Public health officer, Enloe CEO cut to the chase on coronavirus preparedness

Enloe Rehabilitation Center has been converted to a federal medical station, where there are shared private rooms and common housing areas for patients. Photo courtesy of Enloe Medical Center

Dr. Andy Miller, Butte County’s public health officer, is the expert consulted by local leaders about the coronavirus pandemic. As such, he’s transitioned to the medical equivalent of a meteorologist: a forecaster whose predictions carry great interest and impact.

Local residents have stayed home except for vital necessity since March 19, when Gov. Gavin Newsom issued the first of his executive orders to curtail the spread of COVID-19. Many itch to return to normal, but reopening businesses and public institutions hinges on passing the point when risk of contagiousness is highest.

That surge peak on the epidemic’s curve arrives different times at different places. The University of Washington created a model for California based on coronavirus patterns in Washington state. However, Miller needs a localized model to more specifically forecast the North State.

So, when government officials and others ask when coronavirus will peak here, he’s not as confident as he’d like to be. His answer is more reliable than a Magic 8-Ball—and different from how some media outlets have reported—just not intricately precise.

“The modeling for the state shows the state surge coming in [about five] days,” Miller said by phone Friday (April 10). “It’s pretty obvious to most people that in Butte County we have been less affected, so that would indicate we are not in our surge yet—and without local modeling, it’s hard to predict when that will be.

“I saw myself quoted in media as [it] being ‘days’ later; I don’t know how they got that, because my suggestion usually has been ‘weeks’ later. But that’s an educated guess and not based on good modeling at this time.”

Whether days or weeks, he expressed confidence in local preparedness for a surge. So, too, did Enloe CEO Mike Wiltermood, whose hospital is operating a federal medical station (FMS) on the county’s behalf. The local FMS, one of eight in the state, subsumed the Enloe Rehabilitation Center on Cohasset Road last week. Both addressed challenges, primarily supplies, but also the lead time we’ve had locally.

“I personally want to express my appreciation to the community that’s sacrificing, that’s wearing their masks, that’s doing what they can to help reduce the impact of this spread,” Wiltermood said, “so that we can take care of them.”

California’s statewide measures have yielded results. In a news conference Friday, Newsom and Dr. Mark Ghaly, state Health and Human Services secretary, said social distancing and staying home have pushed the surge out to May, though referenced the models Miller cited that indicate a peak coming sooner. Ghaly said California would have faced more than 700,000 hospitalizations for coronavirus; instead, while preparing for a surge of 50,000, just under 3,000 of the approximately 20,000 patients who’ve tested positive have been hospitalized.

Miller looked to New York, which has nine times as many cases despite having half our state’s 39.5 million population; and Italy, population 60 million, which has had nearly as many die from coronavirus (18,851 by April 11) as Californians just testing positive.

“It’s hard not to look at California [in comparison] and say, ‘What was different about these places?’ And there are unique challenges to each place,” Miller said. “The number of cases and deaths in California is quite different than what we saw in New York and in other places around the world.

“So I would say California, and Butte County, I think have done a very good job. I think there’s more to be done, unfortunately, because we’re not at California’s peak and likely at Butte County’s peak.”

The list of what he feels still needs to be done “sounds like a cliché anymore,” he continued, “but the things that we’ve been saying over and over again are the things that have proven effective.”

Miller encouraged residents to go out only for essential functions and, when doing so, maintain a safe distance from others, wear face coverings and wash hands frequently. Ill people should stay home for seven days from the onset of symptoms, 72 hours since a fever breaks and symptoms improve. Anyone sick enough to require care should call ahead.

“That’s what the collective ‘we’ need to do,” he added. “We’re saving lives, strange as it seems, by staying home.”

Surge preparedness

This lull has allowed local facilities to ramp up. Public Health has received federal funding since 9/11 for the Hospital Preparedness Program. Routinely, Miller meets with the three medical centers—Enloe, Oroville Hospital and Orchard Hospital in Gridley—plus other provider organizations to hone surge plans.

“There’s been years of preparations, not knowing exactly what we were preparing for, that help us in this situation,” Milller said.

The Camp Fire brought surges to local hospitals, but also was a localized event that allowed Butte County to draw on others for resources and assistance. The coronavirus has placed everyone in the same straits. However, help is available within the local medical community.

Due to coronavirus measures, hospitals are not performing elective procedures, only necessary treatments and surgeries. This has made physicians, nurses and rooms available for COVID-19 patients.

Enloe had 150 patients Friday (April 10) compared with its post-Camp Fire census of 250 admittees.

Wiltermood said predictive models, by the state and Enloe, project the local coronavirus surge would increase patient count by 40 percent. At this level, the hospital has ample personnel—even with the addition of the FMS.

“That [40 percent surge], for us, is no different than what happened during the Camp Fire,” he noted. “We feel absolutely prepared in terms of bed capacity and staffing to handle that.”

The federal medical station impacts both capacities. It provides a secondary location should the hospital get inundated with COVID-19 patients or need a site for people with other, less acute conditions.

The FMS came together quickly. April 3, the Army Corps of Engineers inspected potential sites in Chico. At 9:30 that night, Miller called Wiltermood to tell him the Air National Guard would start moving equipment into Enloe’s rehab center that Monday (April 6). Chico Sports Club offered to host services typically performed there; that relocation occurred concurrently. Everything was ready by Wednesday.

Typically, fairgrounds or large indoor venues serve as FMS facilities. That’s the case in Shasta County, where the Redding Convention Center has become a 125-bed makeshift clinic. In choosing locations for the eight stations, state officials decided to divide 13 counties between Shasta and Butte counties.

The Enloe Rehab Center now also has 125 beds—more than double its normal capacity of 60, in a building with 30 private rooms. Public spaces would house the greatest density of patients or guests, on cots lined in orderly grids.

“We have lots of options depending on the size of the surge,” Wiltermood said. Those include a “stepdown” for patients making their recovery and accommodations for nursing home residents and/or homeless people exposed to coronavirus.

The search continues

Though Enloe got stocked up for the FMS, supplies remain a pressing problem for the hospital—all hospitals. Particularly scarce is personal protective equipment (PPE) such as masks, gloves, goggles and face shields.

Take masks. Before the outbreak, basic surgical masks cost 5 cents apiece and N95 fine-particle masks, like North Staters wore after the Camp Fire, cost 51 cents. Due to supply and demand, suppliers now sell surgical masks at $6.50 each and N95 masks (when available) at $10.

“The good news is we have a lot of alternative supply lines that we’re exploring,” Wiltermood added. “There are just some things that aren’t available at any price.”

For local hospitals and Public Health clinics, Miller’s department requisitions supplies—procured by federal and state agencies—directly from the state.

“Usually we get a fraction of what we ask for,” he said, “but we have been continuing to get those supplies and we will continue to go through that pathway, because the governor has started to set up additional contracts for the state with suppliers in an attempt to keep that pipeline flowing.”

PPE for local health care workers came into sharper focus Thursday (April 9) when Enloe told its staff and the public that an employee had contracted COVID-19. Milller said “it would not be appropriate” for him to comment on the specifics, but Wiltermood confirmed that Enloe called this “a community-acquired case” because the exposure got traced to a family member.

“We’re doing the best that we can with the supplies that we have available,” he said. “If we could, we’d wrap everybody up in a hazmat suit, but that’s just not available right now.

“So far, we’ve been able to be pretty consistent sticking to CDC guidelines. … We don’t think there’s cause for alarm for the public.”

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