Stronger together: How Eagle County’s health care workers rose to the challenge of COVID-19
The race to protect a community
In the thick of the pandemic, in a year that refused to let up, Caitlyn Ngam started running.
An infection preventionist at Vail Health Hospital, Ngam prefers more daring outdoor pursuits: whitewater kayaking, dirt biking, and tearing down the mountain on her skis. But with her professional life bleeding into every aspect of her personal life, Ngam needed a release valve. As the 14-hour days at the hospital stacked up, and the toll of the pandemic weighed on her, she found herself being pulled outdoors for what she jokingly referred to as “jogging on purpose.”
Running from something? Towards something? Ngam isn’t so sure, but whatever it was, she absolutely needed it.
“I used to be able to leave thinking about infectious disease and masking and hand washing at work,” she said. “And I would go home and go in public and nobody cares about that kind of thing. But now the whole planet is thinking about your work. So it’s harder to escape in that sense.”
Before COVID-19 took over her life, pandemic preparedness was a sidebar in Ngam’s role at Vail Health. It was the “oh, just in case” aspect of a job focused on keeping infections out of the hospital. Name any type of infection — staph, urinary tract, seasonal flu, SARS — and you can be sure that Ngam has, at some point, obsessed over it.
But in early 2020, that “oh just in case” scenario of a global pandemic quickly consumed every waking minute of her life. Protocols and rigorous training are essential to a job that requires constant vigilance, but Ngam said she could always compartmentalize her work. That changed when a mysterious, airborne virus that originated halfway around the world quickly found its way into every corner of humanity, including Eagle County.
The valley’s two largest health care providers, Vail Health and Colorado Mountain Medical, braced for the arrival of COVID-19 by stockpiling personal protective equipment before supply chains were overwhelmed and launching a system-wide high-level task force to solve logistical challenges as they arose. But when case numbers exploded locally in early March, there was no training to emotionally prepare for the reality of a novel virus that was highly contagious and deadly.
“We see all kinds of infectious disease where we need to take precautions all the time,” Ngam said. “But for something to spread that quickly, we knew that it was something different and that we would be kind of off and running from that point.”
They haven’t slowed down since.
Antarctica. That’s where Dr. Brooks Bock was in late January when he first heard about COVID-19. Earth’s least inhabited continent was arguably the safest place on the planet with a global pandemic on the march.
Bock, the CEO of Colorado Mountain Medical, was traveling with his wife on a National Geographic ship to see penguins up close. He first read about the virus that originated from Wuhan, China, in a daily newsletter that rounded up global headlines.
By the time he returned to the Vail Valley in February, he found himself on a voyage unlike any other he’d ever taken in a medical career spanning more than five decades. Over the course of 75 or so days, Bock and Chris Lindley, Vail Health’s chief population health officer, worked out of a command center at the hospital managing the organization-wide response to the pandemic.
What started as a smaller team of high-level managers quickly grew to include as many as 24 different staffers from an array of departments over the months of February, March and April as the first wave of the virus shut down the valley and the state.
The objectives? Keeping the local health care system from buckling under the strain of the virus and protecting health care workers and the community at large.
For each member of the team, especially the two men heading up the collaborative effort, the experience was challenging, exhilarating and emotionally draining.
“We got to be good friends,” Bock said. “I have a tremendous respect for him and I enjoyed working with him.”
The challenge of slowing the virus put all of Lindley’s education and experience to the test. A former unit commander and environmental science officer of preventive medicine in the 793rd Medical Detachment of the United States Army Medical Reserves, Lindley served in Iraq and received a Bronze Star for saving multiple lives during a suicide bomber attack. He holds master’s degrees in public health, epidemiology and business administration.
His first job after getting his master’s in epidemiology was working with bioterrorism preparedness for Denver Health Medical Center.
“It was the first in the country training for pandemic influenza or large scale biological warfare attack,” he said. “These things, I’ve been thinking about them my whole career.”
If Lindley had been prepping for a global pandemic for years, Bock represented the opposite end of the spectrum.
“I certainly never planned to live in a pandemic,” he said. “And hopefully there won’t be another during the rest of my lifetime.”
Working together on the same problems, with the same goals in mind, often times with different approaches, brought the two together — and the two organizations they represented. Colorado Mountain Medical’s merger with Vail Health in July 2019 had, on paper, already created a valley-wide health care network — but Lindley, Bock and Vail Health CEO Will Cook insist that it took a pandemic, of all things, to truly make the two providers inseparable.
“There were lots of moments of concern and doubt,” Bock said. “The amazing thing was that everyone was very supportive. Everyone was very collaborative. There was no one who was trying to run the show. It was a group effort to figure out what we needed to do.”
Each day brought new challenges, and with those challenges came spirited debates, brainstorming sessions and swift innovation.
How to ramp up testing and keep the virus out of the hospital and clinics? Create the state’s first drive-thru testing facility, in Gypsum, and install a testing trailer at the hospital in Vail — both of which were in place by March 7. Also, create a system of “clean clinic” safety protocols to ensure the safety of patients and staff as clinics eventually began seeing patients again for well visits.
How to reach the valley’s Spanish-speaking communities? Partner with the MIRA Bus to begin offering free testing.
How to solve the riddle of a lack of available tests and delayed results from outside labs? Work to develop an in-house test that could be turned around quickly.
How to counter the slow-rolling behavioral health crisis that was engulfing the valley as residents struggled with isolation, joblessness, food and financial insecurity, and the stress of kids learning remote? Provide telehealth training for all behavioral health providers, hire 40 new behavioral health specialists and roll out a community-wide scholarship fund to provide those in need who are struggling financially with free access to services.
“We learned a lot about what it means to be resilient, and I think even before COVID, we were already dealing with a lot of those problems,” Cook said.
He described the response to COVID among his staff like any response to a traumatic event: First there was denial, then a sense of sorrow and being overwhelmed.
“I think that actually the initial phases bonded us together and really helped us respond the way that we did,” he said. “What I’ve liked the most, is, you know, Chris and Dr. Bock and even Amanda Amanda Veit, our COO, and so many others, were spending countless hours in that command center. But they were collaborating, making decisions, moving quickly and avoiding that bureaucratic sort of hierarchy that can sometimes make people feel like I’m not going to even bother to make this decision because I’m going to have to go through three channels above me.”
Bock said he enjoyed becoming a bit of a local celebrity by filming a number of informational videos with Lindley and others early on in the pandemic that helped soothe some of the fears of the community.
“We would call each other the day before and say, ‘OK, let’s make a video on this. Or let’s make a video on that,’” he said. “It was the topic of the moment that we were trying to educate the community on, and they were effective, remarkably effective. I can’t tell you how many people I would see when I was out and about at the grocery store, or wherever I ventured to, not often, but whenever I ventured out for the needs that I had, people would comment on how much they appreciated that and the personal touch that it brought to their lives and the assurances that they received from them.”
Added Lindley: “You always kind of look at the big health care systems, the big hospitals with all they can do,” he said. “Many of them have great resources, very talented people, great financial capability. But I got to see firsthand what this health care system is for this community and what it can do. And without question, I’m 100 percent certain the Vail Health system has done more in this community than any health care system I’ve heard about or ever dreamed about.”
‘This test sucks’
Mark Joffrion parachuted into a crisis. He started his job as the director of Vail Health’s laboratory in March, smack in the middle of the first wave of COVID-19 cases in the valley.
A soft-spoken Southerner who came to the Colorado after stints in labs all across the country, working in Louisiana, Indiana, Texas, Alaska, Oregon, California, Florida and North Carolina, Joffrion described his first weeks and months in his new role as an “everyday scramble” to find solutions to problems that were largely out of his control.
How could the lab get more tests? How could it avoid the growing backlogs for results from state and private labs?
“There was just that need to get results out immediately,” Joffrion said. “We kind of had our hands tied with the testing available and the turnaround times that we were dealing with.”
In the early days of the pandemic, Joffrion and Vail Health officials targeted in-house testing as a solution to both of those problems. Developing a test that worked, however, and being able to turn it around quickly to deliver results in a 24-hour period was a challenge that pushed every tech working in the lab to the brink over the summer and into the fall. As Joffrion and his staff worked tirelessly to find a reliable test, not to mention a manufacturer that could supply it, they coped with the stress that came from repeated phone calls looking for results that too often weren’t available.
The waiting was excruciating.
“It’s tough when we’re not the owners of that answer,” he said. “You know, we know when the results come back to us, but we had no control over when it came. And we were dealing with sometimes two, sometimes three different laboratories to get these results out or get them back to us.”
The lab received a test it could perform internally in April, but the supply was extremely limited, creating the need to horde the tests for the most symptomatic patients. Tests for asymptomatic patients were still being sent to an outside reference lab, with turnaround times taking as long as 10 days.
In May, the lab picked up another test it could perform internally, but again, the volume was extremely limited. Joffrion said he checked the FDA website every day to see which tests had been approved for emergency use and if his team could actually run them in the lab.
By October, he finally found a test that looked like it was doable, and would supply the large testing volume that his team needed to drastically reduce turnaround times.
Stress levels reached a peak, however, in the final weeks of October as techs worked their way through the delicate process of making sure the test actually worked. Joffrion said at one point, in a moment of frustration, one of his techs walked up to him in the lab and pronounced, “This test sucks.”
“But she came and we talked about it and I go back there and she’s just running them like a true professional,” he said, smiling. “She said what she wanted to say, but she got back there and she was running, you know, 60, 80, 100 of these tests at once and just doing an amazing job. That just speaks to the quality of individuals here in this laboratory. They were pushed to that limit, but they knew what we wanted, what our goal was.”
By November, with the test dialed, the lab was finally able to complete all testing in-house, and started receiving samples from collection sites in Summit County and Vail, as well as the Aspen area, becoming a regional testing center.
In November, the lab performed a total of 4,061 COVID tests, compared to just 835 in October and a little more than 200 in September. The lab has since performed more than 20,000 tests since November, often turning over a result in 10 hours or less.
“There were some days it was really doubtful if we could do it, but these are true professionals just stepping up to incredible levels to do what they did,” Joffrion said. “What’s happened in this laboratory is really amazing.”
Coming full circle
Julie Scales is uncomfortable with people making a big deal about her story. During the past 13 months, so many people have gotten sick, she said. So many have died.
There have been 22 Eagle County locals who have succumbed to the virus and more than half a million Americans. But talking to Scales’ coworkers at Vail Health, where she works as a lead respiratory therapist, her recovery from the virus is the narrative that often emerges when they talk about the turning points in the pandemic.
March 14, 2020, is the day when COVID-19 became jarringly personal to them. It’s the same day that the local ski resorts shut down and the hospital saw its highest number of patients admitted. One of those admitted was Scales, whose work often brought her into the emergency department.
“It came home pretty hard,” said Ken Stephen, the charge nurse in Vail Health’s emergency department who oversees the intake of patients.
Earlier that week, Scales had been convinced she had a sinus infection. She had a pounding headache but no respiratory symptoms. Working in a hospital, over the course of a winter, everyone deals with colds and gets run down, and Scales just pushed on with her work. But by Saturday, she was experiencing respiratory symptoms and was admitted to the hospital. A day later, March 15, with her condition worsening, she was transported to the Medical Center of Aurora.
Stephen said seeing Scales being prepped for that ambulance ride down to the Front Range was similar to watching a patient go into the operating room for the last time for organ donation. Scales’ coworkers were legitimately frightened that it would be the last time they’d ever see her.
“It was really, really hard. Of all my ER staff, all of us that worked in the ER the whole time, none of us got COVID that we know of,” he said. “She’s the only one that worked in the ER intermittently, and after she got it, it was like, ‘OK, people, let’s make sure we buddy up.’ We were very, very careful with each other. We protected each other, we had each other’s back and made sure nobody was put at risk if somebody was really sick. We do not rush into that room.”
“It was definitely very scary,” Scales said. “I’m a respiratory therapist. I’ve intubated people on ventilators my whole career, and knowing that that’s where I was headed, I was very scared when I was headed down to Denver.”
Scales spent 10 days in the Aurora hospital, seven of them on a ventilator. She doesn’t remember much. Her daughter, 34, was with her.
“I had my phone, but I didn’t have a charger, so my phone would die,” she said. “My friend told me that I just texted her, and I just said, ‘I’m just going to try and live, OK?’”
After coming off the ventilator, Scales pleaded with doctors to discharge her. She returned home with the help of supplemental oxygen. From the beginning, she was determined to return to work. It took her nearly two months to get back on the job, and it was slow going at first.
“It was very emotional, and still is at times to take care of COVID patients,” she said. “My first ventilator patient that I took care of when I came back was super-emotional. I held it together in the patient’s room. But I had to take the tube out and it was very dramatic.”
Equally dramatic: the scene of Scales being the first Eagle County resident to receive a shot of vaccine on Dec. 16, 2020. That’s when many of Scales’ coworkers said they could finally see the fog start to lift.
Since recovering, Scales has climbed a 14er and marked the one-year anniversary of when she was admitted as a patient by going skiing with some of her coworkers. Gnam was among those who were excited to get out on the hill with her.
“I just made a comment to my daughter that I would like to ski down the hill instead of go down the hill in an ambulance on the 15th,” said Scales, who spent more than three decades working in hospitals in her home state of Indiana before moving to Colorado a few years ago to be closer to her daughter. “I feel really humbled by everything and I feel bad for the people that didn’t make it because when I was sick, we had a lot of people in the valley that were sick.”
Getting to the other side
How does this story end? Vail Health CEO Will Cook isn’t so sure.
Too often, the COVID-19 pandemic has been referred to as a race. A race to save lives. A race to develop effective vaccines. A race to get back to normal.
Cook said Eagle County, as a whole, has run that race better than most places around the country and the state. The collaboration between the valley’s health care providers, local governments and the community at large has been at the center of that.
The county never plunged into the Level Red restrictions that were a crushing blow to neighboring counties. Shools have managed to remain open for the current academic year while other districts around the state struggled to open and stay open.
The pandemic forced innovation, collaboration and created an opportunity for leaders to emerge, Cook said. But that success story doesn’t happen in a vacuum, and the national tragedy of a pandemic that is still killing as many as 1,000 Americans a day, and has claimed more than 500,000 American lives, continues to overshadow the local narrative.
“I’m still waiting for the impact of this to my management team,” Cook said. “In some of the front-line staff, we’re worried now about what we refer to as hero syndrome, which is that you get so caught up in being on the front lines of dealing with this and being in there for vaccinations where people are emotionally elated and overwhelmed and excited and happy. How do you go back to being the H.R. assistant after that? It’s understandable, though. I don’t think we’ve even seen the end of the impact of this.”
Lindley, an eternal optimist, said the last year has flown by for him, and that in a time where charged national debates over the virus, masking, and reopening created deeper fractures in American society, he has been inspired by the community spirit that has carried the day here.
“I think that finger pointing this year has started to decrease and go away,” he said. “And our challenge is, how do we stay in this community collaborative effort going forward? Because we’re going to have other challenges right now. We have a lot of things we have to address. But if we can do it in this response mode I think we’re all in, it’s unbelievable.”
Stephen said hospital workers “saw things that would terrify most people every day without batting an eyelid.”
Making it to the other side of the pandemic, with the county rapidly approaching 30,000 total doses of vaccine distributed, is the light at the end of a tunnel in a trying year.
“They showed up for work and got it done,” Stephen said. “They’re team players, the best team in the land. You could have called in sick. You could have asked not to do it. But not a single one of them did that. We rose to the challenge. We were resilient and we stayed here for the community and took care of them.”
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