Blog | Monday, May 11, 2020

Lessons from a pandemic, part 2


A few weeks ago, I wrote a piece on the lessons I learned from the beginning weeks of the COVID-19 pandemic in Iowa. You can see that here. If any of you feel like I do, three weeks in COVID time seems like a year. It has the feeling of a chapter from Einstein's Dreams.

In ordinary time my week has a rhythm to it, with different meetings and activities on different days. Certain nights we go out for dinner. Now, every day is nearly the same at work and after work. It's all COVID, all the time. I sometimes wonder what normal life will be like but it seems so distant that I find it hard to imagine. I know that at some point this will end but it doesn't seem near enough to be real. It's like being in a surreal time warp that could have been an episode from the Twilight Zone. OK, enough weirdness. Here are my latest lessons:
1. Working at home truly increases efficiency. For the first time ever, I worked at home for an entire week. Previously, I had never worked at home for more than a day, and only if I had a project that required intense focus or a need to get it completed quickly. I had multiple Zoom meetings every day and gave four lectures by Zoom. What I now realize is that the many interruptions in my work day, with all the starting and stopping and the re-start after every interruption really reduce efficiency. At the hospital most of my meetings involve a 5-10 minute walk each way and when you have numerous meetings that adds up. And along the way you stop for unplanned chats that increase walking time. I also feel the need to check in with people that I work with and discuss current work issues. That's a good thing, but I now have a better view of how all of this impacts my workflow.
2. Medical care doesn't necessarily need to be face-to-face. Last week I had my first telemedicine clinic. I had done telemedicine inpatient infectious diseases consults for small community hospitals in the past but never outpatient clinic. It worked very smoothly. For most patients, particularly those with known problems, auscultation, palpation, and percussion don't add all that much. Once the outbreak is over, it will be interesting to see how many clinic visits return onsite. With advances in technology, patients can have blood pressue cuffs that transmit readings, pulse oximieters, and even wireless stethoscopes at relatively low cost, making good assessment in the patient's home much more achievable.
3. Determining what is and is not an aerosol-generating procedure (AGP) needs to be thoroughly explored in future research. See these two excellent posts by Tom Talbot here and here to read more about AGPs.
4. In times of crisis, health care workers' risk tolerance is greatly reduced and risk perception is not always rational. This is natural given all of the information on the outbreak, much of it scary, that comes at us 24/7. There is a cry for zero risk, even though that is likely not achievable. In an effort to advocate for their constituencies, professional societies have added to the anxiety and created more demand for resources that are already scarce, such as testing supplies and personal protective equipment.
5. Once and for all, we need to determine the utility of every item of personal protective equipment for various types of pathogens. This will require federal funding to do the needed research. New designs should be evaluated and current PPE improved.
6. The focus of infection control and prevention research has been too focused on bacterial pathogens. Looking at journals from the last decade, one can see that most of the papers are focused on drug-resistant bacterial pathogens. These organisms pose little risk to health care workers. As above, federal funding will be needed to accomplish the needed work.
7. CDC has not been helpful by producing confusing information that is not practical, and SHEA and APIC have offered little to no guidance at a time when it is most needed. In contrast, the World Health Organization has produced guidance that is based on sound logic and written in a very clear manner.
8. Anthony Fauci, MD, MACP, is a hero. Where would we be without him? Don't think about the answer to that question.

More to come. Stay safe, everyone!

Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on improving the quality and safety of health care, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.