Baylor College of Medicine

Lessons Learned

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To Members of the Baylor College of Medicine Community:

Lessons (hopefully) Learned

All in all, it has been a good week.

When the news has been concerning, I have tried to accurately portray the challenges we face, while pointing out realistic cause for optimism. Now that we are starting – ever so tentatively – to see some good news, I want to ring a cautionary bell.

In terms of the virus dynamics in Houston and the TMC, we had the best week we have had in a month. The now-famous R(t) value (an estimate of infectivity) rose to almost 2 in June, gradually declined to less than 1.0, only to increase again following the July 4 weekend. The R(t) has now trended down for several days, and is once again below 1.0, a level where we should see gradual contraction of community cases.

In fact, new community cases in Harris and the eight surrounding counties have slackened a bit. Based on a 7-day rolling average, on July 18 we were seeing 2,450 new cases. As of July 21 this had dropped by about 11% to 2,174 cases. As usual, this comes with a couple of big caveats. Three days is too early to call this a trend, and for most of May and June we were seeing 200-300 new community cases per day. Over 2,000 daily cases are still a lot of infected people, and no doubt underestimates the actual community incidence. Still, this is good news.

Even more encouraging, hospital admission rates have actually declined. Our team – hospitalists, intensivists, nurses, residents, respiratory therapists and others – is still stretched and working very hard, and it will be some time before the hospital censuses begin to drop, but the COVID-19 admission spigot has slowed, and this is encouraging. Even more importantly, although our ICUs across TMC are still all functioning in “Phase II” bed levels, projections indicate we are not at risk of outstripping our hospital capacity for the foreseeable future.

An additional point of good news. Over the past week, we had some concern that we were seeing increased spread of the virus between providers within our hospitals in clinics. Upon further analysis, much of this infection seemed to be coming from the community, and with the addition of face shields and enhanced staff training, Baylor St Luke’s Medical Center (BSLMC) surveillance data indicate the intra-hospital spread between healthcare workers appears to be minimal.

It appears we may – and I emphasize “may” – have reached a peak and will see things start to improve. Having felt this way after the April surge, I think it is appropriate at this point to reflect on what lessons have we learned as we go forward. Unfortunately, COVID-19 is not a storm that will take its toll and move on. It is a siege that will continue for months.

As we buckle down for what is to come, I think there are two important lessons, one broad and community oriented, the other more personal and focused.

Broad lesson: We must maintain vigilance going forward. Masking and physical distancing are the tools that drove recent outbreak improvements, and we as a community cannot relax our discipline. We at Baylor can lead by example, and the message we carry out to our friends and family is important. From a public policy perspective, state, city and county leadership are aware of the importance of ongoing public health education, especially targeted to demographic groups that may not have fully received the message in advance of this most recent surge. The control of viral spread is a sustained effort we all must get behind – all ages, neighborhoods, ethnic and socioeconomic groups. People living at or below the poverty line present a special challenge as they have been disproportionately impacted by the economic slowdown. These individuals have tremendous need to work, but often do not have the ability to work remotely at home. We need to find a way to safely support everyone in our community.

Our vigilance must continue as the virus loosens its hold and we eventually move to reopen components of Houston. Events like the opening of schools, resumption of sporting events, and relaxation of occupancy restrictions on restaurants need to be done as safely as possible, with careful attention to the impact on COVID-19 spread. We cannot become complacent.

Individual lesson: We need to take care of ourselves. It is apparent now, if it was not before, that we need to settle in for the long haul, and learn to function in the COVID-19 pandemic environment. We have been at this in earnest since March, and will continue to face challenges until an effective vaccine is developed, tested, manufactured, distributed and widely administered. In spite of the challenges, we continue to deliver on the mission of Baylor. Clinicians continue to diagnose and treat non-COVID diseases. Researchers never stopped submitting high quality, competitive grants to fuel new discovery. Educators continue to train the next generation of scientists and health care providers. The good work of Baylor goes on, but over time can take an individual toll.

So as we all buckle down, do something to take care of yourself.

Be kind to those around you. Chances are good they – or someone they care about – are under some sort of significant stress. Social disruption, health concerns, professional demands and financial strain have always been with us, but are far more prevalent in the pandemic environment.

Recommit to a pre-COVID habit. Focus on something you routinely enjoyed – a physical activity, safe family interaction, an evening with a good book – and make sure you regularly make time for it. It does not have to be a big thing, but do not let the coronavirus take away what gives you pleasure.

Get enough sleep, eat healthy and get some exercise.

If you need help, get help. Given the widespread nature of disruption we are all experiencing, a rise in depression, anxiety, substance abuse and related conditions – all treatable – is almost inevitable. Maybe a positive legacy of the pandemic will be to lessen the stigma of seeking behavioral health support. If you need support, contact your primary care physician or mental health provider. Resources are also available.

Stay well. 

Dr. James McDeavitt
Incident Command Center