Hope everyone is staying safe. With the ongoing COVID-19 pandemic, and the incredible work being done by all of you, we want to highlight some topics that are particularly relevant to us.
A message from Dr. Shikha Jain, WIMS Co-Founder and Chair
We are in extraordinary times. Many of you are facing challenges you never dreamed of when you entered your professions. We read stories of heroic ER and ICU physicians working on the front lines, pathologists and rheumatologists volunteering to staff tents outside hospitals and assess patients, physicians quarantining themselves to prevent spread to their families, and health care workers treating patients in spite of PPE shortages. Physicians and other healthcare workers continue to go to work every day to take care of others, often putting their own health in jeopardy. I know many of us are frustrated, and many of us are scared.
Although we are facing monumental challenges, I believe we will come through this stronger in the end. It is hard in the middle of a crisis to see the light at the end of the tunnel, especially when there are so many unknowns. Please remember: we are a community and here for each other. Social distancing can be isolating, so if you are struggling, reach out to a friend, family member, mentor or colleague. Schedule regular Skype/Zoom/Facetime calls. Reconnect with people, and remember you are not alone. We are there with you in spirit, and we see you and your sacrifice. Take care of yourselves and each other, and stay safe and healthy.
Medical students navigate COVID-19
Jennifer Romanello, BS, MD Candidate
Medical school students are temporarily making their education virtual, with schools taking steps to prevent dissemination of the virus among students as well as practitioners, patients, and the whole public. Most schools have pulled their students from clinical rotations until at least the end of March. For these schools, clerkship directors are actively working to create meaningful alternative educational experiences. M1s, whose education has been largely confined to the classroom, are utilizing technologies like Zoom and Slack for online learning and services such as ProctorU for taking tests from home. These changes will be in effect until the end of the semester for some schools; others have not specified an end date.
As many academic facilities are closed, lack of access to library study space is a concern for many students, especially those studying for USMLE Step 1. Test centers for Step 1 are closed at least through April 17th. Many schools cancelled Match Day celebrations and anticipate cancelling commencement ceremonies, too. Different institutions found creative, digital ways to celebrate this former achievement through social media. Drs. Vineet Arora, Shikha Jain, Dana Corriel, Jessi Gold, Austin Chiang, and Ali Khan organized a #DistanceMatch social media competition! There are many questions from students that school administrators do not have answers to at this time, and administrators have their own questions, such as, how will student mental health be impacted long-term? Some students have temporarily shifted back to childhood homes; for those staying near campus, students are reaching out to administrators to volunteer, including providing childcare for children of healthcare employees affected by school closures.
Pregnancy and COVID-19
Ajanta Patel, MD, MPH
Many of us are concerned about the impact of COVID-19 on pregnancy and maternal to fetal transmission. At present, there is no definitive evidence that pregnant women nor their fetuses are at increased risk (including risk of developing COVID-19, birth defects, vertical intrauterine transmission, and delivery/post-natal complications). That said, there are very limited data on COVID-19 in pregnancy.
Maternal Risk: With low numbers, it is difficult to determine if pregnant women contract SARS CoV2 or develop COVID-19 at higher rates than others. Pregnant women are considered an “at risk” population in strategies focusing on prevention of COVID-19 because they are in a higher risk category for susceptibility, severe illness, and mortality from other communicable infectious diseases due to their inherent physiologic changes during pregnancy. Pregnant women should stay extremely vigilant about hand hygiene and avoid sick contacts or areas where community spread of SARS CoV2 is observed.
Pregnancy Outcomes: The CDC has reviewed published data from 34 peri-partum women in China (2nd/3rd trimester). These women were primarily symptomatic (fever, cough) with perinatal onset. The majority of infants were delivered by C-section, many on account of the mother having COVID-19. Around half were late preterm births. There was no reported viral RNA in the amniotic fluid, cord blood, or breast milk from these patients (these tests were done to look for intrauterine vertical transmission). One woman delivered a stillborn baby and was admitted to the ICU. We know that in the SARS and MERS outbreaks, some women did deliver stillborn babies.
Unfortunately, there is no reported data right now on women in early pregnancy. We know from other infections that high fevers in the first trimester of pregnancy can lead to certain birth defects; this concern exists with COVID-19 as it can present with high fever. Because of these concerns, The American Society for Reproductive Medicine has recommended that their physicians and clinics suspend all new infertility treatments during the pandemic.
Neonatal Risk: In the 34 cases from China, there was no evidence of SARS CoV2 transmission from mothers to newborns. However, two weeks ago, a UK hospital reported that a newborn of an infected mother tested positive for SARS CoV2 at 36 hours of life – doctors were not able to determine if the baby was infected before, during, or after birth. The recommendation from the CDC is that infants born to mothers with COVID-19 maintain contact isolation and be tested, with a primary concern for respiratory (airborne droplet) transmission from mother to baby. In China, hospitals have temporarily been separating baby from mother while the mother still has transmissible disease, and the CDC is making the same recommendation for US hospitals (this is not true in the UK). Solutions for breastfeeding may include wearing a facemask during lactation or expressing breastmilk while maintaining good hand hygiene.
Centers for Disease Control and Prevention. CDC.gov/coronavirus. Accessed March 17 2020.
Centers for Disease Control and Prevention, Clinician Outreach and Communication Activity (COCA). “COCA Call: Coronavirus Disease 2019 (COVID-19) Update—Information for Clinicians Caring for Children and Pregnant Women, March 12 2020.” Available at emergency.cdc.gov/coca. Downloaded March 15 2020.
Chen H, Guo J, et al. “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.” Lancet 395 (10226); 809-815.
Bryner J. “Newborn tests positive for COVID-19 in London.” LiveScience.com, March15 2020. Accessed March 17 2020.
Social Distancing for Doctors
Lakshmi S. Tummala, MD
Healthcare work is considered essential, so during this pandemic, many of us are still going to work every day. Some of us have picked up extra shifts to help patients and colleagues. We’ve been following social and print media on #socialdistancing pretty closely – check out physicians @aaronecarroll, @DrMichelleLin, @ashishkjha, @darakass, and @laxswamy – and we compiled some points of interest especially to our work.
Create distance between work and home. Many practitioners are switching to using scrubs at work, with the recommendation to wash hands and change into a fresh pair of scrubs to go home. Once home, mark an area of the house as a “hot zone,” strip and shower, and then start your usual after-work routine. If you wash your scrubs at home, store them in the trunk to minimize cross-contamination. Consider leaving a pair of shoes at the hospital and eliminating your jewelry during this time. Clean your ID badge AND your phone at the end of the day.
Be the bad cop in your community. Rules about social distancing are constantly changing, and there is no magical threshold number for a “safe” gathering. Because we work in medicine, we likely understand the importance of social distancing better than others. To that end, use your voice to help the people around you know what’s okay and what is not. Sometimes people just need to hear “no” to move forward with postponements and cancellations. This pandemic will not last forever.
Set the example for what to do. We’re already seeing implications of this pandemic, even as our count grows – blood drives have been canceled, local businesses are struggling, and “non-essential” workers are reaching into their reserves. We’re in this together, and to the extent that we can, let’s support each other. Reach out to your family and friends about donating blood. Get delivery or takeout from a local restaurant. Consider paying the person who helps clean your house or landscape your lawn even though you’re skipping the actual service for now.
Work together at work. We’ve seen lots of institutions cohorting staff in anticipation of quarantines, and lots of physicians working together to be sure that everyone has personal protective equipment. Remember that we all have our own coping mechanisms. Some people may need to be more absent during these times, and that’s okay, too. This is our generation’s first pandemic, and everyone responds to stress differently, remember that.
Find the silver lining. We read last week that the fish have returned to the canals in Venice, because the ships are gone, and that air pollution has visibly decreased in China. Locally, there are so many stories of people coming together and stepping up. Quarantine time is good spring cleaning time. We don’t know yet if we’re in this for a month, or six months, or eighteen, so let’s be sure to look for the silver linings as we work through it.
Spotlight on a WIM:
Kelly Cawcutt, MD, MS
Dr. Cawcutt is an Assistant Professor of Medicine, Associate Medical Director of Infection Control & Epidemiology, and Co-Director of Digital Innovation and Social Media Strategy at the University of Nebraska Medical Center. Follow her @KellyCawcuttMD.
1. Of what professional accomplishment are you most proud?
"I am incredibly proud to be the first physician in my family. Second, I am very proud of creating a less conventional career with Infectious Diseases, Critical Care Medicine and Infection Control. It is an excellent overlapping niche that crosses from clinic to the ICU."
2. What do you do when you get tired of fighting the good fight?
"I step back. I carve out time alone to reflect on if I am still meeting my basic needs - sleep, exercise, healthy food, time with family, time to do things I love. If I am missing these, I know why I am so tired. Then, I made time for them. I am not a good physician if I am not able to care for myself."
3. What is one thing relating to women in medicine that you hope to see change in the next year?
"Overall, I really want to see pay equity arrive. I realize it is a big ask, but it is a needed one. On a personal note, I want to see a culture change in which I am not constantly asked if I am really the doctor and how old I am."
4. How would you complete this sentence? We don't need to fix women in medicine; we need to fix "the organizations and overarching culture."
3 COVID-19 Asks from an ID/CCM MD:
A. Wash your hands, over and over. DO it again.
B. Practice & preach social distancing, including staying home if sick.
C. Remember, it is not about preventing YOU from getting sick. It is about preventing EVERYONE from getting sick so our healthcare systems can be prepared to care for a surge of patients. #FlattenTheCurve
Inspiration from medical students
This trend of medical students stepping up to help fill gaps has been seen at many institutions across the country, a heartwarming and reassuring sign of the future of healthcare. We have been fortunate to see amazing testimonials and are sharing the best here:
“[Several area students] first connected over the text messages on March 16th and smoothly and quickly created a framework to build on. By the evening of March 17th, they had recruited almost 90 students. . . . with a priority of serving high-need healthcare workers with fewer financial resources.”
“In uncertain times, the best thing we can do is stand together. In the past few days [several students at medical school] have rallied more than 65 of their classmates . . . Volunteers will be providing aid to both [institution] physicians (pet care, child care) and at-risk individuals seen at [institution] clinics (medication and grocery deliveries).”
“[The idea] officially came up during our class meeting [when faculty] started to really paint a picture for us about how vast the impact of this was all going to be for the hospital. . . . I think all of us just felt that it wouldn't feel right for us to simply sit at home and watch things unfold. Most of it stems from a desire to help which is what brought us into medicine in the first place.”
“Additionally, at a time of social distancing, the fact that my class is coming together (virtually!) to discuss and implement ways to help makes it possible for us to maintain our sense of community at this difficult time.”
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Women in Medicine Summit