Saturday, April 18, 2020

COVID-19 Testimony by Lauren Blanchard

To my fellow community of the loving and action-minded,

Lauren and Team Member
My name is Lauren Blanchard. I'm a family nurse practitioner working in Oakland California. I met Alex Pickens over 20 years ago when we were both Peace Corps volunteers working in Côte d'Ivoire, West Africa.

In the intervening couple of decades we have both independently followed our interest in healthcare and community development. We reunited recently and compared notes about how our work has been impacted by the novel Corona virus. Alex asked me to share some perspectives from the front lines of healthcare where I currently work. 

Normally my job entails seeing patients for their annual and intermittent illness type of visits but since the COVID crisis hit California my clinic has pivoted to address the high volume of people worrying about the pandemic.

My company has created a drive-thru test site in a parking garage and I have a few photos that you might find interesting.  I really like the team I'm working with and I find it fascinating to be part of a little field clinic.  It is a deliberately iterative process which has made a lot of changes already in the 3 weeks it's been operational and this has allowed much needed adaptation.  Fortunately, we so far have enough personal protective equipment (PPE) and we are making active steps to preserve it as there is no end in sight.

Patients are first greeted at the street level by parking valets who are wearing masks. Since the masks make it hard to read lips, and we want to keep car windows closed to keep potential germs inside the car for as long as possible, the valets hold flip cards that they rotate through, confirming that the patient is here for COVID 19 testing, that they have an appointment (no testing without an appointment as we are still needing to regulate who gets tests so that we can extend the limited supply of testing to the most high-risk folk); and then directing them up to the label generating stations until they arrive in one of the four test bays we will be using. 

The first picture below shows the workstation on wheels or "WOW!"s, of which we have three. They are run on gas generators located on the first floor of the garage and run up to our second floor workstation via mega extension cords. We have discovered that the generators do not have the capacity to run three WOWs plus all the lighting, a printer, and a couple of radiant heaters, so the morning sessions this week are being canceled so that the electrician team can hardwire electricity into the garage for this capacity. The WOWs are operated by staff borrowed from the surgical suite where they normally have jobs to support surgeries (all elective surgeries have been canceled so there is a surplus of labor from those departments). They check in the patients -- who are identified by their name and their vehicle; document that the test was done; and print labels and after visit summaries.  

When a patient arrives at my site I approach them with a q-tip in hand. (Usually I don't have it at such a menacing angle 😉). I am wearing so many layers that I feel very safe.  The hospital gives me scrubs to put on over my street clothes when I arrive by bicycle. These scrubs are turned in at the end of the shift and washed in the surgical laundry so any germs on them stay at the hospital. Over them I wear a paper gown and bouffant cap on my head and plastic splatter shield which stay on for the duration of the shift but are sadly cast into the landfill after that. My N95 mask is good for up to five wearings as long as it does not get visibly soiled. I have been fitted for two types (see last photo) so if they run out of my initial kind I have a backup, the good ol' 1870, which is reliable. And I have gloves on my hands which I either change after each patient or apply hand sanitizer over the gloves. It seems that I can get up to 12 patients cared for on one set of gloves before they start to dissolve with the effect of the repeated hand sanitizer applications. I feel very grateful for all of this gear as the result is that I feel very inured against the odd droplet. 
Work Station in Parking Garage
At my station, the patient finally lowers their window. I have developed a strategy to minimize my exposure where I ask them to keep their face pointing forward in the car, tilt their nose up toward the ceiling of the car and breathe through their mouth. Then I reach in from the side and insert the q-tip the requisite 5 inches into their nasopharynx. A few quick spins of the test swab, and they are done with that. We are telling people to expect results in 3 days or less; they receive a phone call for positive results and an email through the online portal for negative ones.  The after visit summary, handed to them by one of the WOW stations, explains what to do in the case of positive and negative results. Each test takes about 2 minutes from start to finish and as the supply of tests increases, we will be able to expand capacity until we are able to see 72 patients per day in each one of the four bays. 

The final picture is where the runner stands. Along with the valets, she is the only one not dressed in PPE (personal protective equipment) but instead has a pad to jot down ideas of what we might need for future shifts; a phone to help manage incoming calls from patients who can't find us or to call for urgent supplies; and sneakers so she can run down to the first floor storage closet where we have boxes of labeled supplies if we run through something really quickly. Improvements that have come through the system have included a water dispenser on the floor with us, radiant heaters to offset the sepulchral qualities of a parking garage, and best of all, portable speakers from whence, today, '80s music emanated to keep us going.

I'm grateful for my health, connection to people, my ongoing paycheck, and several other surprise things during this crisis. As the Bay area has slowed to a crawl, traffic is almost non-existent and people are not in such a torrid rush to get from point A to point B. When I am outside gardening, people are walking along the sidewalk are making a lot more eye contact with people and saying hi. It feels very small town compared to the more business-like anonymity one often gets in Oakland. The air is much fresher too with so many fewer cars on the road. 
There are all kinds of creative ways I've heard of people reaching out to help each other. From postcards slipped under the doors of neighbors saying here's my contact info let me know if you need help, to one person who apparently gave out construction paper with green on one side and red on the other for their neighbors to hang in the window. Showing the red side means they need help, showing the green side means they're okay. People leave groceries for each other on the front step. I think it is great that the stores are so often giving the first couple of hours to the elderly to shop in peace. 

I was listening to a podcast yesterday in which an epidemiologist was talking about the various ways that the human species could be wiped out and the common denominator is disease. Either man-made, or naturally occurring. The plague of the Dark Ages killed 25% of the population; in contrast, COVID 19 is only killing about 2% of the population on average. In a weird way, maybe the adaptations we are making now are actually a blessing in disguise, as they are helping us to increase our resiliency and skill set in practice for The Big One.

What can everyday people do? 
Lauren in Personal Protection Equipment
Certainly trying to follow the instructions of health officials is the number one advice I can give. The website seems to be reliable and fortunately does not seem to have been muzzled by the White House. I know it has been very confusing and unsettling to have health recommendations change so frequently but adaptation is absolutely an important tool as we adapt to a challenge that we as a human race have never before experienced. At the time I'm writing this, the CDC is just now recommending that even seemingly healthy regular people wear cloth or paper face masks. These do not have to be fancy medical grade masks although people who have access to the rectangular paper ones called surgical masks should use them. But a bandanna or cloth over the mouth and nose are equally effective. The idea is that the general population may unknowingly be carrying the virus for up to 7 to 9 days before they actually get sick with symptoms. During this time they can spread the virus to their loved ones and to other strangers at the supermarket bus stop or other places where people aren't able to socially distance.  The virus of course comes out in microscopic droplets when we laugh sneeze cough or even talk. These can be caught effectively by a face mask.  

I'm sending wishes for health and endurance to all of the families who are reading this post and who are struggling wondering how to make ends meet when you are told to stay inside and away from your money making opportunity; when you are struggling with how to perform multiple roles at the same time; when you have no personal space or time; when your favorite diversions have been removed from the list of options; when compulsive behaviors rear their ugly heads in the absence of alternatives and healthier outlets for stress. We are all fighting the good fight. I believe if we can pull together as a human race we will minimize the damage that this pandemic causes on us. I'm sending love to all of you. 

Lauren Blanchard, FNP
Oakland, California

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