Dedicated doctors reflect on challenges, successes since start of pandemic

Infectious disease specialist Deeksha Jandhyala, M.D., was in a parking garage at MUSC Health when what she’d been doing for the past two months finally caught up with her. “I remember calling Dr. Lewis on the way home, just exhausted and crying. She asked, ‘Wait, what's happening?’ And I had said, ‘You know, we may get sick and we may die.’ And we were both just kind of coming to terms with that.”

 

Jandhyala and her friend and colleague, Jessica Lewis, M.D., were assessing potential COVID-19 patients in the early days of the pandemic as critical care doctors and nurses asked for their input. Everyone was still learning about how the virus spread, how deadly it was and what treatments might work. 

 

 

Jandhyala and Lewis had also volunteered to work week after week in that role so older colleagues at higher risk of getting dangerously ill from COVID could stay safe. It was a lot to deal with. So was the knowledge that health care workers were dying from the virus.

 

“We were starting to see that it wasn't just older people who were getting really sick and dying. It was also people in their thirties and forties,” Lewis said.

 

“And we weren’t able to test every single patient admitted to the hospital in the early days like we do now. So you would be in a room, seeing a patient for fever. And as you're talking to them, you're realizing we need to COVID test this patient. And so you're kind of, like, slowly backing out of the room, knowing you're going to cause a huge to-do by saying that you need to COVID test them.”

 

Things have changed dramatically over the past year. Health care workers not only know a lot more about how to protect themselves from the coronavirus, but can also be vaccinated against it. And the number of people hospitalized with COVID at MUSC Health is down after surges in July of 2020 and January of 2021. Members of the public are getting vaccinated, too.

 

Those welcome developments have given infectious disease doctors at MUSC Health time to reflect on what’s likely the most memorable year of their lives. Five recently gathered on a phone call for a behind-the-scenes look at what life has been like during the pandemic. All are faculty members in the College of Medicine at the Medical University of South Carolina, along with the rest of the 15-member infectious disease team.

 

 

Hospital epidemiologist Cassy Salgado, M.D., described the day MUSC Health admitted its first COVID patient, March 12. “We had been preparing for what seemed like an eternity. We were meeting every day in an emergency operation capacity. I remember I got an email that day from Tom Crawford, who was the chief operating officer at the time. “It was just three words that said, ‘Here we go...’ And he was right. That was the start of a really long time."

 

She and infectious disease specialist Scott Curry, M.D., have been leading MUSC Health’s COVID efforts. “Dr. Curry and Dr. Salgado basically had like 7,000 emails a day. I'm not kidding. We saw it in real life, and I was like, I don't even know how you get through that. They also spent the night here the first two months I think, and just never left,” Jandhyala said.

 

There was just so much to do. For example, Curry said he and Salgado had to use their expertise in infection prevention and hospital epidemiology to take MUSC Health’s carefully crafted pandemic plan and constantly update it, based on emerging evidence.

 

“We had to read five or six medical papers a day and keep up with the CDC website with changes, and then come up with the handbook for what we were going to do here. I was also running up and down to the ER, seeing patients.”

 

 

When Curry suspected those patients had COVID, he faced another challenge. “At that point, CDC was only allowing us to send tests for hospitalized or critically ill people. And that guidance was really slow to change. It's amazing to think. Now I can order a COVID test and have it back in 45 minutes, but back then I had to send it to Columbia and wait for a week for them to approve us to run it.”

 

Meanwhile, doctors were scrambling to make sure they had the proper garb. One started a website called “Heroes Need Masks,” asking the public for donations.

 

Infectious disease specialist Heather Hughes, M.D., went on the hunt for personal protective equipment in person. “I can remember walking around to every single clinic room at like six o'clock at night, on a Tuesday, the infection control nurse manager and me. We looked at every single room, every single cabinet, we got every single box of masks and took them. Because we didn’t know how many we needed. We didn’t know how long they are going to last. I just remember thinking, ‘Is this real life?’”

 

“Things were changing so fast, every single day was something new,” Jandhyala said. “Like how we tested, what our protocols were, new treatments."

 

They were also frequently being asked by other doctors to consult on potential COVID cases. “I think people were so scared, and the first people that they wanted to call was ID, so we had a consult pager just for COVID. And that thing went off 24/7 all the time. We passed it off like a hot potato between all of us,” Jandhyala said.

 

Fortunately, the doctors had each other to lean on. Salgado said she, Curry and Hughes, who in addition to her work at MUSC Health is the hospital epidemiologist for the Ralph H. Johnson VA Medical Center, had a ritual.

 

 

“My favorite part of the day was when Scott and Heather and I would have our end-of-the day debrief. And sometimes that happened at five o'clock. And sometimes it happened at 10 o'clock. It was really a time to compare what we were doing here at MUSC, what they were doing at the VA. We were trying to stay as consistent as possible, because people go back and forth. We were also able to kind of let off a little steam and just make sure we were thinking straight.”

 

They also checked in frequently with the rest of their team, knowing the stress they were all under. Then, one of their own got seriously sick.

 

Jandhyala, the young doctor who worried about dying from COVID, ended up in her own hospital with it. “Dr. Hughes and Dr. Lewis were the two people that were on the phone with me. Dr. Lewis came in to visit me in the room, suited up in PPE. We were still kind of crying together saying, ‘This is very scary.' We were shocked that there was a man down.”

 

Jandhyala recovered with her colleagues’ support. And they all watched in wonder as something finally went the right way during the pandemic: vaccines.

 

 

“I remember feeling so overwhelmed with the emotion when the UPS trucks left with the vaccines to distribute,” Hughes said. “I was very emotional, like walking — running — to get my first dose. I also felt very honored that our country decided that health care providers should be the first ones to get the vaccine. That was like really the ultimate thank you.”

Curry said the speed with which the vaccines were developed was amazing. “It's a triumph of modern science and the National Institutes of Health’s funding system. For all of its faults and warts, this worked.”

Salgado said it’s been wonderful to see the impact those vaccines, and greatly improved treatments for COVID-19, are having. “It's a giant relief. A lot of reflection is happening now.”

She called it an honor to be able to help during the pandemic.

 

Curry agreed. “I think we all did our duty and did ourselves proud. But it’s sad to see patients die and be alone in such a critical illness,” he said, referring to the fact that COVID patients died without family present because the virus is so contagious.

 

And that heartbreaking part of the pandemic serves as a reminder that the coronavirus is not only still here, but mutating. Lewis said we’re at a critical moment.

 

“There's room for optimism because we have a vaccine that's highly effective and more and more people are able to get it, but we're nowhere close to where we need to be in terms of the number of people vaccinated. And the pace of vaccines is not exceeding the pace at which we're loosening restrictions. And that's the real problem. We’re right on an inflection point, I think.”

 

Jandhyala is doing her part to try to get the virus under control. She’s volunteering in MUSC Health’s vaccine clinic, trying to protect others from the virus that has had such an impact on her life over the past year. “Everyone has done so much for me. It’s a way to give back. Every needle going into an arm is so rewarding to see.”