LEWISTON – When the month began, just a few weeks ago, life seemed pretty normal in Maine, with winter easing its grip, jobs plentiful and a sense that despite an iffy Boston Red Sox team this season, things seemed bright.

Things have changed.

Three weeks into the pandemic caused by a new virus that popped up in China at the tail end of 2019, many jobs have vanished, businesses are closed, people are keeping their distance from each other and even baseball, that most eternal of American sports, has shut down.

Daily updates from Central Maine Healthcare to its 3,000 employees – leaked to Sun Journal – provide a glimpse into how one key institution has dealt so far this month with a potentially deadly coronavirus that threatens to overwhelm its capacity to provide care.

On the first Monday of March, the chief medical director at Central Maine Healthcare sent a note to staff members letting them know about plans to begin providing daily reports to them about the spread of a new virus its infection prevention team had been monitoring since mid-January.

Dr. John Alexander, the chief medical director, said the updates would keep health care providers “well-informed to guide your conversations with staff, patients and our community members.”

Given all that’s happened in the three weeks since, it’s perhaps strange that in the first warning of the month, Alexander’s only specific request to the staff focused not on the new coronavirus but on a killer with a much longer track record.

“Please take every opportunity to reinforce to all that the risk of Influenza infection remains very high in the state of Maine, and that strict adherence to precautions that include hand washing and masking for respiratory symptoms remains the No. 1 strategy for prevention,” he wrote.

The updates’ focus, of course, soon shifted sharply, though that initial advice remains apt.

The same day as his first memo, later in the afternoon, Alexander mentioned in a different one that a COVID-19 case had been diagnosed in New Hampshire involving someone who had recently traveled to Italy, where the disease had begun spreading widely.

To prepare for the virus’ arrival in Maine, he said, the hospital had updated its patient screening protocols and taken steps to allow for the isolation of patients with “symptoms that put them at risk for the virus.”

It required patients with respiratory symptoms to wear masks and hospital personnel dealing with them to put on personal protective equipment, such as gowns, gloves and medically safe masks.

The hospital also barred visitors with respiratory symptoms and children under age 12 from visiting anyone, the memo said. Staff members with even mild symptoms were told to stay home.

In addition, Alexander said, operations and infection prevention teams were busy ensuring the hospital had “more than sufficient equipment, supplies and facilities in the event of widespread disease.”

It was, in many ways, typical of the daily memos that have followed regularly ever since, laying out ever stricter standards and providing an overview of the spread of the virus in the area.

“Communicating with our team members — all 3,000-plus of them — is a critical priority for us, especially during a public health crisis,” said Kate Carlisle, the company’s spokeswoman.

She said Monday the goal of the daily updates “is to make sure our employees have the information they need not only to do their jobs, but to be able to effectively communicate about this crisis with their families, patients and neighbors.”

By March 3, the updates told staff that the health care institutions connected with CMMC were “conducting drills to ensure that all our teams, particularly our frontline staff, are prepared and up-to-date on screening protocols.”

It also mentioned efforts to coordinate preparation with several other Maine hospitals “to ensure our protocols are coordinated and best serve the public interest.”

The following day, Alexander told staff that top doctors had been “briefed on the current situation and are coordinating with each other, along with laboratory and radiology services, to ensure a consistent, evidence-based protocol exists should a patient who screens positive require additional diagnostic or therapeutic interventions.”

It also said the hospital was trying to deploy “additional negative pressure devices in ambulatory locations to assist in evaluation and screening of patients, should the need arise” and “making sure” that powered air respirators will be available in the emergency room as an alternative to the disposable N95 masks for those who have trouble getting a tight seal.

On March 5, Alexander asked any staff members who have traveled to “high-risk areas” or had contact with people diagnosed with COVID-19 to tell managers so they could evaluate the risk involved.

By March 6, a Friday, the hospital told staff that the Maine Center for Disease Control and Prevention planned to begin testing the following Monday. At that point, no tests had been done by CMMC.

“We have not tested any patients, although some have presented with symptoms that required a secondary level of screening,” a March 9 update reported.

The hospital said in its March 10 update that it had conducted its first test for the new disease and submitted it to the Maine CDC “based on a patient with recent residence in a high-risk country” who had “mild and improving respiratory symptoms” and who had been self-quarantining at home.

On March 11, the hospital told staff it had established “an incident command team” and was ready “to scale up quickly if necessary” to deal with an outbreak.

It was also preparing to set up primary testing sites for patients who did not need emergency care, the update said.

The next day, on March 12, Jeff Brickman, Central Maine Healthcare’s president, sent a note to employees informing them “the first presumptive positive case of the virus has been confirmed in Maine” — a patient who lived in Androscoggin County and was tested in the emergency department two days earlier.

In the same memo, Brickman told staff the hospital was “now undertaking serious additional steps to ensure your safety and the safety of our patients.”

Among the new measures was a new screening site for those coming to the emergency room, a near-total ban on visitors and fewer available doors to access the building.

On Friday, March 13, an update told staff members that satellite testing sites were open at each of the system’s hospitals, that access points had been limited, all volunteers sent home and student teaching suspended.

The hospital also closed its gift shop and put an end to self-service in its cafeteria. In-person interviews for new hires were replaced by phone calls.

By Monday, March 16, the hospital had tested about 50 people, including three staff members. The results were not yet available.

The system also “postponed most elective surgeries that require an inpatient stay” and began rescheduling upcoming surgery. Same-day procedures such as endoscopies were still proceeding, the update said.

Food deliveries to the hospital were no longer allowed and some evening hours were added to the grab-and-go choices at the cafeteria.

The next day, the update said a total of three cases from Central Maine Healthcare had tested positive — one at the Central Maine Medical Center Emergency Room, one at the Bridgton Hospital Emergency Room and one at the tent outside of the CMMC Emergency Room. Each of the patients was quarantined at home, it said.

The hospital also told staffers that if they were “experiencing financial hardship as a result of unexpected childcare expenses” because of schools closing, an emergency assistance fund was available. It also told them that managers were exploring the potential for some to work remotely.

In addition, the hospital said it had begun “reallocating team members who may be impacted by lower clinical volumes” to areas where they could be more help.

On March 18, last Wednesday, the hospital warned employees to “be on the lookout for scam emails. Unfortunately, some individuals are taking advantage of the current situation and sending out phishing emails in an effort to hack our system. Avoid clicking on links in unsolicited emails and be wary of email attachments.”

It also told workers they could no longer pick up paper paychecks. They would instead be mailed to those who didn’t have direct deposit, the update said.

An update on Thursday said CMHC had tested 246 people. No new positives had been found, but it’s not clear how many were actually processed. The ones for the three staff members mentioned on Monday had not yet been done.

The first drive-through testing location — at the Topsham Urgent Care – opened.

On Friday, the hospital told staff that it had tested four employees. Three of them had come up negative, the other remained pending.

It announced that starting this week, it would postpone all non-emergency endoscopy and colonoscopy procedures, part of an effort to conserve protective gear. It also began trying to identify child care options for employees struggling with children at home.

On Saturday, the hospital told employees they could park in a section of the garage that had been set aside for visitors.

It also said that “the availability of timely and accessible testing continues to be a major concern” that has generated many questions from patients and employees. It imposed a stricter standard for testing.

Monday, the hospital laid out a new policy for the use of personal protective equipment aimed at limiting its use to situations that require it.


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