EDITOR’S NOTE: Timothy J. Reeves has witnessed the pandemic on the front lines of the rural American health-care system. What follows are his personal reflections on that experience. Disclaimer: The views and opinions expressed here are the author’s views only and do not in any way reflect the views and opinions of the medical center, its board of directors, staff, other affiliated persons, or anyone directly or indirectly referenced within.

Bucktail Medical Center

Bucktail Medical Center is a 43-bed Skilled Nursing Facility (SNF), 16-bed Critical Access Hospital (CAH) community Rural Health Clinic (RHC), and Basic Life Support (BLS) ambulance service.  Located in the middle of Pennsylvania’s northern tier and within the Pennsylvania Wilds; BMC is likely the most remote health care facility in the state.  The hospital dates back to 1909 as Renovo Hospital.  In 1979 the facility was moved across the West Branch of the Susquehanna River to South Renovo when the SNF was added to the hospital and renamed The Bucktail Medical Center.  BMC has always struggled financially:  On October 02, 2015 the facility filed a voluntary petition for Chapter 11 reorganization.  We successfully emerged from Chapter 11 on March 26, 2018.  Almost exactly two years later, we began our response to SARS-CoV-2, commonly known as Covid-19. 

Pandemic – Part 1

Initial Pandemic Response

On March 13, 2020, I locked down our facility from all visitors and non-essential personnel:  Covid-19 was running rampant through U.S. nursing homes.  We contacted family members, Power of Attorney’s, and other frequent visitors to inform them that the building was closed and no one could visit.  We contacted volunteers to inform them that their services, like social visits and assisting with activities, were not essential and that they too were restricted from entering the facility.  No one knew what to expect.  No one knew how long it would last.  No one knew how many facilities would be affected.  No one knew how many residents and caregivers would die.  We allowed “window visits” and dedicated a cell phone for video calls so residents and their families could communicate.  In September, for a short time, we allowed in-person visits; no physical contact (hugs, kisses, or holding hands), social distancing was required, and masks were required as was hand washing before and after the visit.

Timothy J. Reeves, CEO and Administrator at the Bucktail Medical Center (Photo submitted)

Deliveries are made to the outside of the building; facility staff wipe everything clean then bring it inside.  Mail and other items brought in for residents is quarantined for 24 hours before being delivered.  All traffic in and out of the building is limited to one entrance for the clinical end of the building and one entrance for the administrative end of the building.  We started taking temperatures and asking screening questions of our staff every day.  Do you have symptoms like a fever, shortness of breath, cough, or congestion?  As the virus spread through the nation, we added more questions: are you Covid positive or have you been around anyone Covid positive?  Do you wear a mask when you are outside your home?  Have you been in an area or facility with high Covid-19 infection rates?  Have you recently lost your senses of taste and smell?

Planning Begins

Early on, I gathered a clinical team and we started planning our response, should the virus infect our community and our facility.  We developed plans for treating possible and known Covid-19 patients in our Emergency Room (ER), providing acute care in our hospital, and caring for residents in our SNF.  Our response plan changed frequently, sometimes twice daily,  as we learned more about the virus and as new updated guidance was received from the Pennsylvania Department of Health (PA DOH), the Centers for Medicare and Medicaid Services (CMS), and the Centers for Disease Control (CDC).  We identified GREEN, YELLOW, and RED zones.  Initially separated by temporary barriers, then ultimately, each zone was in a different hall of the facility and separated by fire or smoke doors.  BMC is a unique facility because we have both a SNF and a CAH, separately licensed, in the same building, with no physical separation.  Each facility has a set of regulations which often contradict the other.  We struggled to find solutions that met the guidance for both the SNF and the CAH.  We also looked at 1135 waivers for direction.

PPE Shortages

It is essential to keep our employees safe during this pandemic, so the hunt was on for Personal Protective Equipment (PPE).  Some of our regular vendors limited orders to our average monthly order over the past year; our need this year was much greater.  Some vendors were only shipping to existing customers.  Others were happy to take new customers with prices up to five times the usual cost.  The Federal Emergency Management Agency (FEMA) and the Pennsylvania Emergency Management Agency (PEMA) both have sent PPE supplies; through the Regional Response Health Collaborative Program (RRHCP), the PA DOH was also able to provide supplies.  In accordance with CDC guidance, we have reused equipment intended for single use.  We sanitize and inspect each item before it is reused.  Face masks are returned to the same employee after being cleaned.  We need to conserve our supplies.  We don’t know how long this will last or if BMC will experience an outbreak.

Testing

We started testing in May.  We started with PCR tests, which detects the presence of the virus’s genetic material; we collect the specimen and send this test out to another medical laboratory.  Time to get the results varied from 30 hours to 14 days.  By July we were doing antigen tests in our own lab.  Antigen tests detect specific proteins on the surface of the coronavirus:  We can have results in as little as 15 minutes.  We tested residents and staff monthly, then when positivity rates began increasing locally, we tested every two weeks, then weekly, then twice a week, then daily for negative residents and staff.  We ordered as many test kits as we could find.  Soon we had a supply sufficient to test everyone weekly for a few months.  

We soon realized the struggle first responders had getting tests after a potential exposure, so we offered tests to local first responders.  Word got out and soon we were offering rapid antigen testing to first responders throughout the county.  Test kit availability started to slow, so I had to limit antigen tests for a short time. However, with the help of the county emergency management services, we were able to acquire many more antigen tests; enough that we are able to test first responders throughout the county with a supply separate from that for the facility.

To reduce the risk of having Covid positive patients inside the facility, we set up Covid testing in our Special Services Building (SSB), a garage adjacent to the medical center.  People who need Covid-19 testing call our Community Clinic and are screened.  Those who meet the criteria (credible exposure risk, at least 72 hours since exposure, etc.) are given an appointment time for the test.  They drive up to the SSB and are tested without leaving the vehicle.  Those tested with the antigen test generally have their result in a few hours.  For confirmation and a few other circumstances, we continued sending out PCR tests, which were collected the same way.

Staff Meetings

Employees started asking questions about the virus, or they were “reporting” misinformation they gleaned from social media.  I’ve taken and frequently use a quote from a nurse here: “Facebook is for entertainment, not education”.  I decided to meet with staff Monday through Friday during both the morning and afternoon shifts.  The meetings were implemented to provide accurate national and local information, to separate the clinical information from political banter, and to provide employees an opportunity to ask questions.  We talked about masking, social distancing, and hand washing nearly every day.  We talked about how to keep your family safe by developing a plan to change and launder clothing and taking a shower as soon as you get home from work or school.  We demonstrated the proper way to don and doff PPE.  We talked about social gatherings and how to recognize unsafe situations.  We talked about why this virus was so concerning and we talked about the science behind the vaccine.  These meetings continue today.  As we saw more activity, we recorded the afternoon meeting each day and posted it to our web site.

Masking – Part 1

When cloth masks were recommended for safety, members from the community began manufacturing them.  Every pattern, color, and design you can imagine:  They donated them to the medical center by the dozens.  Employees were required to wear them at work and encouraged to use them outside of work.  Residents were also provided with cloth masks to use when out of their rooms.  We talked about how even a cloth, non-medical mask can provide protection.  When paired with frequent hand washing and social distancing, you can achieve a reasonable level of safety.  The caveat is understanding how masking protects you.  My mask stops droplets, which is believed to be the primary source of transmission, from getting to you; it is much less effective at filtering the air you breathe.  The analogy I use, though probably uncouth, is this:  If we are all go around without clothes (no masks) and I pee on you, you get wet (infected).  If you put on pants (you wear a mask) and I pee on you, you still get wet (infected).  If I put on pants (I wear a mask) and I pee on you, you don’t get wet (infected)!  

As we started seeing positive tests in our county, we moved to providing staff with N95 respirator masks and residents kept cloth masks.  Large group activities had been replaced with small groups of five or fewer residents shortly after the lock down.  The groups remained consistent to lessen potential spread.  Each group met at the same time every day.  Instead of the five to seven activities normally available every day, each group met only once per day.

CARES Act Funding

Clinton County granted the facility some of their CARES Act funding.  We used these funds to purchase sanitizing equipment which included an electrostatic back pack sprayer and the chemicals for sanitizing.  We use this to sanitize large areas like the ER or our ambulance.  We also purchased a UV C light which produces radiation to kill viruses, including Covid.  The remainder of the funding went to pay every employee a $3.00 per hour hazard pay bonus for twelve weeks.  The hospital received some CARES Act money also.  We purchased a few essential pieces of equipment to treat patients with complications from Covid, bought PPE and antigen test kits, and paid for sick pay for staff that were positive and unable to work.  The rest was set aside for lost revenue so we can keep providing essential services to our community and keep our staff employed.

Covid-19 Hits Home

As the most remote hospital in Pennsylvania, it took a while for the virus to get here.  While other parts of the state, the nation, and the world responded to a previously unknown strain of SARS CoV-2, we had no positive cases in the facility or in the local community.  Our remote communities are popular with outdoor enthusiasts:  Hunting, fishing, camping, hiking, horse riding, and off-road sports are all popular here.  We watched as local cabins and camps filled to capacity and beyond with people fleeing Covid-19 hot spots across the nation, trying to reduce their risk of exposure.  It was difficult to find an empty camp site throughout the season.  We were certain this influx of people would result in positive cases in town.  Somehow, so far, we seemed to be spared.  

We had an advantage that few other facilities had:  We were able to see how other facilities across the nation responded.  We saw what worked and what didn’t work.  It was clear early on in the pandemic that frequent testing was necessary to understand the spread and to keep our residents safe.  We continued testing residents and employees.

We watched the numbers every day:  No positives.  Not in March, April, or May.  Not in September or October.  Not until after Christmas; December 29, 2020.  In spite of testing everyone twice a week, we had thirteen residents and three staff test positive for Covid-19.  One of the three employees had symptoms, which prompted us to do the testing one day earlier than planned.  No one else showed any symptoms for a few more days.  In a matter of hours, we went from zero to sixteen.  The plan we developed was implemented, with a few revisions.  We hadn’t planned on that many positives at one time, so we made the adjustments necessary to create GREEN, YELLOW, and RED zones sufficient for the numbers we had.  Residents were quickly moved into the proper zones.  Many residents ended up in different rooms and with someone else’s belongings.  All residents were confined to their rooms.  Hallway doors that are normally open are now closed.  Moving into and out of any zone seemed more akin to a prison than a nursing home; doors closing and latching behind you.  Staff in RED zone were wearing full PPE; many residents couldn’t recognize them because they couldn’t see their faces, especially those who were confused and in a room with nothing familiar.  Staff in the YELLOW and GREEN zones also wore PPE.

We moved to using disposable dinnerware facility wide.  All meals for the RED zone were loaded into food trucks and wheeled outside and around to the back door of the RED zone; There was another food truck inside the RED zone.  Three times each day we transferred everything from a tray outside the RED zone to a tray that stays in the RED zone.  Nothing came out of the RED zone through the inside doors.  Everything went directly outside; trash, clothes, linens, ice chests, garbage.  Staff working in the RED zone donned their PPE in the resident shower room.  They exited through the same doors at the end of the hall after each shift, just like the garbage and dirty laundry.  Many positive staff remained asymptomatic and continued working:  They worked in the red zone and entered and exited through the back door.

Scheduling

With seventeen out of eighty-five workers infected, many not able to work, staffing became a true challenge.  We can not cross staff from the RED zone to the YELLOW or GREEN zones.  Ideally, we can not cross staff from the YELLOW zone to the GREEN or RED zones, or from the GREEN zone to the YELLOW or RED zones.  Now, in addition to having staff off ill, I needed to staff three zones instead of one unit: separate nurses and aides for each zone.  Pre-Covid, we filled many shifts with agency staff in spite of a thirty-three percent wage increase for nursing staff, intended to retain current nursing staff and to attract new nurses.  With high demand across the nation for nurses during the pandemic, agency staff just weren’t available, even at two or three times the usual agency rate.  We contacted our Regional Congregate Care Assistance Team (RCAT), Geisinger at the time then later UPMC, and reported that we needed assistance with staffing.  They were able to connect us to the National Guard and two private staffing agencies.  Each provided assistance for about five days.  The National Guard provided one licensed nurse for assistance with passing medications, seven medics, who function as certified nurses’ assistants, and seven General Purpose (GP) workers who assisted with maintenance, housekeeping, and anything else that needed to be done.  The staffing agencies were able to provide additional licensed nurses to cover shifts for medications and treatments.  This staffing assistance was certainly necessary and sincerely appreciated.  Bringing the National Guard in early in the outbreak helped us be better organized in our response.  With staff out for ten or more days, there were still many holes in our schedule. While every employee stepped up to the challenge of providing care for Covid positive residents, there is a core of a few employees who do whatever is necessary for as long as necessary to make sure our residents receive the care they deserve:  You know who you are.  You have my respect and appreciation and you deserve the respect and appreciation of our communities.  At the beginning of the outbreak, one RN resigned.  During the outbreak in our SNF, two RN’s on the hospital side resigned, increasing the need for licensed staff.

Scheduling staff became a nightmare; there is simply no other word to accurately describe the process.  The schedule changes occurred not by the week, not by the day, and not by the hour, it often changed by the minute.  Four weeks after the initial outbreak and one nurse is still very ill and unable to work, another is grieving the loss of an adult child to Covid-19.  Staffing agencies contracting with the state through RCAT to provide emergency staffing and the National Guard have left.  Both Directors of Nursing (DONs) are working sixteen, twenty, and even twenty-four hours straight multiple consecutive days on their units and in addition to their administrative duties.  Other nursing staff are doing double shifts.  Nurses who typically don’t perform direct resident care are on the units doing direct resident care.  Our therapy staff, from a contracted therapy provider, wanted to stay here and assist in providing care to our residents rather than temporarily going to other facilities or taking unemployment.  One of the silver linings we found:  We used therapy staff to fill in open nurses’ aide shifts.

Community Response

Community response has been nothing less than expected; they always pull together in a time of need.  Many people and organizations have dontaed meals and snacks for the staff.  Local churches prayed for us regularly, and during the outbreak they held a prayer cirlce at the facility just outside the RED zone.  BMC didn’t have a working website for several years, early on in the pandemic a local business set up a site at no charge so that we had a way to quickly provide information to the community.  Included on the new site is a Covid page which includes links for accurate information, and a “bot” that will guide a patient through a series of questions to determine if they are at risk for having Covid-19.  There is also an option to schedule a remote telehealth visit.  When positives began increasing locally, telehealth visits were used quite frequently.  The company continues maintaining and updating the site.

 New Administrative Duties

On December 29, 2020, I took my laptop and cell phone and stationed myself at the nurses’ station for the duration of the outbreak.  I’m not clinically trained, so I felt my best contribution was to be easily accessible for quick decisions and to make sure staff had the supplies necessary for care. Initially, everything was hectic.  Staff had seemingly endless needs.  Water, ice, bed linens, cups, wash cloths, IV supplies, medications, garbage bags, gloves, personal care supplies, PPE, cleaning supplies.  I quickly learned where just about every supply was stored throughout the facility.  I learned what supplies were needed to start an IV.  I learned where the big bumps were in the parking lot between the kitchen and the rear entrance to the RED zone when delivering meals, to avoid toppling coffee, juice, milk, and other drinks.  Little by little we fell into a routine.  I spent the next 27 days at my new post, coordinating our response, fetching supplies, and delivering meals.

Covid-19 Treatment

A call from my sister, a pediatrician in Philadelphia, lead our medical director and I to have a conversation with a very knowledgeable infectious disease doctor who was willing to talk to us about the outbreak and treatment options.  We initially asked about Remdesivir, which had a lot of positive press coverage; he recommended monoclonal antibodies developed by Eli Lilly.  He explained that these antibodies were synthetically produced in a laboratory.  He indicated they had good success with this treatment and recommended we try to get some.  He outlined who would be eligible to receive them and made a few other recommendations that we quickly implemented.  As soon as that call ended, we called our pharmacy and asked if they were able to get any Bamlanivimab (the monoclonal antibodies): “Coincidentally, we just got twenty doses in today from a federal program.  No one has asked for any yet, how many do you want?”  We took them all.  Cost?  $0.00.  It was part of a federal program to get this effective and under-utilized medication into communities for treatment.  We assessed each resident to determine who could safely receive the medication, then we spoke to residents and families to explain the treatment and to identify who was interested; every eligible resident agreed to treatment with Bamlanivimab if the need arose.  The clinical team decided to start IV’s on all positive residents for hydration and, when appropriate, the monoclonal antibodies.  We’ve used seventeen doses throughout the outbreak.  This little reported treatment seems to have been effective treating most of our residents who either remained asymptomatic or who had minimal symptoms:  Only two residents who received the treatment died.  

Covid-19 Impact on Facility

Totals have grown to twenty-four residents and seventeen staff.  When our first resident death was imminent, I struggled.  It wasn’t supposed to be like this.  We prepared.  We informed staff daily.  We remained strict on screening, masking, and testing staff.  We continually reviewed and implemented the latest guidance from PA DOH, CMS, and the CDC.  Now, despite those efforts, we were faced with our own outbreak.  How many of our residents will die?  How many of our staff will die?  I sat alone in a waiting area trying to understand how, and why.  Unable to grasp the answers, I went outside to my vehicle and I cried.  We lost a total of four residents and one staff to complications from Covid-19.  Four residents who were infected through no fault of their own; four residents who had no contact with family until the very end; four residents who did nothing wrong.  And we lost a dedicated employee who worked in nearly every department over more than thirty years.  While the outcome could have been so much worse, any loss under these circumstances is too much.

Vaccines – Part 1

On January 06, 2021 we were able to offer all eligible residents and employees the Pfizer vaccine.  Residents and staff who were positive within the past fourteen days could not be included in the first round of vaccines.  All of our residents who were negative on January 06, 2021 and most of our staff who were negative received vaccines.  Every one vaccinated on January 06, 2021 received their second dose on January 27, 2021.  Those who did not get vaccinated on January 06, 2021 had a second opportunity to receive their first dose on January 27, 2021.  Residents who received monoclonal antibodies won’t be eligible to be vaccinated until April 2021, ninety days after receiving the antibodies.  Very few side effects were reported with the first dose.  Several staff had mild side effects after the second dose.  Most side effects resolved within 24 hours.

Returning to Normal

We needed to have fourteen consecutive days with no new positives in order to return our facility to “normal”.  Our most recent positive was on January 08, 2021.  On January 22, 2021 at 3:00 pm I was able to declare the facility Covid-19 free.  After some cheering, we stopped for a moment of silence to remember those we lost to the pandemic.  Listening to sniffles and seeing everyone wiping tears from their faces, I struggled to regain my composure.  Before ceremoniously opening the doors defining each zone, I had a frank discussion reminding staff that we all still need to be vigilant with masking, hand washing, and social distancing to avoid a second outbreak.  I reviewed what infection control measures remained in place but encouraged staff to get residents into regular clothing and out of their rooms.  Soon I saw staff taking residents to the shower room for showers:  A ritual they hadn’t enjoyed for nearly 4 weeks.  Over the next few days, housekeeping started cleaning so we could move residents back to their normal rooms.  Slowly the hallways returned to normal without extra food trucks, laundry carts, and Computers On Wheels (COWS) for charting.  It was no longer necessary to go outside to get from the clinical side of the building to the administrative side.  Testing returned to twice weekly.  Meals are served on regular dinnerware again.  I’ve returned to my office, where I’m trying to determine what I need to address from the past 4 weeks.  

Pandemic – Part 2

There is a second pandemic in our nations nursing homes:  Resident isolation.  Residents in long term care facilities are not responsible for Covid-19, but they are paying a very high price.  This group is most likely to have a fatal outcome once infected, so, as caregivers, we do everything we can to protect them.  Not all residents see it that way, though.  We’ve already taken so much away from them.  We tell them where they are going to live.  We tell them when to get up in the morning and when to go to bed.  We tell them when to bathe.  We tell them what they can eat and when.  We tell them who they are going to room with.  Few freedoms remain; during the Covid-19 pandemic, we’ve taken away nearly every freedom they had left.  In many facilities, residents were confined to their rooms for months on end.  Here, we continued a reduced activities schedule in small groups for as long as we could, but once we had an outbreak in our facility, residents were confined to their rooms.  No activities, no social gatherings, no trips out of the facility, no visits from family and friends, no bible study, no ice cream social.  We cancelled the annual summer cookout with families, and we cancelled the annual Thanksgiving dinner where families come to the facility to share a traditional Thanksgiving dinner with loved ones.  There were no Christmas carolers; Santa visited each room through windows.  They sat in their rooms.  They longed for family and friends.  Many shared feelings saying this was no quality of life.  Many wondered, what’s the point of living?  

Pandemic – Part 3

For nine months our staff faced the risk of having Covid-19 in our community, or worse, in our facility.  It’s difficult enough to go to work every day knowing that the facility you work in might have an outbreak.  It’s grim to hear the horrendous stories of outbreaks in other facilities; dozens of infections, dozens of deaths.  It’s a stress that slowly consumes you.  But having Covid-19 in your facility and wondering if you will test positive today; who else will test positive today; and, will anyone die from this virus today is a completely different stressor.  You can see the fear and the fatigue in their eyes as front-line workers come to work and willingly put themselves at risk.  Donning PPE so you can provide direct care for two dozen Covid-19 positive residents is not worry free.  Did I touch my face before I changed gloves?  I lowered my mask so the resident could hear me, was I exposed?  Some staff separated themselves at home and didn’t interact with their families throughout the outbreak.  Frightened and anxious, the staff continue to provide care and they continue to be concerned for themselves and their families.  

Not for a day, or a week, or a month, but constantly for eleven months with no end in sight.  One mistake could infect you, your family, the facility.  In addition to the recommendations and restrictions from healthcare authorities, many front-line workers have imposed additional restrictions on themselves because they don’t want to be responsible for infecting anyone else at home or at work.

Our country is broken.  Here’s why and how to initiate change.

Regulations and guidance

“We cannot solve our problems with the same thinking we used when we created them.”

Albert Einstein

Both the SNF and the hospital have been required to report information to numerous, different state and federal agencies.  No two reports required the same information nor were they similar in format; the data reported, as well as the frequency of reporting, has changed numerous times.  At one point, hospitals were required to report every eight hours.  We could not access some systems for months and gaining access required daily correspondence, which often was never acknowledged. There is a lesson to be learned:  There should be one single repository for facility reporting.  Any agency requiring (and entitled to) data can access that database and retrieve the information they require in any format they choose.  Facilities should not be spending time reporting to four, five, or six different agencies during a pandemic when staff shortages and higher patient acuity challenge our ability to provide good patient care.  Reporting, and changes to required data, continue.  

Because we are both a SNF and a CAH, we had two, often conflicting, sets of guidance to follow.  This clash is magnified because there is no physical separation between two separately licensed facilities.  Aggressive testing guidance for SNF’s; no testing guidance for hospitals.  Visitors were allowed in hospitals when county positivity rates were lower; still no visitors in SNF’s.  Officials failed us on both the federal and state levels with no clear, consistent guidance.  Yes, I appreciate that there is a very steep learning curve during this pandemic and yes new information emerges very rapidly, but there needs to be one trusted source of guidance or, the agencies we look to for guidance should collaborate and provide consistent information.  While, as facilities, we are responsible to make decisions to protect our residents, patients, and staff, information put out as guidance is the best-known advice based on what is currently known.   Those of us responsible for facilities, residents, patients, employees, and to some extent communities, need accurate, dependable, up-to-date, and consistent sources of information for planning and implementing appropriate responses.

Politics

Both democrats and republicans politicized Covid-19:  In my opinion, neither is less culpable than the other.  A pandemic is a public health matter and not a political matter.  An individual’s response to a pandemic should not be predicated by their political affiliation.  Masking has become an unnecessary and dangerous national political issue.  If your political leanings are to the left of the spectrum, masking is the right thing to do.  Lean to the right?  How dare you infringe on my rights.  Could there be a more asinine approach to public health?  I can’t think of one. 

Our elected federal officials, every single one of them, should be ashamed of their behavior and be held accountable for their choices.  Nearly every political vote relating to Covid-19 was along party lines.  I find it difficult to believe there was no common ground on any of those issues.  We’ve watched while tactics were purposely engineered to delay votes to make one side or the other look bad.  We’ve watched as funding unrelated to public health, let alone Covid-19, padded the bills.  This is not why we elected you.  Each and every vote was a political statement that each elected official chose to make instead of simply addressing the public health issues. Covid-19 is, and will continue to be, a public health crisis regardless of your political beliefs.

Meanwhile, people across the nation are waiting, no, yearning for someone in the federal government, or someone in their state government to take charge.  Not within party lines but in a true, bipartite approach to leadership.  Someone who will do what is right because, well, it is what is right.  Someone who will find, not impede, a common ground.  Someone who will recognize and support good initiatives even if they weren’t theirs, or from their party.  Someone who can recognize a pandemic as the threat it is and not exploit it to promote political objectives and unrelated spending.

Societal Entitlement from Mis-Information

I know there are numerous excuses for not wearing a mask, for not taking proper precautions, and for not believing Covid-19 is real.  So, let me tackle a few of my favorites.  “Masks don’t work.”  They do work.  How do I know?  How much influenza have you seen so far in your home, your schools, your businesses, and your community?  I’m aware of three cases in this community.  Three.  Why such a decline?  Masks, hand washing, social distancing.  “The mask hinders my breathing.”    Study after study has shown this not to be true for the vast majority.  In fact, if you can go to the restaurant, to the store, to church, or to other public places and can walk around or participate, you are well enough to wear a mask safely.  “Covid-19 isn’t real.”  I challenge this Covidiot to work one shift in a unit with Covid-19 positive patients.  No need to waste our PPE on you; no gloves, no gown, no face shield, no shoe covers or hair covers, and certainly no mask.  Spend some time with a few patients.  Breathe the air in the patient’s room.  Help feed or bathe them.  Get coughed on, or worse.  Help move corpses.  At the end of eight hours, you can tell me if you still believe it’s not real and that you feel safe to return to your family without any PPE and without concerns for your family’s health.  Stop being ignorant and self-centered.  Wear a mask and wear it properly, covering both your mouth and your nose. 

No shoes, no shirt, no mask, no service.

Price Gouging

From medical supplies to staffing agencies, many companies have inflated prices for products and services because of increased demand.  Some may argue that the old adage of “supply and demand” is to blame. Under normal circumstances that’s a fair position.  I fear it might be more devious and motivated by greed.  Procedure masks that used to cost $5.00 now cost $50.00.  Agency RN’s that used to cost $75.00 per hour now cost as much as $160.00.  I understand that there is a risk working in a Covid positive facility, but how much of that increase is actually making it to the nurse doing the work; how much of the increase goes to the staffing agency who have no additional risk?  

Vaccinations – Part 2

We were fortunate that our pharmacy offered a program for long term care facility residents and staff to get vaccines.  They procured the vaccine, stored it as required, scheduled dates for vaccinations, and administered the shots with their own staff and supplies, all at no cost to the facility.  The one significant problem identified with vaccinating SNF residents and medical staff is that it needs to move more quickly.  Governor Wolf has lamented the process is too slow.  The Pittsburgh Post-Gazette reported Pennsylvania has administered 121,574 doses as of December 30, 2020 out of 388,450 received.   Another 250,000 was expected to arrive in PA by January 08, 2021.  If vaccination continues to move at this pace, it will take months just to get medical staff completed and the general public won’t see vaccines until mid to late summer.  Once again, a lack of direction and organization from federal and state officials leads to a very poor outcome. (Editor’s note: The New York Times reports that in mid-March, Pennsylvania had administered 4.6 million shots of vaccine. Twenty-four percent of the state’s population has received at least one dose of vaccine, and 12% is fully vaccinated. At current national vaccination rate, the Times estimates that 90% of the U.S. population will have been at least partially vaccinated by August 2, 2021.)

Conclusion

Lack of true leadership.  Deceit.  Complacency.  All present and accounted for.  If you’re happy with the leadership on both sides of the aisle, keep these elected officials in office.  If you’re satisfied that the government is spending your money wisely, continue listening to the lies.  If you’re content that, as a society, we are on the right path, remain complacent.  Keep in mind, though, what you allow you promote.

If, however, you’re tired of bureaucratic incompetence, if you’ve been lied to enough, and if you believe our society is self-destructing, the only cure is change.  You and I have the power to elect new officials.  We have the power to insist on transparent governing, and we have the power to create a society that is less self-obsessed, less inconsiderate, less insensitive, and less vain.  But that change needs to start now and it needs to start with us.