June 10, 2020
Dear Members Of the Baylor College of Medicine Community,
Today, I would like to ponder a paradox.
On the face of it, most of the COVID-19 data we see coming out of Houston hospitals is discouraging. New cases are up. Hospitalizations, which were declining, are on the rise. Admissions to the intensive care unit are increasing. In fact, based on numbers alone, hospital metrics are strikingly similar to the numbers we were seeing in mid-April, at the peak of our first surge.
This increase was expected, and clearly the result of the gradual relaxation of social distancing in Houston and surrounding communities.
Now for the paradox: In April, I would describe the mood of the Baylor community as apprehensive and anxious; in some cases frightened. Today, faced with the same numbers, I see people who are positive and moving forward with a degree of confidence. My question: What changed between April and June? In a relatively short period of time, quite a bit:
- Health System Performance. In April, we were all hearing news stories of multiple, catastrophic failures of advanced health systems under the weight of SARS-CoV-2 infections. We contemplated the very real possibility Houston could be next. By June, we proved we could work collaboratively with our affiliate partners to continue to deliver excellent patient care. Our system was stressed, but did not fail.
- PPE. In April, PPE was in short supply, and the supply chain was struggling to keep up with demand. Providers feared being sent into the COVID-19 battle without adequate protection. Now, our PPE supplies are more than adequate and our supply chain is more stable and efficient. We must continue to monitor our PPE supply and burn rate, but there are no foreseeable concerns of critical shortages of PPE.
- Intra-Hospital Spread. In April, we were learning of health care facilities around the world with disturbing numbers of providers infected while working in the hospital. Healthcare workers were concerned for their safety, and worried they would carry the virus back to their families. By June, we demonstrated that we are able keep providers safe even in a COVID-19-rich environment. Surveillance testing of over 800 providers at BSLMC – including those in very high COVID-19 exposure settings – resulted in only three positive tests.
- Treatment Options. COVID-19 came upon the community quickly, and with no proven treatment options. It produced some very sick people, and was reported to have a very high in-hospital mortality rate. The usual routine supportive care measures did not seem to be very effective. Physicians were flooded with anecdotal reports of treatment options from around the world. We circulated blog postings and emails from physicians in Seattle, New York, New Orleans and Lombardy grasping at treatment straws. A strange new disease with no treatment is a scary thing. Now it is June, and our clinicians have their legs under them. We have well established protocols in place, many based in some evidence (e.g. prone positioning). We have a better understanding of the virus/cell interaction on a cellular/molecular level, and the secondary inflammatory impact of infection. We have emerging options for evidence-based treatment (e.g., Remdesivir, convalescent serum, Tocilizumab), many at least partially pioneered at Baylor.
- Planning. In April, we feared the worst. A great deal of work was done quickly to create actionable plans to create ICU capacity and enhance staffing. Thankfully, those plans were not needed. Now, we have them in our back pocket and feel better prepared should we see a second significant surge.
- Testing. When the pandemic reached Houston, we had virtually no access to testing, and the testing that was available had a turn-around time of several days to a couple of weeks. This meant that any patient with a COVID-19 consistent symptom (fever, cough, etc.) remained a “Person Under Investigation” for an extended period of time. Now, in large part due to the work of Baylor researchers, we have readily available testing, and the results are generally back within 24 hours.
So much has changed since April. We are confident not because we are complacent. The virus is still out there among an immunologically naïve population. We need to keep our guard up. We need to emphasize to our community the importance of sustainable social distancing and wearing face masks for months to come.
We are not complacent. We have gotten materially better at managing in this environment. There are fewer unknowns. We have solved many problems, large and small.
We earned our confidence. It arises from increasing competence. This is a testament to the entire Baylor College of Medicine community. We have operated like a true Learning Health System, to the benefit of our patients.
Thank you all.
James McDeavitt, M.D.
SVP and Dean of Clinical Affairs
Incident Command Center Commander