Expert Conversations: A COVID-19 Year in Review

In this podcast, Jaspal Singh, MD, and Erika Setliff, DNP, talk about the challenges and triumphs they have faced in the last year since the World Health Organization first declared COVID-19 a global pandemic, including how they've adapted as they gathered new information on the disease. 

Additional Resource:

• Evans T. Tyler Evans, MD, MS, MPH, AAHIVS, DTM&H, FIDSA, on COVID-19 vaccine and distribution. Consultant360. Published online March 2021. https://www.consultant360.com/exclusive/consultant360/tyler-evans-md-ms-mph-covid-19-vaccine-and-distribution. 

Jaspal Singh, MD, MHA, MHS, is medical director of pulmonary oncology and critical care education, as well as a professor of medicine, at Atrium Health in Charlotte, North Carolina.

Erika Setliff, DNP, is a critical care clinical nurse specialist at Atrium Health Cabarrus in Concord, North Carolina. 

TRANSCRIPTION: 

Dr Jaspal Singh: Hello, everybody, I'm Jaspal Singh on behalf of Consultant360. I'm one of the medical directors for Pulmonary Critical Care Content and with me today is Dr Erika Setliff. I don't know if you can introduce yourself for the audience?

Erika Setliff, DNP: Sure. My name is Erika Setliff. I'm a Critical Care Clinical Nurse Specialist. I work at Atrium Health Cabarrus, and cover our critical care areas as well as inpatient cardiac.

Dr Singh: Well, Erika, what a year.

Erika: [laughs]

Dr Singh: We're at the [laughs] one year mark of where the World Health Organization called COVID‑19 a pandemic. We have to reflect back on the year. There's a lot of audio, news media outlets started talking about the one‑year anniversary and all things that are happening and all of the things that we've learned.

I thought we would go through some of the lessons that we've shared in our pulmonary and critical care community. Talk to me about what comes to your mind. What are some key lessons learned in the last year?

Erika: Well, that's a big topic for sure. One of the things that stands out to me the most is how incredibly adaptable our teams are. We have learned how to operate with daily, and sometimes more than daily, change in evidence, in protocols, in best recommendation how to keep one another safe, how to best care for our patients, how to best care for one another.

That's something that's amazed me as I look back and reflect on the year. I appreciated this invitation because it made me stop and think, and I realized how very little of that I've done over the past year. It's been full steam ahead for a solid year and the incredible resilience and adaptability of the teams that we work with is the thing that stands out the most to me. What about for you?

Dr Singh: Yeah, kind of the same. I think back about the year and just thinking about how much angst there was about what information there was, how reliable it was, and thinking about that aspect like we talked about. We're adaptable, but we had to adapt on the fly and we didn't know what information was the truth. It was out of confusion. What stood on the negative side for me was the idea of the public distrust of science.

Our public paid the price and what came out of it is that the scientific community, I have to say, came and just saved countless lives. They came at a price. It came with a lot of intense investment, a lot of education. It really exposed our public health system with this mistrust aspect.

In the end, and the last part of the year, the scientific community needs to do a very diligent job about making sure that we have the public trust. The Scientific Committee won. What happened in the vaccine world is just nothing short of miraculous.

I'm encouraged and I hope we the public take heed of the results a little bit and say, "Wow, the scientific committee was right. Masking works, social distancing works and hand sanitation works." That aspect with scientific proved this mettle is really hopeful. I'm hoping that trend continues and that we can move forward as a country.

Erika: Yes.

Dr Singh: You brought on the other part, which is something I've really missed. We had made all these movements same. I work with you at Atrium Health in Charlotte, North Carolina.

I have the pleasure of working together and trying to build this whole idea of advance the goal of team‑based care. In the ICU we do it as a pulmonologist. [inaudible 4:23] lung cancer works, lung cancer is very team‑based.

All of a sudden, people are working from home, they're not available, my pharmacist aren't available, everyone's not available. Families aren't available. It was absolutely something that I hope we don't want to recreate. It should expose how dependent we are on team‑based care. How did you guys reflect on that? How do you take that?

Erika: I agree wholeheartedly, I think it's really highlighted how much we need each other, and how interconnected our teams are. All the things that we've learned over the years about inter‑professional teams and interdisciplinary rounding and how we function together in person.

We've done a pretty good job band‑aiding that with virtual options as much as we can while keeping one another safe. It'll be interesting to see which things stay from those lessons and which things move back to in person, but as a profound extrovert, who gets my energy from those around me it's definitely something that we've felt.

I know it's one of the things that's been challenging in different waves over the pandemic, especially for the true frontline in scrubs, in the room, full PPE caring for the patients. There have been times where they felt really deserted by people with understandable and have full compassion for the fears.

It left a lot of people feeling a little deserted at times, because everything went virtual. You would hear those questions like, "What about my safety?" How do we balance that and the added burden on the real frontline in the room staff that had to change a lot of their practices to facilitate that virtual presence for a lot of other people.

It's been an interesting evolution and I'm encouraged by the in‑person pieces, we've been able to reconnect, prioritizing which things can be in person, and how can we bring in some virtual presence with maintaining that. Human connection really is what it comes down to and how we're all better together.

Dr Singh: Absolutely. It was almost exhilarating how we just went up pandemic started hitting, we all work together to create protocols, guidelines, the operations, logistics, the safety issues. We had administrative partners that rolled up their sleeves to call the backlines calls and make deals to get PPE. All these things that were there.

It was just unbelievable how much the community leveraged together. I'm hopeful that we actually built some of the teams, let me strengthen some relationships, I thought across our entire health system, I think we did. Many hospitals had peer conditions, volunteering across borders, and across the entire country. It was amazing to see the community rally.

Private industry getting involved in healthcare. It was just something unbelievable. I'm hoping some of that team essence stays at the bedside though, this whole idea of families being alone, and isolation and patients being alone and no one really knowing what's happening. It's very scary.

I'm hopeful that we now have learned the lesson of how scary that can be, and leverage technology moving forward. Thinking about other options and having and recognizing that team based rounds, we might have thought it was a luxury before, it's almost necessity.

Erika: It is.

Dr Singh: It's one of those things this pandemic has highlighted. I'm hopeful moving forward, as we start coming back together. People recognize that we actually needed this. Patients did better, we did better, everyone, the community did better. I'm hopeful that we can move forward that way.

Erika: I agree. It's interesting, you talk about all the work that went in during that preparatory period. One of the things that's been very much on my mind, and many others throughout this whole time has been the wellness and resilience of the team. One of the resources that I had shared early on mentioned the term readiness burnout.

That was something that I felt definitely going in my role as a clinical nurse specialist. A lot of my time is around getting the evidence making sure we have the right tools and processes and protocols and all the pieces in place so that people can provide that right care at the right time.

Even before our first patient, hit the doors of the ICU, I was glad to see that term and know that it was a thing, [laughs] that there was a label for it because we didn't even have a patient yet and many of us were exhausted from the preparation and going into a marathon.

Exhausted, was probably not the best way to start out. We've learned a lot over this last year about wellness about building resilience before you need it. When you're in that crisis isn't the time for a resilience lecture. It's got to be part of our culture, our care for one another, our structure as a unit as a team as an organization, so that, that reserve is there when it's needed.

Dr Singh: That's exactly right. It's one of those things that we have to think about, how we prepare for a crisis and how it can happen any moment, and all the preparation that goes into it. Hopefully, some of that now legwork has been done and that can endure. That we don't have to recreate that for the next potential crisis.

In critical care, as you know...

[laughter]

Dr Singh: ...everything can be on a different crisis. It can be infectious in this case, pandemic, for example. It could be traumatic, for example. Heaven forbid, we have some of those things. Those are realities in our world we can prepare for. Hopefully, we've sealed some of those things. We've helped solve some of those issues.

Let's switch gears a little bit. One of the things I enjoy or I'm wrestling with a little bit, I used to travel a lot for meetings. I used to love the connection, seeing colleagues around the country. That just suddenly came to a halt. I've not taken a plane trip in over a year.

Thinking about how meetings have gone virtual and some of that stuff. What are your thoughts about this virtual learning world and virtual education world?

Erika: It has its pros and cons. In some ways, the accessibility is probably the biggest positive. I submitted EdAssist for a conference recently. I didn't have to go through all those pieces that go into the travel piece. I just needed to pay for a conference. That was it.

I didn't have to alter my work life that much. I tried to block a little bit of time here and there, but I was listening on my way home, or Saturday morning sipping coffee with the kids on the couch. That was a pretty great way to do a conference.

Somewhere, there's probably a balance where we capture and capitalize on the good pieces of that, but I don't think I want to lose the energy, the innovation, and the networking that comes from that in‑person collaboration with your incredible colleagues from all over that you otherwise don't get to see.

Dr Singh: Right. I'm thinking the same way. I miss the collegiality, but I'll be honest with you. I don't miss going to a big conference or meeting where in the back of the hallway, and I can barely see the speaker and all these other things. I can't listen to what they're doing versus watching the computer. It's more like they're right there.

Something about that was interesting. Then the other part is as a speaker, I sometimes find myself giving a talk to an empty audience. You have no idea on the other side who's there or who's paying attention. It's an interesting thing. I did like the idea of just‑in‑time learning being available or just‑in‑case learning.

We design critical care courses for those who are just‑in‑case people needed to step up in the roles that they were not comfortable with. We have just‑in‑time learning and just‑in‑case learning, and all that stuff. I thought it was interesting. It was fairly high quality, which I thought was pretty nice.

I'm hoping some of that can stay. That world will stay for a fair amount. We're talking on behalf of Consultant360. They've done a phenomenal job putting together some series that go along this way. Then talk to me about what do you think about virtual care? I do a lot of virtual care.

A lot of us are waiting for something to switch to increase telemedicine and virtual visits. It's been very interesting to me, watching the pros and cons of telemedicine infrastructure. What are your thoughts about that?

Erika: We have been very fortunate to have great structure in place already so that those virtual pieces could take place. Moving forward, as we look to how do we want critical care to look moving out of this past year, we may want to think through which things have to happen in person and which things are as effective virtually.

A lot of what we do can be done virtually. It's even given access in some creative ways for maybe, for example, someone who's got a medical condition and cannot be out on the units.

Even one of our wound nurses, we were able to get virtual access to the cameras in the rooms to do some of the wound grounding by camera. That was a great innovation I thought that we would have never come to otherwise.

I do think it's important. We've talked about that in‑person piece. Somewhere, there's a balance. It will be interesting to see where that lands. The virtual care provides scope and access that we otherwise wouldn't have. We have to be careful not to replace everything with virtual but to use it strategically.

Dr Singh: We do a lot of virtual critical care, for example. It's been interesting that walking the site that don't have...You start to expose the infrastructure issues in a lot of places. You see sometimes patients need someone at the bedside with a good set of eyes and hands and a good listening ear to understand what's happening. You realize that there's pros and also cons.

On the pro side, it's amazing. We've had some colleagues that volunteered to help virtually at the National Health Service System. It's amazing how the technology has evolved. I think that will continue to evolve and hopefully, prepare us as we move forward. That was neat to watch.

As far as your role as a nurse, the nurses, they're a team, the respiratory therapist, all the people. It was amazing how much they took on. Like you said, they're adaptable. They're resilient, but they're tired. We've already had a critical care staffing crisis before all this pandemic hit.

Now, this has escalated to a very high level. Us and a lot of other places around the country have had some issues with wellness, burnout, and people flat‑out feeling unsafe. Talk to us. What were your thoughts about that as you think about the last year? What things we can do better?

Erika: One of the things I've learned from this past year is the importance of having that shared mission and vision. It's gotten us through some difficult times. We'll have to be intentional moving forward as cases decrease, as there's pressure from the rest of healthcare to think about things other than COVID.

It's back to your metrics. It's back to all the things that we've had a little understanding for over the past year. We're still experiencing pockets of it. We have, as you said, a very tired staff who have held on for a long time. We'll have to be intentional about redefining what that new vision is that we all get on board with.

That is one of the pieces of resilience. What is the reason why you're coming in and doing the work you're doing? As this massive thing called COVID is, thankfully, receding somewhat, I don't want to lose that shared vision in the future and what brings us all in this together every day. That's an important piece of the team building.

We definitely have some opportunities in wellness of our staff, still. We've done some things well with that, but some things just haven't been feasible. We've had to have bodies providing care for very sick patients, and many more of them than our structure is designed for.

That's been a legitimate burden. We've got to think carefully about how to allow people the rest they need without having to leave and take a job outside of critical care.

Dr Singh: Thanks. Well done. In the physician world, as well, I think that's very true. You're kind of reminded me about how important strong leadership is, and not just strong, artificially strong, but strong, authentic, courageous, compassionate leadership.

Paying attention to your teammates, pay attention to them, asking them, "How's your family?" "How's your home life doing?" "What hobbies you have that sort of adjust it during this pandemic a little bit?" For a long, that was a big adjustment.

I think recognizing that they may be going through things that they don't even share, they don't bring to work, and that they cannot acknowledge it. The leadership today looks very different than it might have used a couple of decades ago.

It involves a very different level of understanding of what each and every person that you're managing, or are responsible for I should say, is doing. Poor leadership, we also saw this pandemic also has consequences. We have to be cognizant of all that. I'd greatly appreciate you thinking about how we can do things better because I think that shows excellent leadership.

We're at the end of our time, and I wanted to thank you. I'm going to go through some things that we highlight. Basically, we said from what we've learned in the last year and this year is that how adaptable our teams are, how resilient we are.

How much we've learned about preparation, about how science in the end and trust in the public health sector did a lot of good, and that we need to move forward with that messaging. There's personal challenges that teammates are going through and we have to pay [inaudible 20:07] , be cognizant.

To be effective leaders, we have to be authentic, we have to be brave, to be strong, or to be compassionate for our patients and their families as well. When this thing rolls over, that things that we don't want to waste to this crisis is, not only the technology that we've developed from the first re‑virtual learning's, the opportunities to how to connect virtually when working away from home when working off‑site.

Also, when it's time, we need to reconvene at the bad side, teammates, or talk and collaborate more. We definitely missed some of that, for a lot of good reasons. Anything else I missed?

Erika: I think those are the highlights. I'm excited to see how we take what we've learned this last year and move forward on purpose. We've had some conversations about that, where because we've learned how to change every day if we need to I think it gives us a really unique opportunity moving out of this to say, "What are we going to keep? [laughs]

What hasn't worked and wasn't working before COVID. That we're going to change because we're used to changing everything." We've been able to move away from that. We've always done it that way mentality because we've had to? We've got some unique opportunity as a critical care profession to say, "What do we want this to look like moving forward?"

We're used to everything changing anyway, so let's move forward on purpose instead of just by default. I'm excited to see where we go with that, with some of the innovations you've mentioned, with some better understanding of team‑based care and wellness and all of those things. It's going to be an exciting year moving out of this, and hopefully being intentional about some of those opportunities.

Dr Singh: You're absolutely right. I'm hopeful that in the end, the scientific methodology in this intentional focus on innovation and recognizing what's important, what can stick, what we can learn from this, is helpful. We don't remind ourselves. Obviously, COVID is not over by a long shot.

We still got a lot of things and also get the social, psychological, economic fallout of all this is still who knows how that will play out. There's a lot of work still to be done and that race alone, other stuff that we, as non‑COVID‑related as you mention.

Then a reminder to our listeners, give ideas or thought and want to reflect on this podcast, please look at our website and make sure you comment. We love to hear your thoughts as well about what really stuck in this past year that made you stop, reflect, and just obviously, hopefully, we have some rewarding grace. I mean, I think a lot of us enjoy our jobs.

A lot of us thought some reward of being there when the community needed us. It's very tough here, obviously, but in the end, I am personally grateful for the opportunity to be involved in this type of in this pandemic, at every level, on the bad side to the strategic aspects of managing. Let's move forward as a country together. That sounds reasonable?

Erika: Let's do it. [laughs]

Dr Singh: Well, thanks, Erika. I want to on behalf of Consultant360. Again, I'm your host Jaspal Singh. Thank you for listening.