In a time when everything from politics to weather can be described as “unprecedented,” it’s hard to emphasize that one institution has been taxed and tested more than others.

But the coronavirus pandemic pummeled and reshaped nearly every facet of our medical system, forcing innovations, revealing weaknesses and pushing limits.

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In Little Rock, a hospital supply chain manager who used to rely on steady, scheduled deliveries of all the necessities found himself scrumming at 3 a.m. to secure masks and hand sanitizer. Forced to hunt down scarce commodities directly from factories in Malaysia and other far-flung places, he started keeping Pop-Tarts and sandwich meat in his office for the nights when he worked through the sunrise. In Arkadelphia, a school nurse juggled her standard Band-Aids and morning meds with spreadsheets listing which students and staff were quarantining and when they could be allowed back in the classroom. A doctor in Mountain Home, father of four, took his efforts and expertise to New York during the city’s deadliest days. Then he returned to shore up defenses for when the wave hit home. Mask requirements and social distancing protocols transformed the work of hospital chaplains and mental health providers, forcing them to figure out ways to build trust and intimate connections from afar.

So how well did the medical community adapt to this overwhelming new challenge, and what changes will stay with us even after the pandemic has passed? We talked to seven health care providers to find out. 

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Picture of Curtis Broughton of UAMSBrian Chilson
QUIET STORM: Curtis Broughton and his team work hard to stay out of the spotlight.

Curtis Broughton
UAMS supply chain boss is an enthusiastic and unsung pandemic hero.

In the above-ground rabbit warren that is the University of Arkansas for Medical Sciences Little Rock campus, the brawniest work gets shuffled to the back. The shiny towers give way to squat and ruddy garages and brick office buildings, less glossy and more workaday.

The warehouse on the edge of campus, on a dead-end road on a downhill slide toward the interstate, suits Curtis Broughton perfectly. As assistant vice chancellor of supply chain operations, if no one notices him, Broughton said, he knows he’s doing his job right.

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Broughton and his team of 110 people keep UAMS and its affiliated clinics throughout the state stocked. Off-the-charts demand during the coronavirus pandemic means all those surgical gloves, hand sanitizers and face masks aren’t always easy to get. But don’t worry about it, Broughton said. He’s going to make sure the doctors and nurses of UAMS never have to think twice about whether the supplies they need will be there.

“When our physicians and clinicians walk into the room, that’s the last thing we want them to worry about, is a mask there? We want them to worry about their patients, not about that,” Broughton said.

It’s easier said than done. Inside the hospital and clinics, members of the team check inventory multiple times a day to determine who needs what, and when. In the distribution center, which has the feel of a Sam’s Club but without the free samples, a crew keeps tabs on the towering stacks of cardboard boxes. “We’re having to keep a lot of stock on hand because a lot of people are sick,” Broughton explained. Supply chains are less reliable than normal these days, and Broughton never wants to get caught short. So he and his staff bring in pallets of hospital gowns, hand sanitizer, sanitizing wipes and the like. There are also more technical supplies, like feeding tubes and other specialized pieces for patient care. “We have a mix between products that keep our clinicians safe and also products we need to take care of Arkansans.”

Broughton moved to Arkansas from Indiana with his wife and two daughters in January 2020.  

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Within a few weeks of starting his new job at UAMS, Broughton knew something big was brewing. Suppliers started checking in to see what he had on his warehouse shelves, and the internal alarm bells started ringing in Broughton’s head. The only other time he’d gotten similar calls was during an Ebola scare when he worked as a supply chain manager for a hospital in Ohio. Soon, the pandemic was picking up steam and the supply chains for must-have supplies went haywire. 

Companies that used to truck in all the supplies UAMS needed still can’t keep up with demand, so the UAMS supply chain team figures out new workarounds, like going directly to manufacturers and buying in bulk.

“There’s a delicate balance between hoarding and being prepared,” Broughton said. “So we are purchasing enough product so our clinicians feel safe that when they go into the room, that the product is sitting there. The N95 mask they need is going to be there every time.”

Work schedules became unpredictable for Broughton’s team early in 2020, and they remain that way. Shipments arrive on weekends and after hours now, and staff has to be on hand. UAMS warehouse manager Jerry Lewis estimates he’s been putting in an extra 10 to 20 hours per week. Vacation hours pile up, but he’s not ready to claim them yet. There’s simply no time. “It’s the busiest I’ve seen it in 25 years,” Lewis said.

Broughton’s schedule is off, too. Locating and ordering much-needed supplies can’t always be done between 8 a.m. and 5 p.m. That’s why Broughton keeps a minifridge full of sandwich meat and boxes of blueberry Pop-Tarts in his office, because he’s learned that’s the only way he can get his hands on a snack when he’s at the office at 3 a.m.

The late nights and early mornings don’t bother him too much. Broughton is enthusiastic about his unsung calling in a way that’s surprising and endearing and reassuring all at once. This guy is pumped about his job. “You can’t like supply chain. You have to love what we do. You have to love supply chain,” he said.

In his office, stowed away at the end of a gerbil maze of hallways on the backside of the UAMS security building, Broughton scrawls lists, hashmarks, thoughts about what the hospital system needs and how to get it on four oversized white boards hanging on the walls. He likens his invisible role to an umpire in baseball. “A good baseball umpire, you don’t even recognize him as part of the game.” His team operates largely unseen and only gets called out if they make a bad call. When no one takes notice, that’s a good day.  

Austin Bailey  

picture of Susan McDougal of UAMSBrian Chilson
SHARED STRENGTH: Hospital chaplain Susan McDougal went through trying times of her own, and says it’s an honor to help others.

Susan McDougal
UAMS hospital chaplain shares strength with patients and staff.

The team of chaplains and chaplain trainees at the University of Arkansas for Medical Sciences in Little Rock might not be what you expect. Some bring strong Christian beliefs and experience in the pulpit to their work. Not all of them, though. Being spiritual is a job requirement, but beyond that, chaplains are free to mix it up. They read the Bible, but only upon request. They’re happy to talk about anything or nothing at all, whatever patients and their families prefer. For the most part, a chaplains’ job is to show up for the hard stuff.

Susan McDougal, director of the UAMS Pastoral Care department, is a perfect example of a chaplain who arrived at this work via an unexpected path. Not until after a sometimes tumultuous career in banking, real estate and politics did McDougal go through the yearlong training it takes to become an accredited chaplain. Maybe her name rings a bell? Yes, she’s that Susan McDougal, the one who served 22 months for fraud and contempt charges related to the Whitewater scandal of the ’90s (charges that were eventually pardoned in full by then-President Bill Clinton).

Clearly, McDougal has walked through trying times of her own and plotted a way past them, doing her best to leave any bitterness at the jailhouse door. It was during her prison stint that she first realized ministering to others might be her true calling. The possibility of doing similar work in a formal capacity took shape after she got an invitation to speak to a group of hospital chaplains about her time behind bars.  

“He wanted me to come and talk about women in jail because I had been doing some work with the women while I was there,” McDougal explained. “I talked about, ‘Who are women in jail? What do they look like? What do they talk like? Are they dangerous?’ I talked about who I met while I was there and what they meant to me.”

After that talk 14 years ago, chaplains at UAMS asked her to join their program. The Pastoral Care department at UAMS is a sophisticated operation that includes four full-time chaplains and a revolving cast of trainees, usually a couple dozen at a time. McDougal herself graduated from the training program she now oversees.

“To learn how to minister to people in crisis, there’s no better place than a hospital to do that,” McDougal said.

Trainees at UAMS focus on understanding the faith, strengths and challenges they will bring with them to worried families and patients’ bedsides. That self-knowledge can keep chaplains anchored in times of stress. And stress is a constant at a Level I trauma center in Little Rock, McDougal said. “UAMS is a microcosm of the city, and it’s hard to take sometimes. There’s a lot of violence.”

So trainees in the hospital chaplain program spend a lot of time learning how to look inward for strength. “For each chaplain it’s very important that they know what they believe and who they are in their religious faith and spiritual life that will support them. They will need that support as they walk into these situations that are dire and shocking.

“My first night here, my first patient was a young man on a motorcycle who lost his leg in an accident. They came in with his leg still in a cowboy boot. Not the patient at first, just the leg,” she remembered.

The four full-time chaplains on staff cover the hospital 24-7-365, and they are never bored. “We might go from that to the NICU, where a young mother lost her child and is alone. Or there might be a family whose father or husband is dying. Death doesn’t always come quickly, and they’re worn out and tired and maybe not getting along with one another.”

McDougal became director of the program right as COVID-19 was making itself known in Central Arkansas. The pandemic forced chaplains to make some fundamental changes in how they work. Keeping a safe 6 feet away from the people they’re caring for means chaplains can no longer hold hands or offer hugs. So far, none of the chaplains at UAMS has gotten COVID-19.

The pandemic kicked families out of hospital rooms, leaving patients lonely and in need of someone to talk to. Chaplains step in when they can to keep isolated patients in contact with family by phone or Facetime, or just to chat. Chaplains also found that the increased workload, higher death tolls and occasional need to quarantine that came with the pandemic put doctors, nurses and other staff in greater need of attention and care.

“Really, our focus has turned to the staff because this is grueling and it has gone on so long,” McDougal said. More patients are dying, and that takes a heavy toll. The people who work at the hospital have added stresses at home, too. Children are anxious and out of school, older parents are locked in and need tending.

McDougal and other chaplains wheel trolley carts full of free snacks down hospital corridors, a way to show support and keep clinicians fueled during long shifts. Chaplains also help man a free hotline anyone who works at UAMS can call anonymously, any hour of the day.

She suspects the line will stay in operation a good while longer. Despite good news about a vaccine, McDougal says she doesn’t yet see a light at the end of the tunnel. Clocking hours in a hospital during a deadly pandemic isn’t something she can get used to. But McDougal describes this relentlessly tough work as an honor. “It is an honor to be with people,” she said. “You hear their most intimate stories in the worst time of their lives.” 

Austin Bailey  

Picture of Larry Shackelford of Washington RegionalBrian Chilson
LOOKING AHEAD: Larry Shackelford isn’t counting on the virus’ downward trend to continue.

Larry Shackelford
The Washington Regional leader embraces ‘wartime’ metaphor.

Throughout the coronavirus pandemic, Larry Shackelford, president and CEO of Washington Regional Medical System in Fayetteville, found himself looking to the wisdom of wartime leaders of the past, including Abraham Lincoln and Winston Churchill. “The challenges of war are different than those we encounter when battling a pandemic, but there are similarities: shortage of supplies, adverse economic impact, fear, and most notably, lives at risk,” Shackelford wrote in September for Arkansas Hospitals, the magazine published by the Arkansas Hospital Association, on whose board Shackelford serves. 

The metaphor still provides a useful frame, Shackelford said on Feb. 1. “Right now vaccines are the best ammo for this war that we have,” he said. Almost 80 percent of Washington Regional’s staff of around 3,200 has elected to receive a vaccine. Typically, the hospital provides discounts on insurance premiums to employees for participating in a wellness plan. Amid the pandemic, it accepted the vaccine as a substitute to receive the discount. The administration got vaccine buttons printed for staff to wear, in the spirit of “trying to be out front with our patients.” Although infection and hospitalization rates in Arkansas and beyond have declined this year, Washington Regional saw a record number of hospitalized patients suffering from COVID-19 in mid-January and a record low two weeks later. Shackelford isn’t counting on the downward trend to continue. With new, more contagious variant strains of COVID-19 circulating within the region, he’s worried Washington Regional’s resources will again be stretched thin. It’s a race to get adequate supplies of vaccines ahead of the spread of the variant strains, he said. 

To that end, he’s been meeting with other Northwest Arkansas health systems along with experts who specialize in logistics for J.B. Hunt and supply chain officials at Walmart. “We’re talking about, when vaccine becomes [more widely] available, how we as a region can work to get as many vaccines in arms as we can.” He believes Washington Regional could provide 800-1,000 vaccines per day if it had ample supply.

Shackelford, a Fayetteville native and graduate of Fayetteville High School and the University of Arkansas, has a public accounting background. After college, he worked for a time in an accounting firm before taking a job leading the business and finance side of the Fayetteville Diagnostic Clinic. It later merged with several other clinics to become Medical Associates of Northwest Arkansas, known as MANA. Shackleford was CEO there for almost 10 years. He then joined the management team of Washington Regional, supervising clinics and outpatient services, including the surgery and dialysis centers. He became CEO in 2017. 

It’s a big job, but until the pandemic emerged, not one that anyone would call dangerous. “One of the things during war that I think is important is to be there with your staff,” Shackelford said. Washington Regional’s administrative team rotates being on call in the hospital and making rounds throughout the facility. During the coronavirus pandemic, that’s included visiting the ICU and COVID-19 units. Before the pandemic, Shackelford had never donned personal protective equipment.

Since the outset of the pandemic, Washington Regional has treated more than 1,000 COVID-19 patients. As of Feb. 1, it had performed 62,250 COVID-19 tests, and its nurse-call triage center has fielded more than 112,750 calls. That volume has necessitated many changes in the way the hospital operates. Early on, it decided to open a drive-thru testing center in a vacant clinic near the hospital’s campus. Outside of dealing with extreme temperatures in the summer and winter, it’s worked well, Shackelford said. The hospital also designated one of its urgent care facilities strictly for patients experiencing upper respiratory symptoms. In the main hospital, it created three COVID-19 units that can accommodate up to 56 patients. 

Having vaccinated staff helps with one of the more vexing problems hospital leaders have faced during the pandemic: staffing shortages. “Of all of our resources, our human resource is our most precious,” Shackelford said. Like other hospitals, Washington Regional has lost nurses who have been lured away by big-money temporary offers. It also saw nurses in dual-income families step away to care for school-aged children and nurses late in their career decide to retire for safety reasons. 

In its latest surge plan, Washington Regional employed team-based nursing in the ICU. Instead of two ICU nurses caring for four patients, two care for six patients with the help of another noncritical care nurse who handles tasks including providing medicine, checking vitals, updating charts and administrative duties. 

The next challenge on the horizon? Addressing vaccine hesitancy. Shackelford said the hospital had seen indications that pregnant women or women hoping to soon become pregnant were wary of receiving the vaccine. So the marketing team has worked with Washington Regional obstetricians to create videos that discuss reproductive health as it relates to the coronavirus and the vaccine. The hospital has also partnered with the Northwest Arkansas Council, a regional economic development group, and UAMS to push out vaccine information to the region’s large Latino and Marshallese communities.  

Lindsey Millar

picture of Arkadelphia school nurse Beth HasleyBrian Chilson
CARING WITH CLASS: School nurses like Beth Hasley are taking on new duties during the pandemic to keep students and teachers healthy.

Beth Hasley
Nurse guides Arkadelphia schools through pandemic with a steady hand.

If you want to talk to school nurse Beth Hasley, you have to wait your turn. The phone in her office at Arkadelphia’s Goza Middle School rings quite a lot, with parents calling to ask about COVID-19 testing and quarantine protocols. Hasley’s computer dings over and over with new emails. Students file in and out for medicine and Band-Aids.

Hasley takes them all as they come, with an even pace and calm voice that are therapeutic in themselves. After spending the first 15 years of her career as a transit nurse, boarding helicopters to tend distressed newborns en route to urgent care, Hasley knows how to stay focused and steady under stressful conditions.

It’s a trait that serves her well as the main COVID-19 point of contact for the Arkadelphia School District. This role puts Hasley in charge of tracing every positive case in the district. She watches video footage from classrooms to identify who came in close contact and determine who needs to be sent home to quarantine. She helps parents figure out where to take their children for COVID-19 testing and care. And she keeps track of who quarantines and when to make sure they’re meeting guidelines from the Centers for Disease Control and Prevention.

Since August 2020, more than 140 students and teachers in the district have quarantined. It’s a lot to keep up with. “I have spreadsheets for everything,” Hasley said.

Vision screenings, health education, sick students. All those tasks school nurses handle during normal times are still on their to-do lists. So in this pandemic, Hasley works extra hours and juggles multiple spreadsheets to stay in command. She estimates pandemic-related issues soak up 95 percent of her workdays, and the job tumbles over into evenings and weekends. Every school district in the state has a number parents and staff can call with COVID-19-related questions. In Arkadelphia, that number goes to Hasley’s phone.

“Right now, it’s a seven-day-a-week job,” she said.

On top of handling the tedious logistics, Hasley also serves as sounding board and sage. Teachers on the fence about getting vaccinated call for her expert advice. “I have them read scientific articles about it instead of opinion-based pieces. I am pro-vaccine, yes. But I respect that everybody has freedom to choose, especially with something they’re just learning about.”

Her handholding extends beyond staff, to parents and students, too. Tending to the anxiety and loneliness pandemic protocols bring on can be a heartbreaker. And so Hasley, along with the two other school nurses who tend the students and staff in the Arkadelphia School District, offer encouragement, affirmation and reassurance.

“Honestly I think that quarantine does start to wear on the students. The older students especially,” Hasley said. “When it’s a minimum of 10 days and up to 14 days, that’s a lot of school time missed. And for this age group, it’s a lot of social time missed.”

A silver lining of universal virtual instruction for all Arkansas public school students in the spring of 2020 is that children who used to complain about going to school now appreciate it a lot more. They want to be there, Hasley said. That’s one reason she sent her own three children back for in-person learning in August.

Hasley was on the team that made plans for keeping Arkadelphia schools running despite COVID-19. She said she’s confident the team did its best to make school welcoming, safe and as comfortable as possible.

“Our staff has done a really good job of trying to make the students feel like it’s a normal school day,” she said. Still, elementary students now eat lunch in their classrooms, play with only their classmates on the playground and go to the same enrichment activity, like art or music, every day for a week, rather than rotate through all of them each week. “We’re trying to keep classes together so if there is exposure in a group we’re not exposing more children than we need to,” Hasley explained.

Each teacher is loaded down with cleaning supplies for the classroom. Hand-sanitizing stations cap hallways. Water fountains are taped off. Instead, students are provided with bottles for the new airport-style touch-free filling stations. Lockers will stay locked this school year to minimize students’ time in crowded hallways. School custodians are adding “biotech engineer” to their job description now that they’re called on to operate leaf blower-like sanitizing sprayers after hours.

 “I think every parent has some, I don’t want to say fear, but a little trepidation about school during a pandemic,” Hasley said. “It helps to know everyone is doing their best.”  

Austin Bailey  

picture of Methodist Family Health therapist Dana HermanBrian Chilson
COMPUTER SCREEN COUNSELING: Dana Herman knows there are limits to doing therapy via video call, but says there are benefits, too.

Dana Herman
Methodist Family Health counselor embraces teletherapy.  

There’s a book in counselor Dana Herman’s office at Methodist Family Health called “What Should Danny Do?” It’s on the middle row of a low bookshelf, within reach of its intended audience. It walks the reader through a series of pivotal decisions in Danny’s school day, with each social choice leading to one of nine different outcomes, behavioral choose-your-own-adventure style. Danny’s on the cover sporting a red superhero cape with the symbols P2C blazing across the back: “The Power to Choose!” So what does Danny do when a raging pandemic puts the whole school on lockdown?

That’s been Herman’s realm of expertise for nearly a year now — her third year at Methodist Family Health — as a therapist whose in-school sessions were upended when the coronavirus pandemic hit. In-clinic therapy visits aren’t a convenient option for every family, and setting up sessions at school tends to mean that clients can keep their therapy appointments more consistently — and that teachers and school staff can help gauge behavioral progress. When the pandemic hit and Arkansas schools pivoted temporarily to all-virtual learning, Herman said, “childrens’ lives got turned upside down. They went from having a social life and friends, activities and extracurricular things they did to nothing, literally.”

At first, Herman said, the idea of schools being closed was thrilling for her clients. “Students rejoiced,” she said, “but then after a few weeks I started noticing more withdrawn behaviors, depression, ‘We’re missing our friends.’ ” Turns out, the notion that adolescent social lives take place on their smartphone screens — and therefore that teens might be the best-suited among us to weather an isolating pandemic — isn’t quite right. 

Herman watched last spring as her clients’ proms got canceled, then their graduation ceremonies, her clients’ parents all the while consumed by questions about meeting for their families some of the more basic human needs: safety, health, a secure income. Then, Herman watched as summer came and went, her clients effectively grounded from camps, sports, trips and all the peer-to-peer interaction a summer break typically brings. “So you had an extended period of time where, for six months, they had little to no contact with friends, generally.” And that, she said, takes a toll. Her clients who had mild cases of anxiety and depression before the pandemic “were pushed to more moderate or severe, where some of them went suicidal,” she said. “Some of them had self-harm thoughts. It was kind of a perfect storm,” she said. “COVID had a snowball effect.”  

Since those early days of the pandemic, Herman said, her mediums of therapy have been threefold: in-clinic appointments, school-based therapy and telehealth. How much she does of each type of therapy fluctuates depending on what the COVID case numbers look like, whether the schools with which Methodist Family Health partners are allowing onsite therapy sessions and, of course, the specific needs of each client. Telehealth, for example, can be a godsend for a teenager who’s doing virtual school at home while their parents are at work. The client can log in to Methodist’s private platform, enter a password to access the session — just the way we’ve all been doing on Zoom for nearly a year now — and complete their therapy with minimal interruption to their schedule or their parents’ schedules, and without taking the health risk that an in-person visit can pose. That, Herman said, “has evolved the landscape,” and she’s been able to transition much of the work she’d do with a client in her office to the telehealth platform, sharing her screen when she wants to present a handout or conduct a therapeutic exercise. “You can read a lot of body cues on the camera, you know, if a client gets quiet, or starts to cry, or crosses their arms, or turns away,” Herman said. “So that in-person connection is still present, as long as it’s somebody you already have a relationship with.” 

What’s more, Herman expects that telehealth, something Methodist Family Health rarely used before the pandemic, has staying power for the therapy field. With new COVID variants presenting themselves and the vaccination schedule inching along slowly, she said, “we’re gonna be doing telehealth consistently for the foreseeable future. It also has opened up a lot of benefits for parents that generally can’t take off work and come [to the clinic] all the time. Or long-distance clients who are traveling in from out of town and can’t come as often? They can now come more often with telemed. Instead of once a month, they can come twice a month or three times a month. It’s just very convenient. And effective.”

But it’s not for everyone. Young children with severe ADHD, for example, or who may be on the autism spectrum, tend not to do as well with therapy via video call. And for clients who exhibit self-harm behaviors or suicidal thoughts, Methodist Family Health recommends an in-person visit as a matter of client safety and crisis management. 

And whether virtual or in-person, Herman said, she’s found it crucial during the pandemic to keep clients’ parents as involved as possible. “Parents can give me insight into what’s happening at home,” Herman said. “If I’m working with a teenager connecting through telehealth, that teenager might not tell me that they’ve been crying all week, or that they cut last week.” Conversely, she said, “the mental health provider may have info that the parent needs to know. I’ve had tons of students in virtual learning tell me that they are failing classes and their parents have no idea. Or that they aren’t getting any help from their teachers, and the parents don’t necessarily know how to log onto Schoology or these online school platforms to check on their work, so they’re kind of in the dark. So, I’m able to tell the parent ahead of time, ‘Hey, the client is having a lot of anxiety over school challenges and academic problems, and here are some ways you can get more involved and help them with their online virtual school, or contact their teachers to make sure their 504 plan and IEP [individualized education program] is being followed virtually.”

Herman expects her clients in a post-pandemic world will, like the rest of us, grapple with reacclimating to social environments they’ve been absent from for more than a year. “What we’re talking about are the factors that go into adjusting back to normal life, and what is normal? … When you go back to a school environment with high structure and lots of expectations and boundaries that are sometimes greater than they are in home life, there’s gonna be an adjustment, and some students are going to have a difficult time remembering the rules, the routines, the pace. There will be adjustment pains, so to speak.”  

Stephanie Smittle

Picture of Baxter Regional's Dr. Brian MalteBrian Chilson
SMALL-TOWN SURGE: Dr. Brian Malte’s experience with COVID-19 patients in Brooklyn made him a go-to physician when he returned home to Baxter Regional.

Dr. Brian Malte
Baxter Regional Medical Center doctor heeded call for help from New York.

Last spring, during the first wave of COVID-19 infections in New York, Dr. Brian Malte was watching the news when New York Gov. Andrew Cuomo asked for health care professionals from around the country to come and provide assistance to New York hospitals struggling to handle the sudden surge of COVID-19 cases. Given the size of New York City and the number of physicians there, “I was caught off guard,” Malte said. 

Malte grew up in the Philippines and attended medical school at the University of the Philippines, graduating in 2006. He moved to Chicago for his residency training at John H. Stronger Jr. Hospital of Cook County and followed that with a fellowship at St. Louis University. He’s worked as a pulmonologist and intensivist at Baxter Regional Medical Center in Mountain Home (Baxter County) since 2015. Malte’s partner at Baxter Regional, pulmonologist Rebecca Martin, went up to New York at the beginning of April while Malte covered her shifts back home. When she returned later that month, Malte left for Brooklyn, where he worked 15 straight days in the ICU. When he arrived, treating patients with COVID-19 was a new concept for him; Baxter Regional hadn’t had any cases yet. “I co-managed them with other intensivists and got some ideas as to how they were caring for them, adding some of my ideas into the fray,” he said. “It was really quite hectic there. We would have ICU patients that we managed on a regular medical floor because they didn’t have enough beds.” 

Malte said they were intubating patients daily and estimated that four people a day were dying in his unit. 

“That was not even bad compared to when my partner went there,” he said.  

Malte said that things at Baxter Regional were starting to return to normal after a wave of COVID-19 infections in November and December caused his load of patients to quadruple. During that period, a typical day of hospital duty for him started at 4:30 a.m. and didn’t end until late in the evening. 

He said that Baxter Regional was able to match the load of patients with staffing by recruiting more nurses and pulling nurses from nonclinical positions to work with COVID patients. “This way they were able to maintain the ratio of about one nurse to two COVID patients, which afforded good patient care in a busy schedule,” Malte said.  

“As for physicians,” he said, “we’ve had good help collaborating with the hospitalists. They handle most of the admissions, and I’m largely a consultant, but because of me and my partner’s experience in New York, we’ve been pretty much the go-to persons for handling patients with COVID.”

Malte said that at one time there were as many as 11 patients with COVID in the Baxter Regional ICU, “which may not be a lot compared to the other hospitals,” he said, “but I can guarantee you that the staff was really strained at that time.” The ICU capacity at Baxter Regional has about 20 beds. “The thing is,” Malte said, “even as we had COVID patients, we still had remarkably sick nonCOVID patients, and they were occupying the other half of the unit.” 

Malte said the capacity was never stretched to the extent that patients had to be sent to other hospitals.

Malte said the youngest COVID patient he’s seen personally is 21. 

“I haven’t seen any adolescents [with COVID],” he said, “which seems to match what we’re seeing on the data showing that children are less likely to carry the virus. I think opening the schools is not completely a bad idea,” he said. 

Malte’s children attend school in-person.

“My kids are also trained to wear masks and face shields because you never know, kids speak a lot and sometimes they spit on each other’s faces, so I still have them wear a face shield. My kids always said that as long as we wore masks, we should be OK, so I’m surprised that even they can understand it.” 

Malte has a very careful regimen before he heads home from the hospital. He showers at the hospital, his mask and dirty clothes go in the trunk of his car. When he arrives at home, he washes his hands and then takes another shower before he visits with his four daughters. “We have one more on the way,” he said. “Our first boy, so it makes it even more special.” 

Malte stressed the importance of getting vaccinated when given the opportunity. 

“My main thing is I just wish that people would learn to accept that the vaccine is safe, it’s effective. If you get vaccinated now, it’s better for you. People have still gotten the virus despite the vaccine, but if you do get it, it’s not going to be as severe, so it’s going to prevent you from going to the hospital.” That risk of hospitalization, he said, is reduced by vaccine even in newer variants of the virus. But if you get COVID as an unvaccinated person, he said, “you don’t know how it’s going to affect you.” Limiting the spread of the virus, he said, limits the chance of it mutating — potentially into a more lethal version — and making the vaccine ineffective down the road. “This is the importance of getting as many people vaccinated at the soonest time. The faster we can get to herd immunity the better chance we have at controlling this and not making it an endemic disease,” he said.   

Rhett Brinkley

picture of Baptist Health's Dr. Amanda NovackBrian Chilson
‘DIVINELY PLACED’: Dr. Amanda Novack’s last year has been challenging and exhausting, but also “an incredible time.”

Dr. Amanda Novack
Infectious disease specialist joined Baptist Health at just the right time.

When Amanda Novack accepted a position in late 2019 as Baptist Health’s medical director of infectious disease, she expected to focus mostly on “preventing people from getting sick in the hospital.” It’s important work, but relatively mundane, Novack explained, citing “preventing catheter-associated urinary tract infections” as an example. But in early January, she began to be concerned about the novel SARS-CoV-2 coronavirus spreading in China. “Even before Baptist was asking me to, I started focusing more of my attention to it,” Novack said. “By February, everyone thought I was crazy for talking about a time when we might run out of surgical masks. By March, the whole state was shut down.” She worked seven days a week for six to seven weeks without a break. She got calls in the middle of the night just about every night. 

“It’s not exactly what I signed up for, but the truth is that it’s been an incredible time,” Novack said. “It’s been very challenging and very exhausting. But I feel like I was divinely placed right here for this point in time.”

In an earlier phase of the pandemic, Novack spent much of her time on the logistics of detecting and preventing COVID-19. In March she lobbied for Baptist to buy testing machines. “I said, ‘We need these very, very expensive machines’ at a time when it wasn’t clear [the coronavirus] was going to last or not. It wasn’t obvious that we needed to spend millions of dollars to test for this thing that might be gone in a few weeks. I kind of arm-wrestled about some of those things and was very fortunate to be listened to.” Later, she helped launch the high-volume drive-thru testing clinic on Baptist Health’s Little Rock campus. She’s also often been the face of Baptist’s pandemic response in videos the hospital shares on its website and social media. More recently, she’s been treating COVID-19 patients at a monoclonal antibodies infusion clinic in North Little Rock, a joint effort with Baptist and CHI St. Vincent. 

Now Novack is working behind the scenes, lobbying for a major change in the way Arkansas allocates COVID-19 vaccines. Instead of the state allocating doses to every Arkansas county, Novack would like to see vaccines go to the hot spots that need them most. “What makes sense from a vaccine standpoint is markedly different from any other resource. If this was insulin or cancer treatment or blood pressure medicine, I’d say absolutely spread it equally across the counties, make sure every district is equally served. But when it comes to vaccine, that doesn’t make a lot of sense scientifically. The way smallpox was eliminated was not by equally distributing smallpox vaccine. It was by only giving vaccine to the hot spots and when those people were all vaccinated you went to the next hot spot.”

It’s ironic, Novack said, that she would be pushing now for an urban-focused approach because she spent several years of her career trying to bring infectious disease expertise to rural Arkansas. 

Novack, who grew up in Maumelle and later graduated from Hendrix College and the University of Arkansas for Medical Sciences, did an infectious disease fellowship at UAMS and then stayed on as faculty for several years. Later, the Arkansas Department of Health contracted for half of her time from UAMS, and she focused on antimicrobial stewardship, helping clinicians improve how antibiotics were prescribed, in part to combat antibiotic resistance in patients. That experience led her to start her own practice, ID Arkansas, and contract with hospitals across the state that didn’t have access to an infectious disease doctor. Gradually, Baptist, the state’s largest hospital system with facilities across Arkansas, began taking up more and more of her time. “They sort of tricked me into taking a full-time position about two months before the pandemic struck,” Novack said with a laugh. 

For 15 of the 16 minutes she spoke with a reporter over the phone, a fire alarm blared in the background. “I feel like that’s representative of the last year or so,” she said. “There’s always a fire alarm.” 

Lindsey Millar