Pritzker School of Medicine students add COVID-19 to their studies.
Since December, when a mysterious disease began circulating through China’s Hubei province, doctors around the world have received a crash course in preventing and treating the new virus. In March and April UChicago physicians on the front line began sharing what they’d learned about COVID-19 with some of their students and soon-to-be colleagues.
Lesson one: uncertainty is the only constant. “This thing is changing by the week, and could change 48 hours from now,” infectious disease fellow Greg Olson told 110 or so Pritzker School of Medicine students assembled via Zoom. On his shared computer screen was a flowchart of UChicago Medicine’s treatment protocol for COVID-19 patients—very much, he emphasized, a work in progress. Within and across hospitals, “there is no standard regimen” for treating the disease.
Olson was a guest speaker for MEDC 30450, The COVID-19 Pandemic: Perspectives from the Forefront. The course was spearheaded by Jeanne Farnan, AB’98, MD’02, a hospitalist and director of clinical skills education at Pritzker. The three-week elective was aimed at giving third- and fourth-year students—many of whom will soon be caring for COVID-19 patients themselves—an overview of the disease.
The speakers were experts in areas including ethics, epidemiology, virology, medical history, and public health, but all acknowledged that where this virus is concerned, no one is an expert yet. The list of what we don’t know, they told students, is long: the fatality rate of COVID-19 (Maggie Collison, infectious disease fellow); how many people may have died at home from the disease (Katherine Thompson, MD’05, geriatrics); how to approach conversations about do-not-resuscitate orders (Will Parker, MD’12, SM’18, pulmonology); if and for how long you have immunity after being infected (Stephen Weber, epidemiology); and how to reduce disparities in who gets sick (Harold Pollack, School of Social Service Administration).
Yet even in a situation where so much is up in the air, the fundamentals of caring for patients haven’t changed. Thompson reminded students of all the simple ways they can help their older patients stay healthy. Help keep them supplied with 90 days’ worth of needed medications. Simplify dosing regimens where you can. Teach easy at-home exercises that reduce their risk of falling. When communicating with patients and families, don’t overload them with information. “It’s a lot of getting creative about making things as simple as possible,” she said.
Fortunately the medical community is constantly discovering more about the virus. “We’re at a steep part of our learning curve,” Weber said. “In the next six to eight weeks we may know twice as much.” Collison told the students she’d been relying on medical librarians for help in keeping track of all the new COVID-19 journal articles. “There’s so much coming out every day,” she said. “It feels like every hour.” When it comes to treatments, she noted that findings are preliminary and studies hastily designed, but the insights are nonetheless significant: at the time she spoke to the students, the AIDS drug lopinavir and the malaria drug hydroxychloroquine didn’t seem to be having much effect, but the antiviral remdesivir was showing promise.
Mindy Schwartz, an internist and medical historian, used her session to remind students that the past holds lessons too. In an overview of the 1918 flu pandemic, she highlighted the importance of nonpharmaceutical interventions, which made “a huge difference” in that pandemic’s trajectory. Some are familiar to us today: closing schools, banning large gatherings, and requiring cloth face coverings in public. For areas of the country that didn’t take these measures, there were grim consequences. Philadelphia, which held a large parade at the height of the outbreak, had a much higher death rate than St. Louis, which took swifter and more stringent action.
Whether the United States as a whole will look more like Philadelphia or St. Louis is still unknown. But inside UChicago Medicine, it’s St. Louis. “Very early on it became clear that social distancing was going to become necessary for this pandemic,” said Weber, chief medical officer and an infectious diseases doctor. The medical center took action before the US outbreak to reduce disease transmission among health care workers: changing the layout of work areas, eliminating large in-person team meetings, limiting the number of providers in patient rooms, shifting to televisits when possible.
Some decisions long predated the current crisis. At the Center for Care and Discovery, entire floors can be transformed into negative-pressure areas, which limit germs’ ability to escape patient rooms. These were features Weber and his colleagues asked for more than a decade ago, during the hospital’s design phase, hoping they’d never need them.
These measures have kept UChicago Medicine’s health care workers comparatively safe—benefiting both them and the people they care for. “You have to think about your next patient,” course organizer Farnan chimed in.
“Or the next 10, or the next 15,” Olson agreed.
It’s those next patients that Pritzker students are preparing for. “We have the particular privilege, I think, of being the class that graduated amidst this struggle,” says Ty Johnson, a fourth-year. “A lot of people are going to be looking to us to be the reinforcements.”
There’s plenty that can’t be foreseen with certainty in the pandemic, but the students feel they’re getting the skills to face the unknown. “Even though the situation is unprecedented, Pritzker does a good job incorporating critical thinking and on-the-go decision-making, and that will really help us as we enter the workforce,” says fourth-year Lucy Xu.
“It’s definitely daunting to think about starting residency in the middle of a pandemic,” adds fourth-year Kathryn Nutting. “But I became a doctor to help people when they needed help, and that’s what they need right now.
Read more about the Universityʼs response to the COVID-19 pandemic in “Together in Spirit.”