Rachel North was on the other side of the parking lot lane at the Deschutes County Fair & Expo Center when an elderly woman started shouting questions at her.

“How am I supposed to get in this thing?” the mobility-challenged woman barked as she tried to maneuver into a golf cart. “I can’t get in this thing. I need a wheelchair!”

Her tone was either impatient and mean or simply firm and direct, probably depending on the disposition of the person to whom it was directed. In North, she had found the perfect recipient.

“We’ve got wheelchairs,” North said gently, with a big smile on her face. “You get back in the car and wait, and I’ll make sure we get a wheelchair out here to you.”

As she pulled away from the woman’s car, North laughed good-naturedly at the exchange. “I work for the Transportation Security Administration (in the Redmond Airport), and that can be a little rough, you know?” she said. “I’ve been seasoned. I’ve got days and days of stories. This is a piece of cake for me.”

It was a Saturday morning at the fairgrounds, and hundreds of people age 75 and older were arriving to receive their first dose of the COVID-19 vaccine. The weather was cold and unusually blustery, and patchy snow and ice on the ground made access to the large-scale vaccine site inside — operated by St. Charles and Deschutes County, with help from the Oregon National Guard — particularly tricky.

That’s where North and her fellow golf-cart drivers came in. Their mission was simple: Crisscross the parking lot looking for cars with their hazard lights blinking. That was a sign that someone inside (or standing nearby) needed assistance.

“Sometimes,” she said, “they might be waving their arms or honking their horn.”

North is just one of “several hundred” volunteers who have helped make the fairgrounds vaccination site a success over the past few weeks, said Trevor Janeck, a talent acquisition manager at St. Charles who is helping to oversee the volunteer effort. In addition to ferrying people from the parking lot to the door, volunteers are greeting people as they enter, registering patients and helping guide them through the process, among other jobs.

Their efforts have not only been a vital part of the operation so far, they’ve been inspiring, Janeck said.

“The response from the community on this has been incredible,” he said. “Everyone who has volunteered has been so kind and so willing to do whatever it takes to make this place work as smoothly and efficiently as possible. And almost every one of them says more or less the same thing: ‘It’s just so important that we get this vaccine to people, and I want to help however I can.’”

More than 1,000 people have signed up to volunteer at the St. Charles website and at Deschutes County’s website, which is more than the fairgrounds site can even use.

“We’ve had to turn people away,” Janeck said. “It’s just been overwhelming.”

One of those volunteers is Teague Hatfield, owner of the Birkenstock store in downtown Bend. On a recent weekend, he was stationed just outside the clinic, greeting everyone who walked by and funneling people toward the check-in area. He said he signed up after a co-worker volunteered and encouraged him to do so.

“I came out a couple days ago and, honestly, it was just a ball,” he said. “People were in good spirits and it felt like it was helpful, so I came back to do it again.”

Hatfield said he was impressed by the operation and planned to take a shift per week as long as volunteers are needed.

“We’ve all been sitting around waiting for something to happen, so this is exciting that it is happening,” he said. “And being out here, like 99.9% of the people have been friendly and appreciative and the whole bit. This is what I’ve done my whole life, just talked to people.”

On the other side of the clinic, Wendy Worstell stood near in the hallway between the vaccination area and the recovery room, where patients are asked to wait for 15 minutes to make sure they don’t have a reaction. Her job? To make sure no one wandered through without getting their shot.

Worstell is a retired registered nurse with a daughter who teaches for Bend-La Pine Schools. She is currently splitting time between Central Oregon and Eugene and said she came to the fairgrounds to do whatever she could to help.

“I just think it’s hugely important that when we have a pandemic like this, that whoever can step up steps up and helps get the vaccines out there,” she said. “This has been wonderful. I’m so impressed.”

Back out in the parking lot, North dropped off one woman at the front door and started backing her golf cart up to make another run into the sea of blinking hazard lights. With her knit hat pulled down to her eyebrows and her mask up over her nose, she looked like she could’ve been warmer at home. But that really wasn’t an option, she said.

“I volunteer for the Assistance League of Bend. I volunteer for the Nature Center in Sunriver. It’s what you do when you live here,” she said. “I just had the day off and I could sit inside and watch Netflix or I could come out and do a nice thing for people.”

Two days of work. One day off. Then two night shifts, followed by four days off. And repeat.

How you view that kind of work schedule depends on your natural disposition, your approach to life, your domestic situation and other personal circumstances. Some may find it appealing, while others may see it as incompatible with a well-balanced existence.

Either way, that kind of schedule is known as rapidly rotating shift work, and according to Dr. Dave Dedrick, it tends to be hard on human beings’ internal clock.

“Some people would look at that and say, ‘Well, the majority of that time, they’re on days,’” said Dedrick, clinical division director – medical specialties for St. Charles Medical Group. “But those two nights where the work happens outside our normal circadian rhythm puts a tax on the body, because when we’re not in line with our circadian rhythm, our body doesn’t know what to do.”

Dedrick explained the circadian rhythm: “All of these things run like a beautiful orchestra, if you will, and you’re relying on the timing of one part of your body doing something in synchrony with another part,” he said. “The circadian rhythm is the drum major that helps organize all of that, and when it gets out of sync, the wheels come off the cart.”

About three years ago, Dedrick worked with Bend Police to study how the department’s shift schedule affected officers’ sleep patterns and to screen them for sleep apnea. That work was part of a larger effort to improve the health of the unit – an effort that resulted in the introduction of a wellness program that includes yoga practice, mindfulness training and peer support.

Now, he’s doing similar work with the Deschutes County Sheriff’s Office, whose officers work a standard schedule of – you guessed it – two days on, one day off, then two night shifts, followed by four days off. The county reached out to Dedrick last fall as part of its Health of the Force Initiative, which aims to provide tools and resources for deputies to care for their physical, mental and spiritual well-being, said Sheriff L. Shane Nelson.

“The law enforcement profession is stressful on our deputy sheriffs, and their families,” Nelson said. “I work with great teammates. We want to do all we can to improve and take care of them and their families in order to ensure successful careers in providing excellent public safety and customer service.”

Dedrick’s work with the Sheriff’s office will happen through an investigator-initiated clinical trial designed to study how rapidly rotating shift work affects conditions that can lead to cardiovascular morbidity and mortality, such as high blood pressure, high blood sugar and cholesterol levels, sleep apnea and excess body fat around the waist.

“We don’t think of police officers as being a marginalized population, but when it comes to health outcomes, they are very marginalized,” Dedrick said. “They really do very poorly. Part of it is the stress, and part of it is the sleep.”

Dedrick’s trial with the Sheriff’s office is unique in that, thanks to the officers’ schedules, each of the 19 people involved can serve as their own control. Here’s how it will work:

• First, St. Charles collected baseline health data on each officer while they were working the rapidly rotating shift schedule.
• In mid-January, about half of those 19 officers started working all days, and the rest started working all nights. They will do that for about two months and then collect the same baseline data.
• After two months, the two groups will trade shifts and collect data again.
• Near the end of the trial, Dedrick and two partners – Dr. Mark Backus of Cascade Internal Medicine Partners and Dr. Richard MacDonnell of MyMD Personal Medicine – will analyze the data and then hand it over to a statistician to “grind the numbers,” Dedrick said.

St. Charles’ Research Department is setting protocol, obtaining regulatory approvals, coordinating with patients and generally overseeing the trial to ensure the data is completely anonymous and to eliminate any possibility of investigator bias by “letting the data speak for itself,” said Noura Sall, research manager for the health system.

“Often for our trials, the recipe is written by someone somewhere else who works in a particular industry and comes to us and says, ‘Here it is, please follow it to the letter,’” she said. “This time, one of our physicians has an idea and we’re the ones helping to write that recipe. It’s fun and it’s exciting.”

Every single person reading this, I’m sure, is ready to be done with this pandemic.

I know I am. There is light at the end of the tunnel, it’s true. At the same time, we are more than a year into a reality altered by COVID-19, and I’m tired of it. I’m sure you are, too.

As always, though, I’m looking for silver linings. And there’s been a silver lining happening at the Deschutes County Fair  & Expo Center over the past month.

That’s where, in collaboration with Deschutes County Health Services and the Oregon National Guard, we’re administering doses of COVID-19 vaccine to as many Central Oregonians as we possibly can, based on available supply and the state’s sequencing plan. We believe we’ve completed vaccinating most of the Oregon Health Authority's Phase 1A and group 1 of Phase 1B, which cover local health care workers, first responders, educators, childcare providers, corrections officers and staff at long-term care facilities, among others. Since Jan. 20, we’ve administered vaccines to more than 30,000 people, including many seniors.

And we haven’t wasted a single dose. If you’ve heard otherwise, you’ve heard a false rumor. We haven’t wasted a dose, and we will not waste a dose. 

Vaccinating thousands of people is a very good thing, of course, but that’s not necessarily the silver lining I’m talking about.

The silver lining I see at the fairgrounds is one powered by communication, coordination and collaboration. I see an organized and efficient operation stood up in days by a number of smart people who are dedicated to working tirelessly for the betterment of Central Oregon. I know it took many hours of thinking and talking and planning by folks who don’t work together regularly, but who came together to bring this vaccination site to life.

Those people built online schedules and sent out invitations to sign up. They printed and hung signs and stuck tape on the floor to ensure smooth flow. They set up a registration process and a respite room. They created a temporary pharmacy out of thin air. They recruited experienced vaccinators to administer the vaccines.

We have doctors and nurses and pharmacists and patient access pros out at the fairgrounds because they know how important this is and they want to help. We have executives volunteering to spend weekend days there, just to do whatever is needed at any given moment. We have hundreds of people from across our communities showing up to volunteer, simply because they believe it is the right thing to do.

We are not the only organization involved in this effort, of course — not by a long shot. Many local entities have played a part in this process, and if I tried to thank them all, I would inevitably miss one. So, for now, I’ll just offer up an enthusiastic “thanks!” to Deschutes County for its partnership in making the fairgrounds vaccination site a success and to the Oregon National Guard for sending troops to help out. We are fortunate to have partners who are as committed to getting this vaccine into arms and ending this pandemic as we are here at St. Charles.

All of this makes me smile. And I’m not the only one. Over and over again, as educators and others flocked to the fairgrounds in recent weeks, we heard positive feedback about the operation: Easy. Fast. Professional. Safe. “It didn’t even hurt!” Even when some folks had to wait in line out in the cold, never did we hear anyone complain. The place has been buzzing with positivity.

That’s a testament to the teams that made it happen and the time they’ve put into it. Again, I want to express my sincere gratitude to each and every one of them.

Stay safe out there.

Sincerely,
Joe

Grand Rounds - Feb. 5, 2021
"The Many Faces of High Risk Influenza: Best Practices for Recognition and Treatment"

Speaker: William A. Fischer II, MD. Associate Professor of Medicine Division of Pulmonary and Critical Care Medicine Institute for Global Health and Infectious Diseases, The University of North Carolina School of Medicine, Chapel Hill, NC

Access the recording

Objectives

1. Recognize appropriate candidates for influenza treatment or prophylaxis based on guideline-recommended characteristics, without unnecessary testing.
2. Individualize influenza treatment and prophylaxis plans for patients who are at risk for influenza-related complications based on the latest evidence.

Accreditation: Paradigm Medical Communications, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Paradigm Medical Communications, LLC designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is supported by an educational grant from Genentech, a member of the Roche Group.

Target Audience: This activity has been designed to address the educational needs of clinicians involved in the care of patients with or at risk for influenza, including those specializing in internal medicine, family medicine, hospital medicine, gynecology, emergency medicine, and critical care. It may also benefit other clinicians who are interested or involved in the care of patients with or at risk for influenza.

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

This week, I’ve got good news and bad news for you related to our ongoing COVID-19 vaccine rollout.

The good news

Thanks to an incredible effort including St. Charles, Deschutes, Crook and Jefferson counties and the Oregon National Guard, more than 31,000 people in the tri-county area have already received the first dose of the COVID-19 vaccine. That group includes health care workers, educators, first responders and more.

On Jan. 25, we opened up vaccinations to all Central Oregonians age 75 and older, which was ahead of the Oregon Health Authority’s sequencing schedule. We were able to do this because we had already vaccinated the vast majority of those who fall into the first phases of the plan. By doing so, we were able to make our way through a large allotment of vaccine – more than 10,000 doses last week.

The bad news

The state, which controls distribution of the COVID-19 vaccine, is not sending us more first-doses this week. Instead, OHA is redirecting most doses to health systems in the Portland area that are continuing to vaccinate those in the first phases. We are unsure when new first doses will be allocated to us, but we expect this situation could continue for the next several weeks.

This is disappointing, but we feel fortunate that we have been able to get such a great start on vaccinating our most vulnerable residents. It’s also important to remember that we’re truly all battling this pandemic together, because the virus doesn’t differentiate between Central Oregon and the Willamette Valley. It doesn’t recognize county borders or turn around rather than brave snowy mountain passes. If COVID-19 is spreading in Portland, we will be affected. We need as many people as possible vaccinated, no matter where they live.

For those of you who have received your first dose, please know that we have been assured by the state that we will receive second doses of the vaccine. Our second dose clinics will continue as planned.

When we opened up vaccines to a larger population it caused some confusion and a whole flood of questions coming our way last week. In the first 24 hours, we received more than 2,500 voicemail messages on our COVID-19 vaccine scheduling hotline and it took a team of people several days to get through them. We apologize to those of you who had to wait for answers, but we are pleased to say that all those who called either received their vaccine or were contacted with more information thanks to an incredible team effort. 

While I know navigating the system has been difficult for some, we have also been overwhelmed with positive messages from those who have received their vaccine. You can watch one of our 91-year-old patients in this video and hear first-hand about the experience.  

Many thanks to those of you who took the time to write and share your feelings about receiving your first dose. It is heart-warming to hear these stories and know that all this very hard work is making a difference in our COVID-19 fight.  

Sincerely,

Joe

Grand Rounds - Jan. 29, 2021
"COVID-19 Vaccines"

Speaker: Moshe Arditi, MD. Academic Director, Division of Infectious Diseases in the Department of Medicine Executive; Vice Chair for Research, Pediatrics Cedars, Sinai Medical Center; Professor of Pediatrics, David Geffen School of Medicine at UCLA

Objectives

1. Be familiar with the current COVID-19 vaccines
2. Be familiar with the efficacy and safety data with the COVID-19 vaccines
3. Be familiar with the current prioritization for vaccine delivery

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

Shelly Handkins

Shelly joined the board in 2021 after 29 years with Providence Health System, where she worked as Chief Financial Officer of Providence Health Plan, Chief Financial Officer of the health system’s Oregon region and Group Vice President of Payor Contracting for more than 50 Providence hospitals, all employed physicians and ambulatory services across five states.

Handkins is now retired, and in addition to the St. Charles board, she also serves on the board of Lifeworks Northwest, a Portland-based network of behavioral health care providers.

Reason for service: “I have a deep passion for working to deploy affordable, high-quality health care in a population health-based model in order to improve the long-term health of our communities.”

Ann E. Rhoads, CPA

Board Chair

Ann joined the board in 2021 after 33 years as an audit professional with PricewaterhouseCoopers, LLP, including 16 years as an audit partner. She is also on the board for Bend’s Tower Theatre Foundation.

Rhoads has previously served on two other St. Charles committees: the audit and compliance committee and the investment sub-committee.

Reason for service: “I believe access to health care is fundamental to a thriving community and I hope to contribute to our community through St. Charles board service.”

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Jan. 22, 2021

The local COVID-19 vaccination effort is well underway. We are ahead of schedule and are excited to announce the latest in vaccination news.

St. Charles has been working hard with our public health partners to vaccinate everyone in the state’s Phase 1a group. I am pleased to say that as of Thursday morning we received approval from the state of Oregon to move from Phase 1a to Group 1 of Phase 1b in Deschutes County. (If you are in Phase 1a and have not yet received a vaccine, please know that you can still be vaccinated.)

Here is a graphic that explains the phases: 

This means we are actively vaccinating our K-12 and early learning educators along with childcare providers. Our goal is to administer all of the vaccine we have on hand at our large-scale vaccination events at the Deschutes County Fair and Expo Center this weekend. And we are actively working to schedule more vaccine appointments for this group next week.

For a sneak peek into what it’s like to go through the vaccination process at the fairgrounds, please watch this video.

Once Group 1 of Phase 1b is complete, we will again ask for the state of Oregon’s permission to move to Group 2 of Phase 1b, which includes those who are 80 years and older. We will then continue to move through vaccinating the different groups depending on vaccine supply.

At this time, the best way for you to know if you are eligible to receive the vaccine is to visit the Deschutes County website and register. Once you enter your information, the county will send you an email when you are eligible with details on how to schedule your appointment. For information in Jefferson and Crook counties, please visit their websites: www.JeffCo.net/PublicHealth or www.co.crook.or.us/health.

The large-scale vaccine events at the fairgrounds simply wouldn’t be possible without hundreds of people – including many volunteers. It’s been awesome to see the collaboration and community spirit that have brought organizations and people together to make this a success. We’ve received donations of snacks, water and coffee from grocery stores to help keep the team going strong through some very long days.

We are going to be vaccinating people for many months to come and we appreciate all the support to keep the momentum going. Thank you.

A word about Redmond

Unfortunately, we released news this week of a COVID-19 outbreak at our St. Charles Redmond hospital. We are certainly not the first hospital to face this difficult situation as we fight this pandemic, but we do want to reassure you that we are doing everything in our power to control and contain the spread of the virus and to ensure our patients’ and caregivers’ safety.

This type of thing isn’t anybody’s fault. I want you to know that everyone in our organization is working hard to maintain a safe environment, and as an organization we continue to learn and adjust in an effort to improve our safety.

If you have questions or concerns about this situation, please refer to these frequently asked questions, which we will update as our investigation progresses. More than anything, it is important to know that there is no known risk of exposure to people who visited the hospital prior to Jan. 5, 2021, people who visited for outpatient treatment or people who visited a St. Charles clinic. Our staff is actively calling all patients who may have been exposed and giving them instructions on how to isolate and monitor themselves for symptoms. Those calls should be completed today.

In addition, many have asked if the caregivers who tested positive for COVID-19 had been vaccinated. I want to be clear that while some of them had received a first dose of the vaccine, they were not fully vaccinated with two doses. The timing of this outbreak does not in any way reflect on the efficacy of the vaccine – which is shown to be about 95% effective two weeks after the second dose.

We strongly believe the vaccine is an important tool in our fight against COVID-19 and encourage all those who are interested to receive it as soon as they are eligible and supply is available.

This situation highlights that while we are actively working hard to vaccinate our community, the pandemic is not over. A new, more contagious variant of the virus has been identified in Oregon and we must double down on our safety efforts. Although we are all tired of hearing it and saying it, washing our hands regularly, wearing a mask when in public and physically distancing from others should remain our top priority.

Thank you, again, for your support of our team throughout this difficult time.

Sincerely,
Joe