support. Many early changes resulted from these meetings andwere frequently based on resident suggestions. At UMC, our hospitalists would also meet with the Tulane University hospitalists to gain additional perspective on many of the issues that we faced. The internal medicine program director started a daily “COVID CENTRAL” email that included the day’s COVID-19 census at each of our hospital sites, COVID-19 epidemiologic data from New Orleans, Louisiana and the United States, updates on PPE, updates on COVID-19 testing, updates on COVID-19 clinical treatment trials and medications, updates on wellness initiatives and support programs, updates on educational and scholarly activities, vaccinations, and “shout-outs” to house officers and faculty members for their specific accomplishments and heroic efforts. These emails were shared with all LSUHSC medicine department clinical faculty and house officers as well as leadership in the Department of Medicine, School of Medicine and at UMC. This effort increased transparency of the situation and helped build a sense of community during a time where separation of clinical sites could produce feelings of isolation. The residency department maintained communication across all our clinical sites through emails, weekly Chief Resident Committee meetings, and monthly Resident Education Committee meetings. The program director had weekly telephone meetings with the Chairman of the Department of Medicine. The program director attended monthly meetings of the Graduate Medical Education Committee (GMEC) where COVID-19 issues related to residency program function and education were discussed. We continue to use the Zoom format to maintain communication across all our hospital sites and for our regularly scheduled residency program meetings and
and gowns and masks were re-used. Creation of COVID-19 units in the hospital was greatly beneficial for conservation of PPE; gowns could simply be wiped down and gloves exchanged between patient rooms in these units. The OKMC site offered the medicine ward teams an ability to perform virtual patient rounds, thus reducing exposure and decreasing the use of PPE. One house officer and one hospitalist faculty member formed a relationship with the LSU Engineering Department and developed 3-D printed face shields and gowns. We also received PPE donations from other sources that were distributed throughout our hospitals for use. Fortunately, none of our hospitals ran out of PPE. COVID-19 testing of patients and hospital workers changed as rapid automated methodologies became available. Initially, only patients with symptoms of COVID-19 were tested. However, a fewpatients who did not have symptoms and were admitted for other medical reasons also tested positive for COVID-19 as testing became more available. Furthermore, some patients who had been transferred from outside medical sites were not tested for COVID-19 and when tested at our hospital, were positive despite lack of symptoms. For these reasons, house officers were instructed to wear proper PPE and to treat all patients as though they had COVID-19 until a negative test was available. Theuseof surgicalmasks onall patients andhospital workers was instituted close to the end of March 2020. At that time, checkpoints at hospital entrances were established and the temperature of all hospital workers inclusive of physicians and all patients was checked and clean face masks were offered to those who needed them. This practice has been maintained to this date. The City of New Orleans mandated social distancing and the use of face masks early in the pandemic.
educational didactic conferences. RESIDENT AND INTERN HEALTH AND WELLNESS
Despite our precautions, about seven internal medicine house officers tested positive for COVID-19 during the initial peak and another seven tested positive or had close contact with someone with COVID-19 during the third holiday peak of COVID-19 in November and December 2020. Thus about 20% of our internal medicine house officers tested positive for COVID-19. The Associate Dean for Academic Affairs at LSUHSCwas informedof all resident-COVID-19 related issues. Despite an inability to accurately determine where these house officers were infected, we believe several were likely infectedoutsideof thehospital despite social distancingand the use of surgical masks. Of note, a previously published study on the impact of COVID-19 on New York City resident physicians demonstrated no correlation between programs the reported suboptimal PPE and the number of COVID- 19-positive residents. 9 We followed the guidance of the CDC for quarantine and return to work that was in effect at each of these times. The program director remained in 39
At the beginning of the COVID-19 pandemic, PPE consisted of a surgical mask or N95 respirator mask, eye protection, disposable gloves, and disposable gowns. We reviewed PPE donning and doffing with all house officers as recommended by the Centers for Disease Control at that time. N95 respirator masks were only required for use during procedures that would increase the risk of aerosols. However, a few weeks into the pandemic, N95 masks were used for all COVID-19 patient encounters. To further reduce PPE use, only one person on the medicine team would go into the patient’s room. Some faculty saw all the admitted COVID-19 patients and simply filled in the subjective and physical exam portions of a house officer derived progress note. During the month of April some PPE became scarce
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