The Bothwell Regional Health Center Board of Trustees met Tuesday evening via WebEx where the main topic of discussion was the COVID-19 pandemic. 

The meeting began with a presentation on COVID-19 by Chief Executive Officer Lori Wightman and Chief Medical Officer Dr. Philip Fracica. Both began the presentation explaining what the virus is, how it is transmitted, how it is contracted and how it can be prevented. 

Fracica explained COVID-19 is about three times as infectious as influenza and about 10 to 20 times as deadly. He said for every confirmed case there are likely five to 10 in the community that are undetected. It is a novel virus, meaning the human race has had no prior exposure to it. 

“Part of the significance of that is when people get exposed to that and the virus comes into your system, you generally do not get an initial immune response,” Fracica explained. 

Fracica also spoke about the widely used phrase “flattening the curve.” He said when looking at the projection of what the virus is going to do, experts can look at estimates of what percentage of a population they think is going to get the virus and then over what period of time they could get it. Fracica said epidemiology experts looking at Missouri estimate about 40% of the population will be infected. 

“That is a huge difference between that 40% getting it over a six-month period, versus a 12-month period, versus an 18-month period,” Fracica said. “If everybody who’s going to get it gets it in one period that means that they’re all going to be sick over that period of time. 

“They’re all going to be at the hospital at the same time, they’ll all need ventilators at the same time,” he continued. “If you can spread that out, even if the same number of people get it, but if they get it over three or four times a period of time, the peak at any one time will be much smaller.”

Ways to help “flatten the curve” include following the Centers for Disease Control’s guidelines like social distancing, working from home, washing hands frequently, and maintaining a 6-foot distance between individuals. 

“One of the things I think we have an advantage of here is we’ll have likely weeks to months before we get hit with our peak,” Fracica said. “We’ll be able to learn from New York, San Francisco and other metropolitan areas.”

Wightman, Fracica and several Bothwell leaders also spoke about what the hospital is doing in preparation for when Pettis County and surrounding areas hit its peak. Fracica also said Bothwell expects that once larger Missouri cities hit their peaks, they probably will have about half the resources they are going to need. 

“When we get it, not only can we not count on us sending patients there for help, but there’s actually discussions that they may be sending some folks to us to decompress their overload, some of the less sick patients that need hospitalization and possibly ICU stay,” he said. “So when we look to see if we have enough to handle this, it’s not just handling our own population but we may be getting some people.”

Wightman and Fracica were asked how many ventilators the center has, which is 20 with one being fixed. Fracica explained the center started out with seven operating ventilators and they refurbished three, purchased four and have 14 which can be converted to full-fledged ventilators. This tripled the center’s ventilator capacities and Fracica said most big cities were expecting two to three times their normal capacity. 

Fracica said the hospital has created contingency plans for multiple scenarios including not having enough ventilators, not having enough ICU beds, not having enough medical surgical general inpatient beds and staffing challenges. Doctors and staff who don’t normally work with ventilators or in ICUs are brought up to speed on them. 

“We think we have the ability to have a 30% to 40% increase in capacity on a lot of these but what I’d be worried about is by the time we fill all the beds we’ve got available, that we’re not going to be able to have anybody to staff it,” Fracica said. 

Chief Operating Officer Tom Bailey reported Bothwell has roughly 1,000 COVID-19 tests on hand which take roughly two days for results. He is expecting tests that take five minutes to get results to become available soon. Wightman said that up until a day ago Bothwell had tested 55 individuals. 

Vice President of Clinic Operations Keith Morrow said the walk in clinic is seeing a volume drop in patients due to people staying at home. The clinic is also preparing for the peak and has plans to move the clinic into the OBGYN clinic and move the OBGYN clinic to the third floor. Morrow plans to make the main entrance of the healing arts center the “main hub” for COVID-19 patients coming in. He also plans to have healthy patients come in a separate entrance and have only healthy patients on a separate floor. The clinic is also working on more virtual visits. 

Chief Nursing Officer Rose McMullin reported the center has received a lot of donated homemade masks from the community. McMullin also reported on screening for Bothwell staff, working on a surge (peak) plan and getting staff freshened up in areas they haven’t worked on in a while. McMullin has also reached out to some retired individuals for potential help. 

Fracica reported he has also been working on testing prioritization, a plan for revising isolation procedures, treatment protocols, putting together educational materials for physicians who need to get up to speed, modeling what the local surge (peak) would be, working with the ethics community if the hospital was overwhelmed and needed to make decisions for prioritization of resources, and how to optimally use, reuse and disinfect personal protective equipment.

The board also: 

• Heard a financial update from Chief Financial Officer Steve Davis. 

• Approved the payment of bills with expenses at $9,921,773 and liabilities at $14,600,585. 

• Heard from individuals in the SLT Roundtable. 

• Held a closed session. 

The next meeting is scheduled for 6 p.m. April 28.

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