Is this our Midway moment with COVID?

From John Lee’s article referring to: (Image: National Archives and Records Administration, 80-G-414423.) https://www.nationalww2museum.org/war/articles/battle-midway

In his lovely medium.com article, colleague John Lee MD writes about the World War II Battle of Midway, how it was a turning point in the war, and how this moment, in our battle with COVID-19, just might be our moment.

I know CMIO’s and physician informaticists around the country and world are scrambling to marshal our forces to meet the enemy:

  • Building predictive models for deterioration of COVID patients
  • Creating alerts to reduce prescribing of azithromycin and hydroxychloroquine to save our existing supplies in case this is a valid therapy
  • Building and deploying Virtual Visits throughout our organization to reduce COVID exposure to our patients, our staff, our providers
  • Teaching our colleagues and our patients how to use these new tools, using VIDYO, Epic MyChart, ECHO, ZOOM, SKYPE, Facetime, whatever tools you’ve got to connect with each other, with our patients. When everyone is working from home, and only some folks have wifi, or a smartphone, or a laptop, or …
  • Rewriting our documentation templates to keep up with federal and state requirements on what we have to say to live in this new world of virtual care
  • Implementing new COVID ICD10 codes to allow us to track COVID positive patients, as well as COVID PUI (patients under investigation while the test result is pending)
  • Figuring out what happens when we put 2 patients on a single ventilator if shortages occur, how we might automatically downlink ventilator settings directly to the chart. One unanticipated consequence is that the second patient gets NO data from the vent while the first patient might get incorrect (double volume?) data!
  • Building new rooms that are located in emergency tents set up outside the hospital for possible dramatic expansion next week (does wifi go that far? will our WOWs-workstations on wheels survive the winter weather? what is the room number for parking spot #4?)
  • Figuring out how to share resources between hospitals and health systems to see which of us is hit hardest and how to work together best we can
  • This is just off the top of my head for discussions this week.

CMIO’s take? Read Dr. Lee’s post. I like how it is challenging and hopeful at the same time. To my esteemed colleagues in informatics, in medicine. Take a breath. Get some rest. Lets GO.

Social Distancing: This is Not a Snow Day (Medium)

I support this, carefully written by a primary care physician and public health expert. This is a meme worth spreading to combat fear and the virus. Stay safe out there. CTL


I know there is some confusion about what to do next in the midst of this unprecedented time of a pandemic, school closures, and widespread social disruption. As a primary care physician and public…
— Read on medium.com/@ariadnelabs/social-distancing-this-is-not-a-snow-day-ac21d7fa78b4

CoronaVirus: is the Meme more dangerous than the Virus? Yes! and No!

Telehealth Visit (nounproject.com)

https://denver.cbslocal.com/2020/03/09/coronavirus-colorado-consumers-telemedicine/

Okay, everybody, take a breath. We’re in the midst of a storm of Coronavirus news, and it is bombarding us 24-7. As a physician, an informaticist, a parent, and a son of aging parents, I (like many of you) wear lots of hats and have lots of perspectives relating to this pandemic. Boiling it down, here is what I’m aware of, followed by my take:

  • BIOLOGY/HEALTH SYSTEM
  • The Coronavirus – COVID 19 has arrived in the US. Although it is orders of magnitude smaller (fewer infected, ill) than the Influenza virus, there is no vaccine, the duration of asymptomatic (no symptom) incubation is longer, and the infectivity is higher, and so spread is inevitable.
  • It is unclear as yet what the biology of the virus is, as the weather changes, will it gradually dissipate with the warmer months, as others have.
  • Countries like China, Italy and others have large numbers of seriously ill patients, mostly elderly, in cases overwhelming the capability of the health services there.
  • Areas taking severe measures to quarantine, limit exposure, travel, gatherings have had some success in reducing spread.
  • Our health service capability also has a limit, and should a pandemic accelerate here, our ICU / ventilator / hospital capacity could easily be overwhelmed resulting in rationing, having to choose “which patient gets the next ventilator that is available?”
  • It has been, apparently, 100 years since the last major pandemic will major mortality: the Spanish Flu following World War I. Most folks alive have no “gut feel” for what a real pandemic is like.
  • SOCIOPOLITICAL/MEMES
  • A Meme is an IDEA that can spread from human to human even more quickly than actual viruses, especially with the INTERNET. There are VIRUS memes and there are FEAR memes. Lets look at them separately.
  • Hmm, you might even consider THIS BLOG POST A MEME. Consider it a COMMON SENSE MEME (according to me).
  • I’m aware that toilet paper, hand gel, and other items are running out in many stores, as people stockpile. This is a symptom of anxiety/panic.
  • I’m reading about toxic interpersonal interactions as asians are targeted by others as being a source of infection, based on appearance rather than reason.
  • I’m aware that large gatherings are being cancelled, schools and large organizations switching to virtual-meetings to avoid gatherings.
  • Our organization has just put in place a travel ban related to work and the automatic cancellation of all internal gatherings >75 persons, with daily adjustments and announcements.
  • I’m aware of many folks stating “this is ridiculous; I’m going to go on with usual business and ignore these outrageous restrictions.”
  • I’m aware of physician colleagues stating (on the other hand) “This is ridiculous, why are we restricting the testing of any patients for COVID? I’m going to refer EVERYONE for screening because we need to know what the community prevalence is, regardless of symptoms.” At risk: exhausting the testing supply for those at highest risk (symptoms, and recent travel, or exposure to known case).

Whooo. Calm down everyone. Lots of valid viewpoints here.

CMIO’s take:

  • Handwashing, soap and water, as often as you can think of it. Hand-gel is a nice to have, but soap and water please.
  • Avoid touching the face (like saying … don’t think about an elephant. What do you think about?).
  • Consolidate your trips out of the house as possible. Grocery shop for somewhat more, and go out less often. Virtual meetings! Face-time! Skype!
  • Toilet paper shortage? OK, lets try to use less for now. Geez.
  • N95 masks? Save them for the healthcare providers taking care of hospitalized patients. Most plain folk don’t need them. If you desire, ok to get REGULAR masks and then use them to REMIND YOU NOT TO TOUCH YOUR OWN FACE (the major way to transmit is hand to your own face). It does nothing to avoid virus in the air, which is already incredibly unlikely in the community.
  • Go about your business and take prudent common sense measures.
  • I will be going to work at the clinic for our usual work, and screening patients, just like we always do. There are very few cases in Colorado and we are extra vigilant, but still going to work, with no masks UNLESS we encounter a high risk patient with symptoms.
  • We are scaling up our Virtual Visit capability to see patients by online 1:1 meetings over secure connection.
  • Yes, cancelling large gatherings and meetings and moving to virtual when possible is a great idea despite the inconvenience; if we can influence and slow down the pandemic spread/infection curve for our elderly relatives so that we don’t slam and overwhelm the health system, this will save many lives. I’m all for it.
  • Stay safe everyone. Be kind to each other. The FEAR meme can be more dangerous than the VIRUS, but also lets be prudent.