Outside Coronavirus Epicenter, Northwest Health System Workers Brace For What’s Coming

Jess White, a registered nurse at UW Northwest, demonstrates to another nurse how to properly remove a mask on Thursday, March 12, 2020, at UW Medicine's drive-through testing clinic in Seattle. CREDIT: Megan Farmer/KUOW
Jess White, a registered nurse at UW Northwest, demonstrates to another nurse how to properly remove a mask on Thursday, March 12, 2020, at UW Medicine's drive-through testing clinic in Seattle. CREDIT: Megan Farmer/KUOW

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At Pioneer Family Practice in Lacey, Washington, if a patient calls and reports symptoms consistent with coronavirus, they’re instructed to drive to the clinic and wait in their car. A doctor then walks out to meet the patient in the parking lot, conducts an exam and, if warranted, swabs their nose to test for COVID-19.

“We’re making every effort to keep [suspected coronavirus] patients out of the clinic,” said Dr. Edward Cates, who is one of six physicians who work at the clinic. 

This ad-hoc protocol for how to manage possibly infected patients exemplifies the extraordinary measures and improvisations doctors, nurses and front line clinics are employing as they scramble to adjust their practices in the face of a global pandemic and a virus that’s still not well understood.

“I’ve never worked an illness in my 20 year career where I was meeting people out in the parking lot,” Cates said.

While the greater Seattle area has so far borne the brunt of the outbreak in Washington, health care workers outside the epicenter are bracing for what’s to come. So far Thurston County, where Pioneer Family Practice is located, has reported just five confirmed cases of COVID-19 – out of more than 1000 statewide — and no deaths. But as testing ramps up, public health officials warn the peak of the virus is still weeks out. Providers are bracing for a potential wave that could inundate both doctor’s offices and hospitals. Meanwhile, necessary equipment is in short supply and testing capacity is still limited. 

“Testing for COVID-19 will continue to be limited in our community until we have adequate resources to protect our health care workers,” said Gabrielle Byrne, a spokesperson for the Thurston County Public Health and Social Services Department.

Dr. Cates said he and his colleagues have done a “smattering” of coronavirus testing in recent weeks and so far all of the tests have come back negative. But as the virus spreads and demand for testing increases, the disease has the potential to strain the resources of his small clinic.

As of Tuesday, Dr. Cates said Pioneer Family Practice had enough supplies to conduct 17 more COVID-19 tests. But the clinic is running low on the swabs needed to collect nose samples and the vials the swabs go in for transport to the lab. The clinic also has a limited supply of the protective equipment the physicians need to don to collect the samples.

Cates explained that doctors should wear gloves, a gown, mask and eye shield when swabbing patients – a rather intrusive procedure that involves placing the swab deep inside the nasal passage, twisting it and leaving it place for several seconds — because it’s common for the person to sneeze or cough.

“I have to put on a face shield, and ideally for testing you should be putting on an N95 mask, but we’re really short on N95 masks,” Cates said.

Recently, Thurston County’s emergency management coordinator contacted Pioneer Family Practice to ask what additional supplies it needs and allowed the clinic to place an order. But he said they haven’t heard when the supplies might arrive.

The challenges are compounded for pediatricians serving young patients. Even though the evidence suggests most children are fairly resilient to COVID-19, they are not immune to it.

At Olympia Pediatrics, Dr. Brad Stephens said his clinic started testing for COVID-19 on Monday, but is also struggling with limited resources and having to develop protocols to keep patients and staff alike safe. 

Dr. Stephens said he was working through a checklist of eight questions, including: who gets tested, who conducts the test, where to do the test and what test to use.

For now, the clinic has posted a greeter at the front door and is asking patients with respiratory symptoms to check in by phone from the parking lot. They are then brought into the clinic through a side door to keep them separate from other patients.

An additional challenge with children is the invasive nature of the test, which often requires a second staff member to help hold the child in place while the nasal swab is taken.

“Imagine doing that to a four-year-old or an eight-year-old,” Stephens said. “It’s going to be extremely difficult to get them to sit still.”

Olympia Pediatrics is also confronting the universal problem of having a limited supply of protective equipment, known as PPE. N95 masks, in particular, are in short supply with just 44 left as of yesterday in the clinic.

“We’re going to work through our N95s pretty quickly if we’re testing,” Stephens said.

While more masks are on order, Dr. Stephens is hoping that drive-through testing comes to