ELLSWORTH — Administrators at hospitals in Ellsworth and Blue Hill and across the Northern Light system will set up offsite testing areas, restrict visitors and postpone elective surgeries, adult wellness visits and other checkups in an effort to free up staff time and space for anticipated coronavirus patients.
“There are no longer visiting hours,” said Dr. Sheena Whittaker, a pediatrician at Northern Light Maine Coast. “We are restricting all visitors throughout the day.”
Children under the age of 16 “will not be allowed except under extraordinary circumstances,” said Whittaker. Pregnant women will be allowed one partner and one birth support person. Visitors will be allowed for end-of-life patients, but only one or two will be allowed at a time and they will be screened for any symptoms of the coronavirus at the entrance of the building. There are also exceptions for patients with altered mental status or disruptive behavior who may need a support person, or for some surgical patients.
The number of confirmed and presumptive cases in Maine rose to 32 on Tuesday, according to a briefing held by the Maine Center for Disease Control and Prevention (CDC). No cases have been confirmed in Hancock County, but a staff member at Northern Light Mercy Hospital in Portland did test positive for the virus, according to a statement posted by the hospital.
As for cancelling appointments, said Whittaker, “It really is a case-by-case basis. [Patients] will be contacted by our staff and asked to put off the appointments anywhere from two to four weeks,” at which point, “Then we can make another decision.” Whittaker said the hospital is seeing a lot of cancellations from those who aren’t comfortable being in a health care setting right now. “If people are feeling that way, they’re welcome to do that.”
The coronavirus presents with a range of symptoms, many of which are similar to flu. For the majority of those diagnosed with coronavirus, they will have a mild infection that will likely start with a fever, aches and pains and a dry cough. It is “nothing that will make you feel like you need to run to a hospital,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, at a World Health Organization press conference reported on by National Public Radio on March 9.
Those who are “moderately ill” with coronavirus, said Adalja, may have coughing, a fever above 100.4 degrees Fahrenheit, chills and feel like they “don’t want to or can’t get out of bed.” Some people will experience shortness of breath, a symptom that should always be checked by a health provider, Dr. Kenneth E. Lyn-Kew, a pulmonologist in the Section of Critical Care Medicine and Department of Medicine at National Jewish Health in Denver, reportedly said during the press conference. That’s because shortness of breath can be caused by low oxygen levels in the blood, which could lead to other health problems.
People who have mild or moderate cases could eventually develop pneumonia, which, while it may resolve on its own in younger patients, can present serious health challenges for those who are older or have compromised immune systems.
For roughly 14 percent of patients, the disease becomes severe and requires supplemental oxygen, according to a report by a joint mission of the WHO and China. Six percent of patients may become critical and develop septic shock, which can lead to death.
In Maine, Northern Light hospitals are following the CDC guidelines for who should be tested.
“We really have to save our testing kits for people who are sick,” said Whittaker, which she acknowledged is difficult, particularly when the flu and other respiratory diseases are circulating and residents are nervous. “Some people just want to know.”
If you’re worried you might have coronavirus, said Whittaker, call your primary care provider (if you don’t have one, call your nearest emergency department or walk-in clinic) and they will determine whether you should be tested and give you instructions. Health care providers are warning residents not to show up unannounced, which could put others at risk if they do test positive.
The United States has been slow to ramp up testing, and, despite early proclamations from the federal government, tests are not yet available to anyone who wants one. At the moment, the CDC recommends testing those “who have fever, cough, maybe travel,” said Whittaker. “They would be tested,” but only if a health care provider (such as a primary care physician or provider at a walk-in clinic) recommends it.
“If you’re sick but well-hydrated, breathing comfortably and tolerating the illness well, we might ask you to stay home,” said Whittaker, self-isolating for 14 days and calling if symptoms worsen.
Maine Coast and Blue Hill hospitals are working on setting up tents and offsite testing so patients can be tested without entering the hospital. The hospitals are still sending tests to Augusta for processing, which takes up to four days, said Whittaker. “We are getting new test kits,” she said, which “could have a turnaround time of two hours, but we’re not there yet.” Tents will likely be set up at both Maine Coast and Blue Hill “in the next few days,” said Whittaker, but, “We will not be testing people in those tents who are asymptomatic. They will be triaged prior to arrival.”
Maine Coast is a 65-bed hospital with nine intensive care unit beds, said Whittaker. “Most times our nine beds are not full.” The hospital can also move some patients to other areas of the hospital or transfer them to Northern Light Eastern Maine Medical Center in Bangor.
“We have fluidity,” said Whittaker. “We have the nursing homes in the area and we have swing beds at Blue Hill. We do have quite a bit of space.”
Northern Light hospital officials were unable to say how many ventilators are available in a conference call with reporters on Monday, but said they have been in touch with suppliers, the National Guard and state officials in the event they need “to expand beyond our current capabilities,” said Dr. James Jarvis, who briefed reporters.
“Right now,” said Jarvis, “that is not a concern for us.”
The supply of personal protective equipment is also in “a complete state of flux for us,” said Jarvis. “It is going to be problematic as there are shortages across the country and frankly around the world.”
Northern Light plans to launch a phone line that patients who worry they may have coronavirus can call for pre-screening.
State health officials are advising everyone to follow the CDC’s guidelines to prevent the spread of any virus: don’t touch your face, cough into your elbow, stay home if you’re sick, keep more than 6 feet apart from others and “Wash your hands as if you had just sliced a bag of jalapeño peppers and now need to take out your contact lenses,” said Maine CDC Director Dr. Nirav Shah at a press conference on Tuesday morning.
For more information, visit maine.gov/dhhs/mecdc or northernlighthealth.org.