COVID-19 has occupied every corner of the public’s mind since it struck home, but perhaps no more so than for hospitals and health care workers.

The coronavirus pandemic has pushed Southwest Health System in Cortez to hold the majority of primary care visits through video conferencing. And while the scene in rural Colorado is different than in larger urban centers, providers must take precautions to ensure they remain safe and healthy on the front lines.

Meet some of the people on the front lines of the coronavirus pandemic in Southwest Colorado.

A nurse at the gatesPamela Clark is a family nurse practitioner who until recently, specialized in chronic pain management. She joined the Southwest team in January, and for the past couple of months has been a primary operator of the drive-thru flu and COVID-19 clinic.

“I look at my job as a calling, more than just a job,” she said. “When I went into nursing, I knew that it was a high possibility that I could contract some kind of disease.”

When a patient arrives at the clinic, Clark and her colleagues go to their vehicle in full personal protective equipment – N95 mask and shield, gown and gloves. They ask a series of questions about symptoms, exposure to someone with COVID-19 in the past 14 days and whether they’ve been outside the country in the past 14 days.

Depending on their symptoms, patients may be tested for flu and/or COVID-19. Patients with significant health issues are directed to the emergency room or walk-in clinic.

A lot has changed.

“They would call the walk-in clinic or the ER, and someone would meet them at the car in full PPE and take them to a sick room so they weren’t with well patients when they went into the facility,” Clark said.

Right now, if a patient who doesn’t test positive for the flu but meets the coronavirus criteria of fever, dry cough and shortness of breath, a nasal swab specimen is taken by Southwest and sent to an off-site facility for a COVID-19 test. Test results usually take two to seven days, according to Bridgett Jabour, executive assistant at Southwest Health System.

Southwest is working to purchase testing equipment, so that the hospital can conduct in-house testing and get results in two to four hours, Jabour said.

At the drive-thru clinic, Clark’s job also means supporting visitors emotionally. She encourages patients to focus on something they can control, like social distancing and using masks.

“Everyone is afraid of the unknown,” she said. “And that’s truly what you’re talking about when you say, ‘I don’t know if I could be a carrier or not.’ We’re kind of all in the same boat.”

Staff also offer some spiritual care for residents who have lost loved ones to the coronavirus.

At the end of a day, Clark goes home and washes her clothes. She practices what she preaches: social distancing and face coverings.

She remembers doing this before, during the HIV outbreak, when she met every patient wearing mask and gloves.

“And the same thing stands true now,” Clark said. “Standard precautions are what really prevent most of the diseases from being transferred.”

At the front line of communicationDr. Kameo Smith, a family health physician at Southwest, in on the front lines of communication.

In the earliest stages of the pandemic, Southwest Health System took a traditional approach to illness, dividing exam rooms into sick and well rooms, and waiting rooms into sick and well areas. Once Southwest Health realized the dangers of asymptomatic patients, who appear well but were carriers of the coronavirus, things changed.

“Then we really made the transition toward a telemedicine, telehealth model of care,” Smith said.

Smith spends a lot of time now talking to patients on the phone or a video conference, about the same number of patients as before, but she focuses more on problems rather than on preventive care, she said.

Staff still see high-risk and urgent patients in person, but the hospital is careful of how many people come in at a time, Smith said.

“We’re trying to be a little bit choosy about that, so that we don’t have all of them coming here all at the same time,” Smith said. “We don’t want a waiting room full of people.”

Right now, 80% to 90% of primary care visits are conducted through video or telephone at Southwest, said Jabour, and it has seemed to help.

“I’ve really found that as long as we’re in close communication with them, it really helps ease a lot of those fears and anxieties,” Smith said.

The pandemic has turned her into a “germophobe,” Smith said. She is always masked, keeps hand sanitizer in the car, and leaves her work gear in the garage.

“If I get sick I can’t take care of other people,” she said.

House calls take a back seatDr. Charlotte Barry is an internal medicine physician. She was stationed at Southwest’s clinic in Mancos but was temporarily relocated to Cortez when the pandemic hit home.

She treats people ages 17 and up, but compared with other family doctors, tends to get more referrals from older, chronically ill patients, she said. Beginning in January, she began conducting home visits once a month – helpful for patients who can’t drive and perhaps more personal, she said.

“I’ve been delighted at some of the response I’ve gotten to my home visits,” Barry said. “And how welcoming my patients are, and how touched they are that I would come to see them at their house. And that in turn has pretty deeply affected me, I feel like it’s almost a return to the old-fashioned types of medicine.”

The coronavirus interrupted her at-home practice, but when her video and phone work is done, she tries to maintain her monthly home visits.

Stress over the coronavirus threat has affected her patients’ health, too.

“Everybody’s concerned, worried, frightened,” Barry said. “That’s kind of become a big part of a lot of visits, at least right now. More people are experiencing sleep disturbances, even clinical depression, unfortunate levels of anxiety. A lot of folks don’t know what kind of precautions they need to take, a lot of people don’t even really understand what social distancing is.”

She and her colleagues emphasize how patients can protect themselves, making do with what they have.

And her own feelings about the coronavirus?

“I’m more long-term worried than worried for myself in an immediate sense,” she said. “I’m just more long-term worried for what’s going to happen to the medical profession, what’s going to happen to this region, where so many businesses are mom-and-pop businesses. I’m long-term worried. In the immediate sense, this is the job we’ve chosen. You always kind of think about that stuff in the back of your brain.”

Mercy Regional Medical CenterDarcy Rumberger, an emergency medicine physician at Mercy, said that growing up, she swore she’d never get into the medical field. With her two parents both private practitioners, she had a sort of inherent teenage rebellion to the idea.

But, as she went through school, there was no denying her passion.

“When I got into college, (the medical field) fascinated me, and I just couldn’t get enough,” she said. “So much to my parents’ chagrin, I told them I was going to get into medicine.”

Emergency medicine, to be exact. The draw of connecting with people on their worst day, practicing all kinds of care and being able to see immediate results drew Rumberger to the field.

After 10 years of emergency room experience, she was as prepared as one could be when coronavirus started to dominate headlines. But with children at home, and parents she cares for, there was a sense of personal caution.

“It’s exceedingly important we’re as careful as possible,” she said. “We’re all very aware of that, especially if we have susceptible people in our lives. We need to do our jobs, but we also have to go home to our families.”

Kendall Rockler, the medical director for Mercy’s Emergency Department, said hospital staff members have risen to the challenges posed by the virus and created a camaraderie that helps them soldier on despite the emotional toll.

“We’ve always been front-line providers because we never know what’s coming in the front door,” she said. “We all went into this career understanding there’s an inherent risk when we chose this type of medicine.”

That’s not to say the hospital isn’t taking heightened precautions, Rockler said. Mercy created a special wing in the Emergency Department for patients suspected of having the virus, called the “COVID cul-de-sac,” to better isolate the virus from staff and other patients who require care.

And there are a number of new precautions and protocols – putting on and taking off personal protective equipment, showering before and after shifts and leaving shoes at work – that weren’t routine pre-pandemic.

Rockler said Mercy has yet to see a spike in COVID cases. As people stay at home to reduce spreading infections and avoid unnecessary trips to the hospital, the emergency room’s volume has been down.

“That said, the patients coming in sick with it are very sick,” Rockler said. “It really takes a toll, even on people with strong immune systems.”

Southwest Colorado has not seen a spike in cases – in part because of a lack of testing, but also because health officials believe social-distancing measures might be working. But most health officials believe a rise in cases is expected in the coming weeks.

“My message for the community is, let’s keep doing what we’re doing,” Rockler said. “We appreciate everything people have done to stay at home, and we’re here to protect you if you get sick.”

For Rumberger, maybe one of the most poignant moments came last week as she was leaving for work. Her 4-year-old son imparted some innocent advice: Don’t get sick.

“I go to work nearly every day, but he never understood what I do,” she said. “But now he understands I go to take care of people that need me. It was very sweet.”

San Juan Regional Medical CenterBefore leaving work, Robin Malara changes out of her work clothes and shoes. When she gets home, she immediately changes again and takes a shower before interacting with her family.

Normally cautious, it’s an additional precaution Malara has taken to protect herself and her family from COVID-19.

San Juan County had 243 positive cases with 1,961 tests completed as of Friday afternoon, which include 14 deaths. San Juan Regional Medical Center was caring for 16 COVID-19-positive patients as of Thursday.

“The past several months have been a blur,” said Malara, an intensive care unit nurse with San Juan Regional Medical Center for seven years.

Malara said the hospital started preparing months ago for the coronavirus pandemic, and so far, there hasn’t been a shortage of personal protective equipment, or PPE.

“We are seeing some very sick patients right now,” she said. “It has been stressful for me personally as well as for the other caregivers on my unit.”

She added the hospital has created new policies to protect both hospital staff, patients and the community – like separating non-COVID-19 patients and COVID-19 patients into separate wards, additional PPE requirements and daily temperature checks for staff members.

Dr. David Devitre, who has worked throughout the hospital for 10 years, said while the number of patients in the hospital is down from previous years, they are caring for sicker, more critically-ill patients because of the coronavirus.

“It’s a bit different working in a pandemic like this, almost like a war zone,” Devitre said.

Doctors and nurses, who are still learning about the new disease from colleagues in Italy, China and across the U.S., don’t have a definitive way of how best to treat patients, he said.

“After a few days of being stable on a ventilator, we’ve seen patients just crash. It’s probably the scariest thing with the disease,” Devitre said. “They go from being stable to being dead within 12 hours.”

He added that is why it was so important for people to realize the severity of the virus and continue to maintain social distancing to decrease the spread of the disease and lessen the strain on the hospital.

Malara and Devitre expressed gratitude for the support from the community – in donating personal protective equipment, food and money – and the continued work of the front-line responders, including doctors, nurses and hospital support staff.

Reporter Liz Weber, of the New Mexico bureau, contributed to this report.