On the Front Lines: Lake Regional shares an honest look at a grueling year in health care

Dr. Harbaksh Sangha, M.D., talks with Dana Becker, R.N., in the ICU, where Becker is preparing to care for a COVID-19 patient.

2020 has been a grueling year for health care workers around the country. The same can be said on a local level, as Lake Regional Health System has been in the middle of the COVID-19 pandemic from day one. With cases fluctuating on a daily basis, the severity of the pandemic around the lake can, at times, be less than clear. To help paint a picture of COVID at Lake Regional, Dane W. Henry, FACHE, Chief Executive Officer, Director of Ancillary Services Michael Dow, PharmD, and Chief Medical Officer Harbaksh Sangha, M.D., took time to explain exactly what the hospital has been facing over the last seven months and the tough, though hopeful, future ahead. 

“A Lump in Your Throat”

In February, Lake Regional Hospital was just as unsure of COVID as anyone else. Henry says that leadership within the hospital watched the news “religiously,” keeping an eye on national changes and travel restrictions as they happened. 

“We had the same reaction as most, I think. This thing is getting real,” Henry said.

Henry says they felt initially like Missouri might be isolated from the virus as it was mostly coming in on the coasts. Once the gravity of the virus’s spread was evident, he says the hospital took its next steps very seriously. Lake Regional implemented its Incident Command Structure or ICS in early March. The goal was to plan broadly and continue to narrow down that plan as more cases were confirmed nationally and more information was received. However, it wasn’t long until March 22, when Lake Regional took in its first case. Suddenly, a hospital that cares for hundreds of patients at a time was almost entirely focused on the care of one. It wasn’t long before that single case became multiple. 

“There was a lump in your throat when we knew it wasn’t going to just be one patient,” Henry said. 

Dow says that, at the time, he was awestruck by the hospital’s problem-solving abilities to control the situation at hand. As a manager of many wings of the hospital, Dow says they split off into groups, learning from one another and discussing the best way to fight this unknown enemy.

“It was a fascinating time to be in health care,” Dow said. 

Being on the front line, Sangha says there was an equal feeling of fear and responsibility stepping into a COVID-positive room for the first time. He says his doctors spent time learning the use of PPE (Personal Protective Equipment) and studying COVID training modules as they anticipated the first case. Though he was confident in their ability, he says they felt prepared to face the threat, though uncertain of such a new virus. 

“It made me numb, the first time I heard we had a positive case,” Sangha said.

Henry describes navigating through the initial weeks of positive cases as a waiting game. He says much of the goal for leadership at the hospital, like so many others, was to “bend the curve.” Testing was slow early on, and the true magnitude of COVID was still unknown. Henry says they developed a surge plan to prepare for the need for ventilators, anesthesia machines and rooms in general. 

He says that, early on, equipment donations from local resources were key, including help they received from Lebanon and Eldon. Having that cache of equipment was vital in keeping operations afloat during early surges of the virus.  

“The support from this community was absolutely incredible,” Henry said.

Adapting and Persevering

Through April, Lake Regional experienced a decrease in general hospital usage, especially in the ER. Henry says that, when Missouri quarantine restrictions were put into place, hospitals across the country struggled heavily. He says that the leadership of Lake Regional knew that if they didn’t shuffle the existing structure in place, many would lose jobs. As one of the leading employers at the lake, he says this wasn’t acceptable. 

To avoid furloughs and layoffs, Lake Regional moved employees around to suit the growing COVID needs. Some employees of the hospital found themselves working completely new jobs, including work within express care which was one of the few wings that saw an increase in need. 

Once May rolled around and the tourist season began, Henry says they flourished. With no layoffs or furloughs causing an employee shortage, they were able to return to near-normal operations once the population around the area increased and the demand returned. 

“It was one of the best decisions I’ve made in my career,” Henry said. 

Two new forms of health care were starting to emerge, with Lake Regional implementing virtual visits with doctors and COVID screening stations around the area. Henry says that, in regards to virtual visits, it feels like a new era of health care has emerged. 

Sangha says the role of virtual health care is as important as ever, as it is a crucial step in keeping himself and his fellow doctors safe. Many COVID patients do not require ventilation or monitored care, making at-home healing a good option for them. Virtual check-ups allow for Sangha and his crew to care for COVID patients without risk of being infected themselves, while also keeping rooms open to those who are more seriously affected by the virus. 

“I think it has changed hospital work permanently,” Sangha said. 

Moving on through the summer months, the lake saw a huge boom in sales tax, as many used the area to escape from more restrictive states. Lake Regional continued to operate mobile testing sites and virtual appointments to keep the virus at bay. ER usage continued to see a 10-15% decrease, along the lines of national trends. 

It wouldn’t be until late August that the worst would come.

Hitting a Peak

At the end of August, cases began to rise once more. The hospital returned to double-digit inpatients fighting the virus, with late September marking the 100th COVID inpatient. While numbers rose, so did the hospital’s confidence in the care provided. 

Many patients who were being placed on a ventilator saw a 3-4 week recovery period. Sangha confirmed that the assumption that the youth handled the virus better was true in his experience. One of the leading factors in complications came when patients had other medical issues as well, including obesity, diabetes and more. And, of course, those of an older age faired much worse. Sangha says that a consideration forgotten by many is the cost of treatment as well as the emotional strain felt by families. 

Some cause for alarm was felt within the lake area when reports indicated that the hospital was facing 27 inpatients at one time, a third of room capacity. While this was a true figure, Henry says that it was a short-lasting peak. With virus cases growing nationally, he says the hospital has continued to face cases, though the figure of 27 inpatients was as high as they have seen. On average, the hospital faces between 10-20 inpatients on any given day. 

“It feels like watching a beach tide come in and out,” Henry said. 

Moving into October, Dow says that testing for the virus has evolved significantly. Having administered over 12,000 tests since March, Dow says testing for the virus went from multiple days waiting for a result to around 15 minutes with rapid testing. Supplies at this point aren’t broad enough to allow all patients to have rapid results, but the process continues to mature.

As the beginning of flu season began to usher in, Dow says they have started preparations for extreme amounts of testing, as residents get sick and need to clarify what virus they have. With five counties of patients, he expects a busy end of the year. 

What the Future Holds

As the nation moves into the final months of 2020, things are still bleak. The U.S. has officially passed 10 million total cases and the spread is still alive and well. Though, some light has been seen as the end of the tunnel, as vaccine effectiveness is being tested and reported to be coming in time. 

To Henry, there is still much to learn. He says that Lake Regional will remain highly adaptable to whatever is to come. He says they need to remain innovative on how to fight COVID, though be cautious in their planning to make sure all broad possibilities are ready to be met by their doctors. 

For Dow, he wants people to understand that COVID will never truly go away. He says that, as a species, COVID will continue to be a communicable disease that is here to stay. The goal is not to eliminate it, but rather to learn the best strategies to move past it. 

As for a vaccine, Dow expects there will be some form available by next year, but testing will be crucial. Many people will not receive the initial wave, and that will lead to testing being slower. Dow believes that societal normalities may not truly come back until 2022. One thing that is for sure, he says, is that the world has permanently changed. 

Locally, Sangha says that he and his fellow doctors are ready for what’s to come. After having faced three local surges of cases, he feels that they are battle-tested and ready to face however many future surges come. However, this comes with being realistic and being ready to adapt. He says that they know it can be handled if the hospital remains vigilant. He says Lake Regional will prepare for the possibilities of training staff, increasing PPE volume and room capacity. For Sangha, it’s all about the long game.

“We don’t want to exceed our means; we have a plan to keep things in check,” Sangha said. “The anxiety people feel is needed. It keeps us grounded.”

Not Out of the Woods Yet

As a survivor of COVID, Henry feels a personal connection to those who have survived and those who have not. Being young and healthy, he knew heading into his fight with the virus that his chances of survival were high. 

He says that he immediately made plans to distance himself from friends and family. He spent two weeks in quarantine and eventually made it through. Still, he says the gravity of the situation was what he thought about most. He says it’s true that 99% of people will be fine. But if you are unlucky enough to have issues that lead to admission into the hospital, fatality rates jump to 20%. If the cases worsen to needs in the ICU, suddenly it spikes to between 40-50%. 

These figures were the driving force in Henry’s act to separate and care for this virus, and he feels that this mindset needs to be more widely accepted. Henry says that he believes people need to live their lives and not be controlled by the virus, but also be cautious and smart. At the end of the day, like so many other things, it comes down to balance. 

“I think we all need to take a step back and know that we aren’t out of the woods yet,” Henry said. “You should be fine, but know that it will be a tough road ahead for us all.” 

Dane W. Henry, FACHE, Chief Executive Officer Lake Regional Health System.