Since the first warning from the CDC in January of this year, we at the Lac Courte Oreilles Community Health Center, have been diligently preparing for the possibility of a COVID-19 pandemic which could affect our community. We have also been planning how to serve our community in the most effective manner while preventing transmission to the best of our capabilities. We would like to advise the Tribal Governing Body and Lac Courte Oreilles Tribe that we at the Lac Courte Oreilles Community Health Center are confident that we are well prepared for the possibility of a local outbreak and have planning in place to meet unforeseeable eventualities.
The following is a list of some of our key actions for preparedness:
On January 30th, a Center of Disease Control and Prevention health alert was forwarded from the Sawyer county health department advising us that Covid-19 was diagnosed in a neighboring state and that it was an issue of health concern. With the health alert, we also received links to informational and training webpages from the Center of Disease Control and Prevention. At that time, several key health personnel at the Lac Courte Oreilles Community Health Center began to educate themselves about the situation along with recommendations from the Center of Disease Control and Prevention. On that date, a clinic wide email was sent out to all employees with a Sit-Rep and instructions on what message to promote with patients. Namely:
The best way to prevent infection is to avoid being exposed to this virus. However, as a reminder, Center of Disease Control and Prevention always recommends everyday preventive actions to help prevent the spread of respiratory viruses, including:
Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are sick.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects and surfaces.
On February 10th the Lac Courte Oreilles Community Health Center Infection Control Officer sent information to all of our health professionals and paraprofessionals with the latest Sit-Rep from the Wisconsin Department of Health Services, regarding a positive Covid-19 case in Wisconsin along with a graphic flow chart from the CDC containing clear instructions for assessing, identifying and reporting the disease as well as what to advise patients who were being tested. Our Lab also confirmed the ability to test for the illness, should someone present to the clinic with symptoms.
On February 19th, a Sawyer County Public Health Briefing was received from the Sawyer County Incident Command in preparation for the American Birkebiner Event with specific instructions for assessing patients for Covid-19. This briefing was circulated to health professionals who were planning on volunteering for the event. The possibility of Covid-19 transmission was given serious consideration in light of the number of international travelers that the county was preparing to receive.
On February 28th, key Lac Courte Oreilles Community Health Center staff participated in a Wisconsin Department of Health Services COVID-19 Provider Webinar.
On Thursday, March 5th, 2020, the Health Director for LCO-CHC, Gary Girard, attended an Emergency Preparedness meeting at Lac Du Flambeau with several other Tribes throughout Wisconsin. It was discussed that most Tribes did not have a plan and it was best practice to follow current CDC (Center for Disease Control) guidelines.
On Friday, March 6th, 2020, Jeanine Connell, RN, Infection Control Officer for Lac Courte Oreilles Community Health Center, met with Sawyer County Health and Human Services Department to open formalized lines of communication. The County reports they also will be following Center for Disease Control and DHS (Department of Health Services) guidelines in regards to COVID-19 testing. Sawyer County Health and Human Services reported testing should be completed based on these criteria as the number of available tests is limited. Key Clinic personnel also participated in a second COVID-19 Provider Webinar.
Currently The guidelines for testing are that if someone has had prolonged close contact with a person with a confirmed case of COVID-19, has traveled on an airplane, and is contacted by a Public Health Department AND has signs and symptoms of Respiratory Illness i.e. fever, cough, lower respiratory infection symptoms to call the clinic to talk to a Nurse first as they will further investigate your symptoms to rule out other possible illness before referring an individual for testing.
Attached you will find a COVID-19 update from the Sawyer County Health Department along with the latest testing guidance released late on March 9th. At this point we do not have any person(s) under investigation (PUI) in our county but with the third case confirmed in Wisconsin and the quick rise in cases reported in our surrounding states preparedness is key to serving our Community effectively.
On Wednesday, March 11, 2020, Lac Courte Oreilles Community Health Center Health Director, Gary Girard and Jeanine Connell, RN, Infection Control Officer, met with TGB to discuss what the Lac Courte Oreilles Community Health Center currently has in place and how we are responding.
The outcome of the meeting was a determination that Lac Courte Oreilles Community Health Center will follow Center for Disease Control recommended cleaning procedure guidelines, which are already being done in patient care rooms after each patient. It was determined that support staff would be continuously available for cleaning, so that all community shared areas/surfaces, separate from patient care rooms, of the clinic will be wiped down with an antiviral solution at a minimum of every two hours to prevent the spread of disease.
Patients presenting with a cough, shortness of breath or fever, will be prompted by staff to wear a mask and use hand sanitizer upon entering the clinic to prevent transmission of any possible illness. Additional sanitation stations have also been set up in the clinic with instructions upon entering the clinic outer foyers that any patient sick with any of the above symptoms should don one of the supplied masks before entering the clinic common areas.
All staff that is directly assisting a patient with respiratory symptoms, will be required to follow CDC droplet precaution recommendations for utilizing the following Personal Protective Equipment (PPE) guidelines, consisting of an isolation gown, N95 respirator, face shield or safety glasses, and gloves which will be put on by medical staff prior to coming in contact with the patient.
Discussion was head regarding implementing an alternative testing site to decrease transmission. This site is still under discussion as to the best location. Currently, effective today, COVID-19 testing will still be performed in the Lac Courte Oreilles Community Health Center, following the current Center of Disease Control guidelines, with patients being urged to place a mask on and sanitize hands upon arrival at the clinic, until an alternative plan is fully developed.
Any patients meeting the criteria for COVID-19 testing are to immediately be self-quarantined until the test results are returned, which currently take 3-5 days. If a positive test result is confirmed the patient must be isolated and actively monitored until cleared by Local Health Authorities.
This statement was also released by the Lac Courte Oreilles Community Health Center, Health Director, Gary Girard, in regards to Lac Courte Oreilles Community Health Center prevention response actions. “After meeting with TGB, we are hereby cancelling all unnecessary travel and large group events to control the spread of Covid-19. Please cancel the Bizhiki Wellness Gathering, the Volleyball Tournament, and similar gatherings until further notice. In addition, we will be designating a space in the Urgent Care facility for testing any community members whom have been in close proximity with infected individuals or in areas at Level 3 exposure. We are also implementing a new cleaning program during the day and after work hours to disinfect our buildings, which follow the CDC guidelines for this infectious disease. In addition, any meetings which can be accomplished through telephone or skype will be utilized. Patients seen at the clinic will be offered a face mask and gloves. Finally, regular updates will be posted on the health center newsletter. We are working closely with the Sawyer County Health & Human Services and will be following their lead on this. Jeanine Connell is our Infectious Disease Coordinator. Please see her about any questions you have.”
On Thursday, March 12, 2020, the Lac Courte Oreilles Community Health Center held a Clinic Emergency Preparedness meeting to discuss the current plan for patients with possible COVID-19 and how to handle possible cases based on updated guidelines and planning for near future changes to increase prevention of virus transmission.
To date, Lac Courte Oreilles Community Health Center is currently following all CDC recommendations and aligning with Sawyer County Health and Human Services to provide consistent recommendations.
Center for Disease Control Considerations for COVID-19 Testing are listed below:
COVID-19 testing is typically not indicated for patients without an exposure risk who have mild respiratory illness or who are asymptomatic.
Patients with a fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Recently hospitalized patients, symptomatic individuals such as, older adults (age ≥ 65 years) and individuals with chronic medical conditions, and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
Any persons, including health care personnel, who within 14 days of symptom onset had prolonged, close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from high risk geographic areas within 14 days of their symptom onset. Testing should be considered for individuals in this group even if symptoms are mild (e.g. sore throat).
When considering COVID-19 in any patient presenting with respiratory symptoms, whenever possible test for common causes of respiratory illness (e.g., influenza, RSV), and if negative, a test for COVID-19 may be considered. Per www.dhs.wisconsin.gov
The Lac Courte Oreilles Community Health Center, Clinic Manager, has organized with our Triage Nurse and developed a plan that follows the current Center of Disease Control screening questions that will screen for the virus and aid in determining if testing is necessary based on the Center of Disease Control guidelines listed above.
As a Clinic, we also want to remind the Community that we are NOT an Urgent Care or Emergency Care facility, if a patient needs respiratory supportive treatment, they will be referred to the local Emergency Room.
The Clinic CQI team did a “ghost call” on 3/11/20, reception and triage responded exceptionally per Center of Disease Control recommendations.
In addition to our regular cleaning practice at the clinic we will be sanitizing surfaces every 2 hours.
The Health Director reminded staff current estimated mortality rates, based on a Center of Disease Control FACT sheet, of 3.5% of those diagnosed. Those rates are typical of immune compromised patients, the very young and very old. With 60% of our Community having risk for diabetes, heart conditions and other chronic illnesses, we are taking this virus very seriously and preparing in accordance with Center of Disease Control guidelines.
To put into perspective the likelihood of contracting COVID-19, based on China’s current reported statistics of 80,924 confirmed cases and the population estimated population of 1 billion citizens (which is a low estimate), the likelihood of contracting COVID-19 is less than .01% of the population, however this is only based on reported cases, which are typically the worst cases requiring supportive treatment from a medical facility.
All staff were reminded to inform Community members not follow the media for information, but reference credible sources such as the Department of Health Services and Center of Disease Control. Facebook and social media sites are NOT a reliable source of information, unless release from a credible source.
Jeanine Connell, RN, Infection Control Officer for Lac Courte Oreilles Community Health Center, or her delegate will continue to stay in close contact with Sawyer County Health and Human Services, for updates as virus information updates are received. She will then update staff and LCO Community media, such as Face Book, on a daily basis.
Dave Axt, Pharm D, for the Lac Courte Oreilles Community Health Center adds, “If you have questions about how your medications may be affected by the coronavirus pandemic, then contact the LCO Pharmacy at 715-638-5146”.
Commander Summer Pearson also briefed of Lac Courte Oreilles Community Health Center Lab Department procedures in regards to COVID-19:
“Lac Courte Oreilles Community Health Center-Laboratory Response to the COVID-19 Outbreak"
The CDC currently recommends the providers rule out more common communicable diseases prior to testing for the COVID-19 virus. The provider will use their judgement, following CDC guidelines to determine what tests should be ordered. Here at Lac Courte Oreilles Community Health Center we have the capabilities to perform testing for influenza, and strep. We have another instrument that will test patients more in depth for 14 other common viruses and bacterial infections.
These test may be used to screen patients prior to sending testing out for the COVID-19 as the tests listed above can be completed in 1 hour and 5 minutes and the COVID-19 test takes 3-5 days.
If the provider chooses to order the COVID-19 test, it is offered through LabCorp who we already contract with. They can have the test results available in 3-5 days.
Supplies:
We currently have 18 collection kits. The supplies are on backorder and McKesson has assured us we will receive 90 more collection kits by the end of next week.
The collection kit consists of a nasopharyngeal swab and Universal Transport Media. The swab is inserted into the nasal cavity. The swab is placed into Universal Transport Media and closed tightly. The test samples will be picked up daily by the currier for LabCorp who comes here every day at 4pm.”
Katie Sears, RN , Community Health Department Charge Nurse, reports Community Health Nurses have the appropriate training to deliver medications to patients that are in active quarantine. Due to limited staff this service, medication delivery, will be strictly limited to individuals that are quarantined so that we are spreading our resources as far as possible to affectively assist the greatest number of Community Members in need during this time. Medications will be delivered to a mailbox or front door only if the patient is quarantined. Patients requesting additional in-home nurse care while quarantined will be directed to follow up with the local Emergency Department as nurses are not capable of prescribing supportive medication treatment for COVID-19 symptoms.
Home visiting programs will continue as usual unless a patient is reporting active symptoms of COVID-19, then the nurse may advise the patient of the need to seek testing if there is question. Staff with carry PPE (Personal Protective Equipment) with them at all times when completing home visits in the event that a patient may report questionable symptoms.
Health Director, Gary Girard is looking into a Mobile Command Unit for a possible testing site outside of the Clinic to prevent introducing the virus into the Clinic. Community updates will be provided if and when this change is made. Currently we will follow standard check-in procedures and patients will be asked to sanitize their hands and wear a mask to protect other Community members and staff.
In case a patient is triaged over the phone with a complaint of respiratory illness and meets criteria for a person with medium to high risk of exposure to Covid-19, they will be registered and roomed in the old urgent care wing of the clinic to prevent unnecessary exposure of other patients to contagions.
LCO School District will be following the Bureau of Indian Education directives in regards to COVID-19.
We would like to allay any fears that the LCO Community Health Center or our partners with the Sawyer County Public Health department and area hospitals are not fully prepared for an outbreak of infectious respiratory disease in our community. We have highly skilled staff, who have trained and prepared for a public health emergency such as this one, and we have good relationships with local and State partners. We have a well thought out plan of action and we are actively collaborating with area partners on contingency plans. This pandemic will continue to have rapidly changing challenges; however, we are confident that we will continue to be able to meet the needs of the community.
