Hope on the Horizon


Battle-tested healthcare professionals look back at the lessons they learned during the pandemic to prepare for the challenges that lie ahead.

Two years ago last month, the coronavirus began to spread across the country. The virulent strain, which most of us had never heard of before it quickly became part of the nation’s vernacular, caused widespread panic and shut down the world seemingly overnight. Businesses sent their employees home to work remotely, schools quickly transitioned to remote learning and elective surgeries were put on hold. The start of the COVID-19 pandemic was sudden and dramatic. Its end, when it arrives, will be gradual and difficult to define.

Infectious disease experts are cautiously optimistic the nation is entering the pandemic’s endemic phase, but healthcare providers are wary of lingering omicron subvariants, including the contagious BA.2 strain, which last month accounted for more than half of new coronavirus infections in the U.S.

Federal guidelines for face coverings have been relaxed and rates of hospitalizations are on the decline across much of the nation, although case counts continue to rise in pockets of the country.

At the time of this issue’s publication, the U.S. Department of Health and Human Services (HHS) had extended the federal COVID-19 public health emergency (PHE) declaration, which was set to expire this month. The PHE declaration provides state governments and healthcare facilities with additional funding and resources to care for COVID-19 patients and prevent the spread of the coronavirus.

So is COVID-19 coming to an end? How much longer will we need to live and work in a pandemic state? Richard Martinello, MD, an associate professor of infectious diseases and medical director of infection prevention at Yale School of Medicine in New Haven, Conn., says declaring that COVID-19 is endemic a complex issue. “The clinical reality is that we will go from dealing with unpredictable waves of infections to settling into some sort of seasonal pattern,” says Dr. Martinello. “I expect it will take two to three years until we understand that pattern, which will be determined by the degree of immunity within regional populations and how the virus behaves in warm and cold weather.”

He believes there’s an underlying assumption COVID-19 will blend into the background — we’ll learn to live with the nuisance of relatively minor infections — but no one is certain that will be the case. Although COVID-19 will likely develop an endemic pattern, Dr. Martinello cautions it could turn out to be much worse than the seasonal flu. “Declaring the start of the endemic and thinking we need to get back to normal life is a naive point of view,” he says. “We all want the pandemic to be over, but the reality is there’s still a great deal of uncertainty about what the future holds.”

If nothing else, surgical professionals have proven how resourceful and resilient they can be when challenged with the unknown. The nimbleness they’ve shown and the lessons they’ve learned over the past two years will help them navigate the end of the pandemic, whenever it arrives, and prepare them to face whatever comes next.

The healthcare supply chain is dealing with numerous challenges, according to Phyllis McCready, senior vice president and chief procurement officer at Northwell Health in New Hyde Park, N.Y. At the height of the pandemic, Northwell’s surgical departments were well-stocked, so her focus shifted to managing supplies needed to treat COVID-19 patients and protect staff. “We had an ample supply to support our patients and clinical teams,” says Ms. McCready. “We planned well in advance with N95 masks and had small amounts of inventory coming in from the manufacturers. Isolation gowns were our number one item during the beginning of the crisis. They were being used at an unbelievable rate. We had a significant inventory and almost ran out.”

As a large healthcare system, Northwell enjoys certain advantages that smaller and independent ASCs do not. In addition to an ability to leverage favorable deals with suppliers due to its size, Northwell also manages an 86,000-square-foot distribution center that houses more than 3,000 items, mostly disposable products used within Northwell’s labs, ORs and med-surg units. The distribution center maintains inventory to support supply needs at Northwell’s hospitals and surgery centers. “We’ve never been just-in-time from supply manufacturers,” says Ms. McCready.

Diversifying suppliers was a beneficial strategy during the pandemic and will continue to be. “I have multiple suppliers for products that I know are critical to patient care,” says Ms. McCready. “This enables flexibility, which in turn allows us to respond to changing market trends and customer demands.”

The dynamic of negotiating contracts to ensure supply continuity for surgery centers has permanently changed, according to Julie Sebree, vice president of procurement and supply chain for Envision Healthcare, a national medical group representing more than 250 ASCs. Relationships with national, regional and local distribution partners are also under strain.

“We can’t rely solely on our partners to get us what is needed, so we created a centralized purchasing and distribution model for critical products — mostly PPE such as masks, gowns and gloves,” says Ms. Sebree. “We sourced those products directly from manufacturers, stored them in a central warehouse and had them available any time one of our ASCs was unable to get orders filled through their national or regional distribution partners. They had a place internally to get products that were approved, vetted and available to them, so they never had to do without.”

Ms. Sebree says the current supply chain situation is not so much about shortages but what she calls continuing tightness based on shifts in supply and demand. For example, the big issue currently is glove availability. “There has not been any significant investment in glove production since the beginning of the pandemic, but a drastic increase in demand,” she says. “That tightness is going to continue until there’s some investment in additional production.”

Ms. Sebree says the past two years have altered her interactions with vendors and distributors. “The conversations before the pandemic were very transactional to make the purchase,” she says. “The conversations now are much more collaborative and strategic. We talk about forecasting, where we would like to see investment in manufacturing or in their supply chain. We’re asking more questions so we can be proactive and look for diversification in manufacturers, in the geography of manufacturers or in products, so we’re better prepared should we need to pivot again in the future.”

Cutting Through the Confusion

MESSAGE RECEIVED Healthcare workers teamed up to overcome incredible challenges during unprecedented times.  |  Northwell Health

At the heart of any effective pandemic response strategy is regular and consistent communication that cancels out the noise and misinformation that tends to flow freely during a global health crisis, says Saskia Popescu, PhD, MPH, MA, CIC, an infectious disease epidemiologist and global health security expert at George Mason University in Fairfax, Va. “Communication is challenging because we’re explaining nuanced information that is often evolving,” says Dr. Popescu, who was a co-author of the Association for Professionals in Infection Control and Epidemiology’s newly released report about patient safety and pandemic response. “It’s important to be honest and pragmatic, but the evolution of information is a good thing because it means our knowledge is getting better.”

During the pandemic, healthcare facilities learned out of necessity to keep the lines of communication open between infection preventionists and the frontline staff. Even after we enter the endemic phase of COVID-19, says Dr. Popescu, the following best practices should remain in place.

Use multiple formats. Whether it’s post-pandemic protocol changes or information related to a new outbreak, facilities should use a variety of formats and mediums — from leadership rounding and daily huddles to emails and well-placed hardcopy reminders — to get infection information out to busy staff members. Some of the most effective forms of communication that came out of the pandemic were straightforward, highly visual and easily recalled — such as infographics that illustrated social distancing in a variety of creative ways.

Combat complacency. When staff are continuously bombarded with “urgent” information, it’s easy for them to suffer from communication fatigue, a condition that makes it much less likely for them to thoroughly review all the updates they receive. One way to address this problem is to make your staff an active participant in how information is shared and how often they receive it. “Bring in team members and leaders to get their insights into the specific challenges they experience and how you can build those challenges into a sustainable approach,” says Dr. Popescu.

Surgical leadership and infection control professionals should also work together to indicate which updates are truly urgent and worthy of their own distribution, and which ones can be combined to indicate a lower level of importance.

Emphasize staff safety. So much was asked of frontline healthcare workers during the early months of the pandemic, and the communication that drove the ever-changing policies and procedures didn’t always explain why protocols were enacted and how leadership accounted for staff safety in those decisions. Moving forward, this is an area in which facilities can improve how they communicate. “Be empathetic and aware of the impact information has on staff members, while also providing them with guidance they can truly use,” says Dr. Popescu.

She believes surgical leaders need to avoid judgment, ask staff what resources they need to successfully implement evolving policies and procedures, and always keep their fears and worries top of mind. OSM

CONSTANT HUSTLE Supply chain issues have highlighted the importance of monitoring par levels and diversifying suppliers in order to keep shelves stocked.  |  Northwell Health

A possible silver lining to the pandemic is the realization that infection preventionists play a critical role in emergency response management, says Terri Rebmann, PhD, RN, CIC, FAPIC, a professor of epidemiology and biostatistics at the College for Public Health & Social Justice at Saint Louis (Mo.) University. “Infection preventionists help develop protocols to prevent or minimize disease transmission in healthcare facilities, but also in the public setting,” she says.

Dr. Rebmann recommends that all healthcare organizations have an infection preventionist in a prominent position on staff, even during the endemic phase of COVID-19. “Have them conduct regular educational sessions that explain the science behind a protocol and why we’re doing it,” she says.

There has been increased recognition of the importance of infection preventionists in all clinical settings, a factor that will lead to safer patient care. “They are seen as individuals who have expertise that others in health care do not have,” says Dr. Rebmann. “There’s a newfound respect for them in the field.”

Dr. Martinello has been working in infection prevention for 20 years and has always known the important role infection preventionists play in public health. COVID-19 gave them an opportunity to shine. “Eyes were opened that infection preventionists don’t just implement protocols to prevent surgical site infections,” he says. “During the pandemic, my team has worked with every department within our hospital to keep them safe. We’re an important part of the health system’s infrastructure.”

Houston Methodist Hospital officials realized the first step toward being able to perform safe surgery during COVID-19 was to assess how well they were doing in that regard before the pandemic. “We knew our providers were at increased risk, but no one truly understood the virus at the time,” says Shawn Tittle, MD, chief medical officer and chief quality officer in Houston Methodist’s thoracic surgery department. “One of the first decisions we made was to double down on existing safety precautions.”

They also added COVID-19 testing protocols for all patients and staff, new guidelines aimed at limiting airborne contaminants and other comprehensive safety measures, says Dr. Tittle. Their efforts were successful. A study of 141,439 surgical patients cared for at Houston Methodist during the first 19 months of the pandemic showed only 0.1% contracted COVID-19 from a hospital-acquired source.

Houston Methodist achieved success by screening all patients and healthcare workers for COVID-19 symptoms, instituting mask and vaccine mandates, resterilizing N95 masks when there were PPE shortages and increasing the use of pre-op telemedicine to limit patient visits.

The lessons learned from COVID-19 should help the hospital deal with another omicron wave or the next pandemic. “We’ve gained invaluable experience in how to sustain PPE and prioritize surgery,” says Dr. Tittle.

The shutdown of elective procedures in 2020 shined a light on the fallout of neglected surgical care. “We learned that patients’ disease processes progressed, and some died unnecessarily,” says Dr. Tittle. “Understanding how we operationalize ramping down and ramping back up will definitely make us better prepared for the next time.”

The lack of access to medical care during COVID-19 led to untold consequences, including patients presenting with cancer at more advanced stages and hundreds of thousands of canceled colonoscopy screenings. “This showed we need to provide as much care as possible to everyone who needs it, even during a pandemic,” says Dr. Tittle. “We must strive to make this a priority when the situation happens again.” OSM

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