The message hasn’t changed much for six months.

Wear a mask.

Maintain social distance.

Wash your hands.

With COVID on the rise, it is important that the message not be tuned out.

“Since April, people have become tired and burned out,” Warren General Hospital chief nursing officer Joe Akif said. “There is a constant need to stay vigilant as it appears that COVID has now brought its full impact to the County.”

There could be worse to come as the seasons change.

“Our local situation has transitioned from a household spread of cases to more of a community spread,” Akif said. “It is difficult to pinpoint any one event that has led to the increases, but we are seeing eight to 10 cases a day now with people testing positive for COVID 19.”

“For all cases tested at WGH, we have a 2.4 percent positivity rate,” he said. “It is expected to continue to grow with the holidays and people now having to return to the indoors with a change in weather.”

The trend has caused changes to policies at Warren General.

“As was announced a couple weeks back, Warren General has reinstituted a no-visitor policy for the inpatient units and emergency department,” Akif said. “This move was made to protect patients, staff and the general public from the unknown. This decision was made as we start to see a precipitous increase in positive community cases.”

Through Nov. 11, the Department of Health had no reports of Warren County hospitalizations due to COVID. As of Wednesday, the department was reporting eight hospitalizations.

Hospital officials knew it was coming, and so far, the hospital’s resources are not strained.

“Warren General has recently admitted its first COVID-positive patient,” Akif said. “There is a strategy in place that separates these patients from the general population of patients. They have dedicated staff and treatment space.”

“The challenge in the future, if the number of COVID patients grows significantly, will be that it pushes limited resources that are caring for patients that require acute care services not related to COVID,” Akif said. “This may result in the transferring of patients to another facility if they can handle additional patients. We appreciate the inconvenience that it may cause residents, but we want to make every effort that people are receiving timely care in the right environment.”

As the number of patients climbs, there could be additional steps.

“In the coming weeks, the hospital may move to coordinate with the County EMA to resurrect the tent outside of the emergency room to triage patients,” he said. “This would be a safety measure to protect all that come to the emergency department. The hospital is working to get a more rapid testing mechanism to rule out COVID infections before entering the building. Residents need to understand the tent represents a good safety measure, not a dangerous exposure measure. It is safe now and if the tent is brought back to seek emergency care at the emergency room, it will be safe then as well.”

Communication is a point of emphasis for the hospital and Warren County Public Safety.

Hospital personnel are maintaining contact with one another and with colleagues throughout the region.

“The hospital has a weekly meeting that allows for timely decision making with the medical and clinical staffs,” Akif said. “The leadership team at WGH has been in communication with healthcare systems throughout western Pennsylvania on a weekly basis. Erie and Pittsburgh have seen much larger increases in positive cases, hospitalizations, and deaths than Warren County. Our partners in Erie are still taking referrals from Warren General’s emergency Room and inpatient units.”

“This is really through a daily and weekly communication channel that keeps the region aware of capabilities to assure that our residents get the care they need,” he said. “This week, the leaders from the skilled nursing facilities are reinstituting weekly communications.”

During those talks, officials are working together to make sure any hurdle face at any facility can be overcome.

For now, the collaboration is working. As resources grow more scarce, that could change.

“While all are monitoring and still taking patients, we have seen delays at times in transferring patients due to tight resources,” he said.

“Warren General Hospital has learned from our experience and has realized the importance of consistent, timely communication,” Akif said. “This is important not only within our own environment, but also with outside agencies like the EMA.”

“We all know that if one healthcare facility becomes overwhelmed, the existing health care system in Warren is not built to handle the influx of sick patients, residents and caregivers, that the outbreak would bring,” he said. “We have worked daily with Ken McCorrison and his team at the County Emergency Services and also have been in constant communication with the local nurses from our County Health department. It will take the entire community working together to coordinate responses as there are outbreaks. Our leadership has also communicated with the Warren County School District as well to share experiences and our lessons learned. Communication with all of our partners, local and regional, is essential in continuing to deliver exceptional care. As for lessons learned, we learn everyday something new.”

The Public Safety Department is making sure the information it receives from Warren General and other facilities is passed along to responders.

While some agencies are fully versed in the protocols in place at nursing homes and Warren General, there are others that have less frequent contact with those facilities.

To ensure there are no snags, Public Safety Director Ken McCorrison said, “We started up our conference calls with law enforcement and fire and ambulance services.”

Those calls are happening once a week, but could become more frequent if needed.

“Everybody’s dealt with it for a few months,” he said. “Now everyone has protocols in place. We have some background on what we need to do and how we need to react to keep people safe.”

In March and April, making sure everyone was on the same page was more challenging.

“The message changed so rapidly that people were operating off information from three messages ago,” McCorrison said.

Communication isn’t the only thing that’s ramping up in response to the surge.

“I’ve had three large personal protective equipment orders come in,” McCorrison said. “We want to make sure we have what our responders need to stay safe.”

Those resources are in the county “ready for distribution,” he said.

Warren General has had to work to keep its PPE supply up.

“Partnering with local industry like Whirley DrinkWorks and the United Refinery, the hospital was able to increase its supply of vital PPE,” Akif said. “The availability of PPE is still a constant battle. While PPE is still available, certain sizes are more difficult than others to acquire.”

With the surge, demand for PPE is growing again. “As the rest of the country now is seeing a ramping up of need, the available supplies are once again becoming more challenging to acquire,” he said. “We continue to drive this every day. Staff has the appropriate PPE necessary to care for our patients and protect themselves.”

Another scarce resource is testing.

“Testing for COVID still provides challenges for the community,” Akif said. “There is testing completed (at Warren General) for symptomatic patients and patients being admitted to Warren General Hospital.”

“In addition, outpatients are being scheduled to have COVID tests completed and sent to an outside laboratory to process and result,” he said. “Recently these outpatient testing hours have been extended and more slots have been made available. These are typically tests performed with the request of a physician order.”

“The Walk In Care Clinic in North Warren has been doing COVID test as outpatients for patients that are not feeling well,” he said. “These tests are averaging about a three-to-five day turnaround for results.”

“It also my understanding that there will be community testing event in mid-December being offered to the general public,” he said. “This will be a four-day event with about 450 people being tested a day. These tests will not be rapid tests, but results should be available timely after the initial samples are acquired. The public should watch for further details.”

Long-awaited news of a vaccine is starting to arrive.

“Recently we received initial information on vaccinations and their availability,” Akif said. “Preliminarily, we are hearing that the first round of vaccinations for essential healthcare providers may be as soon as mid-December.”

“Vulnerable populations, as defined by the state, will follow this first group,” he said.

Until the vaccines arrive and are in wide-spread distribution, masks are still the first line of defense for individuals. Keeping individuals healthy keeps the community healthy, which contributes to keeping the hospital running smoothly and to keeping those who work there healthy.

“Warren General staff are as vulnerable as all residents of Warren County,” Akif said. “In addition to the use of approved PPE, we try to monitor potential exposures of staff while they are away from the hospital. If staff travel, we ask them to self-monitor upon their return.”

“We also are following the governor’s rules for the individual’s need to test within 72 hours following out of state travel,” he said.

The hospital has those tests for its personnel, but can’t provide them for the entire community.

“There is no testing that I am aware of, at this time, in Warren County for individuals that need the state-mandated 72-hour return to Pennsylvania after traveling test and testing required by employers to have a negative test before returning to work,” Akif said. “This is surveillance testing and the hospital is not equipped to complete this testing at this time. It is my understanding that several large employers in Warren are currently reviewing options to do testing for their employees.”

Focusing on its employees ensures that the hospital will be in the best possible position to care for the community.

For now, the hospital is allowed to continue to provide elective services.

“Recently (Secretary of Health) Dr. Levine and Gov. (Tom) Wolf have released their approach to the provision of elective services,” Akif said. “In summary, the measures are not as restrictive as the orders this past spring, but they have set parameters each region must follow rather than shutting down the entire state all at once.”

“There are three criteria that essential have to do with available resources, staffing, and community outbreaks,” he said. “We are monitoring these criteria and coordinating with our regional partners to make all of our services available to the community. We expect further guidance from the state on Monday, Nov. 30.”

“The hospital is keenly aware of the need for vital staffing resources,” Akif said. “Our team has done a nice job of protecting themselves while away from work. This has led to no staffing issues at this time.”

“There is a quarantining impact as outlined by the Governor,” he said. “Our team has done a nice job of limiting travel as to minimize their exposure risk. As with any employer in Warren County, we have had exposures that have been traced and acted upon when appropriate. If staff are exposed and can work from home, we have followed through. No known positive cases have worked. If a staff member is positive, they quarantine at home, then are monitored when they return.”

“One positive exposure has the potential to close care areas as all staff that could be exposed are traced and tested,” he said. “This again may sound like a broken record, but the use of a mask by everyone is essential. And, it’s not just putting a mask on your face, but assuring that the mask covers your nose and mouth simultaneously. The care team really appreciates everyone’s attention to this detail, as it allows our team to be healthy to treat you and your family members when they need it most.”