It all started with a group text between some Emory Healthcare professionals.
Emory School of Medicine assistant professors and doctors Mark Caridi-Scheible and Sara Auld experienced firsthand that, in working at the intensive care units (ICU) at their respective hospitals, there were no established procedures on how to treat patients with COVID-19. The pandemic has forced doctors to create on-the-spot protocols to care for patients battling the novel coronavirus.
On March 15, the two doctors along with other health care providers created a group text that led to the formation of a committee entitled “Team Best Practice.” The committee now compiles protocols, gives lectures to doctors about the guidelines and consistently updates them with new information from the Centers for Disease Control and Prevention and the Chinese government.
Caridi-Scheible stated that the lack of information surrounding the treatment of COVID-19 has caused most of the protocol to be made by Emory doctors working at different Emory hospitals.
“This is new for everybody across the country,” Caridi-Scheible said. “So aside from other countries … being so busy coping with their own patients, not a lot of information is coming out … Everyone is just making up [protocols] based on their past experiences.”
As more Georgia residents become infected with COVID-19, Emory Healthcare providers are attempting to save as many patients as possible while simultaneously risking their own health. The rapidity of the virus’s spread has forced health care professionals to create novel procedures.
Caridi-Scheible emphasized that the severity of the crisis became woefully apparent in the middle of last week, when death tolls reached an all-time high. Team Best Practice and its subcommittees quickly did research on the novel coronavirus and came up with recommendations which Emory hospitals implemented on April 6.
“It was a phenomenally rapid response to clinical problems,” Caridi-Scheible said. “Usually when we do protocols, … they take months or years and lots of debate. … Everyone has been very focused.”
Caridi-Scheible, who is an Emory School of Medicine assistant professor of anesthesiology, splits his time between the Emory University Hospital (EUH) as an anesthesiologist in the cardiac operating room and as a critical care doctor in the cardiothoracic ICU or respiratory ICU — both of which have transformed solely into COVID-19 units.
Similarly, Auld, an Emory School of Medicine and Rollins School of Public Health assistant professor, performs her clinical work at EUH Midtown. Although she did see patients on the pulmonary service and the ICU at EUH Midtown prior to the pandemic, Auld primarily focused on her research, which pertains to global tuberculosis and HIV. She’s put her research on hold to help those suffering from the virus.
“I think, unfortunately, since so much of my research is global, it depends on what is happening with [the] coronavirus around the world,” Auld said. “I think we have yet to see the impact it will have in many of the settings where I work — sub-Saharan Africa, … Ethiopia and South Africa — I think [the] coronavirus is just starting to take hold there.”
Auld’s job now focuses on developing what Emory doctors call “best practices and guidelines” for critical care providers.
The Medical ICU at EUH Midtown transitioned into an exclusive COVID-19 ICU on March 15, when Auld was attending service in the ICU. At the start of that week, the hospital admitted their first two patients, and by the end of the week, 16 patients had been admitted. Since then, several other ICUs have converted to COVID-19 units.
Team Best Practice is not the only source of newly created procedures, however. Registered Nurse and Infection Prevention manager at Emory Johns Creek Hospital Margaret Whitson works to decrease health care associated infections, promote the adherence of guidelines, analyze surveillance data and ensure the hospital is meeting goals for improved patient safety. Prior to the COVID-19 outbreak in Georgia, Whitson said the Infection Prevention Committee already prioritized pandemic planning.
“When the virus started expanding to Europe and into Washington, we just bumped [pandemic planning] up to the number one priority, so for the last eight weeks that has been the number one priority,” Whitson said.
Whitson stated there has been an ongoing pandemic response plan that specifies best practices, most of which were created during the Ebola pandemic in 2014. When information about COVID-19 was distributed in January 2020, Whitson and the other members of the Infection Prevention Committee began reviewing old protocols and implementing new ones.
Team Best Practice and the Infection Prevention Committee disseminates its procedures across all Emory hospitals. Auld recognized that COVID-19 impacts its victims differently than other viral pneumonia and respiratory-related diseases that she and other doctors have previously seen.
“Some of our traditional supportive care needs to be adjusted slightly,” Auld said. “That includes adjusting how we manage the ventilator and how we manage some of the other inflammatory side effects that have been particularly pronounced with this virus.”
Despite the “rough start in the beginning” with implementing the procedures due to required testing through the Georgia Department of Public Health; Whitson stated that Emory Hospitals did not have the ability to test patients immediately because tests have to be ordered and approved. Ordering and receiving approval for tests took hours and results took up to seven days. It has now been two weeks since all Emory Hospitals have had in-house testing, which has facilitated the integration of procedures, such as necessary isolation of patients infected with COVID-19.
Despite the lack of experience with COVID-19, Whitson noted that Emory doctors have stepped up to the task and have been responding to the pandemic and procedures astoundingly.
“[Emory Doctors] have done amazing, … they have been very proactive in … providing processes for their department to get people triaged and tested and assessed as quickly as possible,” Whitson said.
Caridi-Scheible noted that the number of patients going to the EUH ICU for COVID-19 symptoms has remained steady. Though he recognized that there will be an increase in cases within the next couple of weeks, Caridi-Scheible is hopeful that EUH will be able to combat the issue.
With social distancing becoming a ritual for people across the world, Auld, among other doctors, has changed her routine traveling between work and home to ensure her and her family’s health.
Auld’s ritual begins when she arrives at her car after her shift. She keeps Lysol wipes and hand sanitizer inside her car and has divided the front of her car into a “clean zone” and the back of her car into a “dirty zone” to decrease the chances of contamination between the things she uses only at the hospital and those she takes inside her home. Her ritual extends as intricately as wiping down her glasses with Lysol, as she must enter her house with them.
Caridi-Scheible stated that although doctors are used to experiencing death and have implemented methods to maintain their health, the current crisis has left many Emory doctors in need of support. When health care workers noticed that COVID-19 would be an incredible strain, doctors began conducting huddles so that they could circulate new information and express their fears among colleagues.
Similarly, Auld emphasized how the community has become closer and the hospital has focused particularly on staff wellness.
“There has been a much greater sense of camaraderie and connection among our community of doctors in the hospitals,” Auld said. “I have been personally interacting and meeting and [being] supported by people whom I have never really met before.”
Caridi-Scheible wanted to underscore the good news that’s often overlooked from the crisis: many are surviving.
“I think that what I want people to really understand is that, yes, you should be afraid enough to do the sensible thing, like social distancing and everything, but people do live and people shouldn’t let this paralyze them or ruin their lives — a lot of people are surviving,” Caridi-Scheible emphasized.