Women across the United States will not lose access to contraception, thanks to family planning providers working to prepare for a fall with both flu and COVID-19. Providers and leaders describe their work in this Q&A.

CTU: What are you doing to prepare for a flu/COVID-19 fall and winter? Are there any techniques you learned during the first half of 2020 that should help your facility handle what comes next?

Amy Paris: I would say we are lucky and unique that we are in a region with a low prevalence of disease, and we never had the predicted spike we were all afraid of. During that time, we restructured our workforce to prepare and offer obstetrics and emergency services.

Things have reverted to a pre-pandemic model. We learned a lot from that preparation we made, and I think we would probably go back to the model and take advantage of all the thinking and resource allocation we did in March and April.

Other than that, I am not privy to specific preparations the hospital is doing. Anything could happen. We never had to completely close down during the first wave, so I am confident we have implemented PPE [personal protective equipment] for all workers. We wear masks for every patient encounter, every patient has a mask and temperature check, and we haven’t stopped that stuff. That’s part of why we are able to stay open and keep our staff safe.

We’ll continue to take all the precautions we need to stop the spread of infection in the hospital, and — knock on wood — it’s gone very well. We’ve had very intentional planning and good work on the part of the infection control service. We’ll continue to take all the precautions we have taken and see what happens in our local community in New Hampshire and Vermont on prevalence of disease. But I’m very optimistic in that we handled the first wave and that we can continue to do that even if we have another spike.

Jennifer Howell and Kelly Verling: Perhaps the most challenging component to the COVID response has been the assignment of staff to the COVID response. Clinic aides, nurses, and disease investigation staff were assigned to contact tracing, the call center that triaged community inquiries, and testing activities. Remaining staff maintained the limited clinic operations. As clinic services expanded, staff working on COVID have returned to their normal duties, with some exceptions.

It is likely that staffing challenges may present during the influenza/COVID response in the fall, to support vaccination clinics, with the likelihood of challenges increasing when a COVID vaccine is made available.

We have learned what staffing levels are required for different service levels and what flexibility is required to support the pandemic response. Having adequate supply levels, including PPE, also is a valuable lesson learned as we move into another phase of COVID response.

Jean Smith: We’ve been offering more telemedicine visits to decrease exposure, and I’ve been striving for efficiency in my duties — trying to limit idle time with the clients.

Whitney Howell: In addition to family planning services, our clinics also provide influenza vaccines, which are currently available to the general public at all of our health department locations. To prepare for the upcoming flu season, we are organizing school-based and community-based flu clinic events, including a drive-thru for flu shots. We have seen that a drive-thru model can be a very successful method to bring testing for the coronavirus to the community, and we are hopeful for similar outcomes with a drive-thru flu shot clinic. Additionally, we are preparing for the distribution of a COVID-19 vaccine when it becomes available.

Evelyn Kieltyka: We are discussing flu/COVID-19 preparation. As in the early days, we are following the data and recommendations from the Maine Center for Disease Control and Prevention. Right now, we plan on continuing in-person visits. What we have learned from the early days is that we need to streamline our telehealth visits to make them shorter. We are doing that now.

Catriona Reynolds: We are encouraging staff, clients, and the community at large to get flu shots. We now have systems in place to respond to what the current local infection rate is, and provide services accordingly.

We are a small staff, so we do not have huge capacity for covering when staff are absent. Preventive measures among staff are key. We do hope that if/when staff have to quarantine or have COVID-19, they will be able to continue to work remotely. Of course, if someone experiences severe symptoms, that will not be possible.

We now have solid systems in place for remote work, curbside services, and telehealth. At times of increased lockdown, we will be able to provide more complete care to clients.

CTU: How are you coping with the emotional toll the pandemic has taken on healthcare professionals and staff?

Kieltyka: Staff have been fantastic through all of this. But winter is coming — and in Maine, it’s a long season. We send out weekly staff emails about stress reduction and such. We also are meeting bi-monthly, via Zoom, to discuss what is going on in our clinical practices. I think it’s just good to see each other since we can’t get together.

Smith: It has been very emotionally draining helping the state of North Dakota in the COVID-19 tracing team for cases and contacts as well as maintaining our normal public health duties. Both our provider and I, along with many of my co-workers, take calls after hours and on weekends/holidays to help with the COVID-19 tracing team.

Many of us have had only a couple days off since this all began. But I feel it’s what public health is all about: prevent, promote, and protect the public in whatever capacity we’re called to. That’s why we’re in the public health field — never a dull moment. Like my mom always says, “This, too, shall pass.”

Reynolds: The emotional toll is real. Fortunately, individuals are impacted in different ways and at different times, so when one person is struggling, others are able to step in to pick up any slack and offer support.

Finding ways to create connection and to foster the feeling of being part of a team are an intentional part of our practice. We started using Microsoft Teams, and that has been a wonderful way to collaborate, even if miles apart.

Perhaps most importantly, we meet as a staff for fika twice a week. Fika is a concept, a state of mind, an attitude, and an important part of Swedish culture. It means making time for friends and colleagues to share a cup of coffee or tea and a little something to eat.

At Kachemak Bay Family Planning Clinic, our fika includes five minutes for body regulation, such as breathing exercise, meditation, stretching, Capacitar practice, or journaling prompt. It also has program updates and news, “watercooler conversation,” and some outro music.

We also have an employee assistance program that provides counseling or coaching for staff and their family members.

Howell and Verling: Our staff have remained resilient, flexible, and committed to the Sexual Health Program, along with the COVID response. Staff are encouraged to take time off; however, there are limitations on the amount of leave that can be taken. Staff also have been reminded of our employee assistance program services that are available at no cost. In addition, staff have been supportive of each other when faced with exposures, quarantine, and the daily stressors of working in a pandemic.

Paris: I feel that we’re so fortunate here because we did not see the type of things that people in New York and Louisiana saw with their hospitals being slammed with sick patients and having faced the possibility of running short of ventilators. That kind of trauma didn’t happen here. We have taken care of COVID patients and pregnant COVID patients. I think there is a level of emotional fatigue that happens when we’ve had to be on guard for so long. We had to be so careful and wear PPE all day. That is exhausting, and everyone is feeling that exhaustion to some degree. We’re doing all the things necessary to stay resilient. We come home to our families, count our blessings, practice gratitude, and focus on all the positives and the fact that this is not going to be forever.

I think that our hospital has done a pretty good job of taking care of us by providing PPE and enforcing strong infection control guidelines. For example, when people walk through the door, we risk-stratify them and put a mask on them.

On a basic level, that makes us and the staff feel protected. There also are hospital wellness resources that staff can access. But this is a hard job and it’s a difficult time, and we’re all doing the best we can do.

Howell: Everyone in the Georgia Department of Public Health is working very, very hard right now. The long hours and intense sense of responsibility for the well-being of our community do take a toll, but we are finding ways to support one another. People who work in public health really care about serving others, and we do our best to keep that larger goal of protecting our community in focus.