Looking Back

Thoughts from a Year on the Front Lines of the COVID-19 Pandemic

Though this week marks the anniversary of the first case of 2019 Novel Coronavirus diagnosed in New Orleans, by this time last year, LSU Health New Orleans was already well into response. Its faculty began closely following this new virus and preparing as news came out of China. LSU Health New Orleans Infectious Diseases and Emergency Medicine faculty had held the area’s first Grand Rounds for the medical community -- 2019 Novel Coronavirus (2019-nCoV) Clinician Update -- more than a month earlier. And with hospital partners, they had actively been readying our community to take care of the cases they feared might come.

Dr. Joanne Maffei, Professor of Medicine and Infection Control expert, Dr. Joseph Kanter, then Assistant Health Officer at the Louisiana Department of Health and Clinical Assistant Professor of Medicine in the Section of Emergency Medicine, and Dr. Julio Figueroa, Professor of Medicine and Chief of the Section of Infectious Diseases (ID), all at LSU Health New Orleans School of Medicine, told a packed house what was known about this new virus. They shared early policies regarding isolation precautions, PPE, testing protocols and possible treatment, and vaccine targets.

They were also the core group of clinicians working on policies for response on LSU Health New Orleans campuses.

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Dr. Figueroa recalls, “In early January through February, we were in preparation mode. More anxiety than anything. We were primarily preparing for LSU’s response and hospital planning as well as answering media calls for information.”

“I heard about it in early January 2020, in a tweet from an old colleague,” recalls Dr. Meredith Clement, LSU Health Assistant Professor and Infectious Diseases specialist. “It seemed interesting but not immediately urgent. At the time, I had no idea what it would come to mean. Many of us initially underestimated COVID-19.”

Remembers Dr. Richard Vander Heide, Professor and Director of Pathology Research at LSU Health New Orleans School of Medicine, “I thought at first it was going to be no different than the other epidemics I have been through as a physician – most notably the swine flu/H1N1 pandemic in 2009 that in the end did not really cause a large problem.”

Though a SARS coronavirus, it would increasingly become apparent that this new virus was little like its predecessor.

“The early days of the pandemic, especially once it arrived in the US, were filled with more questions than answers,” recollects Dr. Catherine O’Neal, Assistant Professor of Medicine in the Section of Infectious Diseases at LSU Health New Orleans School of Medicine’s Branch Campus in Baton Rouge. “Wuhan physicians were communicating with the physicians in the US, and then physicians in Italy were doing the same thing. There was a lot of fear and also doubt that this information was real. A respiratory disease with 3% mortality was difficult to comprehend. The direction we were being pushed in seemed counterintuitive to what we know about coronaviruses and lung injury due to viral pneumonia—intubate early, highly contagious by aerosols. It contributed to the fear.”

“It seemed we potentially were watching a tidal wave,” remembers Dr. Benjamin Springgate, LSU Health New Orleans Chief of Community & Population Medicine.

“As I learned more about the SARS-CoV-2 and COVID-19, my oldest son called me from California and asked me if I thought this a ‘real’ thing to worry about,” Dr. Vander Heide adds. “I hesitated for a second (not wanting to worry him and my daughter-in-law) but said ‘yes, I think this is going to be a problem’.”

“Once the first case came to New Orleans, it was more resignation that we were about to have a very different future,” says Dr. Figueroa. “I was on Fox News at 9 p.m. prior to the lockdown from the first cases. I remember Lee Zurik interviewing me as we discussed what we knew then. He closed by saying, ‘I am sure that we will be speaking with you a lot in the coming days…’ It was then that I began to grasp how life would change.”

Dr. Figueroa continues, “I virtually consulted on the first Touro case who later died. He was a driver for one of the ridesharing companies. The first identified case at the VA apparently also was a driver. Hmmmm. Working in the tourism industry was a potential risk factor. Imported from outside? The next day, on the evening of Tuesday, March 10, I was doing another inpatient consult after the first suspected Lambeth House case was identified. That night, two other LH residents developed severe respiratory distress requiring transfer to ICU. I looked at the chest radiographs and saw the same pattern. That was the moment that I knew that COVID-19 was already widespread in NOLA.”

LSU Health New Orleans clinical faculty were on the front lines at hospitals throughout metropolitan New Orleans as well as in Baton Rouge and Lafayette, where LSU Health New Orleans School of Medicine has branch campuses. They were squarely in harm’s way.

Dr. O’Neal, who is also Medical Director of Infection Control and Prevention at Our Lady of the Lake Medical Center, LSU Health’s major Baton Rouge teaching hospital, led the response for her hospital and assisted in the regional response. She was also appointed to the Southeastern Conference (SEC) Committee on Return to Activity and Medical Guidance Task Force for LSU.

Dr. Najy Masri, LSU Health Associate Professor of Clinical Medicine and Director of Hospital Medicine at Ochsner-Kenner, says, “Given my role as a hospitalist, I have been intimately involved in the strategic planning and care for COVID patients at Ochsner – Kenner. Early in the course of the disease, I created a COVID admit and discharge algorithm that is still being used to care for patients with this virus at our hospital.”

Dr. Figueroa remembers, “Early on, there was a tsunami of zoom calls, media requests, patient care questions, and literature search for the latest data. Twitter became an invaluable resource of sharing among ID and public health experts across the world. ID consult was initially required on all COVID-19 patients because of limited resources and insight into the latest treatment protocols. Our LSU ID group spent hours every week discussing and sharing our experiences as well as our research. The same activities were going on in the hospital to attempt and optimize care. People everywhere were very scared.”

Dr. James Aiken is an LSU Health New Orleans Emergency Medicine Physician who is considered to be a national expert in disaster medicine. After spending Hurricane Katrina in Charity Hospital, he has taught response courses for many years. He is an LSU Health attending physician at University Medical Center’s Emergency Department (ED) and Co-Chair of the LSU Division of Disaster Medicine and EMS. Dr. Aiken recalls, “The COVID impact on ED operations was slow to materialize. We were not in crisis response until March.”

And then people started dying. Though OSHA advised not to conduct autopsies, LSU Health Pathology performed among the earliest autopsies on COVID patients. Their morgue at UMC-NO met the CDC requirements to perform a safe autopsy.

Out of an abundance of caution, they decided to do an autopsy limited to the lungs since, at that point, it seemed the only organ that was seriously affected.

“I performed the first autopsy on a COVID patient at UMC-NO on March 16, 2020,” says Dr. Vander Heide. “On the autopsy service, we usually see 30-40 non-coroner (forensic) deaths a month come through the morgue, and we perform autopsies on approximately 8 cases. In March and April, we had 170 non-coroner deaths come through the morgue, and we performed 37 autopsies, most of which were COVID autopsies. It just seemed it was never going to end. The first two weeks, the SARS-CoV-2 testing was not slow and inaccurate. We were seeing changes in the lungs that we were convinced were COVID despite the PCR tests being negative. We communicated with the Chief Medical Officer of the hospital to treat anyone who looked like COVID clinically as a COVID case until the testing was more accurate.”

“The uncertainty of the viral virulence and its ability to infect (serial interval) engendered staff anxiety,” notes Dr. Aiken. This was exacerbated when several faculty, residents and nurses became ill with COVID. By the end of March into April, we were fearful. Going to work became a personal threat to our and our loved ones’ health safety.”

Adds Dr. Figueroa, “Patients continued to come in who were extremely ill, and deaths started to mount. It was a distinct concern that we might run out of bed capacity (needed negative pressure rooms for these patients), supplies (N95 masks, gowns, etc.), and other essentials. Another impressive thing was the severity of illness in young patients. We have been told that this was primarily a disease of old people. Initially, that was true here as well. However, soon after the cases started rising, we noticed a dramatic increase in younger adults, even as young as late teens and early 20s. We also noticed that some pregnant patients seem to have severe disease as well.”

“There was so much we didn’t understand – and still don’t understand—about how the virus affects people differently and what to do about it,” says Dr. Clement. “Early on, we watched patients who were hospitalized suffer, all alone, and some got better, and some didn’t. We were desperate for treatment options—and for studies to show us what treatments were truly effective. We were also distraught and heartbroken by the toll the local epidemic was taking on communities of color. At one point, when I was on service at the end of March, 100% of the patients I was following were Black/African American. And sadly, it hasn’t gotten much better over the past year in terms of inequitable impact of the pandemic.”

“Much as Katrina did, this pandemic brought to light the results of years of socioeconomic inequality, poor access to healthcare resulting in chronic illness, and the vulnerability of our way of life in South Louisiana,” adds Dr. Figueroa.

“We spent long days at the hospital followed by a dress down in the garage and straight to the shower once you got home,” says Dr. Masri. “Visits with family consisted of pulling up in the car at their houses and having them stand on their front porch a distance away. It was frustrating to see so much death with limited resources, but I’m proud of the unified effort of all the hospital staff to do their best each and every day.”

All the while, LSU Health New Orleans faculty were educating the public through months and months of daily media appearances and interviews with national, regional and local media outlets.

“I didn’t sleep much,” says Dr. Springgate. “My colleagues on the inpatient side were working like mad, to the point of exhaustion. From an outpatient clinical vantage point, it seemed the most impactful thing to do was to try to provide clear public health messaging to as many people as possible. Even in the early days, so much misinformation was spreading. I would end up late at night trying to read as much as possible about the virus, get to the news station by 5:30 a.m. on many days for a few hours of programming at WWL-TV, try to hold regular meetings with my staff and MD/MPH students to try to listen to their worries and provide them what little reassurance I could. There was a lot of anxiety – people were worried about their vulnerable family members, didn’t know what activities were safe, what level of cleaning was needed, or contact with others was permitted.”

Meanwhile, Dr. Fred Lopez was doing daily interviews on WWL Radio. And Dr. Figueroa was continually called upon as well.

“I got more media exposure than I ever wanted,” adds Dr. Figueroa. “Getting used to zoom interviews with local and national outlets was something that also stands out.”

As the pandemic progressed, testing was hard to come by. LSU Health New Orleans, the New Orleans Health Department and LCMC Health collaborated to set up the mobile community testing model that the rest of the state eventually emulated. Set up in under-served parts of the community for days or a week at a time, the collaboration brought testing directly to some of the hardest hit. LSU Health New Orleans faculty, staff and students supported the effort in a big way.

Harlee Kutzen, MN, PHCNS-BC, APRN, ACRN, an Instructor of Nursing at LSU Health, said of the experience, “I was grateful for the opportunity to participate in providing and promoting this convenience, painless, readily available, and free covid-19 screening within our community. Prior to this endeavor, the covid-19 testing available was specifically restricted to those individuals who symptomatic to very specific testing criteria and were in possession of a medical provider referral for testing. This left the majority of both exposed or differently symptomatic individuals without a means to know their status and ultimate risk for potentially spreading the virus unknowingly.”

Dr. Springgate’s public service expanded. “Starting in July, I became quite active with New Orleans Public Schools and Orleans Parish School Board and medical advisor and later Chief Health Officer supporting pandemic-related efforts to keep school communities safe and healthy.”

It has been a year of unprecedented challenge, yet also quiet pride and rewards.

“Most rewarding was the remarkable experience of seeing my colleagues apply themselves in such heroic manner to fight for the lives of their patients,” says Dr. Aiken. “And the preserved esprit de corps of the staff. I am so proud of what I witnessed in them.”

“Most rewarding for me has been the ability to see how people from many backgrounds can work together to make a difference,” says Dr. Figueroa. “And the ability of science quickly to address a problem and offer solutions.”

Dr. O’Neal’s greatest reward was, “Seeing true collaboration amongst medical centers and among different groups of physicians.”

Dr. Vander Heide lists among his rewards, “Learning new things about an amazingly devastating disease and realizing Pathology as a medical discipline played a major role in understanding the disease. Secondly, the camaraderie with my residents and the autopsy assistant during the Spring of 2020.”

“I think the opportunity to contribute to pandemic response and help others in small ways through work has been rewarding,” says Dr. Springgate. “So many people feel or have felt helpless, powerless, and hopeless. Whether it was through caring for my patients, or providing public health advice, or helping my students find their footing and stay focused on education, or supporting K-12 public schools reopening, my work has allowed me to contribute in small ways. That opportunity mitigates some of the sense of being powerless that some people have described feeling. Also, having the opportunity to be with my kids and family, and to help them find joy in new ways, has been extremely rewarding.”

Dr. Masri says, “While we lament the losses, we celebrate the victories. Being able to get patients with this virus back to their families is never taken for granted. Just this week, my patient was celebrated by the Ochsner system as the 10,000th COVID discharge in the state since the pandemic began.”

Some moments stand out in stark relief against the backdrop of the devastating pandemic.

“There are so many memorable moments,” Dr. O’Neal shares. “Setting up city-wide testing. Testing athletes. Consoling team members, friends, family. Enjoying the delight of my kids as they went back to school. Watching my Dad tear up in our driveway for Christmas as he handed Christmas presents out outside and then drove away. Celebrating over the phone as he got his second vaccine! This year has been a lifetime of emotions and memorable experiences all wrapped up into an unbelievable pandemic.”

“One anecdote that I think was telling of the early days,” says Dr. Figueroa. “My wife and I turned 60 years old in 2020. We had lots of plans for fun celebratory events and a few trips. Her birthday is on March 21. Clearly, we were not able to do any restaurant celebration. However, Commander’s Palace, for the first time, offered takeout meals. I signed up to have one prepared to celebrate Annette’s birthday with our NOLA children. As I waited in my car to pick up the food, I could hear all of the other customers and staff discussing the pandemic. The majority opinion was that this would be short-lived and that we would soon be back hugging and eating together…. I remember thinking that people have NO idea about how bad it was at that time and was going to get in NOLA soon. For dinner, our children got dressed up in their finest and served dinner to Annette and me with their interpretation of the Commander’s Palace table service. Then we all sat down and ate a fine dinner. It was a moment of grace and normalcy in the midst of the tragedy.”

“Human reliance,” says Dr. Aiken. “As all disasters do, the experience brings out the best and not so good in people. I tried to stay focused on the bravery of so many of my healthcare colleagues who didn’t have the insight those of us who have studied pandemics do, and I saw almost universal commitment to patient and family in the face of great personal harm during that time. I was also greatly affected by the immediate expressions of gratitude and support shown by my community, nation and the world towards healthcare workers. People, having lost so much, gave us food and gifts from their hearts. I had a woman run up to me one afternoon to give me a photograph of a brass band in front of Jackson Square. She told me to never forget what was good in our city. We shared tears over that.”

“I was very fortunate from an academic standpoint that I was able to report some of the early findings involving COVID autopsies which aided in the early therapy of the patients,” says Dr. Vander Heide. “One overarching thought that I had throughout the past year is that we are living through a period of human history. Major global pandemics are rare and have been recorded in history since the time of the Romans. That is a very sobering thought, yet I am proud I contributed a very small piece to that history.”

Dr. Clement’s standout memories include, “Kids going back to school, patients getting out of the hospital and going home (or recovering on their own), getting my own vaccine and feeling so relieved, watching others getting their vaccines… and feeling so relieved.”

All of them spoke about the importance of science.

“Science must prevail when treating and preventing infections,” cautions Dr. Figueroa.

“We have learned a lot about this virus and how to combat it,” says Dr. Masri. “We now have the tools and medications to fight COVID and allow our patients the best chance at success. Hopefully, the focus next time will be on the science behind the virus and not on the politics around it.”

“We are overcoming this pandemic because of science,” says Dr. Springgate. “We need to reinforce K-12 education in sciences and build trust in science and trust in public health messaging. We need to prepare for the next pandemic now.”

What do they want you to know?

Dr. Aiken advises, “There will never be a substitute for personal good behavior during a pandemic. There will probably never be a cure for the viruses and subsequent mutations that cause pandemics. While vaccines and critical care treatment will evolve as it did last year, the only true science and proven significant impact on pandemic mortality are masks, social distancing and personal hygiene. The Romans and later civilizations understood that. And most importantly, during any future healthcare crisis, do not forego seeking medical care for the customary illnesses such as stroke, heart attacks, major infections and trauma. Many people died of non-COVID emergencies that would have been safely treated.”

Dr. Clement declares, “Vaccines are safe and effective and are the only way we are going to see the end of this.”

Dr. Figueroa repeats, “Trust in science.”

Dr. Springgate feels, “We need to focus sooner on at-risk communities and populations – and bolster corresponding efforts in risk mitigation, PPE distribution, information sharing from trusted sources.”

Dr. O’Neal stresses, “I hope that people leave last year understanding the importance of having a collaborative approach to such a widespread problem. Collaboration leads to swift change. We could apply that to so many other issues and problems in our community and reach the solutions so much faster.“

Dr. Vander Heide shares, “I want people to know that physicians are hardworking, caring people that really care about their fellow human beings. But also, physicians can’t do it alone; every health care worker, every spouse or significant other, friend, or family member helped them get through the challenge in different ways.”

Dr. Masri concludes, “I know at this point everyone has COVID fatigue. They want to get back to the normalcy of life and move past this moment in time. However, the battle has been hard, but there IS a light at the end of the tunnel – herd immunity through mass COVID vaccination. Stay the course…”