COVID -19 Chronicle - Update December 2020

COV ID- 19 CHRONI CLE

MAINE MADE US COMMITTED

Northern Light Health’s response to a global pandemic

UPDATE DECEMBER, 2020

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INTRODUCT ION

ENERGY AND PERSISTENCE CONQUER ALL THINGS. - BENJAMIN FRANKLIN

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We will come out of the COVID-19 pandemic stronger than ever— it’s our commitment to you. Walter Elliot, a Scottish politician, once said, “Perseverance is not a long race; it may be many short races one after another.” I think our fight with the COVID-19 pandemic is much like that. We have been through an incredible journey since we formally began COVID-19 Incident Command operations in February. Through the months, the pandemic has evolved as well as our response as we anticipate and adapt to the ever- changing conditions. Recent weeks have been strenuous as numbers rise, but perseverance and Maine grit keeps us moving forward. With each new challenge, we remain focused on developing new, better solutions to safely and effectively serve our communities. In June, we brought you our first COVID-19 Chronicle. Within its pages, we provided an overview of our pandemic rapid response during the early months, information and anecdotes, as well as our strategic plan forward. This issue can be considered an extension to that and will share how far we’ve come, how we’ve adapted, and that we are well positioned to continue to fulfill our mission to serve you—our friends, neighbors, and fellow Mainers. We have yet to close the book on COVID-19—the long fight is not over. My gratitude goes out to our more than 12,000 colleagues—those on the front lines and on our support teams—who have courageously stepped up to the challenge and answered their call of duty to protect our communities and keep them healthy and thriving. Together, we stand true to our commitment to firmly come out of the other side of the COVID-19 pandemic stronger than ever. Thank you for your support and faith in our statewide team. I have no doubt that we will make you proud.

Timothy J. Dentry, MBA President & CEO

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TEST ING

TOTAL TESTS: 92,020

CONFIRMED CASES: 1,141

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

*Northern Light Health systemwide testing data through November 11, 2020

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MAY 2020

JUN 2020

JUL 2020

AUG 2020

SEP 2020 AND BEYOND

Testing by the Numbers Since the COVID-19 pandemic started, testing has been considered a key part of slowing the spread of the virus. Early, accurate detection helps not only guide the treatment of patients who are ill but gives them the information they need to help keep people around them safe. Since we rolled out testing in early 2020, we’ve made the process easier, more accessible, and, best of all, increased the number of tests that can be done every day. Most recently, on November 4, we were able to expand testing to include all inpatients at Northern Light Health facilities across the state, creating an even safer environment for our patients and staff.

Swab and Go Update The big change that our communities and patients may have noticed is where many of our tests are performed. Last spring, we moved quickly to set up testing sites, and Northern Light Health, like many other healthcare facilities across the nation, rented tents to serve as drive through testing locations. Having testing sites in dedicated areas helped us centralize access, reduced the use of personal protective equipment, and reduced risk to non-COVID-19 patients and staff. But winter was coming, with snow and freezing temperatures, and that meant we needed a better solution. Northern Light Health’s Swab and Go testing sites are now housed in dedicated care sites, or in temporary structures resembling garages. Not only will these temporary facilities be warmer this winter, providing better protection from the elements for patients and staff, but they also will save us money and can be repurposed in the future.

Above: Bangor area COVID-19 Swab and Go testing site, located at the Bangor airport. Patients drive in and through to be tested by Northern Light Work Health staff for COVID-19 while remaining in their vehicle.

Pharmacy Even with the increased availability of tests for people with symptoms and without, there are still people who are either unable to get a test, or who want a faster turn around time than other testing options. Northern Light Pharmacy stepped up to meet this need, offering self-pay, drive-thru, self-swab tests at their State Street pharmacy in Bangor. “This service makes testing available to people who desire the convenience of receiving testing at a pharmacy or do not qualify under the other tiers of testing available,” says Matt Marston, AVP, Northern Light Pharmacy. “This was the first pharmacy-based testing available north of Augusta, and we were excited to be able to offer it to our community.” To date, the pharmacy has tested 200 people.

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TEST ING

Left: Sharon D’Amboise, Associate Vice President, Northern Light Work Health, LLC Right: Darcy Haines, Director of Clinic Operations, Northern Light Work Health, LLC

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Rapid Response Team One of the biggest challenges facing our communities is what to do when there is an outbreak in a place where many people may have been exposed to COVID-19. Schools and businesses need assistance to manage symptomatic populations and even outbreaks. Northern Light Health has worked with the Maine State CDC to establish a mobile rapid response team to manage these situations. The rapid response team is made up of staff from Northern Light Home Care & Hospice. Because home care staff are located throughout the state, they can respond no matter where an outbreak may happen to provide testing and, in certain special circumstances, health screenings for the affected or vulnerable populations.

Work Health Most of the time, when people think about Work Health they think about new hire and safety screenings, like drug tests or physical exams for those working labor intensive jobs such as fire fighters and those who work for the department of transportation. COVID-19 has redefined the needs of workers’ health and safety, and Northern Light Health’s Work Health division has been ready to respond and partner with businesses throughout the state to provide testing for their staff to keep them safer at work.

Testing Continues to Evolve As new tests become available, and the technology to schedule and run COVID-19 tests evolves, so will our ability to provide tests and care for our communities. Testing materials and supplies continue to be in high demand, but the work of both our laboratory and our supply chain teams keep us going. By working together with the Maine State CDC and other healthcare organizations in our state, testing access continues to grow, almost daily.

Northern Light Health Rapid Response Team

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TELEHEALTH

“For a rural state like Maine, this is the silver lining of the pandemic. This is a technology whose time has come.” - MICHAEL ROSS, MD REGIONAL MEDICAL INFORMATION OFFICER NORTHERN LIGHT HEALTH

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At Northern Light Health, we continue to use telehealth to serve the needs of our patients during COVID-19 and the use of the service continues to grow across the state. At Northern Light Eastern Maine Medical Center, Michael Ross, MD, regional medical information officer, is watching what he predicts is an important transformation in healthcare delivery. “We are seeing extensive use of telehealth throughout Northern Light,” Dr. Ross explains, “not only for primary care, but for medical specialties like Cardiology, Neurology, Rehab and Rheumatology. Psychiatry is the highest utilizer of telehealth, providing unique benefits to those who require access during this difficult time. The technology has been a lifeline and will be a cornerstone going forward, particularly while we continue to work to slow the spread of COVID-19. It’s easy to use and it is secure. For a rural state like Maine, this is the silver lining of the pandemic. This is a technology whose time has come.” Jacob’s Story Charlotte Ala was concerned that cancelled speech therapy visits at Northern Light AR Gould in Presque Isle would cause her five-year-old son, Jacob, to lose the ground he had gained. However, Jacob’s speech therapist, Sydney Humphrey, made a seamless transition to video conferencing for Jacob’s therapy. “As a therapist, it really allows me to be creative in how I present material to help my patients reach their goals. Because our clinic serves patients across Aroostook County, we have discussed the possibility of telehealth in the past, but the COVID-19 social distancing has become the catalyst to fast track our efforts.” According to Ala, telehealth is working beautifully for Jacob. “The warm and welcoming environment that we were so accustomed to at the hospital has continued with telehealth. It has been wonderful to watch Jacob not only maintain skills he’s already learned, but also build new ones. His therapist works closely with us, just as she would in the hospital setting.”

Chief Medical Information Officer Michael Ross presenting to Northern Light Health staff

Sydney Humphrey, Speech Therapist

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TELEHEALTH

Lance Feller, MD, Northern Light Rheumatology, Northern Light Inland Hospital

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In Waterville, Northern Light Inland Hospital medical staff chief Cathie Kimball, DO is finding telehealth very helpful managing her elderly patients, who are particularly vulnerable to COVID-19. “It has encouraged me to be creative in assessing my patients. It is challenging my assumptions about what I need to assess — and reinforcing what we know about taking a careful history and listening to the patient. Telehealth also gives me an opportunity to see a patient in a home environment, which provides insights I don’t get with an office visit.” Dr. Kimball is finding that many of her older patients are familiar with the technology as they connect with children and grandchildren at a distance. She’s looking forward to being able to use telehealth to stay connected with “snow birds” who winter in warmer climates. Lance Feller, MD, of Northern Light Rheumatology agrees, “I think perhaps the best part is flexibility. We’re able to address patient needs more readily without having them travel to the office. Particularly during this pandemic, it allows me to communicate with and continue to manage patients who would be at a high risk for becoming quite ill if they caught COVID-19, and we would prefer not to have them come to the office if we can avoid it.” Dr. Feller adds that about a third of the practice’s visits are happening through telehealth right now and he anticipates that percentage can grow as more patients become accustomed to the technology. It’s Not Just for Kids In the Portland area, Northern Light Home Care & Hospice and Northern Light Mercy Hospital have found a very different way to leverage the power of telehealth. In April, the team there conducted its first telehealth visit in a homeless shelter. The patient was being monitored for COVID-19 exposure, but the nurse noticed he was having trouble walking. “I asked if I could look at his feet and found he had very significant ulcerations and swelling,” remembers visiting nurse Leann Thayer, RN. “I got the patient registered for services and a primary care doctor saw him via video on my iPhone!” The patient was prescribed some medicine and several days later was doing much better. There are about 200 people without a home each night in Portland and it’s a population that presents many barriers to providing healthcare. Their circumstances change rapidly, they move around a lot, and they don’t have a lot of trust. Providing the service in a place that is familiar to them takes down some of those barriers. “What was keeping me up at night was how we would manage our homeless population, particularly those with underlying conditions,” says Kristen Dow, the director of Health and Human Services for the City of Portland. “Our shelter staff is not medically trained.” Northern Light Health stepped up in a big way, says Dow. Nurses are conducting clinics in four of the city’s shelters, monitoring guests with suspected COVID-19 exposure, and taking care of other health concerns at the same time. “As a primary care physician, I was a bit resistant to the idea of telehealth,” remembers George Stockwell, MD, primary care provider at Northern Light Mercy Hospital. “But we are all realizing there’s actually a lot we can do with it. I have found most patients really like it and some patient visits are actually more productive and focused using telehealth. There will always be a need for face-to-face assessments, but in the case of this patient, it worked very well. We saved him a trip to the emergency department and prevented potentially permanent damage and a need for surgery.” A Tool for Public Health

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SUPPLY CHA IN

“IF YOU WANT TO GO FAST, GO ALONE. IF YOU WANT TO GO FAR, GO TOGETHER. - AFRICAN PROVERB

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A Bell Weather Turned Guiding Star

Supply chain sounded the alarm early on regarding COVID-19 and our ability to source and supply personal protective equipment (PPE), along with usage rates, continue to be an indicator of how the pandemic is progressing. Our team continues to hold steady, sourcing supplies and PPE, but remains vigilant due to surges in positive patients and continued allocation (rationing) by suppliers. The biggest lesson we have learned over the past several months is that just because there is a confirmed delivery date, it doesn’t mean an item will arrive on that day. Similarly, a specific product description does not guarantee that’s the product you will receive. Until a product arrives we can’t be sure that we will receive it or, that when we do receive it, it will meet our standards of quality. Advance orders are important to stay ahead of back orders, and alternative products may look different but have been thoroughly vetted for quality control. We are now focused on transitioning to reusable personal protective equipment, like half mask respirators, and ensuring that we’re following all safety guidelines, such as physical distancing, to ensure that we’re meeting safety goals on all fronts. Can’t Stop, Won’t Stop Northern Light Health’s supply chain team remains dedicated to ensuring staff and patients have the supplies they need for safe care. Implementing daily status updates and weekly logistics calls keep this systemwide team in the know – sharing knowledge, making sure products are where they are needed, and supporting one another.

Example of a half mask respirator used by Northern Light Health

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Example of a powered air-purifying

respirator (PAPR) used at Northern Light Health

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Example of an N-95 mask used

by Northern Light Health

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VACC INAT IONS

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Vaccinations, What We Know and What We Don’t What we don’t know about a COVID-19 vaccine right now, is exactly when it will arrive or what it will look like. Will it be a single dose? Will it require a second dose booster? Will you need to get it every year? These details will come when researchers develop, test, and approve the vaccine. What we do know is that there are several scientific teams working around the globe to develop a safe and effective vaccine to help all of us resume a normal pace of life. We also know that any vaccine that is approved will be thoroughly vetted by Northern Light Health’s own pharmacists for safety and effectiveness before we administer it, just like we do with any other medication.

An Ounce of Preparation For several months, a team at Northern Light Health, along with a larger group from organizations across the state, have been planning and preparing for the eventual arrival of a COVID-19 vaccine. They have been ordering, purchasing, and readying necessary supplies. Vaccination safety protocols have been revisited and site location pre-planning has been conducted around the state. While we cannot control when a vaccine arrives, we are taking action to ensure that we’re ready to provide access quickly and safely.

Pictured: James Cattin, RPh, MS, director, Inpatient Pharmacy, Northern Light Eastern Maine Medical Center with one of the sub-zero freezers that will be used to store vaccines.

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WELL -BE ING “Two months ago, I began working with a three-year-old client. When we first started working together, he was having daily tantrums and refused to follow direction at daycare and in his foster home. In our Zoom therapy sessions, we use play therapy activities including stuffed animals puppets, sand tray work, dolls, a variety of emotion cards. Now, he is using full sentences and telling people when he is upset and why. He is napping at daycare and is much safer to the kids around him. He is a joy to work with and has grown so quickly!” - ELISE MILLER, LCPC

PEDIATRIC OUTPATIENT CLINICIAN NORTHERN LIGHT ACADIA HOSPITAL

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The coronavirus has taken a toll on all Mainers, and Northern Light Acadia Hospital understands the drastic implications of not just the physical health risks this virus poses, but the risks the pandemic brings upon the mental health and well-being of our staff and patients, especially children and adolescents.

The Stakes are High “What we know about kids is that they crave consistency and structure,” Chris McLaughlin, LCSW, Northern Light Acadia’s associate vice president of Community and Pediatric Services explains. “As you can imagine, the sudden loss of these things was devastating in early March.” Children of all ages experienced social isolation and uncertainty while the adults in their life also struggled with these same issues. Acadia provides essential services to Maine children including a hospital-based day treatment program, therapy, medication management, case management, and school-based services. With the pandemic however, it quickly became unsafe to treat patients at the hospital. Schools also turned to remote learning, leaving hundreds of Acadia’s pediatric patients in need of a way to continue their care in the safety of their own homes.

Experience Paved the Way “We had a lot of experience with telehealth prior to the pandemic,” explains Scott Oxley, president of Northern Light Acadia. “We support 17 emergency departments with our tele- psych consult services in addition to having a presence in 44 primary care practices across Maine.” This experience allowed the hospital to quickly expand that technology use to other service lines, and within weeks, Acadia offered nearly 100% of its outpatient services through telehealth with minimal disruption to patient care. “This was a huge undertaking and a true testament to the dedication of our staff,” Scott emphasizes. “We were able to continue to offer our structured programming and quality care at a time when families needed us most.”

Inspiring Outcomes “If we hadn’t made this a convenient, excellent experience for the patient, they would not have engaged at such high rates and received the care they need,” Scott explains referring to telehealth. He adds that it takes an outstanding team effort to make it work well for patients. “What we’re seeing consistently is that the patient satisfaction rate for telehealth treatment is more than 80%.” Chris is also seeing patient “no-show” rates of appointments on a steady decline as transportation and family schedules are no longer the barriers they once were. Acadia’s quality reports are also showing early signs of improved outcomes. Leadership teams are looking closely at data to see if there is a direct correlation to these improvements and its expanded use of telehealth services.

Acadia continues their work to meet the high demand for its pediatric services with an emphasis on early intervention programs. Program leaders are actively recruiting skilled clinicians to expand its presence in schools and are even hiring out of state to address the growing need for telehealth services. The pandemic forced all hospitals to rethink healthcare delivery, but it was Acadia’s innovative and passionate team members that successfully stood up the future of behavioral healthcare in Maine and secured the ongoing delivery of critical services in a convenient and effective manner.

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LESSONS LEARNED DUR ING A PANDEMI C

If there is one thing Mainers know, it is how to adapt and find innovative solutions so that we may continue caring for our neighbors and friends even during the most difficult of situations. This was true during the Ice Storm of ’98 and is certainly true today as we still find ourselves in the most challenging pandemic in recent history.

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“We learned a tremendous amount during the COVID-19 crisis,” explains Tricia Mercer, director, Medical Group Practice Management, Northern Light Health. “Building off of our success of a central phone line to access Northern Light Health COVID-19 services, we are using what we have learned to redefine how we schedule patients for other appointments with the convenience of one number.”

Tricia Mercer Director, Medical Group Practice Management

Since March, teams across Northern Light Health have shown that by rolling up our sleeves, working together, and putting our Yankee ingenuity to good use, we not only build safe processes that effectively help keep our communities healthy, but also contribute to improving future care delivery. Mercer also shares that Northern Light Health’s COVID-19 Care program, supported by Northern Light Beacon Health, has proactively leveraged the population health approach to care for high risk patients during the pandemic. “We may be one of the few health systems in the country who have

leveraged the same technology we use for telehealth to bring real time education to our clinical staff and providers, developing new simulations designed around keeping our staff, patients, and communities safe.” Collaboration has always been critical to the work we do across the state, and during a pandemic, it was key to ensuring a comprehensive response that not only protected our patients but safeguarded our communities. Mercer shared, “We have built relationships with other health systems that prior to COVID-19 we may have seen as competitors. Overall, the pandemic further emphasized to us that caring for our communities is an honor and a privilege for all involved—regardless of affiliation.” Dr. Jarvis added, “We have also been innovative and collaborative working with local manufacturers and universities to develop items such as new personal protective equipment. In addition, our statewide reach has allowed us to rapidly deploy to suspected outbreaks to assist the Maine CDC in collecting specimens, contact tracing, and symptom monitoring. Among all this, it was important that we also support our communities, and we did so by developing a webinar series to help businesses, industries, and schools reopen safely. These statewide efforts help to demonstrate what our system can be capable of when met with new challenges.” With all that the system has in place now, there are no signs of it slowing down as we prepare for the next phase of pandemic response. “Now is the time to plan for the months ahead,” says Dr. Jarvis. “We already have a partnership in place with the state and other health agencies to be able to provide vaccination against COVID-19 when a safe and effective vaccine is available. While the details are forthcoming, we will be prepared to serve our communities. Together, we’re making healthcare work for all of Maine.”

Jim Jarvis, MD, FAAFP Medical Director, Clinical Education and Clinical Lead for COVID-19 Incident Command

nimbly transitioned our care managers to address this immediate need. They were, and continue to be, focused on bringing nursing assessments to high risk, symptomatic patients who do not require hospitalization but who could deteriorate quickly—a service available to all Northern Light Health providers for their patients by referral. This model not only keeps patients out of the hospital, but is ensuring they are receiving personalized, potentially life-saving care.” James Jarvis, MD, medical director of Clinical Education at Northern Light Eastern Maine Medical Center and clinical lead for the COVID-19 Incident Command says that the pandemic has emphasized how our hospitals are not so different after all, and also, as a greater community we can take our strengths to develop amazing solutions. “We have built systemwide clinical guidelines not only for diagnosis and treatment of COVID-19, but other disorders as well that help ensure the care our patients receive is uniform and evidence-based across our hospitals, practices, and home care,” Dr. Jarvis comments. “Together, we have also

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MA INE MADE US COMMI TTED

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“As COVID-19 continues to make its way through our communities, Northern Light Health has developed the tools, processes, and policies to respond. Learning about this virus has enabled us to care for COVID-19 patients and ensure that all patients can safely access the care they need right now. Our incident command teams continue to meet, alongside our safe recovery team to ensure that not only our emergency plans and response teams are ready to go but that the care we provide is evolving along with new information, resources, and science. Northern Light Health is committed to making healthcare work for the people of Maine, and we look forward to serving you in the months to come.”

- Glenda Dwyer, Senior Vice President, Clinical Operations

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Mayo Hospital Mercy Hospital Northern Light Health Foundation Northern Light Laboratory Northern Light Medical Transport & Emergency Care

Northern Light Pharmacy Sebasticook Valley Hospital

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