By Derek Wilson
There’s plenty of laughing and singing during the carpool ride to the next stop. The work isn’t always fun, but the relationships can be rewarding.
“It’s been a lot of hard work, but a lot of really gratifying work,” said Dr. Elizabeth Lowe, who helped get a mobile testing clinic rolling out to skilled nursing facilities five weeks ago. “I’m working harder, longer hours, but it’s gratifying because I feel like I’m making a real difference to insure our most vulnerable patients are safe.”
Lowe and Dr. Irene Teper and a team of nurses drive the MarinHealth Mobile Clinic to skilled nursing facilities and senior housing centers on a regular basis to test patients and staff for COVID-19. They and others were tapped in February to help prepare Marin County for the oncoming storm. They have been at the center of the care system ever since, helping to keep some of Marin’s most vulnerable residents safe.
“The mobile care unit started specifically for residential communities because those are most vulnerable; that’s where the outbreak potential is highest,” according to Dr. Teper, who specializes in internal medicine at Novato Community Hospital. “As soon as we learn a person is under investigation for COVID, we go to that facility and we test that patient or staff member.”
If need be, the team will test every patient and staff member of the facility. To date, the mobile testing unit has tested 291 people and has found 33 positive patients, some of whom were symptomatic staff. In every SNF outbreak, COVID-19 was brought in from the outside by a staff member at the facility. As such, staff will be tested every two weeks. The largest outbreak contained so far by the unit included 80 percent of residents and staff at one location testing positive for COVID-19.
“The staff at these skilled nursing facilities are truly angels. They continue coming into these facilities and putting themselves at risk,” Teper said.
The Marin Healthcare District announced May 20 that it has awarded $942,000 to Marin County Department of Health and Human Services and MarinHealth for five special COVID-19 community-based projects. The mobile testing center of skilled nursing facilities is among those projects. With the award came news that, in partnership with Marin HHS, the SNF mobile testing unit will be set into permanency work already being done by MarinHealth. For an entire year, this full-time mobile testing unit will travel to each facility and regularly test all residents and staff at the 10 SNFs, 50 residential care facilities for the elderly, and two behavioral health facilities in Marin.
Dr. Teper recalled, “Dr. Lowe said a few weeks ago every day just another day at the improv. We have to come up with new procedures. We’re working closely with Marin County Health Official Dr. Matt Willis, and working closely with Kaiser as well to make sure we all provide the same quality of care regardless of insurance status.”
California has not seen a pandemic quite like this in a century since the outbreak of the Spanish Flu in 1918, which killed more than 3,000 residents of San Francisco. The news of a new growing global pandemic forced local doctors to move quickly in January and February.
“Usually as a physician you try to calm the situation down,” Lowe said. “I tried to calm down in face of calamity. My logical brain at the beginning of all this was saying, ‘it won’t be that bad if everyone practices good health habits.’ Within even a week, as we got reports out of China, we had to maintain the calm and integrate a whole new layer of protection. We had to develop a new protocol to help keep staff and patients safe. Pretty quickly, this situation went from this won’t be that big a deal to this is a very big deal.”
Teper was one of the physicians involved in the opening of the adult acute care clinic and drive-thru testing center at MarinHealth’s Novato facility in March.
“About the time the Princess Cruise ship was docking in the Bay Area, I realized very quickly the risk to the community of the spread of COVID, and that travel was no longer as big a factor in the spread because the virus was likely to be spread from within the community,” Teper said. “Disease will spread in the community. We needed a center where patients can go instead of going to their primary care physician where they might infect other patients and staff. We needed a place where every provider had protective equipment.”
Doctors, including Teper and Lowe, are taking time away from their own practices to staff the adult acute care clinic and mobile testing center. Nurses from private offices in Marin and Sonoma counties have joined the team as well. “People gave up their own practices and put themselves at higher risk for the sake of the community. Nurses from vascular care clinics, primary care offices, everywhere. The whole medical community pulled together and made sure the clinic was adequately staffed,” Teper said.
Driving the mobile care unit is a rewarding task for the team, not only for the chance to help others, but also for the chance to have some fun. While in the field, the team has dance parties, sings, records TikTok videos and designs t-shirts. There might be some competition as to who is the best singer on the team, according to Lowe.
“The work ethic around here has never been higher, from nurses to assistants to doctors, the energy is so high,” Lowe said. “Even when people are tired, they still show up, usually with smiles. I have not yet seen a bad attitude here… I start our trips with a team carpool photo. I want to capture pictures of the people in field to give people an idea of what happened during this crisis, to document everything so people can see it.”
Lowe compared the fight against COVID to battlefield conflicts. “No one wants the war to continue, but everyone wants the camaraderie to continue. You start to understand what the veterans went through and the bond they have.”
While Teper acknowledges the potential risk she and her coworkers face in the fight against the spread of the COVID-19 virus, she is confident in the safety procedures in place. Nurses and doctors are supposed to be washing their hands properly, using antibacterials often, and always wearing personal protective equipment. There’s even a strict procedure for how to remove the face shields, gloves, and covers at the end of a shift, and staff keep an eye on each other to make sure everyone is keeping safe, according to Teper.
“At the clinic and hospital, we’re very careful,” Teper said. “We test ourselves and we check our own temperatures every day. We watch ourselves and we watch each other.”
The COVID-19 pandemic has forced medical staff to bond even more closely and become a second family. The doctors likely spend more time with their team members at the hospital, the acute care clinic and the mobile clinic than they do with their own families after a 16-hour work shift. It takes some understanding and some courage all around to deal with the stress.
“The hardest fact is the kids are home-schooling and I’m not home a lot to school them,” Dr. Lowe said, half-joking.
“I was not around my family much in March and April while we were setting up the clinic,” Teper said. “Typically, I finish work by 8 p.m. and get home and crash. By 7 a,m., I’m out the door again. I don’t see my husband and children as often as I’d like, but they’re very proud of the work I’m doing.”
Lowe traveled the world as a medical student in Chicago bringing care to areas such as Guatemala and Belize, but “I never thought I would do medical work like this in my own home town.
I couldn’t imagine this happening in Marin County. I always thought I’d have to leave the country to get that gratifying feeling of helping again,” Lowe said. “I’ve always loved doing medical mission work.”
She continued, “At same time, you get introspective. To stop and think this is happening all around the world becomes an awesome task. No one is alone in this. That part is astonishing.”