The two Washington County hospitals believe they are prepared to handle any COVID-19 cases, with one confirmed case in the county and 537 cases in Maine as of April 8. Although Down East Community Hospital (DECH) in Machias and Calais Regional Hospital (CRH) have only five or at the most seven ventilators at present, they do have plans in place for managing a surge in patients, including the possible use of off-site field hospitals. As of April 3 the hospitals had sent over 40 swabs for testing for COVID-19 to laboratories in the state, with none so far having come back positive.
     Julie Hixson, director of marketing and communications for DECH, says, "We are prepared to swab anyone who falls under the screening guidelines and are prepared to care for any positive cases. We are a critical access hospital, which, ordinarily, means we are limited to the use of 25 beds. However, CMS [Centers for Medicare and Medicaid Services] has relaxed the regulations because of the pandemic, so we can increase the amount if we need to."
     At CRH, DeeDee Travis, vice president, community relations, says, "We have a strong team with a large variety of skills and past experience. Nurses, supervisors and even administrators with critical care experience are ready to put those talents to use if needed."

Testing policies
     Concerning DECH's policies on testing for coronavirus, Hixson says, "Patients who call ahead, or present, to the emergency department go through a screening process. We follow the CDC's [Centers for Disease Control] guidelines for testing, which is inpatients, healthcare providers and emergency responders, those living in congregate settings and those 60 or over who have underlying conditions such as COPD, heart disease or diabetes -- all of whom must be exhibiting symptoms such as fever, coughing and shortness of breath." She points out that providers "will be subjected to the sickest of the sick on a daily basis. It is not our intent to subject them, unnecessarily, to more people who may or may not have the virus."
     Hixson notes that DECH does not have an analyzer for COVID-19 testing. Instead, providers take a swab and send that to the Maine Center for Disease Control and Prevention or Northern Light Laboratory in Bangor for testing. As of April 3, DECH had sent 30 swabs, with 27 coming back negative and three outstanding. DECH is not working to obtain any of the new Abbott Laboratories test that gives results in a few minutes.
     Calais Regional Hospital also does not conduct the testing on site. Travis says, "We collect the samples and send to an outside lab for testing. We have supplies on hand to collect the samples." As for CRH's policy for people who ask to be tested for coronavirus, Travis says, "We follow the CDC guidelines for testing. A patient must fall into one of the prioritized tiers for a sample to be collected and sent for testing."
     As of April 3 the CRH laboratory had received 32 requests from providers for COVID-19 testing. Of these requests, 14 had been tested at the Maine state lab, with no positive tests as of April 6. As for the Abbott Laboratories test, Travis says, "Kits are very limited. We have submitted an application to be considered in the distribution of kits."

Treatment of cases
     Concerning DECH's preparedness to handle cases, Hixson says, "All departments have worked on their surge plans, and we have identified how each room and space in the hospital will be utilized. We do not have an ICU [intensive care unit] and haven't for many years, but we can create a makeshift ICU that could accommodate eight patients. We have two ventilators, and we can use two of the anesthesia machines. We have enough qualified staff to run eight ventilators, so we are in search of four more. The problem is so is everyone else."
     Hixson says that in a worst-case scenario, where DECH cannot transfer critically ill patients to other hospitals like it does now, the Machias hospital does have facilities that can be set up as makeshift hospitals for "healthy" patients, such as the Cobscook Institute in Trescott, the University of Maine at Machias dormitories, the Sunrise Care Facility building in Jonesport and the SuperTek building in Machias. "We would have to rely upon the Washington County emergency preparedness system for cots and other supplies for the facilities that do not have beds."
     Hixson adds, "How many positive coronavirus patients we could handle depends upon the severity of each patient's illness. If we have a surge of COVID patients and room starts running out, we will move our 'healthy' patients to off-site field hospitals. Regardless, we are prepared."
     At CRH, which also does not have an ICU, Travis says, "We have a strong plan for setting up a temporary ICU if needed. We have 19 beds on the inpatient unit, which we can use to care for infected patients with less critical needs. We have two rooms on the IPCU [intensive palliative care unit] with negative pressure. We would use those first." As a critical access hospital, CRH is supposed to be giving priority for transferring patients to those who need higher levels of care.       However, the Calais hospital recognizes the importance of having an alternative plan in the event that it has to keep patients who are sicker for a longer period.
     Concerning whether the hospital will have a sufficient number of ventilators to help treat patients with COVID-19, Travis says, "It is difficult to say not knowing where this is going. Only a small percentage of people who get sick with COVID‑19 need a ventilator. We have three ventilators ready to go and have requested more. If we are able to transfer people who are on ventilators out relatively quickly, three should be adequate."
If a person has difficulty breathing because of coronavirus and there are no ventilators, Travis says,      "There are other ways to support people who might need a ventilator while waiting for one to become available. It is not ideal, but we have the people and skill to do it short term. We have considered and prepared for these scenarios."
     At DECH, Hixson agrees with Travis, stating, "Not all patients who have difficulty breathing will need to go on a ventilator. They may just need oxygen therapy. We will try to transfer the most critical patients to EMMC [Eastern Maine Medical Center] or another tertiary hospital so those patients can go into an ICU unit. Worst-case scenario would be that there are more patients that need ventilators than ventilators available. I think we all know what that means. That is why it is so important that everybody keeps doing what they are doing to flatten the curve. That is why the whole country has sacrificed so much. The social distancing and self‑quarantining are being done so the worst‑case scenario does not happen."

Protecting hospital staff
     As for whether DECH has enough of the personal protective equipment (PPE) that staff may need in the coming weeks, Hixson says, "We are looking for all that we can find and continue to max out on our order allotments from vendors and are following CDC guidelines to conserve PPE.      We are buying as much PPE as we can such as N‑95 masks, face shields and gowns. We have N‑95 masks but will need more. We are also in search of quantities of hand sanitizer to last through the pandemic."
     Hixson points out that the supply chain for all supplies is severely disrupted and that DECH has had to pre-order many regular supplies because suppliers do not know how long it will take them to get items to the hospital.
     Of local efforts to help the hospital with protective equipment for staff, Hixson states, "We have put in an order to Jonesport Shipyard for 1,500 face shields. We are very grateful they are able to make them for us."
     At CRH, Travis says, "We inventory our PPE supply continuously to do our best to ensure adequate quantities. Currently our supply of PPE seems to be sufficient, and vendors appear to be able to fill our orders at this time. Of course it is anybody's guess on actual needs, so we will continue to monitor and follow CDC guidelines."