Pandemic By Robert Leverence, MD

A Year Like None Other:

UT Health San Antonio Reflects on Lessons Learned from the COVID-19 Pandemic

By Robert Leverence, MD

Although COVID-19 is destined to become a part of our lives like influenza, it appears its pandemic days are numbered. So, the temptation for us is to block it out of our minds and look forward to brighter days. However, in the wake of what came to be a devastating public health crisis and the fact experts say it surely will not be our last, it will be important for us to record the lessons learned from this first modern-day world pandemic.

UT Health San Antonio was privileged to play a role in the COVID-19 pandemic, as I believe any academic health science center should. Not only do these institutions harbor the expertise needed to help direct care, but they also behold the clinical resources and capacity for testing, vaccinating and caring for large populations. They also have the research talent to discover effective treatments and the educational and marketing support to help communicate the needed behavior changes inherent in any pandemic.

Perhaps the most important lesson learned during the COVID pandemic was that nothing in my medical or administrative training prepared me for the crisis management it demanded. I do not recall even a single class or lecture on the topic. Before COVID-19, I was not even familiar with basic terms like EOC or Crisis Standards of Care. Fortunately, I had access to the resources of the UTHSA Military Health Institute which quickly educated me on these vital concepts. However, this type of support is not widely available. Consequently, maybe it is time to add pandemic preparation to the growing list of preventive health services now embedded in our health care system.

In brief, here are the lessons learned as I helped direct the clinical COVID response at our academic health center. 1. Know the purpose and structure of an Emergency Operation Center (EOC). EOCs can take on many forms and ours took on a

“wheel and spokes” structure with health science center leaders at the hub meeting on a regular basis. Regular cross talk with other partners such as University Hospital (UH), Metro Health, South

Texas Regional Advisory Council (STRAC)/Regional Medical

Operations Center (RMOC) and the VA Medical Center formed the spokes and were essential to achieving our mission. The nature and frequency of these meetings and communication venues also constantly evolved as circumstances changed.

2. Understand the significance and role of Crisis Standards of Care.

These protocols are something one never hopes to use, but are essential in supporting the frontline health care worker in the event of an overwhelming number of casualties. Thanks to STRAC and faculty from UT Health Center for Medical Humanities and Ethics, we were able to put these protocols together early in the pandemic.

Fortunately, they were never needed here in San Antonio.

3. Be prepared to stand up a cross-department deployment program. I was once told directing physicians is like leading an army of generals and nowhere was that more evident than during this pandemic. Physicians are inherent problem solvers, so they do not generally take orders without questioning them. Consequently, regular effective communication was vital in directing our group of over 1,000 physicians working at multiple sites. Crises have a way of drawing the best from people, and I was privileged to witness this among our faculty and staff. Radiologists volunteered to place central lines and psychiatrists volunteered to work on the palliative care service. Trauma surgeons, anesthesiologists and pediatricians who trained in critical care worked alongside our other intensivists to serve our critically ill COVID patients. Subspecialty physicians were quickly trained on modules prepared by our hospitalists and then placed on standby until deployed to care for COVID patients. I was greatly inspired. Likewise, we worked closely with our hospital partner UH to coordinate the opening of additional COVID units and assignment of nurses. When it was my turn to attend to the care of COVID patients, without exception, a nurse would help me with the tedious ritual of donning and doffing my PPE. Fortunately, a good amount of trust had already been built with UH leadership which helped maintain smooth relations and operations during this constantly changing crisis.

4. Appreciate the need for positive, steady, yet flexible leadership during a sustained operation, particularly in a stressful and everchanging environment such as a pandemic. Ensuring self-care and the physical and emotional wellness of your teammates is essential.

Simply taking the time to ask how they’re doing and encouraging a brief break from the action goes a long way.

This list is not all inclusive. A plan for Predictive Modeling, innovative use of Health IT, dispersing personal protective equipment and recovery were all important as well. The one silver lining from this pandemic is that I will forever be inspired and thankful for having worked with such outstanding faculty, staff, as well as partners throughout the city. Despite the shadow cast on 2020 by this pandemic, my memories will forever be framed by the impressive work I witnessed by these individuals. Good job San Antonio.

Robert Leverence, MD is Chief Medical Officer of UT Health San Antonio and is a member of the Bexar County Medical Society.