Pandemic necessitates a year of adaptation for local medical institutions

Health care in north-central Montana has been forced to adapt amid the COVID-19 pandemic. With more at stake than ever, health care organizations in the region have worked as hard as they can to deal with the evolving situation.

Northern Montana Health Care

Northern Montana Hospital, even back before cases were found in Hill County was preparing for what would inevitably come, setting up an alternate flu clinic capable of administering tests for COVID-19 and closing its facilities to visitors March 13, the day after Gov. Steve Bullock declared an emergency and the day the first cases in Montana were confirmed.

The tests at the special clinic had to come at the recommendation of a doctor, as the disease had yet to arrive in the county and much of the country was still preparing for the surges to come.

The first case in Hill County wouldn't be confirmed until March 25. The next case in the county wouldn't be confirmed until July.

By April, employees were being reassigned, elective surgery was temporarily discontinued and the Flu Clinic has extended its hours to the weekend.

Elective surgery would begin again in Mid-May once NMHC had made the necessary changes to operate during the pandemic and staff were confident that they could reopen the service.

However, by that time, face masks and other personal protective equipment had become a much-needed tool for health care workers nationwide despite a shortage, and local residents had begun to step up to the plate to help the hospital out by making masks for them, as well as other institutions.

A Facebook group created by Shannon Heggem of Havre, Help Needed To Sew Masks For Northern Montana Hospital as it was called at the time, began coordinating people in the community who devoted hundreds of hours to creating masks and other equipment for the hospital.

At the time the country was short on masks and hospitals and other institutions all over the country needed help and the group would eventually expand it efforts to helping other local institutions as well as helping some in other states who reached out for assistance.

Hill County Extension helped with coordination as well, and Walmart donated a lot of material to the group.

Other groups and individuals also contributed homemade masks.

In April the community also began a nightly practice of "Howl for Havre!" in which residents would stand on their doorsteps and shout in solidarity with health care workers in the region.

KNMC 90.1, Montana State University-Northern's radio station, and Havre Area Events Facebook page formed the event and howls could be heard from nearly anywhere in Havre at the time.

Hill County wouldn't see COVID-19 surge in the state until early July, after which spread saw a significant increase along confirmed deaths.

In October, Northern Montana Care Center experienced a surge of COVID-19 confirmations despite measures taken to reduce the spread.

Six of the 12 COVID-19-related deaths in Hill County at the time were residents of the facility. By early November, the COVID-19 wing set up for the care center had cleared and no residents have been reported as confirmed cases since Oct. 19, although multiple residents died of COVID-19-related causes and a few staff members have been confirmed with the disease since.

On top of the immediate effects of the pandemic, an air of anxiety had fallen over the care center creating a difficult a tense work environment for staff of the care center who were doing their best to keep residents and co-workers safe while still caring for their charges.

Northern Montana Health Care's Vice-President of Regulatory and Community Services Christen Obresley praised the efforts of their employees, whom she said had been working harder than ever despite the times.

She said the center has been receiving support from previous employees which has made things a bit easier, with many travelers who've worked in the facility returning to help out, many on very short notice.

In the hospital proper, technological advancements in medicine were being implemented to help general operations and improve the hospital's safety and efficiency.

In September the Environmental Services team at Northern Montana Hospital increased their disinfection efforts by adding two 2280 Syndicate ultraviolet robots to their hygiene program.

These paired robots were designed to work in tandem to emit germicidal energy resulting in fast and highly effective disinfection treatments and reduce Healthcare Associated Infections caused by harmful multi-drug resistant organisms.

At the beginning of October, after holding a successful drive-through in-house influenza vaccination clinic, Northern Montana Health Care held a similar clinic for the general public in the main parking lot of the hospital.

Health care officials and organizations local and otherwise were, and still are, urging people to get influenza vaccinations to reduce cases that could stress a health care system already dealing with the COVID-19 pandemic.

In October Hill County, Montana, and the rest of the country saw the beginning of COVID-19's largest and most deadly surge.

Northern Montana Health Care Director of Infection Prevention Alysia Mosness said in an interview in November that working conditions at NMHC during the pandemic are difficult in general with the hospital having to serve more and more people, and consequently staff having to work harder and longer, often with less help.

She said staff have needed to shift departments and take on more work, especially during those times when COVID-19 has struck a department particularly hard.

"It's very stressful," she said. "You have people from different departments putting back on our clinical nursing hats. We've had moments where it was just, "All hands on deck.'"

She said virtually everyone had to pick up more shifts, work late nights and doing that as they watch their co-workers get sick can be scary.

She said this stress was at it's worst in late October, early November when the surge of COVID-19 in the county was at it's worst.

The situation at NMH has since stabilized, and they never exceeded capacity, but there was a time when they were getting close, which Mosness said was a nerve-wracking experience for just about everyone especially when so many other places were having the same issue.

Even with the surge ongoing nationwide the situation at NMHC seems to have calmed, but their work continues.

Hill County Health Department

Throughout the pandemic the Hill County Health Department has been the primary source of up-to-date information regarding the region's cases and deaths, the dynamics of COVID-19's spread and other information how people should remain safe under the present circumstances.

Since the pandemic began, members of the health department have been fielding questions from the public, providing recommendations on safe operation to businesses and public institutions and, when needed, implementing restrictions to keep the public safe from the viruses.

In particular, the health department has almost constantly been working with local public schools as well as Montana State University-Northern on their plans for re-opening and remote operation.

The health department has also been helping people run large events as safely as possible, though now such events are recommended against by the health department almost universally since the latest surge.

All of this is on top of their efforts to track and combat the pandemic more directly through contact tracing, which has been a challenge in the past few months of this surge.

Even before this latest surge began, Hill County Public Health Director and Health Officer Kim Larson said in September that her department was starting to feel a bit overwhelmed by the amount of work involved in contact tracing.

Larson, after the resignation of Hill County Health Officer Jessica Sheehy had taken over her position, becoming Hill County health officer and public health director effective Oct. 1.

The department attempted to address this workload by using a system called Sara Alert which is designed to make contact tracing more efficient by allowing people who've tested positive for COVID-19, or have been potentially exposed to it, to report their daily symptoms.

They also tried hiring temporary contact tracers and an immunization nurse to assist with the distribution and administration of this year's flu vaccine.

The lack of staff at the department combined with the recent surge of cases had made it impossible for the department to get in touch with people who had tested positive or their contacts with the immediacy they wanted.

When the surge was at its worst, Larson said the department was trying to get it's hands on as many contact tracers as possible to address the massive amount of new cases.

At the time, the Hill County had a workforce of 14 full- and part-time contact tracers, but by that time the number of cases had gotten so high that the county realistically needed over 100 with the infection rate at 141.05 people per day per 100,000 residents.

The health department has since managed to hire more contact tracers and the spread has slowed to a much more manageable level.

The situation has improved so much so that Larson recently said members of the department have been starting to go back to their pre-pandemic duties.

However, the holiday season has brought with it the risk of cases going back up. Hill County managed to avoid a spike in cases as a result of Thanksgiving, but due to the incubation period of the virus, it remains to be seen if one results from Christmas.

Despite recent good news, the surge that began in October is still going, and has necessitated action by the health department.

In response to the surge Larson drafted a health officer order imposing new restrictions to try to reduce the spread of COVID-19 which went into effect on Nov. 4.

The contents of the order were made public weeks before and she had said it would only go into effect if the county's infection rate didn't drop to a controllable level through other means.

The order, among other things, limited the size of social gathering to 25 regardless of the feasibility of social distancing and stipulates that all restaurants, food courts, cafes, bars, pubs, taverns, breweries, distilleries, wineries, tasting rooms, clubs, and casinos shall be required to close for inside business by 12:30 a.m. and reduce that operation to 50 percent capacity.

That order would soon by superseded by Gov. Bullock's own mandates which were slightly more restrictive, so the order was not renewed.

It was at that time that the county started seeing a considerable increase in complaints made about businesses endangering customers and staff by not complying with state and local health guidelines and Larson said she'll be working with the Hill County Sanitarian-in-Training Will Lorett, and Hill County Attorney Karen Alley to address those complaints.

Enforcement of mandates and health guidelines is something the department has been grappling with since the beginning of the pandemic, the unprecedented nature of the situation creating a difficult situation for all involved.

The department as worked to educate business owners about the virus and has helped many make plans for safe operation.

This month, Lorett said his office has been running inspections of businesses and the department has put a three-strike system in place for enforcement.

First, the department gives them an information packet laying out what needs to be done if they are not compliant.

Two days later the department will follow-up and if they are compliant that's where it ends.

If after that visit, if a business is still non-compliant, they will be scheduled for another follow-up two days later.

If they are still non-compliant at that point, Hill County Public Health Director and Health Officer Larson will write a health order to shut the business down.

After that, Lorett said, the business can then come up with a re-opening plan to be approved by Larson, after which they can re-open.

Larson said this kind of thing is not new at all, and similar policies are in place regarding health code violations for restaurants.

In the past few months the health department has also been coordinating with the state to put together a plan for distributing vaccines for COVID-19 in what is sure to be a long and involved process for health care workers the nation over.

Bullhook Community Health Center

Bullhook Community Health Center has also been integral to helping the community deal with the pandemic.

In March, Bullhook began following its infectious disease protocol doing everything it could to minimize risk of spreading the virus, screening everyone with normal appointments for upper-respiratory issues and asking questions about their recent out-of-state travels and will refer them to NMHC when necessary.

Throughout the pandemic the health center has also been a vital resource when it comes to testing.

In July they, in partnership with the Montana Primary Care Association and the Montana Governor's Office, ran an asymptomatic testing event at Havre High School that drew hundreds of people despite hours of off-and-on rain.

This was Hill County's only testing event open to the general public. Before and since, the number of tests necessitated that a person be symptomatic or a contact of someone who tested positive for COVID-19.

The event was organized so people would not have to leave their cars to be tested. Bullhook CEO Kyndra Hall, who was at the event along with a team of testers in full PPE, said people were lining up more than an hour early.

She said the first traffic director at the event counted a line of 110 cars, but that number rose considerably throughout the event, with nearly that many cars lined up down the length of Bullhook Drive SE, and continuing down Heritage Drive and a few hundred feet of 17th street before snaking through Havre High's parking lot.

Over the Fourth of July weekend, Hill County's number of positive cases had jumped from one, which hadn't changed since March, to six by the end of the weekend and to 11 by the start of the testing clinic.

This surge spurred many in the line to come to the event.

Since then the Hill County Health Department has partnered with Bullhook which continues to help them with testing, partnership Hall and Larson have both said is going very well and has made testing far more efficient.