Video Visits offer safe option for health care

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As health care facilities prepare for a surge from the COVID-19 pandemic, patients seeking regular services are seeing changes to their appointments. Tri-County Health Care has worked to accommodate patients in the safest possible way. One important step toward increasing safe access to health care now comes in the form of Video Visits.

This new option opens the door for new or existing patients to receive virtual care for a variety of conditions by connecting them with a Tri-County Health Care provider right from the comfort, convenience and safety of the home. Video Visits eliminate the risk of spreading Video Visits Infographic Imageillness, save on travel time and expenses and allow patients to safely meet with their provider. It also helps conserve the use of masks, gowns and other essential personal protective equipment that are in high demand.

Providers will evaluate, diagnose and prescribe treatment from remote locations using technology such as a smartphone, tablet or computer. Patients and providers see, hear and speak to each other throughout the appointment.

“This virtual option offers the convenience of saving people time and gas money while also keeping everyone safe by minimizing exposure for both patients and staff,” said Julie Meyer, M.D. “It’s a great option and opportunity to stay connected to patients and be available to answer questions and reassure them during this time of crisis.”

Video Visits are similar to an in-person office visit and several of the same services are offered, including routine care appointments, diabetes check-ups, hospital and emergency department follow-ups, Behavioral Health and Mental Health visits, physical therapy and many more. Not all appointments can be completed through Video Visits. Services such as physical exams, lab orders or other in-clinic follow-up procedures may be excluded.

Patients will need a smartphone, tablet, or a camera-enabled laptop or desktop computer, microphone and access to high speed internet. The appointment is then completed through MyChart.

To find out if a Video Visit is appropriate for you, please call 218-631-3510. To learn more about Video Visits, click here.


Pandemic PPE: Intubation boxes provide new barrier

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There are community heroes busy donating their time and effort toward creating personal protective equipment (PPE) to help fight the spread of COVID-19 among health care workers. They are making face masks, gowns, face shields and anything else that can help. Gary Domier of Perham may not have picked up a needle and thread, but he did put his handyman skills to work by building three intubation boxes to protect the staff at Tri-County Health Care.

Creating a barrier to block the virusDoctor demonstrating how an intubation box is another form of PPE in the fight against COVID-19

There has been widespread coverage of the importance of ventilators to help treat the most severe COVID-19 patients. To use the ventilator, health care workers need to intubate the patient, which requires putting a breathing tube down the throat.

During this procedure, the virus is often aerosolized which puts everyone around the area at risk of infection. It is one of the highest risk procedures for treating COVID-19 and that is where the protection of the intubation box comes into play. The box fits over the patient and has a pair of holes where the health care worker can put their arms through to safely perform the intubation process. A clear piece of plastic is draped over the patient so if the virus is airborne in the process, it is concealed within the box.

“The intubation box is a barrier between health care workers and the patient so we’re protected from this aerosolizing virus being exposed to us,” said Rachel Redig, M.D., and Emergency Department Director, and Trauma and Stroke Director at Tri-County Health Care. “This will be used for anyone who is having respiratory distress where they can’t breathe or breathe well enough and needs the assistance of a ventilator. It gives us a very important extra level of protection.”

Building that extra level of protection

Dr. Redig, like many Emergency Room providers around the country, has been diligently researching ways to limit the spread of the virus in the health care facility. She has tapped into a network of ER providers who share tips and tricks on social media. The idea to create these intubation boxes came from a hospital in Chicago, IL.

There has been a rush to acquire PPE and purchasing pre-made intubation boxes was not an option. Fortunately, Dr. Redig knew someone who would be up to the challenge of creating them.

Gary, who is Dr. Redig’s father, usually spends his time woodworking but knew he could build these boxes. The two of them found plans for the boxes online, modified as needed, and Gary started his new project.

The walls are constructed of plexiglass and the frame is comprised of PVC. He spent a day learning the best way to put the boxes together. After the first one was completed, it was brought to TCHC where experts examined it and made notes of any adjustments that would maximize the effectiveness of the box.

Gary finished up the next two in a day, sealed them with caulk and they were ready for use.

“It seems like most of the equipment is being sent to the east and west coasts so we have a shortage up here,” Gary said. “In the end it’s a good feeling to be able to do something like this.”

“We have had several talks about health care workers being exposed day in and day out and the worries about our health,” Dr. Redig said. “I can’t imagine what that is like as a parent, but I think he was thrilled to be able to contribute and provide that extra protection.”

Intubation boxes put to use

There has not been a need for intubation boxes at TCHC in the past, but Dr. Redig has already received positive feedback about using them as an additional protective measure.

photo demonstrating the procedure of intubationThe boxes have been used a couple of times, although not with any COVID-19 patients, and have yielded good results and success.

The boxes Gary built have also had health care personnel outside of TCHC inquire about how to construct their own. After the boxes were built, Dr. Redig posted pictures of them on Facebook, and health care facilities from around the area reached out for the plans.

“These boxes are not a new device, but they haven’t been routinely used anywhere. But with COVID-19 coming, it’s a desperate need for procedures where we are exposed to getting the virus,” Dr. Redig said. “We are using it on all patients we have needed to intubate. It has been used with good success and our health care staff are thrilled to have another measure of protection.”

For updates and additional information about COVID-19 from the experts at Tri-County Health Care, click here. Tri-County Health Care also offers free COVID-19 screening online through its eClinic.

How to support TCHC in the fight against COVID-19

TCHC really appreciates all of the community support pouring in to provide our frontline staff with more PPE. Donations may be dropped off on the table located outside the front entrance of the Wadena Clinic. As we plan for the possible times ahead, we are specifically in need of manufactured N95 masks.

Additional needs include:

Cloth face masks
Clear plastic face shields
Safety goggles
Safety glasses
Used scrubs
Sealed bottles of hand sanitizer


COVID-19: Health Care Workers Answer the Call

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By Susan Marco, Provider Recruitment

My grandmother Ethel was a nurse in Honolulu/Pearl Harbor during World War II. She was sent to nursing school by her Illinois farm family because they thought she would be an old maid based on her heavy-set frame and not being quite the beauty, her sisters were.

The family must have been shocked when little, Ethel Mae, returned from nursing school in Chicago with a tiny waist, full bosom, and her hair styled. It was then that she told her family that she and some of her single friends had taken positions in the exotic-not an official state-tropical oasis known as Hawaii. It was early 1941.

My grandmother was with her friends hiking the lush, dense Hawaiian island mountains on December 7, 1941, because it was a Sunday and they had to go back to work the next day, which happened to be her birthday.

Front Entrance with coronavirus screening tentsThat Sunday, a date that will live in infamy, was a simple Illinois farm girl’s day of fun celebrating an early 23rd birthday and then, everything changed. She was a nurse; and she was called into action.

I think now about my high school senior son, Jack.  He is at home. No prom, no senior slide, no senior anything. I don’t know that he has fully grasped what all of this means; to be frank, I don’t think I have either. Do we have a graduation party? Will I even be able to get the paper plates, plastic forks, napkins to even have a party? Will I be able to get the food? I went to Aldi one day when all of the COVID-19 talk began, and I reached for a tomato out of a flat of tomatoes (probably a flat of 20-25). Just as I was reaching for it, a woman picked up the whole flat and took it.

There were no eggs. There was one package of shredded cheese left. They had a limit on cans of beans.  I stood in the store as if I pushed the Health care workers in PPE set up in the coronavirus screening tentpause button on my television and looked around. What was I missing? Should I be doing this? Did I not get some memo or pay attention closely enough?

I go to work every day just as all health care employees do. I am not an RN like my grandmother; I am not on the essential front line of this virus. I work in an office in the old hospital building where I continue on — continue to work, continue to get up every morning and go to bed every night and continue to show up.

But here is the heart of it all — I show up and do what I can. I take the information that is given to me and I work with it. I go home at night and try to fall asleep and not let the fear and anxiety take over. I get up in the morning, get my cup of coffee and proceed forward. I must trust that the decision makers are making good decisions. I must trust that my co-working providers and nurses have a plan and have the stamina to continue.

We can’t control this — this, being life. We can’t control how the journey switches, changes or alters. We could be hiking one day and be in triage tents in Pearl Harbor the next. We could be an 18-year-old that thinks they have the world by the tail, only to be told there is no end of the senior year, no prom, no senior glory. Yet, the thing is, we are all on this journey together and we need to show up for it.  We can’t control it but we can be present for it. We can take ownership in our part. Perhaps even someday, tell our grandchildren about the event that colored our life’s journey.

About the Author: Susan Marco lives with her husband, Troy, and has two children, Kenzie (21) and Jack (18). Susan enjoys spending time with her family and enjoys reading and writing. Susan also has her own personal blog where she writes about her various experiences as well as tackles the topic of Alzheimer’s, which she knows first-hand in caring for her mother.


The Coronavirus: Flattening The Curve

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As viruses spread, they tend to infect increasing numbers of people at high rates. The initial side of the curve over time, or rate of new infections, will naturally increase rapidly as more and more people are infected. If left unchecked, the total number people requiring health care will quickly rise well above the capacity of our US health care system.

By taking certain steps – canceling large public gatherings, for instance, and encouraging some people to restrict their contact with others – governments have a shot at stamping out new person-to-person transmissions, while also trying to mitigate the damage of the spread that isn’t under control.

The epidemic curve, a statistical chart used to visualize when and at what speed new cases are reported, could be flattened, rather than being allowed to rise exponentially. “If you look at the curves of outbreaks, they go into big peaks, and then come down. What we need to do is flatten that down,” stated Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “That would have less people infected. That would ultimately have less deaths. You do that by trying to interfere with the natural flow of the outbreak.”

Stop the spread of coronavirus by flattening the curve

The notion that the curve of this outbreak could be flattened began to gain credence after China took the extraordinary step of locking down tens of millions of people days in advance of the Lunar New Year, to prevent the virus from spreading around the country from Wuhan, the city where the outbreak appears to have started.

The quarantines, unprecedented in modern times, appear to have prevented explosive outbreaks from occurring in cities outside of Hubei province, where Wuhan is located.

Since then, spread of the virus in China has slowed to a trickle; the country reported only 19 cases on March 9th. And South Korea, which has had the third largest outbreak outside of China, also appears to be beating back transmission through aggressive actions. But other places, notably Italy and Iran, are struggling.

On any normal day, health systems in the United States typically run close to capacity. If a hospital is overwhelmed by Covid-19 cases, patients will have a lower chance of surviving than they would if they became ill when the hospital’s patient load was more manageable. People in car crashes, people with cancer, pregnant women who have complications during delivery – all those people risk getting a lesser caliber of care when a hospital is trying to cope with the chaos of an outbreak.

“I think the whole notion of flattening the curve is to slow things down so that this doesn’t hit us like a brick wall,” said Michael Mina, associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital.

“It’s really all borne out of the risk of our health care infrastructure pulling apart at the seams if the virus spreads too quickly and too many people start showing up at the emergency room at any given time.”

The U.S. has about 2.8 hospital beds per 1,000 people (South Korea and Japan, two countries that have seemingly thwarted the exponential case growth trajectory, have more than 12 hospital beds per 1,000 people; even China has 4.3 per 1,000). With a population of 330 million, this is about 1 million hospital beds. At any given time, about 68% of them are occupied. That leaves about 300,000 beds available nationwide.

Most people with Covid-19 can be managed at home. But among 44,000 cases in China, about 15% required hospitalization and 5% ended up in critical care. In Italy, the statistics so far are even more dismal: More than half of infected individuals require hospitalization and about 10% need treatment in the ICU. As cases spiked, Italian hospitals quickly couldn’t keep up with the patients coming in.

Countries and regions that have been badly hit by the virus report hospitals that are utterly swamped by the influx of sick people struggling to breathe.

Alessandro Vespignani, director of the Network Science Institute at Northeastern University, is gravely worried about what he’s hearing from contacts in Italy, where people initially played down the outbreak as “a kind of flu”. Hospitals in the north of the country, which the virus first took root, are filled beyond capacity, he said.

By limiting exposure to others, also known as “social distancing“, epidemiologists believe the curve could be meaningfully flattened. Social distancing means avoiding contact with others. This is crucial from a global health perspective. Limiting coronavirus cases not only has the obvious benefit of keeping the elderly and vulnerable safe, but it lessens the single biggest public health issue: overwhelmed hospitals.


The Coronavirus: Tri-County Health Care is prepared

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The worldwide outbreak of a new strain of coronavirus, recently named COVID-19 by the World Health Organization (WHO), has had people on high alert for over a month. The WHO has declared it a global health emergency and travel restrictions are in place for residents of the United States. Many questions are circling around this new strain of coronavirus. Should you be worried? How fast is it spreading? What is your local health care organization doing about it? These are all good questions to ask, and we’re here to help fill you in on the outbreak.

So, what is the COVID-19?Coronavirus blood test in hospital laboratory

According to the Centers for Disease Control and Prevention (CDC), this coronavirus is part of a large family of viruses. These viruses are estimated to cause about one third of all cases of the common cold.

The COVID-19 is a viral respiratory illness caused by a coronavirus that has not been found in people before. It was first detected in Wuhan, China.

Patients confirmed with the COVID-19 infection have had mild to severe respiratory illnesses with symptoms that include fever, cough, shortness of breath, muscle aches, headache, sore throat or diarrhea. Patients with severe complications have had pneumonia in both lungs.

How contagious is the COVID-19?

While it is not currently clear how easily COVID-19 spreads from person-to-person, the infection is being reported in at least 30 countries internationally, including the United States.

The infection was first detected in the United States in a person who recently returned from Wuhan on January 21, 2020. Research is still being done on how contagious COVID-19 is. However, like other infections, it is spread through close contact.

The most at risk for serious complications are those age 65 or older, children, pregnant women and those with weakened immune systems.

What can I do to protect myself against the COVID-19?

There is currently no vaccine to combat the COVID-19, so the best way to prevent infection is to avoid exposure. The Minnesota Department of Health (MDH) suggests taking the same precautions recommended for avoiding colds and the flu. These precautions include:

  • Wash your hands thoroughly with soap and water. Use an alcohol-based hand sanitizer that contains at least 60 percent alcohol if soap and water are not available.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, throw the tissue in the trash and then wash your hands.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Clean and disinfect frequently touched objects and surfaces.

What is Tri-County Health Care doing to prepare for an outbreak?

The COVID-19 has not been found in Minnesota, but seven other states, including Wisconsin and Illinois, have confirmed cases. The risk for contracting the new strain of the COVID-19 remains low for U.S. residents. Tri-County Health Care remains proactive and prepared for Side view of young woman with protective coronavirus face mask in town, she standing in front at the bus stop and waiting for her transport after work.any contagious disease and will follow the same protocol with the COVID-19.

Patients who are experiencing symptoms – fever, coughing, shortness of breath – AND have traveled from China or have been in contact with someone that has traveled from China in the last 14 days are asked to call ahead before entering the building. This will allow Tri-County Health Care to take additional steps to keep all patients and staff safe. Registration will also ask new travel questions including if patients have traveled from China or have been in contact with someone who may have been in COVID-19 affected areas, and report symptoms they are experiencing. Patients may also be asked to wear a mask; similar to when presenting with influenza-like illnesses.

Additionally, Tri-County Health Care is working with the MDH and emergency preparedness officials to remain educated and updated on the current status of the outbreak.

How serious is this outbreak?

The majority of the outbreak has been confined to China, where there have been over 70,000 confirmed cases at a 2.7 percent mortality rate. The U.S. has had 15 people test positive for this strain of the virus.

For comparison, preliminary estimates from the CDC show that since October 1, 2019, there have been 26-36 million cases of influenza in the U.S., resulting in 14,000-36,000 deaths.

Tri-County Health Care assures the public that it will continue to monitor the outbreak. We will react according to protocols already set in place. We encourage anyone who has not received the influenza vaccine to get one at a local pharmacy or health care facility.