By Stefanie Jackson – U.S. Sen. Tim Kaine toured the new Eastville Community Health Center Oct. 19 and sat down with local health officials to discuss how the Eastern Shore has responded to the coronavirus and what issues persist as the COVID-19 pandemic continues.
Kaine also wanted to know what types of financial assistance should be included in the next COVID-19 relief bill, which won’t be ready until after Election Day, he predicted.
Nancy Stern, CEO of the Eastern Shore Rural Health System, listed the organization’s biggest challenges early in the COVID-19 pandemic as acquiring PPE (personal protective equipment), paying employee salaries, and educating patients.
Eastern Shore Rural Health has 310 employees, but with the help of the federal Paycheck Protection Program, or PPP, no one has been furloughed during the pandemic, Stern said.
COVID-19 has led to a dramatic increase in telehealth appointments due to patients’ inability or unwillingness to come to the doctor’s office in person, she said.
This increase brought “sadness” and pushback from some doctors, who must see patients in person to treat certain conditions like high blood pressure and diabetes. At least one doctor remarked, “This is not why I went to medical school,” Stern said.
John Peterman, administrator of Riverside Shore Memorial Hospital, agreed that fewer patients have been seeking care in person during the pandemic, resulting in a decrease in emergency room volume and an increase in untreated catastrophic health events like cardiac arrests and strokes.
He estimated that the hospital emergency room’s volume is still down about 15% to 20% and a second wave of the coronavirus could deter more people from seeking emergency care.
Mimi Sedjat, executive director of the Eastern Shore Community Services Board, said telehealth has benefited CSB clients but getting psychiatric care for mental health patients has been problematic.
She referenced Gov. Ralph Northam’s executive order 70, which directs patients away from psychiatric hospitals operating at 100% capacity during the COVID-19 pandemic.
The executive order essentially exempts psychiatric hospitals from the Virginia law that says those facilities must accept patients in mental health crises, even if beds aren’t available.
Sedjat said those patients wind up in regular hospitals, which is unfair to the nurses, who don’t practice psychiatric care.
“After a while, they are just free to leave,” she said of the patients. “Whether they’re a harm to themselves or a harm to others, now they’re out in the community.”
Her top priority financially for CSB is reimbursement through the Centers for Medicare and Medicaid Services, or CMS.
Peterman’s financial concerns included a “huge disruption in payment to providers and hospitals,” although the Coronavirus Aid, Relief, and Economic Security Act has offset costs.
He noted that businesses received PPP loans that became grants, and he would like to see hospitals receive the same benefit.
Peterman was also interested in COVID-19-related liability protection. Kaine said that was “not out of the question” considering the public health emergency. There are precedents, such as drug companies getting protection against lawsuits relating to vaccines that were approved by the FDA (Food and Drug Administration), he said.
Other financial concerns included the suspension of disproportionate share payments, federal financial assistance for hospitals that serve a large amount of low-income patients who have Medicaid or are uninsured.
Both Peterman and Stern want funding for another federal program, 340B Drug Pricing, which reduces the cost of prescriptions for low-income patients.
Richard Williams, director of the Eastern Shore Health District, discussed why the region has responded so well to COVID-19 compared to other regions of Virginia.
Early in the pandemic, hundreds of cases of COVID-19 were detected in Eastern Shore poultry plants, but after PPE and other safety measures were implemented, the outbreaks “stopped cold,” he said.
The CDC (Centers for Disease Control and Prevention) and NIOSH (National Institute for Occupational Safety and Health) helped mitigate the outbreaks and COVID-19 cases “dropped very sharply,” Williams said.
Kaine observed poultry plants had an existing “safety culture” of wearing hairnets, gowns, and other food safety-related equipment, which may have helped employees adjust to the addition of COVID-19 safety measures.
Williams said the manner in which the poultry plants responded to COVID-19 in April and early May “set the tone” for the rest of the Shore.
The Eastern Shore Health District has the best COVID-19 metrics of any health district in the state. It typically has fewer than 10 new cases a week to report, when other health districts may have 150 new cases, he said.
Why has the Eastern Shore performed so much better than other health districts, including its nearest neighbor, Virginia Beach?
“People are smarter about protecting themselves” on the Shore, Williams said. He pointed out that there is more compliance with guidelines for wearing face masks and practicing social distancing.
The ability to work closely with the local health department also has been an advantage.
Sedjat said the Eastern Shore Health District has been a “big help” in obtaining PPE, and she commended all local health administrators for their “phenomenal” collaborations throughout the pandemic – an advantage missing in other Virginia regions.
Kaine said after the COVID-19 public health emergency is declared over, Virginia shouldn’t return to the “status quo” but examine the laws and regulations that have been modified and determine which changes should be reversed and which should become part of the “new normal.”
Part of that new normal should be continued telehealth services and broadband internet access that makes it possible.
Kaine said, “Innovations have proven themselves and we need to now support those to be permanent.”