MUSC doctors share COVID knowledge with overseas counterparts

Faculty and staff at the Medical University of South Carolina are sharing their hard-won knowledge about COVID-19 with colleagues across the globe who are fighting new waves in infections.

From Charleston, Lacey MenkinSmith, M.D., director of the Global Emergency Medicine fellowship at MUSC, is leading an effort to get practical information to doctors at OneWorld Health’s Masindi Kitara Medical Center in Uganda, one of a number of sites around the world that the MUSC Center for Global Health works with.

And infectious disease specialist Krutika Kuppalli, M.D., co-founded a nonprofit group, India COVID SOS, that worked to get information to both the public and medical professionals as India was hit hard and is now broadening its attention to Africa and other areas of Asia as COVID circles the globe.

June has seen a record number of cases and deaths for Uganda. And with less than 1% of the population vaccinated, on June 18, Ugandan President Yoweri Museveni imposed a strict 42-day lockdown.

 

Only a week prior, MenkinSmith had returned to Charleston from Masindi Kitara Medical Center. She was there to work on a Centers for Disease Control and Prevention grant evaluating the effectiveness of a health care worker online training program in high-risk infectious disease.

But with COVID cases already rising, she and the team used their spare time to help their Ugandan colleagues set up an isolation ward and update protocols to deal with suspected or probable COVID-19 cases.

Just as she was set to leave Uganda, she learned the MUSC Center for Global Health had awarded her team a virtual exchange grant to facilitate the creation of continuing medical education for Masindi Kitara Medical Center and its three outlying clinics. When her team originally applied for the grant, the idea had been to create educational modules on a variety of emergency medicine topics. But with COVID spiking, the medical director of the Ugandan health system asked her instead to focus on COVID – and to get the modules done ASAP.

Back in the States, MenkinSmith sent out a call to her MUSC colleagues – who, she asked, would be willing to record a helpful lecture on a COVID topic? Already, MenkinSmith and hospital epidemiologist Cassandra Salgado, M.D., have recorded and sent lectures on hospital protocols and the clinical presentation of COVID. Infection preventionist Kristen Stoltz and Ryan Taylor, R.N., are putting together a lecture on infection prevention and transmission while infectious disease specialist Scott Curry, M.D., is working on a diagnosis lecture.

The lectures are simple PowerPoint-type presentations. MenkinSmith said they’re more focused on getting the information to Uganda quickly than making Hollywood-worthy videos.

“Perfect presentations that get there three months from now aren’t going to make the difference,” she said.

She is also acutely aware of the differences in resources between the U.S. and Uganda, and she and Taylor, who has also worked at Masindi Kitara Medical Center, are coordinating with the other MUSC presenters to ensure the information can actually be used by the Ugandan team.

As an example, COVID tests remain a scarce resource in Uganda. At MUSC Health, by last winter the Emergency Department could test a patient and get the results within an hour or two, MenkinSmith said. At Masindi Kitara Medical Center, doctors must send PCR tests to the capital and won’t get results for a week. A nearby hospital sometimes has “rapid” tests, which return results in about three days.

 

As a result, the Ugandan doctors must rely on clinical diagnosis. These are the protocols that MenkinSmith’s team worked with their Ugandan colleagues to develop, which classify patients as “probable” or “suspect” cases based on a combination of symptoms.

“By the time the diagnostics come back, it could be a week that they’ve been in the hospital. If we haven’t been using the right infection prevention strategies with them, then we would have risked transmission,” she said. “At the same time, if we make the criteria too loose, and everyone becomes a probable case, there’s not enough PPE to last.”

She also helped to develop protocols for who should be wearing what personal protective equipment in which areas of the hospital and how to reuse N95 masks safely for a week at a time.

Because internet connections can be spotty in Uganda, MenkinSmith sends the lectures to the in-country director, who then downloads and takes them to the hospital for viewing at morning staff meetings.

Meanwhile, infectious disease expert Kuppalli has been focusing on the pandemic in India. India’s surge, which peaked in May, overwhelmed its health system. India now has the second greatest number of cases and third greatest number of deaths in the world, according to the Johns Hopkins Coronavirus Resource Center.

In April, Kuppalli and a couple of other doctors developed an infographic with simple, straightforward instructions on how to treat COVID-19 at home when hospital care is inaccessible. Importantly, the infographic also included a list of treatments that were no longer considered effective.

The infographic filled a void, for it quickly went viral and was picked up by the Indian government, World Health Organization and others. Kuppalli and the others then created India COVID SOS, a coalition of doctors, researchers, engineers and community partners working to share evidence-based solutions. The group has created additional educational resources for the public, which have been translated into dozens of languages, as well as launching fundraising and equipment donation drives and providing educational resources for health care professionals, mental health assistance for health care professionals and creative engineering to conserve oxygen.

Now, the group is broadening its efforts, as much of the work is applicable to Southeast Asia, where cases are rising.