All In The Fight

ALL IN THE FIGHT

ALUMNI DOCTORS REPORTING FORM THE FRONT LINES OF THE CORONAVIRUS

by david mckay wilson | David McKay Wilson is a freelance writer based in New York.

Dr. Paul Lantos ’92’s fascination with infectious disease dates back to 1991 at Choate, when he completed a research project on the Black Death in Charlie Tierney’s medieval history class. Lantos, associate professor at Duke’s School of Medicine, and a specialist in pediatric infectious disease, is among four Choate Rosemary Hall alumni interviewed in late April by the Bulletin as the world grappled with a disease that by then had infected 2 million worldwide, with 200,000 deaths. Lantos deployed his expertise to help the Duke community. Dr. Kitty Garza ’97, a psychiatrist and assistant professor at Columbia University Irving Medical Center, addressed the emotional needs of hospital patients and staff. Dr. Dan Carucci ’76 worked on strategies to promote vaccination campaigns at McCann Health while Dr. Amy Lehman ’91 prepared to return to sub-Saharan Africa, where the coronavirus has cropped up in cities as well as in rural villages in four nations on the shores of Lake Tanganyika.

paul lantos ’92 “The nexus was always the Black Death,” says Lantos. “History repeats itself. Today’s crisis is the least surprising global emergency we have ever faced. It happened 17 years ago with SARS, which began in China but was more easily contained. In 2003, we were wondering when the next one would hit.”

For Lantos, who helps oversee employee health for the Duke community and conducts research in the spread of COVID-19 in the Raleigh-Durham area, the coronavirus crisis has brought him deep into the pandemic.

With 40,000 employees at Duke and its three affiliated hospitals in Durham, N. C., Lantos and his staff do daily check-ins with employees who tested positive for COVID. While their primary care physicians address immediate medical needs, Lantos’ office works with employees to figure out when it’s safe for them to return to work.

Duke uses protocols set up under federal guidelines from the Centers for Disease Control and Prevention. Some can return at least seven days after the onset of symptoms, and three days after they are free of fever. But some aren’t ready that soon. Yet other hospital workers stay home in self-quarantine for at least two weeks if they work with immune-compromised patients.

“Coming through our employee health office centralizes the decision, rather than having individual physicians making the decision,” he says. “We understand the scope of the burden on our employees.”

Lantos, who also sees non-COVID patients at a hospital clinic, says the pandemic has changed the health-care system. All hospital personnel, for example, wear masks, and he gets screened upon entering the building by an official who asks if he has had a fever or flulike symptoms.

“Everything about working in the hospital environment is abnormal,” he says. “We don’t know who is exposed. We are at a higher risk. We are leaving our houses and entering a workplace.”

By late April, he participated in discussions about what protocols will be followed on Duke’s campus, hospitals, and research labs, once campus opens again.

“What happens when the labs open and the students return requires a lot of attention and thought,” he said. “It’s not easy. If you contain too much, you hurt people’s mental health and financial life. We need to find the right balance.”

Paul Lantos '92

Christina Kitt Garza ’97

As a hospital-based consultant psychiatrist at Columbia University Irving Medical Center in Manhattan’s Washington Heights neighborhood, Garza works with patients having trouble dealing with their disease – be it cancer, congestive heart failure, or COVID-19.

Garza, who grew up in Bakersfield, Calif., is the daughter of physicians. Her brothers – Dennis Kitt ’99 and Dr. Arthur Kitt ’01 – both attended Choate as well.

Her first brush with infectious diseases came at Choate, when she volunteered at AIDS Project New Haven, doing HIV/AIDS prevention education in a New Haven soup kitchen.

Garza has found that many COVID-19 patients have considerable anxiety. “Some don’t know what it means to have the disease,” says Garza. “They may have heard that people die from it. They don’t know how it will impact life going forward. And if patients have a pre-existing depression or anxiety disorder, the added stress from being diagnosed with COVID-19 may cause these symptoms to flare up.”

When medical personnel appear fully garbed in protective gear, with gowns, masks, and face shields, some patients who are elderly or cognitively impaired may not understand what’s happening. With family members barred from visiting the hospital wards, they can grow agitated.

“Typically, they’d have family members to reassure them by their bedside,” Garza says. “Some may not even understand that they have coronavirus.”

Interviewing a patient in full personal protective equipment raises its own issues, with the gear creating barriers for therapists to make a connection with a patient.

“I wonder about the message it communicates to the patient,” she says. “We have to be cautious, but the appearance the gear creates is not an inviting one. I’m asking the patient to tell me all these emotionally vulnerable things about themselves and in the meantime I am literally in there with gloves and two masks on.”

Many of Garza’s visits now are done remotely, with the patient, alone in isolation, holding a tablet, and Garza speaking from her office. “I don’t love the tele-consults, but at the same time, it helps to maintain some sense of humanity,” she says. “With the visitor restrictions in place it can be really lonely for these patients. Many are starved for a normal human interaction. With the tablet, we can look each other in the eye.

“I don’t love the tele-consults, but at the same time, it helps to maintain some sense of humanity,” she says. “With the visitor restrictions in place it can be really lonely for these patients. Many are starved for a normal human interaction. With the tablet, we can look each other in the eye. We see each other’s facial expressions. There are pros and cons of working this way, but our training allows us to be flexible, to figure out what a patient needs in the moment and to try to meet them where they are at.

Dan Carucci ’76

Dr. Dan Carucci, an international public health expert, found himself in the studios of pharmaceutical giant Johnson & Johnson in April, discussing issues involved with promoting vaccination in a world where pockets of resistance remain to immunizations.

Carucci, global medical director and chief medical officer for McCann Health, was participating in J&J’s online series, “The Road to a Vaccine,” to explain the importance of promoting the vaccine to stop the coronavirus that causes COVID-19.

“Everybody is waiting for the vaccine,” Carucci said. “There’s going to be a new appreciation for the importance of vaccination. At the same time, we need to develop effective communication, so when it’s available, we’ll be able to position it as a valuable proposition to the population.”

Carucci, who was given Choate’s Alumni Award in 2012, gained an appreciation for immunology while at Choate, with his sixth form spring project conducted in a laboratory at Yale-New Haven Hospital.

He came to McCann Health, a global communications network, two years ago, following a career in public health, which included stints running the US Navy’s malaria vaccine program and leadership positions at the United Nations Foundation and a $200 million Bill & Melinda Gates Foundation global health project.

He sees the importance of cultural sensitivity when a public health intervention is proposed. He recalled that during the Ebola virus outbreak in West Africa in 2014, most received the vaccine, but there were some people who refused and actively pushed against it.

He had that in mind when he designed what he called the “immunity charm” for mothers in Afghanistan, to encourage inoculations for their children. In South Asia, mothers put a black bracelet on infants to ward off
evil spirits. Carucci’s charm adds a colorful bead to the bracelet for each vaccination they receive.

“The children wear their history of immunization,” Carucci said. “It’s a powerful visible symbol for that child. It was wildly successful in Afghanistan.”

Once a COVID-19 vaccine gets approved, new issues will arise, Carucci says. It’s clear that there won’t be enough doses for everyone in a community.

“Who gets it first?” asks Carucci. “There aren’t going to be 300 million doses available on June 1 next year. How do we appeal to people’s sense of community to prioritize parents, grandparents, and first responders? How do we create an environment where that’s acceptable? We’re going to have to think hard about it upfront.”

He said the coronavirus crisis could bring a renewed confidence in the health-care sector, with increased knowledge of the importance of vaccinations, and a greater sense of common purpose in American society.

“Despite our physical distance, we are all facing a collective enemy,” he says. “There’s a sense of common purpose. Our planet is healing, with cleaner air and water. The planet is taking a deep breath, and exhaling.”

Since the outbreak began, Carucci has worked from his home once in Washington, D.C. Staying put in DC has provided a needed respite from his regular travels. “I travel so much for work that it has actually been a nice break,” he said. “I’m usually coming from one place or going to the next. My garden is nice this spring.”

Amy Lehman '91

Amy Lehman ’91

Dr. Amy Lehman, founder and CEO of the Lake Tanganyika Floating Health Clinic in sub-Saharan Africa, was making plans in March for a major meeting with her public health team and government officials in Kinshasa, the capital of the Democratic Republic of Congo, when the coronavirus struck the region. Lehman’s team has a plan to digitize medical records in the nation, replacing an unwieldly paper-based system designed in the 1970s with a digital application that would more easily make available the medical records of millions of Congolese.

“As the caseload grew in Kinshasa, a two-week quarantine was put in place for visitors,” Lehman said. “We just couldn’t go.”

Lehman’s proposed digital transformation of the Congo’s medical records would have been useful as that nation – and the rest of Africa – addresses the pandemic with a health-care system strained by pressing structural needs. Lehman’s project involves bringing health-care to people living on the shores of Lake Tanganyika, the world’s second largest lake, with 1,100 miles of shoreline in four nations – the Congo, Burundi, Tanzania, and Zambia.

What has shocked Lehman about the COVID outbreak is how health-care systems in the developed world have fallen short.

“I’m familiar with weaknesses in the African context, with the DRC a hotbed for emergent diseases,” she says. “What was shocking to see was how not on the ball more developed systems have been. It points out how if you don’t invest in infrastructure and longitudinal health-system strengthening, you can find yourself in a very defensive position, sticking your finger in the dike.”

Instead of traveling, Lehman has stayed home in Chicago’s Wicker Park neighborhood with her son, his roommate, her husband, and a longtime friend.

“I’ve maintained my medical license in Illinois if they need to press me into service here,” she said. “As hard as it is for everybody here, at least we have water to wash our hands. Things are easy to take for granted here. Imagine what it means to rip through places in Africa without the infrastructure we have. You see how unprepared we are here. Imagine what it’s like in Kinshasa, one of Africa’s mega-cities, with very dense slum-like circumstances, with no piped water and no plumbing.”

Making matters worse were the spring floods near the border of Congo and Burundi, where 2,500 homes were destroyed by the overflowing river, rising lake levels, and mudslides.

“The floods will increase cholera and malaria,” Lehman said. “Then there’s COVID. It’s a recipe for disaster. We just don’t know how bad it will get.”