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Covid remains at crisis levels in northwest New Mexico. Overwhelmed ICU and National Disaster Medical System intervention garners national news

SJRMC

COVID is not letting down in northwest New Mexico. And it’s making national news. San Juan Regional Medical Center in Farmington was the subject of an NBC News story earlier this week. The report looked at the hospital’s overwhelmed ICU, among other things. KSUT checked in with Doctors Brad Greenberg and Robert Underwood from San Juan Regional. Greenberg is in charge of emergency preparedness and Underwood is Chief Medical Officer.

Interview transcript:

Sarah Flower
As of this broadcast San Juan County, New Mexico is reporting that 57% of their residents are now fully vaccinated. Dr. Greenberg, with the overwhelming amount of COVID-19 patients that the hospital is seeing, are you in addition to, seeing an increase in that vaccination rate.

Dr. Brad Greenberg
We continue to see the vast majority of our inpatient population being in the unvaccinated. Currently, our sum total for this whole wave is that 81% of our inpatients had been unvaccinated. So even though we're seeing a marginal increase in the vaccination rate, which we're big fans of, we're still seeing in the hospital, the unvaccinated representing a very large proportion of those folks that are actually here in the hospital, in the intensive care unit, or even on a ventilator or dying from this.

Flower 
San Juan County, New Mexico saw the highest number of cases since this pandemic began in the month of November. Dr. Underwood for you as a chief medical officer of a rural hospital, how are you faring.

Dr. Robert Underwood
It has changed our operation almost completely from what how we would normally care for patients, both in terms of location. And a lot in terms of workflow, it really is the overwhelming, patient need right now. And so there are certain things that we need to do to care for the COVID patients and in turn protect our own staff from getting COVID along the way. And so that takes up more resources, it changes the way we allow visitation at the hospital, because we don't want to confer it out to our public either. So all of those things have changed in a significant way. I think we've gotten better at it, though, as time has gone on. You know, thanks to Dr. Greenberg, and our incident command, we have learned a huge amount since the pandemic started. And we've gotten to where we we can make these adaptations relatively quickly. But you know, the big thing is the burden of the illness of the patient. We have 14 licensed ICU beds at this facility, we have 9 beds that we call contingency ICU beds, we've had upwards of 40 ICU level patients. And we've had to find places where we can take care of them take care of them appropriately while they're not truly in the full ICU setting.

Flower
At 200% capacity for your ICU, San Juan Regional Medical Center was featured on NBC's National Evening News. I'm curious of the choice, to make that for the first time in 21 months, a camera crew was allowed in this very full ICU. Dr. Greenberg, how did that land for you to be on national news and make that choice to put San Juan Regional in the spotlight on a national scale?

Dr. Greenberg 
You know, we really had just an unprecedented surge and COVID patients with a sustained increase really for weeks, greater than 220%. I think we peaked out at like 280% or so of our capacity with 30 patients on ventilators. And really, we were in this crisis situation for some time, had worked with our partners both at the county, as well as our partners at the Department of Health for the state of New Mexico, then subsequently worked with some federal partners as well. And we were fortunate enough to have assistance come to us through the National Disaster Medical System, which is a portion of the United States Department of Health and Human Services. And we've now hosted three sequential DMAT teams over a period of about six weeks. Their sustained involvement here at our facility, rural facility in northwestern New Mexico really brought a spotlight to what rural hospitals and their impact from COVID-19. And we are sort of a somewhat emblematic of a hospital that is not part of a larger system. We're a nonprofit sole community provider, really doing our best to try to keep the wheels on in the setting of a unprecedented surge. So their involvement, I think precipitated some interest from the national news outlet. And it feels good to get the news out that we're doing our best here in the Four Corners region to try to meet the needs of our community in the region. And now that the NDMS folks have been here, we're actually saying goodbye to our third team today. But it's not because the need has disappeared because they're actually being replaced by two distinct teams, two medical response teams of active duty personnel from the United States Navy who continue to have a very high ICU census. Today, it was 171% of our normal capacity, but we still feel a sense of obligation and a charge to do our best with the resources that we've got and the resources that we've been afforded to integrate into our health care model as well.

Flower
Dr. Greenberg, Dr. Underwood, I want you to talk about health care professionals at this time. What is the burnout like? And how are you supporting your team locally, during what feels like just an impossible, never ending crisis.

Dr. Underwood
There's a number of things that we're trying to do to support our staff. You heard us talking about the level of patients, the acuity of the patients, and the illness, and it takes a physical toll. But it also takes an emotional toll, especially on those folks that are immediately at the bedside. The amount of death that we've seen has been unprecedented. Most of us thought we were not going to see this in our medical careers, but here it is. So that is definitely had an impact. So there's different things that we've tried to do as an organization to try to reach out and provide support services for our caregivers, part of our EAP program, which helps support with counseling and things like that we, we had that as an asset that was available to our caregivers, pre-COVID. But there were limitations on the number of visits someone could have, we've made that unlimited, at this point. There's no doubt at all, there has been an impact on the caregivers, primarily nurses, respiratory therapists, but physicians too. As physicians, we pride ourselves in making people better. And being there in a time of need. The impact of the illness has definitely caused some concern, I think in some of our caregivers who are seeing this day in and day out, without respite. It's been hard.

Flower
I want to talk about the Indigenous communities in which San Juan Regional Medical Center serves. I know you both work closely with IHS and early on it was seeming that the Native American population was so much more disproportionately affected by this pandemic. I'm curious to what you're seeing now, and in terms of who's been hospitalized and the demographic of patients that you're seeing today. Dr. Greenberg, for you.

Dr. Greenberg
Since the pandemic, we've taken care of 1608 COVID related inpatients of Native American descent. So that's 57% of all of our COVID related admissions. And so we pride ourselves on being a regional hub hospital for all comers, including many hospitals on the Navajo Nation and within the Indian Health Service. And we'll continue to do our best to meet the needs of our broader community. Regardless of what zip code to live in, we'll also continue to try to scale our response efforts and make sure that we're providing the highest levels of care for anyone who needs it.

Flower 
Dr. Brad Greenberg and Dr. Robert Underwood of San Juan Regional Medical Center. Thank you so much for joining us here today on KSUT.

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