When the covid-19 pandemic hit the state on March 11, 2020, hospital administrators were thrust into the unknown.
As virus cases in the state grew from a handful in the early days to more than 825,000 over two years, hospitals in the state came together, not as the usual competitors, but as a united front.
They saw the state through overflowing intensive care units, a vaccine rollout that created a political firestorm, ever-changing treatment protocols and more than 10,800 deaths.
Friday marked two years since the state's first coronavirus case was confirmed, and the Arkansas Democrat-Gazette visited with top hospital officials to ask about the lessons learned, the personal toll and how the virus has forever changed health care.
Those taking part included Arkansas Children's Hospital President and Chief Executive Officer Marcy Doderer, University of Arkansas for Medical Sciences Chancellor Cam Patterson, Baptist Health President and CEO Troy Wells, St. Bernards Healthcare CEO Chris Barber, CHI St. Vincent CEO Chad Aduddell and Washington Regional President and CEO Larry Shackelford.
Question. Take us back two years ago, when covid-19 first hit Arkansas.
Shackelford: Confirmation of the first covid-19 patient in our hospital was a significant reality check. There was a realization that our community was being impacted and this was no longer a theoretical discussion, but very real. Testing results were hard to come by in the beginning, often creating uncertainty as to the number and severity of the illness. All of the preparation had paid off, and it was time to put those plans into place.
Aduddell: It was toward the end of April. We had shut down everything, school, activities. We shut down a lot of our care for other patients. All of our surgeries. We did all those things, and it was surreal because the first group of patients that came, it was kind of anticlimactic. The first surge was more like a blip, not really a surge. Here, we had shut down the world in this health care system for a lot of things to prepare for this and yet, there were like seven covid patients in the building at the time.
Barber: When we first starting seeing covid patients in our area, the tornado hit right out of the gate. We were trying to socially distance and we had hundreds of folks coming to the rescue of folks in need. (On March 28, 2020, a tornado hit Jonesboro, injuring 22 people and leaving a trail of destruction.)
Patterson: It was not long after March 11. It became a blur very quickly. It progressed quickly. Suddenly, we were having conversations, not just amongst ourselves, but with other hospitals across the state. 'What are you doing? What's going on in your area?'
Doderer: If you do turn back to March of 2020, Arkansas Children's was as prepared as we could be for something that we didn't necessarily fully see coming.
Q. What was the greatest challenge you faced during the pandemic?
Wells: In any situation, like what happened with covid back in 2020, fear of the unknown is the worst part. We are made to do what we did during covid in terms of hospitals and doctors and nurses. It wasn't that we were being prepared or asked to do something that we didn't know how to do. It was: Were we going to get overwhelmed? Was there going to be enough beds? What could potentially happen when you start looking at infectious disease models of how disease can spread and how contagious was it going to be and what does that mean for health care infrastructure and resources? The last thing health care people want to do is let down the people they serve, the community.
Shackelford: One of the greatest challenges early in the pandemic was that we knew very little about the virus. There was much fear -- very similar to what was experienced with the banking crisis in 1933. Similar to the response of President [Franklin] Roosevelt, I began a series of weekly letters to encourage and provide real-time updates to our team members. In addition, we provided town hall meetings to answer questions and to seek input from our staff as to how to best serve our community.
Patterson: My single biggest regret is we did not anticipate that [vaccine resistance] and we did not spend the months leading up to the vaccine being available, doing a better job of educating rank-and-file Arkansans on how life-saving the vaccine can be.
Doderer: We were slower to feel the impact of the attrition rate that health care has experienced in the last two years, but it is absolutely our biggest challenge. The toll the pandemic took on caregivers created a vacancy rate we haven't really seen in this industry in a long time. That spurred, really accelerated the role of the travel nurse agencies.
Barber: In the first wave, you had the newness of the virus. Science was evolving. We didn't have the supplies with the PPE, so we were doing everything we could to source adequate supplies. Everybody throughout nation and the world stepped up to that and dealt with it. Then comes along with delta with the next wave and a different set of issues.
Fortunately, we did start receiving some therapeutics, and we were so fortunate to have the vaccines that became available at that point in time. We hit that new level, and then once you felt like you were going on a downward trend with delta, omicron comes along. That brought a whole new level of challenge just because of the transmissibility. That's when we really saw record numbers of hospitalizations from covid and the greatest impact of the number of employees out.
Q. How did the pandemic affect your staff?
Aduddell: It's been the unnecessary [unvaccinated] deaths that have really shaken the team because you're not used to that. It's a hospital. We deal with sick patients and dying patients and accidents and trauma. But when someone was healthy two weeks ago and they go to a wedding or to church and then they develop symptoms. Then they're in the hospital, and the next thing you know they're on a ventilator. Two or three weeks later, they're gone. That's hard to process for our caregivers, our support staff, our leadership. It's just hard.
Wells: I'm still saddened and shocked with the young population that was so ill during that delta surge. Unfortunately, we here in the hospital world, had to see that every day. It was heartbreaking for us, and I'm sure it was even more heartbreaking to the nurses and doctors and respiratory therapists that were caring for those patients.
Shackelford: The loss of any patient is hard, but during this pandemic, many of our team members on the front lines have seen more deaths these past two years than during their entire careers. Our team members care deeply for their patients, and for those who were in isolation, our staff also took on the added role of being their support person and formed bonds with those patients and their families. Many have shared with me that they'll remember these patients for the rest of their lives.
With the vaccine now so widely available, there is an added level of frustration. With the vast majority of hospitalizations and deaths occurring amongst the unvaccinated, many health care workers feel a number of these deaths could have been prevented.
Doderer: We learn the power of our team members who aren't necessarily being clinicians, but who provide all of the wraparound services to our families: our Child Life team, our social workers, our pastoral care team who stood there side-by-side to help the families and also help our caregivers ensure that we could maintain the level of conversation and trust of these families who were experiencing such extreme stress.
Patterson: Inevitably there is wear and tear. How many of us gained a few pounds because we didn't exercise, we're stressed out and we didn't eat well? I think most of us fall into that category. How many of us disengaged from our friends and family because we couldn't see them face to face? All of us faced that. While that's a problem that affects every single person, it impacted the health care community worse.
The one thing that keeps me up at night, first and foremost as a physician and health care leader, the first line of the Hippocratic Oath is, 'First, do no harm.' That has to start with first, do no harm for the people who work for you.
Q. What do you see in the future?
Shackelford: To me, covid years feel like dog years. In so many ways, it feels like we have endured much longer than two years of the pandemic. The idea of long-term planning, prioritization of resources of time, people and capital can change very quickly. The pandemic has revealed some of the limitations of our current system for financing of health care. It is time to transform our health care delivery system to one that focuses on the whole person, enhances the patient experience and improves health care outcomes.
Wells: Staffing is still pretty complicated. The thing I think about a lot is, thank goodness for this core group that has stuck with us throughout this -- that hasn't turned over, that hasn't left, but stuck it out and stayed with Baptist Health. The next couple of years are going to be challenging in terms of getting back to where we were before the pandemic.
Patterson: We did not let covid-19 keep us down in other areas. We've got buildings going up all around us. Those didn't stop because of covid-19. We're going to have the state's first orthopedic and spine hospital, right over there. We're going to have the state's first proton therapy center on the east side of cancer. We're going to have the premier sports medicine facility in the country in Springdale. Those things all continued to move forward in spite of covid-19.
That's what we're here to do. We've got a 10-year strategic plan, and there's no way that I'm going to let a stupid virus get in the way of that.
Aduddell: People think about buildings and some of the tangible outcomes of the strategic planning, but, for me, the No. 1 item of our strategic plan is our most important resource, which is our people. Yes, we are strategic planning, and it's about retaining the workforce that we have -- recruiting, building a new workforce from a new generation and helping the nursing programs that are out there around the state grow so that we can replace nurses that we've lost so we can be in a better position than we're in today and that we've been in over the last couple of years.
Doderer: Our plans really focus on building partnerships, building processes and infrastructure across the state that allows all children to reach their highest potential by starting to address child health metrics; looking at vaccine rates; looking at piloting home visiting programs to ensure a new mom and a new baby can get off to a right start; partnering with food pantries and food banks to have good feeding programs for children even in the summer months; and helping private practice physicians do what they do best in taking care of kids and can we bring resources to bear to help them.
We're now two years into that strategic plan and continuing to advance all those efforts and continuing to lead in a pandemic -- because it's not over yet, unfortunately.
Barber: It's been a grind for folks, but we're going to make it through it. There's light at the end of the tunnel. There are a lot of lessons from this to take away and incorporate. I think we're a stronger organization than we were prior to that in what we've learned and how we operate. And I would say we're probably better on things just because it forced you to be innovative with solutions and strategies. We're grateful for our organization, our community and how folks pulled together throughout this pandemic.