By Corey Morris

Away from the interstate and main drag, the Snoqualmie Valley can feel like a world away from the hustle and bustle of the modern world. Along the river with a fly rod or up a switchback on a hiking trail, it’s all seemingly insulated from the world left behind.

That distance and isolation revealed itself to be merely an illusion in recent weeks when COVID-19 reached the Valley.

Today, Snoqualmie Valley Hospital is navigating the complexities of addressing a worldwide pandemic in its own backyard with the resources of a 25 in-patient hospital.

Dr. Kimberly Witkop, interim chief executive officer and chief medical officer, said the hospital is faring well thanks in part to preparation and cooperation between hospitals.

Learning

When the virus was spreading in China, Witkop says local hospitals were preparing for its possible arrival in the United States. EvergreenHealth of Kirkland saw the first case on the Eastside, the second in Washington State.

“All hospitals in the Puget Sound area were in the process of preparing for the ‘should it arrive,’ and then it was when the first cases were identified at Evergreen that we now were made aware ‘it has arrived’ on our coast,” Witkop explained.

Cases in the Valley then were inevitable. But Snoqualmie Valley Hospital could learn from EvergreenHealth’s early steps.

“Now we changed the planning from the ‘when it arrives’ to all of the things that needed to be put in place for when it’s here,” Witkop said. “Evergreen did not have that lead time. They had to make this transition so incredibly fast. We were at an advantage by them being the ones that were the first to get indication so we could all deploy into our active mitigation phase.”

“Evergreen has been incredible to be as transparent as they can be with their experience and their lessons learned. I really can’t say enough positive about them. In the midst of being in the middle of the fire, they continue to look out and are looking out for the rest of us,” Witkop added.

But now, Witkop added, EvergreenHealth is no longer going it alone in the fight against COVID-19.

“That continues as a region, and all of our health care systems. We are in regular contact, in formalized conference calls with one another multiple times per week,” Witkop said. “None of it has stopped. The lessons have not yet been fully learned.”

Now, following preparation and continuing conversations with hospitals throughout the state, Snoqualmie Valley Hospital is set to transfer COVID-19 positive patients to other hospitals when necessary.

“As the hospital systems across the state of Washington, we have a very strong organization. Almost all of us are participants through the Washington State Hospital Association and that is the way that we connect with one another,” Witkop explained.

Though the local hospital doesn’t have “ICU beds with ventilators,” Witkop explained that it does have two ventilators on hand to sustain patients until they can be transported to another hospital, when necessary.

Essentially, the hospital beds in all of the separate hospitals throughout the state are treated like one set of beds, Witkop explained. When Snoqualmie Valley Hospital needs to transfer patients for ICU care with ventilators, it may elect to receive patients who need less intensive care from that other hospital to lessen the overall bed capacity burden.

“In that way, we manage our beds so our beds are part of all the beds. We locate people where they’re going to be able to be served correctly, adequately and also not compromise those who need access to that high end level of care,” Witkop said.

Fear and duty

But those patients are seen by medical staff, and the arrival of COVID-19 means an increased danger to the medical staff.

“Staff is one of your primary resources to endure through this. Having a ventilator is no help if you don’t have staff to run it,” Witkop said. “What do we do for our staff? We are incredibly vigilant about everything that is preventative. Are you wearing the right mask in the right room? Are you wearing the right PPE? Are you separating patients? Are we separating patients as they’re coming in?”

Visitors are no longer allowed in the hospital, and nor are staff members who aren’t working.

That said, there is no guarantee that staff won’t contract the virus, even with rigorous and mindful prevention.

“Across the board, our health care workers are caught in that dilemma: They are people who personally realize that they’re vulnerable — that they, like everybody else, don’t have an immunity to this novel virus, and that they have families at home that they’re concerned about and they don’t want to be a conduit for taking the infection home to their families — and, on the other side, they are absolutely driven to the career and the vocation that they chose to do,” Witkop said. “So it is quite a dilemma.”

How the hospital helps its more than 250 employees and health care workers isn’t as simple morale boosting exercises or pizza parties.

“We don’t so much deal with morale, but we deal with helping everybody reconcile through those different positions that have to be reconciled,” Witkop said.

Yes, the virus is intimidating, but Witkop says there will be an end to the pandemic.

“All that we have as far as answers are concerned is watching what’s been happening in countries that are farther along in this experience than we are, so we continue to learn from them and their experience,” Witkop said. “And then we have some historical experiences to look back on — it was a century ago that there was a pandemic like this. The world has changed, so we have to be a little cautious about some of the lessons we pull forward from a century ago, but we do know that as many, many new viruses have been introduced over the lifetime of humanity, the immune system reacts and we do get immunity from it.”

Lasting impacts

And the virus itself isn’t the only concern. Worldwide, the virus is causing serious economic strain. The hospital is not immune to the pressures of finances, and COVID-19 has added to that pressure.

“While we have an enormous amount of work on our hands readying for the weeks that are ahead of us and the weeks we are in right now, that isn’t really revenue producing. And we have intentionally stopped some of the things that are revenue producing. We limit the number of folks we have coming into clinics. We don’t have any elective procedures any longer,” Witkop said. “That’s just something we have to keep eyes on. And that’s something that will continue even after this pandemic.”

The hospital is being mindful of its approach to those financial speed bumps and Witkop even noted a potential “silver lining.”

“On the flip side, necessity is the mother of invention and we are finding opportunities to stand up and deploy processes and interventions that we can actually see having a long lasting value that either we’ve been thinking about and just hadn’t gotten to it yet or thought it would be more difficult than it turned out to be,” she said. “We are having an extension to the ways that we apply telemedicine, so that’s going to be exceptional. Some of the communication tools that we brought into play will probably persist beyond this event.”

In the end, it’s cooperation that will allow for overall success when it comes to defeating the virus.

“We’re not absolutely overwhelmed right now as a health care system and that’s because everyone has done their part, done their social isolating, and helped to flatten the curve,” Witkop said. “They just have to realize that success means we should continue, it doesn’t mean that success means we get to stop.”