Kim Blix: ‘The squeaky wheel’ gets healthcare workers what they need to respond to COVID-19

In fall 2019, Kim Blix had been leading the emergency preparedness program for Nevada County’s Public Health Department only a few weeks when a string of power shut-offs began. High winds had raised the risk of wildfires, so Pacific Gas and Electric Co. repeatedly turned off electricity for days at a time to nearly a million customers in northern California.

“That was the biggest response mode we had felt in our county for many years, so we thought that was as stressed as we were going to be for a while,” Blix recalled. “Unbeknownst to us, the largest thing to come across our county in terms of disaster and response mode was yet to be.”

Blix’s program organizes local planning and training for emergencies affecting the health and welfare of the public, plus support during actual emergencies, she explained. The county’s healthcare system embraces hospitals, medical and dialysis clinics, skilled nursing and assisted living facilities, private medical practitioners and hospice; so Blix’s job includes getting all those partners what they need to keep operating. In addition, she works with fire, law enforcement and other county agencies “to ensure everyone has the best possible outcome in a disaster or infectious disease outbreak,” she added. “It’s not a small task.”

In the very early days of the novel coronavirus pandemic in late winter 2020, medical workers locally and around the world suddenly found themselves without a reliable supply of masks, gloves, gowns, disinfectant spray and wipes — some of the most basic equipment they need to protect themselves and their patients.

And it all happened so fast.

“Never, never, would anyone imagine a time when our hospitals and first responders would be lacking the personal protective equipment they would need to keep themselves safe in a response. That concept was such a foreign thing to us,” Blix recalled.

“We had to develop a system of how to get PPE into our county and how to be able to track that PPE and push it out to the providers that needed it,” Blix added. That included the logistics of getting semi-trucks into the county, how and where to accept pallet-loads of goods coming from the nation’s strategic stockpile and figuring out how fast medical workers used those goods so she could keep the supply flowing.

“Who would have thought hand sanitizer would be so scarce that we would have to ask the federal government to help us?” Blix continued. “I remember… having to have conversations with the hospital telling them, ‘You need to use bleach-water solution and towels to get your cleaning needs met.’ Something that was so foreign to us became our new reality.”

For Blix, grasping that new reality formed the first chapter of the pandemic.

Chapter two: Sending up flares

Blix is the county’s contact for a statewide system of emergency support called the Medical Health Operational Area Coordination Program; it’s part of the California Emergency Medical Services Authority. Nevada County is part of Region 4, which embraces Sacramento and the counties of the central Sierra Nevada foothills. If Nevada County can’t meet its operational needs, Blix contacts the region: Can a neighboring county help? If not, she sends up a flare to the state level, then, if necessary, to the national emergency network.

“It was my job to advocate for the needs of our healthcare community, to be that squeaky wheel,” Blix said.

At every node of that network was a person who, like Blix, was working long days, evenings and weekends to get people what they needed. “Every person, this has been the longest year of their life,” Blix said, tears springing to her eyes.

“From the moment I submit a request to the moment it’s fulfilled, that request changes so many hands,” Blix explained. “We knew the folks at the state level working at the warehouse, I knew their first names, and when they would call, it was a celebration. We were glad to hear from each other! We took a moment to check in, and then they told us when we were receiving our medical supplies. It really, truly was, and is to this day, quite the beautiful process.”

Chapter three: Selflessness

As a part of the MHOAC network, Blix helped get medications to COVID-19 patients when time was of the essence. “We experienced such community and provider selflessness to get these therapies,” she said.

In July 2020, the MHOAC process brought a vial of remdesivir to a COVID-19 patient in critical care at Tahoe Forest Hospital in Truckee. At the time, the anti-viral drug had been shown, in some studies, to shorten the severity and duration of COVID-19 symptoms in patients who were severely ill. The medicine was in such short supply that Nevada County had been allotted just five vials. When those were gone and a sixth patient needed the potentially life-saving drug, Blix worked through MHOAC to locate a vial at Stanford University Hospital. Tahoe Truckee Airport and Mountain Lion Aviation sent a private pilot to Santa Clara County and back at no cost, according to a county press release.

After less than four hours’ flight time, the patient received the medication.

Chapter four: Grief

Another chapter in the pandemic says something about Nevada County, Blix said: “Those that don’t live here don’t understand that we’re just so tight-knit.” The healthcare world, in particular, is so small and interconnected that most people know each other’s names. “It’s a beautiful thing,” Blix said.

But closeness brings its burdens. When news came of the first COVID-19 case in a skilled nursing facility, shock waves battered the local healthcare network.

“When they started experiencing just unspeakable hardship (at the nursing homes), it was painful. We all felt that grief,” Blix said. “Tears were shed when we started realizing that people were going to die.”

Chapter five: Partners

The small scale of Nevada County’s healthcare network had nurtured strong partnerships before the pandemic.

“We’re closer now than we were a year ago,” Blix said. “We can always get the hospital on the line, our urgent care doc, come together with our health officer and our Health and Human Services (Department) leadership, whoever you need. We can get them in the same virtual room, if we need to, and we’re going to have this conversation, we’re going to work it out until we’ve reached a consensus on what’s going to get us the result that we need…

“That is something that has gone right.”

The pandemic has added a new class of partners to the local emergency preparation coalition: pharmacies. Amid the chaos of the vaccine roll-out starting in late December, pharmacies became an important conduit for getting vaccinations to the public. They will be included in conversations about what went right, what went really well and what could have gone better during the pandemic response, and in future plans and exercises, Blix said.

“Now? Oh, what great opportunities we have with our new partners and our new awareness of what disaster looks like in our county, what emergency response looks like here,” she added.

Chapter six: Celebration

Even at high moments — such as when Blix received a text saying Tahoe Forest Hospital had received its first shipment of vaccines — people responding to the pandemic have had little time, or energy, to celebrate their victories. She looks forward to that chapter of the pandemic.

“There’s still so much work to do, and there was always so much work to do from day one of this response, that we haven’t quite gotten the chance to celebrate yet,” Blix said.

“But one day,” she added. “We’ll celebrate one day.”

Read more stories in our series ‘Retrospective on the pandemic‘