Here Are Some Lessons Learned During the Pandemic

WE ARE CERTAINLY living through an unprecedented period, and it is remarkable how many things I am better appreciating or learning as we do everything we can to treat all the patients who are seriously ill with coronavirus disease 2019 (COVID-19).

At the time of this writing, the end of March 2020, the New York metropolitan area is the hardest-hit region of the country, and its health care systems are stressed to the limit to keep up with the growing number of critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Upstate New York, we are busily preparing for what is anticipated to be a sizable increase in patient volume over the next many weeks, as are health care professionals in most other areas of the country. We have canceled almost all elective and nonurgent nonsurgical and surgical procedures, we have closed our ambulatory surgery centers, and our overall clinic volume has dropped to about 25% of its usual volume. Our hospitals have the lowest patient censuses we have seen in decades, as we have been actively working on emptying our beds to prepare for what is likely to come. Of course, the entire community is contributing to the effort through closing nonessential businesses, schools, and universities; practicing social distancing; and working from home if possible. By the time this is published, I anticipate that we will have a much better idea of how successful we have been at preparing for the surge of patients with COVID-19 and at flattening the curve relative to the number of severely ill patients we need to treat at any one time.

To prepare to write this, I reflected—between nonstop emergency preparedness meetings—on what I am learning from this experience as a pharmacy leader in an academic health care system. Although this list could easily be very long, I am going to focus on just 5 takeaways.

1. Medical literacy is a big problem. I know this is not news, but some observations really brought this home for me. For example, Corona beer sales in the United States slumped early during the outbreak in China, and takeout Chinese food sales plummeted even before social distancing measures. I could not buy vinegar, among many other things, in the grocery store recently. Why? It turns out that information on the internet says to gargle with it to combat SARS-CoV-2. I guess I should not be surprised, given that well-educated physicians are eagerly treating patients with unproven therapies that could be more harmful than helpful. Rational decision making is sometimes the first thing to be sacrificed. I mention this because we routinely try to get patients to understand much more nuanced information about their medications and how those may affect their health. We need to make sure we are not oversimplifying the challenges of overcoming medical literacy limitations that are common in the community.

2. Online meeting formats can work. In the past, I found that most attempts at remote meetings went poorly. There was a lot of “Can you hear me?” “Can you please speak into the microphone?” “Can you repeat that?” “I can’t see your screen,” and “Would everyone please mute their phones?” We also contended with people talking over one another and others getting dropped repeatedly from calls. Amazingly, because of this forced need to conduct scores of remote meetings to practice social distancing, we have quickly gotten very good at running them well. Team members have figured out how to mute their audio and phones, everyone speaks clearly and loudly into their microphones, and the process of screen sharing has turned out to be straightforward. We now routinely videoconference with anywhere from a few people to more than 600, and the meetings are effective and efficient. Who knew that we could finally figure out some basic technology? I am not sure we should ever go back to having so many face-to-face meetings, where we all just monitor our email anyway. At least when meeting remotely, we can monitor our email much less conspicuously. And if anyone gets caught not paying attention, they can always claim they forgot to unmute.

3. People are still our most valuable resource. Early in the planning process, when SARS-CoV-2 was still primarily limited to China, we launched an initiative essentially focused on preparing for potential drug shortages, and we foolishly thought that might be our biggest threat from this disease. As the virus spread around the world, gaining pandemic status, and hit the shores of the United States, it became evident that the ability to adequately staff our health care system to manage a large increase in volume was probably going to be our biggest challenge and threat. As we developed contingency plans looking at 25%, 40%, and even 60% absenteeism rates, while potentially managing 50% and even 100% surge volume, the value of our competent and highly trained pharmacy staff members to our health care system really hit home. We launched an effort to cross-train as many people as possible while still well staffed to make sure we had as much resiliency as possible if faced with a severe staff shortage. Training experienced people to work in new areas is much easier than bringing in inexperienced people and walking them through some very basic functions. We also developed scenarios to use untrained people to do simple tasks to allow our highly trained staff to focus more on technically demanding tasks. This will be valuable for dealing with both short staffing and surge volume moving forward. Finally, our staff members have demonstrated a remarkable willingness to be at work despite their own fears about COVID-19, and they have repeatedly asked how they can help during this difficult time. We should all take a few minutes each day and thank each staff member for their dedication and service to our communities and patients.

4. Remote teaching is not so bad. I recently had to deliver a lecture to medical students using a remote platform. It went remarkably well, and I could monitor the chat box for questions and pause to respond in a very organized way. I also held office hours remotely, which worked better than usual office hours because students did not have to go anywhere to meet with me. If we had had more time to prepare, we could have developed more creative interactive content and multimedia for students that could possibly have exceeded a usual classroom experience. Higher education and teachers’ unions at the primary and secondary levels had better hope that this social distancing does not last too long, as we may just realize a more effective and modern way to teach.

5. Who has the power? On the lighter side, I have long assumed in a postapocalyptic world that those who control the energy, food, and water would have all the power. Apparently, I overlooked those who control the access to toilet paper. They could control with an iron fist, er, well, at least a clean fist.

The future is unknown as I write this. I hope all my colleagues reading this are staying healthy and weathering the storm.

Curtis E. Haas, PharmD, FCCP, is the director of pharmacy for the University of Rochester health care system in New York.