The Trainees’ Take: COVID-19 Commentary from LDI Associate Fellows
Far reach and practical impact
These days, it feels like every article is a COVID-19 article. In the last month alone, LDI Senior Fellows have outlined the unique challenges of delivering post-acute care during a pandemic (solution: more intensive care at home), described the rapid rollout of a robust telemedicine system at Penn (“three weeks to build an army”), and even evaluated the effects of the lockdown in Wuhan, China (it worked). But LDI Associate Fellows, who comprise clinical fellows, postdocs, and PhD students, many of whom work on the frontlines, have also added to the COVID-19 commentary, bringing the unique experience of being a trainee amidst a global pandemic.
First up: Jason Han, an integrated cardiac surgery resident, and Ruchika Talwar, a resident physician in the Division of Urology. Drs. Han and Talwar explain in the Inquirer how widespread delays in care are presenting new challenges for both providers and patients. As a result of Penn’s postponement of elective procedures, “there are patients whose lives are literally on hold. They are praying for the day they can receive the treatment they need.” There are important and difficult questions being asked, including will it be too late? “The answers aren’t straightforward. But the discussion is necessary.”
One place where surgery hasn’t stopped is in emergency care. Elinore Kaufman, a Fellow in Surgical Critical Care and Trauma, reminded us of the incessant plague of gun violence in the New York Times. “As our I.C.U.s fill up with patients struggling to breathe, we look around and ask: Can we save a bed, can we save two beds, for the gunshot victims we know are coming next? Who can watch these ventilated patients if we have to call doctors to the operating room to give a hand?” Dr. Kaufman also reminded us of the unsettling trends in suicide deaths, which account for over half of firearm deaths and often spike in times of economic depression and instability.
Like hospitals, nursing homes are an area of health care delivery that have been disproportionately affected by the pandemic. Over 2,000 nursing homes have confirmed COVID-19 cases, and high rates of mortality frequently accompany these reports. Ashley Ritter, a geriatric nurse practitioner and postdoc in the National Clinician Scholars Program, described how nursing homes can best mitigate the risks on Health Policy$ense. What are the recommendations? Provide support and training for an expanded workforce (especially for nursing assistants, who are often juggling multiple jobs), adopt a regional care strategy, and conduct “a critical analysis of current regulatory and payment practices.”
A central issue that Dr. Ritter identifies is the risk associated with an inadequate supply of personal protective equipment (PPE). Tarik Khan, a practicing family nurse practitioner and PhD student in Penn Nursing, asked: “How did we, the United States of America, find our health-care system so utterly unprepared for this crisis?” The answer, which he details in the Inquirer, is clear: “In 2018, the Trump administration disbanded the National Security Council’s pandemic response team that would have planned the national response when the virus first appeared. When the first documented case of COVID-19 was reported over a year-and-a-half later, the administration wasted a precious month that could have been spent containing the virus and stocking up on equipment. It also gave away 17.8 tons of PPE to China.”
While it’s impossible to do them all justice, I’ll close with two projects that demonstrate the far reach and practical impact of Associate Fellows’ contributions:
Isabel Maria Perera, a bioethics postdoc in the Department of Medical Ethics and Health Policy, worked with LDI Senior Fellow Julia Lynch to create the Procedural Guidelines for Scarce Resource Allocation Teams (SRAT) Under COVID-19: Promoting Fairness, Transparency, and Accountability. SRAT outlines an ethical approach to making seemingly impossible decisions that providers may face due to shortages of key resources like ventilators and frontline personnel.
Lauren VonHoltz, a Pediatric Emergency Medicine Fellow at CHOP, along with LDI Senior Fellows Ashlee Murray and Danielle Cullen, are partnering with community groups and local stakeholders to ensure that needed resources are still available to families in Philadelphia. They’ve even created graphics that cover everything from free meal locations to legislative updates.
Molly Candon, PhD is a Research Assistant Professor of Psychiatry in Penn’s Center for Mental Health, an LDI Senior Fellow, and Director of LDI’s Associate Fellows Program.