Coronavirus Disease 2019

May 13, 2020

Dear Patient,

We hope this letter finds you and your family in good health. The COVID-19 pandemic has brought a great deal of change to our lives. While many things have changed, our commitment to your health and safety is the same as ever.

Our clinic will begin resuming services that we had put on hold due to COVID-19. We will first be scheduling those patients who have ongoing or pressing medical needs.

Your preventive care is also very important to us. If your annual wellness visit was postponed, we want to ensure you are up to date with all your screenings and other preventive care. We also want to help you manage any ongoing conditions so you can experience your best possible quality of life.

Safety and cleanliness in our clinic has always been very important. Now, it’s more important than ever. That’s why we are taking extra measures, and things will seem a bit different next time you come to the clinic. These changes are for your safety, and we hope you continue to feel welcome and comfortable in our clinic. Your health is our top priority. Here are some things that have changed:

• Separate locations for “sick” and “well” visits.
• Plexiglas partitions will be present at registration areas and there will be spacing stickers on the floors.
• Waiting room chairs will be distanced to create a safe space.
• Clinic staff will be wearing face masks and other protective equipment as needed.
• You will be screened before entering the clinic. This includes taking your temperature and asking if you have experienced possible symptoms or exposure to COVID-19.
• Hand sanitizer will be available in waiting rooms.

We urge patients to wear a cloth face mask when you arrive for appointments. If you do not have a mask, one will be provided for you. Wearing your own cloth face mask helps to preserve valuable protective equipment. Mask guidelines are based on recommendations from the Centers for Disease Control and Prevention (CDC).

Limiting the number of people in the clinic remains important. Therefore, please only bring a family member or loved one along if absolutely necessary.

Avera Medical Group Brookings has made virtual visits available during the COVID-19 crisis, and these visits are still available. If you are interested in a virtual visit, please ask your scheduler when you call.

Please call (605) 697-9500 to make an appointment. Our schedulers will work with you to get you in as soon as we can with the schedule backlog we may be experiencing.

Thanks for choosing Avera for your health care; it’s our privilege to care for you. We look forward to seeing you soon.

Sincerely,

Rebecca Vande Kop, MD                                 Patrick Siegling

Medical Director                                               Clinic Director

Avera Medical Group Brookings                       Avera Medical Group

May 7, 2020

Sanford Brookings Clinic has taken a number of steps to ensure safety in the clinic, including employee temperature checks, screening all patients who enter for COVID-19 symptoms, increased cleaning and disinfecting, social distancing in waiting areas, and online check-in for appointments through My Sanford Chart. The clinic has also restructured hours to see children and other patients without respiratory symptoms in the morning/early afternoon and those with respiratory symptoms in the afternoon. Currently, one adult may accompany a child to an appointment.

Sanford Brookings is currently operating from 7am-7 pm Monday through Friday and 8-12 Saturday and Sunday. We continue to encourage any patients who have symptoms of Cough, fever, sore throat to call for an appointment time. We have a screener at the entrance and are allowing one visitor per patient. Both the patient and visitor must wear a mask and are welcome to bring one of their own. We continue to separate our sick visits from our well visits but can confidently say it is safe to receive care for all of your healthcare needs.

Sanford Clinic Brookings

• Arlington Medical Center, White Medical Clinic and Volga Medical Clinic are all operating with modified business hours at this time.
• Any patient who has respiratory symptoms (fever, coughing, shortness of breath) must call their respective clinic FIRST before arriving. Clinic health care workers will determine if patients are eligible for influenza testing at the clinic or if they need to be sent to to another provider with COVID-19 testing capabilities.
  • Arlington Medical Center: (605) 983-3283
  • White Medical Clinic: (605) 629-3333
  • Volga Medical Clinic: (605) 627-5701
• The clinics do not have the capability to test for COVID-19. All suspected cases of COVID-19 will be sent to another provider with COVID-19 testing capabilities.
• For individuals who have regular appointments scheduled and are not feeling well, they should call their clinic and consider rescheduling their appointment for a different time.
• There are many healthcare needs outside of COVID-19 that need attention. The clinics will continue to care for those patients as well during the COVID-19 threat.
• Please remember: this is an evolving situation. Brookings Health System is staying up-to-date on the Centers for Disease Control and Prevention and South Dakota Department of Health guidelines and implementing changes immediately as needed.

We have implemented the following actions to protect the health of expecting parents and babies. Items may change as the COVID-19 situation evolves. 

Before coming to the hospital:

• Please let the OB team know if you or anyone in your family has had the following symptoms:
  • Fever over 100° F
  • Cough
  • Shortness of breath 
  • Traveled to a foreign country in the last 30 days or been exposed to someone with COVID-19

Tours & Education

• For the protection of our mothers and newborns we are not allowing tours of the unit at this time. You can take a virtual tour online here. 
• Since we are not able to provide group classes at our facility, educational books for breastfeeding and labor and delivery will be available at the clinic. These educational booklets contain links to videos that can also be watched.

While at the hospital: 

• Patients may walk in the hallway if wearing a mask.
• Newborns will be kept in the same room with their mother unless:
  • Medical condition of a newborn warrants the newborn to be in nursery.
  • Medical procedures needing to be done in the nursery, such as circumcision.
• Patients or significant others may go to the family room if wearing a mask.
• New Beginnings Baby Café lactation support is available on Tuesday evenings.

Please contact the OB unit  at (605) 696-8052 with any concerns or questions.

• On March 12, 2020, Brookings Health began temporarily restricting outside visitors to The Neighborhoods at Brookview nursing home in order to protect residents, many of whom are classified in the COVID-19 vulnerable population.
• On March 13, 2020, Brookings Health implemented a temporary policy to restrict visitors to Brookings Hospital to immediate family members only. Only one visitor is allowed per patient. Staff will screen visitors upon entrance, checking them for respiratory illness symptoms (fever, cough and shortness of breath) and asking about recent travel.
• On March 17, 2020, Brookings Health System suspended all in-person events, classes and support groups at their facilities. Limiting access from the public allows Brookings Health to maintain the infection control integrity of facilities and protect patients who need care and the healthcare workers who need to care for them.
• On March 30, 2020, Brookings Health temporarily closed Brookings Hospital to all visitors in order to protect both patients and team members from the spread of COVID-19. In addition, all persons entering the facility, including team members, are screened and logged for COVID-19 symptoms and exposure. 
• On April 24, 2020, Brookings Health System released its bed management plan for handling a medical surge capacity of patients in the event the community’s health needs exceeds Brookings Hospital’s normal medical infrastructure due to COVID-19. The plan will be used for the current wave of COVID-19 infections as well as any subsequent waves that may be experienced in the future.
• On May 4, 2020, Brookings Health System lifted the temporary restrictions placed on elective surgery and outpatient procedures, instituting a number of safety protocols. 
• On May 26, 2020, Brookings Health System began allowing one visitor or support person per patient per day at Brookings Hospital, Yorkshire Eye Clinic & Optical, and the primary care clinics in Arlington, Volga and White. This is inclusive all aspects of hospital care, including the inpatient care unit and outpatient procedures such as radiology and respiratory care appointments.
• On Oct. 26, 2020, Brookings Health System closed the inpatient care unit to visitors in order to protect both patients and team members from COVID-19 due the substantial virus spread within the community.
• On Dec. 17, 2020, Brookings Health System began vaccinating frontline healthcare workers for COVID-19. 
• On Dec. 21, 2020, Brookings Health System reopened the inpatient care unit to visitors, allowing one visitor per patient per day for all non-COVID patients.
• On January 19, 2021, Brookings Health announced it was partnering with both the Sanford Health Brookings Clinic and Avera Medical Group Brookings to begin vaccinating eligible in phase 1d of the Department of Health's vaccination plan. 

Brookings Health System is following guidelines from the CDC and South Dakota Department of Health regarding COVID-19 variants of concern which have been proven through scientific research to be more contagious or to cause more severe disease. 

Following recommendations from the CDC and South Dakota Department of Health, Brookings Health System will submit COVID-19 specimen samples for variant testing to the South Dakota Public Health Laboratory for confirmed COVID-19 patients who demonstrate any of the following conditions: 

• Have previously had COVID-19
• Are fully vaccinated
• Do not respond well to common therapeutics and treatments

PLEASE NOTE: Information about variants is rapidly emerging. Scientists are working to learn more about variants, including how widely variants have spread, how the disease caused by variants differs, and how variants affect existing therapies, vaccines and tests.

• Facilities have negative air flow (pressure) rooms in the emergency department, inpatient care unit and same-day surgery area to care for patients if needed while maintaining infection control integrity within the facility.
• Brookings Health screens all individuals entering facilities for symptoms of COVID-19 according to CDC guidelines.
• Brookings Health has encouraged people to call our facility first before entering if they are experiencing COVID-19 symptoms.
• Patients under investigation of, or confirmed to have, COVID-19 are cared for in isolation, separated from non-infectious patients.
• Staff performs extra cleaning and disinfection of high-touch surface areas.
• Brookings Health continues to follow CDC and South Dakota Department of Health guidelines and implements any guideline updates immediately.
• When a local case is suspected, Brookings Health works with the CDC, South Dakota Department of Health and other authorities as needed.

• Brookings Health has updated health system policies and procedures with Coronavirus guidelines for staff to follow in the same manner as previous outbreak threats, such as SARS and Ebola.
• Brookings Health continues to educate care teams and staff about COVID-19, including how it spreads and how they can protect themselves if called upon to care for a patient.
• Brookings Health has the needed safety equipment, including masks and respirators, in place to protect health care staff as needed.
• All persons entering the facility, including team members, are screened and logged for COVID-19 symptoms and exposure.
• Brookings Health has established COVID-19 worksite protocols for team members in accordance with CDC guidelines. The protocols establish what team members should do if they are ill as well as gives quarantine guidance after travel.
• On Dec. 17, Brookings Health System began vaccinating frontline healthcare workers for COVID-19.

Care providers are following General Testing Recommendations from the Department of Health to help determine if a patient should be tested. Symptoms healthcare providers look for when they test include fever greater than 100°F, cough, shortness of breath OR one of these symptoms that cannot be attributed to another condition: fever or chills; fatigue; muscle or body aches; headache; recent loss of taste or smell; sore throat; congestion; nausea or vomiting; diarrhea.

If you’ve had close contact with an individual who has a confirmed case of COVID-19, call your primary care provider. Contact is defined as being within 6 feet for more than 15 minutes with a person or having direct contact with infectious fluids from a person with confirmed COVID-19.

If you show no symptoms and have not had known close contact with a confirmed case, continue the recommended safety precautions, including good respiratory etiquette, hand-hygiene, social distancing, wear a face covering in public, disinfecting high-touch surface areas and monitoring your health.

The Department of Health has also provided this Fact Sheet on who should get tested for COVID-19.

Brookings Health System does charge for diagnostic testing costs for COVID-19 just like any other lab test. Patient insurance is accepted and any out-of-pocket patient costs will go toward co-pay and deductibles. 

Results for COVID-19 tests administered at Brookings Health System's emergency room take approximately 20 minutes.

If your test was administered by the Sanford Brookings or Avera Medical Group Brookings clinics, please contact their respective facilities for results. 

Yes. Brookings Health System has put safety measures in place to protect all patients from COVID-19 and any other infectious disease. That includes respirators and masks, frequent hand washing/sanitizing, and social distancing.

There are many other healthcare needs outside of COVID-19, including women who need to deliver babies and individuals with other medical emergencies. We continue to provide care for those patients.

If you have ongoing chronic health conditions, we urge you not to delay or deny your care. 

Brookings Health System followed Governor Noem's Executive Order regarding COVID-19 and temporarily only performed urgent and emergent surgical cases.

On May 4, Brookings Health System lifted the temporary restrictions placed on elective surgery and outpatient procedures and instituted a number of safety protocols. 

Patients who wish to schedule their elective surgery or outpatient procedure should first visit with their care provider.

Brookings Hospital has reopened the inpatient care unit to visitors. If a rise in COVID-19 cases occurs, Brookings Health may reinstate a restricted or no visitor policy for the inpatient care unit.

At this time, one visitor or support person per patient per day is still allowed at Yorkshire Eye Clinic & Optical; the primary care clinics in Arlington, Volga and White; and other services at Brookings Hospital, including outpatient procedures and emergency room visits. OB patients will be allowed one partner plus one birth support person, such as a doula.

All individuals entering Brookings Health System facilities will continue to be screened for COVID-19 symptoms. They will be asked to follow all infection control guidelines, including proper hand hygiene, and asked to don a cloth mask. Patients, visitors and support persons may bring their own mask or may opt to wear one supplied by the health system. Individuals will also be encouraged to maintain six-foot social distances and not to unnecessarily linger in public spaces.

Following the South Dakota Department of Health (DOH) guidelines, visitor restrictions will remain in place for The Neighborhoods at Brookview skilled nursing home. The DOH has stated reopening nursing homes, like The Neighborhoods, will be a phased approach using recommendations from the Centers for Medicare & Medicaid Services (CMS). Once nursing home visitor restrictions can be lifted, Brookings Health will work with the DOH and CMS to ensure reopening criteria for The Neighborhoods is met.

YES. Brookings Health System follows all CDC guidelines, including universal source control measures. All persons entering any Brookings Health System facility must don a well-fitting cloth mask, facemask, or respirator to cover their mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.

In the interest of public safety, Brookings Health indicates on our website the current range of patient-occupied hospital beds according to the Bed Management Plan for COVID-19 Medical Surge Capacity. 

Please Note: Brookings Hospital's range of COVID-19 patient-occupied hospital beds is not a direct correlation to the number of COVID-19 positive cases or patient hospitalizations within Brookings County. 

In accordance with the February 2020 HIPAA Privacy and Novel Coronavirus Bulletin issued by the Office for Civil Rights and the U.S. Department of Health and Human Services, Brookings Health cannot give affirmative reporting to the media or public at large about an identifiable patient or specific tests, test results or details of a patient's illness without the patient's written authorization.

Brookings Health System has four ventilators on-hand at Brookings Hospital. In addition, two more ventilators are on-hand with the Brookings Ambulance. 

The South Dakota Department of Health also has a pool of ventilator equipment available to hospitals as-needed during the COVID-19 threat. Brookings Health System has access to this pool and can request additional ventilators as needed anytime throughout the pandemic. 

Please Note: A ventilator is different than a respirator. Ventilators are devices designed to assist patients to breathe when they can not breathe on their own. Respirators are masks designed to protect the wearer from inhaling particulates from the air. Brookings Health maintains a ready supply of respirators to protect health care workers who must care for COVID-19 or other infectious patients. 

Brookings Hospital has two dedicated intensive care (ICU) rooms in the Inpatient Care Unit. However, in accordance with the COVID-19 Bed Management Plan for Medical Surge Capacity, Brookings Health can provide intensive care as needed anywhere throughout the hospital.

Intensive care is the continuous monitoring and treatment of critically ill or injured patients using special medical equipment and services. Intensive care requires a team of doctors, nurses, pharmacists, dietitians, therapists and others of the medical team working in close collaboration to continuously monitor the patient and adapt treatment as needed. As such, in the case of a medical surge, Brookings Health will provide intensive care to patients as needed regardless if they are housed in ICU rooms or not.

• Brookings Health is the lead partner in the Brookings County Pandemic Preparedness Plan. We work with Brookings County Emergency Management, Brookings chapter of the American Red Cross, the City of Brookings, South Dakota State University and other surrounding counties and communities with a response plan in place for the outbreak of any pandemic.
• Brookings Health System has 49 hospital beds to care for people, including those with infectious diseases. For COVID-19, we have medical surge capacity of 80 beds. If a local outbreak occurs and if Brookings Health System’s facilities become overwhelmed, the county’s pandemic response plan goes into action.
• The pandemic response plan’s goals include:
  • Contain and control disease outbreak
  • Limit the number of illnesses and deaths
  • Preserve continuity of critical government functions
  • Minimize social disruption
  • Minimize economic losses
• The public can read the full pandemic plan at BeReadyBrookings.com.

• COVID-19 is a respiratory illness that can spread from person to person.
• Patients with COVID-19 experience mild to severe respiratory illness with symptoms of fever, cough and shortness of breath.
• Complications may include pneumonia in both lungs.
• Older adults and those with chronic medical conditions like heart disease, diabetes, lung disease or other immune compromising conditions are at higher risk of developing more serious complications from COVID-19.
• Children are more likely to present with mild symptoms. There is currently no evidence that children are more susceptible to COVID-19.
• The best prevention is to avoid being exposed to the virus.

Viruses constantly change through mutation, meaning new variants of a virus will occur over time. While sometimes new variants disappear quickly, other times new variants will persist and stick around. 

Multiple variants of the COVID-19 virus are circulating globally. The CDC currently classifies variants by three categories: 

• Variant of Interest: has caused discrete clusters of infections in the U.S. or other countries, or seems to be driving a surge in cases. It also has gene changes that suggest it might be more contagious or that may help it to escape immunity created by natural infection or vaccination. Therapeutics and tests may not work as well against it. 
• Variant of Concern: has been proven through scientific research to be more contagious or to cause more severe disease. It may also reduce the effectiveness of therapeutics and vaccines. People who have previously had COVID-19 may become reinfected by the new strain.
• Variant of High Consequence: causes more severe disease and greater numbers of hospitalizations. It has also been shown to defeat medical countermeasures, such as vaccines, antiviral drugs, and monoclonal antibodies. 

Scientists and public health officials are currently focusing on variants of concern and variants of high consequence to learn how to control their spread. They want to know if the variants spread more easily; cause milder or more severe disease; respond to current medicine and treatments; respond to vaccines; and are detectable by current tests.

Learn more about variants and the progress being made on them from the CDC.

• Contact your primary care provider if you have any COVID-19 symptoms and fall into one of the following groups:
  • Over 65 years of age
  • Under 5 years of age
  • Pregnant
  • Have a chronic medical condition like heart disease, diabetes, lung disease or other immune compromising conditions
• If you do not fall into those groups, contact your primary care provider if your illness is worsening, including:
  • A fever of 100.4°F or greater
  • Difficulty breathing
• If you develop emergency warning signs for COVID-19, seek medical attention immediately. Emergency warning signs in adults include:
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
• Call your healthcare provider before seeking care and explain your symptoms.
• Immediately put on a facemask before entering any healthcare facility. This will help protect others, including health care workers, from becoming infected or exposed.

• Stay at home except to get medical care. People who are mildly ill with COVID-19 are able to isolate at home during their illness. About 80% of patients can be treated at home for COVID-19. The rate of patient who experience serious complications is only slightly higher than that of seasonal influenza.
• Avoid public areas. Do not go to work, school, daycare, church, shopping or anything else in the public.
• Separate yourself from other people and animals in your home. Try to stay in a specific room and use a separate bathroom if available. Wear a facemask around other people or pets.
• Cover your mouth and nose with a tissue when you cough or sneeze and immediately throw used tissues in a lined trash can. Immediately wash your hands.
• Wash your hands often with soap and water for at least 20 seconds (sing Happy Birthday twice), especially after blowing your nose, coughing, sneezing, going to the bathroom, and before eating or preparing food. Use hand sanitizer with at least 60% alcohol if soap and water are not available.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Avoid sharing personal household items, such as dishes, glasses, towels or bedding. Wash household items thoroughly after use.
• Clean and disinfect all high-touch surface areas.
• Monitor your symptoms.

If you seek treatment, call your health care provider’s office before visiting them. If visiting Brookings Health System’s emergency department, call (605) 696-9000. If visiting Avera Medical Group Brookings, call either 1-877-AT-AVERA or (605) 697-9500. If visiting Sanford Health, call (605) 333-4444. Explain your symptoms to your health care provider.

• If you are being actively monitored, your healthcare provider will call the state health department. Persons placed under active monitoring or facilitated self-monitoring should follow instruction provided by the South Dakota Department of Health.
• If you develop emergency warning signs for COVID-19, seek medical attention immediately. Emergency warning signs in adults include:
  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face
• For discontinuing isolation, stay at home until you’re instructed to leave if you have confirmed COVID-19. The decision to discontinue isolation will be made on a case-by-case basis in consultation with healthcare providers and authorities.

• Remain calm. We must not let fear influence our decisions.
• If you're eligible, get a vaccine.
• Remember: this is an evolving situation. Get information about COVID-19 from a credible source and do not spread misinformation. Brookings Health recommends the CDC or South Dakota Department of Health for the latest information.
• Practice good respiratory etiquette and hygiene: cover your coughs and sneezes with a tissue. If a tissue is not available, cough or sneeze in your upper sleeve. Avoid touching your eyes, nose and mouth with unwashed hands. Wash your hands often with soap and water for at least 20 seconds (sing Happy Birthday twice). If soap and water are not available, use an alcohol-based sanitizer that contains at least 60% alcohol.
• Practice social distancing when out in the community. Try to stay 6 feet away from other people. Do not hug, kiss, shake hands or make other unnecessary contact.
• Clean and disinfect high-touch surface areas, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, etc. every day. COVID-19 is easily cleaned by household cleaners or soap and water. Make sure you read and follow household cleaner instructions to ensure germs are killed.
• Wear a face mask in public following CDC guidelines. Based on evidence-based research, the CDC recommends wearing cloth face masks in public. The cloth masks do not protect the wearer, but instead prevents an unintentional spread of the virus from the wearer to others. Recent studies show many individuals with COVID-19 do not show symptoms. Those who eventually develop symptoms can transmit the virus to others before symptoms appear. As such, wearing cloth face masks in public can help slow community transmission of COVID-19. 
• Monitor your health. Be alert for COVID-19 symptoms and take your temperature if symptoms develop.
• Stay at home if you’re sick and self-isolate to prevent the spread of illness.

Recovery from COVID-19 is based on when symptoms started and when a person seeks care and gets tested. 

A person is considered recovered when: 1) seven days have passed since the onset of their symptoms; 2) they've been fever free for at least three days and other symptoms, such as cough, have improved.