Editor’s note: Interviews for articles in this issue of Pinal Ways were conducted in early or mid-May, and reflect the state of the industry at that time.

There has been a lot of talk in the news, in commercials and in everyday life about how unprecedented these times are with the COVID-19 pandemic. And it's true that very little that America has experienced in recent months has happened in modern times. However, disease experts and health care providers know that while this was an unprecedented time, it will happen again. Nobody knows when, or what form it will take, but another pandemic will take place, and the professionals in the field are already preparing for that occurrence.

Pinal Ways spoke with Kore Redden, who heads the Pinal County Public Health Emergency Preparedness and Response Section, which has been studying and helping fight the disease, about how local government is going to get ready for what's to come, as well as Dr. Jonathan Willms, director of OB/GYN services at Sun Life Family Health Center, about steps being taken by health care organizations.

Plans on plans on plans

Redden listed all the plans her office had in place long before COVID-19 started making its way around the globe. There's a pandemic response plan, a continuity of operations place, an emergency operations plan, a medical countermeasures plan and so on. So even though there hasn't been anything quite like the COVID-19 pandemic in modern times, she still believes officials were ready for this.

"Plans work, and our infectious disease plan on how we handle outbreaks and new diseases, that was all written in there and it's working," Redden said. "Do we know about every little nuance about this disease and what's going to happen next? Sometimes we don't, but we know what our role is no matter what, because this is epidemiology and this is it, this is what we do."

So when word about a dangerous form of SARS started coming out of China in December, Redden and her team knew not to take it lightly. Unfortunately, they had to wait for the rest of the world to start treating the coronavirus with the same level of urgency.

"Tt's hard because all emergencies happen locally, we're affected locally, but there's times where there's things that are out of our capability or authority," Redden said. "We can't shut down the airport. We can't internationally effect a response until it really starts to affect us locally. We can only do what we can with the data and cases that are popping up. We know we would want to just shut everything down, and could have much earlier but it would have been too early. You can play this out so many different ways and come up with different outcomes, but I think we knew something was happening, pretty early on."

Willms said many health care organizations probably wish they could go back to December to start preparing for the disease's arrival. However, it's hard to know when something like COVID-19 pops up whether that's going to be the real deal. He said the guidance from federal agencies just wasn't there.

There was also a massive shortage of personal protective equipment that caused problems in places like Sun Life. Willms said they're going to learn from that, and once the supply and demand for PPE gets back to normal, they're going to start stocking up whenever they order equipment so they have what they need for the future. They will of course need to monitor expiration dates to make sure that equipment doesn't go to waste, but Sun Life will start erring on the side of caution when it comes to its inventory.

"I think we've realized we can't look to the state and federal government for extra supplies of PPE," Willms said. "I hope health care providers of all sizes develop their own stockpiles so when something does happen again, we will have enough masks, we will have enough gloves to protect ourselves and our patients. We can't rely on elected officials. We have to take it upon ourselves."

Tests get put to the test

When COVID-19 first started making its way into Pinal County, health officials had the same problem everyone else in the country did: There just weren't enough tests. Restrictions had to be put in place on who had access to a test, causing frustration and fear among those who thought they might have been exposed to the virus.

For health care providers used to providing patients with what they need and assuring them they are in safe hands, turning people away because of a testing shortage was difficult. However, organizations like Sun Life simply do not have the capability of making their own tests. They rely mostly on the federal government for that.

"It would have been great to be able to test some of the close contacts early who weren't showing symptoms but might have been exposed," Willms said. "Nationally, there just wasn't that availability. People were seeing stories in the news and watching TV, and they were scared. So people were calling our office because they were in contact with someone who was positive and wanted to get tested. It's difficult as a physician to say, 'I'm sorry, we're strictly following the CDC's recommendations due to the limited number of tests.'"

For the county response team, a lack of testing meant lack of certainty over how widespread the disease actually was. It also inhibited their ability to learn more about how the virus works.

"I think we were learning more about your disease and our criteria for tests, as we get testing resources, and you see the change, especially when commercial testing became available," Redden said. "We saw a shift in not only our testing that we were dealing with, where we had to meet state lab criteria and do testing that way. We saw that kind of give us a little bit of relief when we had commercial testing as well."

Maintaining a new normal

As the world gets back to living life, experts hope the hard lessons learned during the pandemic won't get tossed to the side. The world is going to have a new normal and everyone will need to maintain safer practices or risk the next highly infectious disease causing the same turmoil, or worse.

Willms thinks there have been some silver linings for the health care industry. For years, there's been a sense that health care providers should increase the availability of telehealth services. Even in normal times, bringing a bunch of sick people into one waiting room and have them sit together didn't make a lot of sense. During a pandemic, the need is more stark. So in a way, these past few months might have accelerated some much-needed changes.

So telehealth is here to stay, and so are several other measures Sun Life has taken during the pandemic that now make sense for the long run. Willms expects offices to continue screening patients before they get to the back rooms to ensure they aren't going to spread disease to more people than they otherwise would have. 

"Personally, I think there's been a lot of good throughout health care that's come out of this," Willms said. "My patients have been very grateful for what we've done to help protect them, the changes we've made, the fact that we have stayed open throughout the whole thing. I know there are a lot of negative things circulating around social media right now about the health care industry in general. I hope people are smart enough to see through that and don't develop any negative attitudes toward us."

He also hopes individuals take their health into their own hands, and don't stop treating their hygiene seriously as the risk of getting COVID-19 goes down. Willms thinks Americans, and he includes himself, have taken for granted how healthy the United States has been when it comes to highly infectious disease. That there hasn't been a pandemic like this in over a century perhaps caused people to let their guard down when it came to proper hygiene. Now, he hopes people remember how scary this time was and maintain some of the self-care regimens that were adopted to fight off COVID-19.

"I hope people come out of this — I know I sure am — with a greater appreciation that I need to be more diligent in cleaning my phone, cleaning my keys, my wallet, anything that could be a potential source of spread," Willms said. "The problem is, everybody is hyper-vigilant right now, but as COVID dies down it's just human nature to forget things like that and to get back to how things were. But my hope is that we are aware of those practices that we've started."

Redden also hopes people will be more receptive to the recommendations of health officials, so next time a disease like the coronavirus hits, people will take it seriously earlier, which could help nip the spread in the bud and prevent the effects of a pandemic from causing such havoc on society and the economy. But she knows this has to be done through education and not through scare tactics.

"We definitely try to manage the education information without fear. We've always done that. We have people that are really good about delivering the message, very responsibly and safely. We don't want to cause panic," Redden said. "We do get those who listen to friends or listen to their social media platforms and find information that can be scary. They either feed into it or they ask about it, and we like the inquiries that we do get from the public because we can message it in a way that's not based in fear, but reality."

Those in the predictive modeling field like Redden are the first to admit that what they do is not fool-proof. While many would like them to come to full conclusions they can express with absolute certainty, they instead work in probabilities. By definition, the less likely outcome will sometimes wind up being reality. It's up to the public, then, to understand this and maintain faith in science even when something unexpected happens.

That becomes all the harder when science comes under attack from politicians, as has happened over the course of the pandemic. Jabs at gigantic organizations like the World Health Organization can trickle down to smaller ones like Pinal County Public Health, and that erosion of trust can make it harder for recommendations to be taken seriously by some members of the public.

"We can all make mistakes in our messaging or clarifying something, but I really think that the information about the disease is what we should focus on," Redden said. "We can't get into what happened in China, and why it happened and how it got to us. We'll worry about that later. We care about everybody who is exposed, or who is sick, and who is a positive case. We're not China. We're not the World Health Organization. We're not even the CDC. As long as we stick to our objective and our mission, which is to prevent further spread and investigate all exposures and positive cases, that's all we can do right now."

Ready for what's next

While in many ways the response to the pandemic has kept people apart physically, they have found ways of staying close together in spirit, and maybe even finding ways to get more connected. That's no different in the health care industry, where Willms said staff from all Sun Life's offices around Pinal County have been more in touch with each other recently, coming up with strategies and ideas that have worked in their different communities. He said he hopes that communication continues in order to provide the best service for patients possible.

He said throughout all the struggle and the fear, morale never wavered among the people he worked with. And he believes that strength will only grow in the face of the next crisis of this magnitude.

"They've been brave. They've been coming to work every day with a good attitude and taking care of any patient that walks through that door, even the ones who think they might have COVID," Willms said. "I've just been so appreciative of their hard work and their dedication to continue to serve all of our patients."

Through interviews with every surviving COVID-19 patient in Pinal County and complex data that constantly flows into the county response center, a clearer understanding of the virus started to take shape. This has meant initial ideas of how to battle its spread, like monitoring travel to China, had to be scrapped when it became clear that plenty of people were getting it without leaving their surrounding area. It also meant expanding what Redden calls "co-morbidities" that someone might have that would put them more at risk of dying from the disease.

"We want to have as much data as possible to really paint that clear picture. Worldwide there's a lot but then there's also these nuances, with different countries and their mitigation efforts and their demographics and all of that comes into play," Redden said. "So we're collecting data by the minute and we will look at it and re-look at it as more data comes in. That's the best way to handle all of it and really look at the full picture."

Every day brings new challenges to the county's response team, and the stress can become so overwhelming that Redden often wondered whether people were going to show up the next day. But they always did, and they did so committed to making sure people who did get the virus got all the help they needed to get through the scary time.

"We work six days a week, we call countless amounts of people. There are times we get yelled at and there are times that we are praised for our services and our intervention. Everybody comes to our command center every day — one thousand percent readiness, one thousand percent passionate to be here and to be a part of this response. We care about the outcome."

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