By George A. Vascellaro, D.O.
Family Physician and Chief Medical Officer, CPN Health Services
As an avid long-term reader of current events, I first became aware of COVID-19 when a Family Practice News article in mid-January 2020 educated me on a “mystery pneumonia” spreading in Wuhan, China. Shortly thereafter, it was determined to be a coronavirus and officially named COVID-19, or SARS-CoV-2. I kept daily watch on related current events and reports of spread patterns and concerns in the United States.
My upfront concern turned into action when I read Bill Gates’ coronavirus article (cpn.news/gates) published on Feb. 28 in The New England Journal of Medicine.
Rapidly, I started reviewing early national Center for Disease Control and Prevention guidelines and quickly created a Citizen Potawatomi Nation Health Services coronavirus team led by Kassi Roselius, M.D., M.P.H. Dr. Roselius is a board-certified family physician, CPNHS medical professional director, public health coordinator and CPN tribal member. The team gathered to determine CPNHS COVID-19 pandemic preparedness and needs. From this came the initiation of COVID-19 patient screening tools at intake desks of all clinics. We updated these as CDC guidelines changed. Dr. Roselius and I began daily communication and joint conference call/emergency management meeting attendance with CPN Human Resources Director Richard Brown and CPN Emergency Management Director Tim Zientek. Information from these meetings was relayed to Vice-Chairman Capps and Chairman Barrett, which began their daily involvement as well.
This preparedness tier was considered up to date until the first documented case in Oklahoma occurred, albeit updating as other foreign nations were added to the CDC travel warnings.
Shortly thereafter, the first case in Oklahoma was in Tulsa on Friday, March 6. This led us to the next level of CPNHS COVID-19 preparation and planning — mainly to keep screening and ongoing planning processes modernized, but also proactively procuring available personal protective equipment. Shortages and order fulfillment delays were noted at this time.
Again, this preparedness tier was considered up to date until the first regional case occurred.
Ironically, the next domino fell in a dramatic fashion on Wednesday, March 11, due to a positive COVID-19 case of an NBA player in Oklahoma City. The OKC Thunder vs. Utah Jazz game schedule for that evening was cancelled abruptly, and the organization ended up cancelling the entire season shortly thereafter. The next morning, CPNHS implemented the next phase of preparation, per the most current resource at the time: the CDC’s Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission. At the time, we were in the “none to minimal” preparedness phase because there were no cases of community spread in Oklahoma. CPNHS then started implementing the “none to minimal” preparedness phase and planning for the “minimal to moderate” phase.
On Thursday, March 12, Dr. Roselius prepared a letter on behalf CPNHS, educating all of our patients about the COVID-19 pandemic and the steps implemented by CPNHS at that time to protect them, our employees and their families.
CPNHS medical leadership also started counseling other CPN enterprises, departments and community leaders on the truly dangerous reality of the COVID-19 pandemic situation and the CDC’s implementation of mitigation strategies. Each entity needed to be referencing, implementing and planning immediately both for work and home.
Once again, this preparedness tier was considered up to date until the first case of community transmission occurred.
Just a few days later, the first case of community spread occurred two counties from CPNHS, and we implemented the “minimal to moderate” phase. This is when we began changing CPNHS patient care processes, which included limiting visitors and screening at all doors with temperature/symptom checks. COVID-19 tents were placed outside of both the East and West clinics to triage and separate potential cases from our still critical, acute and chronic care needs. We started collecting COVID-19 tests to send out to our reference labs. The CPNHS pharmacy started delivering medications curbside. We started implementing augmented patient care workflow for the safety of patients, health care employees and the families of both. All wellness exams were rescheduled for six months later. Megan Wilson, M.D. – family physician and CPN tribal member — was tasked with leading the hurried development of CPNHS plans and infrastructure for telephone and telemedicine.
On Monday, March 16, The President’s Coronavirus Guidelines for America – 15 Days to Slow the Spread was released. (It has since been extended to April 30.) This designated health care, pharmacy and food services as critical infrastructure industries that had a special responsibility to maintain our normal work schedule. CPNHS contains all three of these.
And again, this preparedness tier was considered up to date until the CPNHS positive COVID-19 lab result occurred.
On Friday, March 20, CPNHS received the first positive COVID-19 lab result on a patient successfully identified and triaged through our COVID process, so no undue exposure or potential transmission occurred. Due to this, Dr. Roselius implemented the next phase of our COVID-19 protocols. There are too many to list, but the main theme was minimizing patient contact by implementing CPNHS’ telephone and telemedicine plans.
Understand, this is a general overview, and there have been so many levels of preparation and unbridled support from Tribal Chairman Barrett, Vice-Chairman Capps, CPNHS staff and all other CPN departments and enterprises.
With complete confidence, I can affirm that CPNHS is ahead of the COVID-19 preparedness curve and remains that way. CPNHS leadership has done everything it can up to this point to care for its patients’ essential medical needs while guarding the safety of patients, employees, families and communities.
Unfortunately, by best estimation, we are in the early innings of this pandemic, and it may last months to over a year. CPNHS will continue to find the balance between essential patient care needs and the safety of patients, employees, their families and their communities. What you need to do first is keep up frequently with CDC COVID-19 guidelines for families, work, communities, etc. The hard part will be to continue to be aware, obedient, patient and steady. This too shall pass.
Thanks to all from the bottom of my heart. God bless and stay safe. I am praying for all.