WAGNER — As administrator, Whitney Podzimek prayed for months that COVID-19 would be kept from her Good Samaritan nursing home residents.
Just before Christmas, Podzimek realized her worst fears when 30 of around 40 residents were infected with the coronavirus. She, along with others at the nursing home, prayed for a miracle to spare the residents’ lives.
A short time later, their prayers were answered from two blocks down the street.
Wagner Community Memorial Hospital, an Avera Health facility, had received a shipment of bamlanivimab (“BAM” for short). The laboratory-made proteins mimic the immune system’s ability to fight off harmful toxins or foreign substances such as viruses.
Podzimek doesn’t believe the timing was coincidence.
“I’m a believer (in God), and I prayed for our residents, our staff and all of their families for protection from the virus,” she said. “I believe wholeheartedly our faith and our prayers were heard.”
Bryan Slaba, the hospital’s CEO, had been searching for any new treatments for the coronavirus. He knew of ongoing research in the field.
“Wagner had seen one of the state’s first COVID cases last March. This community has been battling the pandemic for months,” he said. “I had been following news about BAM and knew we needed it as soon as it became available. We received a shipment on a Thursday, used it on Friday and saw amazing results that Saturday.”
He described the first patient as “feeling like Superman.”
WCMH has administered 93 doses at the nursing home and for other persons ranging in age from 50-104, Slaba said. Of that number, 91 recovered. In particular, Wagner has shown a dramatic departure from the nationwide COVID-19 mortality rate of about 40% for nursing home residents, he added.
“These are people who are alive and enjoying their daily activities,” he said. “When you work in a small town, you’re taking care of people you know. You’re going to do whatever you have to do to keep people alive. I give all the credit to my team. I think they saved lives at the nursing home.”
The BAM recipients have shown few side effects, Slaba said. He considers the therapeutic as a major weapon for high-risk individuals.
However, BAM must be administered shortly after a positive test for COVID-19 for its peak effectiveness, he said. The Good Samaritan Center has tested its residents and staff since late September, providing early detection of COVID even when symptoms aren’t showing.
The hospital keeps at least 10 vials of BAM on hand at all times, seeking to start an infusion within 3-4 hours after a positive test, Slaba said. The most anyone has waited was 8-9 hours.
“When our staff receives a call, they set up regardless of the hours,” he said. “If someone needs an infusion at 7 a.m. or late at night, we give it.”
Dr. Mikaela Koenig, a WCMH staff member, also serves as the medical director for the nursing home. She informed Podzimek about the available BAM as well as details about the therapeutic.
The nursing home administrator was struck by the news.
“With the help of God, we were able to keep COVID out of our nursing home for months until an answer came,” she said. “Just as we had the virus enter our nursing home, BAM became available.”
Wagner’s success received statewide attention this month. Gov. Kristi Noem noted the effort during her State of the State address, recognizing Slaba in the gallery. In addition, South Dakota Department of Health officials have spoken of the promise with the new therapeutics.
Podzimek found the statewide attention unexpected but expressed appreciation for the recognition of local efforts. In addition, the nursing home has been commended during an assessment for using BAM infusions in the long-term care setting.
The U.S. Food and Drug Administration (FDA) issued an emergency use authorization for BAM as a monoclonal antibody therapy. Eli Lilly and Company developed BAM specifically directed to block the virus’ attachment and entry into human cells.
BAM is targeted for patients at high risk for progressing to severe COVID-19 and/or hospitalization. The group includes individuals age 65 and older or who have certain chronic medical conditions.
Besides providing the infusions, the hospital provides additional testing to help detect positive cases, Slaba said. WCMH uses molecular testing for COVID-19, which is more than 99% accurate. The method offers greater accuracy than various rapid testing kits which can produce false negatives,
The Good Samaritan residents and families were notified of the BAM availability and needed to give their permission. In the meantime, a blizzard hit Wagner, raising questions on how to give infusions to the nursing home residents without leaving the facility.
“We had patients with dementia and Alzheimer’s that weren’t ambulatory, and we had a snowstorm going on,” Slaba said.
He contacted South Dakota Secretary of Health Kim Malsam-Rysdon to learn if the hospital could give the infusions on an outpatient basis at the nursing home.
“We wanted some direction that we were on point,” he said. “I called (Malsam-Rysdon) to verify we were within compliance by taking this therapeutic and administering it to residents in the long-term care setting.”
MAKING THE MOVE
Once state officials gave the go-ahead, the next step was transporting a mobile version of the infusion station. “We literally had someone go through 7 inches of snow with an IV pole in a hazmat suit.”
Podzimek commended the WCMH commitment in the middle of hazardous weather conditions to visit the nursing home’s COVID unit.
“Instead of having to drive three or four residents over to the hospital, their staff came over to the nursing home where the residents could remain comfortable and warm,” she said. “Not only did they administer the treatment but they also provided the staff to monitor our residents after the infusion was given.”
WCMH also offered PAPRs (a form of personal protective equipment) to the nursing home for use in its COVID unit, Podzimek said.
“I think it’s important to note, as none of our staff working in the COVID unit became infected with the virus, which helped us to keep our building staffed consistently throughout the outbreak,” she said. “The use of PAPRs has been identified as best practice for infection prevention and control protocols.”
The WCMH staff has provided follow-up care, Podzimek said. Providers visit nearly daily to make rounds, visiting residents and ensuring additional care.
The WCMH staff members provide infusions at all hours as needed, Slaba said. The infusion itself takes an hour and requires a nurse to provide constant monitoring. A visit, including set-up, processing, documentation and return, requires about three hours.
Because of the intense labor and time commitment, WCMH doesn’t treat and monitor more than two nursing home residents at a time, he added.
The hardest part of the process, particularly at first, may have been convincing the nursing home residents they had COVID, Podzimek said.
“We had residents who tested positive and thought it was ridiculous because they didn’t feel sick. But we were able to detect the virus well ahead of any symptoms,” she said.
“After the BAM infusions, I was going to residents’ rooms, and they were still doing things like writing Christmas cards. They didn’t feel sick. We’re grateful to have them still be doing things on their own. I feel BAM provided early intervention.”
Slaba credited the infusions for saving even more lives than realized.
“I’m no epidemiologist, but it’s a situation where a virus can be extremely devastating given the health care concerns within our community,” he said. “We could be looking at having lost 14 community members and how many others. Now, we know for sure how they have survived and thrived.”
Both Slaba and Podzimek credit the success of their emergency planning, both short- and long-term, and communication between their facilities. They also recognized the sacrifices their staffs have made throughout the pandemic, taking on additional work such as double shifts, holidays or working 20 days in a row.
“It isn’t the pencil-pushing geeks like me, it’s the hard working nurses and other staff who make it work,” Slaba said. “They’re the ones saving lives. They’re the ones who stay late and come in early when they are needed.”
In addition, the two administrators credit the resources provided by their respective health systems. Slaba creditd the support he has received from Avera in terms of receiving the infusions and keeping the local supply replenished. Podzimek noted the support of the Good Samaritan central campus in Sioux Falls, including Regional Vice President Heather Krzmarzick.
Podzimek sees a light at the end of the tunnel, particularly for the residents who have been separated from their loved ones for nearly a year.
“We are able to reopen in some capacities according to regulations and guidelines to allow visitation, communal dining and small group activities with masking and social distancing protocols in place,” she said.
She remains hopeful that the current vaccination programs combined with BAM infusions mark a significant step forward.
“I feel like there’s a lot to learn from our story,” she said. “I’m hopeful we’re moving in the right direction to end this pandemic.”
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