As of Thursday, the state of Iowa has 66 additional positive cases of coronavirus, bringing the total to 614, according to the Iowa Department of Public Health. There have been 8,054 negative tests to date.

As of Thursday, Hamilton County has had no positive tests for COVID-19, according to Shelby Kroona, Hamilton County Public Health administrator.

On the local front, healthcare professionals are preparing for when those first positive case arise. At Van Diest Medical Center and Van Diest Family Health Clinic, precautions for patients and staff have included eliminating visitors to the patient floor, canceling non-essential medical appointments and procedures and screening everyone who comes to the hospital.

“We have opened an incident command with about 13 leaders from the hospital who have met daily since about March 18 when we started to see a few more cases in Iowa,” Lisa Ridge, VDMC chief executive officer said. “The incident command, the frontline staff and providers have done an excellent job of being nimble and fluid through the whole process.”

Ridge said the incident command looks at things like the staffing, equipment needs, looking at the facility’s services and what has been reported to the governor’s office or to the Iowa Department of Public Health.

At the end of the day, the incident command issues a report to the providers who share the information with the frontline staff, Ridge said.

“We have a lot of communication going out through emails and through the marketing department,” she said. “We’re also meeting with the providers in person once a week to talk about the information and any new guidelines we receive.”

The hospital is utilizing the guidelines and data issued by the Iowa Department of Public Health and the Centers for Disease Control, as well as the governor’s office, to direct their decisions about the facility, according to Ridge.

Even though the current situation is stressful, Ridge said she commended the hospital’s leaders, providers and frontline staff.

Lee Miller, director of clinics, said the clinics are also carefully monitoring the guidance from the IDPH and CDC.

“When the testing framework changes or they recommend different processes for handling these patients we’re doing that,” she said.

Miller said the clinics are triaging any patients with respiratory symptoms to identify those who may require COVID-19 testing versus those who have a random non-specific respiratory illness.

“We’ve moved recently to seeing non-sick patients in the morning,” Miller said. She added that while most non-essential, routine visits have been postponed until the pandemic has passed, some patients still need to see the providers.

The afternoon is devoted to those with respiratory symptoms.

“That’s been working fairly well,” according to Miller. “Patients like that idea and it makes it a little easier to triage those respiratory patients.”

Patients and visitors are screened as they arrive at either the clinic or the hospital and any person displaying respiratory symptoms will be asked to wear a mask. At each entrance a quick respiratory assessment is conducted, and the person’s temperature is taken, Ridge said.

“We also have segregated waiting rooms, with one area designated for respiratory patients. And we’re asking them to stay six feet apart,” she said.

Patients with questions about COVID-19 can call the clinic where they will be connected directly to a nurse who can help them.

“They can discuss any symptoms they may have,” Miller said. “They talk with the patients and providers to determine what the next step is for those patients.

She said the phone line has been well utilized in recent days.

“We also direct people to call 211 if they have basic questions about COVID-19,” Miller said.

Additionally, the clinic can now offer virtual visits with providers via the internet.

“The patient is at their house. The provider is able to talk with them and see them and go over some of the more routine things the patient may need to be seen for,” Miller said. “We’re doing multiple virtual visits each day.”

Amy McDonough, chief nursing officer, said cardiac and pulmonary rehabilitation visits have been suspended since those patients are generally higher risks. Senior Life Solutions meetings have also been suspended at time.

For those who are admitted to inpatient beds, the no visitor restrictions can be a challenge.

“We understand that they want to interact with their family members so we have made electronic devices available so the patient can Facetime with family and friends,” according to Lori Foster, marketing director. “We’ve gotten terrific, very positive response from those patients.”

Foster said all of the hospital’s external events have been cancelled or postponed. Internally, the hospital and clinics have limited gatherings and meetings to less than 10 people or utilize one of the online applications, like Zoom or GoToMeeting.

The staff is monitoring the hospital and clinic’s supply of personal protective equipment daily.

“We’re not at a critical level here,” Ridge said.

VDMC is a critical access hospital which means they have a 25-bed limit. But during the pandemic, Ridge said those restrictions have been listed. The staff has been planning for a surge, if there are more than 25 patients at one time.

“We’re planning for that. We’ve identified rooms that we can put patients in if we have more than 25,” Ridge said. “Because we’re in the MercyOne Health system, we’re constantly in communication with them and if the situation puts us at capacity or Mercy is at capacity, we’d likely take the lesser sick patients here at VDMC.”

“Sometimes you have to think outside of the box and think of different rooms we’ll need,” she said. “We’ll definitely be able to handle the surge if that happens.”