When Jaison John, MD, and Hemali Patel, MD, both assistant professors in the Department of Internal Medicine at the University of Texas at Austin Dell Medical School, received an email in late March asking if anyone in their division wanted to volunteer on the front lines of the COVID-19 pandemic at NYU Langone Health, neither of them hesitated.
The email went out on Saturday, March 28. “By Thursday night, we were in New York. On Friday, we got a brief orientation, did some EPIC virtual training and had a quick tour, and by Saturday [April 4], we were opening up a COVID overflow unit in the hospital,” John said.
As fast as the novel coronavirus is spreading across the globe, physicians across academic medicine have been equally quick to volunteer their time and talent to help their fellow providers in U.S. COVID-19 hotspots. Medical school deans have been reaching out to other deans and teaching hospital CEOs have been calling other CEOs, all capitalizing on relationships they’ve built over the years around the shared missions of academic medicine to educate the next generation of physicians and to provide critical care to patients of all socioeconomic backgrounds.
While John and Patel were the first two physicians from outside New York state to volunteer, several dozen physicians from other institutions have since stepped up, said Katy Wesnousky, MBA, chief of staff for NYU Langone. “We now have 40 volunteers from pulmonary and critical care departments across the country, and I’m onboarding another 20. I can’t tell you how much it means to the staff here. Every doctor makes a difference.”
“These incredibly talented providers will be hip to hip with us providing care for the people of New York. They are staying a month; it’s incredible. That amount of continuity is welcomed and will be very impactful. They will be able to provide tremendous support for our front-line providers.”
Craig Albanese, MD
This week, a team of 20 critical care, hospital medicine, and emergency department physicians and nurses from the University of California, San Francisco (UCSF) arrived in New York to begin work at NewYork-Presbyterian, said Craig Albanese, MD, NewYork-Presbyterian senior vice president, chief operating officer of the Morgan Stanley Children’s Hospital, and chief clinical integration officer for the NewYork-Presbyterian enterprise.
“These incredibly talented providers will be hip to hip with us providing care for the people of New York,” Albanese said. “They are staying a month; it’s incredible. That amount of continuity is welcomed and will be very impactful. They will be able to provide tremendous support for our front-line providers.”
Let’s go to New York
When COVID-19 first appeared in the United States in late January, Washington state was the epicenter of the outbreak, with some of the first U.S. deaths tied to a Seattle-area nursing home and dozens of cases in the community. California also saw an uptick in illness, but quick action by the governors of both states to issue stay-at-home orders halted the spread of illness and COVID-19 never totally overwhelmed the health care systems in those states, said Joshua Adler, MD, chief clinical officer for UCSF Health.
“About 10 days ago, there was some early evidence that the curve was flattening in the Northern California Bay area. And our people said, ‘If that’s true, we need to go help somewhere else,’” Adler recalled. “By that time, New York had emerged as the new epicenter, so we thought there might be an opportunity to spare a modest number of people to go to New York.”
A subsequent call between longtime friends and colleagues Mark Laret, president and CEO of UCSF Health, and Steven Corwin, MD, president and CEO of NewYork-Presbyterian, sealed the deal. Likewise, the Dell-NYU Langone exchange was facilitated by a longtime friendship between Clay Johnston, MD, PhD, dean and vice president for medical affairs at Dell, and Steven Abramson, MD, executive vice president and vice dean for education, faculty and academic affairs at the NYU Grossman School of Medicine.
The UCSF providers, as well as the Dell physicians, are being compensated by their home institutions. NewYork-Presbyterian and NYU Langone, respectively, are taking care of accommodations, travel, and meals.
Credentialing has also been expedited, thanks in part to an executive order from New York Gov. Andrew Cuomo in late March that allowed for health care providers licensed in other states to receive provisional licenses in New York. “Our credentialing office worked directly with theirs, and it’s been taken care of,” Adler said. “Like a lot of things in the COVID pandemic, some things that might have taken three months and three acts of Congress happened almost overnight.”
That rapid response has been critical to ensuring that physicians who are eager to help out can be credentialed and deployed to the areas where they are needed most.
John and Patel, who are both hospitalists, were originally assigned to open a 32-bed overflow unit at NYU Langone Health on Saturday, April 4. But by then, patient volume had started to peak and the overflow unit was only receiving a few patients. So they sent a note to Kevin Hauck, MD, assistant director of the hospitalist program at NYU Langone, and asked to be reassigned.
“They texted me and said, ‘We are here to work,’ so we got them reassigned into our regular medical units,” Hauck said. “They were immediately able to ease the burden on the other hospitalists.”
John was reassigned to take over one of the teaching services, so he had three residents working under his supervision to manage a unit with lower acuity patients. “You hear a lot in the news about patients who do very poorly, but we were discharging four to six patients to go home each day,” he said.
Patel was on a team with supplemental attending faculty — essentially faculty from all over the hospital who had volunteered to care for COVID-19 patients. NYU calls it the COVID Army. “I worked with endocrinology and rheumatology faculty. The chair of ophthalmology was even on my team toward the end of the week. The camaraderie was heartwarming. I was responsible for providing the internal medicine oversight,” Patel said.
Many of her patients had to be escalated to higher levels of care throughout the week, but some improved. “There were such a wide array of clinical conditions,” she said. “Things are happening so quickly and you’re trying to communicate virtually with the patients’ families, in order to ensure they are updated. It was challenging but it was also great to see medical students and other faculty members coming together as part of this care coordination team.”
Bringing lessons home
The UCSF physicians will be deployed into emergency departments, general medicine teams, and intensive care units based on their areas of expertise. “Because of the number of patients and the size of our hospitals, they will be interspersed with our physicians and nurses” at NewYork-Presbyterian hospitals in Manhattan and Queens, said Albanese, who noted that 85% of hospital beds in the 10-hospital NewYork-Presbyterian system are occupied by patients suffering from COVID-19.
While UCSF physicians are eager to help, they are also hoping to learn from their experiences, in case COVID-19 makes a reappearance in the San Francisco Bay area, Adler said. “Not only will our people be able to help them, but our folks can learn a lot about what a much more severe state of affairs looks like.”
“This is probably one of the most incredible experiences I’ve had in medicine. We’re living in history right now where this disease is overwhelming the health care infrastructure. I knew I had to help in whatever capacity I could.”
Jaison John, MD
University of Texas at Austin Dell Medical School
John and Patel feel much more equipped to care for COVID-19 patients now that they’re back home in Austin. On Monday, they debriefed their division on what they’d learned about the disease but also talked about how NYU Langone had reorganized their workforces and units to handle the influx of patients.
“Over the week, I gained extremely useful information about the overall care and maintenance and monitoring of this disease process,” Patel said. “The lessons learned will be very pertinent to our community back home in Austin.”
“This is probably one of the most incredible experiences I’ve had in medicine,” John added. “We’re living in history right now where this disease is overwhelming the health care infrastructure. I knew I had to help in whatever capacity I could. It was a very rewarding experience. I would do it again.”