A YEAR INTO A PANDEMIC LESSONS LEARNED 2020 COVID-19 BY THE NUMBERS

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04 RICHARD J. ANDRASSY, MD 22 MORE THAN BEN BOBROW, MD 06 KEVIN MORANO, PHD 24 GEORGE WILLIAMS, MD 08 MARIESA JANECKA RN, BSN, CCM 26 576,000 LOGAN HOSTETTER, MD 09 MILTON “CHIP” ROUTT, JR., MD 28 PEOPLE HAVE DIED FROM THE THOMAS J. MURPHY, MD 10 CORONA VIRUS IN THE U.S. LILLIAN KAO, MD 29 NATHAN CARLIN, PHD SINCE FEBRUARY 2020 12 CHARLES “TREY” MILLER, PHD 30 CATHERINE AMBROSE, PHD 14 OMONELE NWOKOLO, MD 32 LATANYA LOVE, MD More than 32,402,000 cases 16 THERESA M. KOEHLER, PHD 34 have been reported. TARUM JAIN, MD 17 OFFICE OF EDUCATIONAL PROGRAMS 35 TIMOTHY GEORGE, MS3 18 PAMELA PROMECENE, MD 36 MICHAEL R. BLACKBURN, PHD 20 GERARD FRANCISCO, MD 38 HOLGER K. ELTZSCHIG, PHD 21 LESLIE BECKMAN YASMIN CHEBARO, PHD

SOURCE: THE WASHINGTON POST | MAY 2021 Richard J. Andrassy, MD Executive Dean, ad interim Chair and Professor, Department of Surgery Jack H. Mayfield, MD Distinguished University Chair in Surgery Denton A. Cooley, MD Chair in Surgery H. Wayne Hightower Distinguished Professor in the Medical Sciences

It’s been quite an interesting year. The past 11 months, I’ve been the things done and their personal well-being deteriorated during this interim dean. In some ways it has been a challenging time to be dean time. I used my free time to do more exercise and tried to use my with COVID and the vaccines coming out; on the other hand, it did time wisely and not be despondent. slow down a lot of the interactions you would normally have. So, I have had to spend a lot of time on Zoom and WebEx. There are some The good news is we can use what we learned to increase productivity days when I have Zoom fatigue. and happiness. Instead of a meeting to set up a meeting, have a virtual meeting to get it organized and have a final meeting face to face. A lot It’s been rewarding to see how our faculty, residents, fellows, and of people have found they are more productive at home – they save students in so many ways stepped up to the plate to work together an hour each way by not traveling in traffic. and care for these very ill patients despite the fact they were putting themselves at risk and may have had illnesses and deaths in their own The important thing is that we learn from this experience – take away families. I really want to give credit to the nurses and providers who the good things and let go of the bad. were on the frontline during that period of time risking their health and their families’ health to take care of these very ill patients. And I’m very impressed by how our own doctors started looking into advancing the care of these patients with COVID so rapidly that many patients were saved here who would have died elsewhere. A lot “It’s been rewarding of sacrifices were made for the benefits of patients, and yet we were able to continue on with the education of students and residents during this time. to see how our faculty,

Through this pandemic I’ve learned how we as a nation could come residents, fellows, and together in a crisis. On the local level, there are a number of things we have learned that I think we will continue to use even when the students in so many pandemic is over, such as using telehealth to save patients traveling. We’ve learned we can do a whole lot of business, meetings, interviews, ways stepped up to the and initial contacts with people via Zoom and WebEx.

I’ve also seen a lot of our students, residents, and faculty have a plate to work together hunger and need to meet in person. Despite how easy it is to do grand rounds and M&M on Zoom, it’s still not the same as visiting and care for these very face to face. People still like to get out and have dinners and lunches – meals seem to be a way to break through barriers. All of the national ill patients despite the and international travel can be done via Zoom, but there is still a benefit from meeting at society and association meetings, and people fact they were putting crave socialization.

Some people have used this time to improve their health, and others themselves at risk...” didn’t do well with it. Some had relationships that got better, and others had relationships deteriorate because of too much interaction. I’ve seen how certain people who are used to this interaction really don’t do well without the socialization. Their capacity for getting

LESSONS LEARNED: A YEAR INTO A PANDEMIC 5 Kevin Morano, PhD The biggest impact on the administration part is that we’ve got a we scrubbed everything all the time as well. We had excellent safety fairly largish office for administration/faculty affairs, 8 or 9 of us, protocols – the on-campus positive rate never went above 3 percent, Associate Dean for Faculty Affairs Professor, Microbiology and Molecular Genetics and by March and April, the suite was completely empty. I made the and less than half of those COVID-19 cases were transmitted at Associate Vice President of Faculty Affairs and Development personal choice to remain onsite throughout this time – I’ve been work. Roger J. Bulger Distinguished Professorship here 8 a.m. – 6 p.m. during the week, and some of the other senior leadership did similar things, or flexed back and forth from the office We did a wonderful job reducing risk as far down as we could while to home. But, the majority of the staff have been working at home for still maintaining our research presence. We adapted by moving 12 months now. our research personnel into split shifts so that we kept adequate distancing. There have been plusses and minuses. It’s really different and quiet in the office now – definitely a minus, lacking that connection, lacking Everyone has had to adapt and be clever. Here in Houston we the ability to drop by someone’s desk to see how it’s going, chat about have had so many disasters that can interrupt our work, that we small stuff, remind about a project deadline. have become quite skilled at adapting and coming together to deal with these major operational impacts. We have been flexible and We’re trying to make up for that with a weekly video meeting. We accommodating with people, working in a supportive way while found that it really helped if we held the meeting with the cameras following all of the safety rules. on. Many prefer to meet with the cameras off – they might not be preparing themselves every day like they did when they were going into the office. But, if it’s only a phone call, you don’t get the visual cues. There’s something human about seeing someone face to face. Without that, it feels like there’s something lacking. We’ve been having our video meetings weekly for a year now. The good news is “Here in Houston we have the work is getting done as efficiently or more efficiently than it did at the office. There is no wasted time on the bus, commuting, getting had so many disasters that distracted at the office. At home, the work is targeted and efficient. We are still doing the university’s and school’s business in a different can interrupt our work, way as if nothing happened.

A big question is how does this change business? Do we bring that we have become everyone back, or is there value to saving people time and money to sit at their own house instead of a cubicle? We were already on a trend quite skilled at adapting for years with educating students via video. Do we need a 300-seat lecture hall? and coming together to On the research side, we had to balance the imperative of continuing deal with these major our important research with safety. My colleagues across the country had wide-ranging experiences, with some being shut out of their labs for months. We had a most-accommodating environment through operational impacts.” Dr. Blackburn’s careful attention to ways of minimizing risk so that we never shut down. Some lab heads made the personal choice to shutter their labs for a period of time at the peak last spring, but a lot of us, we never shut our labs. We were fortunate to have enough space to social distance, and everyone wore masks. When we weren’t sure about the impacts of transmission through surface contamination,

LESSONS LEARNED: A YEAR INTO A PANDEMIC 7 The year 2020 was a very devastating year for so many, but it also provided us with the opportunity of self-reflection. I learned so many lessons and had the opportunity for personal growth. For me, 2020 The strength of a unified and focused team was once reminded me be mindful of the Global Village, not again taught to me almost every minute of every day. just my little world. I saw how the virus decimated so many people. Never have I felt so helpless. The Surgeons Council rallied immediately and mapped a logical and functional pathway that I realized that since I couldn’t fix the world, I needed would fit the Texas Medical Board’s mandates while to find a way to manage my emotions related to preserving our critical surgical missions. Surgeons, COVID. I was angry, sad, and anxious over the anesthesiologists, infectious disease, OR nurses and situation. I kept thinking, “Why can’t people just staff, and administrative representatives learned follow instructions and wear proper masks?” I needed to communicate clearly (and sometimes almost to learn that I could not fix everything. Nurses are constantly) to optimize surgical patient care. These built to put band-aids on boo-boos! I learned I needed decisions included scheduling, staffing, testing, to find peace. I believe in the therapeutic power of treatment protocols, and on and on. mindfulness. I needed to practice mindfulness. I learned the incredible value of leaders like Drs. I have found my mindfulness activity – knitting. I Colasurdo, Lowe, Katz, Patel, Lally, Tandon, Citardi, have to concentrate on the pattern, so I can’t think Ostrosky and also Greg Haralson, Justin Kendrick, about my COVID emotions. I practice relaxation Etta Hawkins-Hodge, Sharlet McGowen, and breathing exercises and am finding peace. numerous others.

I still feel sad and helpless, especially when I hear how I learned the devotion of the orthopedic residents and my patients are suffering, but I am acknowledging staff to patient care and each other. that I can’t fix the world. I’m OK with that. And the most important lesson learned was observing how everyone worked so hard to protect each other by doing the difficult and necessary work that was far above and beyond their routine job descriptions. It Mariesa Janecka RN, BSN, CCM was, and still is, a beautiful thing to see every day.

Certified Clinical Case Manager Bayshore Family Practice Center “The strength of a unified and focused team was once “For me, 2020 reminded me be again taught to me mindful of the Global Village, not almost every minute of every day. “ just my little world.” Milton “Chip” Routt, Jr., MD Professor of Orthopaedic Surgery Andrew R. Burgess Chair in Orthopedic Surgery Trauma

9 LESSONS LEARNED: A YEAR INTO A PANDEMIC 9 Lillian Kao, MD Professor of Surgery Jack H. Mayfield, M.D. Chair in Surgery Director, Division of Acute Care Surgery

Rocks exposed to high temperatures and pressures can be changed to Practice – Treating injured patients has been especially challenging form a different rock, or metamorphic rock; turns out that any type during COVID. There has been an uptick in all trauma patients, of rock can be modified by the processes of metamorphism. particularly penetrating (i.e., due to gunshot wounds or stabs, etc). Whereas other surgical services have cut down operations during The pandemic and the social injustices that were at the forefront of the beginning and peaks of COVID, the trauma service has had to the news last year both created extreme pressures that have helped to ramp up person-power. Unlike primary care, which can incorporate bring about metamorphosis. telemedicine into their practice more easily, trauma care occurs at the bedside and requires a hands-on approach. We have had to learn Research – Pre-pandemic, we had been already moving toward to be more efficient – luckily we were in our new tower at Memorial the idea of a learning health care system, which allows for rapid Hermann-Texas Medical Center that has a hybrid operating room continuous learning and innovation informed by research and that allows us to simultaneously do vascular and interventional practice. We have had to learn to rapidly generate evidence to inform radiology procedures and general surgical procedures. We have the care of COVID patients (and of non-COVID patients given had to work much more closely as interdisciplinary teams to be changes in which patients are seeking and receiving health care good stewards of limited resources (like operating rooms and blood during the pandemic). For example, I was part of a multi-center trial products) to maximize efficiency and to optimize patient care. We comparing antibiotics to surgery for acute appendicitis. The trial have had more communication than ever before between teams to was completed close to the beginning of 2020, and the follow-up facilitate problem-solving. We have been lucky not to have had to was shortened in order to be able to publish the results to inform have people change clinical care roles – i.e., we have enough critical the care of patients with appendicitis – many of whom were being care capacity that non-intensivists do not need to manage ventilators. treated with antibiotics (due to less operating room availability, due to fears of undergoing surgery during COVID, due to desire not to Equity, diversity, and inclusion – I have seen much more focus and spend time in the hospital, etc). I am part of another multi-center actual action around EDI. I just got off a call where we are trying trial (that Bela Patel and Laura Moore are the site investigators for) to raise money to fund a research award for surgical research for whereby stem cells were being used to treat Acute Respiratory Distress underrepresented minorities. I am also chairing a task force on EDI Syndrome; the trial quickly shifted to enrolling a large proportion of for the Committee on Trauma – right now, one project is revamping patients with COVID pneumonia in order to gain evidence about a trauma educational materials to remove implicit bias (i.e., photos potential therapy. This is not just happening at UTHealth. Recent of only Black patients when describing gunshot wounds and white articles have cited the faster adoption of universal remote consent, patients when describing motor vehicle collisions). A recent article in telemedical monitoring, use of novel and more efficient study designs JAMA discussed how we should collect data on and report race and (adaptive designs), etc. in order to overcome enrollment barriers ethnicity. We had speakers for our Grand Rounds series in surgery during COVID. Hopefully, this ability to make research more on developing a cultural competency curriculum, on diversity – an efficient to promote rapid learning will stick around. academic strategic approach, etc. I am a series editor for a book that just came out on Success in Academic Surgery: Diversity, Equity, and Education – Much of education has shifted to online, virtual, distance Inclusion. These movements and actions allow for some good to come learning. In addition, many students and residents have had changes from the tragic events of last year. in their exposure to different rotations (i.e., medicine residents have spent more time than usual in the ICU in order to care for COVID In summary, I think that overall, change has been positive. The patients). We are still learning how to optimize virtual learning – I pandemic and other events of the last year have shown that people think that attendance is up, but engagement is down. We still need will rise to the occasion – that through teamwork and collaboration, to better learn how to engage learners virtually. Additionally, we have we can overcome challenges. Additionally, we have seen both had to shift how we evaluate trainees – rather than a time-based (i.e., individuals and institutions exhibit remarkable resilience and agility. “The pandemic and the social injustices that resident spends 4 weeks exposed to a specific subspecialty) or volume- based (i.e., resident performs X number of a type of case) approach, were at the forefront of the news last year we really need to shift toward competency-based assessments. Again, this trend was already happening, but now we are going to have to both created extreme pressures that have pivot faster. helped to bring about metamorphosis.”

LESSONS LEARNED: A YEAR INTO A PANDEMIC 11 Center for Advancing Translational Sciences increasingly in-person interaction, I expect a lot network trials nationwide. UTHealth extended of meeting spaces to be upgraded with respect affiliations to North Texas, South Texas, and West to their teleconferencing capability as some Texas and built bridges with hard-hit Hispanic fraction of participation seems certain to be and Native American communities in the border virtual for years to come, if not permanently. region, West Texas, and New Mexico. Personally, I learned to work from a lot of The pandemic put a hard stop to non-COVID-19 different places, and I learned to hate the laptop research in March 2020. By June, the hold was less and appreciate VPN more. I have also gradually released as PPE supplies stabilized prioritized staying physically active throughout and research groups worked with clinical this time and have been making do with areas to restart their projects. In contrast to minimal home gym equipment. At some level, the centralized process developed for COVID my workout consistency has been improved by projects, accountability for re-engagement in non- having more control over my work location. I COVID projects was placed with the research have also learned to cook more with enhanced teams and their academic unit-level supervision. efficiency and have probably improved my We required them to document processes, reach nutrition as a consequence of minimal dining out if guidance was required, and retain process out. Thank God for Instacart, which has documentation in case of problems, but trust was changed my life. placed with teams without a centralized prior approval process. This worked surprisingly well. Overall, collegiality has been strong, and I have been impressed and honestly kind of The CCTS KL2 training grant project, which moved by the ability of people to cooperate provides support to faculty conducting clinical and develop innovative solutions. The past year or translational research, was severely disrupted. has reinforced my faith in the ability of our A 4-5 month enrollment hiatus for projects that university community to rise to the occasion have only 24 months of funding is a significant and put common goals ahead of personal ones. hit to productivity. Realistically, many projects Crisis has a way of creating focus and stripping were set back 6 months to a year because until the normal chaos down to the essentials. Some vaccines were widely available, many patients things you should manage centrally (COVID avoided health care settings for non-emergency clinical research), and some things you should problems. We are currently working with the leave with the teams and academic units (non- NIH to extend KL2 appointments for the most COVID clinical research). Knowing when to do severely affected research projects. Classes and which is as much art as science and adaptability Charles “Trey” Miller, PhD seminars moved online like everything else. There and pilot testing when possible are crucial in have been pluses and minuses. Pluses include getting the balance right (or as right as you can Associate Dean for Hospital Quality Initiatives improved attendance because people can Zoom get it on average – there are always going to be Professor, Cardiothoracic and Vascular Surgery from anywhere, even when on-service, which outliers that require special-case solutions). Associate Vice President, Clinical Research and Health Care Quality might have prevented in-person attendance in normal times. Minuses are that it is much harder to read the room online and more introverted In March of 2020, then-Dean Barbara J. Stoll to know what the other panels were reviewing, students may not participate very much in asked me to convene a workgroup to develop an centralized coordination and prioritization the discussion-resistant online format. Online organized research response to the coronavirus was required. Top-down processes usually teaching is great for delivering content one-way pandemic. Four areas were identified: 1) a cohort don’t work very well in shared-governance but not great for group discussion. We have to enumerate and describe cases, 2) informatics, academic environments, and UTHealth is experimented with small-group breakout sessions, “Crisis has a way to describe medical record phenotype and assess highly distributed by design and institutional but these have been of variable value and are potential risk factors, 3) an infrastructure for culture. But the occasion required a centralized highly facilitator-dependent. scientific review and prioritization of interventional process, and people understood the need for of creating focus clinical trials, and 4) a bio-repository for future it and were generally supportive. Innovations The IRB also has moved completely online. This translational research. Most of my effort has been included building a pre-IRB review process has required a change in workflow (especially and stripping the focused on the clinical trial process in Houston and expanding the clinical research footprint in for counting votes) since discussion is not as and bringing West Texas and New Mexico sites the community. The investigators were highly spontaneous. into our Clinical and Transitional Science Awards collegial and creative – for instance, Dr. Ben normal chaos (CTSA) network trials. We convened a workgroup Bobrow’s group opened trial sites at Memorial I expect teaching and committee functions will to serve as the pre-Institutional Review Board Hermann hospital facilities across the city that likely remain in some hybrid format – in person scientific review process that allowed for the vetting had never done trials. The CTSA workload down to the and online – for the foreseeable future. The trick and prioritization of projects. IRB regulations are has been enormous but highly productive. will be to keep the good parts and not the parts not structured to address prioritization of studies, UTHealth’s network entities have been among that enable micromanaging (which is where essentials.” and with four IRB panels that would have no way the highest enrollers for NCATS (National human nature tends to lead managerial decision- making). As the environment evolves back to

LESSONS LEARNED: A YEAR INTO A PANDEMIC 13 Omonele Nwokolo, MD Associate Professor of Anesthesiology

A lot changed for me professionally and personally in pandemic life with masks and online school made life not 2020. Professionally, I became the new operating room too different from her classmates. She’s almost at the end director at Memorial Hermann-Texas Medical Center. of chemotherapy now, and I am glad we have successfully That was a big step in my career and just as I was starting navigated all of that. that, COVID-19 started. So, my welcome to the job was now having to manage anesthesia and surgery with a new Another traumatic experience this year was that challenge of a global pandemic. my husband and his parents were diagnosed with -COVID-19 near Christmas. My husband was actually an We quickly formed committees to figure out what we inpatient on the COVID unit at Memorial Hermann, so needed to do to get patients tested and how to best staff I would go by and peek at him before and after my shift. the OR. With evolving knowledge of transmission of the What I learned is that everyone, from Dr. Colasurdo, Dr. COVID-19 virus and need to conserve PPE, we formed Eltzschig, Dr. Patel, Dr. Xavier, the ICU doctors, and all teams for intubation, with one person going from one of my colleagues were just a text away. Everyone rallied operating room to another intubating and extubating to support us. I wouldn’t have wanted to be in any other patients. Due to the unknown nature of the virus at the institution but here when it happened. beginning of the pandemic, and not knowing what to expect, there was a lot of fear and concern. There was a This has been a challenging year personally and lot of reassuring and handholding to get through it. I professionally. I’ve just learned you have to manage life lead a perioperative subcommittee as part of a larger Back – things will come at you; you can either let it destroy to Work task force for Memorial Hermann, looking at you, or you can face it. Then use it to build strength how to socially distance patients in the waiting room and and resilience and keep it moving. You have to look at how to stagger patients heading into the operating rooms silver linings. That is the lesson I have learned during this when we were allowed to resume elective surgeries again. incredible year. Despite a few COVID infections, we were lucky to have no serious morbidity or fatalities in our department – this is a huge blessing and one of the things I am most proud and happy about.

My Anesthesiology colleagues rose to the occasion during this pandemic. I saw amazing teamwork from my partners – we were going into an airway of a patient that we know has a disease that could potentially kill us, and we still did what we needed to do. I learned people are selfless and resilient.

I also had personal tribulations during 2020. My 9-year- old daughter was diagnosed with an ankle tumor in May 2020. The pandemic actually helped us to get used to social distancing and not mixing with other kids. She went through chemotherapy all this year, and the “I’ve just learned you have to manage life – things will come at you; you can either let it destroy you, or you can face it.”

LESSONS LEARNED: A YEAR INTO A PANDEMIC 15 Theresa M. Koehler, PhD Office of Educational Programs

Herbert L. and Margaret W. DuPont Distinguished The pandemic touched every aspect of the Office year came additional safety measures – all students Professor in Biomedical Science of Educational Program’s (OEP) operations in ways were provided with PPE and were tested on their Chair, Department of Microbiology and Molecular Genetics both large and small, but by embracing change ability to properly wear it. Rounding was modified “... by embracing and working to find creative solutions, OEP has on some services to a virtual format using iPads continued to deliver a high-quality education to or table rounds, and didactic sessions remained Our Departmental Seminar Series has expanded, change and our students. virtual. allowing us to enjoy virtual visits with scientists working to from all over the world. In addition, many scientific Transitioning exams to a remote format was one The Surgical and Clinical Skills Center, where conferences have gone virtual, allowing our of the largest and most complex undertakings, learners interact with standardized patients and students and postdocs to attend multiple meetings requiring cooperation across departments and participate in simulation activities, made major find creative and to present their work to larger audiences. many faculty and staff volunteers. Almost all of changes to their operation during the pandemic. The ability to communicate virtually is a new and our educational activities transitioned to a remote They altered the center’s physical layout for greater solutions, OEP important additional skill that will serve all of our virtual format: problem-based learning, team-based social distancing to continue safely running in trainees well into the future! learning, lectures, and gross anatomy (in person on person skills and simulation sessions. They also has continued to a limited basis). set up a WebEx room kit system in the simulation rooms to accommodate students unable to attend deliver a high- To make the experience as effective as possible, in person. This allows the remote student to see we implemented new platforms to deliver our the simulator and room setup, other students, the quality education education remotely, including InteDashboard for instructor, and to interact with everyone in the team-based learning and 4D Anatomy for gross room. anatomy. By using established vendors and systems to our students.” and embracing AI remote proctoring with faculty review, we were able to successfully deliver all our exams remotely with far fewer make-up exams than in the past.

During the Doctoring courses, students learn the art of being a doctor, including history taking and physical exam skills. Typically, students practice these skills with standardized patients and take practical exams to assess their performance. To avoid putting our students and standardized patients at risk, we pivoted to a combination of video instruction, distanced skill sessions using standardized patients and manikins in large classrooms, and distanced practical exams.

Our clinical activities required considerable modification during the early days of the pandemic and had to meet the needs of three distinct groups of students – those who were just completing second year and were about to transition into clerkships, those who were completing their third year, and those who were about to graduate. All clinical activities ceased from March 2020 through June 2020, which led to the adoption of online cases, modules, streamed didactics, and interactive sessions via WebEx to meet learning requirements. Everyone was able to successfully complete their remaining coursework for the academic year using these new modalities. With the resumption of clinical activities in June 2020 and a new academic

LESSONS LEARNED: A YEAR INTO A PANDEMIC 17 Pamela Promecene, MD Associate Dean for Graduate Medical Education Professor, Obstetrics, Gynecology, and Reproductive Sciences

I was quite new to my position when COVID hit. I started in this is an important milestone. Orientation and other supportive September and COVID was in March, so it was a birth by fire. I don’t events also were virtual. Because the Medical School held its virtual know how to do this job without COVID. commencement in early May, a group of the graduates who had matched to our Internal Medicine residency program elected to For the world of graduate medical education, we had to basically start their training early and went straight into caring for really sick continue the mission of patient care and continue to educate the COVID patients. That is just one example of how dedicated our trainees. The residents are incredibly dedicated, flexible, and resilient. students and trainees have been throughout the year. They were amazing with their ability to put their heads down and do the work, cover for each other and show up every day when their We are not sure if we will be able to have in-person residency friends with other careers were working from home. At times, they graduations this year, but we are planning for virtual orientation felt like they were putting themselves and their families at risk. It was again. We are evaluating how things went last year and hopefully encouraging and empowering to work with them in that capacity. I learning to do things better and more efficiently this year. found strength in their strength and resilience. Everyone was affected by the pandemic, but Internal Medicine residents were carrying the All of the programs did virtual interviews during the residency ship for a long time. recruitment phase. The university provided a license for a program called VidCruiter, which some programs used, and other programs On the education side, we had to pivot into virtual platforms, which used WebEx. Because in-person interviews are so costly to the was both good and bad. It’s hard to do clinical education in a virtual individual and the programs, I think we will maintain some portion platform, especially procedure-driven fields – those you can’t do of a virtual format for the future. I would like for our residents to be though telemedicine, you have to have hands-on medicine. Being able to travel for away electives and for us to host residents for away able to use a virtual platform was helpful for didactic teaching and electives, since this is important for the educational process for those discussions. A combination of in-person and virtual will help make us who want to complete a fellowship. better educators, especially in a city that is challenged with distance and traffic. I don’t know if we would have made the shift unless we This year has been a before and after kind of year in our lives. And had to, but when push comes to shove, you just make it work. we are still finding our way out – getting on the other side of it. In the future, we will use virtual platforms more routinely and more Our residents usually graduate in June, and we welcome our new efficiently, but it won’t replace human contact, or our need to do cohorts in June and July. Last year, all of the residency graduations some things in person – we need to find a happy medium. We need were virtual, which were difficult for all of the programs since to stay nimble and flexible.

“This year has been a before and after kind of year in our lives. And we are still finding our way out – getting on the other side of it.”

LESSONS LEARNED: A YEAR INTO A PANDEMIC 19 teach Data Science course was going to be tricky using a virtual platform. Yasmin Chebaro, PhD without an expert instructor “in the room.” We were confident we could transition to a virtual I believe there are two significant Lessons Program Manager, Office of Postdoctoral Affairs platform, but we needed features that WebEx Learned from 2020 that will serve us well into was not yet offering. We did our homework and future endeavors. First, is the immense value of Leslie Beckman transitioned our classes to the Zoom format. our relationships with others. Our hard work “Clinically, we Yasmin and I attended webinars to learn how to cultivating professional and personal rapport with Assistant Director, Office of Postdoctoral Affairs use the features, including how to be engaging UTH and TMC stakeholders. Be it faculty, DMOs have learned a lot. on Zoom training sessions. It worked! And, it and admins, EAP/Ombuds, IT, and many others At the beginning of the pandemic, our commute to worked well enough that we were able to include working together, we were able to be of service to campus was paused, but our services to UTHealth our postdocs from Austin into our programs. We our postdoc community. Second, is the importance Logistically, we postdocs and faculty continued. We knew we were plan to continue that offering, and the faculty and of being resilient. No one was prepared for a not going to stay at work as our office is across the staff in the remote locations are very grateful. yearlong plus pandemic that would change life in recognize that we hall from the Infectious Disease lab. They needed every aspect. Being able to adapt and pivot was key all the space possible, and they were there 24/7. Challenge 2: UTHealth was the only major to our services to others and our personal sanity. While we had to adjust to a new home office and institution in the TMC to not completely shut have underutilized figure out what to do with our Postdoc Training down the labs. While there was much uncertainty Program, of utmost concern was how were we at first, we sprinted into action. We worked telemedicine.” going to offer comfort to the postdocs whose closely with Administration and Departments research would be jeopardized if they were unable to ensure shifts were being adhered to and that to be in their laboratories. They could potentially postdocs were feeling as safe and comfortable as “Being able to lose years of training, hard work, not to mention possible with their new schedule. We leveraged the loss to future science. our relationship with Employee Assistance Program leaders and the UTH Academic adapt and pivot Gerard Francisco, MD While there is much to consider here are two of the Ombuds office. Seminars were offered on stress major challenges and our solutions: management, meditation, and resiliency. We was key to our Professor and Chair, Department of Physical and started a weekly meeting with our colleagues Rehabilitation Medicine in the Postdoc Offices at Baylor and UT MD Wulfe Family Chair in Physical Medicine and Rehabilitation Challenge 1: We were mid-semester in three in- class courses each with unique issues. How would Anderson Cancer. We offered each other services to others postdocs give their talks in the Presentation Skills participation in postdoc webinars, including a course? The NIH requires Responsible Conduct in host of virtual programs for National Postdoc and our personal Research training to include case studies and small Appreciation Week. We have even extended our group discussions. And then the very difficult to outreach to HMRI, UH, and Rice to hold our annual postdoc career symposium in May 2021 sanity.“

These have been the most challenging times for us, a family-like atmosphere. This camaraderie do wish we had more unifying or inspiring national and as we are navigating through, we are learning really helped us during the tough times. And at leadership to get people to work well together. how to respond and feeling more comfortable. one point, six of our faculty and residents had Other countries were able to get better control over Clinically, we have learned a lot. Logistically, we COVID. The faculty helped each other out as they the pandemic early on through lockdowns and recognize that we have underutilized telemedicine. isolated and recovered – organizing a meal train, discipline. volunteering to cover shifts – I never had to step in The pandemic also sadly highlighted social, to assign shifts. People were so supportive of one I am very proud about how our well our Medical economic, and racial disparities even more. While another, which helped our department emotionally School and University responded. I never felt alone. our hospital, TIRR Memorial Hermann, has a and mentally. But we still missed seeing each other The chairs had phone calls two or three times a wonderful set up and some of our well-to-do as we are a social group. Before the pandemic, I week. And while other universities had to downsize patients can access it without difficulty, we have would take the faculty and residents to dinner once or reduce salaries, our leaders were creative and those without smartphones or the internet or those a quarter to just visit – no business talk. I take were able to meet our financial needs by having who have cognitive difficulty using technology. pride in knowing our faculty and fellows very well. us donate vacation days. This accomplished two These issues were uncovered in Houston. The During the pandemic we had to get creative to do things – it didn’t demoralize employees by taking physical, financial, personal, and emotional things differently – I sent meals to the residents, something away from them, and it empowered resources of our patients became more raw – they and we had virtual get-togethers, but it wasn’t as employees by making them a part of the solution. I were more exposed to us. That was one area we good as talking in the same room. We did a virtual am very proud of how McGovern Medical School were not ready to deal with. happy hour during the holidays to catch up with at UTHealth handled the pandemic – putting the everyone. value on people. The second area that was exposed during this time – in a positive way – was our department’s The pandemic also uncovered some big divides – collegiality. I’m fortunate that our faculty work pro-vaccine, anti-vaccine; Republican, Democrat; well together, and I’ve always wanted us to have pro-mask-anti-mask. I’m always for diversity, but I

LESSONS LEARNED: A YEAR INTO A PANDEMIC 21 Ben Bobrow, MD Professor and Chair, Department of Emergency Medicine John P. and Kathrine G. McGovern Distinguished Chair Nancy, Clive and Pierce Runnells Distinguished Professor in Emergency Medicine

The Department of Emergency Medicine faced uplifting to our team. Hundreds of people wrote and overcame numerous unique challenges with us heartfelt letters, and lots of companies showed COVID-19 as the frontline health care providers up with food to feed the emergency personnel. We “Even though there with the highest risk of exposure to the sickest would often need to work our 8-plus hour shifts COVID-19 patients. in full PPE, which is really warm, uncomfortable, and stressful – you can’t eat in that. So, it was was a lot of fear at Back in March 2020, there was a lot of fear and really encouraging and heartwarming to have this uncertainty. At the beginning of the pandemic, community support. the start, our staff we held nightly UTHealth EM team calls and updates to optimize our internal communication As we were caring for patients, we also pivoted kept showing up and processes. Simultaneously, we had regular to trying to help find a cure for COVID-19 virtual meeting with emergency medicine experts acute lung disease. We partnered with the for work. And while in NYC and Seattle who already had real-world Department of Anesthesia and rapidly got FDA experience treating large numbers of critically ill approval to conduct a novel drug trial funded by some medical COVID-19 patients. There was a lot of back and the Department of Defense to test a new drug, forth about what was safe practice, what were best Vadadustat, to prevent and improve acute lung specialties had to PPE requirements, and how to triage and treat injury from COVID-19. We have now enrolled COVID-19 patient in the Emergency Department 177 patients in this multi-center clinical trial, as recommendations were being formed. March which uses UTHealth’s research. I’m really proud shut down during 2020 was particularly challenging, taking care of of that. all of our patients and ourselves with all of the the pandemic, uncertainty. We have continued with our educational mission, creating an asynchronous module-based curriculum the emergency In the Emergency Departments of LBJ General for our MS4 rotators and creating simulations of a Hospital and Memorial Hermann-Texas Medical hybrid in-person plus remote via WebEx to allow department was Center, we set up a new COVID triage process, for a greater inclusion of medical students and but initially it was difficult to identify COVID-19 residents. always open to take patients due to issues with inadequate and unreliable testing. We transformed our pedi ED Even though the media and community support unit at Memorial Hermann and made it our ED has waned, our whole team still shows up every care of everyone COVID unit, and created a special COVID pod at day and every night to take care of everyone in the LBJ, establishing designated infection-controlled community who has a medical emergency or simply and in fact was areas to help minimize exposure of all emergency needs help. As the safety net for the Houston department patients and staff. community, we are honored to be ALWAYS open often busier than and ALWAYS ready. However, this continued Even though there was a lot of fear at the start, our pace does take a toll on people, some more than ever as patients had staff kept showing up for work. And while some others. We have had virtual opportunities to focus medical specialties had to shut down during the on innovative team building, wellness, and even nowhere else to go pandemic, the emergency department was always a “Quarantini-Quarantine with a Martini” happy open to take care of everyone and in fact was often hour to help us relax, reconnect with each other for urgent medical busier than ever as patients had nowhere else to and ourselves, and recharge. And we will continue go for urgent medical needs. We received a lot to focus on wellness and self-care as we work of positive media coverage and articles about the together. This has been an enormous year, but this needs.” essential nature of the emergency department, and team has shown incredible grit and resilience, and I the community showed its support, which was am humbled to be part of this squad.

LESSONS LEARNED: A YEAR INTO A PANDEMIC 23 George Williams, MD Associate Professor Department of Anesthesiology and Critical Care Medicine

It started at the end of March/beginning of April, once it became hospital carrying boxes of toilet paper. All of these ethical constructs clear that COVID was coming to the United States, and we had to and contracts – these norms breaking down around you at the same be prepared. It seemed like our life stopped and everything went time we are providing care, and we have to stay focused on that. to planning and meetings, planning and meetings. We had about 5 hours of meetings in a day on top of normal clinical obligations, Once we got past six months, after we got past the surge, things which made it difficult. Everything you were doing had to take a almost became normal. We got used to lots of COVID patients, we backseat – even if it was a bill or something for your house, anything. created extra ICUs, and got called to help in other places. We were I remember going from some stage like ‘let it come, we are ready.’ called to help in other Hermann Hospitals – other ICU doctors had Then we started having some patients, and it started building. gotten sick. People we had no existing relationships with, we had never met before, but every time they called us to help, we went. My patient population is multi-surgical patients, and as Those barriers in the community that we had had – me versus you anesthesiologists, we are the ones intubating. There was a lot of – in that situation, there was no time for that. Everyone was trying concern about undiagnosed COVID patients in the community, and their very best, whatever we can do, all hands on deck. Some residents intubation is the highest risk procedure in terms of getting exposed to went to our ICUs to help out. We put together some emotional COVID. The operating rooms were still going, and we couldn’t test support to help them cope with the number of fatalities – something everyone. On the ICU side we took one, two patients and seemingly that used to be just on paper has become a really functional system overnight we have all of these COVID patients. So, in the span of 3 because we had to. months, we went from extreme planning to extreme clinical volume that was affecting everything. From the 6- to 12-month period, the biggest pattern I saw was trying to engage the public more. We are trying to educate about social One of the most interesting clinical effects was that we became distancing and now vaccine hesitancy. We are also making sure we afraid to have our trainees help out with patient care. So, you have can get back to our academic mission and what’s important, because a resident whose job it is to take care of patients in the operating before you know it, another 6-12 months have gone by. We’ve room, and they can’t intubate anymore, they can’t extubate anymore, barely been able to work on our papers, on excellent teaching, it’s all everyone has to leave the room and only the attending can provide just about keeping up. It was a tangible experience to see what our the care. In the ICU, we are afraid to let them see the patients, no practice would be like if education wasn’t front and center. That is not medical students can come in. We transitioned from this robust our culture. academic practice teaching everything we do to apologizing multiple times a day for not letting our trainees do anything. It’s been an interesting year for all of those reasons. There have been challenges personally, psychologically, clinically, but also challenges Then we got deep into the PPE conundrum. That happened when meeting our mission, being a benefit to the public, dealing with the patients came in, and we couldn’t order anymore. A lot of people constructs we all take for granted in our community and with our in the community got creative. One of the things that was very society being intact. I’m very grateful and glad I was here for this. I special to me was when a fraternity created and delivered an acrylic know it was something I was supposed to do, and I’m really grateful intubating box to us at LBJ Hospital. They had seen online how I get to do what I love. Getting a chance to do what you love is so helpful it would be. I got my first cloth face mask from a Vietnamese special and rare, and I got a chance to put everything out there to church; people brought lunch to the whole hospital. It was so special help as much as I could. because it was a very scary time.

I didn’t realize how stressful it was going through it, because I compartmentalize things and have always felt like a strong person. But, it can really affect you. It became an extreme situation for me when we had a case with a young mom who had COVID who did “I’m very grateful and glad I was here for this. not survive but whose baby did following a c-section. Once that happened, then it really jelled to me as a person – this is not normal I know it was something I was supposed to do, stuff. Then there became a series of experiences like that, there’s someone who looks like someone you know who has a young family, and I’m really grateful I get to do what I love.” someone wants to visit their family but they can’t. You consult other doctors, and they are afraid to see patients. You see people leaving the

LESSONS LEARNED: A YEAR INTO A PANDEMIC 25 I was on one of the ward services during the second year of my try this drug, give steroids, don’t give steroids, give anti-coagulates, internal medicine residency. When the COVID patients started don’t give anticoagulation.’ The academic frenzy of research and showing up in Houston, the Internal Medicine Department started publications and amount of data that came out was overwhelming. looking for volunteers to serve on these COVID units – we were What was being practiced was changing on a daily basis, and we starting to make designated areas in the ICU or on the general floors. didn’t know what was going to help, so it was, see what you can do so At that time, we didn’t know a lot about it – we had heard it was very people don’t get worse. Now there are accepted guidelines of plasma, infectious and there was mortality from the disease. So, they didn’t steroids, remdesivir. There are things now that we feel we can do, and Logan Hostetter, MD want to make anyone fill those roles, if they didn’t feel comfortable. sometimes as a doctor you feel like you have to do something. Now Internal Medicine Resident, third year We still had patients we had to take care of, so I volunteered for there is some standard of care for these patients, but there are still one of those COVID teams early on. I just remember the traffic in limitations. Houston has never been better. I remember driving to work one of the first days Houston was shut down, and I was probably one of the The pandemic really points to the academic rigor of medicine and only cars on the road super early in the morning. At that point, it was lifelong learning, and that there’s always things to things to be “Everyone who taking 4 to 5 days for the COVID tests to come back, and in the first discovered and advances to be had. Everyone who is in medicine week we ended up taking care of 8 to 10 COVID positive patients always has an innate sense of responsibility to contribute to the is in medicine and saw what the disease was doing. It was a very eerie experience, furthering of medical education and educational knowledge. I am certainly something I won’t forget, especially early on. truly privileged to have been a part of this during my training. I have always has an learned a lot, and I am now very good at taking care of ARDS. You I think our graduate medical education, especially our program definitely appreciate your colleagues and the community who were innate sense of director, Dr. Swails, had a very intent focus that residents, in supportive of you by wearing masks – it went a long way, that’s for particular, were protected. Their commitment to us was that we sure. All of the incredible people you get to work with, from the responsibility would not see patients who had COVID unless we had the proper nurses and other house staff and attendings, people were making a lot equipment. Early on, our hospitals did a really good job providing us of sacrifices, not knowing what taking care of COVID patients would to contribute to with protective equipment. The big thing was the N95 mask scarcity mean to them. And I’m grateful for our supportive leadership – Dr. for a while – we were using the same mask for a few days, but we at Swails made a lot of sacrifices and cares a lot about the residents. It the furthering of least had the equipment to take care of those patients. I felt we had was a tough year, but I learned a lot and will never forget. the appropriate gear for what we were going up against. medical education The graveness and vastness of COVID is something we’ll never forget and educational – ever. On some of our teams, we had some of the first deaths in Houston from it; it’s really unexpected and there’s no preparing for knowledge.” that. It’s something that’s perpetual now – talking to families now in the ICU, people are expecting their loved one to be on the ventilator for one or two days. Early on we didn’t know what to tell people – now we know to tell people their loved one will be in the hospitals for weeks to months.

It’s very interesting, in medicine you typically have an algorithm for things you can do, but for COVID, early on there was no algorithm. It was, ‘hey maybe try hydroxychloroquine, maybe try plasma, maybe

LESSONS LEARNED: A YEAR INTO A PANDEMIC 27 Thomas J. Murphy, MD Nathan Carlin, PhD Associate Dean for Health Policy, Medical School Professor, Health and Human Spirit Program “We need to keep what Chief Medical Officer for Community Clinics Samuel E. Karff, D.H.L., Chair in the John P. McGovern, Stanley Family Distinguished Chair of Population M.D., Center for Humanities and Ethics was better.“ Health and Community Medicine In many ways, the pandemic that struck in 2020 was very depressing. that we had to communicate our schedules on a daily basis in order to It derailed so many of the happy things that we were planning for the be able to attend various work meetings as needed. spring: banquets, graduations, and other celebrations. Personally, it cancelled a conference that I had been planning for a year. Because I am an introvert, and probably a workaholic, I don’t think the pandemic affected me as much as many other people. I really “Future planning But it wasn’t all bad. In terms of pivoting, the pandemic happened don’t mind being alone. But, even for me, I do miss my friends, coffee at an ideal time for my own teaching schedule, which gears down in shops, and restaurants in Montrose. I really like Anvil and all of Chris is critical. We March, after being very heavy in January and February. So, I had time Shepherd’s restaurants. It'll be good when the pandemic is behind us! to prepare the move to online teaching, which many professors across the country did not have. need to be able I was very skeptical of online teaching at first, since many of our to prepare for classes are seminars. I teach, for example, a seminar for MS4s called pathographies of mental illness, which meets three times a week for three hours each session – this course lasts for a full month. Before catastrophes and the pandemic, I doubt I would have ever taught a seminar online. But, through this experience, I found that the technology works very know how to deal well and that the experience was not all that different than in-person. In some ways, it was even better, in that only one person can talk at a time. Moving forward, I will keep some of this teaching online even with them.” when the pandemic is over, unless students object and really want to meet in-person again. My guess, though, is that they will appreciate the convenience of these online seminars, especially during interview season.

I also found that I was more productive working from home than in the office, for very simple reasons. There was no commute to work. There was no travel time to meetings, which can add up, even if it is a 5-minute walk to and from a meeting, plus any small talk after these meetings with friends and colleagues.

There were a whole lot of things we learned in the past year. In the In the practice of medicine, we introduced telemedicine. In primary I would say, though, that there is something lost in only working clinical arena, there were three significant lessons we learned: the care, we saw it had modest benefits. For instance, I had a severely from home, as I have done for a year now, and that is the synergy value of the primary prevention, the importance of treating the entire obese patient that I saw in person. When I saw him, I told him I and creativity of in-person meetings of the McGovern Center for population, and the importance of public health. noticed he lost weight. He said yes, 40 lbs. and asked me how I knew. Humanities and Ethics. Also, it is harder to bounce ideas off other I replied that I could see he took his belt in by two notches. Now, if team members in the moment if everyone is working from home. It When it comes to prevention, this past year 6 million women in the I saw this patient in a telemedicine consult, I would never have seen seems to me that, in the future, an ideal situation for productivity and United States did not get their mammograms, people didn’t get their this. creativity would be some kind of a flexible, hybrid model. It seems as colonoscopies, kids didn’t get their vaccinations. Delay of care is though just going back to the model of pre-COVID times, pure and denial of care. This will catch up with us. How do we plan for the future? We need to re-emphasize the simple, would seem to be less productive. We need to keep what was importance of primary care and support it financially and better. Future planning is critical. We need to be able to prepare for philosophically. We need to identify patients who have had care catastrophes and know how to deal with them. We also need to be delayed and find a way to reach out to these patients to fill gaps. We Balancing work and family took some effort, because we have a able to deal with the stresses of our providers and learn how to care have a lot of opportunities to improve health care. toddler. When the numbers in Houston would spike, we would for them before they crater. withhold our daughter from daycare. To manage this, my wife and We need to be prepared for the next challenge. We must deal with the I would split our days, giving each other 6 hours of protected time For my patients, it was a very different year with social isolation, problems that have been revealed by the social determinants of health. during the work day (6 a.m. to noon, and noon to 6 p.m.), and we depression, an increase in domestic violence, violence toward My work never slowed down over the past year. would work evenings as well, when our daughter was asleep. This children, and an increase in alcoholism. The physical and behavioral worked for us, because we both have flexible jobs, but it did mean health effects will reverberate for years to come.

LESSONS LEARNED: A YEAR INTO A PANDEMIC 29 Catherine Ambrose, PhD

Associate Professor and Director of Research Department of Orthopaedic Surgery

“It was chaotic at the beginning, but we learned working virtually is possible, and it’s not as bad or inefficient as we thought it was going to be.”

For me it started when we were all told to work from home for a virtual format has been a blessing for those in outside locations. couple of weeks. We didn’t know how long it would last. Pretty quickly I learned my home office was not going to be sufficient, so Our residents are back together in person again with the faculty I went back and forth to work and brought home some computer meeting virtually – we all meet each Thursday morning, and they equipment so that I could transition my work from the lab. I like that face-to-face interaction. The Department of Orthopaedic had multiple students signed up to work in the summer, but the Surgery has switched to virtual away rotations, where we could GLOBAL IMPACT OF THE COVID-19 PANDEMIC Summer Research Program was cancelled, so all of those projects have online meetings and conferences with students to get to know were eliminated or suspended. We had cell culture experiments them. The plan is for us to able to host students whose medical that we decided to abandon as it requires someone to be in the lab schools do not offer orthopedic surgery. every day. Personally, the commuting and parking have been a challenge The research assistants in my lab transitioned to projects they during the pandemic. I had been commuting in a vanpool that was could do from home – working on manuscripts, data analysis, disbanded and then carpooled with someone who went working INCREASE IN programming. I learned to do online meetings better. We all from home full time. I came back to the Medical School Building LAYOFFS AND A SURGE IN learned how to connect with people online and keep track of how in May, working part time. I will spend four days a week at the CLOSING DEPRESSION AND the research projects were going. All lectures could be done online. Medical School and one day working at home, and that works out. BUSINESSES ANXIETY We had programs for incoming residents that were hands-on that My research personnel share an office, so they are on an alternate had to be revised for the trainees. It was chaotic at the beginning, schedule and rarely at the building at the same time. Parking at the but we learned working virtually is possible, and it’s not as bad or Texas Medical Center has been a nightmare for so long, flexible INCREASE IN inefficient as we thought it was going to be. schedules may be a way to solve that problem. REMOTE WORK HOMESCHOOLING AND JOB ON THE RISE In some cases, a virtual presence had a positive effect. I am a I think in the future for meetings, both locally and for national and INSECURITY member of the UTHealth Interfaculty Council, and we meet international meetings, we will keep a hybrid formula of in-person monthly at UCT. Depending on the members’ schedules, we would and virtual. We also have seen a need to be more prepared – for have 75 percent attendance. Now we have had meetings with 100 the lab we had a limited amount of Lysol wipes, ethanol, and we percent attendance because we can meet online. As chair of the can’t get access to a 1-millimeter syringe because it’s used for the Faculty Senate, it’s really helpful for our clinical faculty to have the vaccine. After things get back to normal, the world in general, and online meetings because we have an attendance requirement. The us specifically, we need to stockpile a few things. SOURCE: MEDICAL NEWS TODAY | MARCH 2021

LESSONS LEARNED: A YEAR INTO A PANDEMIC 31 LaTanya Love, MD

Dean of Education, ad interim Associate Professor of Pediatrics Executive Vice President, Student Affairs and Diversity

“We learned that technology can be our friend. I’m grateful technology has evolved, and that we have adapted to it.”

In early 2020, we started hearing about COVID cases. Once the of Educational Programs created a committee to focus on for years and found that the students prefer it, so this pivot was not to the technology during the process. This ended up being a highly rodeo was cancelled, we knew COVID had officially arrived in returning the students to campus. We met weekly, and our various that challenging for us. We successfully made it through the first competitive year for medical school admissions. We received more Houston, and we had to make some important decisions quickly subcommittees met more frequently. Students were an integral part semester with some modifications. applications than we have ever received before. We were fortunate that were hard decisions, impacting our academic schedule and of this committee. We were able to bring back the clinical students that the virtual interviews allowed us to interview more applicants traditions. in mid- to late June. A lot of people helped make it possible, Now that the PPE supply was better and the vaccine was in works, than ever before and allowed our faculty interviewers flexibility. including procurement, which assisted with PPE – surgical masks, we looked at offering more for the spring semester. We were so Considering Match Day was the first decision. Talking with our safety goggles, everything we needed. We had to shorten and fortunate that UTHealth was able to offer the vaccine to all of our We learned that technology can be our friend. I’m grateful infectious disease experts, looking at state and national data, it modify the clerkships, but it worked out. By July, we realized that learners – it made people feel better about coming back to campus. technology has evolved, and that we have adapted to it. Our Office wasn’t going to be safe, so we had to cancel our traditional in- was the right thing to do – nothing can replace hands-on patients Now the first- and second-years having been going into clinic as of Diversity and Inclusion has started offering their seminars and person Match Day. It was an extremely difficult decision to make, for clinical students. And our students were eager to come back. part of their preceptorships, and of course our clinical students lectures virtually, and we are getting a much greater attendance but it was the right thing to do. have been nonstop since June. We are all waiting to see where the than before. It also allows us the ability to archive everything. Then in August, we were looking at what to do with our new class future lies for us. We have cancelled in-person Match Day again, I think we will continue to offer online events to reach a wider The next big decision was what are we doing with current of incoming students. We usually host all kinds of welcoming but we are cautiously optimistic for an in-person Commencement audience. Some of our students prefer the virtual platform. students? We gathered in a “war room” to think about how we activities to acclimate them to McGovern. We knew it wouldn’t be at a large venue, Minute Maid Park. could change our learning model to keep everyone safe – the safe to have the Annual Henry Strobel Retreat at Camp Allen, so We will need to sit down and debrief and review student feedback entire UTHealth community. We decided to switch to virtual student leaders did a good job of providing a red-carpet welcome at Our admissions process has been all virtual – a complete change to see what worked best. I miss seeing students and co-workers learning for everyone. All of our medical school classes were at the Medical School Building. for us, which was difficult as we really enjoy welcoming potential in the hallway to bounce ideas off of each other, and we want to different educational points, so we had to think strategically about students to our campus and the Texas Medical Center. We had a get students on campus as much as we can the next year. We also continuing the educational experience for each year. We offered Going into the fall 2021 semester, COVID-19 cases were high in few hiccups along the way, but by midway we were running our learned how resilient our students, faculty, and staff are. When virtual and asynchronous learning, and it worked out well given the Houston. The Curriculum Committee had to modify gross anatomy virtual interviews like a well-oiled machine. We have such amazing we had to pivot in the beginning stages, our faculty did such an circumstances and challenges that were around us. by creating smaller student groups. We transitioned problem-based student ambassadors and a great admissions team who knows how amazing job, going above and beyond to ensure students were still learning to virtual platforms and moved our team-based learning to problem solve all the technological challenges we might face. We getting a quality education despite the challenges. People were The Office of Admissions and Student Affairs and the Office to virtual platforms. We have been streaming our medical lectures had prepared faculty interviewers who became more accustomed having to deal with their own personal issues yet still showing up every day giving 100 percent.

LESSONS LEARNED: A YEAR INTO A PANDEMIC 33 Timothy George “If there is MS3 anything that Tarun Jain, MD Internal Medicine/Pediatrics, PGY4 this pandemic has taught me, “In some ways, it is that life is the pandemic unpredictable didn’t change and oftentimes things at all.” shorter than we anticipate.”

Residency is full of uncertainty. 1. Be forgiving. As a part of the House Staff Association and as 2020 was a year filled with uncertainty and instability. I began the I spent the first summer months completing online coursework a chief resident, I have had the privilege to view the hospital and year with a trip to San Diego to present research I had started the for rotations around which time multiple unjust murders of Black By the middle of my third year, I had come to accept this fact, medical school through different lenses. Uncertainty is not exclusive previous summer. In February, more people started talking about a Americans by police gained national attention. This sparked whether I was dealing with an erratic call day or contemplating long- to residency, and neither is the fear or frustration toward others that virus that was rapidly spreading, and the initial consensus was that it emotional and necessary conversations within a variety of groups term career prospects. Regardless, I had some sort of vision for myself can come with it. Sometimes — out of necessity — decisions can be would not be any worse than the seasonal flu. In early March, after and unfortunately worsened an already polarized climate amidst in 2020. made with an incomplete picture, and they are often not malicious. completing my last preclinical exam, everything shut down as we the continued pandemic. The school had decided to start slightly That being said, it’s also important to: moved into our dedicated period of step 1 studying. shortened in-person rotations in June so that we would finish the Like it did for so many others, the COVID-19 pandemic threw those year on time. Later in 2020, the uncertainty returned when our plans in the shredder. 2. Take a stand. The only way for any meaningful change to occur This is where the uncertainty started. class started thinking about how much of the fourth-year format, is to point out when someone crosses a line, intentionally or not. including step 2 CS, away rotations, ERAS, and residency interviews, In the hospital, I found myself busier than ever, struggling to keep Otherwise, the same unhealthy behaviors will continue, and the The school sent out emails regarding a delayed start to third year for would be continued from the previous cycle. It was not until well into up to date with a disease that seemed to be changing daily. While the situation will continue to worsen. our class, requiring that our lottery for the sequence of third-year 2021 that we got the answers we were looking for. din of residency had previously left me relishing time to myself, I was rotations be re-run. missing chances to spend time with old friends and meet new ones. 3. Ask. Especially with the pandemic, so many things seem to be Looking back on 2020, one of my recent realizations was that on hold or out of reach. Even though something might not seem Next came the instability. practically all of our clinical training has been done through masks. Yet life kept moving forward. My lease was still expiring, and I possible, it never hurts to take a chance if you have an idea. It’s It even seems odd to think that people used to deliver babies and still had to move. Deadlines for research conferences, fellowship surprising what doors a single email can open! Prometric began canceling step exams without warning. I was conduct virtually all patient interactions and examinations without applications, and interviews loomed over me. In some ways, the optimistic that I would be able to take step 1 on my original date a mask on. I believe that my class has become more resilient after all pandemic didn’t change things at all. 4. Remember why we’re doing this. When the pandemic first started, because it was less than a week away, and I had not received any the obstacles we faced and overcame in 2020. A major lesson I will many medical students, residents, fellows, and faculty put themselves notification. Inevitably, the dreaded cancellation email came. I, like take away is that, even with uncertainty and instability, life will keep In this sense, I consider myself quite lucky. I have my health, the out of their comfort zone and volunteered for the front lines. It’s an many of my classmates, started scrambling for Prometric testing dates moving. It is easy to spend countless hours worrying about what is to support of loved ones, and a wonderful family that I have found in honor few others have to be able to be a part of so many people’s lives with great frustration as the website was not equipped to handle such come, but the only result of that is wasted time. If there is anything my residency program. and to have the opportunity to help improve this chaotic situation. high traffic. I got another test date a couple of months down the that this pandemic has taught me, it is that life is unpredictable road. However, that got canceled as well when Prometric decided they and oftentimes shorter than we anticipate. Therefore, regardless of Throughout this pandemic, I have learned several lessons that I try 2020 was a crazy year, and 2021 has had its share of surprises as well. would move to 50 percent capacity and cancel half of their testing circumstance, we should find time to do what we enjoy with those my best to hold to — although I’m not always successful! Still, there are silver linings in each challenge, which at least keeps slots at random. Eventually, I secured a spot in May a few days after that matter to us while we still have the chance. things interesting! Prometric decided to reopen and was luckily able to get it over with.

LESSONS LEARNED: A YEAR INTO A PANDEMIC 35 Michael Blackburn, PhD Dean of Research, ad interim Professor of Biochemistry and Molecular Biology and William S. Kilroy, Sr. Distinguished University Chair in Pulmonary Disease Executive Vice President, Chief Academic Officer Dean, Graduate School of Biomedical Sciences John P. McGovern Endowed Distinguished Professor

When we saw what was happening in Europe in March of last year, can I help” emails from so many people. It made me proud of our we had to move very quickly and think, “What are we going to do institution that people cared so much, stepping out of their normal with research labs and education at McGovern and UTHealth?” It area. became clear that we would have to change. So, the initial response from me was to seek data. And I did this by interacting with the People were flexible and willing to do whatever it took to solve the CDC and NIH, and I made a lot of phone calls with colleagues who problems instantaneously. We were worried if we would we have head up research programs at NYU, Mt. Sinai, and others. They have enough PPE, thinking we could run out in a week – and we had medical students, labs with post docs, research techs, and faculty, people gathering up supplies from across the university. The other similar to us, and I wanted to know what they were doing. thing I reflect back on is the health care environment. We are so fortunate to have the doctors and nurses do what they did and are still Some of it was very hard. New York was getting slammed. It was doing it today – truly amazing. We always promote the importance a challenge to calibrate and make decisions based on data. You of the academic health care environment, and that manifested itself have to be able to make decisions quickly with not as much data with COVID by being of the academic research question-oriented as you are used to. I also sought feedback from local researchers. manner and getting things done. Our residents and faculty were able And we pivoted. We did this in clinical arena and with research, to change the way we treat patients. I have been a scientist 30 years, rapidly setting up communication with our research leaders, having and I love reading the literature and solving problems; I had never scheduled phone calls to effectively listen and give information. read so much every day about what they learned in China, Italy, Across the country, institutions were pulling people out of labs. throughout the United States on COVID – learning about the spike We did not want to do this and made the decision to not eliminate protein, learning about the virus’ mechanisms. President Colasurdo is research. The virus was very scary, and we were questioned, “Were the same way – I get a paper a day from him about COVID. We learn we putting people at risk?” I was happy to make the decision and and modify, and it’s been a lot of fun. I’ve never been so intellectually own it because I had feedback from people around the country. We stimulated because it really matters and you make decisions on what modeled our program around the intramural program at the NIH, you learn. I didn’t see that coming. which has a similar set up to ours, and they did not shut down either. We diminished the density of personnel in the labs and made sure we I had concerns about education – how will the pandemic affect the had adequate communication. Communication with faculty was a ability of our students to make progress. It was the right decision to mixed bag – some were grateful we did not shut down, others less so. pull our students of the clinics – they needed to focus the clinics on I learned you have to own decisions, listen, and make sure people get COVID. We moved education online. The educational programs dropping, the price of oil was going down, and people were losing the resources they need. In my experience, I have never gone through at all schools did so well – still providing a high level of education their jobs. But with our team, Kevin Dillon, Mike Tramonte, Angela anything like this. Another thing I learned is that you may have a virtually. Once we started securing adequate levels of PPE, and we Smith, Julie Page, Nancy McNiel – we not just survived, we thrived. I “It required a lot of work, meeting agenda, but in a crisis, people express a lot of things, and you learned wearing masks is a way to dampen the spread of virus; we learned a lot from them and am proud to be associated with them. have to be responsive. learned how to screen, test, contract trace, say no to certain things, people who went above then we were able to bring the students back to campus. Making that One thing to bear in mind is that this is a pandemic, and people have On an institutional level, we came into the pandemic unprepared and decision was great. been on edge. It is really important to layer compassion, empathy, and beyond. I’ve never seen had to learn on the fly – how, when do we test for COVID? I’m so and flexibility and remove the absolutes – thou shalt work on campus, proud of the teams at UTHealth. When you think about the PIs, the I learned how important strong leadership is during a crisis. When for instance. We are here to listen and put a plan in place. I am proud anything like it. It was scary research labs – they were so responsive and created safe environments. I had daily phone calls with the dean of every school, they had to how the deans, chairs, and administrators all looked inward and Environmental Health and Safety – Bob Emery and Scott Patlovich lead and make decisions and communicate with their staff and started working it out. Hopefully our students, faculty, and staff had and their team, stretched but providing information and help, which communicate back to us. They all stepped up and made tough flexibility to get through this. It’s all about the people at UTHealth. but gratifying.” was very critical. We changed physically as well – Amar Yousif, Bassel decisions; we didn’t have a committee meeting to solve that problem. They all rose to the occasion and were creative. It’s just wonderful Choucair and Information Technology who pivoted and took us In a crisis, we don’t have that luxury of time to get feedback, we just to be associated with an institution where everyone understands the online overnight so we did not shut down research and education. It had to make the decision and own it. Working with the deans was a importance of the mission. It made me proud to be a part of this required a lot of work; people who went above and beyond. I’ve never real honor. Working here on the financial side to get us through this school. seen anything like it. It was scary but gratifying. I received “how crisis also was important. At this beginning, the state income tax was

LESSONS LEARNED: A YEAR INTO A PANDEMIC 37 It has definitely been a year that was different from anything I’ve and if things go bad – there have been 500,000 deaths in the United experienced before. As a department, on many levels, we came out States from COVID, and most of those patients died from ARDS. stronger than before. The pandemic was an event that united people. Suddenly the research we’d been doing went to a different level of We rolled up our sleeves; we did what we had to do. significance and impact. In March, when COVID was starting, Dr. Ben Bobrow and I started to think COVID could represent an I was impressed how my faculty handled the clinical requirements. opportunity to take our prior lab findings to patients. We now have We were on the forefront of doing health care with COVID patients $5 million in Department of Defense funding, NIH support, and – we went through the hospital and through the operating rooms have launched a large-scale randomized trial to see if Vadadustat, a having to intubate patients who were suffering from COVID. My drug that activates hypoxia-inducible transcription factor, which is faculty all did well – we didn’t have any losses in our faculty or stabilized during ARDS and something we started studying 10 years residents or advanced practice providers. But it was challenging and ago, can prevent or treat ARDS in COVID patients. scary to intubate patients who were testing positive with COVID. It was challenging to do anesthetics on these patients because we didn’t By some degree I have to say I was just very lucky to be a physician- know at the beginning how long we would have PPEs and the safety scientist who has been interested in studying ARDS with some ideas level of what we were doing. Were we potentially bringing the disease and findings. COVID put our research and ideas on the front page home to our families? So being a chair of a department of frontline from a question, ‘Is ARDS still a problem?’ to now everyone agrees, providers for patients of COVID was definitely a challenging time, yes, it is something we need to address. It is unheard of, that we could but we came together in some ways stronger than before, and I’m very go from an idea to 200 patients in a clinical trial in just a year’s time. proud of my clinical faculty. This would have never happened without the pandemic.

I have to say the same goes for my researchers. Many of our researchers started to get highly involved in research related to COVID. They got PPE, they got vaccinated, and they’re not scared of doing research with the virus and with infectious SARS-COV-2 models for us to learn about the virus and understand new ways of how to deal with it. “COVID put our research From a personal perspective, it had some impact on my family of course. My children schooled from home this year, we have a 10- and ideas on the front and 11-year-old and they are best friends with each other, so their social life was not dramatically impacted. The biggest impact on page from a question, ‘Is my personal life was that I could not see my parents, who live in Germany. I try to visit my parents once or twice a year, and I haven’t ARDS still a problem?’ to seen them now in 18 months – hopefully I will be able to see them this summer. now everyone agrees, yes,

For me as a scientist, COVID actually had a very positive effect. it is something we need to My research has been focused on studying organ injury. Probably the most impactful research we have done in this regard has been address.” on acute respiratory distress syndrome (ARDS). ARDS transformed with COVID-19. Patients who have SARS-COV-2 pneumonia can develop ARDS – their lungs become leaky, they fill up with fluid, Holger Eltzschig, MD, PhD Professor and Chair, Department of Anesthesiology John P. and Kathrine G. McGovern Distinguished University Chair Associate Vice President for Translational Research and Perioperative Programs

LESSONS LEARNED: A YEAR INTO A PANDEMIC 39 WE ARE IN THIS TOGETHER – AND WE WILL GET THROUGH THIS, TOGETHER.