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COVID Update with Dr. Dan Heinemann of Sanford

Lori Walsh: Dr. Dan Heinemann is the vice president and chief medical officer at Sanford Health Network and he's joining us for an update on coronavirus preparations at Sanford facilities. Dr Heinemann, welcome. Thanks for being here.

Dr. Dan Heinemann: Oh, thanks Lori. Thanks for having us.

Lori Walsh: We have many questions from listeners who have been sending in their thoughts for us. But I wanted to ask you first, in your mind, what's the most pressing question for today? What do you think is a ... This is such a rapidly changing story. What's the snapshot right now for you?

Dr. Dan Heinemann: Well, I think we're still at a point where, if we behave properly and by behaving properly I talk about social isolation and distancing, continuing to wash our hands, watch where we go, and only going absolutely have to, we still have an opportunity to change kind of the trajectory or the severity of this outbreak for our area. And so again, it's a plea. If you can stay home, stay at home. If you have to go out, make it absolutely important that you go out, and make sure you wash your hands before you go into a location. And then make sure you wash your hands when you come out of a location. And then just kind of continue to stay at home.

Lori Walsh: Yeah, it is still possible to make a difference. These behaviors are making a difference is what I'm hearing you say.

Dr. Dan Heinemann: It is still possible. And a lot of this is we're now at a spot where we need to make sure that we can protect our healthcare workforce. And so that's another reason why these kinds of things are very important to protect the people that have to come to work and take care of the patients. And if we start to lose our workforce, it puts the care in jeopardy.

Lori Walsh: Dr. Anthony Fauci said during President Donald Trump's and the task force, the White House task force press conference last night, that it was very important to shine a light on these communities where there hasn't been a lot of testing right now. Reporters ask them to be more specific about that. Like, where are you talking about? President Trump said the farm belt for example. So tell me a little bit about testing data. It's so important to get those tests done. Are we seeing a change in how we're doing those tests? And are we getting more data now that we really need?

Dr. Dan Heinemann: Well, we are in a spot where we can get more testing. It can still be a little frustrating, as we have tests that are out there that are still pending. But our local healthcare organizations have now begun testing locally. In other words, both Sanford and Avera are now able to do a test in-house. We can't do thousands and thousands of tests a day, but we're ramping up to do probably 4 to 800 a day over the next few days. And that will help us to understand who's positive.

Now, we may be using a lot of that testing for our inpatients. Give you an example. We could have 14 patients in our hospital who screened out and and have symptoms and we've tested, and now we've put them in an isolation area. We've got all kinds of protective equipment on our staff that are taking care of them. Getting that information back in 24 hours versus five to six days can tell us whether we need to keep the patient in isolation, whether we can move that patient to another part of the hospital, and not have to use as much of our valuable protective equipment to continue to care for that patient. So that's one way where testing is going to be very helpful.

As testing becomes even more prevalent, we can now start to see once what the prevalence of community spread and spread of the virus is in a community, and that can help us understand what we need to do. But until we get that kind of testing ability, it is crucial to limit our exposures to others, so we don't pass this disease on it. It must be spread person to person, and if we interrupt that chain, we will slow that progression down and allow our healthcare or healthcare systems to be able to manage the patients that need to be managed.

Lori Walsh: All right. I have a couple of sort of rapid fire, I hope, questions for you. I'm going to ask you to answer these as quickly as you can, so we can get through some of these listener requests. Some people are sending out social media requests to sew masks, sew equipment for healthcare workers. Is that something you could even accept?

Dr. Dan Heinemann: Not right now. We do not believe that there's a fabric out there that we could accept for health care workers at this time. We've got what we believe right now to be adequate supplies of protective equipment. If our communities continue to help us keep the spread down and at a manageable rate, we should be able to manage with the protective equipment we have today.

Now we are constantly reevaluating the amount of protective equipment we have. So we're not accepting homemade masks at this time, because we can't test them to prove that they're going to protect our healthcare workers when they are exposed to the virus.

Lori Walsh: The tests that we are doing right now, do they stay good for a period of time before processing? When we're hearing about a backlog, are the samples still good to-

Dr. Dan Heinemann: Yeah. The samples are good, because we're, we're looking to detect virus in the samples, it's in viral transport media. So yes they are, it's not like they degrade over time. And they're in a controlled environment once they get to the lab and then they're in a queue. So the labs are doing everything they can possibly do to maintain the integrity, if you will, of that sample.

Lori Walsh: Is every hospital system making their own guidelines for ethical choices in triage? New York State has released a statewide guidelines. Is that coming from the state of South Dakota or does Sanford and Avera and Monument make their own internal guidelines for how triage decisions are made?

Dr. Dan Heinemann: Most of those guidelines may be made internally by an organization, but they're guided by acceptable ethical standards that are out there. So while the extra language of each individual policy might be a little bit different, it's guided by overall ethical principles that are out there, as well as what would be considered standard medical care.

So even though the Sanford policy might look a little different than the Avera policy or the Monument policy or the Prairie Lakes policy, or you name it's policy, they are all guided and drafted under the guidance of routine, standard ethical policies.

Lori Walsh: What kind of transparency are we committed to in the future? And here's what's behind this question. In other cities, what's happening as healthcare workers are going home and they're saying, "This is a terrible day. I put 31 people on vents in one shift." But nobody can talk to the media about it, rumors are circulating.

And so some hospitals have started putting a daily count. How many COVID-19 positive cases do they have, how many ICU beds are being used, in the effort to squash those rumors. Going forward as things get a little worse, what kind of transparency is Sanford sort of looking at to keep the facts in the community?

Dr. Dan Heinemann: We need to be careful that individual's rights are still protected. And I think what I would suggest, and this is happening. Is that our state department of health is a great clearing house for all of this data. So Sanford, Avera, Monument, lots of folks are reporting that data to our department of health, and to local incident commanders, if you will.

So I believe that the public should expect that they're going to get accurate information from their local as well as their statewide public health authorities, in terms of what's going on. I think there's been good transparency at a statewide level. You might not know the names of individuals, but it's very clear and our state has been very clear in documenting and indicating where the tests are. Because that's important to help communities understand whether they need to bear down a little bit more on their communities, adherence to social distancing and other good public health policies.

Lori Walsh: So what's behind that, I'm sure you understand, is this fear of people that their local hospital is going to not be able to keep up with the surge. So that's why people are asking for hospitals to say how many ... And some of it's a comfort measure, I get it. They want to just know something, and nobody's asking to violate anyone's privacy or tell us who is there. But if somebody has the question, is Avera in Sioux Falls, is that hospital full? Or how many beds are they increasing? Those are the kinds of questions people are trying to get at with that transparency question.

Dr. Dan Heinemann: Well, I think there is transparency and that all of that information ... The chief medical officer for Sanford Health, Stanford Medical Center sits on the Minnehaha County's Sioux Falls Incident Command. And he's there specifically to update that Incident Command on where Sanford is at. So they're sharing that information. So that would be the place where that information should come from.

And I think our community is in a really good spot, because we have excellent cooperation between the two health systems, the county, the city. We're all in this together and we work very well together. So I, I would suggest to your listeners that we are being transparent, we are sharing that data, and that information is out there for people. It may not be coming from Sanford and Avera and or Monument, but it is out there and it is being shared.

Lori Walsh: Through the department of health.

Dr. Dan Heinemann: Through the department of health.

Lori Walsh: It's just important to remind people, not through your local Facebook feed, through the South Dakota Department of Health at COVID.sd.gov and we of course provide those reports on SDPB Radio as well.

As Sanford facilities are evaluating surge capacity, we're also watching what's happening in the nation, especially in places like New York. How do you feel about our ability? Dan, there are many modeling things online with how many based on your population. Governor Kristi Noem said 30% of our population could fall ill with this, 80% it will be mild. But that leaves 20%, that could be serious. That's 52,000 people who could have serious illness in South Dakota. How do you, in our remaining two minutes, look at surge capacity for individual communities and prepare to be as responsive as you might need to be?

Dr. Dan Heinemann: If all of that number came down with COVID-19 and were severe at the same time, we will overwhelm the system that we have in the state of South Dakota. Our goal has always been since we started this preparation in January, to do everything we can to mitigate that number showing up in a few days. If we see that number over a period of days, weeks, probably weeks more than days, but weeks, we can manage that in South Dakota. And if people cooperate and we help mitigate the spread, then we will have fewer numbers of people at any one time that need to be hospitalized, and that's what has to happen. And that's why that's part of our preparation and our planning, is what can we do to mitigate this, so we can manage the influx of patients that need the care?

Testing helps us with that because now we have a patient that's been admitted to one of our reverse airflow rooms. We get the testing back in 24 hours, negative. Now we can transfer that patient to another part of the hospital. Who now allows a bed, a protected bed, possibly even a ventilator if necessary, to be available for that individual.

And it all comes down to managing that number.

Lori Walsh: It all comes down to us doing what we've been asked to do, and doing it really well and doing it right now. Dan Heinemann, thank you so much for being here with us. Dr. Heinemann, we appreciate your time.

Dr. Dan Heinemann: Absolutely. Thanks for again asking us, and we're available anytime.