When the COVID-19 pandemic reached the United States in February 2020, the ID Division at the Alpert Medical School of Brown University quickly reacted by 1) expanding our inpatient capacity to meet the clinical demands of the pandemic; 2) providing infection control/antimicrobial stewardship leadership and expertise to our hospitals, administrators, and clinicians; 3) providing expert consultation to the RI Department of Health public health response; and 4) prioritizing research including treatment trials for COVID-19 to help our patients in both the inpatient and outpatient settings. To facilitate and coordinate these efforts and to rapidly disseminate emerging data on COVID-19, the Division hosted daily conference calls for all Division members and ID fellows from March-May 2020.
In March 2020, the ID Division established the Carpenter Services at Rhode Island Hospital and The Miriam Hospital, named after the late Dr. Charles C. J. Carpenter, founder of the Immunology Center and former Chair of the Department of Medicine at The Miriam Hospital. These inpatient services were dedicated to the clinical management of patients with COVID-19 and enrolled patients into COVID-19 treatment trials. The services were staffed by a faculty member at both hospitals and an ID fellow at Rhode Island Hospital from March-June 2020. At the peak of the pandemic, the daily census of patients hospitalized for COVID-19 across both hospitals reached 200.
The Division had a mature pandemic plan for our healthcare system based on prior efforts preparing for SARS, MERS-CoV, and pandemic influenza. However, in response to SARS-CoV-2, that plan was modified to further mitigate risk to our staff and patients. Our hospital system was one of the first to institute universal masking of all staff and patients to mitigate risk of SARS-CoV-2 in our hospitals and clinics. We were also one of the first to utilize vaporized hydrogen peroxide using STERIS machines to reprocess N95 respirators and using steam sterilization to reprocess surgical masks when there were shortages of PPE early in the COVID-19 surge. These and other infection control interventions dramatically reduced risk of COVID-19 in our healthcare system.
Collaboration with the RI Department of Health
The Division worked closely with the Department of Health to help guide COVID-19 response efforts. Dr. Philip A Chan, MD, MS serves as one of the consultant Medical Directors of the Rhode Island Department of Health and coordinated with the Division to provide expert infectious diseases expertise on various aspects of the statewide response. The Division participated in a weekly Infectious Diseases Education and Advisory Committee meeting where topics related to COVID-19 were discussed.
The Division prioritized COVID-19 related research including inpatient and outpatient treatment trials. Led by Dr. Karen Tashima who is the PI of the NIH-sponsored AIDS Clinical Trials Group (ACTG) at The Miriam Hospital, Division faculty and fellows enrolled approximately 200 patients in the first three months of the pandemic into an antiviral treatment trial, offered additional experimental treatments through studies and registries, and is participating in COVID-19 vaccine trials. Faculty and fellows of the Division are actively investigating COVID-19 clinical outcomes among immunocompromised patients including persons with HIV and persons who have undergone solid-organ transplantation, co-morbidities that predispose to poor clinical outcomes, and the disproportionate impact of COVID-19 among populations of color, particularly among Hispanics in RI.