COVID-19 Real-Time Response
From a virtual ICU to a Navajo Nation quarantine, public health experts solve novel challenges.
Inside the Virtual ICU
The intensive care nurse stands inside a plexiglass box mounted on casters, something like a phone booth that rolls. Two sleeves through the glass allow her to attend to the patient. The nurse doesn’t need a mask and won’t have to change protective gear between COVID-19 patients. Cameras enable two doctors inside the room to work with five doctors far away.
This is the “virtual ICU,” the present and future of patient care in a pandemic.
“We can have doctors in New York taking care of patients at night via telemedicine,” says Roberta Schwartz, PhD, MHS ’94, executive vice president and chief innovation officer at Houston Methodist, a system of seven hospitals in Greater Houston. “This is also how families are able to visit ventilated patients.”
Schwartz’s technology innovation team had been working on rolling out the virtual ICU for months, with the first unit set to open in March. The technology of the virtual ICU converts clinical patient data into algorithms that identify which patients most need attention and enables the hospital’s intensive care doctors to respond quickly, whether there’s an ongoing pandemic or not.
When COVID-19 hit Texas, physicians who’d had difficulty accepting the new technology were suddenly all in. Now, wired cameras are in use in 130 rooms, and hundreds of tablets allow virtual care in other units.
To provide protection for staff performing in-person procedures, Houston Methodist’s machine shop built the plexiglass boxes, as well as special intubation boxes that improve upon models created in Wuhan, China. The boxes go over patients’ heads as they lie in bed, allowing medical staff to safely intubate, free from exposure to aerosolized particles that could contain coronavirus.
“As an academic medical center, we’ve got the inhouse talent and wherewithal to build this out ourselves quickly, and we’re sharing these plans with other hospitals,” Schwartz says.
While many medical professionals have felt isolated from their families while serving on the pandemic’s frontlines, husband and wife physicians Heather Hayanga, MD, MPH ’08, and Jeremiah “Awori” Hayanga, MD, MPH ’08, have been in the fight together.
As a member of West Virginia University’s COVID-19 incident command team, cardiac anesthesiologist Heather Hayanga led development of systemwide protocols for safely caring for surgery patients at WVU hospitals. One example: Ensuring that anesthesiologists intubate patients in a negative pressure room, which traps dangerous particles and keeps them from getting into the rest of the hospital.
Meanwhile, thoracic surgeon Awori Hayanga, also of West Virginia University, advised incident command on protocols for conducting extracorporeal membrane oxygenation, or ECMO, on COVID-19 patients whose heart and lungs are not working. (With ECMO, surgeons drain the patient’s blood, pump oxygen into it, and return it to the patient’s body.)
Because of his ECMO expertise and his work studying the use of artificial intelligence to prevent outbreaks, in April Awori Hayanga was appointed special adviser to the U.S. Department of Health and Human Services.
All of this with a 3-year-old at home.
“We’ve just gone with the flow and we’ve done what we needed to do to get the job done,” Heather Hayanga says.
Communicator and Adviser
When other people were stocking up on shelf-stable food, medication, and toilet paper ahead of COVID-19 lockdowns, Josh Sharfstein, MD, bought a microphone.
With that simple tool and some help, the Bloomberg School’s vice dean for Public Health Practice and Community Engagement launched the podcast Public Health On Call. It offers listeners daily coronavirus insights from experts in fields ranging from epidemiology and medicine to history and business.
From its first episode on global preparedness, misinformation and community transmission in early March, the podcast has been downloaded more than a million times.
Since the start of the pandemic, Sharfstein has stepped—or rather sat—in front of the camera many times, too, appearing on MSNBC, PBS, C-SPAN, and others from his basement office. And every Thursday, he shares information with mayors across the nation in a weekly briefing co-hosted with Bloomberg Philanthropies, the Harvard Kennedy School, and Harvard Business School.
“I want to be of direct assistance to health officials, governors, mayors who are reaching out,” he says. “But I also want to bring the strength of the School to all of those people and their organizations. So, I'm constantly linking faculty [to officials], trying to identify ways to bring the research that the School does to the point of action.”
From Civil War to COVID-19
As a medical student in his native Syria, Houssam Alnahhas put his education on hold in 2011 to lead an underground medical team in Aleppo treating injured demonstrators at the start of the country’s civil war.
The Bloomberg School MPH student now finds himself in the midst of another crisis—the COVID-19 pandemic.
Although he does not have the required certifications to practice medicine in the U.S., he’s volunteering on the ground helping front-line medical staff at Johns Hopkins Bayview Medical Center do their jobs.
As deputy area commander, he supports emergency department leadership in the COVID-19 response, mainly by helping to coordinate operations in the surge tent, a temporary structure near the hospital entrance to screen and test people with COVID-19 symptoms who are not critically ill. The idea is to shield emergency department patients from possible exposure.
Alnahhas ensures that the tent is stocked with needed medical devices and PPE and that protocols are in place to maintain a safe environment.
Safety was nowhere to be found in Aleppo when Alnahhas risked his life to deliver medical care to protestors. As the conflict escalated, three of his colleagues were detained, tortured, and killed.
Ultimately, working in a war zone led him to public health. “In an active conflict, it’s not enough to react to what’s happening,” he says “It’s a necessity to plan ahead to deploy a response.”
While the Syrian civil war and the COVID-19 pandemic are starkly different crises, Alnahhas sees a clear parallel.
“What the world is witnessing right now with the COVID-19 pandemic and what I experienced back in Syria is the uncertainty. When people don’t know exactly what will happen next, they don’t have enough evidence to build any response, to build any policy,” Alnahhas observes. “In these events the role of public health is clear … in both developing and developed countries.”