As the number of COVID-19 cases continue to rise across Vermont this fall, the laboratory technicians and medical staff of NMC’s Curbside Collection site remain diligent and optimistic.

“It is a real honor to be able to serve the community in this capacity,” says Jessica Scanlon, a Laboratory Assistant, instrumental in organizing the daily ebb and flow of the Curbside Collection Site.

“We have a very fine-tuned system right now,” Scanlon says, following months of tweaking the lab testing procedures, monitoring volume capacity and meeting staffing needs throughout the on-going pandemic.

Prior to the national resurgence of COVID-19 cases, the St. Albans Curbside site had hit peak testing levels back in August, with approximately 450-550 weekly tests being processed during October.  With Vermont’s total positive infections now surpassing 4,000 – over 40-percent of those cases reported in November alone – the need for quick and efficient testing – and access to it, is more pertinent than ever.

As an order-driven collection site, any patient utilizing NMC’s Curbside screening is either referred by a medical provider or self-initiated through NMC’s COVID-19 Hotline. Those scheduled for surgery or specific out-patient procedures at NMC are also required to have pre-operative screenings for the virus, conducted within a particular timeframe.

“We do not provide medical advice or lab results directly to the patients,” says Scanlon. “Nor do we allow walk-ins, this is not a pop-up testing site.”

Systematic testing continues, notwithstanding delays resulting from the Oct. 28 Cyber Attack on UVM Medical Center’s digital network. Locally collected samples had been couriered to UVMMC for months, prior to being processed at the Broad Center in Massachusetts. Following the breach, NMC’s samples were re-routed to the Mayo Medical Clinic in Rochester, Minnesota for processing and return of results.

“Our normal turn-around time went from three days to five days,” says Scanlon. “Then a national C19 surge happened, hitting Mayo hard, our turn-around time is struggling at five-to-seven days.”

Meanwhile, as the UVMMC’s system continues to regain functionality, the Curbside team remains optimistic that turn-around times will soon return to just three-to-four days, Scanlon says.

“Our community has been overwhelmingly understanding and supportive of the struggle we face. We fully understand the impact this has on people’s lives, their livelihoods, and families.”

Drive-Thru Convenience

Established quickly to fulfill the growing need for local testing, the Curbside Collection Site has taken several thousands of samples from Franklin and Chittenden County patients, since the onset of COVID-19.

Back in March, NMC’s Incident Command/COVID-19 Response team began searching for a more stable location for testing. “At the time, we were testing anyone suspected to have COVID thru a side door outside our old ICU,” says Kristy Cushing, PT, NMC’s Rehab Services Manager.

Patients with COVID-like symptoms were being tested from their cars as a precaution. “We found we were bottle necking and because it was adjacent to the Emergency Department (ED), traffic was becoming a concern,” Cushing says. “We knew COVID wasn’t going away.”

Cushing was asked on March 18 to set-up a team to spearhead the relocation of the COVID-19 testing site, to an empty space within the Valley Crossroads building, owned by NMC.

“At the time, Ortho had dropped their schedule, as all clinics had orders to do such, so we had two Physician’s Assistants (PA) free at the time.  We walked down to the temporary COVID space and an ED provider did Nasopharyngeal swab training,” she recalls. A support team of RiseVT, Physical Therapy, and other staff was assembled to support the effort.

Her team did a walk-thru of the new space, identifying necessary equipment and procedural needs. “The next day, March 19, we were up and running at Curbside, testing patients at noon,” Cushing says.

The Valley Crossroads plaza location allows patient traffic to flow from behind the building forward and remains convenient in proximity with NMC’s main campus. “Around 15-20 patients were being tested each hour,” says Cushing. “We did it this way to be respectful of conserving Personal Protective Equipment (PPE). The collector would get all geared up in PPE and do one car after another.”

The collection team manually transported samples to the NMC lab three times a day, Cushing says. At that time, the laboratory technicians did not participate in the collection of samples at the Curbside site. Instead, as the Ortho PA’s headed back to their clinics, a team of Rehab Physical Therapists (PT) were trained as collectors, helping to maintain curbside operations for the next five months.

Transitioning again in July, the patient-testing process was handed over to the laboratory staff, a dedicated team of seven, now under the supervision of Mandy Hill. “The Curbside team made a lot of improvements from there,” Cushing says of the progression. “However, I was super proud of opening the site within 28 hours of the request.”

“The team did a great job setting everything up,” says Scanlon. “We were happy to get in and be able to put the science to it,” she says. “We’re all one team up here.”

Patients should expect to interface with only two people during a typical curbside collection, a runner and a collector in full PPE. “As the runner goes out first to give directions to the driver – it is important for the driver, whether being tested or not, to listen and understand directions given by the runner,” says Scanlon.

After swabbing a sample, the collector ‘comes in dirty,’ thru a side door – where the runner can help assist with anything the collector needs. Neither the runner nor collector interacts with others inside or outside the Curbside site while in PPE.

The Curbside site utilizes two methods for testing patients, based upon what is ordered by providers. The Nasopharyngeal Swab, often referred to as the more invasive or painful type, tests for indicators of both COVID-19 and Influenza. The Anterior Nares Nasal Swab tests for COVID-19 only, rimming the inside of both nostrils.

“I was very nervous about the specimen collection part. I had heard that it was very unpleasant and that it hurt a bit,” says Nilda Gonnella-French, a patient who was tested Curbside.

“Basically, she put a nasal swab up my nostril, spun it around to the count of 10, removed the swab and placed it in my other nostril and spun in around to the count of 10; removed the swab and placed it in the transport container.  I was then able to drive away.”

Earlier this fall, Gonnella-French attended a social event out-of-state. Following a seven-day quarantine, she was required to have testing before returning to work as Risk and Accreditation Coordinator at NMC.

“I was involved with COVID response planning at NMC from March and was very familiar with the fact that we had this service,” she says. “It was not until September, when I had the opportunity to take advantage of the convenience of the curbside collection center, that I really got a true appreciation for the service we are providing for the community.”

She requested an appointment on Friday and by Sunday morning was waiting at the Curbside Collection site. “The line was moving forward smoothly. When I got close, a tech came out and gave me the instructions.  It was a very clear and simple process,” she says.

“The nasal swab collection process did not hurt at all.  It was slightly uncomfortable, as there is a swab up your nose, but very minimal.  I would not hesitate to do it again if it were to be necessary.”

She received her test results on Tuesday. Patients are always notified, regardless of result status, by their medical provider and through the NMC Patient Portal.

While there is currently no limit on the number of COVID-19 tests a person can undergo, there may be fees for testing. Finances should not be a barrier to testing, though, and patients with questions about cost are encouraged to contact their provider or NMC directly.

“This community is very lucky to have a curbside collection center.  It is a huge convenience both for employees and their families and the greater Franklin County area to have this service,” says Gonnella-French. “They are very personable, and the collection and testing can occur in a timely manner to minimize work interruptions.”

The team at the Curbside site continue to rely on one another, with each day ushering in the unknown. “COVID isn’t the mother-in-law, who stays for a while and then leaves,” says Scanlon.

Expectation for the Curbside Collection site is to be functional for at least two years, with the possibility of additional services, as circumstance prevails.

“I want to thank all the folks that were involved in the inception and the revisions of this innovative idea, to get it to be the well-oiled machine that it is today,” Gonnella-French offers.

“We chose this profession because we care about the science,” Scanlon says, of the team at Curbside. “We are proud to be able to provide our community with access to necessary testing; and to be held accountable for reliable results.”

 

Close to Home: Curbside COVID-19 Testing in St. Albans

After a necessary business trip took him to northern Texas, Chris West returned home to St. Albans to begin the fourteen-day state required quarantine period.

“It is what it is, the price for travel and the ability to still work, for which I am grateful,” says West, who began sleeping in a guest room at the back of his home.

With his wife at higher risk due to cardiac and pulmonary issues, West took as many precautions as possible, including sitting at the opposite end of the table during meals and using a separate bathroom. “Maybe I am inclined to wash my hands for a little longer now,” he says. “Hand washing has been ingrained in me from childhood, but who knew you were supposed to take 20-seconds to do that?”

As Friday approached, the seventh day of his quarantine, West decided to call the NMC COVID-19 Hotline, to inquire about testing.

“Setting up the appointment was quick and totally painless,” he says. “They asked me why I was requesting a test and if I was experiencing any of a long list of possible symptoms. They wanted to know the date I had returned to Vermont so they could appropriately schedule the test.”

He received a phone call later that afternoon, informing him of an appointment at NMC’s Curbside Collection Site for the very next morning. West arrived and waited just a few minutes, even though he was several cars back in line. Following traffic cones around the building, he was met by the runner and collector.

“There were just two people I interacted with, one to inform me of the procedure and one to take the sample. There was no pain, it actually tickled,” says West.

“It really could not have been simpler, and the drive-up location meant avoiding the hospital, which is almost always a good thing if you can.”

West says he began checking the NMC Patient Portal every few hours, starting that same evening. “I knew they said it would be 48-72 hours, but as the eternal optimist and compulsive phone checker, I wanted to know as soon as I had the official results.”

Surprisingly, Saturday evening his result came in. “The first thing I did was stand up, walk over and kiss my wife,” he says, “assuring her that I was virus-free.”

West also received a call from his Primary Care office that Monday morning, informing him of the same result he had received via the Patient Portal.

Before COVID-19 West traveled regularly for business, usually three weeks per month. He says he is grateful for an accessible testing site, especially one close to home, as circumstances may require him to leave the state again.

“Being patient and waiting for the result was the most challenging part,” he says. “I was sure I didn’t have the virus but getting tested was the right thing to do. You can either chose to be a part of the solution or ignorantly be a part of the problem.”

 

Concerned You May Have COVID-19?
Call NMC’s COVID-19 Hotline at 802-752-1500.

If you have symptoms of COVID-19 (cough, fever, shortness of breath, respiratory symptoms) and are seeking medical advice, please call NMC’s COVID-19 Hotline at (802) 752-1500.

• As always, if you have a medical emergency, please call 911;
• If you have a primary care provider who is not employed by NMC, you can call their office;
• If you have general questions about the coronavirus, please call 211.

This call is a telephone office visit. Each caller is registered, assessed by a provider, given appropriate medical direction; and billed as a primary care office visit (insurance coverage is the same as an in-office visit).

NMC providers are staffing this line 7 days per week to help you get the care you need: 8am to 8pm Monday through Friday; 8am to 5pm on Saturday; and 9am to 3pm on Sunday. If you have questions about your symptoms, please call us at (802) 752-1500.