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COVID-19: In the Middle of a Pandemic, Looking Back

In the beginning, it was clear to me and others that we were in unchartered waters in the care of the COVID critically ill. This was both exciting and unsettling; and it generated anxiety amongst all the staff. We had no experience with this virus and sought information from anywhere we could get it. We skyped people in Italy, messaged others on chat boards, talked to our regional colleagues, and monitored data from our national societies. We all felt like we were on the cliff without a safety net, yet here we had no choice but to be diligent and do our best with what we had.

The patients were extremely ill and unpredictable. We made observations early about clotting and ventilator interactions. We shared our information, too. The amount of information exchanged was phenomenal and important, as it validated what we were experiencing and helped to define aspects of this new disease. We instituted early proning on nonintubated patients, modified earlier treatment recommendations with new data, and participated in clinical trials. We were fluid and nimble in our care, using data to make our changes.

I say “we,” as it was my pharmacist, hospitalists, infectious disease group, and intensivist colleagues who were trying to make sense and devise treatment plans from what we saw and what we knew using any available data. We huddled daily and discussed. This truly was a problem that needed to be solved quickly and safely, and it took the whole of our system and others to make it so.

In reflecting on where we were then and where we are now, so many lessons have been learned. At the start of the pandemic, a group decision was made to make our hospital as safe as possible for both the patients and staff. We took lessons from what we saw in other areas of the country. We co-located, used negative pressure rooms, and followed the current isolation guidelines along with modifying visitation. None of our frontline worker have acquired COVID-19 from our patients, which we attribute to this prior work and staff diligence. We learned to work together more efficiently and embraced how best to communicate any information that was valuable to the front line. We learned to be flexible and creative, especially with our patients and families, using technology for family visits and selective in-person meetings for goals of care discussions.

This virus was disruptive and forced us out of our comfort zones. We were challenged; scared; saddened by death; irritated by the lack of high-level federal leadership; and disappointed that at the beginning, the science behind why we do what we do was abandoned. But, we persisted, were creative and determined. We were able to make an impact on what seemed like an impossible situation. Many people today are alive due to that collaborative effort by all the teams.

As I look back and contemplate how we got to where we are now, I am impressed and comforted by the extraordinary willingness of others to help each other. The collaborative effort was incredible. The collective goal to work out issues permeated the care that we provided, and it is a reminder that together we can solve any problem.

— Margaret Wojnar, MD, Professor of Medicine, Pulmonary and Critical Care,    
    Penn State College of Medicine and Milton S. Hershey Medical Center

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