Charles Magee, MD
By Charles Magee, MD
Perspective can become distorted or lost if we allow too much time between glances into the rearview mirror. I want to take a moment to share the journey and provide a brief perspective of the Acute Care Special Pathogens Unit journey into COVID19…
COVID19 blew in with the chill of winter in late February. It landed squarely in the Special Pathogens Unit with intensive care providers and nurses prepared to fight this new viral pathogen. By March, the COVID19 patients outnumbered beds in the initial MICU Special Pathogens Unit, and it was clear there was a need for an acute-care Special Pathogens Unit (SPU). And so Hospitalists and nurses on 3West led this charge into the fight against COVID19.
Evolving into a SPU required swift and dramatic change to both provider and nursing standard work. Leveraging telemedicine and bundling care, and adhering to rigorous process for every patient encounter allowed for minimized exposures and conservation of precious Personal Protective Equipment (PPE). Best practices emerged at breakneck speed as we sought to employ the latest evidence into our COVID19 care. This amounted to a constant barrage of rapidly evolving practice changes and guidelines. Does anyone remember hydroxychloroquine?
And while we lacked definitive therapeutics, developments to optimize throughput in clinical diagnostics and PPE conservation proved critical to our inpatient success. Rapid COVID testing allowed the ED and other units to test-in-place, providing much-needed mitigation to the frequent patient movements on and off the acute-care SPU for persons under investigation (PUI).
The In-Home Monitoring program (IHM) facilitated out-of-hospital patient monitoring, extending our bandwidth to manage COVID positive patients safely and effectively outside the hospital, allowing our dedicated staff to focus on those with severe COVID illness. Yet perhaps most worthy of mention is the vigil held by our hospital epidemiology team, who deciphered clinical risk and applied testing strategies day-in and day-out. To Costi Sifri and his dedicated team, we owe an incredible debt of gratitude.
With the thaw of spring, April brought hope of new therapeutics. Thanks to the alacrity of UVA clinical researchers such as Patrick Jackson, UVA participated in the study of Remdesivir, as patients and providers clutched to it with great optimism as it demonstrated measurable beneficial effects. Yet, at the same time, we witnessed increasing community spread and quickly learned how to flex as an organization to manage surges in cases at local nursing homes.
To honor those inflicted with severe COVID19 and those caring for these patients, COVID19 care was moved to the brand new South tower, surrounded by incredible vistas and a renewed sense of hope to both patients and staff.
It seemed we had a handle on COVID19 with yet more emerging therapies and another clinical trial with convalescent plasma by May. In June, Dexamethasone changed the landscape for our sickest patients. We were increasingly sharing success stories of patients emerging from epic journeys into and out of the intensive-care SPU.
From left: Lindsey Sinclair, Samantha Hudgins, Candace Rice, Carly Frazier, Daniesha Shelton, Kamden Pleasants, Stephanie Brownell, Eli Hammer, Ian Crane, Enrica Marchi, Persey Bediako, and Scott Austin.
Despite the therapeutic advances and powerful patient experiences, our reflective practice recognized the growing fatigue as an increasingly visible problem all around us. The department quickly offered support in staffing providers on the acute care SPU. This professional support will not be soon forgotten, and we offer our sincere thanks to our colleague volunteers from across the department and for the invigorating presence of the house staff. These efforts have boosted morale dramatically and provided a renewed commitment to the patients on the acute care SPU service.
So, where are we with COVID19 in October 2020? How are we doing? With over 500 COVID19 admissions at UVA, we are proud to share our hospitalized patient mortality rate of just 12%. Our success with COVID19 could not have been achieved without leader focus and support from day one.
It would be remiss not to take a moment to recognize excellence across the entire care team. First, our incredibly brave and dedicated nursing colleagues; they have demonstrated true grit. Our Respiratory Therapy, Physical and Occupational Therapy, Speech and Language Pathology, RN Case Managers, and Social Workers have also answered the call. And of course, our expert consultants coming to the bedside to help provide the best care for these incredible patients. To all, we offer our sincere Thanks!
Although we have worked hard to understand and treat COVID19 disease for nearly eight months, we continue to navigate uncharted waters. Fall and Winter 2020 will undoubtedly bring new epidemiological challenges, novel diagnostics and therapeutics, and potential vaccine candidates we hope will re-shape the epidemiology of COVID19. Regardless of what lies ahead, we look forward with calm hearts, clear minds, and unwavering determination to beat COVID19!
Filed Under: In the Know
Tags: November 2020, November Medicine Matters, November Medicine Matters Newsletter