March marks a year of the COVID-19 pandemic, and while vaccinations and relaxed restrictions have brought back a sense of normalcy for many people, area health care providers are still in the thick of it.
But as they continue to adapt to the ever-changing regulations prompted by the public health crisis, doctors and dentists are finally seeing the light at the end of the tunnel.
Patients are returning and finances are rebounding, many said. And through it all, employees have proven up for the challenge.
“We’ve learned how to adapt and flex what we do very quickly, and to be able to come together and have people step into roles they’ve never been in before,” said Cynthia McGuire, president and CEO of Monadnock Community Hospital. “It’s really given people opportunities to shine in different ways.”
Hospitals still recovering
The Peterborough hospital’s safety protocols have been mostly the same since the early days of the pandemic last March, according to McGuire. In addition to masking and social distancing, this includes screening all patients and staff for COVID-19 symptoms, testing all inpatients for COVID-19 before admission and enhanced disinfecting.
When it comes to procedures, telemedicine has played a huge role over the past year, McGuire said.
“We were gradually moving into a telemedicine approach for some of our services ... and we are still using it now for about 20 to 30 percent of our physician office visits for people who have difficulty coming in,” she said.
Patient numbers are back to about 85 percent of what they were before the pandemic, she added, which has helped with the hospital’s financial status.
Like other hospitals nationwide, Monadnock Community Hospital took a major hit due to the cost of treating COVID-19 patients and the revenue lost when the state required elective procedures to be postponed for months.
To help offset the financial losses, hospitals received several grants and loans from government programs throughout the year.
Still, by the end of fiscal year 2020, Monadnock Community Hospital had lost about $500,000, according to spokeswoman Laura Gingras.
But McGuire said recent months have looked promising.
“The last two months we’ve been quite successful, and actually broke even in January and February with no [federal] dollars, though we do still have some of those dollars in reserve,” she said. “We’ve budgeted really cautiously this year ... so we are expecting to break even by the end of the year.”
Cheshire Medical Center is also doing better financially, according to Chief Operating Officer Kathy Willbarger.
The Keene hospital is expected to break even in the next six to 12 months, she said, though it is currently still running at a loss.
From March 16 to the end of April, Cheshire Medical was losing $2 million weekly, a spokeswoman said previously. Prior to the pandemic, the hospital had a $2.6 million, or 1.6 percent, positive year-to-date operating margin.
The hospital was unable to provide an updated figure Thursday.
Patient numbers are also coming back, though Willbarger said they continue to ebb and flow.
“We are not yet consistently back to ‘normal’ in the outpatient areas where some patients continue to be reluctant to come in for care,” she said in an email. “Yet certainly better than last spring, especially with so many virtual visit options available to patients.”
The Dartmouth-Hitchcock Health affiliate is also continuing its COVID-19 safety precautions, such as mandatory masking, limited visitation and daily screenings for patients and staff.
Area practice in ‘very promising place’
For Monarca Health, a direct primary-care facility on West Street in Keene, this year was a bit different than for hospitals.
The practice opened in the fall, right as COVID-19 cases in New Hampshire were starting to rise again after hitting a low in mid-August. But despite this, co-owner Aurora Leon said Monarca’s patient numbers have continued to grow.
The practice’s model allows patients to pay a monthly fee directly to their provider for services, rather than the provider billing the patient’s insurance.
As members, patients can call, text, video-call or email Leon or co-owner Dr. Joaquin Carral; have extended doctor’s visits, averaging about an hour; book an appointment within 48 hours; and attend classes on healthy cooking or altering chronic disease progression.
The practice has about 80 patients, according to Leon. At most, Monarca could have 800 patients split between Leon and Carral, but to break even, it needs 100.
“We are in a very promising place,” Leon said.
She added that part of the reason for Monarca’s continued patient increase is that many people feel safer at the small practice, which intentionally employs only herself and Carral.
“The problem was hospitals were overwhelmed with things like COVID, so the regular things ... were left out,” she said. “So a lot of people after six months of the pandemic were still lost, still having drug overdoses, having a lot of issues with anxiety, not sleeping, and definitely needed primary care.”
The practice offers telehealth services, but Leon said in-person visits are Monarca’s main focus, to understand the full patient. So rather than allowing in-person visits only when necessary, she said Monarca adapted to ensure patients could come into the office more often.
“If the patient was very nervous, of course we could do telehealth; it’s the decision of the patient,” Leon said. “But we also don’t book patients back to back, so we could clean in between them, and our clinic, since it’s really low overhead ... we’ve decreased the risk of contact.”
Dental offices see plenty of patients
For area dentists, the pandemic started off rocky, with many practices shutting their doors, furloughing employees and performing only emergency procedures for months due to safety concerns.
By summer, most had reopened, with new, strict protocols in place.
At Noble Dental Care — formerly known as Keene Smiles Dental — at 69 Island St., those same safety protocols continue, according to owner Dr. Thomas “T.J.” Filip.
When patients come in, he said, they are screened for COVID-19 symptoms and have their temperature taken at the door. All staff wear N95 face masks and face shields.
The number of people in the treatment rooms has also been limited, Filip noted.
Additionally, he said all of his employees are now fully vaccinated, and Noble Dental Care is also seeing an increase in patients who’ve been immunized.
This has led to the practice seeing a record number of patients.
“Last year we saw no patients in the second half of March. That continued until we began to reopen in late June,” he said in a text. “This March we’ll have more patient visits than we’ve ever had. For the first time we’ll have more than 400 patient visits.”
And financially, Filip said the practice is doing well.
Noble was in the “strongest possible financial position” prior to closing last March, according to Filip, and while three months of no revenue certainly hit the practice hard, it’s started to recover.
“Crazy things happen in this world. I had no idea a global pandemic would be one of them,” he said. “But I know there will be more crazy things to come!”
At Montshire Pediatric Dentistry in Keene, patients are required to complete an electronic prescreening form prior to their appointment, the waiting room is no longer used and surfaces are constantly disinfected, according to owner Dr. Jonny Norris.
The office also alternates which exam rooms are used, he said, to allow the rooms to “breathe and get a break.”
Some dental procedures have been adjusted as well, Norris said, with less invasive techniques employed when possible.
“Ultimately our patients have been the benefactor of these new practices because we had to get creative,” he said in an email.
These protocols are now second nature, but Norris said at first it was a lot of trial and error to determine what worked and what didn’t, based on guidance from several state and national dentistry and health associations.
“In the early stages, their recommendations were not congruent,” he said. “However as months passed, they became more aligned.”
The practice is continuing to see more patients, which is partially due to Montshire’s move over the summer to a new location on West Street that is four times larger than its previous one, according to Norris.
“This has allowed us to see more patients, practice [social distancing] ... all while helping more kids,” he said.
Montshire sees about 40 patients daily, Norris said, compared to only 12 at its lowest point amid the pandemic.
Like Noble Dental Care, Norris added that financially the practice is doing well, despite the pandemic’s hardships.
“We are fortunate,” he said in the email. “Expenses have all increased, across the board, but we are still taking care of patients, staff, and servicing loans. We could be better but we could certainly be a LOT worse.”
After a dramatic decline since mid-January, COVID-19 cases are rising again in New Hampshire.
The state averaged 329 new cases per day for the week ending Thursday — up 37 percent from March 6, when the seven-day average hit a low of 240. The percentage of tests coming back positive has drifted up as well, hitting an average of 4.4 percent for the week ending Wednesday.
Cases remain far below their peak in December and January, when they sometimes averaged more than 800 per day. But the recent uptick is something health experts had warned about as cases declined, saying that relaxing public-health measures amid the spread of more contagious variants could reverse that progress.
“We are not yet out of the woods, mask use and social distancing is still essential, travel should be limited, and everyone without a contraindication” — a condition that raises the risk of an adverse reaction from the vaccine — “should step forward to be vaccinated as soon as it is available to them,” Dr. Michael S. Calderwood, an infectious disease physician and the chief quality officer at Dartmouth-Hitchcock Medical Center in Lebanon, said in an email Friday.
A steep decline in new cases in January and February, followed by a plateau and recent rebound, mirrors national trends.
Calderwood cited several national statistics indicating that compliance with public health precautions may be slipping.
The percentage of Americans who say they always wear a mask in public has ticked down three percentage points since peaking at 78 percent on Feb. 12, according to survey data. Cellphone mobility data show Americans are moving around more than a month ago. And air travel recently hit its highest point since the pandemic began.
Dr. Aalok Khole, an epidemiologist with Cheshire Medical Center in Keene, said he doesn’t know exactly why cases have gone up in New Hampshire, but suggested some possible factors.
Outbreaks on college campuses, increased travel and, perhaps, more people out and about as the weather warms “may have led to some dropping their guard and failing in conservative measures like hand hygiene, mask compliance and physical distancing,” he said by email.
Khole noted that the cases are largely in people under 60, “so not in the group that has been extensively vaccinated.”
It’s unclear how much new COVID-19 variants have played into the rise locally, Khole said. More than 50 cases of the more contagious B.1.1.7 variant, first identified in the United Kingdom, have been detected in New Hampshire, according to the most recent count from the Centers for Disease Control and Prevention. While the state has no known cases of either the B1.351 or P.1 strains — first found in South Africa and in four travelers from Brazil on their arrival in Japan, respectively — both have been identified in Massachusetts.
“We are testing more for these variants now compared to back in Jan 2021 — both within NH and across the US,” Khole said. “… But we still aren’t testing as much as we should be.”
Meanwhile, the number of hospitalized patients appears to have plateaued in New Hampshire, fluctuating between 63 and 82 in the past two weeks — though far below the peak of more than 330 in early January, and “nowhere close to overwhelming healthcare facilities,” Khole said.
Still, both Khole and Calderwood pointed to the ever-increasing number of vaccinations as a reason for optimism. With much of the most vulnerable population vaccinated, Khole said, the state is seeing far fewer deaths than it was a couple months ago.
As of Friday, more than 350,000 Granite Staters had received at least one dose of a vaccine, of whom 200,000 are fully vaccinated — meaning more than a quarter of the state’s population has now been at least partly inoculated, according to data from the N.H. Department of Health and Human Services. And on Thursday, Gov. Chris Sununu announced that any adult who wants a vaccine will be eligible to sign up by the end of this coming week.
“I think the best ray of hope is increasing number of vaccinations per day and further groups becoming eligible for the shot,” Khole said. “This is our ticket out of this pandemic and we need everyone to get on board.”
The police say she was kidnapped, but Alexis White disagrees.
White, 17, said the March 19 incident that led to the arrest of Cameron Snody, an 18-year-old from Texas, on kidnapping charges was just three teenagers making an impulsive decision to run away.
She and her father, Jake White of Winchester, told The Sentinel in an interview Wednesday they want the charges against Snody dropped.
“He had no intent on harming us,” she said. “... It was kind of like a joyride.”
N.H. State Police announced the charges against Snody in a news release the afternoon of March 19. In the release, the agency said Swanzey police had asked for help with a “reported kidnapping.” It said Snody had traveled there to meet a 17-year-old girl he had been talking to online, then driven to New York City with her and her 15-year-old friend.
An affidavit written by a New Hampshire state trooper that day, and obtained by The Sentinel Monday, indicates that Alexis White and her older sister had picked Snody up from the airport more than a day earlier, and that Snody, White and the 15-year-old discussed running away before they drove to New York early Friday morning.
Snody was charged under a part of New Hampshire’s kidnapping law that makes it a crime when someone “takes, entices away, detains, or conceals” a child under 18 who isn’t a relative “with the intent to detain or conceal” the child from a parent or guardian.
Alexis White said she and Snody met on a messaging app a few months ago. They ended up having feelings for each other, and she asked him if he could fly to New Hampshire to meet her, she said.
Though she didn’t tell her parents, knowing they wouldn’t approve, she arranged for Snody to stay at her older sister’s house. She said she, her sister and her sister’s boyfriend picked him up from the Manchester airport on Wednesday, March 17.
The next day, Alexis White said, her 15-year-old friend came over to meet Snody. Alexis White said Snody was not the one who brought up the possibility of running away, and said it was a bad idea before eventually agreeing to it.
“It was not his idea,” Alexis White said. “He really just wanted to sleep.”
They left around 3 a.m. in a car Snody had previously been given permission to use, though he told police he didn’t have permission to drive it out of state. (He was charged with larceny but Jake White said the family has no interest in pressing charges over the car.)
She said that after they reached New York, her father called to tell her that they had to come back, Amber Alerts had been issued and the police had been notified. Her friend called a family member, and the Swanzey Police Department began using cellphone pings to track their location, according to the affidavit.
Jake White was able to speak to Alexis and then directly to Snody. Jake White said he told Snody that if he drove straight back, nothing would happen to him, and gave him directions. Snody said they were on their way back, according to Jake White and a summary of the conversation that appears in the affidavit.
White said he decided to call police again after all just to be safe. According to the affidavit, Swanzey police were already pinging a cellphone in the car and notified Connecticut State Police of its location. Police stopped the car, which was headed north on Interstate 91, and arrested Snody without incident, according to a report from a Connecticut state trooper.
Body camera footage released by Connecticut State Police and aired by a Fox affiliate shows officers pulling Snody out of the car and onto the pavement.
Looking back, Jake White said he now believes the whole thing could have been avoided if he had been, as he put it, a little less overprotective in the months leading up to it.
He’d been aware his daughter was talking to Snody online, but had refused when she had asked if Snody could come visit. “I wasn’t even willing to be open-minded and hear her out,” he said.
White said he was irate when he first learned they’d run off. “When I called those police, I wanted that kid hung,” he said.
He said he has since read some of the messages they exchanged, and said he saw nothing predatory, but rather Snody trying to build his daughter up.
“He’s not a predator, he’s not an animal,” Jake White said. “That kid is a normal, well-adjusted kid from a good home who just got in a big misunderstanding.”
Jake White said he has explained to N.H. State Police that he wants the case dropped entirely.
The Sentinel does not know the identity of the 15-year-old, and so could not reach out to her family for comment.
N.H. State Police declined to comment. “The investigation remains active and ongoing,” Paul Raymond, a spokesman, said in an email Thursday. “The NH State Police will release further information when it is available and appropriate to do so.”
Cheshire County Attorney Chris McLaughlin did not respond to a request for comment about how his office plans to handle the case.
The Connecticut public defender who represented Snody at a bail hearing this past week did not return a phone message, and efforts to determine whether Snody has a lawyer in New Hampshire were not successful.
A Connecticut judge on Monday reduced Snody’s bail to $10,000, of which only 10 percent must be paid. It was not clear whether he remained in custody as of Friday.
White said any parent would freak out to find a child missing, and he’s glad police located the group safely. But at this point, he doesn’t see why it needs to be a criminal matter, saying “his life should not be destroyed over this.”
“How many kids sneak off with their friends and go to concerts in Mass.?” White said.
Jake and Alexis White spoke out to WMUR this past week because, Jake White said, they felt the situation had been misrepresented.
Jake White said that since his name became public, strangers have harassed him and his family online, despite not knowing the facts. He said it’s taken a mental toll. One reason he agreed to speak to The Sentinel, he said, was because he wants the harassment to stop.
Alexis said her dad has mostly shielded her from that. But she’s wondering if the courts will even allow her to talk to Snody while his case is pending, and is worried about how he’ll be affected by all this.
“I want it to be closed,” she said. “I want him to be able to get out and live his life again. I don’t want him to be behind bars. I don’t want him to have his whole life ruined over something that was … a big misunderstanding.”