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COVID-19: Year in Review · The SHEA Podcast

• 0:08
  SPEAKER_03: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shea, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:24
  SPEAKER_03: I'm Dr.
• 0:25
  SPEAKER_03: Jennifer Hanrahan, infectious disease specialist at the University of Toledo, and I will serve as today's podcast moderator.
• 0:32
  SPEAKER_03: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:42
  SPEAKER_03: Shay is excited to launch this episode of the podcast, COVID-19 Updates, What We Know Now.
• 0:49
  SPEAKER_03: Today's discussion will focus on COVID-19 a year in review.
• 0:54
  SPEAKER_03: So our speakers today are Dr.
• 0:56
  SPEAKER_03: Kirsten Schuti, infectious disease physician and medical director of infection prevention and control at Asante, Dr.
• 1:04
  SPEAKER_03: Scott Steinecker, Medical Director for Infection Prevention, Medical Director for Antimicrobial Stewardship, and Medical Director for Infectious Diseases Research Studies at Parkview Health, and Dr.
• 1:14
  SPEAKER_03: Jay Varke, hospital epidemiologist at Emory University Hospital.
• 1:18
  SPEAKER_03: Thank you all for joining us today.
• 1:20
  SPEAKER_03: Let's move right into the discussion.
• 1:23
  SPEAKER_03: Can you provide all of our listeners with your background and experiences, particularly as it relates to the pandemic?
• 1:30
  SPEAKER_03: Dr.
• 1:30
  SPEAKER_03: Shudi, we'll start with you.
• 1:32
  SPEAKER_02: Hi, Dr.
• 1:32
  SPEAKER_02: Hanrahan.
• 1:33
  SPEAKER_02: Thank you for the introduction.
• 1:35
  SPEAKER_02: As you mentioned, I'm an infectious disease physician and medical director of infection prevention at Asante, which is a small three hospital health system in Southern Oregon.
• 1:43
  SPEAKER_02: Our Ivy group is also small with just three providers subsequently.
• 1:48
  SPEAKER_02: And I think my colleagues on this panel and probably many of your listeners can also relate to this.
• 1:52
  SPEAKER_02: My colleagues and I have all been wearing more than the usual number of hats since January 2020.
• 1:58
  SPEAKER_02: In addition to serving as the content expert with our incident command team to help guide our health systems response to the COVID-19 pandemic, I've had the privilege of working with our local health departments on COVID-19 related efforts within our larger community and was selected to serve on Oregon OSHA's Rules Advisory Committee for General and Exceptional Risk Workplaces, a group tasked with assisting in the development of a temporary rule to address and mitigate the risks of COVID-19 in the workplace in Oregon.
• 2:26
  SPEAKER_02: At the state level, I've continued to contribute as a member of the Oregon Health Authorities Healthcare Acquired Infection Advisory Committee, which I've been a part of since before the onset of the pandemic.
• 2:36
  SPEAKER_03: Sounds like a very busy couple of years for you.
• 2:39
  SPEAKER_03: It has been busy.
• 2:41
  SPEAKER_00: Yeah.
• 2:42
  SPEAKER_03: All right.
• 2:42
  SPEAKER_03: Dr.
• 2:43
  SPEAKER_03: Steinecker, can you tell us what you've been doing?
• 2:45
  SPEAKER_00: Dr.
• 2:46
  SPEAKER_00: Hanarhan, thank you very much.
• 2:47
  SPEAKER_00: After doing my fellowship at Emory University, I went ahead and went into private practice in Ohio and had been in private practice for about 17 years.
• 2:56
  SPEAKER_00: 10 years ago, I had the opportunity to come on board as the infectious disease healthcare epidemiologist for Parkview Health System, which is a 10-hospital, approximately 1200-bed hospital system, and have been doing that for the past 10 years.
• 3:12
  SPEAKER_00: We have been writing the roller coaster since the increase in COVID, the recognition in December, and then opening up our incident command center in March of 2020.
• 3:22
  SPEAKER_00: And our hospital has accordioned to balloon because we decided we will not close.
• 3:28
  SPEAKER_00: We will find beds, make beds, place beds.
• 3:31
  SPEAKER_00: We've also been very active in developing an informatics team to help provide us the needed information.
• 3:36
  SPEAKER_00: Long COVID Clinic also, I've been very instrumentive in assisting the Indiana Department of Health with their various advisory committees.
• 3:45
  SPEAKER_03: It sounds like you have been extremely busy as well.
• 3:48
  SPEAKER_03: So, Dr.
• 3:49
  SPEAKER_03: Varkey, can you tell us a little bit about your background?
• 3:52
  SPEAKER_01: Sure.
• 3:52
  SPEAKER_01: Thanks, Dr.
• 3:53
  SPEAKER_01: Hanrahan, and happy to join this group of colleagues.
• 3:56
  SPEAKER_01: So I joined the faculty at the Emory University School of Medicine in 2009 after completing my residency and fellowship at Duke.
• 4:04
  SPEAKER_01: I initially actually was the first medical director of our first antibiotic stewardship program here at Emory University Hospital.
• 4:11
  SPEAKER_01: And then in 2015 took over as hospital epidemiologist.
• 4:15
  SPEAKER_01: Prior to that, I guess my first, I wouldn't say pandemic experience, but I guess experience in a public health crisis, I was one of five ID physicians back in fall of 2014 who took care of four patients with Ebola virus disease during the 2014 West African outbreak.
• 4:31
  SPEAKER_01: And then similar to both Dr.
• 4:33
  SPEAKER_01: Steneker and Shuti, I've worn multiple hats over the last year and a half.
• 4:38
  SPEAKER_01: In addition to my day job as medical director of our infection prevention program, I've been part of our hospital's COVID leadership team, the Systems Incident Command Center, where each of the epidemiologists throughout the Emory system has somehow been able to maintain a collaborative relationship in terms of troubleshooting some of these unanswerable questions.
• 4:58
  SPEAKER_01: And then I've also done some consulting with both our university as well as a few private companies.
• 5:03
  SPEAKER_03: All right.
• 5:04
  SPEAKER_03: So as we come to the end of 2021, what have we seen from COVID-19 compared to 2020?
• 5:11
  SPEAKER_03: What do you see as the similarities and differences?
• 5:14
  SPEAKER_03: What have we learned?
• 5:15
  SPEAKER_03: Dr.
• 5:16
  SPEAKER_03: Steinecker, I'll start with you.
• 5:18
  SPEAKER_00: I think the key thing that we learned is that what we teach our hierarchy of controls, of masking, hand washing, social distancing, et cetera, work.
• 5:28
  SPEAKER_00: And that when we initially confronted COVID and we observed this hierarchy of controls, observed lockdowns and decreased in transportation, et cetera, that we were able to greatly suppress the curve.
• 5:40
  SPEAKER_00: As we moved on, we relaxed a little bit.
• 5:42
  SPEAKER_00: We had another wave, wasn't terrible.
• 5:45
  SPEAKER_00: And then as we relaxed even further, we've had a natural experiment.
• 5:49
  SPEAKER_00: What happens when you don't do an observe in thoroughness, the hierarchy of controls?
• 5:55
  SPEAKER_00: And with that, most recently, we've seen a tremendous number of cases in the tri-state Indiana, Ohio, Michigan region that have surpassed what we had even seen in previous waves.
• 6:06
  SPEAKER_00: So I think that really what we've learned is that what we've preach, what we teach, what we know works, it's just that the severe COVID fatigue has allowed this natural experiment to show that when we don't do it, people will continue to get sick and continue to die and develop long COVID, which impacts up to 10 to 15% of our workforce.
• 6:29
  SPEAKER_03: Dr.
• 6:29
  SPEAKER_03: Barke, would you like to add anything to that?
• 6:32
  SPEAKER_01: I would echo all the comments Scott made in terms of just reinforcing that strict adherence to basic and fish control, something that all of us have been preaching for most of our careers, is actually really effective.
• 6:44
  SPEAKER_01: And that public health interventions work.
• 6:46
  SPEAKER_01: They're just really, really difficult to do and even harder to sustain.
• 6:50
  SPEAKER_01: The other thing that I think, and it's sort of striking, I guess, that we're doing this podcast right now at the end of December, during probably not even the peak of the Omicron surge, is it can be humbling in terms of recognizing all the unknowns that this variant and this kind of state of the pandemic has given us.
• 7:08
  SPEAKER_01: But, you know, as I told my team this morning, I think it's important not to lose sight of all the things we've learned.
• 7:15
  SPEAKER_01: And the fact that, and this I think is something that we can still reinforce with our patients, our coworkers, and you know, all the countless number of family and friends who we've become unofficial consultants for, is that in the end, this is still a respiratory virus.
• 7:29
  SPEAKER_01: We know how it's transmitted, we know how to prevent it.
• 7:32
  SPEAKER_01: And some of the great gains we've made in terms of understanding how to prevent, how to treat, and how to protect populations, we shouldn't lose sight of even in the midst of this most recent and challenging uh upsurge.
• 7:44
  SPEAKER_03: Dr.
• 7:44
  SPEAKER_03: Shudy, what do you think has been one of the major changes?
• 7:48
  SPEAKER_02: Yeah, I think Dr.
• 7:49
  SPEAKER_02: Steineker and Dr.
• 7:51
  SPEAKER_02: Varkey's points are absolutely, you know, things that I would echo as well.
• 7:55
  SPEAKER_02: I'm gonna maybe switch it up a little bit and talk about some of the differences that I've seen.
• 8:00
  SPEAKER_02: When I was thinking of similarities and differences, one of the things that popped to top of my mind was the shortages.
• 8:06
  SPEAKER_02: I never thought when we started this that we would be dealing with such physical supply challenges in terms of PPE and test reagents and swabs and other things in such short supply that we really had to develop and realistically think about crisis strategies to try to continue to provide care in order to address those lacks.
• 8:26
  SPEAKER_02: But I think moving into 2021, you know, we're in a lot better position with many of those things in terms of their availability.
• 8:35
  SPEAKER_02: So, in general, a much better position with physical supplies.
• 8:39
  SPEAKER_02: But I think we've now seen this morph into the human domain, where the shortages that we're seeing and facing now are really both from a direct and indirect effect of COVID-19, the increased demands on our healthcare workers.
• 8:52
  SPEAKER_02: It's been really challenging, I think, for their morale.
• 8:55
  SPEAKER_02: And it's tested all of our resilience.
• 8:58
  SPEAKER_02: I think that's the big difference I'm seeing.
• 9:00
  SPEAKER_02: And I'm hoping we'll be able to keep sight of that and make some real efforts to support the mental health of all of our healthcare provider team members in the coming year, because I do think unfortunately those are likely to worsen before they improve.
• 9:14
  unknown: Yeah.
• 9:14
  SPEAKER_03: Thank you, Dr.
• 9:15
  SPEAKER_03: Shuddy.
• 9:16
  SPEAKER_03: I think those are really important points and probably some of the more difficult to deal with than just physical supplies.
• 9:23
  SPEAKER_03: So in terms of infection prevention, and I think that this question is really important right now, especially in light of the changing guidance that came out from CDC recently.
• 9:34
  SPEAKER_03: What do you all think has changed the most in terms of our understanding of SARS-CoV-2 in regards to infection prevention?
• 9:42
  SPEAKER_03: So, Dr.
• 9:43
  SPEAKER_03: Varke, I'll start with you.
• 9:45
  SPEAKER_01: Such a great topic.
• 9:46
  SPEAKER_01: I think among the many things that, and I'm speaking personally in terms of what I've learned is, you know, I think this traditional dichotomy of how we've thought about respiratory pathogens in terms of being transmitted by droplet versus airborne, probably a lot more artificially dichotomous than it is in reality.
• 10:06
  SPEAKER_01: You know, our colleague Mike Columbus has uh had a great article review with Don Milton.
• 10:12
  SPEAKER_01: So this is a combined effort from colleagues at Harvard and the University of Maryland, where they really did challenge this dogma and really helped describe in an academic way how these pathogens behave in a continuum.
• 10:25
  SPEAKER_01: And pathogens that we that might be traditionally thought to be spread by droplet may in fact spread by some of these short-range aerosols.
• 10:33
  SPEAKER_01: And that we probably need to adapt our interventions a little bit more intentionally depending on the pathogen and what we're trying to prevent.
• 10:41
  SPEAKER_01: I think that that is something that we can apply not just to the rest of this pandemic, but the way we do infection control at all of our hospitals, especially if we ever go back to kind of a traditional respiratory viral season.
• 10:54
  SPEAKER_01: One example I'll give that I think might apply to my colleagues on this podcast is, you know, our oncologists and more importantly, their nursing staff were way ahead of the game on this in terms of wanting to adopt universal masking years ago, with this recognition that they wanted to try source control.
• 11:12
  SPEAKER_01: They were recognizing the fact that their vulnerable patients were at risk for influenza, for RSV.
• 11:17
  SPEAKER_01: And I do think as we move on, even though this is going to be difficult from a morale standpoint to sustain, I could see a scenario where we continue doing universal masking for a long period, even as we wind into a new phase of this pandemic.
• 11:32
  SPEAKER_03: Yeah, thank you.
• 11:33
  SPEAKER_03: Dr.
• 11:33
  SPEAKER_03: Shudi, what do you think has changed in regards to infection prevention?
• 11:38
  SPEAKER_03: I think that Dr.
• 11:39
  SPEAKER_02: Varkey stole the words right out of my mouth because that was exactly what I was going to comment on is the spectrum of this artificial distinction between droplet versus aerosol transmission.
• 11:51
  SPEAKER_02: I think SARS-CoV-2 and our knowledge of transmission of this particular virus has really caused us to re-envision that spectrum and reassess the measures that we take in terms of infection prevention and control.
• 12:05
  SPEAKER_02: And I think in the future we'll see a lot more of a focus in recognizing that on source control and masking, but also on environmental factors and air handling within our not just our healthcare system buildings and our hospitals, but our outpatient clinics and hopefully in the workplace as well.
• 12:22
  SPEAKER_02: So I think all of those things are probably one of the biggest implications I've seen coming from the pandemic.
• 12:30
  SPEAKER_03: Dr.
• 12:30
  SPEAKER_03: Steinecker, do you have any observations about the changes in infection prevention?
• 12:36
  SPEAKER_00: As we look back into the past, as we try to predict the future, we looked back at MERS, CoV, and SARS-CoV-1, and we thought that surfaces would play a much higher route of transmission than actually have transpired.
• 12:51
  SPEAKER_00: And I think that's really changed our processes to a great degree.
• 12:55
  SPEAKER_00: And as we look at some of the other respiratory viruses, recognizing that droplet and aerosol are key for some, but for others, it's much more surface-related transmission.
• 13:06
  SPEAKER_00: And I think that that realization that there is really a pretty significant difference is was eye-opening to many of us.
• 13:13
  SPEAKER_00: I also think that we had some very interesting cultural issues that came up the virus has highlighted.
• 13:20
  SPEAKER_00: The first is the risk of transmission with singing.
• 13:24
  SPEAKER_00: Who knew that attending a choir practice, even standing six feet apart, could yield such a high rate of transmission of a respiratory virus?
• 13:32
  SPEAKER_00: And then the sheer amount of opposition that came through to us, through particularly social media, to which we were completely unprepared and still remain unprepared and do not have an adequate response for the misinformation that has been widely disseminated during this outbreak.
• 13:52
  SPEAKER_03: Yeah, I think those are all incredibly important points.
• 13:55
  SPEAKER_03: And so, Dr.
• 13:55
  SPEAKER_03: Steinecker, I have to follow up and I have to ask you since realizing that surfaces don't play as much of a role, have there been changes in terms of your infection prevention practices in the hospital setting?
• 14:08
  SPEAKER_00: We've enrolled in a heavy investment in UV light robots and deployed those with the realization that they were that surfaces weren't nearly the problem.
• 14:19
  SPEAKER_00: We subsequently repurposed our robots for more of the other highly multi-drug resistant organisms, particularly Clostridium defecial and or clostridioides, typically, depending on where you're which side of the Atlantic you're on.
• 14:33
  SPEAKER_00: But uh still, we found that we did not need to use UV light.
• 14:37
  SPEAKER_00: We did change some of our cleaning processes to better represent the amount of time necessary to achieve adequate decontamination.
• 14:45
  SPEAKER_03: Okay, thank you.
• 14:47
  SPEAKER_03: So you all come from different areas of the country and different healthcare settings.
• 14:52
  SPEAKER_03: Can you share what your area and organization have seen in regards to COVID?
• 14:57
  SPEAKER_03: So, Dr.
• 14:57
  SPEAKER_03: Shuddy, I'm going to start with you since you're on the West Coast.
• 15:00
  SPEAKER_02: Yeah, sure.
• 15:02
  SPEAKER_02: So we were actually somewhat fortunate in Southern Oregon in that we saw our first relatively small wave of cases later than many other parts of the US.
• 15:12
  SPEAKER_02: So in late fall of 2020.
• 15:14
  SPEAKER_02: And that wave really was attenuated by the start of the vaccine rollout in late 2020 and early 2021.
• 15:20
  SPEAKER_02: So we had a bit more time to prepare than I think many other parts of the country did that had a higher number of cases earlier.
• 15:27
  SPEAKER_02: But even with this extra time to kind of get ready for and knowing we were going to see COVID-19 in our communities, you know, the larger surge of cases that we saw with the introduction of the Delta variant over the summer of 2021 really taxed our health system's capacity.
• 15:42
  SPEAKER_02: And since then, we've continued to see fairly high levels of ongoing transmission within our community and our region.
• 15:49
  SPEAKER_02: And we've really struggled a bit to catch up from surgeries that were delayed and canceled.
• 15:54
  SPEAKER_02: And we've struggled with hospital capacity, both due to a lack of skilled nursing facility beds to discharge patients to, as well as with staffing challenges.
• 16:03
  SPEAKER_02: And so we're not in a particularly optimistic place, I think, heading into the beginnings of what I expect will be a rapid rise in cases due to the Omicron variant, which we've recently identified in our area over the past week or two.
• 16:16
  SPEAKER_02: Dr.
• 16:17
  SPEAKER_03: Steinecker, what has it been like in your area?
• 16:20
  SPEAKER_00: In our tri-state area of northeastern Indiana, northwestern Ohio, and southern Michigan, it's really been fascinating to see the social context with our vaccination rate being between 24 and 55%.
• 16:36
  SPEAKER_00: Clearly, that hurts us.
• 16:38
  SPEAKER_00: And within our scope, we can control the size of our hospital, seek out whatever we need with our supply chain, make it ourselves if we need to.
• 16:47
  SPEAKER_00: And we did reach out to local manufacturing to create what we could not purchase.
• 16:51
  SPEAKER_00: But still, I've been absolutely amazed that we have this social context and lack of vaccination and understanding of what vaccination can do that has been very concerning.
• 17:04
  SPEAKER_00: And yet the number, sheer number of unvaccinated people that are being admitted into the hospital continues to be the major pressure on our systems.
• 17:13
  SPEAKER_03: Dr.
• 17:14
  SPEAKER_03: Barkey, what has it been like for you in Atlanta?
• 17:17
  SPEAKER_01: It's interesting.
• 17:18
  SPEAKER_01: I would say that I feel like I'm in, I hate to use the phrase because we I think all of us have overused it a lot the last 18 months, but I've sort of feel like I've been in my own bubble in Metro Atlanta compared to the rest of the state.
• 17:28
  SPEAKER_01: Because it really, I think that the pandemic experience has been different.
• 17:32
  SPEAKER_01: I will say in Metro Atlanta and what we've experienced here at Emory, we also were somewhat sheltered from the initial spring wave that we saw in spring 2020.
• 17:40
  SPEAKER_01: A lot of our preparations, we actually didn't quite need to break the glass that we thought we needed to.
• 17:45
  SPEAKER_01: In summer of 2020, Georgia was at a time actually had the highest COVID rates in the country as part of the Sunbelt wave that occurred in summer 2020.
• 17:53
  SPEAKER_01: And, you know, January of this year was brutal, mostly because we knew we had to roll, we were rolling out vaccines at the same time of having, I think, a peak of 120 active patients in our 600-bed hospital, 40 of whom were in the ICU.
• 18:06
  SPEAKER_01: I think 12 who are on active ECMO.
• 18:09
  SPEAKER_01: My thoughts at that time naively was that it can never ever quite get that bad again until the Delta wave in August, which was very similar to what we experienced last summer.
• 18:18
  SPEAKER_01: And right now, as of this morning, we have 68 folks that are hospitalized, 10 in the ICU.
• 18:23
  SPEAKER_01: And I'm we're on a clear, you know, logarithmic rise upwards.
• 18:26
  SPEAKER_01: So I'm I'm not quite sure where we're going to peak.
• 18:29
  SPEAKER_01: That part is humbling.
• 18:30
  SPEAKER_01: I will say it's been nice to see it.
• 18:32
  SPEAKER_01: Just to wrap up, I would say, you know, in my bubble in Metro Atlanta, I do feel that most people, most folks in the schools are trying to adhere to the public health interventions and be able to roll with it.
• 18:43
  SPEAKER_01: It has been eye-opening moving outside of Metro Atlanta or talking with colleagues who have family who have tried to visit over the holidays and recognizing, you know, so much of the state has unfortunately moved on or has tried to move on, even though the virus really isn't moved on from us.
• 18:58
  SPEAKER_03: Yeah, so we've talked a lot about all the difficulties.
• 19:02
  SPEAKER_03: We've had some great successes as well.
• 19:05
  SPEAKER_03: So, what do you all see as some of the biggest successes for healthcare professionals?
• 19:09
  SPEAKER_03: Dr.
• 19:10
  SPEAKER_03: Steinecker, I'll start with you.
• 19:11
  SPEAKER_00: For us, one of our biggest successes was launching monoclonal antibody outpatient infusion tied mostly to our emergency room and then generalized to some standalone clinics.
• 19:23
  SPEAKER_00: But we've been in a process of infusing, when available, about 200 patients a day.
• 19:28
  SPEAKER_00: And that's reduced our hospital admissions, we estimate, by about 20%.
• 19:33
  SPEAKER_00: We've also seen outstanding teamwork amongst the hospital leadership, both physician and non-physician.
• 19:40
  SPEAKER_00: And that leadership and teamwork has allowed our system to really respond and flex to a degree that other systems nearby have not been able to do so.
• 19:51
  SPEAKER_00: That and providing an environment for our staff for our return to work, those who become ill or have been exposed, I think are been key successes that we'll continue to take forward.
• 20:02
  SPEAKER_03: Dr.
• 20:02
  SPEAKER_03: Shudiv, what are your thoughts in terms of our successes?
• 20:06
  SPEAKER_02: I think we've had a number of successes at various levels.
• 20:09
  SPEAKER_02: And really, it depends on how you're defining healthcare professionals.
• 20:12
  SPEAKER_02: I'm going to assume broadly here.
• 20:14
  SPEAKER_02: But first and foremost, I think as a society, as a healthcare field, as a scientific endeavor, the rapid development of safe and effective vaccines has been probably one of the most successful, if not the most successful thing that we've been able to accomplish thus far.
• 20:31
  SPEAKER_02: That being said, I think, you know, while it might be a glass half full versus half-to-empty situation, depending on kind of how you view some of these things, I also think that the amount of innovation we've seen regarding the rapid establishment and expansion of telemedicine and how to utilize that and utilize it well, the quick organization and stand-up of mobile and drive-up testing sites, which we were one of the first to set up in our little corner of Oregon.
• 20:57
  SPEAKER_02: And then things like drive up monoclonal antibody clinics that we've been able to utilize and leverage to decrease hospital admissions, just like Dr.
• 21:06
  SPEAKER_02: Steineker mentioned, have been some of our big biggest successes.
• 21:09
  SPEAKER_02: Dr.
• 21:09
  SPEAKER_03: Varkey, what do you think has been the biggest success?
• 21:13
  SPEAKER_01: Yeah, I can think of two, and they coalesce very nicely with what Dr.
• 21:16
  SPEAKER_01: Shudi and Steineker just mentioned.
• 21:18
  SPEAKER_01: I'd say close to home for all of us, it's really been wonderful, even in the midst of a crisis, to see how our infection prevention teams have stepped up.
• 21:27
  SPEAKER_01: Think back to my team when the pandemic started, a couple of them were just out of public health school.
• 21:33
  SPEAKER_01: This was one of their first jobs working in an academic medical center or in a tertiary hospital.
• 21:38
  SPEAKER_01: And to suddenly kind of be put on the firing lines, it was a certainly a flight or fight kind of response.
• 21:44
  SPEAKER_01: And it's really, really impressive to see the team step up and be, I think, really fulfill our mission, right?
• 21:50
  SPEAKER_01: I think a lot of what we do is cheering on sort of the unsung heroes of the hospital.
• 21:56
  SPEAKER_01: But in this case, it truly has been collaborative where I've seen infection prevention.
• 22:00
  SPEAKER_01: Hospital epidemiology, step up in our roles as subject matter experts and to really partner with frontline staff in terms of caring for patients in a safer manner, COVID and non-COVID.
• 22:11
  SPEAKER_01: So that's something that I'm proud of internally.
• 22:13
  SPEAKER_01: I'd say the other piece to it, kind of outside of ID and infection prevention, is sort of seeing how our colleagues have stepped up across the hospital and outside the hospital.
• 22:22
  SPEAKER_01: So primary care, Scott mentioned the monoclonal program.
• 22:25
  SPEAKER_01: I'd say inside the hospital, seeing how hospital medicine, critical care have stepped up and really been running point on caring for seriously ill and in many cases critically ill patients, and letting ID and infection prevention again go to our traditional consulting role and giving advice on how to do it.
• 22:44
  SPEAKER_01: It's been under some very tenuous circumstances, it's really that aspect of it has made me proud to be an ID and to be in hospital upbeat.
• 22:53
  SPEAKER_03: All right.
• 22:53
  SPEAKER_03: So Dr.
• 22:53
  SPEAKER_03: Shudi, I'm gonna start with you.
• 22:55
  SPEAKER_03: You already touched on this subject.
• 22:57
  SPEAKER_03: So as the virus becomes more contagious, as we've seen with Omicron, how do you think we can deal with staffing challenges?
• 23:05
  SPEAKER_02: Yeah, that's a tough question.
• 23:07
  SPEAKER_02: And I feel like one that's maybe a little politically fraught right now with the updated CDC guidance.
• 23:12
  SPEAKER_02: I think it's a challenge, really.
• 23:14
  SPEAKER_02: We're in a situation where we're trying to look at the best evidence we have for transmission and trying to apply what we know from earlier variants to the Omicron variant and hope that the same information really holds true, which I think presents some challenges and the realities we're facing in terms of how transmissible this new variant is, and that while vaccination may still prevent our healthcare workers from becoming seriously ill and ending up in the hospital themselves, it doesn't do as much in terms of preventing them from getting sick in that initial period where they can still transmit this variant to others is really, I think, the challenge that we're facing.
• 23:53
  SPEAKER_02: So I'm not sure I have any great or completely novel approaches to this, but I think trying to walk that fine line of determining who's exposed, who's most at risk of being infectious at any point in time, and then keeping them away from others or doing our best to control the level of transmission risk they pose, while also recognizing and trying to be flexible with getting those who can go back to work who we don't feel pose that same level of risk back as quickly as possible.
• 24:24
  SPEAKER_02: I do think that's going to be a bit of a moving target.
• 24:27
  SPEAKER_02: And I think time and more information is going to tell us where we end up with that.
• 24:32
  SPEAKER_03: Yeah, I think it's certainly a difficult question.
• 24:34
  SPEAKER_03: Dr.
• 24:34
  SPEAKER_03: Steincker, what are your thoughts on this?
• 24:37
  SPEAKER_00: ParkView has hired over 460 travelers to help support our staffing and with the expanded number of beds, as we've expanded 115 to 130% of our normal capacities at each of our hospitals.
• 24:53
  SPEAKER_00: Still, that staff feels a tremendous sense of burnout.
• 24:57
  SPEAKER_00: And it's not necessarily the work that's required, the showing up and actually doing the job.
• 25:02
  SPEAKER_00: It's the fact that there is a bit of a violation of the trust.
• 25:07
  SPEAKER_00: And what I mean by that is that the same people that will trust us for an MI or a stroke or some other significant surgery turn around to get admitted with COVID, deny they have COVID, and then are requiring, demanding, insisting on ivermectin.
• 25:23
  SPEAKER_00: And this has and refusing to be vaccinated.
• 25:26
  SPEAKER_00: Why do they trust us for these other things?
• 25:29
  SPEAKER_00: And now they won't trust us for this.
• 25:32
  SPEAKER_00: And so I think that there's been a fundamental shift in the philosophy of my healthcare workers showing up where they tell me, look, Scott, I show up, I put in my time, I go home, and I leave it behind.
• 25:44
  SPEAKER_00: It's not like we're trying to fight the battle like we were the first couple of times around.
• 25:50
  SPEAKER_00: Wow.
• 25:51
  SPEAKER_03: Dr.
• 25:51
  SPEAKER_03: Varkey, any thoughts on how to deal with some of the staffing issues?
• 25:55
  SPEAKER_01: No, I wish I had a solution to this, but honestly, it is our biggest challenge.
• 25:59
  SPEAKER_01: And I hate to be grim, but I don't see it getting better anytime soon.
• 26:03
  SPEAKER_01: We can talk about new models.
• 26:04
  SPEAKER_01: We can talk about being and revisiting safe return to work guidance.
• 26:10
  SPEAKER_01: But honestly, I see those as temporizing measures.
• 26:13
  SPEAKER_01: When you look across every service line, every component, whether it's a direct patient care, facilities, food and nutrition, every single aspect of caring and running a hospital is affected by staffing.
• 26:25
  SPEAKER_01: To that end, I just don't think there's a single solution to the one aspect of it, and I think we'll get a real life experience with it as we all deal with this Omicron surge, is and I'm keeping my fingers crossed on this, is that although we're clearly dealing with a more infectious variant, if we can better contain and if this is truly less virulent, then the question is, can we actually build enough capacity to return our staff to work safely and also build enough, I'll say, resilience within our hospital to care for the patients we have.
• 26:59
  SPEAKER_01: But I do have to just highlight, I mean, I think all of our comments really illustrate the paradox with this variant, right?
• 27:07
  SPEAKER_01: Compared to the previous waves where we were concerned about the mortality of our patients or even among some of our coworkers, this one, I think all of us saw the fact of what was going to happen.
• 27:16
  SPEAKER_01: We as healthcare personnel are members of our community.
• 27:19
  SPEAKER_01: So when community transmission goes up like this and we have healthcare personnel that are getting sick, we just simply do not have enough people to staff and run our hospital the way we want to.
• 27:28
  SPEAKER_03: All right.
• 27:29
  SPEAKER_03: So this next question, I'm sure you've all been asked this a million times.
• 27:32
  SPEAKER_03: I have certainly been asked this question.
• 27:35
  SPEAKER_03: So get out your crystal balls.
• 27:37
  SPEAKER_03: What do you think 2022 will bring for us?
• 27:40
  SPEAKER_03: When will this be over?
• 27:41
  SPEAKER_03: Will this be over?
• 27:42
  SPEAKER_03: Will it become more like the regular flu that we deal with?
• 27:46
  SPEAKER_03: Dr.
• 27:47
  SPEAKER_03: Steinecker, I'll start with you.
• 27:49
  SPEAKER_03: What do you predict for 2022?
• 27:51
  SPEAKER_00: Right now, today, we're dealing with approximately 15% of our population, including those that get tested and those that we estimate that have minimal or asymptomatic infection.
• 28:03
  SPEAKER_00: But how long can we continue to burn through our population at nearly a point prevalence of 15%?
• 28:11
  SPEAKER_00: It's clear that people keep getting infected and reinfected.
• 28:15
  SPEAKER_00: And at some point it does become the common cold.
• 28:18
  SPEAKER_00: But then we have the influence of the variants.
• 28:21
  SPEAKER_00: And I think it's inevitable that, particularly in other countries, we're going to see additional episodes where the virus jumps out of humans into some other mammalian or non-mammalian species, jumps back into humans, and now has become some kind of a recombinant organism to which we can have little protection, perhaps.
• 28:43
  SPEAKER_00: And I think what's most important that we focus on is how do we develop the rapid systems for defining a new monoclonal antibody, a new booster vaccine, a new protease inhibitor, some new treatment that's going to allow us to be able to adapt rapidly to the new threat.
• 29:02
  SPEAKER_03: Okay, Dr.
• 29:03
  SPEAKER_03: Varke, what are your thoughts about what 2022 is likely to bring?
• 29:07
  SPEAKER_01: Well, I think it's safe to say that our hopes of the pandemic ending is not going to be an event, but it's clearly going to be a process, probably more subtle than all of us wanted.
• 29:16
  SPEAKER_01: But that being the case, I still do remain optimistic on a couple of fronts.
• 29:21
  SPEAKER_01: One is I think availability of frequent and rapid testing, which again sounds insane right now, just given the shortages all of us are feeling during the surge.
• 29:31
  SPEAKER_01: I do think that that'll change.
• 29:33
  SPEAKER_01: And I do think that this particular Omicron wave has highlighted the need of actually having it and has brutally highlighted kind of the inefficiencies of relying on PCRs that have a turnaround time of, in some cases, 72 to 96 hours.
• 29:47
  SPEAKER_01: So I think that actually will be better.
• 29:49
  SPEAKER_01: Do I think it'll get to the point where everybody has their own lateral flow test next to their toothbrush?
• 29:54
  SPEAKER_01: Maybe not quite to that degree, but I think the availability will be better.
• 29:58
  SPEAKER_01: Second, I actually remain optimistic on the availability of therapeutics and hopefully therapeutics that are easier to take than say administrating monoclonals, even though all of us have kind of been involved in systems to make that more readily available.
• 30:12
  SPEAKER_01: But I think the two agents that were recently approved by EUA that can be taken orally, I think other ones in that pipeline really do hold potential to actually protect hospitals and make this more of an outpatient disease that the health system can handle.
• 30:28
  SPEAKER_01: The last thing I would say, and again, this sounds maybe too pie in the sky, but I truly do believe it, is that despite all the politicization of vaccination, I still do think that we are moving to an era of where businesses will demand their employees essentially be vaccined by mandate.
• 30:46
  SPEAKER_01: And I think this will probably be embedded in terms of with insurance.
• 30:50
  SPEAKER_01: And I think to that end, we will creep our way towards a better, I won't say herd immunity, but I'll say population-based immunity as you roll into 2022.
• 31:00
  SPEAKER_03: Thank you.
• 31:00
  SPEAKER_03: Dr.
• 31:01
  SPEAKER_03: Shuddy, what are your predictions for 2022?
• 31:04
  SPEAKER_02: Be in the role of gazing into that crystal ball is always an uncomfortable position in case you turn out to be wrong.
• 31:10
  SPEAKER_02: But I think in general terms, this pandemic, like every other one before it, will come to an end one way or another.
• 31:18
  SPEAKER_02: I'm not terribly optimistic that that end point will be in 2022.
• 31:23
  SPEAKER_02: And I think rather than a specific point, it's likely to be a transition into something new or different.
• 31:29
  SPEAKER_02: Whether that's seeing our current variants kind of die out with population-based immunity that gets elevated through inoculation and through natural infection well enough that we can fend this off and it does become more like a common cold coronavirus, or whether we see it come back in a new form after being through some animal intermediate hosts again, I think is hard to say.
• 31:55
  SPEAKER_02: Hopefully not.
• 31:56
  SPEAKER_02: That's my personal hope on that second one.
• 31:58
  SPEAKER_02: But I do think that we will get to a point where we will see this as something that won't overwhelm our healthcare systems like it has done for the last two years, whether it's 2022 or it takes a little bit longer.
• 32:11
  SPEAKER_02: I do also want to point out that I think we need to be aware that we also have some potential to modify that trajectory.
• 32:19
  SPEAKER_02: And one of the ways we do that is really making a collective effort to get our vaccinations and get the therapeutics that exist more equitably distributed globally so that we don't have pockets of areas that face those challenges that put pressure on the virus to emerge in new forms.
• 32:38
  SPEAKER_02: So I'm hopeful that 2022 will bring a more concerted effort in that way.
• 32:43
  SPEAKER_02: So we don't have those concentrated therapeutics and vaccines mostly in resource-rich nations, but better distributed globally.
• 32:51
  SPEAKER_03: Yes, thank you.
• 32:52
  SPEAKER_03: You've all made some really important points.
• 32:56
  SPEAKER_03: So what final thoughts do you have for our listeners?
• 32:59
  SPEAKER_03: Dr.
• 33:00
  SPEAKER_03: Barkey, I'll start with you.
• 33:02
  SPEAKER_01: Yeah, I guess just two points.
• 33:03
  SPEAKER_01: And I know this is preaching to the choir, thinking about the audience that would listen to this podcast, but I would say, you know, one, let's not forget the fact that this really has been two pandemics, right?
• 33:14
  SPEAKER_01: It's been the pandemic of the virus and of misinformation that all of us have felt.
• 33:19
  SPEAKER_01: And I would say that even though it's been disheartening, I refuse to give up that we can't concede the battlefield to those that are spreading this misinformation.
• 33:31
  SPEAKER_01: Again, we have the expertise to do it.
• 33:33
  SPEAKER_01: And I do believe that even though there are people who have dug in their heels on their feelings on this, with our expertise, we can still reason our way through this and that there are still a population of people that are willing to listen.
• 33:45
  SPEAKER_01: The second piece I would say to it is just again, this is my thanks to infectious diseases, is just recognizing that the failures that we as a society have encountered responding to this public health crisis, the failure to take timely and effective actions, they always, whether it's this pandemic or the other ones, disproportionately affect the most vulnerable members of our society and often end up being patients that infectious diseases take care of.
• 34:13
  SPEAKER_01: And this is again just reiterates part of the reason why I'm proud and happy to be part of this group.
• 34:17
  SPEAKER_03: Thank you, Dr.
• 34:18
  SPEAKER_03: Barkey.
• 34:19
  SPEAKER_03: Dr.
• 34:19
  SPEAKER_03: Shudi, what are your final thoughts?
• 34:22
  SPEAKER_02: One final thought is actually, you know, something that I think has been one of the biggest challenges around this pandemic, and that's about communication.
• 34:30
  SPEAKER_02: And I believe Dr.
• 34:31
  SPEAKER_02: Barkey hit on that a little bit earlier, but people are tired and they're overwhelmed by the amount of information they're hearing about COVID-19 and the misinformation they're seeing and hearing from otherwise trusted resources, family members or friends.
• 34:47
  SPEAKER_02: And I think it's natural to want definite answers, to have a sense of security and certainty about where we're going and what to expect in the future.
• 34:56
  SPEAKER_02: But the reality is we just don't have that all the time right now.
• 35:00
  SPEAKER_02: We have some educated thoughts and guesses that are well informed.
• 35:05
  SPEAKER_02: But that sense of uncertainty is something I think we need to do a better job at communicating.
• 35:10
  SPEAKER_02: Because if we don't start to do that, we really run the risk of that fatigue that people are experiencing, that overwhelm that they're experiencing, leading to them just checking out.
• 35:19
  SPEAKER_02: And if they check out, they take the easy thoughts and solutions.
• 35:22
  SPEAKER_02: It cements what they've already heard or anticipated or what makes sense to them.
• 35:27
  SPEAKER_02: And it undermines our credibility as well when we don't communicate that uncertainty and we move with the data, we move with new evidence, and we change to evidence-based guidelines and recommendations.
• 35:38
  SPEAKER_02: So that would be my final thought, and I guess my plea as well to everyone who's in a position to help work towards that is really being cognizant of how we communicate this uncertainty while still being reassuring and giving a sense of security to folks that are relying on us for good information.
• 35:56
  SPEAKER_03: That's hard to do.
• 35:57
  SPEAKER_03: Yeah, very important.
• 35:58
  SPEAKER_03: Dr.
• 35:59
  SPEAKER_03: Steinecker, what are your final thoughts?
• 36:01
  SPEAKER_00: To echo Dr.
• 36:02
  SPEAKER_00: Markey and Dr.
• 36:03
  SPEAKER_00: Shudie, I want to really say our biggest challenge is going to be to respond to the social media and those responses.
• 36:11
  SPEAKER_00: I really appreciate the role that Shea has played in getting information out and being as supportive as they can.
• 36:18
  SPEAKER_00: I would like to really push that hospitals, local leaders, and professional media spend more time in pushing back aggressively the false information that's put out.
• 36:29
  SPEAKER_00: Lastly, I think that we need to focus on long COVID because that threatens 10 to 15% of our workforce, and we just can't really afford that.
• 36:38
  SPEAKER_00: And more importantly, we need to be in a position where underperforming folks that are in the workforce can be identified and then brought into a treatment regimen because we do have some treatments that are fairly effective and are improving all the time.
• 36:53
  SPEAKER_03: All right.
• 36:53
  SPEAKER_03: Well, thank you all for such a great conversation and for joining us today.
• 36:59
  SPEAKER_00: Thank you.
• 36:59
  SPEAKER_00: Thank you very much.
• 37:00
  SPEAKER_03: Thank you for having me.
• 37:01
  SPEAKER_03: Thank you again to our speakers for sharing their perspective and experiences.
• 37:05
  SPEAKER_03: Thank you all for listening throughout the year.
• 37:08
  SPEAKER_03: Today is the final episode of 2021 and is number 34 of the year.
• 37:12
  SPEAKER_03: We'd also like to announce that starting in 2022, we will be launching episodes of this podcast series on a monthly basis.
• 37:20
  SPEAKER_03: This podcast can be accessed on SHA's online education center, Learning CE, under the Rapid Response Program, where you will also find resources such as the SHA COVID-19 town halls.
• 37:32
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• 37:34
  SPEAKER_03: Take$20 off any membership type using the coupon code LEARNINGCE22 at checkout.
• 37:41
  SPEAKER_03: This concludes today's episode of the Rapid Response Podcast.
• 37:45
  SPEAKER_03: Thank you for tuning in.