoms have resolved prevent spreading to others if they're not tested even to try and prevent further transmission in our community.

Laura Knoy:
How significant a change is this, Dr. Chan, from maybe a week ago?

Dr. Benjamin Chan:
So, as I'm sure you're probably aware, we only identified our first person with COVID-19 in New Hampshire about three weeks ago. So this is just a very rapidly changing situation both in New Hampshire and nationally. And over those three weeks we've managed to test over two thousand three hundred people and have identified 78 individuals with with COVID-19. So, you know, we've we've managed to rollout testing pretty quickly and have tried to ramp up testing. But unfortunately, there are limitations in the supply which have have necessitated in the last week or so trying to prioritize some of the testing for those who are at highest risk of spreading this in the community where those were at highest risk of severe complications. And so this is something that is changing on a rapid basis even over the last week.

Dr. Benjamin Chan:
But hopefully as more testing becomes available, more testing will be available in the future. But that's always difficult to predict.

Laura Knoy:
Oh, that's interesting. OK. So this is for now, it may change in the future. And what the state said on Friday seems to follow what the federal government is saying. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who's been quoted a lot lately, said just recently not every single person in the U.S. needs to get tested. When you go in and get tested, you are consuming personal protective equipment, masks and gowns. He said these are high priority for the health care workers who are taking care of people who have coronavirus disease. So that seems to be the message from the federal government and the state government. Now, couple questions for you, though, Dr. Chan. What is this sort of pullback on testing mean for tracking the spread of this disease? If we don't really know who has it and who doesn't. How can we stay informed?

Dr. Benjamin Chan:
Yeah, that's a great question. And, you know, I think first I would point people to our Web site that is giving updated numbers about a number of people being being tested in that number of people being diagnosed on a daily basis. So, you know, I think this will certainly have an impact on the number of people confirmed with COVID-19. Right. We are in the process. And other states are in the process of developing a case, what we call a case definition of public health, not just for confirmed people, but for people that we have a high suspicion may be infected with COVID-19, because it does impact our public health response. So, for example, if someone's diagnosed with COVID-19 and a family member, a close family member comes down with consistent symptoms, there would be a high suspicion for having COVID-19. We would want to know about that person and be able to track whether, for example, there are a health care worker. And so this is what the case definitions can help and help determine. For right now, we're only reporting on our Web site confirmed cases. We are still doing testing in our public health laboratories. There are commercial labs that have brought on COVID-19 testing. And I know that some hospitals in New Hampshire are looking at bringing on COVID-19 testing, testing, testing. We'll still be out there. We will still be able to test and identify people. But what the what individuals might see is that those numbers may reflect more serious illness in the coming week.

Dr. Benjamin Chan:
So with more miles...

Laura Knoy:
It must be hard to to create policy, given that you really don't have very good information. And I'm not blaming you, Dr. Chan, but given the shortages and testing supplies and given this new approach from New Hampshire Health and Human Services, which seems to be tracking federal health advice, I just don't know how you create good policy, given that you don't have good numbers.

Dr. Benjamin Chan:
Yes, so we definitely are following the numbers that we do have. You know, this is this is a virus that is spreading rapidly and I think it we can presume we know it's in most of our communities and spreading. Right. The majority of infections, but we're identifying are still in people who are traveling either domestically or internationally. So travel poses a risk, certainly still. But we know that this is a virus that's circulating in our communities. And so people need to be taking the appropriate precautions regardless of what policy is in place to say, you know, at least six feet from other people, avoid gathering. These are the basic social distancing measures that we that we've been talking about for the last several weeks.

Laura Knoy:
Given the tightening up on testing that we've been talking about, Dr. Chan, what might that mean for so-called contact investigations where people who had contact with an infected person were tested to see if they needed to isolate themselves or people? You know, a lot of college students coming home from other states and even from abroad. So does this pull back on testing limit our ability to do these so-called contact investigations?

Dr. Benjamin Chan:
So we're still conducting contact investigations and we will continue to do so not only on confirmed cases, but also on people that are of high suspicion for COVID-19. That's where the case definitions come into play that we're working on developing. So, you know, identifying people that may not have been tested, but might have symptoms consistent with COVID-19. But I think your point highlights the critical point here where if someone has symptoms of COVID-19, as this virus becomes more prevalent in our communities, people need to be taking the extra precautions and following the guidelines for if someone were to have mild illness and be diagnosed with COVID-19. Right. So someone had mild illness that is a symptom of COVID-19 but doesn't need to go in and be tested. They still need to remain at home. And some of the guidance we put out there, whether someone's a friend with COVID-19 or suspected to have COVID-19, that they need to remain home for at least seven days since symptoms first appeared. And before they leave their homes, they need to be symptom fever free for at least 72 hours and symptoms have to be improving. Right. So this is this is different from some of the typical guidance people may hear. It's a little more stringent in terms of how long people need to stay home for. But in this day and age, as you know, COVID-19 spreads across our communities. Anybody with symptoms of COVID-19, whether that's a mild flu like illness, a cough illness or even a fever, needs to take the extra precaution and stay home for the duration of time.

Laura Knoy:
I want to remind our listeners, Dr. Chan, that they can join us. And today, on The Exchange, how Granite Staters who work in health care are doing. The shortages they face, what equipment they need. And a little bit later, we'll just talk about how they are coping in this very difficult time for them. Just a couple more questions for you. Dr. Chan, one more on testing, please.

Laura Knoy:
How much does this again, I hate to keep going on tightening up on testing, but that's what we're hearing from you and the federal government. Could this mean that we would see fewer reported cases leading to a false sense of security? Hey, it doesn't look that bad in New Hampshire. I might as well, you know, run around to the grocery store and do a bunch of errands.

Dr. Benjamin Chan:
You know, there's there's been a lot of focus on testing. And, you know, I think that the limitations in supplies will certainly impact our ability to test everybody who wants to be tested or might have symptoms of COVID-19. But that doesn't change the underlying, you know, public health and medical response and the need to be prepared for the numbers of people who will be ill and potentially need to be hospitalized. And it doesn't change the recommendations that are out there, that people that are sick need to stay home even at the earliest symptoms of illness. And it doesn't change the messaging that people that are are well and otherwise feeling well need to keep their distance from other people. And I think that that's a that's that's that's difficult to do, especially over the coming week. But people need to be aware that this virus is circulating in our communities. They need to avoid being in group gatherings. And if they're out, for example, going to the grocery store. People need to be sure to stay at least six feet away from other people. You know, we've we've heard people waiting in grocery shop grocery lines, you know, being closer than 6 feet, people need to keep their distance. And I don't think that the ability with any limitations in testing change the underlying message and recommendations there.

Laura Knoy:
Well, again, we want to hear from our listeners your questions and comments about this. Our welcome this hour. Especially if you work in health care as we focus on how these Granite Staters are doing.

Laura Knoy:
Dr. Chan, Anne sent us an e-mail, Anne says, I am very concerned that Governor Sununu's call for banning gatherings is woefully inadequate and says, I am a nurse in a New Hampshire hospital. Why would we not do all we can to limit transmission? And thank you for working on the front lines in our health care system. And thank you for writing today. Because, Dr. Chan, I did want to ask you about increasing talk about shelter in place.

Laura Knoy:
Health and education leaders in Exeter on Friday called on the state to impose an immediate statewide emergency order to stop all nonessential activity outside the home or shelter in place. I'm sure you're aware of this. You don't need me to read to you what they said, but they basically said from a public health perspective, this is the only way to decrease transmission of the virus in New Hampshire communities. As a public health doctor. What do you think? Is this time for this?

Dr. Benjamin Chan:
Yeah. You know that that's a that's a great question and one that we're hearing a lot from people not only in the community, but our health care providers and our hospitals. You know, and this is these are these are very challenging, challenging decisions and a challenging situation because there are not clear criteria for when to take more certain aggressive, you know, steps. What I will say is that our message has been and continues to be that people need to, you know, avoid social contact and close social contact as much as possible. And I think many people are are listening to that and abiding by that. There are some who who may not be. But the purpose of these types of recommendations, whether it's school closures, you know, canceling mass gatherings or large groups of people, you know, closing down restaurants, for example, and only having takeout options available, all of these measures are intended to try and slow and control the spread of COVID-19 in our in our communities. So many of these measures have already been implemented in New Hampshire and other countries, other states around around the country. And the ultimate impact of these types of measures still remains to be seen. And that's partly why it's so important to follow the numbers as closely as possible, as best we can...

Laura Knoy:
As best we can, because we talked about how the numbers are flawed given the lack of testing. So it's kind of circular, isn't it?

Dr. Benjamin Chan:
Yes, it's a it's a complicated, complicated situation. You know, if we could be out there testing everybody, certainly we would do so. But that's not the reality of the situation that we're in right now. But what I can say is that, you know, this is this is a multi layered approach. And it's not it's not an all or nothing approach to controlling this virus. There are various tools and strategies we have at our disposal. Some states have gone to the shelter in place extreme. And, you know, that remains an active area of discussion, not only in New Hampshire, but many other states. I know that many people are concerned. And as you know, appropriately, they should be, given what we've seen in other states and other countries, especially the concern for a surge on our health care system. And that's something that we're obviously following very closely and can track. Right. We can track, you know, with our hospitals, the number of admissions and hospitalizations and ICU admissions. But we will continue to take appropriate and aggressive steps based on how this outbreak proceeds. And we will try and be proactive in doing that. But I understand that there's a lot of question and concerns about what the next steps are all like...

Laura Knoy:
I'm just wondering. Yeah, how like how is that decision made? What's the what's the ABC boxes that you check where you and the governor and others say, OK, now's the time shelter in place?

Dr. Benjamin Chan:
Yeah. And I think that's that's a that's a good question as well, that, you know, this really is that is it is a team based approach. We keep saying that.

Dr. Benjamin Chan:
But and it's true, you know, we're listening to our partners in health care providers in the community. We just had a call with some of the hospitals over the weekend, for example. We're in we're in communication with them. We hear their concerns. We're we're in the process of preparing and working with the hospitals to increase capacity in the case there's there is the increased surge. But these ultimate decisions are based on a lot of discussions and looking at the data and the numbers and how the outbreaks are progressing, not only in New Hampshire, but in other states. And honestly, the effectiveness of interventions being done in other states as well. You know, we are, you know, a number of weeks behind other states in terms of their outbreak, like in California and New York - by the way, New York accounts for about almost five percent of global infections right now also, though, no other other states are certainly being hard hit by this. And we're trying to take aggressive steps to try and mitigate the impact on our community in New Hampshire.

Laura Knoy:
Well, Dr. Chan, while we still have you for a few more minutes, I do want to engage with our audience. Mackenzie writes that she's a pharmacy technician, saying pharmacy staff are often forgotten about as important health care workers, especially independent pharmacies. Absolutely, Mackenzie. Thank you. I have a good friend who is a pharmacist and she has been self isolating expect except for going to work for a couple weeks now because she cares about her customers and does not want to make them sick. So, Mackenzie, thank you. I also want to take a phone call, Dr. Chan. April is calling in from Dover. Hi, April. You're on the air. Thanks for being on the exchange today.

Caller:
Hi, how are you? Thank you for taking my call.

Laura Knoy:
Sure, April, go ahead.

Caller:
I wanted to address the new testing procedures because it seems like it could be an issue for since we're not in shelter, shelter in place, which means essential and non-essential workers are still going to work. It leaves a gap of where people are having decide whether the symptoms are really covered issues or if they could just possibly have a cold because their employers are not giving them, you know, if if they have a confirmed case of COVID. Yes. Stay home. But it leaves a lot to be determined by individuals to determine what stage they're at. Whether it's serious or not serious? And also financially. If they take the time off work and they can't have a test. You know, are they supposed to stay home for 14 days and just ride it out? And if it's not a cold, they could have been going to work.

Laura Knoy:
Wow. April, I hear what you're saying. Thank you for calling in. So given the supply shortages, Dr. Chan, you keep talking about the national supply chains. And then that's led to a lack of testing here in New Hampshire.

Laura Knoy:
But April's saying, so how do I navigate this with my employer if I don't get tested and I don't necessarily have COVID, then I can't really take time off because I don't have this scary illness. So go ahead, Dr. Chan. Love your thoughts.

Dr. Benjamin Chan:
And that's a that's a difficult position to be in. And I appreciate April's comments there. You know, I think there's there's a couple that there's a number of points in there. But I know we have limited time. So let me just say that, you know, first, if someone's concerned about their illness, then certainly if they're experiencing more severe symptoms, they should be calling their health care provider. Right, their health care provider. Ultimately, is is the decision maker in using clinical judgment as to whether someone can or should be tested or not. The second comment that I make is that all places of employment should be making allowances as to the best of extent that there is then the extent possible to allow telework and potentially even liberal leave policies, because as this expands, more and more people are going to be coming down and infected with COVID-19. And whether someone's tested or not, again, anybody that's symptomatic is to stay home for at least seven days since their symptoms began and they need to be improving and fever free for at least 72 hours. The comment about 14 days, that's for people that may have been exposed, but not symptomatic. Right. That's the, period, people need to stay home, that they could develop symptoms and if they were exposed to someone with COVID-19.

Laura Knoy:
Okay. And last question, Dr. Chan, I know you have to go. Dean writes, Is there a central resource such as a Web site or a phone number for volunteers who want to assist the medical community? Dean, thank you so much. I did I did want to ask you that, Dr. Chan. How can the rest of us, you know, show our appreciation for the people who are really in the middle of this?

Dr. Benjamin Chan:
Yeah, it's certainly a I appreciate people wanting to reach out and help with the effort. Probably what where I would direct people is to look within your local communities, look to your local health care system and hospital, you know, community and medical clinics and reach out to those organizations to see if there's some way that you can volunteer and help.

Dr. Benjamin Chan:
You know that there are there is a need. I believe right now for volunteers and some in some agencies. And so I would encourage people to reach out to their local health care agency to see what kind of help the local community could could use.

Laura Knoy:
And I know some hospitals have been asking for donations, especially with masks. Construction companies often have access and they've been generous. Last question, Dr. Chan, what makes you hopeful during these times?

Dr. Benjamin Chan:
Yeah, and and this is this is a difficult, difficult situation. And, you know, this is not going to be over in in a few short weeks. You know, we expect this pandemic to go on for weeks or months, even. How many months? It is unclear.

Dr. Benjamin Chan:
But the you know, the things that give me hope or are what I see even in my local community and my work colleagues here in public health, the support that people are offering one another even on even on a daily basis. And I think that it's that support that we can give one another that is critical in these tough times.

Dr. Benjamin Chan:
And so I would encourage people living in their communities to look out, to support one another if there's somebody struggling or might need to be at home as they're on quarantine. Maybe they've been asked to quarantine, you know, reach out and support those individuals as best we can. I think that seeing these types of situations and these reports is what gives me hope.

Laura Knoy:
Ok. Well, thank you for being with us very much.

Dr. Benjamin Chan:
My pleasure. Thank you.

Laura Knoy:
That's Dr. Benjamin Chan. He's the state epidemiologist. Coming up, we hear from two health care leaders, one who runs several major hospitals. Another who oversees a community health center.

Laura Knoy:
And let's keep hearing from you. We welcome your questions and comments today, especially if you work in the health care field. Stay with us. This is The Exchange on NHPR.

Laura Knoy:
This is The Exchange on NHPR. I'm Laura Knoy. Today, what New Hampshire health care workers need and how they're managing in a difficult and anxious environment. Let's hear from you, especially if you work in health care. Tell us what it's like now in your workplace. What are you expecting? What are you preparing for? What do you need? With us for this part of our show is Dr. Joseph Pepe. He's president of Granite One Health, which is a network of New Hampshire hospitals, including Catholic Medical Center in Manchester, Huggins Hospital in Wolfeboro and Monadnock Community Hospital in Peterborough. And Dr. Pepe, a busy time for you. A big welcome. Thank you very much.

Dr. Joseph Pepe:
You're welcome. Thank you for having me.

Laura Knoy:
Also with us, Kris McCracken. She's CEO of Amoskeag Health, formerly known as Manchester Community Health Center, Child Health Services and West Side Neighborhood Health Center. And Kris McCracken, thank you also for being here. Really appreciate it.

Kris McCracken:
Thank you so much for having us.

Laura Knoy:
Well, and Dr. Pepe, you first. We're focusing on health care workers this hour. Again, how they're doing dealing with this coronavirus. How has the virus and fears around it affected your staff so far, Dr. Pepe?

Dr. Joseph Pepe:
Well, it's it's one of those things where this is unprecedented. And so we don't have all the answers and because we don't have all the answers, that that uncertainty can create fear. So part of my job as well as every leader's job, is to try to give them the truth in what we expect with out causing panic. And the best way we do that is communication, communication, communication. And as they say, being very transparent about what we know, what we don't know and what we're doing to prepare.

Laura Knoy:
Yeah, I would imagine that emphasis on what we don't know is important, Dr. Pepe. You said you're trying to give your employees the answers, but the answers seem to keep changing every day, sometimes even every hour. So that's a tough environment for you to give clarity and leadership, isn't it?

Dr. Joseph Pepe:
It really is. It's like nothing we've ever experienced before. Where, as you say, things can can change by the hour. And so we we say that disclaimer every time we put out something in communication. And and so it lets people know that that they need to keep checking back on the daily updates that we give. And we round all over the hospital to try to clarify things and make sure that we take care of any confusion, because we certainly don't want to add to this crisis.

Laura Knoy:
Right. Well, Kris McCracken, how are your employees doing?

Kris McCracken:
I would say Dr. Pepe's suummary is perfect. It's exactly what all of us, I think, in this field are experiencing. There's a number of fears. And as you can imagine, there are people who work in clinical settings that they themselves are not clinical. And so, you know, the amount of information they might know about the situation might be what anybody else who's not a medical or clinical person might know. And providing that education when we're in the midst of a PPE personal protective equipment shortage and where people their immediate response is to want a guard, but with every manner of...

Laura Knoy:
Sure.

Kris McCracken:
...Here is is tough. It's it's a tough message.

Laura Knoy:
Clarify for me, if you could, what you mean by people who are working in a clinical setting but are not themselves having clinical training. So do you mean like the people who sort of do patient intake and so forth? They're they're kind of freaking out and you're needing to calm them down, is that what you're saying?

Kris McCracken:
Oh, sure. I mean, there are individuals who might work in a billing department or might work in your finance department or might answer phones that they themselves don't have a particular background in clinical care. But even the clinicians are having to talk about to look sometimes on an hourly basis to see updated guidance from the CDC. So it's complex and it's overwhelming even if you are clinical and if you're not clinical, it's even more complex and overwhelming.

Laura Knoy:
Sure. So some support for those folks who really are just trying to figure it out. You know, both of you mentioned shortages. And I want to read just a couple comments from our listener survey on this and then ask what you're seeing at your respective facilities. Scott in Webster wrote, My wife works in a hospital and I fully expect she will bring the virus home someday. Scott says as like elsewhere, they don't have enough protective equipment to even do proper fit testing of masks, et cetera. Scott, thank you for providing to our survey at NHPR dot org and Virginia in Peterborough also wrote. She says, I'm appalled by the inconsistency of our leaders in federal government who don't seem to understand the medical people must have sanitary conditions, protective gear and equipment so that they can minimize the effects of the virus on all of us. But Virginia says after three months, it still seems doctors, nurses and hospitals are in great need of equipment. Dr. Pepe, what do you need at your hospitals in terms of equipment?

Dr. Joseph Pepe:
Well, right now, it changes daily. Right now we need disposable stethoscopes. We need regular surgical masks. We need the respirators called N-95 masks. We need gowns. We need face shields. We need goggles. There's so many things we need. But but our biggest my biggest concern is that if if we go through a peak and we're not able to flatten that curve, we will need more ventilators than we currently have in the city. And and so that disturbs me or concerns me the most.

Laura Knoy:
Now, have you asked for donations of those other never mind ventilators for the moment. But those other pieces of equipment, the masks and gowns, have you asked for donations like Dartmouth-Hitchcock has?

Dr. Joseph Pepe:
And we have we have asked for donations in the news local newspaper. We've asked for donations on our website, on social media, Linked In, Instagram and so forth. And the good news is that we are getting a lot of donations. People are dropping off things that are lobby anonymously. They are construction folks are coming with the N-95 masks and several construction companies. We are having people actually sew masks for us and and finding out exactly what we need. We have people procuring anything that they can get their hands on. And as soon as they do it, we find that we go from perhaps seven days worth of equipment to five to eight, nine days worth of equipment. And then after a while, it goes back to seven days and five days worth of equipment. So it's a constant, constant battle.

Laura Knoy:
So you mentioned sewing and I did see a couple articles about people being asked to and responding to requests for homemade masks. But I got to say, like, how effective or safe are those Dr. Pepe? What kind of material are we talking about? Just what I have in my my sewing bag downstairs. Leftover old Halloween costumes or what?

Dr. Joseph Pepe:
Well, we're trying to give them directions on making the best possible mask they can, knowing that it's not going to be perfect. We started this with normal operations and then we got into what we call contingency operations, where we start making policies and doing things that we've really never done before. But the science was all there and we we went by guidelines that that is perfectly good to do as we move further along in the in the contingency plan. We will while we hope not to, but we may move into a crisis operation, in which case everything goes out the window and you're trying to do your best you can with the people, you can with the products you have to take care of patients.

Laura Knoy:
Now, even though it's far from perfect, I want to remind our listeners that you can join us with your comments and questions. We're finding out how New Hampshire's health care sector is doing, how people who work in health care are feeling in this anxious environment.

Laura Knoy:
Kris McCracken, how are the people who work for you viewing testing right now, given that at the national and state level we're hearing a shifting message on this. Now the word is if you're not super sick, stay home and don't take up precious time and resources and staff getting tested nationally any way. They seem to be saying just assume you have COVID-19. And if you feel under the weather, but not too terrible, just stay home.

Laura Knoy:
How is your staff feeling about this sort of mixed picture on testing?

Kris McCracken:
Well, I think said optimally, all of us would like to be able to comfort our patients who desperately would like answers to those questions. You've got folks who have loved ones at home that could be at high risk that they don't want to expose. You've got individuals like your earlier e-mail, I think that you read or caller about folks that could potentially go back to work and would like to, but their employers will not use them to come back to work until they've gotten a test that says that they're negative.

Kris McCracken:
And of course, at this point, those tests are being limited to health care workers and municipal frontline responders, so on and so forth. So it's very hard to explain to someone who calls on the phone and says, I just I need to go back to work, can I please get a test? He won't take my clearance letter from the doctor saying I've been screened and I came up positive for flu instead. And say to them, I'm sorry, at this point, the testing supplies are insufficient.

Kris McCracken:
And we are recommending based on CDC guidance that you assume that you stay home for those 14 days. But will the employer allow that because of the employer's fear?

Laura Knoy:
And wow, that's really frustrating. Yeah, go ahead.

Kris McCracken:
That's the cycle that's frustrating for the staff, is that they're responding to very, you know, either individuals who have a desperate need to get a clearance letter that they can't get because they can't get a test or individuals who are just fearful for themselves or their loved one.

Laura Knoy:
Wow.

Dr. Joseph Pepe:
Kris is right.

Laura Knoy:
Go ahead, Dr. Pepe. Yeah.

Dr. Joseph Pepe:
Yeah. You know, we're not saying that it's not important to not get a test and that it isn't a priority for you. What we're saying is that in crisis situations like this, there are actually higher priorities. And and the more the public gets tests that they don't need to be hospitalized. Basically, what they're doing is they're utilizing the personal protective equipment we need to to to have and to conserve in order to take those tests. They're also causing a backlog of the tests so that there's a higher turnaround time. The longer there's a turnaround time to get an answer back, positive or negative, those patients in the hospital have to stay isolated. And we have to burn through personal protective equipment every day that we don't have a test result back. And lastly, we need to test the health care workers because we need to keep them safe, not just because we need to keep them safe, but we need to keep them working so that we can take care of the very sick patients that are coming through.

Laura Knoy:
You know, it's interesting, Dr. Pepe, I'm hearing you and Kris talk about these shortages and these tough choices that you have to make. I just can't help but reflect Dr. Pepe, you know, here we are. This is the United States of America. We're supposed this great, rich, fabulous country. Right. So what do you think about the fact that we have this kind of severe shortage of really basic supplies? I mean, we're not talking, you know, high tech, expensive equipment here. We're talking about gowns and face masks. Did you ever think you'd be in this position of having to sort of ask the community on Instagram for basic gear?

Dr. Joseph Pepe:
I never thought I would be in that position. Having said that, I I think a lot of people knew in the health care field that if we had a severe pandemic like the Spanish flu of 1918, that we wouldn't have enough personal protective equipment and ventilators and so forth. So we really we we were not prepared. No one in the world was prepared for a pandemic like this. And so looking at it optimistically, what I'd like to say is that when this is all said and done, hopefully we will have learned a valuable lesson and will be much better prepared, because if we get a pandemic in the future that has a higher mortality rate, a higher death rate. We we will be better prepared because if that came now, it would be much, much worse than it is now.

Laura Knoy:
And Kris McCracken, Dr. Pepe, let's go to our listeners again. Join us as we talk about how the coronavirus, the threat and the expected spike in patients is affecting the Granite State's health care workers. And both of you, let's go to our listeners now and take a phone call. And good morning. Go ahead. You're on the air. Welcome.

Laura Knoy:
Sorry, go ahead, you're on the air. Yeah, go ahead.

Caller:
Hi, Laura. Hi, Laura. I was so glad to hear you and Dr. Pepe talking about homemade, masks face masks. I'm very concerned about grocery store pharmacists and cashiers. And, you know, I've been asking, shouldn't they be advised to things on face coverings to protect themselves and to protect their customers? There's so much vulnerability there. You know, there is data in the professional professional medical literature about testing the efficacy of homemade masks in Cambridge University Press Journal, Disaster Medicine and Public Health Preparedness in 2013 such tests were done. And of course, they're not as effective as, you know, the most effective commercial masks, but they're better than nothing. And even now, the CDC is telling health care workers that in a pinch, they could use a bandana. You know, shouldn't our grocery store cashiers and pharmacists be wearing some sort of face covering?

Laura Knoy:
Well, Mary, thank you very much for calling. I was at the grocery store yesterday and I had that same thought. Kris McCracken, what do you think?

Kris McCracken:
Well, I certainly think the desire is to get protection out to as many people as possible. But in truth, what they're saying through CDC is that the focus has to be on getting those masks on to people who are infected or potentially infected so that they are not spreading vs. taking up all of the supplies for people who are worried about becoming infected. So there are lots of guides on the CDC Web site that talk about exposure and what environment you're in. And brief exposure, brief interventions are not supposed to be nearly as risky. And of course, you're talking about a public setting where you could have anybody coming in and you don't know. But I think when we get to a point where there are sufficient supplies to provide that, that's that's lovely, but at this point, we want to keep those masks on people who may themselves be sick. And I will defer to the physician on the phone to offer clarification on that.

Laura Knoy:
All right. Dr. Pepe, go ahead. Yeah.

Dr. Joseph Pepe:
Yes. I couldn't have said it better myself. Chris is right on with that. Everyone's nervous about this. What what we want from the general public is we really want social distancing. Stay six feet away from people. What we're finding is that this in general is what we call droplet contagious. So that so that if you're if you're six feet away from people and they're not sneezing and coughing and so forth, it's a lower, much, much lower risk. In the health care setting, we're doing things to people in which we are causing what we call aerosolation. So what happens is when you intubate people, put them on a ventilator or you give them a nebulizer for asthma, it causes that to go into the air and that's much more likely to cause infection.

Laura Knoy:
So I see. So don't worry so much at the grocery store, Dr. Pepe's is what you're saying.

Dr. Joseph Pepe:
It is it is what the CDC would call very low risk. It doesn't mean that it's their own, but it's very low risk. And again, we need to understand that 80 percent of people who get COVID either are asymptomatic or they they can handle it at home just like they could another illness, only 20 percent that actually have to be hospitalized.

Laura Knoy:
Sure. And I want to ask both of you one last question, and I really appreciate your time today. And to you first, Kris McCracken, health and education leaders in Exeter on Friday, I asked Dr. Chan this earlier, called on the state to put in an immediate statewide emergency order to stop all nonessential activity outside the home. These are the shelter in place orders that a few states and cities have put into place. This was signed by, you know, the president of Exeter Hospital, the head of the Exeter Chamber of Commerce, the superintendent of schools, the chair of the select board, sort of a wide array of political and health and education leaders. As a health leader in your community, do you want to see a shelter in place? Would that help you?

Kris McCracken:
I I certainly am not a scientist, but I'm reading what the scientists are writing, and based on what I can see from CDC and other organizations like the World Health Organization, the more limits we have for contact, the better off we'll be. There are plenty of curve projections that show the efficacy of 100 percent locked down like they did in Wuhan to stay in place order to social distancing to none of the above. And it is very clear that a stay in place order is the second to lowest risk for seeing a wide increase in the number of people who get infected. So I certainly would support that order.

Laura Knoy:
Dr. Pepe, how do you feel about that?

Dr. Joseph Pepe:
I think it's scientifically correct that us staying home, staying in place is where everyone should be. Right now, I'm only going out for absolute necessities such as going to the hospital or going to pick up medications and getting absolutely needed supplies. But other than that, no one should be going into crowds. No one should go into restaurants and bars. No one should be going to the beach with crowded with crowds. This is definitely something that the community, our entire community should consider. People don't think that we are Wuhan. They don't think that we are Lombardy, Italy. They don't think that we are Washington State or or California, but or even New York. But it's going to come and it's tough to see that when you're in the eye of the storm. Storm. But this is the calm before the storm. We expect an influx of patients probably at the beginning of April and probably peaking in in May. We don't and if we don't flatten this curve, then we will have. We will be over committed and we will be overwhelmed by the number of patients and does not. There's only one thing worse than losing a patient to COVID, and that's losing a patient because we don't have the capabilities in the equipment to handle it.

Laura Knoy:
Well, Dr. Pepe and Kris McCracken, heavy responsibilities on both of you. And we very much appreciate you taking the time for us today. Dr. Pepe, thank you for being with us. We really appreciate it.

Dr. Joseph Pepe:
You're welcome.

Laura Knoy:
That's Dr. Joseph Pepe. He is presidency of Granite 1 Health, which includes Catholic Medical Center, Huggins Hospital in Wolfeboro and Monadnock Community Hospital in Pittsburgh. Kris McCracken, good luck to you and thank you all so very much for your time.

Kris McCracken:
Thank you. We appreciate your time.

Laura Knoy:
That's Kris McCracken's CEO of Amoskeag Health. Coming up, a family doctor describes what he's seeing in his office. And more of your questions and comments. So keep them coming. Stay with us. This is The Exchange on NHPR

Laura Knoy:
This is The Exchange, I'm Laura Knoy. Today, how New Hampshire's health care providers are faring. What they need, what they're seeing and how they're managing. And let's hear from you, especially if you work in health care. With us now is Dr. Douglas Phelan. He's with Elliot Family Medicine in Bedford. He's an attending family and preventative medicine physician with a master's in public health. And Dr. Phelan, welcome. We really appreciate you being with us.

Dr. Douglas Phelan:
Thanks, Laura. Thanks for having me.

Laura Knoy:
Well, I want to ask you right off the bat how this whole crisis is affecting you and your workers.

Dr. Douglas Phelan:
Yeah, well, I think much in the way that those who have spoken before me have said, you know, we are here and and we are, you know, we're human, too. Of course, we have our concerns about our health and subsequently what that means to our families and all of the patients that we need and want to help going forward. You know, being in health care, I think many, if not all of us feel this as a vocation, as a calling. I know I do. And as such, I look forward to doing what I do every day for the health needs of our community. You know, if we can't be here now, then then when? Really? But I do acknowledge, you know, we do have our anxiety about it. And that's, I think, two different levels to different to different people. And we temper this, which with as much rationality as we can muster. I'm sure all the health workers and first responders are feeling now, though, as I do, that they're teams that they get to work with our colleagues or co-workers, those we don't get to see. Like I don't get to meet necessarily the first responders and the pharmacists. We've risen to this challenge in a way that we never thought that we might have to. And so that is a reassuring thing and something that brings us some some calm in this storm. And I also want to thank patients for their part in helping how we're doing with this in overwhelming fashion. Patients have been understanding of our changes and your flexibility to work with us in new ways helps us strengthen. At the end of the day, we fall back on doing the best job we can in the safest way possible.

Laura Knoy:
Yeah, that's the message that I'm hearing from everybody. And it's understandable. You do the best you can with the limited and changing information that you have and the limited resources that you have. I've heard, Dr. Phelan, that many doctor's offices have either canceled or curtailed routine procedures, surgeries and so forth. Karen in Laconia wrote us, she says, Is it recommended that routine procedures like mammograms be put off until after the crisis? It's a great question, Karen. What do you think, Dr. Phelan?

Dr. Douglas Phelan:
That is a great question. I can say for us around here. You know, different decisions on these things are left in two different folks' hands. I know for our office, regular routine care has been suspended and we're re-evaluating that on a rolling basis as far as what visits are getting canceled and what visits are turned into telehealth and telephonic encounters. And if there's somebody who we feel absolutely needs to be seen for something which obviously is not routine preventive care. Then we talk about whether it would be prudent to bring them in and precautions. What we've heard as far as testing and elective procedures is, is a suspension as well. Procedures that need to be done on an urgent or emergent basis are being done. But routine screening such as, you know, you had mentioned to the caller had mentioned mammograms and also screening colonoscopies for colon cancer, those types of things, any elective procedures are being held off at this point.

Laura Knoy:
Yeah, I was wondering about about that myself. Karen, so thank you very much for writing in. How is that curtailment of elective procedures or routine screenings? How is that affecting the financial health of your practice, Doctor Phelan?

Dr. Douglas Phelan:
Oh, that's a very good question. I wish I had more knowledge about that, but I'm sure there's an effect. But I think what we've heard and what we firmly believe is we're going to have to sort out the finances of this whole thing later. Our our first job right now is to make sure that we're doing what we need to do. And we're hopeful that our our governments, at whatever level, are going to help meet any financial burden that health care institutions have at this point.

Laura Knoy:
We talked, as you heard earlier, with other health care leaders and they all mentioned the shortages that health care providers are facing, protective gear, testing supplies. What sorts of shortages do you have, Doctor Phelan, at your office at the Elliott Family Medicine?

Dr. Douglas Phelan:
Yeah, we have the same concerns that were brought up by everybody before me. You know, masks, gowns, gloves, hand sanitizers, wipes. They bleacher antimicrobial hospitals have other needs, you know, foot covers, surgical caps, the isolation gowns, I forget if I had mentioned that, the N-95 respirators, these are all all things that are important in various ways to different settings of practice and and testing and working with patients who are covered, suspected or covered positive. And so you'll see various health organizations listing out donation lists for a lot of those items. And we also get, you know, occasionally we are getting supplies of this. I am not sure where entirely they're coming from, where they're normal ordering that has been backordered but finally broke through or we hear about this government stockpile. I'm not sure what is coming from where currently. I think Dr. Pepe had said this, that, you know, where we're being told that things are running low and then here we got a small supply that boosts us back up for a little bit. So fortunately, as of yet, I haven't experienced being out of the things that we were told that we would have. But we we certainly prepare for this still being an escalating issue.

Laura Knoy:
How much are you using telehealth, Dr. Phelan? And that's real interesting. And you mentioned it earlier.

Dr. Douglas Phelan:
Yeah. So telehealth prior to this, it was an interest of mine. It's something I've been active in in terms of trying to get things increased with it around the state and around the country. But it's something that we had not done any of. And now we are shifting. You know, many of all of my visits today, for example, are going to be after the telephone. We're working on getting up platforms that are going to enable us to do this. I'm hopeful that, you know, we are going to have a lot of changes in a post COVID healthcare system, and I'm hopeful that our ability to use telehealth in a better way and a more widely adopted way is potentially one positive change that can come from this. We used to not necessarily have the insurance buy in from commercial payers.

Laura Knoy:
Right, that's changed, hasn't it?.

Dr. Douglas Phelan:
That has changed in an emergency setting. And so now that we have the ability to use this, I think for finding just how really just how good of a tool this can be. So I'm hopeful that it continues to increase.

Laura Knoy:
You know, Jessica wrote us an e-mail to say her mom is a nurse practitioner working in a pediatric office and that her mom has had numerous children come in with COVID-19 symptoms without the parents disclosing important information about recent travel in areas with lots of COVID-19 cases. Jessica says they are not wearing masks. She says we have to be better than this and follow best practices. Jessica, thank you for writing and boy, I just don't even know what to say to that e-mail, Dr. Phelan. There's there's so much there are people bringing people in with symptoms. Maybe they don't need to be there. Maybe they're not giving the full picture. I just wonder what you think.

Dr. Douglas Phelan:
Yeah, that's certainly a potential. And so from the first aspect, we ask everybody in the community to, you know, somebody had asked before, you know, what can we do in the community? What can we do to do our part? And to be completely upfront with your health care providers and officials is certainly near or at the top of the list there. What we're doing in our office when we have to bring somebody in is oftentimes we are getting into our gear and meeting them in the parking lot with a mask so that they don't let alone enter the waiting room, they don't enter the building without some type of respiratory barrier. We bring them in. We minimize staff contact with them so that only, you know, routinely different offices might have somebody meet a front desk person and then get roomed by a medical assistant. We're doing our best if we have any concerns to to limit that down so that I will go get them from the parking lot. I will remove them so that we minimize the number of staff if there's any concern to have contact with them.

Laura Knoy:
Sure. Again, trying to minimize all those contact points that you normally would have in a normal situation. Dr. Phelan, we have to close it out there, but I hope we can talk to you again. I really appreciate you being with us. And please accept my my best wishes for good luck as this continues. Thank you.

Dr. Douglas Phelan:
Thank you.

Laura Knoy:
That's Dr. Douglas Phelan with Elliot Family Medicine in Bedford. He's an attending family preventive medicine physician with a master's in public health and Exchange listeners, if you have a moment, please go to our survey at NHPR dot org. We want your comments, questions, stories about how the coronavirus has changed your life. Your input helped shape our coverage and lets us know what's important to you. So again, go to NHPR dot org. We'd love to hear from you. I'm Laura Knoy. and this is the exchange on NHPR.

The views expressed in this program are those of the individuals and not those of NHPR, its board of trustees or its underwriters. If you liked what you heard, spread the word. Give us a review on Apple podcasts to help other listeners find us. And thanks.