When the COVID-19 pandemic reached the United States in February 2020, the ID Division at the Alpert Medical School of Brown University reacted quickly and effectively by 1) expanded our inpatient capacity to meet the clinical demands of the pandemic; 2) provided infection control/antimicrobial stewardship leadership and expertise to our hospitals, administrators, and clinicians; 3) provided expert consultation to the RI Department of Health public health response; and 4) prioritized research including treatment / vaccine 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 during the initial surges of the pandemic. The Division continues to regularly provide the most up-to-date information to the faculty, fellows, and hospital staff.
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 during the initial surge of the pandemic in Rhode Island. At the peak of the pandemic, the daily census of patients hospitalized for COVID-19 across both hospitals reached 200. As the number of cases stabilized, the specialized COVID services were no longer necessary and questions related to the care of COVID-19 patients were handled by the usual ID consult services as well as the antimicrobial stewardship program. Our ID Ambulatory Center quickly developed a specialized clinic to follow patients recently discharged from the hospital with COVID-19 and established a “long-COVID” clinic that helps coordinate care for patients dealing with prolonged symptoms related to their infection. Additionally, the clinic participated in SARS-CoV-2 vaccination efforts.
Infection Control & Antimicrobial Stewardship
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 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.
The antimicrobial stewardship program (ASP) was critical in the development and implementation of hospital treatment protocols for COVID-19. The program was able to coordinate efforts between ID, pharmacy, critical care, and the medical services to ensure our inpatients and outpatients had access to available COVID therapies, especially those under EUA. Of note, we were able to rapidly implement outpatient monoclonal antibody therapies for our community, providing over 1600 patients with access to this therapy, thus preventing hundreds of hospitalizations. As new therapies become available, the ASP continues to educate and implement policies to ensure these are available for our patients and community.
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 continues to provide infectious diseases expertise on various aspects of the statewide response. The Division participated in a weekly Infectious Diseases Education and Advisory Committee meeting hosted by the Department of Health where topics related to COVID-19 were discussed.
The Division prioritized COVID-19 related research including inpatient and outpatient treatment trials. The ID division was heavily involved in numerous clinical trials of COVID-19 therapies, including remdesivir, convalescent plasma, and monoclonal antibodies. 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. The Division is still heavily involved in adaptive trials to provide our patients with an opportunity to receive the most up-to-date treatments available.
Community Advocacy During COVID-19
The Division worked hard during the COVID-19 pandemic to ensure the diverse RI community had access to treatment, prevention, and education about COVID-19 infection. Dr. Katrina Byrd, Combined Med/Peds ID Fellow and President of the Brown Minority Housestaff Association has engaged faculty and trainees to participate in statewide COVID-19 vaccination events. She has worked closely with communities of color by providing education at local churches, through social media, and radio and television media to provide information about COVID-19 and vaccines. She has worked with the Providence NAACP, African American Ambassadors Group, and African Alliance of Rhode Island. Recently, she coordinated medical volunteers for the state’s Mass COVID-19 Vaccination Events that was focused on increasing vaccination rates in BIPOC communities in RI. Her advocacy for COVID-19 vaccines with churches gained local and national media coverage and she received recognition by the U.S. Surgeon General, Vice Admiral Vivek Murthy, MD, MBA. Dr. Martha Sanchez, Assistant Professor of Medicine, worked with RI Department of Health to develop an educational series of videos in Spanish for local community workers at several stages of the pandemic providing information regarding COVID-19 and vaccines. Dr. Sanchez, along with Dr. Touzard-Romo, Assistant Professor of Medicine, Dr. Karen Tashima, Professor of Medicine, and former ID fellow Dr. Raul Macias-Gil, participated in COVID-19 educational interviews in Spanish with Telemundo, social media outlets, local radio stations, and churches.