The Seattle area became ground zero of the COVID-19 pandemic in the U.S. after a nursing home there experienced widespread infection within its own building. There was only one thing Katherine Silveri could do, and that was to jump in and help organize some of the first drive-thru stations in the country to test people for the virus.
“I think many of us were caught off guard with Coronavirus,” said Silveri, a physician assistant (PA), and Doctor of Medical Science (DMSc) student at Rocky Mountain University of Health Professions. “We saw this novel virus taking hold half a world away and thought that it would be difficult, but it won’t have an impact on us here.”
That was until an epidemic of the COVID-19 virus took hold of the nursing home. Residents, caregivers, and emergency personnel were all affected, resulting in more than 35 deaths, mostly of older people with preexisting conditions, from one location.
Until the nursing home tragedy, Silveri and her colleagues conducted questioning among recent travelers. They would find a few people positive with COVID-19 and then coordinate with infection prevention and the department of health to help control community transmission.
But in the case of the nursing home, “Genome sequencing confirmed there had been community transmission likely happening for weeks,” she said. This caused great confusion among the healthcare workers regarding if they had been infected, how they should test, who they should test, “and the list goes on,” said Silveri.
Not fully understanding what they were up against, Silveri, called on her military background to review a disaster clinic protocol that was initially set up for a possible Ebola outbreak.
“We worked on the disaster clinic from the lens of MASH [style] tents,” she said. “We planned on setting these up outside all major campuses to triage before letting patients into the emergency department. It took us a week for our first pass.”
In the meantime, they found out that testing for the virus was not adequate, and they still didn’t fully know what they were dealing with. The MASH tents weren’t going to help them at that time. Critically short of personal protective equipment to protect healthcare professionals, they “needed to reduce the risk of exposure while identifying as many positive patients as possible.” They also needed to continue to keep patients out of the emergency department unless absolutely necessary.
They needed a way to identify, do a quick visual check for stability, and educate patients on what to do. In essence, they shifted to a drive-thru model.
“We worked to change the tent model into a drive-thru model,” said Silveri. “We decided to test only symptomatic patients (those with fever, cough, shortness of breath, or runny nose). We were concerned if we tested those without symptoms, we could get false-negative results sending a message that the patient was cleared when, in fact, they could still be in early incubation.”
There was an outpouring of providers and other healthcare workers lining up to be part of the drive-thru clinic. “The response was heartwarming,” she said. “We had surgeons whose schedules were cleared of elective surgeries, midwives, specialist providers, medical assistants, front desk staff, pediatricians, physician assistants, nurse practitioners, and others who were all lining up to help in any way they could.”
Shortly after the opening of the first drive-thru clinic, two others were opened. The emphasis at all three was to test.
“This has truly been an amazing time in my career. To see everyone coming together and sacrificing their time with their family, their health, and their personal interests to serve others has made it that much easier to push through the long days and nights,” said Silveri.
Silveri said the Coronavirus really taxed their healthcare system and highlighted flaws in the system. “In the weeks following the real crisis, we were in full swing of bringing telehealth to all departments to reduce in-person visits and conserve personal protective equipment,” she said. “I expect this to have a lasting effect even after the virus is under control. The data many organizations will have to show on the impact of the quality of care should be immense.”
The community has been overwhelmingly supportive through this situation, according to Silveri. Whether through donations, food support, learning for kids, medical supply donations, or other means, “it has been uplifting.” The people in the Seattle area have been very conscientious of others, with patients not getting upset, expressing gratitude, and understanding.
As far as Silveri’s work in providing some of the most critical tasks in helping test people to suppress the outbreak, she said, “On day two of our drive-thru clinic, I developed a cough. This was hard because I really wanted to be there to support everyone that was volunteering and make the learning curve as easy as possible. But I knew I couldn’t. I needed to be tested to rule out COVID-19.
“It has been difficult to see a project that you pour so much into move on [without you], but I am also extremely proud to see it progress and serve our community. As a patient myself, going through the drive-thru, it was heartwarming to be offered so much support from those who I had been working alongside. I was able to receive the care and expertise that my team worked so hard to put together.”
Happily, when Silveri received her test results, she found she was negative for the COVID-19 virus.