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Roxanna Gapstur: Today, we're going to talk about the evolution of the COVID-19 pandemic and how we're continuing to lead our communities as a trusted partner here at WellSpan, especially important as we gear up for the flu season. Joining me is Dr. Eugene Curley. Dr. Curley is one of WellSpan's Infectious Disease Physicians and Chair of the Clinical Practice Standards Task Force. This task force is responsible for creating and updating the clinical protocols our organization has followed to provide the safest, highest quality care during the pandemic. Dr. Curley, thanks for joining.

Dr. Curley: Thank you for having me. It's an honor to speak here today and pleasure to finally meet you in person

Host: Dr. Curley, it's also great to see you in person. I know we've probably had contact virtually through zoom, but it's wonderful to actually see your face. At the moment we're recording this episode, it's early October and like many healthcare organizations around the country. We're educating our communities about the importance of flu vaccination and how to spot the difference between COVID and the flu. Can you help our listeners understand how these two contagious respiratory illnesses are both different and similar?

Dr. Curley: Sure, so both influenza and SARS Kovi Two, which is the virus that causes COVID-19, they're both respiratory viruses, which can induce an upper respiratory illness or URI. They're both contagious from person to person they're transmitted mostly through respiratory droplets. The symptoms of the viruses are nearly indistinguishable and may include cough, shortness of breath, fever, myalgia’s GI symptoms, your standard URI symptoms. To complicate matters further, there are a host of other respiratory viruses, things like rhinovirus, there is seasonal coronavirus, even RSV. The two symptoms that seem fairly unique to COVID-19 patients is loss of taste or smell. It's not seen in all COVID-19 patients, but when you do see it, that pretty much clues you in that this is probably COVID-19 and not influenza. I think that's going to be a clinical clue for this upcoming influenza season. I know our laboratory services are also working on getting point of care testing for our ambulatory practices. So I think this flu season, we're going to be relying more on diagnostic testing and PCR testing to differentiate between these respiratory viruses. Some experts are predicting that we're going to see increased cases of flu this year. I'm hoping that we actually see decrease cases of influenza being that we're being hyper vigilant with social distancing, masking and hand hygiene. But nonetheless, I think this is a very important season that we all should be getting our flu vaccinations.

Host: This is really important guidance. Thank you, Dr. Curley, as an infectious disease physician, you specialize in complex medical cases and your job is to be a detective of sorts diagnosing infections and prescribing the most effective treatments. Can you tell us about the complexities of COVID-19 and the experience leading us through the creation and adaptation of our clinical protocols as we learned more about the virus?

Dr. Curley: Sure. And I like to give a shout out to Dr. Alyssa Moyer, Shane Walker, and the rest of our clinical standards branch, as we were given the difficult task of vetting and creating guidance on all COVID related matters. Our treatment group, which was comprised of pharmacy and ID across all WellSpan entities, we met separately to create and revise COVID-19 order sets and as well, working on our treatment algorithms, developing guidance on a novel virus or disease process was challenging to say the least. As a clinician, we're taught to practice evidence based medicine. But as you can probably imagine, there was very little evidence back in March when we started these groups. Honestly, there's still very little good evidence today is we're not even a year into the pandemic. Probably the biggest thing I learned working with our group is that all data is not good data. For example, back early in the pandemic, we were trying to decide whether we were going to add a hydroxychloroquine to our treatment algorithms.

And we were reviewing articles that went through the experience of hydroxychloroquine use and maybe 20 or just 30 patients. We also looked at articles on ivermectin and the effect on SARS Kovi Two, not in patients, but just in cell cultures. It was difficult to come up with any clear conclusions from reading these articles. We really didn't start seeing the good data, these large randomized multicenter trials until about June of this year and many are still underway. So the landscape of infection control, testing, and treatment, they continue to shift. It's frustrating because your patients and colleagues, they look to you for answers. But unfortunately we still have a lot to learn about this virus.

Host: Yeah, that sounds like a really challenging situation. Dr. Curley, when you first started working with the incident command system here at WellSpan in the clinical practice standards, task force, did you ever think we'd still be fighting this virus nine months later?

Dr. Curley: During the lockdown earlier this year, I was hopeful that maybe the pandemic would only last a matter of months, but once everything opened back up reality set in. Over the last few weeks. We've seen tremendous spikes in cases nationwide and here at WellSpan. And I think the reason is simple. We're just not doing enough to prevent the spread of this virus. We know how the virus has spread respiratory droplets from person to person fomites on high touch surfaces. We're not social distancing, we're not wearing a mask. And I don't mean you and I, but I use, emphasize we, because it only works if we're all participating and doing what we need to do. We clearly saw that the cases dropped during the lockdown. And since opening back up, we're seeing these spikes. When I talked to my family, my friends, even my colleagues here at work, I generally make the joke that I feel like I'm the only one that's still operating as if there's a lockdown and not being judgmental, I totally understand the impact of the psychosocial stressors, people are tired of being in the house.

Many people can't work from home. You know, schools have definitely reopened. And I think that's contributed to some of the spikes we're seeing. And I definitely understand the financial impact on individuals and businesses, but we just need to remain extremely vigilant and focus on these fundamental concepts, social distancing, masking, and hand hygiene. I like to bring up one other important concept. One that I think just flies under the radar. People don't quite grasp. And it's the concept of asymptomatic and presymptomatic spread. So obviously some COVID-19 patients never develop symptoms and we would put them in the asymptomatic category. You have other COVID-19 patients who are asymptomatic at the time they test positive, and then they develop symptoms much later, sometimes days later, sometimes a week or more later in both categories of patients. These patients are extremely contagious, even though they don't have symptoms.

So, it's very difficult to control. And that's why it's not safe to be around others, especially if you're not wearing a mask. We've heard about some of these super spreading events on the news, funerals, churches, family, reunions, weddings, even meetings, and the common theme with these super spreading events. These are large gatherings of asymptomatic unmasked people. So I don't really think that the spikes that we're seeing are related to a change in how the virus has spread nor a change in PPE requirements. I think it boils down to those fundamental concepts of social distancing, masking, and hand hygiene.

Host: You're raising so many good points, Dr. Curley, I wonder as an infectious disease physician, you're trained to expect the unexpected for our clinical team members though, who are serving on the front lines. I can imagine that the shifts in the pandemic and the different changes in guidance have been somewhat frustrating and maybe concerning.

Dr. Curley: Yes, for sure. The changing guidance over time has not been just frustrating for clinicians, but for I'm sure for leadership for patients for the public in general, commonly when the CDC or department of health would publish these changes, they did. So without a clear explanation or evidence, and I'm sure there, there is an explanation or evidence, but they just weren't transparent with it. And in terms, some people, they start to lose confidence with the experts. I think it's important to take a step back, level-set, and remember that we're dealing with a completely novel virus and disease process. And although it feels like we've been dealing with COVID-19 for a long time, it's still very early in the pandemic. It hasn't even been a full year. The verdict is still out on many of the available therapeutics and we still don't even have a vaccine. We're still generating this data and experience that will hopefully eventually be needed to publish whatever the final COVID guidelines are. Hopefully, maybe sometime next year. We're at that point, I think until then we need to expect more changes. We need to be flexible and we need to continue to trust the experts in this arena.

Host: Yeah. When we think of 2020, we certainly associate it with change. Don't we, the positive side of the unfortunate reality that we've seen is that our care teams have leaned into these new ways of working and caring for our patients. The strides we've made in such a short amount of time to shift to telemedicine with e-visits and video visits has really been incredible. It's a Testament to our innovation mindset during the pandemic. We've also seen the benefits of innovative medicine.

Dr. Curley: That's a great point. This is all new. Obviously we didn't have a blueprint to guide us back in the spring and we're definitely operating under a time. Crunch. Innovation has been a huge theme at WellSpan during the pandemic. We've changed how we conduct meetings through zoom and Teams, where we care for patients creating COVID specific units in the hospital and ushering in telemedicine. Also a change how we care for patients from a transmission based precautions, isolation, testing, and even treatments. Our clinical standards and treatment teams spent countless hours reviewing the literature, the data, reaching out to healthcare organizations, brainstorming how to best serve our patients and how to keep our employees safe. Our laboratory services team. They were able to acquire multiple testing platforms so that our patients had access to testing. We were able to partner with the Mayo Clinic and obtain convalescent plasma for our patients very early in the pandemic. Our pharmacy team was also able to obtain a stockpile of Remdesivir for our patients. So WellSpan has done a fabulous job investing in COVID care and providing access to the best therapeutics available. Anecdotally, I can share that these therapeutics are quite promising and they definitely seem extremely safe. And although the final verdict on efficacy is yet to be determined. I think that our patients are benefiting greatly from their use.

Host: It's the countless stories of caregiving team members who've gone above and beyond to care for our patients. These are really the bright spots in a really dark time. I think that's exactly how our communities have viewed WellSpan during the pandemic, really as a trusted resource and partner during this scary time. And we couldn't be that partner without you and the expertise of our infectious disease team.

Dr. Curley: Thank you Roxanna, our ID team, we're honored to be able to help out during these unprecedented times it's been stressful for sure. And I'm sure other specialties have felt this. Within ID we've seen dramatic increases in our patient census. I personally feel that the management of COVID 19 patients is significantly more time consuming compared to patients with other infections and keeping up with the latest COVID literature alone is just very challenging. I've had the pleasure of being able to talk with a lot of my ID colleagues across all the entities at WellSpan. And what I can say is we're a resilient bunch and we're all dedicated to patient care. For me personally, the patients get me through the day I thrive on patient care and being able to lend my expertise for their wellbeing. So I think for the current time, I think we try our best to weather the storm. And hopefully we get a safe, effective, wildly distributed vaccine soon and can get back to some normalcy.

Host: Yeah, that would be really great. Wouldn't it? Your insights are a really good reminder that our physicians and providers are human as well. And at the same time, you're leading us through a pandemic and caring for patients. You're also navigating its impacts as a person, as a mother, a father, a husband, a wife, a teammate. We're just so grateful for WellSpan physicians and advanced practice providers and all of our caregiving team members. It's really our collective resilience and commitment to delivering the safest, highest quality care that enable us to continue to guide our communities through the pandemic and beyond. Dr. Curley, any closing thoughts for our listeners today?

Dr. Curley: Yes. I'd just like to encourage everyone to continue to be strong, safe, and vigilant, be flexible and embrace change rather than fight it. Continue to trust the experts and continue to social distance where I'm asking, wash your hands. Thank you.

Host: Oh, that's a wonderful way to close. Thanks for joining me today, Dr. Curley. I really appreciate you being here.

Dr. Curley: Thank you.

Host: That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.