March 30, 2021

Looking back at the pandemic — care during the surges

A multipart series capturing the reflections of Kaiser Permanente employees and physicians on the global COVID-19 pandemic and how it changed their work and lives.

Kaiser Permanente has adjusted in-person and inpatient care to ensure the safety of members, patients, employees, and physicians during the pandemic.

It happened quickly — from curfews to lockdowns, to empty shelves and empty streets. On March 16, 2020, 6 counties in California’s Bay Area issued a stay-at-home order to try to slow the spread of the coronavirus, now considered a pandemic. A few days later, on March 19, a statewide public health order directed all Californians to stay at home. On March 25, Washington’s governor issued a Stay Home, Stay Healthy executive order. And by early April, most of America was following similar measures.

Kaiser Permanente, like many organizations across the country, sent some employees — those who could — home to work. But a large segment of its workforce was needed at the front lines of the global health crisis.

The organization was well prepared after decades of experience confronting highly infectious diseases and crises. Still, for Scott Young, MD, senior medical director for quality at The Permanente Federation, there was an important distinction.

“What was different here is the pandemic hit virtually everywhere all at once,” said Dr. Young. “Instead of having one medical center affected, or maybe part of a region, the whole organization got hit pretty quickly.”

What was different here is the pandemic hit virtually everywhere all at once.

The surge of patients

“All of us in Southern California sort of felt it at the same time.” Larry Rick, a physician assistant specializing in infectious diseases, and a member of the United Nurses Associations of California/Union of Health Care Professionals, said the medical center where he worked started to see its first wave of COVID-19 patients in April 2020. “We really felt that we were going to be put to the test.”

You are vital written in chalk outside a hospital entrance
One of many chalk drawings recognizing front-line health care employees — this one at the entrance of the Glenlake Comprehensive Specialty Center in Atlanta.

It was a scary time for caregivers on the front lines. They are professionals trained to deliver compassionate quality care. They’re also human beings, dealing with a dangerous, fast-spreading virus. “It's OK to be afraid,” said Rick. “It’s OK for your feelings to be your feelings, but you have to ground them in science if you're going to be effective and safe.” 

The guidance on how to safely care for COVID-19 patients changed often in the early days of the first surges. Analyzing COVID-19 guidelines from federal, state, and local health agencies became a new focus for Craig Robbins, MD, medical director for the Kaiser Permanente Care Management Institute’s Center for Clinical Information Services and Education.

“We have a great evidence-based-medicine network within Kaiser Permanente,” explained Dr. Robbins. “We mobilized to help assess the growing evidence for clinical care and operational questions like the effectiveness of medications, mask-wearing, and personal protective equipment.” Infectious disease leaders met regularly to review the evidence and guide decisions for care across Kaiser Permanente.

“All we could do is look to the experts within our organization and what they were telling us,” explained Karen Strauman, RN, a chief nursing executive in Northern California. She took the information coming from the command center to staff on her hospital’s floors. “I would say, today, this is what we know. I wouldn't be saying that this is hard and fast, but today, this is what we know.”

The changing face of outpatient care

To help control the spread of the virus and conserve personal protective equipment for front-line employees and physicians, in April 2020 Kaiser Permanente temporarily closed or limited services at many medical offices and clinics across the organization. For Teresa Mixon, a pharmacy area operations manager in Georgia, that meant closing 16 of the 25 Georgia pharmacies.

“If your pharmacy was closed, you’d be deployed to another pharmacy that was open,” said Mixon. “We wanted to have our team there, so every open facility would have the appropriate help to meet the increased demand.” Safety measures were put in place, including plexiglass barriers at point-of-service stations, masking requirements, and bold signs reminding people to keep 6 feet apart.

We wanted to have our team there, so every open facility would have the appropriate help to meet the increased demand.

As clinic staff made safety changes to in-person care, IT staff enhanced Kaiser Permanente’s existing integrated telehealth capabilities to handle a larger volume of people choosing to get care from home. By April 2020, phone or video visits made up 80% of appointments, compared to an average of 15% before the pandemic.

The blur of the surges

The next 8 months were a blur for many at the front line, with memories coming in flashes.

“I think my family requiring that I had decontamination procedures as I came home and that I followed them rigorously, is still burned into me,” recalled Rick. He also remembers using his commute time to predict the next surge in hospital patients. “The worsening traffic, as you realized more people were not following the guidelines, I knew, OK, we're not going to be doing so well in a little while.”

Mixon remembers the long hours, but also how it felt when staff were appreciated. “I remember hearing ‘thank you’ on the radio to all health care providers. We had members come out with sidewalk chalk and write words of encouragement outside our medical offices, which lifted everybody's spirits.”

Thank you written in chalk on a sidewalk
A message of thanks drawn in chalk outside the Athens Medical Office in Georgia.

Rick recalls early on, when personal protective equipment was hard to find, a group in Los Angeles dropped off a donation of 3D-printed face shields. “We were so honored to receive this giant box of hundreds of face shields. It was moving. It was incredible. It reflected that the community respected what we were offering.”

“The summer seems like it just never ended,” remembered Strauman. “Then in late August or September, it seemed we got a bit of a breather where we started to get a little optimistic, but everybody else was saying, ‘It's coming, it's coming.’ And then it did. For many of us the holidays were overshadowed by the extreme patient care needs.”

What Strauman and Rick will never forget is the loss of life and the incredible toll it took on the families left behind and the caregiver teams.

“It's hard to allow that you lost patients into your psyche,” said Rick. “We're still affected by it. That will never leave us.”

“I think those of us closest to direct patient care are having reservations about how we can continue to do this,” shared Strauman. “So much sickness, so much death. So many families and sad, sad stories.” But she’s also seeing amazing resilience. “People are now beginning to see the light at the end of the tunnel. I see hope and I see joy coming back into their work.”


Part 1: Looking back at the COVID-19 pandemic — the early days
Part 3: Looking back at the pandemic — lessons learned