'Stay humble at the outset': 4 physicians on how COVID-19 shaped infectious disease work

As the monkeypox outbreak evolves, hospitals are reflecting on the early days of their COVID-19 response. 

Globally, there have been more than 2,500 confirmed monkeypox cases as of June 17. In the U.S., there have been 113 cases across 20 states and Washington, D.C. 

Amid the possibility that more hospitals will treat patients infected with the monkeypox virus, Becker's asked physician leaders the following question: How have lessons from the COVID-19 pandemic shaped your preparation and response to other infectious disease outbreaks?

Four responses: 

Editor's note: Responses are lightly edited for brevity and clarity. 

Ohm Deshpande, MD. Vice President of Population Health and Clinical Financial Services at Yale New Haven (Conn.) Health: Our coordinated systemwide COVID-19 response that began in 2020 was key to our ability to move nimbly, iterate our treatment pathways quickly in response to emerging research, and scale them across our 2,600 inpatient beds and hundreds of ambulatory sites. The effectiveness of our coordinated infrastructure was proven by the fact that COVID-19 mortality for our entire system, inclusive of our quaternary care academic center and our four smaller hospitals, was among the lowest in the nation and by far the lowest in Connecticut. Our Care Signature clinical convergence/standardization initiative was instrumental to coordinating our clinical experts and implementing their wisdom into front-line clinical workflows. For monkeypox, and future infectious disease outbreaks, we are leveraging our Care Signature approach to ensure the most up-to-date clinical management algorithms are easily accessible at the point of care. Doing so will ensure patients are appropriately navigated, our clinicians are well supported, and that we can identify and safely and effectively manage the patients and communities we serve.

Soniya Gandhi, MD. Associate Chief Medical Officer and Vice President of Medical Affairs at Cedars-Sinai (Los Angeles): The COVID-19 pandemic has created many important opportunities for growth that will improve our response to future infectious disease outbreaks. COVID-19 forced us to collaborate across disciplines that are often siloed within healthcare organizations. Clinicians and operational leaders had to nimbly meet the ever-changing needs of patients and employees while working with communications professionals to share new information with these audiences. The pandemic also made it clear that healthcare organizations must be prepared to quickly meet an increased demand for services. This ability to scale up services requires a robust supply chain, a reliable pipeline for PPE and a plan to expand capacity. Lastly, our providers have become accustomed to using enhanced PPE. This familiarity should make them feel more comfortable and capable when responding to future outbreaks.  

Susan Kline, MD. Infectious Disease Expert at M Health Fairview and the University of Minnesota Medical School (Minneapolis): I will always remember that an emerging infectious disease could surprise us and carry a greater pandemic potential than might be apparent at the outset. We need to stay especially humble at the outset of an outbreak, especially if it is with a novel pathogen. That new pathogen may not follow the patterns of previous infectious disease outbreaks.

The COVID-19 pandemic and the new monkeypox outbreak have proven that we are more closely interrelated than ever before in human history. Diseases that were previously in one country or continent can now easily spread around the world. To be better prepared for the next unusual and emerging infectious diseases, we need to make it easier for primary care clinics and hospitals to detect these illnesses rather than centralizing diagnostics at a small number of specialized labs with difficult patient access.

Additionally, we must continue to invest in research of infectious diseases and expand our capability for treatment and prevention of these emerging infections with vaccines and therapeutic agents. And we must carefully consider and prepare for the unintended consequences that disease mitigation strategies may have on the economy, education, patient care and mental health.

Colleen Kraft, MD. Associate CMO at Emory University Hospital (Atlanta): At Emory Healthcare, we have been thinking about preparation and response to pandemics and healthcare employee safety since 2002. Our multidisciplinary teams within Emory's Serious Communicable Diseases Unit/Program based at Emory University Hospital can rapidly mobilize and access a multitude of resources, which can extend to the rest of our system when needed. With every surge during the pandemic thus far, having that bedrock has helped us in clinical decision-making and healthcare worker support.

There are several manuscripts published about Emory's close involvement with the National Emerging Special Pathogens Training and Education Center, which was established in 2015 to prepare and care for patients with Ebola virus disease and other special pathogens in the United States. Emory Healthcare is one of 10 Regional Emerging Special Pathogen Treatment Centers, which undertook readiness activities that enabled them to play a pivotal role in the nation's COVID-19 pandemic response. A second paper illustrates the value of biocontainment units in the current pandemic and their potential role in preparing healthcare facilities and health systems for future infectious disease threats


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