The incredible workload in combatting COVID-19

Courtesy photo The Sublette County Public Health team during a vaccine clinic this spring. Pictured, from left, are Jaclyn Nelson, Stacy Blaha, Steve Kipp, Angie Kolis, Janna Lee, Jim Mitchell and Robin Carnes.

PINEDALE – Steve Kipp participated in a routine statewide exercise concerning responses to a potential flu pandemic on Jan. 21, 2020. Kipp, Sublette County’s Public Health response coordinator, also kept his eye on a troubling new pandemic sweeping Europe and Asia.

Within 24 hours of the flu training, the CDC verified the first domestic COVID-19 case in Washington state.

“That kind of kicked everything off for us,” Kipp said.

Sublette County Public Health immediately activated its health emergency operation center, or EOC. The EOC’s early role was monitoring the situation as COVID-19 spread across the nation, Kipp added.

The first case hit Wyoming in March.

“I remember it was March 13, because that was Friday the 13th,” said Robin Carnes, an RN at Public Health.

Gov. Mark Gordon declared a State of Emergency and the Wyoming State Health Officer issued public health orders to contain the novel coronavirus. Routine life in the state came to a screeching halt as communities shut down. Public health agencies across the country found themselves at the epicenter of the crisis.

“This pandemic was unprecedented in our lifetime,” said Janna Lee, Public Health nurse manager. “Nobody had really ever dealt with state orders and lockdowns. I don’t think we had any idea how long this response would go on and continues to go on.”

Initial response

First responders representing agencies in Sublette County established an incident command system, or ICS, to coordinate a response to the pandemic. A unified command was set up, including Shad Cooper of Sublette County Unified Fire, Dave Doorn with the Sublette County Rural Health Care District (SCRHCD) and Lee.

The ICS team worked with the community “at all levels,” said Lee, to plan for the worst-case scenario if regional hospitals filled up. Lee, the Public nurses and Dr. Brendan Fitzsimmons, Sublette County public health officer, collaborated with school districts, early childhood centers and businesses to interpret state health orders.

Cooperation at the local level played a crucial role in containing COVID-19. Lee frequently worked with other nurse managers in the state to share ideas and collect advice.

Experts at the Wyoming Department of Health were available for guidance through the pandemic, Lee said. Clayton Van Houten, the state’s infectious disease epidemiology unit manager, was on Lee’s speed dial.

State agencies acted as a vital buffer between local and federal governments.

“We were fortunate to have that overarching support group (at the state),” said Kipp. “They answered phone calls and dealt with a lot of legislation and rules coming down from the feds.”

Meetings dominated life at Public Health early in the pandemic. Initially, the local incident command team and state agencies met at least once a day, said Lee.

“For a few weeks there, it was get on Zoom at 7 a.m. and get off at 6 or 7 at night and go to bed and get up and do it again,” said Kipp.

Incident command teams rely on a public information officer to maintain a consistent and clear message to the public, Lee explained. Sgt. Travis Bingham took on the role first, paralleling his job at the Sheriff’s Office. Later, Cat Urbigkit stepped into the job, followed by Deanne Swain.

Public health departments struggled to stay on top of fluctuating messages as scientific knowledge of COVID-19 advanced. Sublette County’s ICS team, including Public Health, hosted twice-weekly video updates at first to keep the community updated on the frequent changes in public health orders at the local and state level.

A voice on the other end

COVID-19 gathered steam in Sublette County and spiked in autumn 2020. The incident command team struggled with 80 active cases at one point, Lee said.

“Last fall, (COVID-19) really got more into community spread and we were dealing with pretty intense scenarios at the Sublette Center with staffing and residents,” Lee added. “The clinics had a lot of sick people and very active cases in November.”

Phones rang off the hooks as Public Health was inundated with questions from frightened, confused and frustrated community members.

People in Sublette County were fortunate to have a human being – a nurse in this case – on the other end of the line. Parts of the country resorted to automated systems to deal with the deluge in questions.

The initiative to answer all phone calls in person came from Angie Kolis, administrative assistant at Public Health, Lee said.

“That has been a huge public service because a lot of bigger public health offices went to a phone tree system,” Lee added.

Misinformation spread and people sought sound advice from the nurses.

“Sometimes there would be rumors in the community and people would call and ask, ‘What do I do?’” said Jaclyn Nelson, an RN at Public Health.

The nurses logged hundreds of hours making outgoing calls. Public Health maintained contact with positive COVID-19 cases and checked in with community members in isolation and quarantine to make sure their needs were met, Carnes explained.

Nelson tracked people’s health, Carnes said, referring people with severe symptoms or those failing to show signs of improvement to the clinics.

Contact tracing took up a significant chunk of time. Public Health hired an additional employee, Joanie Christie, to help with the workload.

Contract tracing was a relatively new phenomenon for public health agencies, said Carnes. Before the advent of COVID-19, public health nurses restricted contract tracing to specific sexually transmitted infections, she added.

The timeline for contact tracing varied on a case-by-case basis. In straightforward instances, where the patient knew exactly where they were exposed and limited their contact with others, the follow-up phone calls typically took 15 to 20 minutes, Carnes explained. Many cases were complicated, and took hours to get through all the contacts, she said.

During the spike in cases, the nurses had to make the most difficult calls.

“We’ve talked to the people who were really sick,” Lee said. “We’ve talked to the families of people who lost someone. It is hard.”

Public Health nurses received additional training to deal with their role as a source of information during the crisis and how to deescalate antagonistic phone calls. Carnes said the focus lay in approaching people through a “public health lens.” Using empathy and validating people’s concerns was the key, Carnes explained. Appealing to a sense of community also helped.

“When this is all over, we still have to live with each other,” she said. “We are still going to be in this community, so how can we all work to get through this.”

Vaccine rollout

Public Health’s role in the pandemic took a dramatic and positive turn following the Food and Drug Administration’s first COVID-19 vaccine emergency use authorization on Dec. 11.

Sublette County received its first doses right before Christmas and administered the first jabs over the holidays. The Wyoming Department of Health issued a vaccine rollout plan that prioritized certain groups, including people over 70 and health-care workers.

Public Health nurses went into overdrive to schedule vaccine clinics, get people registerd, calling to schedule appointments and giving the shot, Lee said.

Lee credited Kipp and Jim Mitchell, Sublette County Emergency Management coordinator, for organizing and managing drive-through clinics. Bill Kluck, EMS operations director at the SCRHCD, and his team were on standby to monitor people, Lee added. Volunteers from organizations like the Lions Club also played significant roles keeping the clinics running.

During the first phases of the rollout, Lee stated that they vaccinated 300 people per day. Cars lined the hill leading to the Museum of the Mountain Man.

“We can pack up a clinic like no other now,” Lee said.

Coping and community

In addition to contact tracing, fielding questions and concerns, disseminating information and giving vaccines, Public Health continued to offer regular services. Carnes highlighted the large flu shot clinics held during the surge in COVID-19 cases.

Beginning in May 2020, Public Health spearheaded surveillance testing two afternoons a week to track the pandemic, Nelson said.

The new responsibilities, combined with their regular duties, meant Public Health staff put in significant hours.

Lee and Kipp worked seven days a week for at least 11 hours when the pandemic first hit Wyoming, Kipp said.

“The 11-hour day would be our short day that week,” he added. “It was closer to 14 to 16 hours for awhile.”

The workload took a toll. To help the staff cope, Trisha Scott, Sublette County Prevention coordinator and former mental health professional, organized weekly mental health meetings.

Lee said these sessions were critical in reducing the stigma of discussing mental health for both Public Health staff and the public.

“Everybody is struggling with mental health now,” she said. “We all have anxiety, we’re all dealing with a lot of isolation and stressors. How can we all make that a part of normal conversation?”

“We would reserve Friday morning just to close the door, to make sure that nobody was having any major issues,” said Carnes. “It was helpful to know you weren’t alone.”

“It was just good to talk and know that we’re working together as a team,” Nelson stated. “During those mental health meetings, we would say, ‘How are you going to be good to yourself today?’”

A sense of community also helped the staff cope. Carnes thanked the many people that volunteered at vaccine and testing clinics.

Jim Mitchell played a key role in setting the county up to deal with a crisis through weekly emergency response meetings before the pandemic, said Kipp. The gatherings included department heads from first responders, the SCRHCD and Public Health.

“We’ve all been on a first-name basis,” Kipp added. “We all have each other’s phone numbers on speed dial. (Responses) go very smoothly. I have to credit Jim Mitchell with making sure this county really is tied in together.”

Kipp recognized the dedication of the nurses at Public Health, from giving shots in sub-zero blizzard conditions to answering panicked phone calls during off hours.

“It was amazing to see all these nurses pick up a new set of job requirements and really run with the,” he said. “They’ve all done a fantastic job.”

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