Inside the Tumwater clinic that saw Thurston’s first positive COVID-19 test
At any given time, there are up to 10 vehicles parked outside the Tumwater Family Practice Clinic at 150 Dennis St. SW. Driver’s side windows are rolled down, revealing patients who wear surgical masks already distributed by clinic staff.
Medical assistants and physicians wearing gowns and protective equipment tote buckets back and forth between the vehicles and a white tent just outside the clinic. The white tent serves as a “containment zone” for supplies, apart from the actual clinic itself.
The patients are in their vehicles because the clinic has determined via phone screening that they should not come inside the clinic due to possible COVID-19 — maybe they have a fever, a cough or both.
Once patients pull up, they’re asked more specific questions: Have you had contact with a person known to have COVID-19? Where do you work? A medical assistant takes their vitals.
At the end of this litany of protocols — all created by the clinic in recent weeks — the parking-lot patients may ultimately be tested for the disease caused by a novel coronavirus that’s sickening hundreds of thousands of people and overwhelming health-care systems around the world. Or a physician may determine their case is likely just seasonal allergies or a common cold and forego the test.
According to Clinic Administrator Jennifer Tyler, the clinic perceived and adopted its new procedures on the fly, in the absence of clear direction from state and federal public health officials.
“It’s gotten better as time’s gone on, but in the beginning we had to do a lot of it all by ourselves,” Tyler said.
Using this model, the clinic found what was very likely the county’s first positive case of COVID-19 on March 11.
Creating a blueprint
When Washington state saw its first positive coronavirus cases in January, then its first virus-related death in late February, Tyler knew it was time to mobilize. She heard of other primary-care offices turning away patients with COVID-19 symptoms, and was “pretty horrified.”
“That’s what we’re here for,” Tyler said. “We all signed up for this.”
The clinic’s first priority: Protecting clinicians and staff so they could continue to work through possible exposure to patients with the virus.
The clinic immediately started requiring staff and patients to wear surgical masks, Tyler said.
Planning ramped up March 6, when Tyler heard on the radio that Quest Diagnostics was going to start processing COVID-19 tests at a lab in California. The Tumwater clinic was already working with Quest for other tests.
The clinic started collecting test samples that day.
By March 9, when they could start submitting those samples, the clinic had protocols in place for parking lot appointments, according to Tyler.
She worked with the Tumwater Fire Department and local hospitals to create and finalize policies, in case a suspected COVID-19 patient needed to be taken to the hospital.
Tyler says the clinic complied with initial, restrictive federal Centers for Disease Control and Prevention (CDC) guidelines for testing at first, then expanded its criteria ahead of the CDC to test more people. Now, the clinic is “pretty much in step,” Tyler says, as the federal agency has loosened its criteria.
While everyday checkups and appointments have declined at the clinic, calls from patients with symptoms of COVID-19 have risen.
Dr. Karolina Wilczynska-Oberc, a physician at the clinic, told The Olympian about one-third of the patients she’s seen recently have had exposure and have symptoms consistent with the disease. The Tumwater clinic has been testing between 10 and 23 people per day for COVID-19.
“If there’s any possibility of it, we’re testing them,” Wilczynska-Oberc said.
Tyler said she’s shared the clinic’s new protocols with a group of other clinic managers across the state. Locally, she said Yelm Family Medicine and Pioneer Family Practice in Lacey are implementing similar practices and sharing lessons learned.
The streamlined situation at these local clinics doesn’t reflect many Washingtonians’ experiences in trying to get tested.
Social media and everyday conversation are rife with stories of symptomatic people who are ping-ponged from a medical provider to a state agency, to a local agency, and back again.
Providence St. Peter Hospital started drive-through testing for COVID-19 in Lacey for high-risk patients last weekend.
The Tumwater clinic is owned by four physicians, and the smaller team there is in a more agile position to react and adapt than a big hospital system like Providence, according to Tyler.
“I imagine Providence and the bigger facilities get bogged down in red tape,” Tyler said. “And we just don’t have that here. And we wanted to help.”
The county’s first case
On March 11, the clinic received its first presumptive positive result from a sample it submitted March 9, according to clinic records shared with The Olympian.
Quest called the physician assistant who conducted the test in the middle of the night, Tyler said, and the clinic immediately notified the local health department and the patient.
“My heart just dropped, because then you know it’s a whole other level,” Tyler said. “You prepare for it, you think about it, you know it’s going to happen. When it actually does, you’re just kind of in shock and it’s another mode.”
It’s very likely this was the first COVID-19 case discovered in Thurston County.
Thurston County announced its first positive case, a man in his 50s, on March 11. And the state Department of Health later confirmed that man worked for the state Department of Health in Tumwater.
Thurston County Public Health would not confirm with The Olympian nor the clinic that its March 11 result was the first positive in the county. But the timing and patient’s descriptors align.
As of Monday, it was still the only positive result the clinic had received after running 170 tests — but test results were taking about one week to come back to the clinic.
Limitations
Like every other health-care provider in the state, it’s a daily struggle for the clinic in Tumwater to obtain the necessary equipment to test patients: test kits, materials and personal protective equipment (PPE) for medical providers are hard to find.
The CDC recommends clinics collect “an upper respiratory nasopharyngeal swab (NP),” which requires the person testing to stick a swab deep into the patient’s nostril, hold it there, then rotate it as its removed. That swab then goes into a vial of medium that allows it to be transported.
The clinic has received some swabs from Quest and continues to request more. In the meantime, it’s gotten creative, raiding its supply of testing kits for procedures such as lesions and cervical swabs to verify what equipment can be used. But the supply is limited.
“If we can’t get any more tests, then we can’t test,” Tyler said. “That’s the bottom line.”
People collecting samples wear PPE such as N95 masks, which are effective at blocking very small particles, as well as gloves, eye protection, and gowns.
The clinic hasn’t gotten a shipment of N95 masks from its normal supplier in weeks, Tyler said. Local businesses, such as auto repair shops, have donated masks. And the clinic has submitted requests to the state, which has received shipments of medical supplies and test kits from the federal government in recent days.
It has about 450 surgical masks left, which it gives out to patients with symptoms or who are concerned about exposure, along with all staff.
The clinic sees about 150 to 200 patients per day.
“We actually have patients offering to sew masks for us,” Tyler said.
The clinic is accepting new patients with COVID-19 symptoms until it no longer has the capacity — there are some insurance-related limitations on who they can see.
For those who can’t get in at a local clinic or don’t meet criteria for testing, there’s not a consistent message to share.
“I don’t know if there even is a sentence to tell people,” said Ali VanZandt, the clinic’s billing department supervisor who also works as an EMT in Grays Harbor. “Because it is situational, depending on the office and the facility and who’s willing and who’s not. And, unfortunately, there’s more not willing, right now, than willing to be at the front line of this.”
A positive test result, VanZandt pointed out, doesn’t change the course of treatment for a patient, because there is no known treatment.
“If you don’t have the resources, the best thing you can do is just not go out.”
This story was originally published March 24, 2020 at 5:45 AM.
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