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Early quarantines foreshadowed a growing threat in the Berkshires

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Throughout the Berkshires, it began with a foreshadowing.

Trips abroad forced a few people into 14-day quarantines. More houses locked down, one by one.

Then invisibly, everything changed.

On March 3, two South County men separately arrived at the emergency room at Fairview Hospital in Great Barrington, struggling with upper respiratory symptoms. At Berkshire Medical Center in Pittsfield, a Clarksburg man who also was sick had already been admitted.

None of the three had traveled abroad, then considered the key risk factor for infection with the new coronavirus. By March 7, one of the men had tested positive, and hospital officials confirmed that this was their first known case.

Patricia Manning, a retired nurse who volunteers at BMC, was at the hospital that day.

She started her usual Saturday shift at 11:30 a.m., throughout which she typically sees 60 patients. On a step-down unit on the fourth floor, she said she heard a nurse talking to a supervisor in hushed tones in a corner where two hallways meet.

"He's been here for several days; he hasn't been masked; he had a roommate," the nurse said she told them.

They stood in front of a closed door, she said. A sign saying "staff only" — "or something like that" — was up on the door.

Two days later, on March 9, Manning said she awoke with a mild fever, chills and a headache. The following days were marked with profound fatigue, she said.

Manning said she wasn't sure if she had come into contact with the patient who had tested positive. "It's just that we go into so many rooms," she said.

Still, she isolated herself. She tried multiple times to be tested, but was told she didn't meet criteria. By the time federal criteria loosened and she was finally tested on March 18, she said she was on the mend. The results came back negative.

While it appeared the hospital was caught off guard by the first patient, the 29-year nurse said the hospital did the best it could with the resources and information available at the time. "It's all you can do," she said. "I certainly don't feel the hospital did anything inappropriate."

Yet, it was test results from those first patients that sent the hospital scrambling.

And soon, more than 160 staff were furloughed for 14-day quarantines, forcing the hospitals to hire more than 50 travel nurses.

Across America and the Berkshires, the ferocity of the virus snuck up on health care systems. The pandemic has warped life into the surreal, as shutdowns isolate residents and strip them of work. Nothing is spared as case counts and death tolls rise. Financial markets still rattle and the economy withers.

Hospital leaders believed that they were prepared. In February, they said they had had the virus on their radar back in December, when it began coursing through Wuhan, China. Despite extensive planning as they followed guidance from the state and federal government, COVID-19 had locked its foothold in the Berkshires.

Somehow, all the drills and the planning weren't enough. And those working on the front lines are frustrated.

"Seeing how bad the pandemic was in Italy and China, I think we could have been more prepared as a hospital, as a community, as a country," said Amber VanBramer, a critical care unit nurse at BMC and union leader who is taking care of COVID-19 patients and those awaiting results. "I think we were more prepared for the Ebola [virus] that we would never get."

CONTAGION

On March 11, the World Health Organization declared disease from this new strain of the virus a pandemic.

The next day, Pittsfield Mayor Linda Tyer declared a state of emergency, when nine people in the Berkshires had tested positive. Gov. Charlie Baker came to Pittsfield City Hall that day to deliver a news conference and reassure the public that Boston had its eye on its westernmost county.

"State officials are working closely with the impacted hospital, as well as the local officials to monitor the situation and keep the community safe," he said at the time.

A day later, North Adams Mayor Thomas Bernard also declared a state of emergency.

Around the county, self-quarantines soared to a degree that local boards of health lost track despite their efforts. And as officials struggled to determine how the county's first patients contracted the virus, it became clear that the virus was here and that people were spreading it unknowingly.

Public health professionals called this "community spread," and Berkshire County was one of the first areas in the state to experience it. Unclear, however, was how much it had spread.

Berkshire Health Systems, which runs both hospitals, already knew it had an exposure problem. And the state Department of Public Health picked up on a common thread, giving "BMC Related" its own exposure category.

BHS had already sprung into action, launching a nursing call hotline on March 8. On March 16, it started to set up its drive-thru testing operation.

Call volume soon began to overwhelm the new center, said Michael Leary, director of media relations for BHS. It received 360 calls on March 19 alone, and the average call length grew longer — and so the team expanded to meet the demand.

The week of March 19, BHS received federal approvals to begin analyzing samples in-house on its own machines rather than shipping samples out for testing. Preparations for this are still in progress.

Finding itself at the heart of the crisis, company executives came to The Eagle newsroom to discuss the situation.

"We're seeing more and more and more community transmission from one [person] to another," said Dr. James Lederer, chief medical officer.

It wasn't just here. It was around that time that the curve of cases in the U.S. began to bend upward. And Lederer suggested that the behavior of this virus was akin to something that hadn't been seen in more than a century.

"We've had scares with SARS, and with avian flu and with swine flu or H1N1, and with all of these other things over the last 20 years that we've had to address, but we've never had a true outbreak. The last big outbreak was the 1918 pandemic flu, and that taught us a lot, but the people who lived through that are all gone."

VULNERABILITIES

Exposure from the first three COVID-19 positive cases had rippled out and forced more quarantines.

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The ambulance crew that on March 3 rushed the Otis man to Fairview was exposed, and so was the hospital staff that treated him. That same day, a 70-year-old Great Barrington man who had struggled with a cough all winter walked into that emergency room. He was sent home with a vague diagnosis. By Friday, he had worsened, and a family member drove him to BMC. He remains in critical condition with COVID-19.

In Clarksburg, it is unclear how many people were exposed to that patient, thought to be the first in the county to test positive.

Hindsight has nurses still alarmed. At the hospital triage in the ER in the days surrounding March 7, the vulnerabilities were very clear.

"There was next to zero protocol," said one ER nurse who spoke on the condition of anonymity for fear of losing their job. "It's hard to sort of fault anybody."

There was a commingling of ER staff, patients and others.

"There were tons of exposure risks," said the nurse, "There were definitely [COVID-19] positive patients coming in, staff, and other patients. People would just be sitting out in the waiting room with a mask on, but came in without a mask on."

Workers with the largest health care union in the state, the Massachusetts Nurses Union, were seeing these scenarios statewide.

Early into a crisis projected to peak in late April, there were already two big problems apart from this commingling that nurses say might have contributed to the virus' spread in the Berkshires: shortages of personal protective equipment, like N95 masks, and testing kits.

Limited testing renders the daily case counts statistically meaningless in terms of the virus' true impact, say local doctors.

And early on, the Centers for Disease Control and Prevention tightly controlled who could be tested. The agency did so while apparently awash in confusion about potential patients, according to newly released documents. Any missteps might have affected the entire public health infrastructure, including BHS. When the narrow risk factors were lifted, testing was expanded to patients who had not traveled abroad.

The mask shortages were another area where the CDC stepped in. The agency loosened its guidelines to allow for reuse in times of scarcity. Hospital leaders point to this protocol. But some nurses, like VanBramer, said they were outraged by the CDC's shift on what are typically disposable masks.

"I don't think in times of crisis you relax your standards," she said.

Nurses said supplies early on at BMC were dangerously low and still are; BHS officials say they are currently "stable" as they work daily to ensure this. What they didn't anticipate was a national shortage, and that N95 masks were primarily made in Wuhan, Leary said. The outbreak there, he said, shattered the supply chain.

Nurses say they understand, but that this safety issue needs airing.

"The public needs to know," VanBramer said. "We can't lie about it."

"Reality," is what MNA President Donna Kelly-Williams called these problems, in her third letter to Baker and state Legislators. She said blame is pointless, but that health care workers should behave as if all patients are COVID-19 positive.

The coronavirus case count in the Berkshires stretched past 100 on Friday, to 105 people testing positive. On Saturday, the cases climbed to 119. Four county residents have succumbed to the virus, according to the Massachusetts Department of Public Health, which added two Berkshire deaths on Friday: a woman in her 90s, and a man in his 60s who had preexisting health conditions.

As case counts across the state soared last week, the virus crept into a Berkshire nursing home, Williamstown Commons, where 14 residents had tested positive as of Friday afternoon. Four caregivers at the facility also tested positive.

In the last week, Baker extended the school shutdown until May 4, and gave other orders that he hopes will slow the march of the virus.

While the county watches as New York City's hospitals are engulfed by patients, BHS is preparing for a surge as well, Leary said. The network is expanding the number of isolation beds and tightening visiting and screening rules.

And in this latest foreshadowing, it is also retrofitting anesthesia machines so they can be used as ventilators, responding to a need that might grow in the coming weeks.

Heather Bellow can be reached at hbellow@berkshireeagle.com or on Twitter @BE_hbellow and 413-329-6871.

Amanda Drane can be reached at adrane@berkshireeagle.com or on Twitter @AmandaDrane and 413-464-2859.

TIMELINE

Feb. 24: Pittsfield reports family in quarantine after travels to China.

Week of March 2: Two Monument Valley Middle School students are quarantined in Dalton after traveling abroad; Clarksburg man who later tests positive is admitted to BMC with symptoms.

March 3: Two men who later test positive arrive at Fairview Hospital. One is a Great Barrington resident who went home that day. The other lives in Otis, and was transferred to BMC.

March 4: A fifth Pittsfield resident is in quarantine after traveling to China.

March 6: The Great Barrington resident who had gone to Fairview on March 3 arrives at the BMC.

March 7: BMC confirms that its first patient has tested positive.

March: 9: BMC creates nurse hotline.

March 12: Pittsfield Mayor Linda Tyer declares a state of emergency.

March 13: North Adams Mayor Thomas Bernard declares a state of emergency.

March 15: Darlene Rodowicz, executive vice president at BHS sends a memo to employees saying that more than 160 employees had been furloughed for quarantine in the preceding weeks, and that more than 50 travel nurses had been hired.

March 16: BMC begins drive-thru testing.

March 17: Rodowicz says that the furloughed employees are cycling back to work as their furloughs end, and that the travel nurses will stay on.

March 22: The first Berkshire County resident, a man, dies from COVID-19.


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