It's hard to remember just how little health care workers understood about the COVID-19 virus when it first made its way to the United States.
In February 2020, Spokane became one of the first U.S. cities to knowingly take in patients with the virus, as Providence Sacred Heart Medical Center's special pathogens unit — one of only about a dozen in the country — was specifically designed to handle highly contagious infectious diseases. Initially starting out with staff in what were nearly spacesuits while four patients infected on a cruise were quarantined here, the learning curve was steep, says Dr. Dan Getz, who started as Providence's chief medical officer for the Inland Northwest just as the pandemic began.
"We had patients kept for weeks behind glass because we weren't quite sure what to do with them," Getz says.
The best practices for COVID patients evolved throughout the course of the pandemic, particularly as places that were hit worst first, such as New York City, shared what appeared to work and what didn't work to save the lives of those who landed in intensive care units, or ICUs. Quickly, physicians shared advice to "prone" patients on ventilators, or have them lay on their stomachs. It also appeared it might be better to wait as long as possible before putting someone on a ventilator, Getz says.
Washington took the risk extremely seriously early on, halting all "elective" surgeries — up to and including things like tumor removals — so hospitals would have enough staff and supplies when the influx of patients hit.
"In retrospect, I think we played a hurry up and wait game," Getz says. "We were very aggressive in Washington state in preparing for what we knew was going to come in terms of the volume of patients."
But we perhaps underestimated how long it might take for that to occur, he says.
"We paused a lot of surgeries that people were waiting for, and I think that impacted a lot of people negatively in terms of their health care," Getz says. "It was our first pandemic, right? So we did the best that we could."
The worst wave of patients would arrive a year and a half after the first shutdowns started, when the delta variant of the virus hit the Inland Northwest the hardest. While the earliest groups to be hit hard by the virus included the elderly and those in assisted living facilities, this wave was different. Providence, MultiCare and Kootenai Health all saw a massive influx of younger patients in their 20s, 30s and 40s arriving in the ICU in August, September and October of 2021. Many of the patients had few co-morbidities (conditions that make death more likely), but there were few success stories where people survived the ICU.
Getz recalls that rationing of things such as face masks, disposable gowns and other "personal protective equipment" was effective. While Providence thankfully escaped shortages in Spokane, at one point staff members needed to load up supplies to help a Providence facility in Everett that was down to about a day's worth of materials.
Similarly, Alex Jackson, the chief executive and senior vice president for MultiCare Inland Northwest, says that Deaconess and Rockwood facilities never experienced significant shortages of supplies, but conservation continues to this day.
"I think our teams are trying to conserve our supplies better now than, if you will, B.C. — before COVID," Jackson says.
Once vaccines became available, MultiCare was particularly focused on getting its employees and the community vaccinated.
"While those first couple vaccine clinics were good, we also recognized at the scale we were doing it, we would not be able to vaccinate as many employees and high risk people as we wanted," Jackson says. "We had to look at how to do it more effectively and efficiently. Those early days we were doing maybe 25 or 50 in a day, and a few weeks later we were doing 800, 900, 1,000 vaccinations a day."
HEALTH CARE CHANGES
While the pandemic was traumatic for just about everybody, health care workers in particular were negatively affected.
Jackson says that MultiCare focused on three guiding principles from the early days of the pandemic: how to serve patients, how to serve employees, and how to serve the community.
MultiCare/Rockwood started a program called "code lavender" to provide mental health and support services to its employees who were struggling, and has expanded its mental and behavioral health offerings for the community. Multiple primary care facilities now have embedded behavioral health professionals on site, so patients can get referred just down the hall from their doctor, says Kevin Maloney, a MultiCare spokesman.
Getz says that while there has certainly been turnover among health care professionals, including some early retirements or career changes, he's noticed that those who've stayed in the field have more of a focus on a healthy work-life balance.
"We've been very fortunate. We're seeing more people come into the professions that we have openings for," Getz says. "What you've seen also is a shift in the people who've stayed in the profession, they're valuing their personal time, they're valuing their mental health, they're maybe working a little bit less because they want to have time to spend pursuing other activities or spending time with their loved ones. I think collectively that's going to be a good change moving forward."
In some cases, patients have been arriving at health care facilities sicker, because they didn't seek care or screening tests over the last few years. But the good news is that many health care systems have more than caught up in their ability to offer surgery and care at even higher rates than before the pandemic, Getz says.
Now, the focus is on how to economically recover from the aftermath of the pandemic, Getz says. Reimbursement rates from insurance companies and Medicaid and Medicare don't keep pace with the cost of wage increases and expenses.
"We lost a lot of money as a result of what we had to do in the pandemic, and we're still struggling economically," Getz says. "We need to be very good stewards of our resources so we can continue to deliver care for the poor for another 160-plus years."
Jackson similarly says MultiCare continues to be focused on its mission to serve the community despite the current financial outlook in the health care field.
"MultiCare was founded in 1882," Jackson says. "I'm really proud of how MultiCare rose to the challenges during COVID, and I'm really confident that we'll continue to rise to the challenges in 2025 and beyond as well." ♦
