June 17, 2020
Dear Members of the Baylor College of Medicine Community,
Today I want to talk about control – specifically, frustration over those things we cannot control, and the importance of recognizing and maximizing those things we can.
For a phenomenon that has been with us for a relatively short period of time, it may seem strange to speak in terms of “epochs,” but it does feel like we have lived through some very distinct phases in this pandemic. April was categorized by a long list of unknowns, rapid community viral spread and an overall mood of fear and anxiety.
May seemed different. We regained a little more of a sense of routine. The virus, though not in retreat, seemed to have reached a point of community equilibrium. We breathed a small but tentative sigh of relief, and even had some optimism that we could simultaneously re-engage our regional economy and hold the infectious invader at the gate.
By June, we started to see the impact of the loosening of distancing in the community. If you have followed the recent numbers, community cases are sharply increasing, and hospital capacity is feeling the strain. Political polarization has accelerated and become personalized – “you can’t make me wear a mask” vs “I am offended by your reckless behavior.” Some of April’s anxiety has returned, but this time tinged with fatigue. When will this all end?
One of the hardest parts of dealing with the impact of the pandemic is that so much is out of our control. City, county and state officials will make decisions regarding how our community will respond. Leadership of Baylor and other TMC facilities are engaged on a daily basis in encouraging appropriate action. We can recommend, promote, cajole, provide data, and we have substantial influence. But at the end of the day, these decisions are out of our control.
The reality of the situation is obvious, but bears stating. We will be working and living our lives outside of work in the midst of a significant – and at this point, growing – viral presence in our community. Given this reality, let’s focus on those things we can control:
- Mask/maintain distancing/don’t come to work sick. This is our armor, unequivocally the best things we can do to keep the virus out of our Baylor work environment.
- Adopt a “universal precautions” mindset. In the hospital environment, providers are at risk for exposure to blood-borne pathogens (e.g. HIV, Hepatitis B & C). As a consequence, if a provider is at risk of coming into contact with any bodily fluid, it is universally assumed that the patient has a blood-borne disease, and appropriate protocols followed. We need to adopt this same mind-set around COVID-19. You should assume everyone with whom you come into contact is infected and actively shedding virus – even if you know they had a negative test yesterday. If you mask and maintain distancing, you are relatively safe.
- Hold each other accountable. Masking is required at Baylor. To keep our environment as safe as possible, we need to point out to each other when we are falling short. If I am not wearing a mask, or if I am not maintaining appropriate physical distancing, I want you to point this out to me. This needs to be not in the spirit of “tattling,” but as a collective act of compassion to our work community.
- Carry your armor outside of Baylor. Most of our time is not spent at work. I strongly encourage you to maintain scrupulous attention to masking and distancing outside of work. Frankly, your risk of exposure from a store clerk, waiter or the person on the next treadmill is probably greater than anything you will encounter at work. Wearing your armor and maintaining universal precautions outside of the walls of Baylor helps to protect you and your family. It also provides positive role models in our community. We will win converts not by preaching or scaring people into compliance, but by serving as an example.
A word of warning. We will see more infections of members of the Baylor community. This is not a failure, but an expected consequence of living in the middle of a pandemic. Baylor leadership and the ICC will also continue to do whatever is necessary to keep our community as safe possible. We have a rational approach to workplace testing (symptomatic employees and learners, surveillance testing of high exposure areas, random voluntary sentinel testing, internal contact tracing).
I have asked our Testing Advisory Committee to reconvene to review our internal testing guidelines in light of the increase in community spread. We are refreshing our surge planning efforts from earlier in the outbreak. We have passed all our internal social distancing audits with flying colors, and are making good progress in an a appropriately paced recovery across all mission areas.
We seem to say this a lot – this is far from over. I share in your concern, anxiety and fatigue in dealing with the situation thrust upon us. However, I remain extremely confident that our community will work together to see us through this ongoing crisis.
James McDeavitt, M.D.
Incident Command Center