a novel coronavirus, SARS-CoV-2 (COVID-19), began spreading rapidly throughout China and now is a global pandemic, with cases reported in over 192 countries and territories worldwide. Clinically, COVID-19 ranges from a mild, self-limiting respiratory illness to severe progressive pneumonia and multiorgan failure. The first COVID-19 case was reported at the beginning of March in New York City (NYC), and now just 3 weeks later, NYC and its suburbs have over 5% of global cases. Worldwide, there is a rapid increase in the number of cases daily, including the number of patients requiring hospitalization and intensive care support.Although our internal medicine, emergency department (ED), pulmonary/critical care, and anesthesiology colleagues are at the frontlines, neurologists are playing a critical role in patient care. Here, we describe the initial steps our department has taken to prepare for the COVID-19 outbreak. We highlight some of the steps neurology departments should urgently consider to prepare for an increased volume of patients with COVID-19 in their hospital system. This article provides a comprehensive guide for other neurology departments in terms of preparation for an influx of COVID-19-positive patients into their hospital system. General departmental initiativesAs a department, we began holding routine meetings to prepare for COVID-19 in mid-February. Multidisciplinary meetings are held with key staff including nursing leadership, intensive care leadership, inpatient and outpatient neurology department leaders, and departmental administrative leadership (table 1). At the beginning of March, we held webcasts to our department weekly, given the restrictions for large in-person gatherings to provide updates on inpatient and outpatient clinical care activities, departmental research ramp down, human resources issues, and updates on hospital and public health guidelines including key epidemiologic information around COVID-19. There was an opportunity for departmental members including support staff to ask questions around work-related concerns.Providing mental health support for the challenges we all face during this time due to social distancing and separation, child and elder care, financial, and clinical pressures was identified as an early critical component of our efforts. In addition to departmental neuropsychologists volunteering to provide free private counseling services, hospital-wide free telemental health support has also been made accessible to our department.
Many advances in prevention, diagnosis, and treatment of neurologic disease have emerged in the last few decades, resulting in reduced mortality and decreased disability. However, these advances have not benefitted all populations equally. A growing body of evidence indicates that barriers to care fall along racial and ethnic lines, with persons from minority groups frequently having lower rates of evaluation, diagnosis, and intervention, and consequently experiencing worse neurologic outcomes than their white counterparts. The American Academy of Neurology (AAN) challenged its 2017 Diversity Leadership Program cohort to determine what the AAN can do to improve quality of care for racially and ethnically diverse patients with neurologic disorders. Developing a fuller understanding of the effect of disparities in neurologic care (neurodisparity) on patients is an important prerequisite for creating meaningful change. Clear insight into how bias and trust affect the doctor–patient relationship is also crucial to grasp the complexity of this issue. We propose that the AAN take a vital step toward achieving equity in neurologic care by enhancing health literacy, patient education, and shared decision-making with a focus on internet and social media. Moreover, by further strengthening its focus on health disparities research and training, the AAN can continue to inform the field and aid in the development of current and future leaders who will address neurodisparity. Ultimately, the goal of tackling neurodisparity is perfectly aligned with the mission of the AAN: to promote the highest-quality patient-centered neurologic care and enhance member career satisfaction.
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