Germ Warfare: Fighting COVID on All Fronts

July 15, 2021

On December 17, 2020, Paula Bolton, MS, CNP, ANP-BC, director of Infection Control, received McLean’s first dose of the COVID-19 vaccine.

This signaled the beginning of the end of a very long year that saw Bolton and her colleagues in Infection Control and Internal Medicine working to protect the hospital’s patients and staff from COVID-19.

With days blending into one another and “normal” work hours becoming a distant memory, Bolton and her Infection Control partner, Sophie S. Forte, MS, ANP-BC, WHNP-BC, have often found themselves working around the clock. “Calls at 3am from a clinician on a unit who was concerned about something related to COVID became routine this past year,” said Bolton, who left countless hot meals on the dinner table while attending to yet another emergency.

“Saying this past year was challenging doesn’t even scratch the surface, but I am extremely proud of every one of my colleagues—both those on-site and those who have had to work remotely—for everything they have done to keep our patients and one another safe during the pandemic,” said Bolton, who has overseen Infection Control for more than 20 years, in addition to being the program director for McLean’s Psychiatric Neurotherapeutics Program.

“It was and continues to be a hospital-wide effort, with every part of our community contributing to our successful battle against this virus.”

Though not everyone could be on campus during COVID, their contributions were widely felt. Thanks to the hospital Board of Trustees and donors who funded the COVID-19 Support Fund, McLean’s frontline staff received meals, pick-me-up snacks, and wellness packages to help them through the darkest days of the pandemic.

While Bolton was one of the most visible McLean responders to the pandemic, since March and for the foreseeable future, the hospital’s Incident Command team, composed of administrators, clinicians, and researchers, have worked daily to support Bolton’s efforts to maintain a safe environment for everyone on McLean’s campuses.

Adapting Quickly and Safely

“Throughout the pandemic, we have been ahead of the curve, and as a result, we have kept the prevalence rate of COVID on our campuses to a minimum,” said Joseph Gold, MD, chief medical officer and co-incident commander for the COVID-19 response. He noted that McLean did not plan to treat patients with active symptomatic COVID infection.

However, plans were made to identify patients quickly and isolate them as necessary. If an individual began to exhibit symptoms of the virus, they were placed in a designated isolation room where they were closely monitored by the specially trained unit nursing staff and the hospital’s Infection Control and Internal Medicine teams while they awaited COVID test results.

“If a person tested positive, we transferred them to a medical hospital within Mass General Brigham that is more equipped to manage the physical challenges that often accompany COVID. This system worked extraordinarily well to the benefit of our patients and our staff.”

Woman taking selfie while man delivers vaccine

Gold said bringing together leaders from across the hospital, creating isolation rooms, limiting the number of double rooms, and reducing the number of on-site staff across McLean’s campuses were also key to maintaining a healthy environment for on-campus inpatient and residential programs that continued to care for patients in person throughout the pandemic.

According to Gold, many difficult decisions were made early on in the pandemic. This included:

  • Instituting a no-visitor policy and facilitating patient Zoom and FaceTime visit with friends and family
  • Reducing admissions in inpatient and residential programs to accommodate physical distancing and the creation of isolation rooms
  • Asking all administrative employees and 90% of research staff to work from home
  • Converting the partial hospital services (day programs) and outpatient clinics from in-person treatment to virtual visits

“These transitions occurred so rapidly that I think it was hard for many of us to process what was happening. We just knew that this was the best path for us to take in order to maintain a safe environment for those who were seeking urgent psychiatric care on our campuses and those who were treating them,” said Linda M. Flaherty, RN, PMHCNS-BC, senior vice president of Patient Care Services and co-incident commander for the COVID-19 response. “While it may not have seemed obvious at the time, our staff who were asked to work from home made an enormous contribution by reducing potential exposures to COVID. With lower risk of virus transmission, we were able to keep our inpatient programs open for acutely ill patients.”

Making Progress Every Day

According to Bolton, physical distancing, masking, hand hygiene, and having isolation beds for patients who were awaiting COVID test results were critical to keeping McLean campuses safe in the first months of the pandemic. However, despite all efforts, the hospital did see COVID-19 clusters in its geriatric psychiatry program and its residential women’s treatment program. Each of the clusters was caught early but did result in both programs having to close for deep cleanings and to ensure staff were COVID-free before returning to work.

As access to testing became more available, McLean was able to require a negative test before admission for all patients, began offering optional asymptomatic testing for staff, and procured an on-site rapid testing machine, which allows for any patient exhibiting symptoms to be tested and learn of their results within an hour. All of these efforts further protected the McLean community from illness.

“Easy access to testing was a true game changer for us,” said Bolton. “Thanks to these advancements, we were able to be more confident that we were identifying COVID-positive individuals before they arrived on campus or before their symptoms became severe. These added precautions allowed us to decrease the number of isolation rooms and add more double rooms, thereby increasing much-needed patient capacity.”

With so many protections in place, by midsummer, the hospital also began working to bring researchers back on-site—developing safety plans for each lab that required physical distancing, sanitization of all equipment, and masking at all times.

“Having our research labs operating—albeit with modified hours and staffing patterns to ensure adherence to physical distancing—was a major step toward returning to some normalcy for us,” said Michele L. Gougeon, MSS, MSc, chief operating officer and executive vice president, who is spearheading the hospital’s COVID-19 recovery process.

“Increasing bed capacity, bringing research back to campus, operationalizing rapid testing for patients and employees, and rolling out the vaccine have all been key elements to our recovery,”
– Michele L. Gougeon, MSS, MSc, chief operating officer

While so much of the focus of the past year has been on COVID, McLean and other psychiatric services across Massachusetts saw a substantial increase in the need for urgent psychiatric care, resulting in McLean’s decision to open a new 20-bed adult inpatient program and increase its inpatient capacity at McLean’s Middleborough campus.

“Increasing bed capacity, bringing research back to campus, operationalizing rapid testing for patients and employees, and rolling out the vaccine have all been key elements to our recovery,” said Gougeon.

A Look Ahead

By April 2021, 84% of McLean’s employees, including dietary and housekeeping staff, have been vaccinated—something that sparks hope for many. However, Bolton is quick to point out that COVID is not over yet and continues to stress vaccinations, taking precautions to be safe, and practicing good hand hygiene.

“The vaccine offers optimism that someday—maybe not tomorrow or even in the next six months, but someday soon—we won’t need to worry about COVID, but for the time being, even those of us who are vaccinated need to take precautions,” said Bolton.

“But there is hope,” she added. “Though many of us would love to forget 2020, it’s important to remember the good that we achieved. We never lost sight of our mission—to care for some of society’s most vulnerable people. Our response to the COVID crisis has made me reflect on how grateful I am to be part of this community and its unyielding commitment to the people we serve.”

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