How Has COVID-19 Changed Infectious Disease Care?

Segment Description: Paul Blair, MD, MHS, MSPH, infectious disease physician at Johns Hopkins Hospital, discusses the changes to everyday life as an ID specialist brought on by COVID-19.

Interview Transcript (modified slightly for readability):

Contagion®: Hello, thanks to our viewers for joining us. And thanks to you, Dr. Blair, for speaking with Contagion. I'll start by asking a bit about your background in infectious diseases and we'll just take things from there.

Blair: I'm a recently trained infectious diseases physician at Johns Hopkins. I have a couple hats that I wear. I'm in a sepsis research group at Henry Jackson. But really the only hat I've been wearing for the past three or four months has been COVID research and patient care. So it's been on my mind pretty non-stop, since at least in January.

Contagion®: Understandably, I remember writing my first article about it. "China investigates small cluster of pneumonia of unknown etiology," but having that sense that this was something bigger. It's been months of COVID.

Blair: People say, even if they're not in health care, that time has a new sense right now. You lose your weekends. You're talking to people for 12 hours a day. And it's hard to predict what needs to be done and what both what the next day's going to be like, but also I think there's a sense of just having a groundhog day feeling where every day you're pushing to try to make things better, but every day you wake up to the news. And it seems like it's only getting worse. Although I think this week that feeling may hopefully change a little bit.

Contagion®: On that note, how has this changed your your day to day as somebody in ID, your everyday experience and what your interactions with patients are?

Blair: I'm primarily in a research position. So I spend most of my time during the year doing research. So it's been a little bit of changing how I do research but also changing clinical care. I am on clinical service right now. For doing infectious diseases consults. It has changed a lot for a lot of people. There's been different roles that are being filled by infectious diseases physicians, because there's so much to do so.

What I'm doing is not necessarily what another infectious disease doctor is doing, but typically, when somebody calls infectious diseases and asks a question, we look at the chart and we go see the patient. And then we talk to the team and write a note and kind of do that throughout the day. That's in a nutshell.

Now, there's a lot more dynamic changes, it's hard to predict some of the workflow. The division at Hopkins has done a really good job preparing to make sure that we're well equipped to answer the large number of questions related to patients with COVID.

The most tangible change is that of thinking about infection control to a much higher degree and putting it into our workflow. We're used to having to put on gowns and gloves and oftentimes masks for the majority, if not the majority of patients, a large number of patients, but this is entirely different than what we're used to doing.

There's certain areas of the hospital where I think this setup is more similar to what I am more acquainted with, in places I've visited in Sub-Saharan Africa where they have a donning and doffing station. They have a safety officer to make sure that you do everything appropriately, you have to change into scrubs that are either washed or thrown away before you go into these areas.

And while we do have to wear masks throughout the day for anything we do, if we go into these certain areas where patients with their patients with COVID-19 or under under investigation for that, then we do have to put on the gown, the double gloves, the N95 or the PAPR. There's that extra time factor and also thinking about what we can do both from a systems level but also an individual level, so that you minimize the risk to other patients that don't have COVID-19. For example, one thing you might do is see all the other Patients that don't have COVID-19 first and then at the end of the day, see those with COVID-19. But of course, you have to consider the acuity of illness too, and also want to prioritize those that have more acute illness.

Contagion®: That makes a lot of sense. So looking into your background a bit, you have some experience in Ebola. And could you detail that and and let us know how it has informed your reactions and responses to what's going on now?

Blair: Most of my experience in Ebola has been that with research. So both in lab studies and observational studies in East Africa and also West Africa, in areas where there is a lot of biodiversity and population density, and a lot of times poor health infrastructure. Those areas often often can unfortunately lend itself to the development of viral hemorrhagic fever outbreaks.

When I was a resident, there was the 2013 to 2016 Ebola outbreak which, which basically spanned my entire residency and due to the policies, which was not unique to where I did residency, it was expected that house officers did not go to West Africa for obvious infection control reasons and making sure that there are adequate personnel.

But I do think it's challenging for trainee to not be able to contribute if they really do want to contribute. That's the sort of thing that has motivated people to go into this line of work, selflessness when disaster strikes. So I think that's one thing that I've been thinking about, is that it might be challenging for some trainees. On the one hand for the trainees that are being thrown out there and into the midst of the pandemic, just imagine. But then the other hand, those that are stuck at home or isolated from quarantine. I imagine it's also challenging for those who feel like they really want to help.

There's been this sense of community and also just everyone really feeling that the current state of things is unacceptable and everyone trying to find a way to help. The other thing in relation to the research work I've done with Ebola I've been thinking about is: a lot of people did not expect this type of Ebola setup to to occur in United States hospitals to this degree. It is not the same level of PPE or personal protective equipment. But one of the takeaway points is that while emerging infectious diseases may occur in isolated outbreaks, people have started to realize that the virus knows no boundaries. Particularly with the extent of globalization and transportation and increased population densities in the world. They will continue to to occur in the future. The outbreak was obviously precedented in a lot of ways at least within the past 100 years. I think it's going to change our lives and policies and the way we think about emerging infectious diseases in in a way that that we could could have never anticipated.