A year ago today, COVID-19 arrived in Johnson County.
Certainly, the virus had been ravaging communities and killing thousands of people, first in China, then in places such as Italy and Spain, and finally reaching the U.S. coasts.
But life in Indiana had largely gone on unaffected. That all changed after March 11, 2020.
“We had three individuals coming to our (emergency department) who we were pretty sure had it,” said Claire Roembke, manager of infection prevention at Franciscan Health Indianapolis. “One of those three was admitted. From that get-go in March, things started happening pretty fast.”
The county’s first COVID-19 cases were diagnosed on this day a year ago. For area hospitals, it marked the change from preparing for an unknown disease to carrying out the protocols regarding using personal protective equipment, providing supportive care to patients and other guidelines that had been put in place.
As of Wednesday, 363 Johnson County residents have died due to complications caused by the disease, and more than 800 county residents have been hospitalized. The past year was like nothing area hospitals have ever seen, and put tremendous strain on all aspects of their operations.
Realizing it was real
Hospital leaders had uncomfortable meetings about how to determine if they had to ration care, and how they would do that. They created committees of different specialists and hired clergy.
“It was a lot of things we hadn’t been faced with, but now, we truly had a pandemic staring at us and we had to put some tough plans in place,” said Dr. David Dunkle, president and CEO of Johnson Memorial Health.
But at the same time, the difficulty showed what they are capable of, what solid planning can achieve and how dedicated their staffs are.
“I was proud to be part of a team. People came to the table and asked what was needed, how can they help. We were in this together,” said Anita Capps, a registered nurse and administrator at Community Hospital South.
Roembke had faced the possibility of a widespread breakout of disease in the past. In her role at Franciscan Health Indianapolis, she has helped the hospital system construct plans to combat such diseases as H1N1, Ebola and various strains of flu.
Generic guidelines have been put in place to deal with potential pandemics. Then Roembke and others can fine-tune those plans to fit the quirks of individual diseases.
Franciscan Health Indianapolis’ infection control committee started planning a potential response to the coronavirus in November of 2019, just as the infection totals started to tick up in other parts of the world.
By January, the committee could recognize that COVID-19 was going to be a serious problem. Educational programs were assembled to help doctors, nurses and staff understand the virus, how to best protect themselves and what to do if patients came to the hospital in need of treatment.
“The way that this pandemic forced folks to pull together and function as a unified team, it was so impressive,” said Dr. Christopher Doehring, vice president of medical affairs at Franciscan Health Indianapolis. “We’ve had so many people, continuing to this day, who have stepped up and answered the call in ways they didn’t have to, and ways they never anticipated needing to.”
Putting plans into action
Other hospitals were making similar plans.
Dunkle had been CEO of Johnson Memorial for less than a year when the pandemic hit Johnson County. Early in 2020, he and other hospital leaders had an emergency plan in place for a hypothetical pandemic, but few thought this would impact central Indiana greatly.
“We didn’t really have a lot of pressure at that point. It wasn’t until we had the first case in Indiana that it changed,” Dunkle said. “In some ways you look back and think, I wish that we could have predicted this. But it’s been 100 years since we had a pandemic like this in the United States.”
By the beginning of March, it was clear that COVID-19 had come to Indiana, and almost immediately, to Johnson County. Johnson Memorial Hospital took their existing emergency plan and went to work updating it with the information they had about the virus and with guidance from the Centers for Disease Control and Prevention and the Indiana State Department of Health.
They had to plan for the logistics of protecting staff while treating patients, such as how they could get personal protective equipment, if they could acquire purifying respirators, and how to staff the different parts of the hospital while devoting personnel to intensive care as cases increased.
Preparations were put in place to use the newly constructed emergency department, which had not opened at that point, if they needed space for ill patients.
“Our staff stepped up in ways that the general public just doesn’t realize,” Dunkle said. “We didn’t know what kind of risk our staff was putting ourselves in. We didn’t know how deadly this virus was. We weren’t entirely sure how it was transmitted. But we had people coming to work, taking care of the sick. And not just the doctors and nurses, but everyone.”
Though there were many unknowns about COVID-19, officials took what they knew about the best ways to protect against coronaviruses, and made sure their entire hospitals followed those guidelines.
Fear of the unknown
As the pandemic picked up momentum, constant communication was key.
“There was a lot of anxiety, as you can imagine. This was a brand new virus that no one had ever heard of. There was no real treatment other than supportive treatment,” Roembke said. “It was very important to go back to the basics that we knew, to prevent transmission.”
At Community Hospital South, the emergence of COVID-19 in the United States prompted them to update their existing emergency management plan to focus on this particular respiratory disease. They detailed how to handle a surge of patients in the emergency department, and the ways that staff would keep patients with COVID-19 symptoms away from patients at the hospital for unrelated illnesses.
They tried to highlight the needs the hospital would have as the pandemic reached Indiana — a challenge as so little was known about the coronavirus at this point.
“None of us have ever been in a pandemic before. We definitely didn’t know anything about this COVID-19 coronavirus, or the true impact it would have,” Capps said. “So we looked at preparedness as far as (it) being a respiratory illness and taking the facts that had already been shared by the media, and just trying to ensure we were addressing every area that would be impacted.”
Part of the challenge was staying up-to-date with best practices and recommendations coming from state and federal officials about how to address the virus.
“We were evaluating what we were hearing from different research and journal articles and how to react to it. There for a while, it was very rapid-fire,” said Nicole Goddard, vice president of operations at Community Hospital South. “On documents, we started putting times on them, because we realized things were changing so quickly that we wanted everybody to know that they had the absolutely latest information from us.”
As the first patients started to arrive at Community Hospital South, those plans transitioned to reality. It was a fraught time, Capps said.
“There was a lot of emotions. There was the fear of the unknown, the anxiety of, as a caregiver in this building, being potentially exposed and what that means for me and my family,” she said.
Sense of spirit, pride
The past year has been exhausting, emotionally draining and endlessly changing for everyone in the health care field. That hasn’t stopped, though the number of newly reported cases and deaths has been decreasing consistently for weeks.
Increased vaccinations and the continued reliance on good-health practices such as mask wearing and social distancing will help us overcome COVID-19. But work remains to be done.
Despite the pain of the past year, the work that so many put in has fostered a sense of pride in the hospital communities.
“I’m amazed at how nimble the organization really is, and all of the creative things that have been done as the situations came up. The willingness of the staff to accept being in a COVID unit, when they really didn’t know what that meant,” Roembke said.
And that spirit extended beyond hospital walls to include the entire health care community.
“We all came together,” Capps said. “It wasn’t about market share or competition. It was, how are we — all of the health care systems in the area — partnering so that we had everything to the best of our ability to provide care.”
