Medical workers assist with coronavirus screening Tuesday under a white tent at the Maine General Medical Center, Thayer Center for Health on North Street in Waterville. Morning Sentinel photo by Rich Abrahamson Buy this Photo

 

MaineGeneral Health officials announced Tuesday the hospital system’s first coronavirus-related death.

The death of a patient, whom state officials later described as a woman in her 80s, happened Monday at the Alfond Center for Health in Augusta. It marks the first death in Kennebec County linked to the COVID-19 illness caused by coronavirus.

Meanwhile, one person with COVID-19 remains at the Augusta hospital, officials said. Altogether, the hospital has had three patients with COVID-19, with one remaining at the hospital and another having been transferred to a higher level of care, according to Steve Diaz, chief of staff for MaineGeneral.

Dr. Steven E. Diaz, MaineGeneral Health’s chief medical officer.

The Maine Center for Disease Control & Prevention had announced three coronavirus-related deaths statewide Monday, a number MaineGeneral officials said did not include the Augusta hospital death. The CDC on Tuesday announced five deaths had occurred.

Meanwhile, Diaz and Chuck Hays, MaineGeneral’s chief executive officer, said Tuesday in a Skype interview with the Morning Sentinel that of the 4,500 employees in the MaineGeneral system, about 140 are expected to be working from home by the end of this week, once software is in place to enable that. Most of that number likely will be from among about 400 people who work in cubicle settings at MaineGeneral’s offices at the Hathaway Creative Center in Waterville.

Hospital officials said a networkwide assessment determined that only about 400 of its 4,500 employees could potentially do their work from home. MaineGeneral operates hospitals in Augusta and Waterville, as well as other local facilities such as outpatient practices and express care.

Employees at the Hathaway location include those in human resources and finances.

“There are people in the area that are critical to our function,” Hays said.

Chuck Hays, chief executive officer of MaineGeneral health.

MaineGeneral provides a broad spectrum of services to patients living in 88 communities throughout the Kennebec Valley region, according to officials. The health care system has 31 separate buildings, some with multiple tenants, such as at the Hathaway Center. Multiple practices are housed in most of its locations.

MaineGeneral started initiatives to address the coronavirus pandemic early on — before it was formally announced it had spread to Maine — and has a detailed plan to address COVID-19, according to Hays.

The plan, which consists of hundreds of pages, includes reorganization of services, emergency department screening, cancellation of elective or non-urgent surgeries, implementation of tele-business for non-urgent issues, reduction of visits and development of an inventory of resources, according to Hays.

Also, the health care system has developed lists of what it will need for supplies now and in the future, created a labor pool and list of labor needs, re-deployed some employees to the emergency departments to help with screening and others to help screen employees who have been sick or traveled, pursued avenues to ensure employees’ children have day care services, and started the process of asking employees, if they want to and could work from home, to do so. More than 140 people applied, Hays said.

MaineGeneral is working with the CDC, state Department of Health and Human Services and other hospitals to be as prepared as possible for what lies ahead in a situation that is always in flux.

“We are making changes daily,” Hays said.

He is proud, he said, of the MaineGeneral team — and of the community.

“Our team has really come together and created a can-do atmosphere,” he said. “They continue to come in and do an incredible job, keeping our community healthy, so I’m comfortable that we will get through this because we have such a great team.”

Diaz said that, in the world of emergency services or disasters, the directive is “plan, prepare and practice.”

“That is what we’re doing, and everyone is embracing that,” he said.

 

ASSESSING NEEDS

MaineGeneral is testing people for coronavirus in its emergency departments when warranted, following the guidelines set by the CDC, which can change daily. MaineGeneral express care locations in Augusta, Waterville and Gardiner can test people in non-emergency situations, and tents have been set up in Augusta and Waterville to help screen people before they come to emergency rooms.

There is no rigorous science occurring quickly enough to help spell out the best way to address the coronavirus, according to Diaz. Some countries emphasize social distancing, staying home and using masks. MaineGeneral is making the best decisions it can with the resources available.

“We have, every day, adjusted to issues that are upon us and will continue to do so,” Diaz said.

He has no preconceived notions as to how many people will need treatment.

“I can’t predict what will happen,” he said. “I know we’ll be overwhelmed. Everyone has been.”

As to whether they feel they will have enough staff to take on what is coming, Hays and Diaz are optimistic. Hays said that right now, they do not see a staff shortage, but as Diaz says, one can not predict.

Diaz has developed a list of retired medical professionals, some of whom have come forward to volunteer their services. That includes those in private practice who are not associated with MaineGeneral.

“We have that list; we’re planning around it,” he said.

Hays is frequently asked if MaineGeneral has enough ventilators and personal protective equipment, he said. He responds that right now it does. But as to how long the supply will last, he said he never answers that question. Officials every day are looking for sources of equipment, according to Hays.

MaineGeneral, Diaz said, currently has enough coronavirus tests according to the CDC algorithm.

 

CRITICAL CARE

As of Monday, 343 tests had been performed at MaineGeneral, 115 were pending with the state lab as of Tuesday and nine of those test results were positive, the rest negative, Hays said.

There are no simple answers to questions about how masks should be used or how many ventilators MaineGeneral has, according to Hays and Diaz. The public has come forward with hand-sewn masks, which are appreciated and may be used in areas where the CDC says not to wear them, according to Hays. Staff are able to take them home with recommendations about how to clean them; they also will be cleaned at the hospital.

“They can be worn in the hospital, but only in areas we don’t require a mask,” Hays said.

MaineGeneral is following CDC guidelines and educating employees on mask usage, but not policing them if they decide to wear one in situations where they are not recommended, for instance.

There are different varieties of ventilators in the hospital that all work a little differently, including those used in the critical care unit for people needing to be ventilated for a long time, ventilators used for transporting patients and those used in anesthesia units, according to Diaz.

“Different patients need ventilators for different reasons,” he said.

The Augusta hospital has 16 critical care beds, also referred to as intensive care beds, and eight are filled.

Coronavirus screening is underway Tuesday under the white tent at the right at the MaineGeneral Medical Center, Thayer Center for Health on North Street in Waterville. Morning Sentinel photo by Rich Abrahamson Buy this Photo

MaineGeneral is working with and closely communicating with other hospitals including those in the Northern Light system, such as Inland Hospital in Waterville; Central Maine Medical Center in Lewiston; and those in the Maine Health system, including Maine Medical Center in Portland and Franklin Memorial Hospital in Farmington.

Diaz cited an example of how that cooperation will benefit the hospitals. If, for instance, a hospital has a ward of 18 beds and 15 are being used for patients with COVID-19, that hospital might reach out to other hospitals to say it has three beds open for COVID-19 patients instead of filling them with patients suffering a different affliction.

“That kind of coordination will be what we do daily, depending on surge patterns,” he said.

Hays and Diaz encouraged people to continue to wash their hands frequently and practice social distancing, with Diaz emphasizing a critical directive:

“Stay home,” he said.

Meanwhile, Hays said he is amazed at how MaineGeneral staff have pulled together in response to the coronavirus situation and said people in central Maine are lucky to have such good people working for them.

“It’s extremely impressive,” he said.

MaineGeneral keeps a coronavirus update on its website, mainegeneral.org, which also includes guidelines for the public to follow.

 

FINANCIAL IMPLICATIONS

Recent federal legislation signed by President Trump provides $100 billion to hospitals and health care services across the country dealing with the pandemic, though Hays said he is not certain how it will be dispersed.

“Believe it or not, that’s a drop in the bucket,” he said.

He said MaineGeneral is working with the state, which has been very helpful.

“We continue to have discussions about how we can continue to keep ourselves afloat as we push volume, as long as we can push it, so we have capital to deal with it,” Hays said.

The federal government is allowing hospitals to look back four months and ask for the draw rate for Medicare, he said. The government has agreed to do that for a short period of time, but that will be reconciled at the end, according to Hays.

“So, it helps you from a cash flow perspective, but not expenses,” he said. “It’s about equal to a no-interest loan.”

Hays said that when MaineGeneral designed its Augusta hospital, it took into account the need to flex-up in an emergent situation. Day surgery in the former Waterville hospital — which was converted to Thayer Center for Health, an outpatient center — had curtains between patients. The Augusta hospital has hard walls, Hays said. Design features within the hospital allow it to flex beyond its license capacity in a pandemic or other disaster, he said.

So far, the coronavirus hot spots aren’t that large in central Maine, where MaineGeneral is equipped to serve greater Kennebec County and help support other communities as determined, on a day-by-day basis, according to Diaz.

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