COVID-19: The Worst Days of Our Careers

Cunningham, Chinazo O.; Diaz, Chanelle; Slawek, Deepika

doi:10.7326/m20-1715

Cited by 13 publications

(12 citation statements)

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“…We have lost the intimate connection with our patients at their most vulnerable points; felt powerless in the face of the very real fear felt by patients, trainees, and our colleagues alike; and, worst of all, have been left unprotected. ( Cunningham et al, 2020 , p. 1)…”

Section: Discussionmentioning

confidence: 99%

The mental health of health care workers in Oman during the COVID-19 pandemic

Badahdah

Khamis

Mahyijari

et al. 2020

Int J Soc Psychiatry

149

166

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Background: COVID-19 disease is one of the most destructive events that humanity has witnessed in the 21st century. It has impacted all aspects of life and all segments of populations, including already vulnerable health care providers. Aims: This study sought to detect the prevalence of mental health issues in sample of physicians and nurses working in several health facilities in Oman. Method: We gauged the mental health conditions of 509 physicians (38.1%) and nurses (61.9 %) using the Perceived Stress Scale, Generalized Anxiety Disorder Scale and World Health Organization Well-Being Index. Results: The study revealed a high prevalence of stress, anxiety and poor psychological well-being, especially among females, young health care workers and those who interacted with known or suspected COVID-19 patients. Conclusion: The outcomes of this study support the handful of studies published during this global health crisis that have found that the mental health of health care workers has been harshly affected and predicted that it will continue, to various degrees, to be affected in the foreseeable future. The results of this study highlight the urgency of providing administrative and psychological support as well as current and accurate information on COVID-19 to health care workers.

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Section: Discussionmentioning

confidence: 99%

The mental health of health care workers in Oman during the COVID-19 pandemic

Badahdah

Khamis

Mahyijari

et al. 2020

Int J Soc Psychiatry

149

166

View full text Add to dashboard Cite

show abstract

“…T he pandemic spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has, within a few months, led to a global health and economic crisis (1)(2)(3). COVID-19 is usually characterized by symptoms of acute respiratory infection, such as fever, headache, dry cough, and shortness of breath, but may show further symptoms involving the gastrointestinal tract (gastroenteritis-like, with vomiting and diarrhea, or a hepatitis-like picture) and the central nervous system (most notably anosmia) (4 -8).…”

mentioning

confidence: 99%

Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome

Lax

Skok

Zechner

et al. 2020

Annals of Internal Medicine

678

402

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Background: Coronavirus disease 2019 caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become pandemic, with substantial mortality.Objective: To evaluate the pathologic changes of organ systems and the clinicopathologic basis for severe and fatal outcomes.Design: Prospective autopsy study.Setting: Single pathology department.Participants: 11 deceased patients with COVID-19 (10 of whom were selected at random for autopsy).Measurements: Systematic macroscopic, histopathologic, and viral analysis (SARS-CoV-2 on real-time polymerase chain reaction assay), with correlation of pathologic and clinical features, including comorbidities, comedication, and laboratory values.Results: Patients' age ranged from 66 to 91 years (mean, 80.5 years; 8 men, 3 women). Ten of the 11 patients received prophylactic anticoagulant therapy; venous thromboembolism was not clinically suspected antemortem in any of the patients. Both lungs showed various stages of diffuse alveolar damage (DAD), including edema, hyaline membranes, and proliferation of pneumocytes and fibroblasts. Thrombosis of small and mid-sized pulmonary arteries was found in various degrees in all 11 patients and was associated with infarction in 8 patients and bronchopneumonia in 6 patients. Kupffer cell proliferation was seen in all patients, and chronic hepatic congestion in 8 patients. Other changes in the liver included hepatic steatosis, portal fibrosis, lymphocytic infiltrates and ductular proliferation, lobular cholestasis, and acute liver cell necrosis, together with central vein thrombosis. Additional frequent findings included renal proximal tubular injury, focal pancreatitis, adrenocortical hyperplasia, and lymphocyte depletion of spleen and lymph nodes. Viral RNA was detectable in pharyngeal, bronchial, and colonic mucosa but not bile. Limitation:The sample was small. Conclusion:COVID-19 predominantly involves the lungs, causing DAD and leading to acute respiratory insufficiency. Death may be caused by the thrombosis observed in segmental and subsegmental pulmonary arterial vessels despite the use of prophylactic anticoagulation. Studies are needed to further understand the thrombotic complications of COVID-19, together with the roles for strict thrombosis prophylaxis, laboratory, and imaging studies and early anticoagulant therapy for suspected pulmonary arterial thrombosis or thromboembolism.

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“…Faced with a disease that had no treatment and caring for large numbers of patients decompensating and dying, the stress and heartbreak felt by our frontline providers cannot be overstated ( 17 ). We alleviated this stress through constant communication between leadership and the frontline providers (see above).…”

Section: Coordination Communication and Collaborationmentioning

confidence: 99%

Teamwork and Leadership Under Fire at the Epicenter of the COVID-19 Epidemic in the Bronx

et al. 2021

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The first Covid-19 patient was admitted to Montefiore Medical Center (MMC) on March 10, 2020. Soon thereafter there was a rapid and exponential surge of Covid-19 admissions to MMC that could have resulted in catastrophic consequences if MMC had been overwhelmed, as happened in Europe. To adjust to this crisis our institution, under the inspiring leadership of Dr. Philip Ozuah, President and CEO of Montefiore Medicine, adopted an “all hands on deck” approach, mobilizing our entire workforce to expand our units to accommodate the growing number of patients being admitted. Given that the internal medicine (IM) and ICU units are part of the department of medicine (DOM), the DOM was at the center of this mobilization. The DOM is the largest department at MMC and mobilizing it required careful planning, seamless teamwork, and strong leadership. To achieve that goal, we applied a framework that we designate the “3C framework,” denoting Coordination, Communication, and Collaboration. In this report we describe the many initiatives the Montefiore Einstein DOM implemented during the Covid-19 pandemic using the 3C framework. These included establishing the Medicine Covid-19 Taskforce to lead our efforts, starting a daily newsletter for up-to-date communications, rapidly expanding the ICU and IM units, converting most specialty inpatient consults to eConsults, coordinating research studies, and more. The goal of this report is to serve as a guide on how the 3C framework helped us organize, mobilize, and energize the department of medicine effectively and efficiently during this unprecedented crisis.

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COVID-19: The Worst Days of Our Careers

Cited by 13 publications

References 0 publications

The mental health of health care workers in Oman during the COVID-19 pandemic

The mental health of health care workers in Oman during the COVID-19 pandemic

Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome

Teamwork and Leadership Under Fire at the Epicenter of the COVID-19 Epidemic in the Bronx

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