Precautionary Measures: Providing Addiction Treatment Amid COVID-19

In the first chaotic days of the coronavirus pandemic, addiction treatment providers found themselves contending simultaneously with two potentially fatal illnesses: substance use disorders and COVID-19. Listen in as host William C. Moyers talks with Vic Vines, MD, a regional medical director at Hazelden Betty Ford, about pivots and precautionary measures taken to ensure patient and staff safety—and to keep the doors to lifesaving treatment open amid the pandemic.

0:00:13 William Moyers
Here we are, another interview in our Let's Talk podcast series. Thanks for joining us. I'm your host, William C. Moyers. These podcasts feature experts on the gamut of issues that matter to Hazelden Betty Ford. The same issues that matter to you, our audience. From substance use prevention to cutting-edge research, treatment of addiction and recovery from it. These conversations have become quite popular the past two years. And if you're a regular viewer or listener to these podcasts, particularly if you're viewing them, you'll note that for today, things around the set look a little bit different. Of course they do. We're recording this in the midst of the pandemic that has affected all of us. Hazelden Betty Ford takes seriously the need to do everything possible to prevent the spread of Coronavirus among our patients and our employees. Even here in the studio we are following public health guidelines.

0:01:07 William Moyers
[continued]
As a result, I can take off my mask for this interview because the production crew, the Executive Producer, and yes, even my guest, Dr. Victor Vines, are elsewhere in the building. Good social distancing 101. Dr. Vines was hired as our Regional Medical Director for Minnesota and joined our organization in January of this year, 2020. Talk about a baptism of fire in the middle of a Minnesota winter. But Dr. Vines, you got to Hazelden Betty Ford expecting to plunge full-boar into addiction and addiction medicine and being part of the vital team and all of a sudden you found yourself part of a COVID response team with a pandemic on your hands.

0:01:49 Dr. Vic Vines
Yes. That was completely unexpected. And—and quite a surprise. I was delighted to be invited to be a part of the COVID command team. You know, William, I've—at the time of this recording, and we're doing this in June of 2020, I have still not completed my onboarding process. That was going to be about a three-month or a three-and-a-half-month process. With learning that would be scheduled and continued for a long period of time. But, less than two months into the process, COVID came along and turned everything on its ear. And that has—it's actually been a real benefit for me because I've gotten to know and work with directly many of the people in leadership positions throughout the Hazelden Betty Ford organization on both coasts and in between. In ways that I never would have. As—if I was simply functioning as a Medical Director. So, the COVID task force, the instant command team that we have, has been a real plus for me in terms of getting connected into the organization.

0:03:03 William Moyers
And what has that response team had to do the last couple of months?

0:03:08 Dr. Vic Vines
So, to give you some timeframe, we first met our very first call and organization of our command team, we stood that up on Thursday, March the 11th. And it's important, you now, we did that even before the President announced that this was a national emergency. He did that on the next day, on Friday the 13th. And we had already put our organization on notice that we were going to do something different the day before. You know the first thing that we did was to acknowledge that there were risk factors out in the community and the possibility that the virus could be brought onto one of our sites, specifically one of our residential sites. But it also affected our intensive outpatient. Was the recognition that if the virus got foothold in any of our sites, and spread, that we would look at the possibility of having to close down one or more of our sites. And from the very outset, we took extremely aggressive measures to make sure that did not happen.

0:04:15 William Moyers
How do you balance, Dr. Vines, the attention, the energy, the goals, of treating potentially two fatal illnesses within a system of care? You've got addiction of course, substance use disorder, and then you've got the pandemic of Coronavirus. It's—how do you do it?

0:04:34 Dr. Vic Vines
Absolutely. And our Medical director Dr. Marv Seppala, was the one who first put that out for us to all see and that was when we are looking at two potentially fatal illnesses, we have to make a risk determination. Do we close down because we don't want COVID, or do we say we will find a way to treat and try to keep COVID out? For our patients that come into treatment, when people's lives have gone so far off the rails that they need residential treatment, the likelihood that their addiction will be lethal to me is higher than the chance of developing a COVID illness that would lead to a death. We recognize that. However, we can't completely discount the risk of COVID because we have employees and we have other staff and we have the—the patients who if they were to get an infection with COVID, it could—it could potentially be a devastating illness. And so we had from the very outset, we put into place steps and measures to try to identify what was—who would be at risk—try to separate those folks from others who might be at risk of becoming very ill, and then try to keep the doors open and keep everything rolling as best we could.

0:06:02 William Moyers
And so far, knock on wood, so far so good. We've only had a relatively small number of employees and even patients who've tested positive for the virus, is that correct?

0:06:15 Dr. Vic Vines
That is true. And you know that—it's important that we are testing now. And that has been one of our latter developments. You know at the very beginning, what we did was limit people who were coming on campus. We did health screening, we asked questions, we took temperatures, and this was all from day one. I think we started taking temperatures on Saturday, March the 14th. Was the first day that we put up that detail and started screening people and if they had fever or if they had any of the symptoms, primary symptoms of COVID, we turned them around and sent 'em back home. So nobody came on campus. Whether a contractor or vendor, patient, staff, nobody could come on without going through that screening process. And the other thing that we did was we identified people initially it was people who might be at risk were they to get sick. People who had underlying health conditions, who had because of their age or other medical co-morbidities, might be at higher risk. And we kept those from coming on to the campus, asked them to work at home if they were employees. And then, gradually moved to an awareness that anybody that was not necessary for patient-facing care and could work at home we asked them to do that. So, we emptied out a lot of our administrative buildings and kept those people from either potentially bringing the illness onto the campus or from contracting the illness themselves. So, that was one of our first major steps.

0:07:59 Dr. Vic Vines
[continued]
We in our intensive outpatient group, we moved to doing virtual sessions instead of face-on sessions. So that we could minimize that likelihood of transmission. And the consistent message that we've had from the very beginning and still have today is enforcing the idea of covering a cough or sneeze, washing your hands, physical distancing. We put masks for staff and for patients in place many weeks ago. We have asked that people wear a mask continuously when they're in public spaces. And with other people on the campus. And then we began testing probably five weeks ago now. Five or six weeks ago we started testing everybody who came into treatment, into residential treatment, we have been doing the viral testing looking to make sure that we don't have somebody with known infection coming into our community.

0:08:55 William Moyers
And that testing is really critical, isn't it?

0:08:58 Dr. Vic Vines
That testing is critical. And, you know, one of the problems with the testing has been that—and it was a risk that we knew—waiting for those test results to come back. We have a patient that is an unknown in terms of their COVID risk. And isolating those patients for the day and a half or so that it takes has actually put a little bit of a bottleneck on our admissions. And we decided, made a very deliberate decision that economically, we would just accept that as part of the reality of living with COVID. That we couldn't bring in and admit as many people as we had been able to before. And as we've spoken about before, some of the good things that we've learned, lessons learned, we have figured out how to do the isolation process, do the testing, get the results back and get people back into programming quickly. In ways that have been creative and have been really amazing to watch. Our staff has been incredible in terms of how well they've communicated and how well we have integrated our patients into treatment when they come in.

0:10:06 William Moyers
We've got about five minutes left and as we've emphasized already, we're recording this end of June 2020 and with the virus being what it is every day is a new day with new headlines, new realities. I think there was a sense that perhaps we would be over the first wave if that's how you wanna call it, you know, by the summer and be all bracing for the second wave. But it doesn't seem like the first wave has dissipated. In fact it seems to be spreading. So the question I have for you, knowing that things could change radically, between right now and by the time this Let's Talk podcast airs, but how do you and the team, and how does the organization, anticipate the re-opening of our full menu of services? And I say that in the context of the fact that there are other treatment providers in Minnesota and around the country that are already talking about or actually have already been planning or have opened again after the first spate of incident. So how do we—how do we anticipate that, how do we plan for that? 

0:11:13 Dr. Vic Vines
It's a really good question. One of the things that we have done that as a command team we have decided is that safety of our residential patients or outpatients and our staff is our—is our primary concern. And everything that we do has been around maintaining that safety. So in terms of trying to decide what it will look like to reopen to family programs, what it will look like to reopen to on-site outpatient and intensive outpatient. What it will look like to have students, graduate students, interns, come back in. What it will look like to have alumni gatherings. We are right now developing a criteria set to look at and say how do we—how do we say that it's safe in any given community? And whether it's in Oregon or whether in California or in Chicago or here in Minnesota or in Florida, each of these communities is going to have a different risk profile for the—for the infection along the way. And our command team's work right now is around deciding what are the criteria that each community is gonna have to look at individually to decide now is the time that we can safely begin to bring people back in. And until we know and can be assured that we can do that safely in the community where people will be coming back, we're not going to—we're not going to a wholesale reopen yet. We've done good—we've done good by our patients and good by our staff right now in keeping the infection out from—from our facilities. And we're gonna stay with that.

0:12:46 William Moyers
Let me pivot very quickly to people who might be tuning in who are struggling with substance use disorder. They wanna get help, they're not certain that now's the time to get it. I want you to put your hat on not only as a Doc, but also as you've disclosed, the fact that you're a man in recovery, long-term recovery. So you've got a very keen professional and a very keen personal perspective on these things. What's your response to people who might say, 'Ah, man, you know, I drink too much or I take too many opiates, but I just can't risk going to treatment now.'

0:13:19 Dr. Vic Vines
That's a really good question and let me—let me address that by saying the fact that you may be considering going to treatment and asking for help about a substance use disorder or about alcohol use or about any of the behavioral type addictions that can frequently go along with those, what a wonderful first step that you've made in terms of acknowledging that—that there is help out there. What I want people to know is that at Hazelden Betty Ford, we place your safety and your care and your health, which includes helping you avoid having a COVID infection, and it includes helping you begin to wrestle with the physical, the mental, the spiritual, the emotional issues that need to be wrestled with to be able to help get you into a place of recovery and a place of serenity. That's—that's something that we do and we can do both. And we are doing both very well right now.

0:14:16 William Moyers
Dr. Victor Vines, thank you for bringing your perspective to our podcasts for today. The Regional Medical Administrator for Hazelden Betty Ford in Minnesota, we're glad you're with us.

0:14:26 Dr. Vic Vines
Thank you, it's good to be here.

0:14:27 William Moyers
And thanks to all of you for joining us. Be sure to tune in again for another edition of our regular podcasts, Let's Talk. On behalf of our Executive Producer, Lisa Stangl, and our podcast team from the Blue Moon Productions in the Twin Cities, we wanna remind you to stay safe and stay healthy in these times. And all the time.