Photo 1:  Dunkirk City Fire Chief Mike Edwards leads the salute of hospital workers despite an unexpected snowfall.
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Photo 2:  A view from inside.  Hospital staff was asked to enjoy the parade from inside the facility so as to avoid having to rescreen on re-entry to the hospital.

​The COVID-19 Pandemic has many of us wondering what am I going to do? Where can I get the help I need? Following is information to help answer your questions and connect you with local resources from across Chautauqua County. 

​Brooks-TLC Hospital System, Inc. is working closely with the New York State Department of Health and the Chautauqua County Department of Health and Human Services to reduce the risk of potential exposure to COVID-19.  The hospital will provide updates when new and developing precautionary measures will be implemented at the hospital. 
 
Overnight Access and Screening
Effective immediately and until further notice, all hospital visitors and employees will need to enter through the Emergency Department entrance between the hours of 8 p.m. and 5 a.m. to be screened for fever and cough.  The Emergency Department is immediately adjacent to the Outpatient entrance, which is still being used as a point of entry for everyone entering the hospital building at all other times. 
Patient discharges will take place at the main lobby exit only.  No other egress access is permitted at the lobby doors at this time.
 
Visitation
Any visitors meeting criteria as medically necessary to the care of a patient will be limited to one (1) visitor at a time.
 
Medically necessary is defined as being essential to the care of the patient, or for family members or legal representatives of patients in imminent end-of-life situations
 
Outpatient Hours
Beginning March 28, 2020 and until further notice, all Saturday outpatient services will be suspended, including laboratory, radiology, EKG and other specialty diagnostic testing.  Outpatient services remain open Monday – Friday, 6:30 A.M. – 5 P.M.
 
For further changes, closings, announcements, etc., please also visit the website at https://www.brookshospital.org/news. 

As the Brooks-TLC our Emergency Preparedness team continues meeting daily to assess COVID-19 developments in our community, until further notice, everyone, including employees, outpatients, visitors, medical staff, and vendors entering the hospital will be screened for respiratory symptoms and fever at the OUTPATIENT entrance at the front of the hospital.
Please plan to arrive early for your appointment, shift, meeting, etc. as there may be lines at the door.
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Emergency Department (ED) patients ONLY should continue entering at the ED door.

Thank you in advance for your cooperation as we work to protect the health and safety of our community members.

The outbreak was first recognized in early December 2019 in Wuhan, China, but has spread widely throughout the world, including to the United States. While COVID-19 has been widely covered in the news media and the number of cases has grown substantially, incidence in New York State remains low. Respiratory symptoms like fever, cough, or difficulty breathing, are much more likely to be caused by a seasonal illness like the flu rather than COVID-19.

It is important to note that the vast majority of those who contract COVID-19 will not require hospitalization; symptoms are often mild enough that one can recover while quarantined at home.

1.  What is coronavirus disease 2019?
Coronavirus disease, now known as COVID-19, is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China.

2.  Who is most at risk for contracting COVID-19?
Those who recently traveled to an area where cases of COVID-19 are occurring are most at risk, and they should consult their doctor for the latest information. The CDC maintains a list of countries with significant COVID-19 cases.
 
3.  How does coronavirus spread?
There are many types of human coronaviruses, including those that cause the common cold. They typically spread from an infected person through the air in tiny droplets produced when coughing or sneezing. These droplets, when they come into contact with another person’s mucous membranes (e.g., mouth, nose, or eyes), can lead to infection. The virus can also be transmitted if you touch a person, an object, or a surface on which the virus has settled and then touch your mouth, nose, or eyes before washing your hands.

4.  What are the symptoms?Patients with COVID-19 have had mild to severe respiratory illness with symptoms of:

• fever
• cough
• shortness of breath

Symptoms usually begin within two to three days of exposure but could take as long as 14 days to develop.
 
5.  How can I protect myself?
The steps to protect yourself from COVID-19 are generally the same as those for the seasonal flu. See below:

• Wash your hands frequently with soap and water for at least 20 seconds. Use an alcohol   based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
•  Avoid close contact with sick people.
•  Cover your cough or sneeze with a tissue or your elbow.
•  Avoid touching your eyes, nose, and mouth with unwashed hands.
•  Clean and disinfect frequently touched objects and surfaces using a household cleaning spray             or wipe.

6.  Should I purchase a facemask to protect myself?
The Centers for Disease Control and Prevention (CDC) does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including the flu and COVID-19. Facemasks should be worn by healthcare workers and those who exhibit symptoms of coronavirus to help prevent the spread of the disease to others.

7.  Should I be tested for COVID-19?Call your healthcare provider if you feel sick with fever, cough, or difficulty breathing and have been in close contact with a person known to have COVID-19 or if you live in or have recently traveled to/from an area with ongoing spread of COVID-19.
 
Your healthcare provider will work with the state and local health departments and the CDC to determine if you need to be tested for COVID-19.

8.  How is COVID-19 treated?
There is currently no FDA-approved medication for COVID-19. People infected with the virus should receive supportive care such as rest, fluids and fever control to help relieve symptoms.

9.  What if I recently traveled to an area with COVID-19 cases and now have symptoms of a respiratory illness and/or fever?
If you were in a country with a COVID-19 outbreak and feel sick with fever, cough, or difficulty breathing, within 14 days after you left, you should:

•  Seek medical care; Call the office of your health care provider before you go, and tell them about your recent travel and symptoms. They will give you instructions on how to get care without exposing other people to your illness.
•  While sick, avoid contact with people, don’t go out and delay any travel to reduce the possibility of spreading illness to others.
•  Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
•  Wash hands often with soap and water for at least 20 seconds to avoid spreading the virus to others.
•  Wash your hands with soap and water for at least 20 seconds immediately after coughing, sneezing or blowing your nose.
• If soap and water are not readily available, use an alcohol-based hand sanitizer that contains at least  60% alcohol.

10.  What are the guidelines for home isolation if I have a confirmed or suspected case of COVID-19?
For those with a confirmed or suspected case of COVID-19, a healthcare provider and local public health staff member will evaluate whether you can be cared for and recover at home. If home care is deemed appropriate, you will be closely monitored by staff from your local or state health department. Home isolation requirements include the following:

• Restrict activities outside the home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride sharing, or taxis.
• Separate yourself from other people and animals in your home.
• If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from exposure to the virus.
• Wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not stay in the same room with you, or they should wear a facemask if they enter your room.
• Cover your mouth and nose with a tissue when you cough or sneeze.
• Wash your hands often with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol and avoid touching your eyes, nose, and mouth with unwashed hands.
• Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.
• Clean high-touch surfaces regularly such as doorknobs, bathroom fixtures, toilets, counters and tabletops, phone and laptops.
• Monitor your symptoms and seek prompt medical attention if your illness is worsening.

11.  Is there a vaccine currently available for COVID-19?
There is currently no vaccine available for COVID-19. According to the federal government’s Coronavirus Task Force, a vaccine could potentially be available within 12-18 months.

12.  How is Brooks-TLC prepared to treat infectious diseases?
We have developed procedures to make sure that people arriving for care at our ER are quickly screened for infectious diseases such as COVID-19. This includes questioning people about whether they have traveled abroad in the last three weeks or come into contact with people who are traveling abroad. Our procedures enable us to quickly isolate and screen for any possible cases of infectious disease.

13.  Is Brooks-TLC implementing visitor restrictions?
To help avoid the spread of infection and to ensure a safe environment for all, we ask that those who are ill not visit our facilities unless they are seeking treatment.

14.  Should I travel internationally?
CDC recommends avoiding nonessential travel to China, South Korea, Iran, Italy and Japan at this time. If you must travel:

• Avoid contact with people who are sick.
• Avoid animals and animal markets.
• Wash your hands often with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol and avoid touching your eyes, nose, and mouth with unwashed hands.
• Older adults and travelers with underlying health issues may be at risk for more severe disease.

For the most up-to-date information regarding COVID-19, please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html.

On any given day, the GI Lab at Brooks-TLC Hospital System, Inc. is a busy place.  Familiar faces, gastroenterologist. Hyder Alam, MD and general surgeon, Joe Askar, MD, are on site almost daily, and can be seen working a well-oiled machine with GI nurses at the hospital.  In recognition of March as Colorectal Cancer Awareness month, both physicians discuss the importance of colonoscopy in cancer screening. 

According to Melanie Leuer, RN, BSN, Brooks-TLC clinical education coordinator, “A rotation experience at Brooks provides students with meaningful engagement in service of a rural population.  The practical hands-on experience with a cross section of our population demonstrates how access to healthcare services is critical to good health.”

With a high percentage of Medicaid population, many patients in this type of rural setting face a variety of access barriers including financial challenges to pay for services, lack of transportation, communication barriers, and more. 

Melanie and clinical nursing instructors are working to incorporate critical thinking into lessons that focus on establishment of trust with patients, active listening, patient empowerment, etc.   Ultimately, the end goal is to provide students with an immersive clinical experience in a culturally diverse setting. 

The current clinical rotation began on January 22 and extends through May 2020. 

By Mary E. LaRowe and Christopher Lanski

Efforts to preserve healthcare in the Chautauqua region by the Brooks-TLC Hospital System Board of Directors have come under fire. The board recognizes the loss of any health service wounds the community, and we understand the emotional reaction.
 
On behalf of all our board members, however, our focus now must be on the future and working collaboratively to make sure that a new hospital is built in Fredonia, preserving regional services. We face extraordinary, generational challenges. According to the August 2019 Becker’s Hospital Review, 113 rural hospitals closed in the past decade in 27 states. And some 21 percent of rural hospitals – 700 in all – are at risk of closure in coming years.    
 
As we work with the state Health Department [DOH], our elected representatives, union leaders and all stakeholders to move this $67 million hospital to ground-breaking, we seek community support. One pillar of the new hospital funding and approval process will be to demonstrate community commitment and economic viability. To that end, we want to present some facts and clarify a few misconceptions.
 
In regard to the TLC closing, the hospital and the DOH months ago coordinated numerous prerequisite steps necessary for closure. The planning was very well thought out and carefully considered. Relative to Kaleida Health’s role, Kaleida is not a source of bailout funds or additional revenue nor does it direct operations or make decisions at Brooks-TLC. Our management agreement with Kaleida Health provides resources at reasonable cost.
 
Next, our leadership team continues to work closely with DOH, as we have for the last four years. Our financial position is crucial in procuring funding to transform to a replacement hospital for the aged Brooks campus, now more important with the closure of TLC.
 
Hospital leaders worked diligently to reduce expenses by $8 million in recent years and maintain services at TLC, but inpatient volume fell in response to economic pressures from insurance companies; implementation of new technologies for outpatient care; and declining regional population. These factors further eroded revenues. We face similar issues at Brooks, and closings also recently occurred in Lockport, Newfane and North Tonawanda.     
 
We fought hard to keep services viable at both campuses, but market forces and a litany of other factors made it impossible to maintain both. Nonetheless, with DOH and state Office of Mental Health guidance, we are monitoring community members with mental health challenges, and re-training staff at Brooks to care for these individuals.
 
Board members also faced invalid criticism as “outsiders.” Every one of our board members works locally.  They serve as unpaid volunteers because they care about preserving healthcare for our communities. To provide that quality healthcare into the future, we must have the cooperation and support of the community and its leaders. That is why we’ve briefed newly elected officials.  
 
For months, we knew that a transformation plan involved making difficult decisions. There will be more to be made. But all decisions are made to ensure that our communities have access to necessary care.
 
Mary E. LaRowe is president and CEO and Christopher Lanski is board chair of Brooks-TLC Hospital System Inc.