RRH ponders path forward

After preparing for surge, hospital faces new challenges

Rebecca Neipp

News Review Staff Writer

RRH ponders path forwardFor most health care providers, the focus on public health for the last several weeks has emphasized taking precautions to limit spread of COVID-19 and preparing for the surge in demand that accompanies outbreaks.

But Ridgecrest Regional Hospital is now facing more nuanced threats on the horizon — including the ability to safely provide prevention and treatment for unrelated conditions, meeting the ongoing fiscal obligations that come with continued operations, and helping its community survive the mental and emotional — to say nothing of the financial — hardships that come with social isolation and economic disruption.

Each of those challenges can be exacerbated by social distancing protocols, acknowledged RRH Chief Executive Officer Jim Suver. However, abandoning those protocols too soon, or too abruptly, can be devastating.

“Until we know more, and get better direction from other public health officials — it is absolutely critical that we keep doing what we are doing,” he said. “It is working in our community.

“Even though the hospital has prepared for the worst, our hope is that we will never have a need to implement our worst-case scenarios. If we can avoid that, it will be thanks in large part to the cooperation in our community.”

Suver noted that part of what makes planning and preparation so difficult is that so little is known about immunity, transmission and recovery from the novel coronavirus. Extreme caution is just a way of buying time until a vaccine — and a greater understanding — is developed.

But in the absence of a modern playbook, Suver points to the Spanish Influenza pandemic that raged from 1918 to 1920. Officials estimate that 500 million were infected (a third of the world’s population at that time), and some 50 million were killed. In the United States, more than half a million perished from the disease.

However, data tracking in large American cities during that time shows that social distancing protocols had dramatic impacts on the destruction of the disease.

One thing that statisticians have learned from those practices is that cities that did not carefully time or modulate their exits from distancing suffered even bigger spikes after restrictions were lifted.

“That is obviously one of the things we want to avoid here,” said Suver.

Although Suver acknowledged that Ridgecrest — like most places — has been unable to conduct adequate testing to facilitate a more comprehensive picture of infection, only five positive results have been reported from the samples taken at RRH.

In the United States, which has the highest reported incidence of the disease, there are approximately 2,500 positive cases per 1,000,000 residents. In California, that number falls to 866/million. Kern County falls even further to about 738/million, and Ridgecrest diminishes to only about 114/million [county and city numbers have been modified to facilitate an even comparison].

Suver attributes that in large part to the remote location of the Indian Wells Valley, the relatively low population density and a general adherence to social distancing measures outlined by Gov. Gavin Newsom and safety protocols dictated for the Centers for Disease Control.

However, while the isolation of our community can play to our favor in limiting outbreaks, it puts the hospital in a precarious position should a surge in the demand for treatment come to fruition.

“Unlike a lot of metropolitan areas of California, I don’t have the option of sending patients to another hospital a few miles away. Part of my stress comes from knowing that, if for any reason this ramps up in our community, we are going to have some very complicated issues to deal with and very few resources nearby. That is why we have put so much effort into our preparations.”

Suver commended his team — including Dr. Stephanie Crapo of the emergency department, Dr. Megan Stone in urgent care and Brenda Diel in quality assurance — with increasing our capacity for treatment.

“I am blessed with a fantastic team, from our senior leadership down. Our hospital is so well positioned to address the needs of our community.”

However, as communities enter the sixth week of unprecedented measures, Suver said that he and his team at RRH are beginning to see other issues rise to the surface.

“One caveat to our surge preparations is the difficulty in getting the necessary supplies. The county has told us that they cannot help us unless we get down to a two-day supply of personal protective equipment, but we want at least a 30-day supply to allow for any potential increase in patient volume. One of the things we are coming to understand about surges is that we cannot always predict when they will happen. And, once again, we are pretty much on our own out here.”

Another concern for Suver and primary care physicians is the potential neglect of other health issues. “With all the focus on COVID-19 people are not taking care of critical health problems that are quite frankly just as dangerous.”

The hospital revised patient visits to limit potential exposure, and increased telemedicine options for patients and doctors. “But if you need to see your doctor, we will make that happen,” he said.

“The last thing we need is a flood in the emergency room of people suffering from underlying medical issues.” If you call the hospital, 760-446-3551, someone will offer instructions for how to proceed with a visit.

“The other major concern I have is the impact our practices are having on the economics of our community, state and nation,” said Suver.

“I know that just from a hospital perspective we have dipped millions and millions into our reserves in order to keep up our staff and supply levels. I cannot even imagine how small businesses are coping under these financial pressures — especially those who have been forced to close operations and have no, or limited, revenues to keep up with ongoing financial obligations.”

Suver said that a key to moving forward will require federal support of more available testing and faster results. “That is not something we have control over locally, but if we cannot test more people — if for no other reason than to rule out who is immune — it is going to be impossible to regain any semblance of normalcy. Right now we have no real way to even assess that risk.”

This week the RRH team has also begun to more seriously take note of lessons learned — from certainty in supply chains to inter-agency communication — so that they can improve their readiness and response.

“In terms of our supplies, we saw early on that our dependency on China put us at risk when their production was disrupted. But we also need to look at how federal stockpiling has affected us. Medical supplies go bad — we saw that with masks and ventilators.

“The one improvement we have seen is that California has a lot more buying power for supplies and equipment than we have at the hospital. If our governor continues to purchase on our behalf, and makes sure those supplies are fairly distributed, that could help us.”

Suver said that he was pleased by the support from City Manager Ron Strand, Police Chief Jed McLaughlin and Mayor Peggy Breeden.

“We have also had fairly productive talks with our state agencies. However, the level of communication we have experienced with Kern County has made some things difficult.

“I know that this is a huge county, geographically, and that the concentration of COVID-19 cases is on the west side. But I think old perceptions in Ridgecrest that the east side is overlooked have been reinforced during this crisis.”

As for timing about when we might see a shift toward relaxed distancing requirements, “I wish I had better intel to share. I don’t have the magic number, because I don’t think anyone knows when it is. But our governor has laid out a fairly cohesive plan, and I agree that once we have adequate capacity, equipment, testing and protections for our most vulnerable, we can start shifting toward normal.

“But keep in mind, we may not have the same ‘normal’ moving forward.”

Pictured: A graphic, originally published by "National Geographic," shows how the different implementations of social distancing impacted infection rates of the Spanish Flu in the early 1900s.

Story First Published: 2020-04-24