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When the novel coronavirus reached Nevada County in March 2020, the telephones at the Public Health Department got even busier than usual.
Often, Health Technician Lisa Richardson was the one who answered.
“There were tons of phone calls,” Richardson recalled. “So many people were so scared and so worried. They just wanted to have contact with someone who knew more than what they were hearing.”
Nevada County Public Health technician
– County vaccine coordinator
– Bachelor of Science degree in organizational psychology, Brigham Young University
– Yearly training through California’s EZIZ system in vaccine safety, storage and monitoring
– Training in reporting to the California Reportable Disease Information Exchange
– Quality Improvement Leadership Team member
Richardson has been with the county Public Health Department since 2017. She has three major roles: She handles the local reporting of 80 contagious diseases to the California Public Health Department. She coordinates immunization appointments and handles the related documentation, which also goes to state databases. And, she bills insurance companies for many of the healthcare services the department offers to residents.
“My responsibility is basically to make sure all of those programs get the support they need. Clerical, ordering the vaccines, making sure they stay safe… I need to keep up with the billing codes and insurance companies and what is and isn’t covered, ” Richardson said. “It’s a challenge for me to juggle all three of those roles.”
But early in the pandemic, just answering the phones grew overwhelming.
“We want people to know we are there to answer their questions,” Richardson said, “but it’s hard to find time to answer their questions and do (my) job.”
Callers asked advice and counted blessings
Early in the pandemic, researchers still were trying to understand how the virus that causes COVID-19 spreads. Federal, state and local leaders gave conflicting guidance.
“A lot of people were calling and asking our advice about whether they should mask or get a test,” Richardson said.
“The hardest part was the older people. A lot of the older people were very isolated and very scared,” Richardson recalled. “One lady, she was talking about wanting to get the COVID vaccine. She talked for a long time. She wanted to say how she’s been all by herself, she couldn’t get out, she was in some remote place…
“She said how blessed she was because she had a mom and dad who loved her. She didn’t have them anymore, and she said, ‘You should just be so happy if you have parents who are still alive.’
“That really touched me, because both my parents are alive, but they’re getting old. It gave me a reason to reach out to my parents,” Richardson said. “Talking to people like that just makes you rethink everything.”
Giving frightened people a ‘space to be heard’
This pandemic, Richardson observed, has “brought out the best and the worst in people…
“We had a lot of reporting that people were meeting at a certain spot where they weren’t supposed to and not wearing masks, or this store is not doing this, or this restaurant is not doing that,” Richardson said.
“During the lockdown, a lot of people were very angry and demanding… especially when the hair salons closed,” Richardson said. “They’d call and say, ‘We want to talk to Dr. (Ken) Cutler,’” who at the time was the county’s health officer and responsible for local health decisions in the pandemic response.
“When you’re scared, you become much more vulnerable. You might do things you wouldn’t normally do,” Richardson said. “You need to give people that space to just let them be able to talk… Knowing they were heard and validated made them feel like they were being listened to, that their struggles were important.”
Vaccines bring new hope, questions, fears
When vaccines became available in Nevada County starting in January 2021, new anxieties arose: Vaccines were in short supply, they were reserved for the county’s most vulnerable residents and for medical and other essential workers, and getting an appointment was really hard.
“In the beginning, I was trying to find vaccine (appointments) for people,” Richardson recalled. “It was so heart-wrenching. They were so scared for themselves or family members…
“One woman who wanted to get on the vaccine list, she was missing a lung. She must have called three or four times to get on the list,” Richardson said. “I figured out how to get her the appointment… She brought me these gorgeous sunflowers, and said, ‘Thank you so much for getting me on that list!’”
Richardson recalled conversations with in-home health workers who qualified for the early vaccines, but who wanted to give their slots to the people they were caring for. “Or the caller would say, ‘I don’t want to jump ahead of the line when somebody else needs it more,’ and they’d be like 90 years old,” she added.
People also tried to circumvent the priority groupings, such as the man who claimed he was an essential worker because he had designed a government facility, Richardson recalled.
In the first weeks, for every single appointment made, Richardson entered each person’s information manually. That became a frustrating clog in her workflow, she said. The process became much easier in mid-February 2021, when Nevada County began participating in MyTurn, California’s web-based appointment system.
Vaccines require special care
The COVID-19 vaccines need special handling, which fell to Richardson.
Each of the three vaccines approved for emergency use in the United States of America comes with a different number of doses per vial and vials per box. Each brand has different instructions for handling their shipping containers. For storage, each vaccine requires different temperatures depending on whether it is frozen, ultra-cold frozen, or is refrigerated. Some have to be thawed out before they can be used, and Richardson tracks the movements between those states.
The vaccines each have different storage periods at those temperatures, and different use-by dates, depending on the form of storage and how the packaging is handled. In the early days of vaccination, “the Pfizer was being stored in the shipping box with dry ice, which needed to be refreshed every five days, since we didn’t have a deep freezer,” she said.
Richardson checks the storage temperatures for each vaccine and records them daily. Monitors on the storage units send her a text message if they fall outside the acceptable range; she has to go check it, then perhaps contact the manufacturer to see if the medicine can still be used, she said.
In addition, she makes sure the department has enough supplies for the vaccination clinics: syringes, gloves and masks for those working — a tougher task while supplies were short — plus copies of vaccine information sheets to hand out to people who come. For mobile clinics, the vaccines travel in portable coolers equipped with temperature trackers, which ensure the vaccines stay safe off-site, Richardson said.
“It’s a lot of detail, and the list is constantly changing,” Richardson said. “Once you start getting a rhythm of how you’re going to do it, you know it’s going to change.”
National case counts start here
Those daily case counts and positivity rates that have absorbed Americans on the evening news? They come from Richardson and her counterparts in local public health agencies across the nation.
For every COVID-19 test in the county, Richardson enters positive, negative and unclear lab results. Case information includes details about the patient: location, gender, age and ethnicity. Details about the test include the type, when it was taken, when results came back, and what was being tested — live virus or antibodies? “There are thousands of records for reportable diseases,” Richardson said.
Some of the reports upload automatically into the California Reportable Disease Information Exchange, a computerized database. Others are faxed in, which Richardson enters by hand. She might have to contact doctors or others to complete the information required.
Reports of positive COVID-19 tests are forwarded to other women in the department who call the patients, trace their contacts, and give people advice on next steps: isolation, quarantine and getting medical help.
“We got probably thousands of records, and just trying to keep on top of them…” Richardson shook her head. She finally got some help inputting the reports.
“It’s hard to enter all that data and answer the public’s questions, too,” she added. Responding to this pandemic has been “like a rollercoaster,” Richardson said, “so many pivots… constantly changing, constantly adjusting.”
Immunizations have slowed in Nevada County, but they still are not available for children younger than 12 years. Cases have declined, but COVID’s faster-spreading delta variant has been circulating locally since early June, current county Health Officer Dr. Scott Kellermann estimated.
“I hope the disease will subside, but with cases still coming,” Richardson speculated, “who knows what’s going to happen?”