Managing Your Health
At the Baltimore Convention Center Field Hospital, at M&T Bank Stadium and UMMS hospitals across the state, Marylanders are rolling up their sleeves to get a vaccine that was developed and available to the public in record time.
After being vaccinated herself this winter, Karen Kotloff, MD, professor of pediatrics and the lead investigator of the Moderna vaccine at the University of Maryland School of Medicine (UMSOM), was overcome with emotion.
"I have to say I had tears in my eyes after being vaccinated, having worked in the clinic 13-hour days to vaccinate as many people as we could,” Kotloff said. "We hit the ball out of the park, having this vaccine ready in such a short timeline."
"We are objectively leaders in what Governor Hogan has called the greatest peacetime undertaking in American history," said Mohan Suntha, MD, MBA, president and chief executive officer of UMMS. "It is a massive undertaking – among local and state government, health care providers and communities."
Looking back on the year, Suntha and other leaders at UMMS find that the intensity and urgency of pulling together has made the system and each of the affiliated hospitals stronger, knowing they can tackle a crisis head-on with combined strength and ingenuity.
By the second week of March 2020, much of the country was beginning to panic. Everyone wanted information they could trust.
UMMS team members were gearing up to provide that information. The UMMS Community Health teams set up a hotline staffed by nurses to field calls from Marylanders asking about everything from COVID-19 symptoms to how to get a test to ailments that had nothing to do with the virus.
While many Marylanders were caught off guard by the virus, UMMS leaders and care teams knew what to expect, thanks to UMSOM faculty experts in virology, infectious disease, critical care and emergency medicine.
Months earlier, faculty physicians and public health specialists at UMSOM had been tracking the course of the disease in other parts of the world, as well as in the Pacific Northwest and in New York City.
They knew it would be rough and that very sick patients would need the highest level of care. They also knew that many of the patients might not survive and that nurses, doctors and other front-line team members would face the biggest challenge of their careers.
By February 2020, even before the first COVID-19 cases were reported in Maryland, UMMS set up an "incident command structure," a standardized model used in emergency responses. The incident command structure allowed for cooperation across all UMMS hospitals – as well as with local, state and federal government. UMMS added to this command structure its deep connections to community leaders, faith leaders and businesses.
By mid-March of 2020, Gov. Larry Hogan issued a state of emergency – schools closed and scrambled to set up remote learning. Workplaces in Maryland that could do so allowed team members to work from their homes. Essential front-line workers in health care, food service, public service and grocery and drug stores struggled to find the necessary personal protective equipment (PPE) to work safely.
Researchers in the UMSOM's Center for Vaccine Development and Global Health (CVD) immediately joined the worldwide effort that would eventually lead to the vaccines approved for emergency use just 11 months later.
Meanwhile, experts in internal medicine, microbiology and immunology and epidemiology studied the new virus, the ways in which it was spreading and the therapies that had the best chance of treating patients, collaborating with the University of Maryland Medical Center (UMMC) on rapid response and preparedness planning in the face of a growing outbreak.
UMMS made sure that Marylanders had access to hospital care, as well as telehealth and outpatient services. The University of Maryland Access Center fields calls from hospitals across the state that need to transfer their patients, and during the pandemic worked intensively to make sure Marylanders got the care they needed as close to home as possible. UMMS made sure to have enough beds to cover the two surges of COVID-19 cases thanks to:
UMMS created a systemwide staffing pool to be able to deploy nurses, physicians and other team members between hospitals as needed. UMMC, the largest hospital in the Medical System and its academic medical center, established a "cavalry" of nurses and physicians at each of its two campuses who could be assigned wherever the greatest need was.
UMMS marshalled forces not only in its hospitals, but also in a parallel effort to inform the public and engage them in slowing the spread of the disease.
Starting in March, regular public webinars were hosted by Mohan Suntha, MD, MBA. Suntha, other leaders and guest faculty speakers explained the science of the virus and described medical strategies. They answered questions from members of the public – but especially local government leaders and clergy, who are in a position to carry the information to others.
UMMS put its creative and web teams to work to produce articles and videos guiding the public about how to care for mild symptoms at home, what medications to use, how to safely purchase groceries and restaurant food and how to maintain health to avoid unnecessary trips to the doctor.
Suntha and the team also hosted regular webinars for the 28,000 team members of the system through each stage of the response. The webinars also thanked team members for their dedication to the health of their patients while also struggling with the fear of exposing their own families to the virus.
When visitor restrictions were in place, UMMS hospitals provided clinical team members with iPads to virtually connect patients with their loved ones. The iPads also allowed the team to meet with a patient's family.
Shortages of PPE were reported across the country as hospitals and states scrambled to obtain enough to keep team members and patients safe. Members of the general public were asked not to buy medical-grade masks so that health care providers could have enough.
Teams in the sterilization departments that normally clean and disinfect surgical instruments were now also disinfecting the more durable masks and shields to allow more than one use. The conservation and sourcing of PPE paid off and continues to let clinical team members know they are protected.
UMMS created a strategic medication stockpile with a three-month supply of 30 medications key to treating COVID.
UMMS team members who procure supplies rose to the occasion, using existing relationships with vendors and reaching out to unexpected partners, such as Under Armour, which directed its factory to design and manufacture masks, face shields and specially equipped fanny packs for health care workers.
Fashion designer Christian Siriano, a Maryland native, was doing his part in New York, devoting his design studio and workers to making masks and other PPE.
When community members who sew started offering to make masks for hospitals to give away to the public (so that health care workers could have the high-grade N-95 masks), the reaction at first was skeptical, but the science indicated that homemade masks could play an important role in slowing the spread of COVID-19 in the community. Until manufacturers could gear up for mass production, these homemade masks were an important step in mobilizing the community.
Another large batch of cloth masks was donated by crafters organized by the University of Maryland School of Nursing. As an academic health system, UMMS has a strong partnership with University of Maryland, Baltimore, which is more important than ever to enhance innovative health care and expanded ability to reach out to communities.
By January 2021, after a slowdown of cases in the summer and early fall, hospitals were still dealing with a surge in patients after the holiday season. UMMS hospitals continuously strategized to meet the demands.
"Our supply of PPE and equipment remained solid," said David Marcozzi, MD, professor of emergency medicine and the COVID-19 incident commander for UMMS.
According to Dr. Marcozzi, the hopeful news is that preliminary studies show the vaccines are effective against the variant strains of this virus, although the variants are more transmissible.
"We are re-examining ventilation at all our hospitals to protect against the variant strains that are more contagious," Marcozzi said. "The more cases that occur, the greater the chance of virus mutation. With that in mind, it is incredibly important we do all we can to prevent the spread in our communities."
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