Maran Shaker, a U.S. Army combat medic in Afghanistan prior to entering the UNLV School of Medicine’s first class in 2017, took the phone call from a frantic mother of three, a young woman sobbing so uncontrollably it was difficult for him to understand her.
The woman wanted a family appointment for the COVID-19 curbside testing program run by UNLV Medicine, the medical school’s clinical practice, but she wanted something more, too. She wanted assurance Shaker couldn't give: “She continued to ask me, ‘Are my kids going to die?’”
UNLV Medicine began COVID-19 testing on March 23. By the middle of the first week of April, 2,500 people had been tested. About 11 percent had tested positive for the novel coronavirus that causes the disease.
Vital to understanding how to defeat a disease, testing also helps allocate medical resources. The United States does not have an unlimited supply of medical supplies, including the ventilators used to overcome severe cases of the infection. If health officials know which areas are hardest hit, funds and supplies can be sent to those areas so better care can be administered.
Nearly 15,000 people, including doctors, nurses, respiratory therapists and certified nursing assistants working with coronavirus patients, called the UNLV Medicine contact center during late March and early April, all asking for an appointment in the testing program directed by Dr. Michael Gardner, CEO of UNLV Medicine.
So many calls and questions came into the UNLV Medicine administrative offices on West Charleston Boulevard that the number of medical students and physicians required to answer them jumped from five to 18. UNLV medical students and physicians took the calls spread out in rooms to meet social distancing guidelines.
On a recent day, students Hadley Johnson and Sarah Grimley, and resident physician Dr. Mitchell Lyons, worked the same questions into their conversations with callers: Do you have a sore throat or cough? Have you felt that you have had a fever or measured a high temperature? Are you having trouble breathing or having shortness of breath? Did you have contact with a person who tested positive COVID-19?
These questions and others are part of a Centers for Disease Control and Prevention screening protocol to determine if someone meets the criteria for a test. Patients only receive an appointment if they meet CDC requirements.
“The first week was especially tough with an enormous volume of callers,” Shaker said after a 12-hour day of taking appointment calls for the testing program held near downtown in the Las Vegas Medical District. “Some hadn’t even spoken to anyone in days and just wanted to connect with another person. Other callers were too afraid to buy groceries and reported that they were only eating what they could find at home. One elderly gentleman was afraid to go through the testing process. When I asked him why he said, ‘If I test positive will they take me away or lock me up?’ He believed that if someone tests positive, they were taken away to a location where they were quarantined.”
Shaker, responsible for the lives of up to 40 soldiers every time his unit went on a mission in Afghanistan, couldn’t get the retiree and the young mother out of his mind.
“One of her children had shown flu-like symptoms for a few days including some cough, sore throat, and a fever,” Shaker recalls. "Then the second child followed with similar symptoms, and now the third as well. All of them sick and getting progressively worse.”
The more Shaker spoke with the elderly man and the young woman the more he knew the calls were about more than just screening individuals for an appointment.
“This pandemic is extremely scary,” he said. “We must do everything in our power to distribute accurate medical information and services to the Las Vegas community.”
Empathy for the woman’s situation — embodied in some reassuring patient education, information about medical and social services, guidance on what to do in case of emergency, as well as a testing appointment — helped Shaker calm the woman down, giving her a glimpse of hope by the end of the call.
“I think this experience will better prepare me for my intended career in emergency medicine,” Shaker said. “A military concept that I embrace is that when things go wrong, we don’t rise to the occasion but we fall back on our training. This pandemic will help better prepare a generation of health care providers and enhance our ability to respond to such large-scale medical needs. This could very well be our training for something bigger in the future.”
A testing center comes to life
It is 8:30 in the morning and Dr. Gardner notes that this part of his team has already been at the testing site for more than an hour. The first patient isn’t scheduled until 9 a.m. Tracy Geiger, the UNLV director of physician services and testing site project manager, explains the process:
“We arrive early to the site to huddle and to ensure that everyone understands their role for the day,” she said, adding that Gardner’s strategic plan makes it easy for medical professionals to buy into the project and step in to relieve each other. “Once he communicated it to his leadership team, we were off and running.”
There is a chill in the air, but the sun is quickly burning it off. Members of the team who will interact with patients wear a KN95 mask, face shield, disposable gown and gloves.
“I have to tell you that as important as this testing is, the most difficult work is in the contact center,” said Gardner, who played a key leadership role in Houston after Hurricane Harvey stormed through America’s fourth largest city in 2017. “The number of calls for testing has been almost overwhelming. People are scared and our students and physicians are doing a good job of calming them down. People appreciate actually talking to a live person when they’re upset.”
In some other appointment-only testing programs around the country, automated phone systems were used. Systems often became so overloaded that all callers got for hours, and sometimes days, was a busy signal, leaving the already overwrought even more harried.
After a meeting Gardner had in mid-March with officials of Clinical Pathology Laboratories, the lab agreed to supply UNLV Medicine with 1,400 hard-to-find testing kits, with a promise of supplying more as they became available.
The speed with which the UNLV program was set up — less than a week — underscores the importance of having the right people in the right place at the right time.
Gardner was aware other drive-through testing programs set up in the country frequently turned chaotic when hundreds of cars, often creating mile-long traffic jams of angry drivers, showed up at the same time for testing. So he decided it would be best to do testing by appointment with live phone assistance.
Arrangements were made with Las Vegas Metro Police Department and UNLV Police for traffic control and security. Generators were rented to power IT equipment and to refrigerate patients' specimens before they were sent off to Clinical Pathology's testing center in Texas. Tents were secured for staff to work out of the elements and to house medical devices and computers. Networking was provided to connect computers in the parking lot to UNLV Medicine’s medical record system.
Masked medical personnel directed the driver through a lane of red cones and motioned for him to stop outside a white tent that served as a testing station. Standing outside the driver’s half-open window, certified nursing assistants April Miranda and Tiffany Robledo checked the man’s identification, got his insurance information, took his temperature, and checked his oxygen levels. He was then instructed to blow his nose. Within seconds, Robledo reached through the open window, swabbed inside the man’s nose and the patient was on his way.
His sample was securely packaged, refrigerated, and later that day was on its way to the testing center. About five days would pass before the man knew his test results. All positive results are also being reported to the Southern Nevada Health District.
“Medical assistants and administrative people are working side by side with resident and faculty physicians, every one with the idea of helping the community," Gardner said. "We knew we couldn’t meet the entire testing need but we wanted to do our part. It’s what a state medical school in Las Vegas should be doing.”