PINE BLUFF -- In early March 2020, nurse Erin Bolton laughed in her office at Jefferson Regional Medical Center at a question from Dr. Steven Wright.
"Erin, how do I order a coronavirus test on a patient?" Wright had asked.
"You're kidding, right?" Bolton replied.
In Arkansas, March 11, 2020, marks the beginning of the covid-19 pandemic that in the two years since has afflicted more than 800,000 Arkansans and killed nearly 11,000.
To Jefferson Regional, however, it was March 6, 2020, that set the events into motion that made the Pine Bluff facility Hospital Zero.
It was that evening -- a Friday -- that James Black arrived in the hospital's emergency room, seeking answers to myriad symptoms, including respiratory distress.
Over the weekend, Wright, a nephrologist, and his team of residents from the University of Arkansas for Medical Sciences had trekked back and forth from the patient's bedside to a classroom for brainstorming sessions, trying to solve the mystery of Black's illness.
Test after test failed to bring answers.
"Everyone was saying: 'It could be this. It could be that.' The guy was getting sicker, but we didn't have a firm diagnosis," Wright said.
Black was quickly moved into the intensive care unit.
"We were excluding things as we went. It kept being, 'No.' 'No.' 'No.' 'No.' Once you exclude all that, it has to be something else. Even though you don't want to believe it, it has to be that," Wright said.
"I ordered the test."
Friday marked the official two-year anniversary since Arkansas discovered its first case of covid-19. In the past two years, the doctors and nurses at Jefferson Regional have cared for close to 1,500 covid-19 inpatients as well as more than 5,000 emergency room and urgent care virus patients.
This is the story of the first.
It's a story of hard lessons learned and of triumphs, of heroes and of tragedy.
It's also a reminder of the uncertainty that gripped Arkansans two years ago.
Approaching the second anniversary, health care workers at Jefferson Regional provided their most complete account of Arkansas' first coronavirus case and its first outbreak.
CODE ORANGE
Immediately after Gov. Asa Hutchinson announced Arkansas' first covid-19 case at a news conference on March 11, 2020, the public address system blared "CODE ORANGE!" throughout the 316-bed Jefferson County hospital.
"Internal Disaster," Bolton said.
The code triggered all members of the management team to report to a central location.
"At that point, we were able to tell them that we had the first covid patient in the state of Arkansas," said Bolton, the director of quality and regulatory at Jefferson Regional.
Emergency duties were doled out and plans were made.
Employees' cellphones buzzed with loved ones who had heard the governor's announcement.
"We were all getting texts," Bolton said. "'Are you OK? What's going on?'"
Two hospital classrooms were combined into the makeshift Covid Command Center.
"Most of us lived there for the next six weeks," Bolton said. "It was the middle of April before we were able to close it down even temporarily."
Nurses slept in their cars between shifts. Some physicians and other health care workers didn't leave the hospital for weeks at a time.
In that first week, 16 health care providers tested positive for the virus, leaving a gaping hole in staffing.
The ill included physicians and the medical residents who had spent the weekend trying to diagnose Black. The hospital was left with only one respiratory therapist.
Medical director Dr. Naznin Jamal and Dr. Abrar Khan oversaw the care of each covid-19 patient in the beginning, alternating shifts, missing their families.
"We avoided family members for months at a time," Jamal said. "We just didn't want to spread it to our more vulnerable populations. I know a lot of nurses did the exact same thing."
Doctors, nurses, unit staffers and housekeeping personnel volunteered to leave their usual posts for the covid floor.
"And then when schools closed, it was issues of figuring out who was going to watch children. That affected everyone, not just nursing, so every department had those kinds of issues," Robin Peddy, the hospital's nurse manager, said. "You saw people who would jump up and say, 'OK, I'm here.'
"That's what I can say, throughout this facility, is even though there was a horrible situation and we were all scared, everybody jumped in and got together and said: 'OK. What can we do to help?'"
MARCH 11, 2020
On the morning of March 11, 2020, Bolton was standing in a hospital classroom, about to begin a safety huddle to review staffing shortages and any issues that could affect patient traffic and care.
Her cellphone rang.
It was a Little Rock number she didn't recognize. She stepped out into the hallway.
"Erin, this is Cat Flowers from the Department of Health. I need you to sit down," the voice on the other end said.
Bolton's breath caught in her throat.
"No, ma'am," she said. "I know what you're going to tell me."
"You have the first coronavirus patient in the state of Arkansas," Flowers said.
Bolton shakily scribbled the instructions being dictated to her.
When Bolton didn't return to the morning meeting, her supervisor, Mary Daggett, the hospital's vice president and chief quality officer, went out to the hallway to check on her.
"I remember flipping the paper over and writing, 'FIRST COVID PATIENT,' and holding it up to her," Bolton said. "Her eyes just got big. I'm nodding and pointing and still trying to listen."
Bolton handed a list of covid-19 task force members to a staff member close by.
"I need these people in Classroom 1 at 10 o'clock."
At 10 a.m., Flowers began a conference call by telling the team: "We don't have long. The governor's going live at 10:15."
Soon, Hutchinson announced that Arkansas had its first case of covid-19.
"While he did not call us by name, he referred to us as 'a hospital in Pine Bluff,'" Bolton said, laughing. "We're not like Little Rock. If he had said that about Little Rock, you would have to take a few minutes to maybe figure it out. He might as well have said our name."
GETTING THE TEST
Testing Arkansas' first covid patient was a struggle.
At the beginning of the pandemic, covid-19 tests were scarce nationwide, and the state Health Department maintained strict criteria to determine who was tested and who wasn't.
The state could only perform about 20 tests per day, Dr. Jennifer Dillaha, then the state's medical director for immunizations and outbreak response, said at the time.
Prior to March 11, 2020, only 12 Arkansans had been tested for the novel coronavirus. All were negative.
Symptomatic patients with no obvious connection to travel or other exposure were denied tests.
In the past two years, more than 6.6 million covid-19 tests have been conducted.
After first laughing at Wright's request, Bolton contacted the Health Department. Black, the first patient, had not disclosed any travel history, and chances of testing him were slim.
"At that time, they agreed to do a respiratory panel on him and told me that if the respiratory panel was negative, then they would do the coronavirus test," Bolton said.
The hospital team quickly collected the samples needed for the panel, which checks for pathogens in the respiratory tract but not covid-19 at the time. It all came back negative, but the Health Department still declined a covid test.
"I called Dr. Wright back. He was not very happy," Bolton said.
Wright was convinced that Black had the virus.
"Travel was the thing. We didn't have the travel," Wright said. "I told them: 'He's very sick. We've looked at everything else. I think this is worthwhile to take the chance on the limited number of resources that you have on this case.'"
The Health Department didn't budge.
Later that day, doctors learned that Black had recently traveled to New Orleans for Mardi Gras.
"If you go to Mardi Gras, you might as well had gone to every country in the world," Wright said.
Finally, the Health Department agreed to do the test.
THE TREE
Last month, nearly two years after that first fateful day, Bolton stood in her office and reverently traced her finger from one tree limb to the next that was drawn on a 6-foot-tall piece of white butcher paper taped to the wall.
The drawing hung for months in the hospital's Covid Command Center before Bolton claimed it.
"This is where it all started," she said.
Bolton pointed to the top, where James Black's name was written.
"As we started that contact tracing, we began to realize that we already had staff members that had called in sick," Bolton said.
The tree's branches quickly filled up with the names of physicians, nurses and other members of the health care team who had come in contact with Black and became infected. Next came his family members as positive tests were returned.
"We became a hot spot very quickly," Bolton said. "Not only did we have the first covid patient, but we already had additional people that were sick that we ended up having to test."
Bolton and Michelle Powell, the hospital's chief nursing officer, set up a drive-thru testing site outside the hospital so the potential patients wouldn't have to go inside.
"We would gear up like we were going to a hazmat field and go out and swab these folks," Bolton said. "We were just getting so much information. We were trying to protect them, protect us, protect our other patients from everything that was going on."
The swabs were being packaged like hazardous materials and sent via courier to Little Rock once a day.
It wasn't enough.
Unlike today, with at-home test results in 15 minutes, the results of the PCR tests at that time took at least a week, sometimes longer, to return because of the sheer volume of tests being processed.
"We started making a second run every afternoon," Bolton said. "We would package them up and one of us would put them in our own cars and drive to Little Rock. We had an employee that lives in Sheridan, so they would go home via Little Rock and drop them off."
The community cases climbed rapidly.
Lines in the drive-thru testing site grew to nearly 700 on some days.
"We started getting people that we couldn't tie back to the tree," Bolton said. "As it spread more through the community, we found that the tree was useless."
THE PLAGUE
A fearful Jefferson County looked to its hospital for answers and reassurances during an uncertain and terrifying time.
The hospital workers were barraged with questions they couldn't answer and requests they couldn't meet.
"People would drive up here and demand that we give them a mask," Bolton said.
In the beginning of the pandemic, masks were so hard to find that health care workers worldwide were reusing theirs day after day. Soon, people began sewing cloth masks at home to meet the shortage.
Most places prepare with marketing and public relations when there is an issue, Brian Thomas, Jefferson Regional president and chief executive officer, said.
"There was zero time for that here," he said. "I remember that being one of the biggest challenges, the outside pressure and Facebook was lit up with panic in a matter of five minutes of the press conference."
"People thought it was the plague."
Powell, the chief nursing officer, agreed, adding that no amount of preparation would've gotten them ready for the ever-changing nature of the virus that changed their lives.
"There weren't protocols," Powell said. "There weren't practices. You would put something in place and then, within a day sometimes, we'd find out that's not what we needed to be doing."
Dr. Reid Pierce, the chief medical officer, said it was a different emergency every day.
"We were starting to realize that this was really going to go on for a long way and we were going to be in this constant emergency crisis mode," Pierce said. "Weeks and weeks went by, people were getting more and more physically affected by all of this. At one point, I remember standing up in front of the command center and saying, 'We have to consider that we are in a war and we have to be on war footing.'"
Jefferson County schools closed down by that first Thursday. By Friday, Hutchinson had closed down schools statewide.
"We were getting phone calls at the house, 'What's going on?'" Thomas said. "It became personal at that level because people were looking at us like we were leaking out the pandemic into the state of Arkansas."
At the same time, the Jefferson County community rallied in support of the hospital. Nearly 300 meals for health care workers have been delivered, along with dozens of baskets of goodies and even artwork from children that now decorates the hospital's hallways.
Seamstresses in the area made fabric masks and donated them to the hospital.
On April 2, 2020, while Black was still hospitalized, people in vehicles packed the hospital's six parking lots, honking their horns and flashing their headlights in unison as they prayed together.
Black spent 47 days in intensive care at Jefferson Regional before being transferred to Cornerstone Speciality Hospital in Little Rock to complete his long road to recovery.
Neither he nor his wife returned messages left by the Arkansas Democrat-Gazette for this article. He and his family did talk publicly about their experience during an anniversary event at the hospital last year.
NEW NORMAL
Powell pushed through the doors of the hospital's covid floor last month, smiling as she greeted a nurse updating a chart, with a cafeteria team member balancing a tray of food and a doctor backing out of a patient's room.
All were masked, but none had the hazmat-style equipment of the pandemic's beginning.
The 21-room ward had 18 covid-19 patients that day, all in varying stages of illness.
A bulletin board was packed with information about covid research, reminders of patient care protocol and event notices.
"Covid positive patients and their pulse ox 2CE per Dr. Jamal."
"Always attempt to wean O2 when sat are consistently 95 or >."
Looking back, Peddy, the nurse manager, said a lot was learned just in that first week.
"Because of his [Patient Zero's] decline, and the normal treatments that we do with patients in respiratory distress, we figured out that, no, we don't need to do this," Peddy said.
The lessons continued at a hard and fast pace.
Powell said they were able to meet the new surges as they came by planning ahead and ordering a sufficient inventory of covid-19 tests during the valleys.
"We kept planning for the next wave," she said.
In two years, 223 covid patients -- including two employees -- have died of the virus at the Jefferson County hospital.
Jamal said the deaths weighed unimaginably on the team of caregivers, but she learned to never give up hope.
"The dying process was difficult to bear every day. You could kind of tell the prognosis, but you still want to keep trying and you want to be optimistic. Optimism really does lead to improvement in care," Jamal said. "We had patients on the ventilator for weeks. We had patients using high-flow oxygen for weeks. And we've seen them walk out of here."
Today, the Jefferson Regional team is stronger and closer than ever, its members said. They recount memories with knowing nods dispersed by hardy laughter. They brush off praise and redirect it toward their colleagues.
"These cats did all the work, man," Wright said, waving a hand to encompass his surrounding colleagues. "After that first point, I was just a spectator. The hospital organized and put their group together and the command center and the team that Dr. Jamal ran. From that point, I went back to being a spectator."
Thomas, the hospital's CEO, said he was proud of how the employees rallied from the first patient through the many surges and now in a valley.
"Quite honestly, just watching how that transpired over the last two years is amazing," Thomas said. "We've got a very strong team of people."
Erin Bolton, Director of Quality at Jefferson Regional Medical Center talks with a reporter during a round-table discussion about the experience of having Arkansas' first COVID patient as they approach the two year anniversary on Friday, Feb. 18, 2022. See more photos at arkansasonline.com/313covid/ (Arkansas Democrat-Gazette/Stephen Swofford)
