Testing, Tracing, and Rebuilding Ties Key to Healthcare Reopening
While hospitals in COVID-19 hotspots deal with the deluge of infected patients, many non-essential services have been temporarily shuttered to shunt resources toward the surge and to comply with social distancing and stay-at-home advisories. The transition to telehealth in the interim has been a success, with promise for its widespread use even beyond the pandemic, but the need for in-person care remains. So-called “non-essential” services include important medical procedures like MRIs and surgeries that could have serious health consequences the longer they’re delayed.
With trend data indicating that the surge has passed its peak in several areas of the country, hospitals and health centers are eager to reopen their halted service lines. But even though the surge has ebbed, the road ahead is long. Hospitals face a delicate balancing act of inviting patients back into clinical spaces while still fighting the ongoing pandemic.
Much remains unknown about COVID-19 and its spread, and many businesses are taking a “wait-and-see” approach while resuming operations in phases. Infectious disease expert Cassandra Pierre, MD, MPH hopes to take a slightly more calculated approach at Boston Medical Center, where she is the associate hospital epidemiologist. Tracing the origins of infections among hospital staff is crucial for planning the reopening of non-COVID clinical spaces, she says, especially as PPE supply chains are still limited.
Pierre and other researchers at the hospital are working to collect information that will allow them to deploy resources such as care providers, support staff, and PPE more wisely. In speaking with the health system’s CEO Kate Walsh, Pierre explains that understanding the trends of infection may allow them to staff clinical areas with providers who have already have antibodies against the virus, for example.
Watch or read their conversation to learn more about the research Pierre and colleagues are doing to trace the infection among hospital staff, how this type of insight could inform other hospitals' return to business, and how community outreach will be crucial.
Kate Walsh: What are you looking for and hoping to find in the infection tracing study?
Cassandra Pierre, MD, MPH: The study is a collaboration between Karen Jacobson, Tara Bouton, and a number of us in infection prevention who have been really concerned about COVID-positive illness in our employees. We want to understand, where are they getting this infection? Is it from the community? Is it from the hospital?
Some colleagues have agreed to partner with us to help us trace this infection — basically to look at the viral code, the viral tagging of these infections among our healthcare workers — to tell us whether they are coming from the community, or the patients they care for, or even from each other in the healthcare setting. We also hope to determine, what is it about the healthcare employees who become infected that made them more vulnerable? Once we know that, we can help prepare to prevent this. And of course, the pandemic is still ongoing, so if there's anything that we can use to improve conditions as time goes on, we want to quickly do that as well.
KW: This understanding is going to be an important part of how we begin to gradually reopen for business. Explain how this will help keep the hospital and community safe going forward.
CP: When we think about reopening, the way to know that we're ready is through testing, testing, testing. Testing in our community, but also likely testing in our healthcare workers, and knowing what the trends of infection have looked like in our staff and our employees and our colleagues. We need to make sure that we're protecting those who are more at risk, and we need to just understand where we've had more infections and where those areas may be. We're actually more protected by having a number of people already positive and recovered working in areas where we feel comfortable having patients come back into the hospital.
KW: So the detective part of this work is actually figuring out the fingerprints of the coronavirus?
CP: Yes. We know that every virus has a signature and not every virus has the same signature. Even COVID-19, there are different signatures among different strains of that virus. By looking at that, we'll be able to tell more easily whether there are related groups of infections, and that will help us to determine whether these infections are coming more from the community or the healthcare center itself.
KW: As we get over the surge and the curve flattens and all those epidemiologic events come to pass, what can we do to make sure that the communities we care for get healthy and stay well as health centers reopen?
CP: One of the things is really reaching back out to the community to re-strengthen our ties. As a consequence of this pandemic, we've had to shut off non-essential medical services and transition those into things like telehealth, which actually has been quite rewarding for some of us, but we'll need to be making sure that people know that when we're open for business and we want to see them. We want to make sure that their health needs are being met, that people have primary care and primary care clinicians that they trust, who in some cases look like them and who are offering culturally competent care.
KW: So our rebuilding is not only within the walls of our hospital, but also outside.
CP: Absolutely. I've been in a couple of discussions with people in the community where I've really felt strongly that we have to leverage our positions as physicians and make sure that we're speaking to people who are in positions to enforce policies that affect the health of our patients. Luckily because of this, I think it's stirring up these conversations, and so we're reaching out — we need to continue to do that. We need to continue to have those partnerships with people who are at the grass roots as well as in positions of power in our state and in our country.