Dr. Joe Thompson, former Arkansas Surgeon General and current president of the Arkansas Center for Health Improvement (ACHI), doesn’t see the light at the end of the pandemic tunnel.
Thompson noted that nurses and other hospital personnel across the state are beginning to cross-train in preparation for expanded roles as the strain on the healthcare industry increases.
“Don’t be surprised if they start pulling old docs like me back into practice to help out,” he told Arkansas Money & Politics. “We’re going to have to recruit more doctors, nurses and respiratory therapists. I can’t imagine that we’re going to be able to avoid doing that.”
Thompson called the times unprecedented and thinks most people will “probably get infected” and fall into one of three groups: sick with obvious symptoms; exhibiting mild symptoms but not tested and self-quarantined (most of the population); and totally asymptomatic.
It’s that first group, the one whose members require immediate care, that could ultimately overwhelm the healthcare system, he said. “The fear, the legitimate fear, is because none of us has immunity, this can spread so quickly.”
Thompson said the virus is a new one that our bodies and immune systems haven’t seen before.
“So, when our body gets exposed, it doesn’t know that it’s been attacked by a pathogen that could potentially take our life.”
April introduced the steeper part of the pandemic’s curve with the number of infections, hospitalizations and even deaths on the rise. Availability of testing is “slowly getting better but still behind.”
“Unless you’re a doctor or a health care worker, you’re going to have a hard time finding a test kit,” Thompson said. “The country was woefully under-resourced for test kits.”
As the virus continues to spread, ACHI analysts are collecting data that will be turned into information, he said. ACHI is a public/private joint venture sponsored by the Arkansas Department of Health, the University of Arkansas for Medical Sciences, Arkansas Children’s and Arkansas Blue Cross and Blue Shield that develops evidence-based research to improve health in Arkansas through advocacy and collaborative program development.
Thompson said the highly contagious and potentially dangerous nature of the virus is what makes social distancing so important. That includes the 6-feet apart rule and no groups larger than 10 individuals, preferably outside. The virus is transmitted through respiratory droplets created through coughs and sneezes.
Rural states like Arkansas may have an advantage over densely populated (and heavily visited) areas such as COVID-19 hotspots New York, Chicago, New Orleans, Los Angeles, San Francisco and Miami. But once the genie is out of the bottle, there’s no going back.
“We’ve moved from containment to it’s in our communities and spreading quickly,” Thompson said. “This is why we needed to move to social distancing.”
Unacast, a Norwegian firm with offices in New York and Oslo dedicated to collecting “human mobility data,” recently issued a social distancing scorecard. The United States received a letter grade of C while Arkansas was issued a D-. Fayetteville and Jonesboro earned grades of B- while Pulaski and Benton counties each received a C.
Thompson acknowledges the psychological impact of the virus and the varying degrees of shutdown that have accompanied it. “This is a mental body slam,” he said.
Arkansas physicians are coping with the many impacts of COVID-19, but also are straining in some significant ways, said Arkansas Medical Society Vice President David Wroten.
“People still get sick and need to see their physician,” Wroten said. “Yet, the public health advice is to stay home. To deal with this, physicians are using telemedicine to treat as many patients as possible without the patient having to come to the office. I would venture to say that because of this pandemic, the use of telemedicine by front-line physicians will leap ahead about five to 10 years from what it would have done in normal times.
“Thankfully, our larger insurance companies — Medicaid, Arkansas Blue Cross and Blue Shield and Ambetter/Qualchoice — have all amended their coverage policies so that visits can be covered when using the telephone only as the communication device. Normally, the telephone, audio only, is not considered telemedicine and therefore not covered. So that is helping tremendously.”
Currently, the biggest challenge is the lack of access to personal protection equipment (PPE). This is creating major problems.
“This puts the patient and the health-care team at risk,” Wroten said. “Many practices are either running short on supplies or cannot get them at all. Yet, physicians are finding creative ways to care for their patients, including taking laptops and iPads to the parking lot so that patients can do virtual visits from their vehicle. That may sound strange, but for patients who live in areas with poor access to the internet, it’s the only way they can see their doctor.”
While the challenges ahead appear very daunting after seeing health-care systems in countries like Italy, Spain and Iran overwhelmed, Wroten said that at the end of the day, Arkansas physicians will do whatever is necessary to take care of their patients.”
For Matt Troup, CEO of Conway Regional Health System, coronavirus represents an opportunity to “innovate and to think differently and adapt.”
“It’s really changed just about every aspect of what we do here day-to-day and how we do it. It’s a very different place today than it was even as little as a month ago,” he said. “It affects us in the sense that we are gearing down a lot of our elective surgeries. We haven’t done elective surgeries in almost two weeks. So, in some sense, we’re taking revenue and patients out of the hospital, which has had a negative financial impact. We’re on the ramp-up for what may be a surge and what may be additional volume. It’s kind of the worst of both worlds in terms of preparation. Virtually every hospital that faces this has gone through a similar process.
“I have colleagues all across the country that I’ve talked to over the past few weeks, and all of them are cutting back on elective surgeries, which is typically where hospitals tend to enjoy a pretty strong revenue stream. Now we’re taking that out of the equation in preparation for COVID-19.”
Bo Ryall, president of the Arkansas Hospital Association, knows a surge of COVID-19 patients is headed hospitals’ way. He told Arkansas Money & Politics that hospital leaders across the state have been working around the clock to prepare for the specific challenges ahead, which include simply staying afloat financially.
“Hospitals are collaborating regionally to create surge plans; assessing their stores of personal protective equipment and optimizing its use; educating hospital workers and training them in the unique protective measures we must take because of how easily the virus spreads; setting up and operating screening, testing, and triage locations dedicated to seeing patients who are experiencing symptoms of COVID-19; maximizing the testing capabilities and resources currently available, so that they have access to the best possible information and limiting and screening hospital visitors to protect them, hospital patients and hospital employees,” he said.
“But the greatest impact in the early weeks of the pandemic has been the hit hospitals have taken financially. When non-emergent, elective procedures must be postponed to slow the spread of this virus, it takes a toll on hospital revenue. Many of our hospitals, which often operate on already thin margins, are problem-solving in the face of these threats to their future financial viability.
“That’s why we’re seeing some hospital employees furloughed, at a time when we need the intelligence, heart and hands of every single Arkansas health care worker. The focus must become protecting hospitals and thereby ensuring access to hospital care for all Arkansans, throughout this pandemic and beyond.”
Ryall said hospitals are just as focused on protecting frontline health-care providers by equipping them with essential training and education. They must be cared for if hospitals are to care for patients.
“Arkansas’ hospitals are more than acute care centers. They are also our communities’ local specialists in emergency response, preparing for the unexpected and supporting Arkansans in times of crisis and uncertainty,” he said. “Infection prevention-and-control systems are in place year-round, and all hospitals and health systems are required to conduct regular preparedness drills to ensure that we are always ready to provide care, no matter what the circumstances.
“That being said, hospitals are only a part of the picture of a state’s overall level of preparedness. We’re also relying on public leaders and individuals throughout the state to take the measures we know can slow the spread of the virus: following recommendations for social distancing, practicing hand and environmental hygiene, and leaving home only when necessary.”
In addition to shutting down elective surgeries and in-person appointments, Conway Regional has temporarily closed entire departments and other system components such as imaging services and its health-and-wellness center, which serves roughly 6,500 members. Many employees have been reassigned, and the fitness center repurposed into a free day care center for employees.
Like other hospitals across the state, Conway Regional is offering drive-through screenings and preparing for a possible surge in COVID-19 patients.
“We know how we’re going to address that need if and when it arises,” Troup said. “Capacity is misleading. There’s more capacity in the system than you might think. Our supply chain team did a phenomenal job of staying ahead of COVID-19. They began ordering up extra PPE months ago in preparation. We have acquired additional ventilators and are continuing to work on additional ventilators as well as beds. We are licensed for 150 beds. We don’t always use 150 beds, but we’ve acquired more beds and have plans for that. There’s a lot of things that happened before COVID ever came to Arkansas.”
Cam Patterson, University of Arkansas for Medical Sciences chancellor, said UAMS Medical Center also has cancelled all elective surgeries and set aside floors and wings specifically for COVID-19. In addition, UAMS has expanded its digital health offerings and launched free drive-through screenings at its main Little Rock campus and at underserved areas in eastern Arkansas.
None of these measures are good for the bottom line but are necessary, he said.
“We had to do the right thing for our patients and the state of Arkansas. As an academic medical center, UAMS is unlike other hospitals in that we are also a university. This means that in addition to making adjustments to our clinical enterprise, we had to make plans for our students. We suspended on-campus classes and adapted to a distance curriculum that allows our future doctors, nurses, pharmacists and other health care professionals to continue their education. Likewise, our research continues during this time.”
Patterson said managing a budget normally dependent on revenue from elective surgeries and appointments is representing a delicate balance.
“We are dependent on revenue from our clinical enterprise to not only fund our hospital and clinics but also to supplement our five colleges and graduate school and our research,” he said.
But carry on the institution will, he stressed. As of April, no employee furloughs were planned.
For Ryall, forecasting “business as usual” for hospitals is difficult. He says there’s “really no way” to forecast when that might happen, or what the new normal will even look like.
“But caring for patients is ‘business as usual’ for hospitals, and they are doing that today, tomorrow and every day,” he stressed. “If we want to put ourselves at an advantage in the event, God forbid, that another pandemic the scope of this one arises, we would do well to remember how essential the health of our hospitals is and to pursue measures that sustain them financially and operationally, so that can continue to provide care to Arkansans – in times of calm and in times of crisis.”
Troup said COVID-19 represents a watershed moment for the industry, and he thinks it will help propel healthcare fully into the digital age.
“I wouldn’t wish a pandemic on anybody, but I come to work every day more energized and more excited about health care and my vocation than I probably ever have in my almost 24-year career,” he said. “I feel like years from now, we’re going to look back on COVID-19, and say, ‘That’s when telehealth took hold in American healthcare.’”
Patterson agrees that as more Americans are introduced to digital healthcare, they’ll want to continue using it.
Whatever “back to normal” ends up being, it doesn’t appear imminent. Thompson said the pandemic will be a multi-month event, but “we could get lucky and have it flame out like the flu in warmer weather.”
Looking ahead, he believes that even if football season commences this fall, (with an emphasis on the ‘if’), it will proceed without fans.
“We’ve got a ton of information coming at us,” he said. “But we’re a learning society, so we’ll find ways to adapt. Long range, I’m optimistic we’ll get through this. But short term, we may be in for some rough experiences over the next several months.”
(Becky Gillette contributed to this story.)