On the western edge of South Dakota, Aimee Uhrig, RN, BSN, CCM, lives near an old gold rush town steeped in American history, not far from Mount Rushmore, American Indian reservations, and the rugged Black Hills National Forest.
Carolyn Apanavage, BSN, RN-BC, CEN, of Managed Care Advisors works as a medical case manager for the UMB COVID-19 Hotline from her New Market home as her son, Brayden, attends virtual school in the background.
When she picks up the phone, she’s connected with University of Maryland, Baltimore (UMB) faculty, staff, and students looking for help with COVID-19 through the UMB COVID-19 Hotline. With UMB a leader in helping to end the pandemic through clinical trials, research, and public health policy decisions on a national level, it dawned on Uhrig that some of the very people she helps to keep safe at work are the same folks she sees on TV or in the newspaper sharing their expertise. She’s a connection to history being made.
“When we got in the middle of this and we started realizing some of the people we’re talking to are in the middle of the studies, it was like, ‘Whoa, this is stuff I would have read about in my Weekly Reader as a kid,’ ” said Uhrig, who has worked in telephonic nurse case management since the 1990s.
East of Uhrig by 1,600 miles, her co-worker, Carolyn Apanavage, BSN, RN-BC, CEN, is ready to call back UMB patients from her newly constructed townhome in New Market, Md., steps from Lake Linganore.
All she has to do is look over her shoulder to see her son Brayden completing his third-grade assignments during virtual schooling, as so many parents can relate.
The small home office is cozy for two, decorated with awards, degrees, and a few reminders of pre-pandemic life. On one wall is a photo of Apanavage carrying Brayden as a toddler down the Ocean City boardwalk; on another is a purple-filled concert photo of her favorite country music star, Kip Moore.
“It feels good. I was an ER nurse for 10 years. This is a drastic change of pace for me. I almost felt guilty at the beginning of this because I was not on those front lines like I used to be,” Apanavage said. “Being a part of the pandemic with such a huge system feels like I’m doing something.”
While they work for Bethesda, Md.-based Managed Care Advisors (MCA), they are contracted by UMB to operate and maintain the UMB COVID-19 Hotline, which is also available for University of Maryland Medical Center (UMMC) and Faculty Physicians, Inc. employees.
UMB is putting faces to the names of the nurse case managers whom faculty, staff, and students have only interacted with by phone and may never meet.
“It brings me incredible pride and gratitude to know that by doing what we do best, we have been able to make a difference in the lives of so many struggling to balance family, school, and work while facing the real possibility of COVID-19 exposure and/or infection,” said Lisa M. Firestone, president and CEO of Managed Care Advisors. “It is truly a privilege to be part of the UMB team.”
Here From the Start
Uhrig and Apanavage have supported the hotline since the beginning, and have become like family, being a vital part of helping to stop the spread of COVID-19 by compassionately guiding the UMB community through symptoms, diagnosis, exposure, and high-risk travel.
“The team has truly enjoyed this,” Uhrig said. “It’s a feeling of that’s what you signed up for when you want to be a nurse. But I think for some of us, it’s more than that. This was a pandemic. This was worldwide. Maybe we were giving back. Maybe we were somehow able to help people to sort things out. Maybe we were just a voice on the end of the phone.”
Apanavage joined MCA in January 2019. A year later, her work became all-things COVID. In the middle of it all, she moved into a new home in August. She’s even recruited a couple members of the team.
In the beginning, Apanavage and her colleagues printed Word documents and PowerPoint slides that showed a flow chart of what to do based on the symptoms or information shared by a caller. It’s an on-paper algorithm that she now has memorized.
“It was hard at first, especially with the exposures,” she said. “They’d say, ‘Oh, I walked into a patient’s room, and I had this type of mask and the patient had no mask on. I was there for 20 minutes.’ You had to figure out their risk level. That was the harder part because no one fit into the cookie cutter of low, medium, and high risk. Sometimes you use clinical judgment to make the best determination of whether they should quarantine or keep working.”
That’s a tall order at UMB, where there is so much overlap among the clinical, academic, and affiliations. Each Thursday, MCA talks to UMB staff, led by Marianne Cloeren, MD, MPH, associate professor of medicine, who oversees the COVID-19 Hotline.
“Like many campuses, UMB had to build a COVID response on the fly, as the pandemic evolved,” Cloeren said. “This hotline is a critical link in keeping our community safe, and we consider these nurses a part of our UMB Infection Prevention team.”
Cloeren and company review issues, emerging concerns, and new guidance on a regular basis. A common question is figuring out where UMB employees do their day-to-day work with so much overlap between the University, hospital, and other areas. That determines whether to send people to internal or external testing sites, and makes sure people are calling the right number.
“Just figuring out who’s who is a challenge for everybody,” Apanavage said.
High Volume
From March through Dec. 31, 2020, 8,424 calls have been placed to the hotline. They are first answered by operators who document reported information and redirect calls, forwarding appropriate cases to the nurse case managers. Of the 8,424 calls, the nurse case managers have provided ongoing support to more than 4,507 employees, physicians, professors, and students, or about 15 cases a day. There are cases to follow-up on that were reported during the evenings, then a flood of fresh calls when the morning shift starts.
An eight-hour telework shift can fly by with calls and cases to care for and information to relay to UMB contact tracers. Every day is different with guidance needing to be tweaked here or there. Lately, vaccine-related calls are trending, Apanavage said. One new question: Have you had a COVID-19 vaccine in the last 48 hours?
“I always encourage people that they’re doing the right thing by saying, 'You called the hotline, you reported your symptoms and your positive tests,’ ” Apanavage said.
Calls can take anywhere from five to 20 minutes. The longer calls involve someone asking for help upfront to figure out what they can and can’t do, whether that’s about if they can send their child to daycare or should plan for time off depending on symptoms and test results. The occasional small talk or banter in between symptom checking has provided some lighter moments.
“I think people sometimes walk away from their conversation with us thinking, ‘Oh, there really is a human on the other end of the line,’ ” Uhrig said. “We don’t get into people’s daily lives but every now and then somebody will offer a nugget, and I find it enjoyable.”