Masks Are the Rule

Now the rule is: If you work in the hospital, you wear a mask. Staff dealing with non-COVID patients wear a procedural mask. Those dealing with suspected or positive patients are in N95 masks or a powered air-purifying respirator. Even the administrative staff is expected to wear cloth masks while in the hospital. And community living center staff has been in full PPE (gown, gloves, procedural mask, face shields) since late March.

“It takes a tremendous amount of continuous education of the staff as to the risks and how to mitigate those risks. We don’t want someone catching something here and taking it home, taking it to their families,” Heimall said. “Very early on—the second week of March—we began buying additional scrubs and issued them to all employees caring for patients so they’re not in their civilian clothes. They can also shower here before going home.”

Regardless, the psychological toll on employees is profound.

“I spent 30 years in the military,” Heimall explained. “You train for mass casualty situations, and with those it’s very intense for a short period of time, a couple of hours, and then you clear the emergency room and operating rooms and then things come back to normal.”

What hospital staff are experiencing now is very different, he noted.

“I think what most of us experiencing, especially in hot spots, is a prolonged intense period of time when you come to work. For those 8-, 10-, 12-hour shifts you’re completely going, you’re at risk most of the time, or are afraid you’re at risk most of the time, and you have to come back and do it again tomorrow morning,” he said. “The cumulative impact of that level of stress is something that all healthcare leaders will have to address.”

The DCVAMC has formed a critical stress management response team consisting of chaplains and behavioral health specialists to help support the staff. On Sunday, April 16, the hospital saw its first employee death from COVID-19. The team spent that Monday working with co-workers to help them manage their grief.

“As we’ve done contact tracing with employees, there’s also tremendous fear and a great deal of anger when telling them they’ve been exposed. Our team is helping them deal with that, as well,” Heimall said.

Whether the virus had already peaked in DC or if it was still a few weeks out, Heimall said that he does not expect the effects of the pandemic to go away anytime soon, and he’s concerned about the fall.

“We’re going to have to be suspicious and aware of COVID for a long time to come,” he declared. “People are going to start getting back to a normal routine. But I’m very concerned about July, August, September and the next flu season. How many patients are we going to get who are asymptomatic but are carrying COVID? How long will we test everybody who comes into the hospital? I think until there’s antibody tests or a vaccine, that’s something hospitals will have to be concerned about.”

One of the few positives coming out of this crisis, Heimall said, is that we’ll have a nation of people more engaged in their own healthcare than ever before and particularly aware of how individual behavior affects health status.

“Handwashing is a great example,” he said. “We’re going to go into the next flu season, and everyone will be washing their hands. That won’t just reduce COVID, but influenza, MRSA, C.diff. That’s one of the bright spots to look forward to.”

Heimall also expects that the increase in veterans choosing telehealth services will remain once the pandemic has passed. That will not only be more convenient for veterans who have to battle DC traffic to get to the medical center but will also help keep hospital-acquired infections down.

But when that future will arrive is unknown. In the meantime, the hospital and its staff are taking it one day at a time.

“I am just so incredibly proud of the staff we have now,” Heimall said. “There’s just a lot of fear and uncertainty—and it’s understandable —but they come back. They come back every day. Their dedication to the veterans we care for is absolutely phenomenal.”